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15 Cards in this Set
- Front
- Back
define muscle spasm and relate it to pain.
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an involuntary tension that occurs where the person is unable to completely relax the muscle; this spasm creates pain impulses from the muscle to the CNS (it is a cycle where increases in pain=increases in spasm)
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what are some causes of spasm?
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excessive usage and local injury, over medication (anti-psychotics), epilepsy, hypocalcemia, and neurologic disorders (MS, PD)
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spasms may present with inflammaiton, edema, pain, loss of coordination and reduced mobility. what types of drugs/therapies are used to treat spasms?
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antispasmotics; combinations of analgesics, anti-inflammatory agents and centrally acting skeletal muscle relaxants and rehab (immobilization, hydrotherapy, ultrasound, exercise, massages, and maniupulation)
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Name specific skeletal muscle relaxants (and their MOAs) used to treat spasticity.
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Baclofen (GABAb agonist) inhibits transmission at spinal level and depresses the CNS; diazepam (GABAa agonist; sedation is a problem); tizanidine (alpha 2 adrenoreceptor agonist indicated for spasticity associated with MS or spinal cord injury; centrally acting muscle relaxant); clonidine (centrally acting alpha-2 agent that activates inhibitory neurons that reduce sympathetic outflow which decreases vasomotor tone and heart rate; DANTROLENE: acts directly on skeletal muscle and produces few central A/es making it the drug of choice (increase dose slowly)
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how do centrally acting drugs work?
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not clear, but thought to create a sedative effect that allows person to relax, rest and allow muscle to repair itself; muscle relaxants are usually combined with an analgesic (aspirin or acetaminophen)
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what is the antispasmotic drug of choice?
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Dantrolene - acts directly on skeletal muscle and produces fewer side-effects
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how does intrathecal baclofen work?
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baclofen turns down the gain on the muscle stretch receptor feedback loop by enhancing presynaptic inhibition at the synapse between the muscle afferent and the motor neuron.
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what is a contra-indication for giving the drug of choice antispasmotic?
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Dantrolene is contraindicated in hepatic impairment; acute muscle spasm, pregnancy, and breast-feeding
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name the indications and contra-indications for tizanidine.
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indications: spasticity associated with MS or spinal cord injury (possibly: trigeminal neuralgia, chronic low back pain, cluster headache, spasmotic torticollis, neuropathic pain); C/I: hepatic impairment
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name muscle relaxers used for chronic low back pain.
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cyclobenzaprine (Flexeril), orphenadrine (Norflex), metaxolone, chlorzoxazone, methocarbamol, Carisoprodol (Soma)
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describe the cyclobenzaprine (Flexeril) and its S/e.
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centrally acting, structurally similar to TCAs, nocturnal muscle spasms; S/E: drowsiness, cardiac dysrhythmias, Anticholinergic (dry mouth, blurred vision, urine retention, constipation, increased IOP)
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Describe carisoprodol (Soma).
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precursor of meprobamate, centrally active, S/E: sedation, DROWSINESS, dependence (withdrawal)
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name the drug that is under investigation for uses in MS; daily doses 1000mg qid; s/e: DROWSINESS; its centrally active and inhibits polysynaptic reflexes.
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methocarbamol
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name the drug that reduces spasms, taken 400-800mg tid, s/e: nausea/DROWSINESS/Dizziness.
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metaxalone
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this drug is an analogue of diphenhydramine under investigation to be used in spinal cord injuries and has S/E: anticholinergic s/e and rare aplastic anemia.
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orphenadrine citrate
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