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where do skeletal muscle relaxants work?
- sc level
- nmj
- muscle itself
*paralytics prevent muscle contractions, not muscle relaxants
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Spacticity
- injury to cns and brain
- exagerated muscle stretch reflex
- decreased descending inhibition to alpha motor neurons
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muscle spasms
- damage to peripheral nerve root rather than cns
- increased tension and inflammation after muscle injury
- tonic contractions-build up latate
- noceceptive input from damaged tissue exites alpha motor neurons which pertpetuates spasms
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list two agents used to treat muscle spasms
- diazapam
- polysynaptic inhibitors
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diazapam (valium) works by...
is used for...
adverse affects are...
- potentiating gaba
- acute lbp-short term management
- sedation, dependence, tolerance, decreased physcomotor ability
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carisprodol
- aka soma
- polysynaptic inhibitor
- use with caution, metabolizes to meprobamate (strong potential for abuse)
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cyclobenzaprine
- aka flexaril
- polysynaptic inhibitor
- blocks serotonin receptors (dc's alpha motor neuron activity)
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metaxalone
- aka skelaxin
- Polysynaptic inhibitor
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methocarbamol
- aka robaxin, skelex
- polysynaptic inhibitor
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orphenadrine citrate
- aka Norflex
- polysynaptic inhibitor
- Noregesic= norflex+asprin+caffeine
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baclofen
- aka lioresal
- treats spasticty
- gaba derivative and gabab receptor agonist
- drug of choice for ms- lacks adverse effects
- also used to treat chronic alcohol abuse
- adverse effects:confusion and hallucinations
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when is intrathecal bacolfen used?
adverse effects?
- severe, intractable spaciticty
- pump malfuction, tolerance, respiratory depression
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dantrolene sodium
- aka dantrium
- treats spasticty
- effects muscle directly by impairing release of caclium
- effective in severe spasticity
- a.r. - hepatotoxity
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diazapam
- aka valium
- treats spasticty and muscle spasm
- potentiates gaba
- used for cerebral palsy and sc lesions
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gabapentin
- aka neurontin
- treats spasticty
- raises overall level of inhibition in sc
- used with SCI and MS
- a.r.- ataxia
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tizanidine
- aka zanaflex
- treats spasticty
- alpha 2 adrenergic agonist
- inhibits firing of interneurons (pre and postsynaptic inhibition
- also treats chronic Head aches and pain
- just as effective as baclofen and diazepam, but with better side effect profile
- a.r.- sedation , dizzyness, and dry mouth
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botulinum toxin
- muslce relaxant
- inhibits release of ACH by inhibiting proteins needed for ACH release
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