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Chapter 29

Chapter 29. Agents Used to Treat Musculoskeletal Health Alterations. Skeletal Muscle. Also called striated muscle; is attached to the skeleton Contraction is under voluntary control Contraction controlled by the nervous system . Agents: Musculoskeletal Disorders.

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Chapter 29

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  1. Chapter 29 Agents Used to Treat Musculoskeletal Health Alterations

  2. Skeletal Muscle • Also called striated muscle; is attached to the skeleton • Contraction is under voluntary control • Contraction controlled by the nervous system

  3. Agents: Musculoskeletal Disorders • Nerve impulses travel down the motor neurons of the nervous system • Cause skeletal muscle contraction • The neuromuscular junction contains the terminal of a motor neuron and a muscle fiber • Motor axon terminals contain thousands of vesicles filled with acetylcholine

  4. Classes:Musculoskeletal Drugs • Neuromuscular blocking agents • Centrally acting skeletal muscle relaxants • Direct-acting skeletal muscle relaxants • Skeletal muscle stimulants

  5. Neuromuscular Blocking Agents • Action • Block the action of acetylcholine • Mimic acetylcholine action and prevent cholinesterase from working; the muscle becomes overtired and the client is unable to use the muscle

  6. Neuromuscular Blocking Agents • Relax or paralyze the skeletal muscles • Used for: • Surgery • Electroconvulsive therapy • Endotracheal intubation • Tetanus treatment

  7. Neuromuscular Blocking Agents • Used to relax one or more muscles • Neuromuscular blockade • Paralyze skeletal muscle groups • Does not affect cardiac muscle • To assist intubation and mechanical ventilation • Usually administered IV • Close monitoring required • Antidotes should be readily available

  8. Neuromuscular Blocking Agents • Not useful for spasticity or rigidity of muscles caused by neurological disease or trauma • Many drug interactions

  9. Centrally Acting Skeletal Muscle Relaxants • Depress the CNS in the brainstem, basal ganglia, and neurons of the spinal cord • Do not act on the neuromuscular junction • Relieve pain associated with skeletal muscle spasms—cerebral palsy • High risk: sedation

  10. Centrally-acting musculoskeletal agents • Baclofen – PO (Kemstro), intrathecal (Lioresal) • Spasticity from multiple sclerosis or spinal injury • Carisoprodol (Soma) – PO • Metaxalone (Skelaxin) – PO • Should be taken with food

  11. Centrally-acting musculoskeletal agents (cont’d) • Diazepam (Valium) – PO, IM, IV • May cause dependence • Cannot be mixed in syringe with other drugs • Discontinue gradually to avoid withdrawal reactions

  12. Centrally Acting Skeletal Muscle Relaxants • Use cautiously with other CNS depressants • Administered orally or parenterally • Patients should be cautious when performing activities due to sedation • May cause dependence

  13. Direct-Acting Skeletal Muscle Relaxants • Inhibit calcium release from the skeletal muscles • Muscle is then less responsive to nerve impulses • Dantrolene acts directly on skeletal muscle; relaxes spastic muscle • Used in the treatment of multiple sclerosis, cerebral palsy, spinal cord injury, and stroke

  14. Adverse Effects • Diarrhea • GI upset • Photosensitivity • Changes in sensory perception • Insomnia • Depression • Hepatotoxicity • Hepatitis

  15. Myasthenia Gravis • Affects 1 in 20,000 people • Development of skeletal muscle weakness • Symptoms include drooping eyelids, difficulty swallowing, and inability to perform simple tasks

  16. Myasthenia Gravis • May be caused by damage to acetylcholine receptors at the neuromuscular junction • Autoimmune reaction • Therapy is aimed at increasing the concentration of acetylcholine at the neuromuscular junction

  17. Myasthenia Gravis • Neostigmine (Prostigmin) • Pyridostigmine bromide (Mestinon) – most popularly used for PO • Longer duration, better tolerated PO than neostigmine • Edrophonium (Tensilon, Reversol) – parenteral (IV) used for diagnosis or MG crisis

  18. Skeletal-Muscle Stimulants • Correct muscular weakness such as myasthenia gravis • Inhibits the action of anticholinesterase; more acetylcholine is available to cause and maintain the muscle contraction

  19. Skeletal-Muscle Stimulants • Side effects/adverse effects • Caused by unusual cholinergic activity • Increased salivation • Diarrhea • Intestinal cramping • Bradycardia • Miosis

  20. Myasthenia Gravis: Nursing Considerations • - assess muscle functioning with vital signs - watch for symptoms of myasthenic crisis - take medication before eating or activity - plan activities after taking medications - patients need to carry identification of condition

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