Neurological disorders, MG, PD, spasicity

cyclobenzaprine, baclofen, dantrolene, carbidopa-levodopa, pyridostigmine bromine

cyclobenzaprine therapeutic & pharmacologic class

skeletal muscle relaxants, TCA derivatives

cyclobenzaprine action

unknown; relieves local spasms without disrupting muscle function, increases mobility and decreases pain/tenderness

cyclobenzaprine adverse effects

sedation is most common; abrupt withdrawal causes agitation, auditory or visual hallucinations, seizures, psychotic s/s

cyclobenzaprine contraindications

MI acute recovery, hyper PTH, heart block, arrhythmias, HF

cyclobenzaprine NI

take exactly as prescribed, avoid other CNS depressants, taper off 2 week period

cyclobenzaprine BBW

avoid use with opioid drugs

baclofen therapeutic & pharmacologic class

skeletal muscle relaxants, gamma-aminobutyric acid agonist

baclofen action

hyperpolarizes nerve fibers causing decreased reflex activity

baclofen contraindications

pts using spasticity to maintain posture/balance

baclofen adverse effects

sedation, drowsiness, fatigue, confusion, intermittent hypotension & urinary frequency; abrupt withdrawal causes agitation, auditory or visual hallucinations, seizures, psychotic s/s

baclofen NI

admin evenly spaced intervals, taper off 2 week period

dantrolene therapeutic & pharmacologic class

skeletal muscle relaxants, hydantoin derivatives

dantrolene action

decreases Ca released for excitation-contraction coupling relaxing contractions; may prevent increase of intracellular Ca

dantrolene contraindications

active hepatic disorders, pts using spasticity for posture/balance

dantrolene adverse effects

muscle weakness, drowsiness, diarrhea, fatigue, fatal hepatitis

dantrolene NI

admin w food/milk, muscle weakness safety, monitor/teach hepatitis s/s & notify provider

carbidopa-levodopa therapeutic & pharmacologic class

antiparkinsons, decarboxylase inhibitors-dopamine precursors

carbidopa-levodopa action

levodopa converts to dopamine once past the BBB, inhibits overstimulation of muscles; carbidopa decreases peripheral metabolism of levodopa

carbidopa-levodopa contraindications

MAOIs, narrow/closed angle glaucoma; caution in hepatic impairment, decrease dose w renal impairment and elderly

carbidopa-levodopa common adverse effects

anxiety, headache, GI upset, orthostatic hypotension, palpitations, anginal episodes; elderly: hallucinations, dementia, drowsiness

carbidopa-levodopa serious side effects

choreiform, dystonic, bruxism, ballismus, rhythmic movement of feed or hands & bobbing of head

choreiform

continuous rapid jerky movements

dystonic

jerking twisting movements

bruxism

clenching teeth

ballismus

flinging extremities

carbidopa-levodopa NI

admin w food or immediately after, don’t take w protein, increase fiber & fluid, avoid pyridoxine, take at regular intervals

pyridoxine foods

avocados, bananas, beef liver, oatmeal, chicken, pork, mashed potatoes

pyridostrigmine bromide therapeutic & pharmacologic class

muscle stimulants, cholinesterase inhibitors

pyridostigmine bromide brand name

mestinon

pyridostigmine bromide action

blocks acetylcholinesterase increasing availability of ACh p

pyridostigmine bromide contraindications

bowel/bladder obstruction from parasympathetic activity; caution w asthma/COPD due to increased respiratory secretions and cough

mestinon common adverse effects

urinary tract urgency, flushing, cough w mucus, stomach & abdominal cramps, n/v/d, rash

mestinon serious adverse effect

cholinergic crisis: parasympathetic stimulation causes respiratory muscle weakness, hypotension, bradycardia, increased secretions- tears, respiratory, urine, stool; antidote is atropine

mestinon NI

don’t skip doses, plan activities/eating, monitor timing/effects, drowsiness safety

cyclobenzaprine use

muscle spasms

baclofen use

muscle spasms, spasticity

dantrolene use

muscle spasms, spasticity, malignant hyperthermia

carbidopa-levodopa use

parkinsons

pyridostigmine bromide use

myasthenia gravis