Pharm Muscle Relaxants Ch 25 Karch

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Chapter 25

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Muscle Relaxants

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Muscle relaxants may either work
_____ or _____

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Brain and spinal cord
or
Directly in muscle fibers

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Damage to the CNS nerons may cause

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Permanent muscle spasms

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Posture, Balance, and Movements are spinal reflexes regulated by

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cerebellum, basal ganglia, and cerebral cortex

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Two types of spinal reflexes

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Simple-involvess an incoming sensory neuron and an outgoing motor neuron-reflexes

Complex-Involving interneurons that communicate with related centers in the brain.

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CNS Pyramidal tract

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Fibers that control precise, intentional movements
Voluntary

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CNS Extrapyramidal tract

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Fibers that control unconscously controlled muscle actvity.
Allows teh body to mate automatic adjustments in posture, position, balance
Involuntary

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Neuromuscular abnormalities
Muscele spasm

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Often result from injury to teh musculoskeletal system.
Caused by the flood of sensory impulses coming to the spial crd from the injured area

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Neuromuscular abnormalities
Muscle spasticity

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Results from damage to neurons within the CNS.
May result from an increase in excitatory influences or a decrease in inhibitory influences within the CNS

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Hypertonia

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Excessive stimulation of muscles

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Centrally acting muscle relaxants work here:

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In the CNS-brain and spinal cord
Interfere with the reflexes causing spasm and pain

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Direct acting muscle relaxants work here:

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Directly in the muscle fibers
Botulinum
Dantrolene

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Centrally acting muscle relaxants
Action

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Not totally known
Involve upper or spinal interneurons

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Centrally acting muscle relaxants
Indications

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Alleviation of signs and symptoms of spasticity
Used in spinal cord injuries or diseases

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Centrally acting muscle relaxants
Pharmacokinetics

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Rapidly absorbed
Liver metabolized
Urine excreted

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Centrally acting muscle relaxants
Contraindications

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Known allergy
Rehumatic disorders

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Centrally acting muscle relaxants
Cautions

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Epilepsy
Cardiac dysfunction
Conditions marked by muscle weakness

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Centrally acting muscle relaxants
Adverse reactions

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Anticolonergenic:
Drowsiness, fatigue, weakness, confusion, headache, nausea, dry mouth, hypotension

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Centrally acting muscle relaxants
Drug-Drug interactions

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CNS depressants

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Centrally acting muscle relaxants
Prototype

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baclofen
Lioresal

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Direct acting skeletal muscle relaxants
Actions

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Interfering with the release of calcum from the muscle tubules.
Prevents fibers from contracting
Does not interfere with neuromuscular transmission

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Direct acting skeletal muscle relaxants
Indications

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Treatment of spasticity directly affecting peripheral muscle contraction
Managemetn of spasticity associated with neuromuscular diseases
Spasticity assciate with multiple sclerosis, cerebral palsey, polio, tetanus, and malignant hyperthermia

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What drug is used to treat malignant hyperthermia?

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dantrolene
Dantrium

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Direct acting skeletal muscle relaxants
Pharmacokinetics

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Slowly absorbed via GI
Liver metabolized
Uring excretion

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Direct acting skeletal muscle relaxants
Contraindications

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Known allergy
Spasticity
Hepatic disease**
Lactation

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Direct acting skeletal muscle relaxants
Cautions

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Women
All pts >35 years
Cardiac disease

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Direct acting skeletal muscle relaxants
Adverse reactions

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CNS & Smooth Muscle Depression:
Fatigue, weakness, confusion, GI irritation, Enuresis-night pee

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Direct acting skeletal muscle relaxants
Drug-Drug interactions

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Estrogen-hepatotoxicity
Neuromuscular junction blockers

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Direct acting skeletal muscle relaxants
Prototype

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dantrolene
Dantrium