Skeletal Muscle Relaxants Overview
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Questions and Answers

What are common adverse reactions associated with skeletal muscle relaxants?

  • Nausea and vomiting
  • Insomnia and agitation
  • Rash and flu-like symptoms
  • Drowsiness and dizziness (correct)

    • Which skeletal muscle relaxant is known to pose a risk of hepatic toxicity?

  • Tizanidine (correct)
  • Diazepam
  • Cyclobenzaprine
  • Baclofen

    • In which scenario would the use of Flexeril be contraindicated?

  • Patient with a recent heart attack (correct)
  • Patient undergoing physical therapy
  • Patient with a history of migraines
  • Patient taking daily vitamins

    • Which of the following drugs is specifically used for pre-exposure prophylaxis (PrEP) in high-risk groups?

    <p>Truvada</p> Signup and view all the answers

    What is a common adverse reaction of NNRTIs used for HIV treatment?

    <p>Stevens-Johnson syndrome</p> Signup and view all the answers

    Which adverse reaction is commonly associated with NRTIs?

    <p>Lactic acidosis</p> Signup and view all the answers

    Which nursing intervention is recommended when administering skeletal muscle relaxants?

    <p>Avoid alcohol and other CNS depressants</p> Signup and view all the answers

    Which drug class inhibits protease, which is crucial for HIV replication?

    <p>Protease Inhibitors</p> Signup and view all the answers

    What is a possible adverse reaction associated with aminoglycosides?

    <p>Nephrotoxicity</p> Signup and view all the answers

    Which drug is primarily used to treat Methicillin-resistant Staphylococcus aureus (MRSA)?

    <p>Vancomycin</p> Signup and view all the answers

    What should be monitored when using aminoglycosides?

    <p>Peak and trough levels</p> Signup and view all the answers

    Which condition is NOT a contraindication for the use of linezolid?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What is a major potential reaction from vancomycin administration?

    <p>Red man syndrome</p> Signup and view all the answers

    Which of the following antifungal medications can cause hepatotoxicity?

    <p>Ketoconazole</p> Signup and view all the answers

    What is a common adverse effect of acyclovir?

    <p>Bone marrow suppression</p> Signup and view all the answers

    Which of the following statements regarding fluconazole is correct?

    <p>Can cause gastrointestinal issues.</p> Signup and view all the answers

    What is a significant interaction with acyclovir that increases its levels?

    <p>Gout-causing drugs</p> Signup and view all the answers

    Why should antimicrobial drugs be used cautiously in patients with renal impairment?

    <p>Risk of nephrotoxicity</p> Signup and view all the answers

    Which of the following conditions may indicate the need for antibiotic therapy?

    <p>Bacterial infections</p> Signup and view all the answers

    Which of the following is NOT a use for Zoxime?

    <p>VRE infections</p> Signup and view all the answers

    Which drug is known for causing vein irritation upon administration?

    <p>Linezolid</p> Signup and view all the answers

    What therapy is typically required for superficial fungal infections?

    <p>Long-term therapy</p> Signup and view all the answers

    What is one of the key reasons for using multiple HIV medications together in treatment regimens?

    <p>To minimize side effects</p> Signup and view all the answers

    Which adverse reaction is associated with integrase inhibitors?

    <p>Difficulty sleeping</p> Signup and view all the answers

    What should patients do to prevent nephrotoxicity while taking Acyclovir?

    <p>Increase fluid intake</p> Signup and view all the answers

    Which of the following is a common side effect of CCR5 antagonists?

    <p>Upper respiratory infections</p> Signup and view all the answers

    What essential patient teaching should be emphasized for those on HIV medications?

    <p>Consult a healthcare provider before any changes</p> Signup and view all the answers

    What is an essential precaution for patients experiencing neutropenia?

    <p>Avoid fresh fruits and vegetables</p> Signup and view all the answers

    Which assessment finding indicates a potential adverse reaction to chemotherapy?

    <p>Fatigue and shortness of breath</p> Signup and view all the answers

    When administering chemotherapy, what safety measure should nurses adopt?

    <p>Use protective equipment at all times</p> Signup and view all the answers

    What effect does chemotherapy have on hair?

    <p>Temporary hair loss that may return</p> Signup and view all the answers

    What type of medication is Filgrastim classified as?

    <p>Colony-stimulating factor</p> Signup and view all the answers

    Which of the following foods should patients undergoing chemotherapy avoid?

    <p>Fresh fruits</p> Signup and view all the answers

    What is a critical lab test to monitor during antiretroviral therapy?

    <p>Liver function tests</p> Signup and view all the answers

    Which complication is most likely associated with chemotherapy-induced peripheral neuropathy?

    <p>Loss of sensation</p> Signup and view all the answers

    Which practice should be avoided to minimize the risk of injury for patients with thrombocytopenia?

    <p>Engaging in high-impact sports</p> Signup and view all the answers

    What is an important aspect of managing chemotherapy side effects?

    <p>Regularly monitoring vital signs</p> Signup and view all the answers

    What is a significant concern when using Tizanidine over a prolonged period?

    <p>Physical dependence</p> Signup and view all the answers

    Which adverse reaction is specifically associated with Baclofen?

    <p>Nausea</p> Signup and view all the answers

    What is the recommended approach for administering skeletal muscle relaxants to minimize gastrointestinal upset?

    <p>Administer after meals</p> Signup and view all the answers

    Which of the following adverse reactions is NOT associated with antiretroviral therapies?

    <p>Dizziness</p> Signup and view all the answers

    Which statement correctly describes the contraindications for using Flexeril?

    <p>Contraindicated in patients with recent heart attacks</p> Signup and view all the answers

    What potential drug interaction should be considered when using Flexeril and MAOIs?

    <p>Increased risk of seizures and fever</p> Signup and view all the answers

    Which side effect is associated with both Dantrolene and Tizanidine?

    <p>Hepatic toxicity</p> Signup and view all the answers

    What describes the adverse reaction profile of NNRTIs when used to treat HIV?

    <p>Includes flu-like symptoms and central nervous system manifestations</p> Signup and view all the answers

    What is a significant adverse effect specifically associated with the use of streptomycin?

    <p>Neurotoxicity</p> Signup and view all the answers

    Which of the following is not a contraindication for the use of aminoglycosides?

    <p>Asthma</p> Signup and view all the answers

    What is the mechanism of action of vancomycin?

    <p>Inhibits bacterial cell wall synthesis</p> Signup and view all the answers

    What serious condition can occur with rapid intravenous administration of vancomycin?

    <p>Red man syndrome</p> Signup and view all the answers

    Which medication is classified as bactericidal?

    <p>Zoxime</p> Signup and view all the answers

    Antivirals like acyclovir are primarily used to treat infections of what type?

    <p>Viral infections</p> Signup and view all the answers

    What is a notable adverse reaction associated with the use of amphotericin B?

    <p>Thrombophlebitis</p> Signup and view all the answers

    Which lab tests should be monitored to detect nephrotoxicity during antifungal treatment?

    <p>BUN and creatinine</p> Signup and view all the answers

    Fluconazole is contraindicated in patients with which condition?

    <p>Electrolyte imbalance</p> Signup and view all the answers

    Which of the following interactions is a potential risk when taking acyclovir?

    <p>Increased levels with gout-causing drugs</p> Signup and view all the answers

    What type of infections do antifungal medications primarily target?

    <p>Fungal infections</p> Signup and view all the answers

    Which of the following is an effect of long-term antifungal therapy for superficial infections?

    <p>May require therapeutic monitoring</p> Signup and view all the answers

    What is a common side effect of ganciclovir?

    <p>Dizziness</p> Signup and view all the answers

    Which adverse reaction is specifically associated with integrase inhibitors?

    <p>Suicidal ideation</p> Signup and view all the answers

    Which condition is treated specifically by antivirals like Tamiflu?

    <p>Influenza A and B</p> Signup and view all the answers

    What is a critical lab test to monitor for patients on HIV medications?

    <p>Liver function tests</p> Signup and view all the answers

    Which of the following is a common complication of chemotherapy?

    <p>Anemia</p> Signup and view all the answers

    Which immunologic condition is NOT associated with chemotherapy treatment?

    <p>Hypertension</p> Signup and view all the answers

    What practice should be implemented for patients experiencing neutropenia?

    <p>Avoid fresh fruits and vegetables</p> Signup and view all the answers

    What strategy is most effective to prevent nausea during chemotherapy?

    <p>Use antiemetics before meals</p> Signup and view all the answers

    Which side effect should patients taking Acyclovir be most cautious about?

    <p>Nephrotoxicity</p> Signup and view all the answers

    Which of the following is a critical instruction for patients receiving chemotherapy?

    <p>Monitor body temperature daily</p> Signup and view all the answers

    What long-term effect may occur due to chemotherapy treatment on hair?

    <p>Temporary loss with regrowth in altered texture</p> Signup and view all the answers

    What is the primary purpose of using multiple HIV medications in treatment regimens?

    <p>To reduce dose and side effects</p> Signup and view all the answers

    What is a key precaution when handling chemotherapy agents?

    <p>Use protective gear for at least 48 hours after administration</p> Signup and view all the answers

    Which dietary adjustment is crucial for cancer patients undergoing chemotherapy?

    <p>High-protein, high-calorie, nutrient-dense meals</p> Signup and view all the answers

    What is an important consideration for patients taking CCR5 antagonists?

    <p>They can cause severe liver damage</p> Signup and view all the answers

    What is the recommended action for a patient with thrombocytopenia?

    <p>Utilization of an electric razor</p> Signup and view all the answers

    Study Notes

    Skeletal Muscle Relaxants

    • Used for acute, painful musculoskeletal conditions like muscle spasms.
    • Common adverse reactions include drowsiness (CNS depressant), dizziness, and in some cases, urinary tract infections (UTIs).
    • Zanaflex, Diazepam, cyclobenzaprine, and Tizanidine can cause UTIs.
    • Tizanidine has a risk of hepatic toxicity (liver damage).
    • Long-term use can lead to physical dependence.
    • Baclofen can cause nausea, constipation, urinary retention, and seizures.
    • Dantrolene can cause hepatic toxicity and muscle weakness.
    • Contraindications include pregnancy, lactation, and MAOIs (within 14 days of using Flexeril).
    • Flexeril is also contraindicated in patients with recent heart attacks, cardiac conduction disorders, and hyperthyroidism.
    • Diazepam is a controlled substance.
    • Drug interactions:
      • CNS depressants increase CNS depressant effects.
      • Flexeril and MAOIs increase the risk of seizures and fever.
      • Norflex and Haldol increase the risk of psychosis.
      • Sanoflex and antihypertensives increase the risk of hypotension.
    • Nursing interventions:
      • Administer with or immediately after meals to minimize gastrointestinal upset.
      • Use only for short-term treatment (2-3 weeks).
      • Avoid alcohol and other CNS depressants.

    HIV and AIDS Drugs

    • Used to treat HIV infection and AIDS.
    • General adverse reactions: nausea, vomiting, diarrhea, altered taste, headache, fever, chills, rash, numbness, and tingling (circumorally or peripherally).
    • Truvada and Descovy are approved for HIV prevention in high-risk groups (pre-exposure prophylaxis or PrEP).
    • PrEP drugs are used for adults who:
      • Practice safer sex.
      • Are confirmed HIV negative.
      • Have high-risk sexual partners.

    HIV Drug Classes and Adverse Reactions

    • NNRTIs: Inhibit a protein needed by HIV for replication.
      • Adverse Reactions: rash, Stevens-Johnson syndrome, flu-like symptoms, headache, fatigue, central nervous system manifestations, nausea, and diarrhea.
    • NRTIs: Inhibit DNA synthesis and viral replication of HIV.
      • Adverse Reactions: bone marrow depression, lactic acidosis, vomiting, diarrhea, enlarged liver (hepatomegaly), and fatty liver.
    • Protease Inhibitors: Inhibit protease, crucial for HIV replication.
      • Adverse Reactions: vary.
    • Entry and Fusion Inhibitors: Block HIV's entry into CD4 cells. Used when other antiretrovirals are ineffective.
      • Adverse Reactions: localized injection site reaction, bacterial pneumonia, fever, chills, rash, and hypotension. Administered subcutaneously.
    • Integrase Inhibitors: Inhibit integrase, a protein HIV uses to insert its genetic material into CD4 cells.
      • Adverse Reactions: headache, difficulty sleeping, skin rash, liver damage, kidney failure (renal failure), blood in urine (hematuria), and suicidal ideation.
    • CCR5 Antagonists: Prevent HIV from entering lymphocytes.
      • Adverse Reactions: cough, upper respiratory infections, central nervous system effects (dizziness, numbness), liver damage (hepatotoxicity), and severe diarrhea (pseudomembranous colitis).

    Other Antivirals

    • Acyclovir treats herpes simplex viruses and herpes zoster.
      • Adverse reactions: nephrotoxicity (kidney damage); increase fluid intake to prevent.
      • Bone marrow suppression; monitor blood cell counts.
      • Contraindicated if neutrophil count is <500 or platelet count < 25,000.
        • Contraindications: allergies, pregnancy, lactation (benefits may outweigh risks)
        • Use cautiously for unstable cardiac disease, renal impairment, low blood cells, history of epilepsy, and respiratory disease.

    Chemotherapy

    • Cytotoxic medications that kill fast-growing cancer cells and healthy cells (skin, hair, intestinal mucosa, hematopoietic cells).
    • Absorbed through skin and mucous membranes.
    • Nurses require personal protective equipment.
    • Administered intravenously, topically, or into body cavities (varies with cancer type and protocol).
    • Oral chemotherapy is as toxic as intravenous chemotherapy.
    • Never crush, split, break, or chew oral chemotherapy medications.
    • Administered through central lines or catheters (long-term: port).

    Chemotherapy Complications

    • Immunosuppression: neutropenia (low white blood cell count) and bone marrow suppression (check CBC regularly).
    • Neutropenic Precautions:
      • Private room.
      • Limit exposure to crowds and plants.
      • Frequent hand washing.
      • Avoid invasive procedures.
      • Dedicated equipment in the room.
      • Colony-stimulating factors (e.g., Filgrastim) to boost white blood cell production.
      • Daily temperature monitoring.
      • Avoid potentially contaminated foods (fresh fruits/vegetables, undercooked meat/fish/eggs, and certain spices).
      • Discard room-temperature beverages after an hour.
      • Wash dishes thoroughly in hot, soapy water.
      • Daily cleaning of utensils and personal hygiene items (e.g., bleach-cleaning the toothbrush).
      • Report fevers above 100°F.
    • Nausea, vomiting, anorexia (loss of appetite): Administer antiemetics before meals to prevent. Antiemetic medications may be needed at home for several days after chemotherapy.
      • Remove strong smells.
      • Utilize non-pharmacological strategies (e.g., acupressure, relaxation).
      • Maintain adequate nutrition with supplements and appetite stimulants (e.g., Megase).
      • Encourage small, low-fat, dry meals.
      • High-protein, high-calorie, nutrient-dense meals.
      • Use plastic eating utensils to avoid taste issues.
      • Identify and avoid food sensitivities.
    • Alopecia (hair loss): Provide support with scarves, wigs, or turbans. May initiate 7-10 days after treatment.
      • Temporary, often returns within a few months after therapy.
      • May differ in texture or color.
      • Shorten hair before therapy to reduce weight loss and extend time before hair loss.
      • Protect scalp from sun.
    • Mucositis and Stomatitis (mouth sores): Inspect the mouth routinely and document findings. - Utilize topical anesthetic before meals. - Practice meticulous mouth hygiene, pre- and post-meals. - Use non-alcoholic mouthwashes. - Use a soft toothbrush and floss gently. - Frequent cool water rinses. - Medications to treat mouth sores. - Soft, cold, bland, high-calorie foods (avoid alcohol and tobacco).
    • Anemia: Assess for fatigue, weakness, dizziness, shortness of breath.
      • Prioritize rest.
      • Administer erythropoietic medications (e.g., Epoetin alfa).
      • Provide iron supplements (ferrous sulfate).
      • Monitor hemoglobin levels regularly.
    • Thrombocytopenia (low platelet count): Monitor bleeding tendencies.
      • May need blood transfusions or platelet transfusions.
      • Utilize an electric razor.
      • Avoid nonsteroidal anti-inflammatory drugs (NSAIDs).
      • Prevent injury.
    • Chemo-induced Peripheral Neuropathy: Assess sensations for loss (hands, feet, limbs).
      • May cause pain.
      • Monitor for orthostatic hypotension.
      • Evaluate for erectile dysfunction.
      • Ensure proper foot care.
    • Chemotherapy management requires a multidisciplinary team to monitor side effects.
    • Protect the IV site as chemotherapy is vesicant.
    • Administer medications to control side effects.
    • Maintain good oral hygiene.
    • Encourage wig use if appropriate.
    • Regularly monitor lab work.
    • Prevent injuries.
    • Monitor vital signs (especially temperature, a critical sign of infection, even in readings that appear lower than expected).
    • Wear protective gear when handling chemotherapy drugs and body fluids for 48 hours after administration.
    • Educate patients about side effect recognition, hygiene, avoiding crowds, clean handling of food, and other precautions.

    Aminoglycosides

    • Primarily treat infections from gram-negative microorganisms.
    • Used to reduce bacteria before abdominal surgery.
    • Treat hepatic coma.
    • Used with other drugs for tuberculosis treatment.
    • Adverse reactions: allergic reactions, photosensitivity, nephrotoxicity, ototoxicity, neurotoxicity.
    • Streptomycin causes neurotoxicity, leading to numbness, tingling, paresthesias, and circumaural numbness (numbness around mouth).
    • Contraindications: aminoglycoside allergies, pre-existing hearing loss, myasthenia gravis, lactation, pregnancy.
    • Use cautiously with renal impairment and other neuromuscular disorders.
    • Interactions: increased nephrotoxicity with cephalosporins, increased ototoxicity with loop diuretics.
    • Monitor peak and trough levels.

    Zoxime

    • Bacteriostatic and bactericidal.
    • Bactericidal-Kills bacteria
    • Bacteriostatic-Inhibits/slows down bacteria
    • Treats vancomycin-resistant enterococci (VRE), healthcare-associated pneumonia, community-acquired pneumonia, and skin/skin structure infections.
    • Adverse reactions: gastrointestinal issues, headache, dizziness, insomnia, rash, fatigue, depression, nervousness, photosensitivity, pseudomembranous colitis, thrombocytopenia.
    • Contraindications: allergies, pregnancy, lactation, phenylketonuria.
    • Use cautiously in patients with bone marrow depression, hepatic dysfunction, renal impairment, hypertension, or hyperthyroidism.
    • Interactions: increased bleeding and thrombocytopenia risk with antiplatelet drugs.

    Vancomycin

    • Inhibits bacterial cell wall synthesis and increases permeability.
    • Used to treat Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. diff).
    • Potent drug with nephrotoxicity and ototoxicity.
    • Causes red man syndrome (body redness).
    • IV administration can cause pain and thrombophlebitis.
    • Infusion reaction: nausea, chills, fever, neck pain, sudden drop in blood pressure.
    • Contraindications: vancomycin, corn, and corn product allergies.
    • Use cautiously in patients with renal or hearing impairment, during pregnancy, and lactation.
    • Should not be given with other ototoxic or nephrotoxic drugs.

    Linezolid

    • Bacteriostatic.
    • Used to treat VRE.
    • Can cause vein irritation; incompatible with saline or heparin flushes.
    • Adverse reactions: nausea, vomiting, diarrhea.
    • Interactions: increased serum levels of antiviral, cancer, immunosuppressant medications, calcium channel blockers, and benzodiazepines.

    Antivirals

    • Shorten viral outbreak duration; do not cure or prevent spread.
    • Acyclovir treats herpes simplex virus types 1 and 2, and herpes zoster (genital herpes, cold sores, shingles).
    • Ganciclovir treats HIV and is used for prophylaxis in organ transplant patients, and cytomegalovirus retinitis.
    • Interferons treat Hepatitis B and C.
    • Tamiflu treats influenza A and B.
    • Ribavirin treats respiratory syncytial virus (RSV).

    Adverse Reactions of Antivirals

    • Systemic acyclovir: crystaluria, nephrotoxicity, bone marrow suppression, GI disturbances, headache, fever, insomnia.
    • Topical acyclovir: burning, stinging, itching.
    • Contraindications: allergies, pregnancy, lactation (benefits outweigh risks)
    • Use cautiously with unstable cardiac disease, renal impairment, low blood cell counts, history of epilepsy, and respiratory disease.
    • Interactions: increased acyclovir levels with gout-causing drugs, increased valacyclovir and acyclovir levels with cimetidine, and increased theophylline serum levels with acyclovir.

    Antifungal Medications

    • Treat superficial and deep fungal infections.
    • Superficial mycotic infections (e.g., tinea pedis, tinea cruris, tinea corporis, tinea unguium, candidiasis).
    • Superficial infections may become systemic (lungs, brain, GI tract).
    • Antifungal drugs are fungicides and fungistatic agents.
    • Adverse reactions: infusion reactions, irritation, stinging, redness, thrombophlebitis, nephrotoxicity, bone marrow suppression, electrolyte imbalances.

    Ketoconazole

    • Adverse reactions: hepatotoxicity, gynecomastia, irregular menses.
    • Contraindications: allergies, pregnancy, renal dysfunction, bone marrow suppression, anemia, electrolyte imbalance.

    Nursing Interventions

    • Superficial/deep fungal infections require long-term (months) therapy.
    • Monitor creatinine and BUN for nephrotoxicity.
    • Teach thrush patients about swishing and swallowing medications.
    • Do not chew or swallow lozenges; suck until dissolved.
    • Thoroughly clean applicators before use.
    • Clean skin before topical application.
    • Antivirals given without regard for meals, unless GI distress occurs.
    • Genital herpes patients avoid sex during lesion presence; use barrier methods even without lesions.

    Amphotericin B

    • Treats systemic fungal infections and meningitis.
    • Contraindicated with antineoplastic drugs.
    • Adverse reactions: nephrotoxicity, electrolyte imbalance, fever, chills, headache, nausea, vomiting, hypotension, orthopnea, thrombophlebitis.
    • Protect from light; use dark bag. Topical stains clothing.

    Fluconazole

    • Treats cryptococcal meningitis, oral/esophageal/vaginal candidiasis.
    • Can cause GI issues and hepatotoxicity.
    • Interactions: cimetidine, diuretics. Ringworm treatment may last months; therapeutic effects may take months.

    Other Medications

    • Gentian Violet: antifungal that stains everything purple.

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    Description

    This quiz focuses on skeletal muscle relaxants used for treating acute musculoskeletal conditions. It covers common side effects, contraindications, drug interactions, and specific medications such as Tizanidine and Diazepam. Test your knowledge on the implications of long-term use and nursing considerations.

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