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Antispastic Skeletal Muscle Relaxant

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1. Antispastic Skeletal Muscle Relaxant

Antispastic Skeletal Muscle Relaxant Antispastic Skeletal Muscle Relaxant Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Antispastic (...) Skeletal Muscle Relaxant Antispastic Skeletal Muscle Relaxant Aka: Antispastic Skeletal Muscle Relaxant , Baclofen , Lioresal , Dantrolene , Dantrium II. Pathophysiology These agents are used to reduce severe spasticity (e.g. spinal cord injury, , ) III. Indications: Spasticity Spinal Cord Injury IV. Contraindications Not indicated for general musculoskeletal problems V. Agents Baclofen (Lioresal) Baclofen binds GABA B receptors Oral Baclofen does not cross blood brain barrier well Instead, Baclofen

2018 FP Notebook

2. Antispastic Skeletal Muscle Relaxant

Antispastic Skeletal Muscle Relaxant Antispastic Skeletal Muscle Relaxant Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Antispastic (...) Skeletal Muscle Relaxant Antispastic Skeletal Muscle Relaxant Aka: Antispastic Skeletal Muscle Relaxant , Baclofen , Lioresal , Dantrolene , Dantrium II. Pathophysiology These agents are used to reduce severe spasticity (e.g. spinal cord injury, , ) III. Indications: Spasticity Spinal Cord Injury IV. Contraindications Not indicated for general musculoskeletal problems V. Agents Baclofen (Lioresal) Baclofen binds GABA B receptors Oral Baclofen does not cross blood brain barrier well Instead, Baclofen

2015 FP Notebook

3. What is the evidence for the use of Baclofen in acute muscle spasm and in particular for acute back pain

in the results: “Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality, 24 trials (80%) were on acute low back pain. Four trials studied benzodiazepines, 11 non-benzodiazepines and two antispasticity muscle relaxants in comparison with placebo. Results showed that there is strong evidence that any of these muscle relaxants are more effective than placebo for patients with acute LBP on short-term pain relief. The pooled RR for non-benzodiazepines versus placebo after two (...) is more effective than placebo on short-term pain relief and better overall improvement (level C). The pooled RR for non-benzodiazepines versus placebo after two to four days was 0.80 [95% CI; 0.71 to 0.89] for pain relief and 0.49 [95% CI; 0.25 to 0.95] for global efficacy (level A). The various muscle relaxants were found to be similar in performance. A review of medications for acute and chronic low back pain (3) published in 2007 reports: “Among skeletal muscle relaxants, we found sparse evidence

2012 TRIP Answers

4. Tizanidine

(DS 103-282), and baclofen in the treatment of chronic spasticity in multiple sclerosis. 374-83 A double-blind trial with two parallel groups was carried out (...) to compare the antispastic effect and tolerability of a new muscle relaxant, tizanidine (DS 103-282), with those of baclofen in the treatment of spasticity due to multiple sclerosis. Twenty-one hospitalized patients with stable spasticity participated in the 6-week trial. Eleven received tizanidine and 10 baclofen in gradually (...) nasal spray, a novel intranasal delivery method for the treatment of skeletal muscle spasm. 885-91 10.1007/s40261-013-0137-2 The skeletal muscle relaxant tizanidine is approved by the US FDA (...) and the European Medicines Agency for treating spasticity and is supplied as tablets for oral administration. However, tizanidine has a poor bioavailability, due to extensive first-pass metabolism. Therefore, the nasal route of administration, which bypasses portal circulation, may increase

2018 Trip Latest and Greatest

5. Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning

with stroke should develop and adhere to local urinary and faecal continence guidelines including advice on appropriate referral. a electrical stimulation to the supraspinatus and deltoid muscles should be considered as soon as possible after stroke in patients at risk of developing shoulder subluxation. ? Patients should be asked about pain and the presence of pain should be assessed (for example, with a validated pain assessment tool) and treated appropriately, as soon as possible. ? Given (...) , control group 76, p=0.04) the evidence is insufficient to support the introduction (or removal) of very early mobilisation (less than 48 hours after stroke). b stroke patients should be mobilised as early as possible after stroke. 4.1.3 THERAPEUTIC POSITIONING The most appropriate position in which to nurse and place a patient following a stroke remains unclear. The aim of positioning the patient is to try to promote optimal recovery by modulating muscle tone, providing appropriate sensory information

2010 SIGN

6. Urological Management in Neurological Disease (Overview)

-500 µV firing at rates of 1-4/sec. This activity is at its lowest when the patient’s bladder is empty. As the bladder fills, the firing rate increases slowly until bladder fullness is perceived. At that point, the type II fibers are contracted voluntarily in a graded way. When bladder capacity is reached, some voluntary units as large as 3 mV are seen. The motor units of the sphincters are of shorter duration than those of skeletal muscles and resemble the units of facial muscles. Individual motor (...) mechanism, which, in turn, allows the treating physician to develop a strategy for managing it. [ ] Neurourology, although a relatively new field of study, has revolutionized the management of a vexing problem that affects millions of patients. Next: Neuroanatomy of Pelvic Floor The striated muscle forming the urethral rhabdosphincter and the periurethral striated muscle (part of the pelvic diaphragm) together make up the external urethral sphincter mechanism in humans. In women, the rhabdosphincter

2014 eMedicine.com

7. Cauda Equina and Conus Medullaris Syndromes (Follow-up)

table should start at 15 degrees, progressing by 10 degrees every 15 minutes up to about 80 degrees with the necessary precautions. Other activities include the following: Wheelchair propulsion training Standing table exercises Functional electrical stimulation for increased muscle tone Lower extremity orthoses to aid balance and walking Ambulation exercises Family training and community skills A home exercise program Occupational therapy Conduct the following: Wheelchair training, especially (...) origin; treatment may include narcotics in the acute setting and tricyclic antidepressants later. Patient education, biofeedback, and relaxation techniques may also be used. Nerve root ischemia is partially responsible for the pain and decreased motor strength associated with cauda equina syndrome. As a result, vasodilatory treatment can be useful in some patients. Mean arterial blood pressure should be maintained above 90 mm Hg to maximize blood flow to the spinal cord and nerve roots. Treatment

2014 eMedicine.com

8. Urological Management in Neurological Disease (Follow-up)

-500 µV firing at rates of 1-4/sec. This activity is at its lowest when the patient’s bladder is empty. As the bladder fills, the firing rate increases slowly until bladder fullness is perceived. At that point, the type II fibers are contracted voluntarily in a graded way. When bladder capacity is reached, some voluntary units as large as 3 mV are seen. The motor units of the sphincters are of shorter duration than those of skeletal muscles and resemble the units of facial muscles. Individual motor (...) mechanism, which, in turn, allows the treating physician to develop a strategy for managing it. [ ] Neurourology, although a relatively new field of study, has revolutionized the management of a vexing problem that affects millions of patients. Next: Neuroanatomy of Pelvic Floor The striated muscle forming the urethral rhabdosphincter and the periurethral striated muscle (part of the pelvic diaphragm) together make up the external urethral sphincter mechanism in humans. In women, the rhabdosphincter

2014 eMedicine.com

9. Multiple Sclerosis (Follow-up)

. In addition, armodafinil (Nuvigil) has also been suggested as being helpful with fatigue. Nonpharmacologic treatment of fatigue involves energy conservation, work simplification, scheduled rest periods, and the use of cooling garments (eg, vest, hat, collar). Regular exercise also may help alleviate fatigue. Medications used in MS management often can contribute to fatigue. These drugs include analgesics, anticonvulsants, antidepressants, muscle relaxants, sedatives, and immune-modulating medications (...) problem with a single medication. For patients with cognitive impairment, benzodiazepines may be contraindicated due to their adverse CNS effects. Dantrolene sodium (Dantrium) acts directly on skeletal muscle to decrease spasticity. This agent is used less frequently than baclofen because of its hepatotoxicity at higher doses and numerous drug interactions. The anticonvulsant drug gabapentin (Neurontin) is particularly useful in patients who experience spasticity and neuropathic pain. It is easily

2014 eMedicine.com

10. Multiple Sclerosis (Follow-up)

. In addition, armodafinil (Nuvigil) has also been suggested as being helpful with fatigue. Nonpharmacologic treatment of fatigue involves energy conservation, work simplification, scheduled rest periods, and the use of cooling garments (eg, vest, hat, collar). Regular exercise also may help alleviate fatigue. Medications used in MS management often can contribute to fatigue. These drugs include analgesics, anticonvulsants, antidepressants, muscle relaxants, sedatives, and immune-modulating medications (...) problem with a single medication. For patients with cognitive impairment, benzodiazepines may be contraindicated due to their adverse CNS effects. Dantrolene sodium (Dantrium) acts directly on skeletal muscle to decrease spasticity. This agent is used less frequently than baclofen because of its hepatotoxicity at higher doses and numerous drug interactions. The anticonvulsant drug gabapentin (Neurontin) is particularly useful in patients who experience spasticity and neuropathic pain. It is easily

2014 eMedicine.com

11. Cauda Equina and Conus Medullaris Syndromes (Treatment)

table should start at 15 degrees, progressing by 10 degrees every 15 minutes up to about 80 degrees with the necessary precautions. Other activities include the following: Wheelchair propulsion training Standing table exercises Functional electrical stimulation for increased muscle tone Lower extremity orthoses to aid balance and walking Ambulation exercises Family training and community skills A home exercise program Occupational therapy Conduct the following: Wheelchair training, especially (...) origin; treatment may include narcotics in the acute setting and tricyclic antidepressants later. Patient education, biofeedback, and relaxation techniques may also be used. Nerve root ischemia is partially responsible for the pain and decreased motor strength associated with cauda equina syndrome. As a result, vasodilatory treatment can be useful in some patients. Mean arterial blood pressure should be maintained above 90 mm Hg to maximize blood flow to the spinal cord and nerve roots. Treatment

2014 eMedicine.com

12. Cauda Equina Syndrome (Follow-up)

table should start at 15 degrees, progressing by 10 degrees every 15 minutes up to about 80 degrees with the necessary precautions. Other activities include the following: Wheelchair propulsion training Standing table exercises Functional electrical stimulation for increased muscle tone Lower extremity orthoses to aid balance and walking Ambulation exercises Family training and community skills A home exercise program Occupational therapy Conduct the following: Wheelchair training, especially (...) origin; treatment may include narcotics in the acute setting and tricyclic antidepressants later. Patient education, biofeedback, and relaxation techniques may also be used. Nerve root ischemia is partially responsible for the pain and decreased motor strength associated with cauda equina syndrome. As a result, vasodilatory treatment can be useful in some patients. Mean arterial blood pressure should be maintained above 90 mm Hg to maximize blood flow to the spinal cord and nerve roots. Treatment

2014 eMedicine Emergency Medicine

13. Multiple Sclerosis (Follow-up)

. In addition, armodafinil (Nuvigil) has also been suggested as being helpful with fatigue. Nonpharmacologic treatment of fatigue involves energy conservation, work simplification, scheduled rest periods, and the use of cooling garments (eg, vest, hat, collar). Regular exercise also may help alleviate fatigue. Medications used in MS management often can contribute to fatigue. These drugs include analgesics, anticonvulsants, antidepressants, muscle relaxants, sedatives, and immune-modulating medications (...) problem with a single medication. For patients with cognitive impairment, benzodiazepines may be contraindicated due to their adverse CNS effects. Dantrolene sodium (Dantrium) acts directly on skeletal muscle to decrease spasticity. This agent is used less frequently than baclofen because of its hepatotoxicity at higher doses and numerous drug interactions. The anticonvulsant drug gabapentin (Neurontin) is particularly useful in patients who experience spasticity and neuropathic pain. It is easily

2014 eMedicine Emergency Medicine

14. Multiple Sclerosis (Treatment)

. In addition, armodafinil (Nuvigil) has also been suggested as being helpful with fatigue. Nonpharmacologic treatment of fatigue involves energy conservation, work simplification, scheduled rest periods, and the use of cooling garments (eg, vest, hat, collar). Regular exercise also may help alleviate fatigue. Medications used in MS management often can contribute to fatigue. These drugs include analgesics, anticonvulsants, antidepressants, muscle relaxants, sedatives, and immune-modulating medications (...) problem with a single medication. For patients with cognitive impairment, benzodiazepines may be contraindicated due to their adverse CNS effects. Dantrolene sodium (Dantrium) acts directly on skeletal muscle to decrease spasticity. This agent is used less frequently than baclofen because of its hepatotoxicity at higher doses and numerous drug interactions. The anticonvulsant drug gabapentin (Neurontin) is particularly useful in patients who experience spasticity and neuropathic pain. It is easily

2014 eMedicine.com

15. Multiple Sclerosis (Treatment)

. In addition, armodafinil (Nuvigil) has also been suggested as being helpful with fatigue. Nonpharmacologic treatment of fatigue involves energy conservation, work simplification, scheduled rest periods, and the use of cooling garments (eg, vest, hat, collar). Regular exercise also may help alleviate fatigue. Medications used in MS management often can contribute to fatigue. These drugs include analgesics, anticonvulsants, antidepressants, muscle relaxants, sedatives, and immune-modulating medications (...) problem with a single medication. For patients with cognitive impairment, benzodiazepines may be contraindicated due to their adverse CNS effects. Dantrolene sodium (Dantrium) acts directly on skeletal muscle to decrease spasticity. This agent is used less frequently than baclofen because of its hepatotoxicity at higher doses and numerous drug interactions. The anticonvulsant drug gabapentin (Neurontin) is particularly useful in patients who experience spasticity and neuropathic pain. It is easily

2014 eMedicine.com

16. Urological Management in Neurological Disease (Treatment)

-500 µV firing at rates of 1-4/sec. This activity is at its lowest when the patient’s bladder is empty. As the bladder fills, the firing rate increases slowly until bladder fullness is perceived. At that point, the type II fibers are contracted voluntarily in a graded way. When bladder capacity is reached, some voluntary units as large as 3 mV are seen. The motor units of the sphincters are of shorter duration than those of skeletal muscles and resemble the units of facial muscles. Individual motor (...) mechanism, which, in turn, allows the treating physician to develop a strategy for managing it. [ ] Neurourology, although a relatively new field of study, has revolutionized the management of a vexing problem that affects millions of patients. Next: Neuroanatomy of Pelvic Floor The striated muscle forming the urethral rhabdosphincter and the periurethral striated muscle (part of the pelvic diaphragm) together make up the external urethral sphincter mechanism in humans. In women, the rhabdosphincter

2014 eMedicine.com

17. Cauda Equina Syndrome (Follow-up)

table should start at 15 degrees, progressing by 10 degrees every 15 minutes up to about 80 degrees with the necessary precautions. Other activities include the following: Wheelchair propulsion training Standing table exercises Functional electrical stimulation for increased muscle tone Lower extremity orthoses to aid balance and walking Ambulation exercises Family training and community skills A home exercise program Occupational therapy Conduct the following: Wheelchair training, especially (...) origin; treatment may include narcotics in the acute setting and tricyclic antidepressants later. Patient education, biofeedback, and relaxation techniques may also be used. Nerve root ischemia is partially responsible for the pain and decreased motor strength associated with cauda equina syndrome. As a result, vasodilatory treatment can be useful in some patients. Mean arterial blood pressure should be maintained above 90 mm Hg to maximize blood flow to the spinal cord and nerve roots. Treatment

2014 eMedicine Surgery

18. Cauda Equina Syndrome (Treatment)

table should start at 15 degrees, progressing by 10 degrees every 15 minutes up to about 80 degrees with the necessary precautions. Other activities include the following: Wheelchair propulsion training Standing table exercises Functional electrical stimulation for increased muscle tone Lower extremity orthoses to aid balance and walking Ambulation exercises Family training and community skills A home exercise program Occupational therapy Conduct the following: Wheelchair training, especially (...) origin; treatment may include narcotics in the acute setting and tricyclic antidepressants later. Patient education, biofeedback, and relaxation techniques may also be used. Nerve root ischemia is partially responsible for the pain and decreased motor strength associated with cauda equina syndrome. As a result, vasodilatory treatment can be useful in some patients. Mean arterial blood pressure should be maintained above 90 mm Hg to maximize blood flow to the spinal cord and nerve roots. Treatment

2014 eMedicine Surgery

19. Urological Management in Neurological Disease (Diagnosis)

-500 µV firing at rates of 1-4/sec. This activity is at its lowest when the patient’s bladder is empty. As the bladder fills, the firing rate increases slowly until bladder fullness is perceived. At that point, the type II fibers are contracted voluntarily in a graded way. When bladder capacity is reached, some voluntary units as large as 3 mV are seen. The motor units of the sphincters are of shorter duration than those of skeletal muscles and resemble the units of facial muscles. Individual motor (...) mechanism, which, in turn, allows the treating physician to develop a strategy for managing it. [ ] Neurourology, although a relatively new field of study, has revolutionized the management of a vexing problem that affects millions of patients. Next: Neuroanatomy of Pelvic Floor The striated muscle forming the urethral rhabdosphincter and the periurethral striated muscle (part of the pelvic diaphragm) together make up the external urethral sphincter mechanism in humans. In women, the rhabdosphincter

2014 eMedicine.com

20. Multiple Sclerosis (Treatment)

. In addition, armodafinil (Nuvigil) has also been suggested as being helpful with fatigue. Nonpharmacologic treatment of fatigue involves energy conservation, work simplification, scheduled rest periods, and the use of cooling garments (eg, vest, hat, collar). Regular exercise also may help alleviate fatigue. Medications used in MS management often can contribute to fatigue. These drugs include analgesics, anticonvulsants, antidepressants, muscle relaxants, sedatives, and immune-modulating medications (...) problem with a single medication. For patients with cognitive impairment, benzodiazepines may be contraindicated due to their adverse CNS effects. Dantrolene sodium (Dantrium) acts directly on skeletal muscle to decrease spasticity. This agent is used less frequently than baclofen because of its hepatotoxicity at higher doses and numerous drug interactions. The anticonvulsant drug gabapentin (Neurontin) is particularly useful in patients who experience spasticity and neuropathic pain. It is easily

2014 eMedicine Emergency Medicine

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