Ati Nervous System Meds (Miscellaneous Cns Meds)

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neuromuscular blocking agents

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depolarizing neuromuscular blockers: succinylcholine (Anectine)
nondepolarizing neuromuscular blockers: pancuronium
atracurium, vecuronium

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neuromuscular blocking agents MOA

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block acetylcholine at the neuromuscular junction resulting in muscle relaxation and hypotension, do not cross blood/brain barrier, so complete paralysis can be achieved without loss of consciousness or decreased pain sensation

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succinylcholine MOA

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mimics ACh by biding with cholinergic receptors at the neuromuscular junction
results in muscle paralysis
short duration of action

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parncuronium, atracurium, vercuronium MOA

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block ACh from binding with cholinergic receptors at the motor end plate
muscle paralysis occurs because of inhibited nerve depolarization and skeletal muscle contraction
reversal agent- neostigmine

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neuromuscular blocking agent uses

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general anesthesia to promote muscle relaxation
used to control spontaneous respiratory movements receiving mechanical ventilation
seizure control
used during endotracheal intubation and endoscopy

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neuromuscular blocking adverse effects

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respiratory arrest from paralyzed respiratory muscles
hypotension possible with atracurium

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succinylcholine adverse

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low pseudocholinesterase activity can lead to prolonged apnea- withold meds if low levels
malignant hyperthermia (muscle rigidity accompanied by increased temperature reaching as high as 109 degrees F)
muscle pain in upper body and back (normal)
hyperkalemia

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neromuscular blocker contraindications

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succinylcholine- risk of hyperkalemia (major trauma, severe burns)
caution- myasthenthia gravis, respiratory dysfunction, fluid and electrolyte imbalances

Front 9

neuromuscular blocker admin

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continuous cardiac and respiratory monitoring during therapy
have life support available and monitor following admin of a neuromuscular blocker for respiratory

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neuromuscular blocker interactions

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general anesthetics are often used concurrently in surgery- dosage of tubocurarine should be reduced to prevent extreme neuromuscular blockade
aminoglycosides and tetracyclines can increase the effects of neuromuscular blockade
neostigmine and other cholinesterase inhibitors increase the effects of depolarizing neuromuscular blockers such as succinylcholine

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neuromuscular blocker effectiveness

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muscle relaxation during surgery
no spontaneous respiratory movements in clients receiving mechanical ventilation
absence of seizures in clients receiving electroconvulsive therapy
successful endotracheal intubation

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Muscle relaxants and antispasmodics

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centrally acting muscle relaxants: (diazepam) Valium
peripherally acting muscle relaxants: (dantrolene) Dantrium

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baclofen (Lioresal)

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centrally acting muscle relaxants

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cyclobenzaprine (Flexeril)

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centrally acting muscle relaxants

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tizanidine (Zanaflex)

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centrally acting muscle relaxants

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diazepam

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acts in CNS to enhance GABA and produce sedative effects and depress spacisity of muscles

use: relief of muscle spasm related to injury and spasicity, anxiety and panic disorders, insomnia, stats epilepticus, alcohol withdrawal, anesthesia induction

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cyclobenziprine, tizanidine

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acts in CNS to enhance GABA and produce sedative effects and depress spacisity of muscles
no direct muscle relaxant action and so do not increase muscle strength

use: relief of muscle spasm related to muscle injury

Front 18

baclofen

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acts in the CNS to enhance GABA, produce sedative effects, and depress spasicity of muscles

use: relief of spasicity related to cerebral palsy, spinal cord injury, and multiple sclerosis

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dantrolene

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peripherally acting muscle relaxant that acts directly on spastic muscles and inhibits muscle contraction by preventing release of calcium in skeletal muscles

use: relief of spasticity related to cerebral palsy, spinal cord injury, MS
treatment of malignant hyperthermia

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all muscle relaxants adverse

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CNS depression

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centrally acting agents: diazepam, cyclobenziprine, tizanidine adverse

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hepatic toxicity- tizanidine
physical dependence from chronic long-term use

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baclofen adverse

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nausea, constipation, urinary retention

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peripherally acting: dantrolene

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hepatic toxicity
muscle weakness

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muscle relaxants and antispasmodics contraindications

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baclofen and dantrolene pregnancy risk C
diazepam- controlled substance (schedule IV)
pregnancy risk D
use cautiously in clients with impaired liver and renal function

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muscle relaxants and antispasmodics interactions

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CNS depressants have additive CNS depressant effects

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muscle relaxant admin

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withdrawal reaction if stopped abruptly
avoid CNS depressants

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muscle relaxant effectiveness

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absence of muscle rigidity and spasms, good range of motion
absence of pain
ADLs

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muscarinic agonists

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proto: bethanechol (Urecholine)

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muscarinic agonists MOA

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stimulation of muscarine receptors of the GU tract, thereby causing relaxation of the trigone and sphincter muscles and contraction of the detrusor muscle

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muscarinic agonist Use

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nonobstructive urinary retention, usually postoperatively or postpartum
investigational basis to treat gastroesophageal reflux

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muscarinic agonist adverse

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extreme muscarinic stimulation may result in sweating, tearing, urinary frequency, bradycardia, and hypotension

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muscarinic agonist contraindications

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urinary or gastrointestinal obstruction, PUD, coronary insufficiency, asthma, and hyperthyroidism

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muscarinic agonist admin

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1 hour before or 2 hour after meals to minimize nausea and vomiting
monitor I and O

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muscarinic agonist effectiveness

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relief of urinary retention

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muscarinic antagonists

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M3 receptor selective: oxybutynin (Ditropan)

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darifenacin (Enablex)

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M3 receptor selective muscarinic antagonist

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tolterodine (Detrol)

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nonselective muscarinic antagonist

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muscarinic antagonist MOA

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inhibits muscarnic receptors of the detrusor muscle of the bladder, which prevents contractions of the bladder and the urge to void

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muscarinic antagonist use

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overactive bladder

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muscarinic antagonist adverse

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anticholinergic effects-increase fiber, 2-3 L of fluid a day
CNS effects

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muscarinic antagonist contraindications

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glaucoma, myasenthia gravis, paralytic ileus, GI or GU obstruction, urinary retention
Caution: GERD, heart failure, kidney or liver impairment

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muscarinic antagonist interactions

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antihistamines, TCAs, or phenothiazines can result in extreme muscarinic blockage- concurrent use is not recommended

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muscarinic antagonist admin

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transdermal patch is administered 2 times a week
instruct clients to apply to dry skin of the hip, abdomen, or buttock and to rotate sites

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muscarinic anagonist effectiveness

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decrease in urinary urgency and frequency, nocturia, and urge incontinence