February 8, 2023

Hello everyone we are going to talked about muscle relaxation today muscle relaxants why isn’t this ok there we go spasmolytic s– so these are lysis means to cut spasm is a spasm now it’s like when the muscles spasms or contracts uncontrollably so this is these are going to be medications that cut or stop these uncontrolled kind of overactive muscles so this is

Why these are also known as muscle relaxers just a little bit of terminology there so and this is worse with some chronic diseases or some injuries so anyway it’s just kind of kind of depend on your patient as far as when you’re gonna need to prescribe some of these spasmolytic therapies and like i said anti spasms are also known as muscle relaxant just a little

Terminology i use some interchangeably i typically refer to them as muscle relaxers and not anti agents but it just as melodic therapy but it’s you know just depends on what textbook you’re looking at norwich professors talking or whatever but they’re you know they’re all the same thing on here some goals of the therapies got and read through those so again for my

Exam and for categorization for me these are going to be your categories your gap but gaba mimetics and then your other relaxants and the reason i say for me is because there’s been students in the past that have brought to my attention that these are classified in other textbooks in different ways but i try not to get too confusing for you guys so i don’t worry

About okay they don’t worry about other textbooks but for my exam and for classification purposes you know just stick to what i haven’t in my slides so first off we have the gaba amino butyric acid which is this is where you get the g a b a this is where you get the gaba gaba mimetics i used to all my exams i would just put gaba everywhere but the exam committee

This year wants me to spell everything out which is cool like i said much love shout out to the exam community i know you’re out there i know you’re listening i know you got love for me because i got love for you but anyway so now i’m gonna be spelling it out so hopefully the gabba symbol works but i’ll still put this too so just a heads up on the exam on that we

Had a little gabba thing i’m gamma that’s a gamma game a symbol gamma out there so i’ll be writing it out but anyway so that’s just a side note so baclofen and diazepam just a couple there baclofen first it’s actually it’s a gaba subtype b agonist so yes please study that my students every year that you want us to know that it’s a b gaba beat yes yeah please not

Trying to be harsh or anything but yeah if you could please learn that and again the reason is because i’m some board review questions i’ve seen where they have gaba you know so level of detail but meccans action there go ahead and read through it but as far as classification and kind of take-home point it is a gaba agonist so its uses here you notice it’s used

For as a muscle relaxer so and specifically for ms spinal cord injuries and for stroke intrathecal which is this is how it just in case you didn’t haven’t heard the term intrathecal administration before have a definition here but intrathecal the intrathecal administration is for severe spasticity of spinal cord or cerebral ord of spinal cord origin or cerebral

Origin so just note there too that you may see that in an inpatient setting adverse effects definitely need be thinking about sedation and lowering the blood pressure of the hypotension and then the hypotonia so it actually can cause some muscle weakness in the sense that so it’s it’s almost kind of too good at being a muscle relaxer and that it kind of it sort

Of overshoots so up to 35% of patients there so that’s definitely something to be mindful of so these are some common adverse effects or baclofen diazepam this is a benzodiazepine so we’ve seen this in other modules and/or we will see this in other modules okay i can’t remember i my my head hurts if i try to think of the whole year or whatever but anyways this one

Is on specifically works on the gaba a just a little bit different than the baclofen right gaba b gaba a and so go ahead and read through this this does cause sedation as well it can also be used for seizures and anxiety and then to that we’ve i think believe noted already that there is abuse of potential with the benzodiazepines in general and specifically with

The diazepam here are some concerns related to the adverse effects and what i have in the corner oh yeah the paradox paradoxical reactions have the blue button is true and then the blue button says the red button is false so it’s just a paradox thing i usually get a kick out and then of the students it’s funny like when i would present this in person i’d be like

You cool cool buttons right and was like just no reaction no nothing it’s like just you know and one’s like is that on the test now but anyway so concerns related adverse effects definitely make sure you look through these cns depression we talked about that in the sense that it can cause some drowsiness dizziness but that’s definitely something to think about

Hey anterograde amnesia i mean is an issue – especially with higher doses and longer term use and the paradoxical reactions read through those those are interesting but they just basically things that you wouldn’t think could happen these paradoxical reactions are actually more more pronounced potentially in your pediatric and elderly patients so please note that

As well that when you’re giving these to the you know if you’re working in geriatric setting or pediatric setting to be mindful of that other relaxants here kind of a grab bag of things first off is botox which is the botulinum toxin which is interesting history and stuff but i won’t get into it with you guys don’t don’t stress too much about that i’ve done in

The past and i was just like again falling asleep i’m like what are you talking about because i have to be mindful this is the last module of the semester and it’s just like you guys are you guys are tired i get it i’m tired – no but yeah where it’s just you get to them the semester you’re just like don’t don’t put paradox buttons on my slide let me know what

I need to know for the test and you know but anyways so you guys are good mechas an action here just please basically inhibits acetylcholine neurotransmitter release and and its uses there lots of the uses here please read through all of them you know some migrant prophylaxis i didn’t mention it in the other migraine presentations oh it is it’s like considered

Off-label you may see it but most people have our familiar with it or have heard of it in hollywood because it’s used for facial wrinkles / other cosmetic purposes but go ahead and definitely read through all those and it’s used for spasticity so that’s why we’re talking about in this cycle of benzo priene this is generic flexural this is another medication that

May be penant beneficial for helping with muscle spasms it is sedating and then it can cause xerostomia this is a big issue and the decrease got a motility so that might be an issue depending on on your patients dantrolene this one i want you guys definitely put a star here as far as its use life-saving as an antidote for sexcellent succinylcholine which we’ll

Talk about here in a little bit but yeah so definitely please look at that go through the meccans section but it’s also can be used for spasticity and that’s why we’re talking about it here adverse effects has a box warning related hepatic toxicity and you can also again it’s it’s a very effective muscle relaxer and like ones we’ve seen before it can cause muscle

Weakness and here’s the butt box warning laid out so you guys can read through the details of it but take one point hepato toxicity with dantrolene definitely make sure your student susanna dean this one is gonna is a alpha-2 adrenergic agonist again can be used for pain but mainly it’s a muscle relaxer you notice – it also be concerned with a xerostomia just dry

Mouth muscle weakness again relatively speaking less than baclofen but again just kind of so you kind of noticing a pattern here it’s something you need to be mindful of what these muscle relaxers sedation again that’s another kind of stereotype of these muscle relaxers you guys notice a lot of these are causing sedation so kind of a generalization you can make and

Then hypotension can be problematic this one is just you read through this but just know that we’re you know paralytics are also known as neuromuscular blocking agents which are also known as muscle relaxant so again you’re going to depend on textbook or what you’re reading you may see some different uses i’m sorry some different titles being used and then this

One too is just showing where some of the medications work kind of related mecca’s fashion but they’re working with the motor endplate so here we are if we have the neuromuscular blockers please note which ones within your study and which ones are nondepolarizing and which ones are depolarizing and it’s relatively straightforward the depolarizing the only one is

A succinylcholine so that’s kind of nice i think and the other ones are all nondepolarizing these are also known as curare form drugs the turbo karen is gonna be was the proto typical one the first one out it is no longer available in the us or canada maybe so in other countries but as we pull from market because of its adverse effects etc and some of the newer

Ones are a lot safer and better tolerated but for all of these they all you can say mechanism action they basically compete with acetylcholine at the nicotinic receptors and this produces muscle relaxation and paralysis which is can be advantageous so you’ll see the anesthesiologist if you do rotations with them they’ll they’re in their little drug bags they have

Little kits they have they’ll have these in there because they help with intubation they help with muscle relaxation during surgery they may also help with e c et cie the electro convulsive no ect electroconvulsive therapy which is used for very similar psychiatric patients so may be used for people have major depressive disorder which we’ll start talking about

In the psych module you learn about that later and there’s just an f y these were originally derived from a plant and that the the tribes down there we’re using them for their arrow poison which is kind of cool so there’s some cool videos of i used to put a video of like this guy in the south america hunting monkeys with these darts but again the eye rolls and

The blank stares no but yeah so anyway if you guys won’t look that up you can it’s cool fyi nondepolarizing and her muscular blockers drug interactions so definitely put a start but you have to become of that be mindful of that adverse effects respiratory paralysis you know that can definitely be an issue and please note heat is reversed bias ito clothes kinase

Inhibitors for example the neostigmine it can cause hypotension and tachycardia and then a histamine release so and it’s lesser with the newer ones as moreso with the older ones next onto the depolarizing a neuromuscular blocker is the only one you have to study and worry about is succinylcholine and so anytime that someone would if they may be just more mentioning

Or if an exam question talked about a depolarizing neuromuscular blocker you would know or after study you would know that they are talking about succinylcholine so please go ahead and read through the meccans of action and note too that there is a phase 1 and phase 2 of the f succinylcholine it is important to note that so please when studying look at that and

Basically what it is is that the caloris inhibitors prolong process at this phase of phase 1 and the cologne are seasoned hibbott errs reverse paralysis at this phase so that is your then i’ve noticed that i’ve listed up here the neostigmine for example is 1 so that can affect you know affect the patient as far as you want to prolong the paralysis or do you want to

Reverse the paralysis uses again anesthesiologist main will be using these muscle relaxation during surgery or the ect and then intubation so anyways and the other thing to note too that these are rapidly height broken down basically by the pseudo cholinesterase and so this is basically something that gobbles it up so therefore there is a short duration of action

Adverse effects please note that there is a box warning for hyperkalemia more likely in pediatric patients with let’s start by that muscle pain and then malignant hypothermia which please you can put here the dantrolene is the antidote for that so definitely start by that one make sure you guys are studying that so dantrolene is gonna be used for this malignant

Hyperthermia and then the the precaution here depending on the makeup of the patient there are some generic genetic variants of the pseudo clone esterase and so it’s rare but you know serious that some of these patients will metabolize this drug very slowly so please note that as well and here’s the box warning with the hyperkalemia just in rhabdomyolysis just go

And read through that but that’s definitely some important to study for and now we have a summary summary table how does a summary slot i can get that out so definitely please as usual go through this make sure you look at the clinical applications adverse effects and contraindications same thing is with these and then i have some sample questions in here and i

Can’t remember why i think cuz i was using this for another for undergrads and i put some cuz i and i’m nicer to them my undergrad students know i i had some sample questions to just go ahead and i mean you can look through that oh whoa whoa tim and eric what’s going on so definitely look through those those are good good practice questions so and if you have any

Trouble with any of them whatever let me know but yeah there’s a good stuff good good good practice questions yeah cuz i think what the undergrad i would do quizzes and stuff at the end of lectures but anyway so i’ll let you guys have those alright hopefully this went okay for everybody as always feel free to email me questions comments feedback and thank you guys

For your time and attention i appreciate it as always i will talk to you guys later have a good one bye

Transcribed from video
Muscle Relaxants Lecture By CStrongPharm