Pharmacotherapy of MUSCLE SPASM and SPASTICITY

Muscle Spasm
• are involuntary contraction of muscles that are usually localized to a specific
muscle group. As the muscle contracts and tightens, the spasm causes sudden,
intense pain, which slowly diminishes after few minutes
• If it occurs in the legs, patient refer to the condition as a Charley horse or Cramp
The term "charley horse" is also used to describe simple painful muscle cramps in
the leg or foot, especially those that follow strenuous exercise. (The term may
date back to American baseball slang of the 1880s, possibly from the pitcher
Charlie Radbourn who is said to have suffered from cramps.[9] Another story
mentions a horse named Charley that used to work at the Chicago White Sox's
baseball stadium. In those days, an old, retired horse was often called "Charlie”).
• The most common etiology of muscle spasm is injury to a skeletal muscle.
• Muscle Spasm usually occurs when muscle is over used or suffers trauma,
hypocalcemia.

Non Pharmacologic Therapy for Muscle Spasm

• Application of heat or cold to the affected site.
• A source of heat applied to the area will work best to reduce cramping and relieve
localized pain.
• The application of cold to the site has the ability to slow transmission of pain
impulse and is more effective for pain relief than heat.

Pharmacotherapy of Muscle spasm

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)

2. Central Acting Skeletal Muscle Relaxants.

• Relieves muscle spasm by their action in the Central Nervous System(CNS)
• They do not have any direct effect on the neuromuscular junction or on the
muscle.
• Drugs
• 1. Cyclobenzaprine
o Route: PO
o Mechanism of Action: Produces anticholinergic effect. Acts centrally
(CNS) and thus has no direct action on skeletal muscle.
o Adverse effect: Commonly reported adverse effect are drowsiness,
dizziness and xerostomia. Sedation can be a limiting effect with the first
few doses.
o Drug interaction: Not administered with alcohol because significant
sedation may occur.
o Signs of Overdose Include CNS depression (decrease level of
consciousness) and Tachycardia.
o Treatment of Overdose: Physostigmine maybe administered to reverse
serious anticholinergic adverse effect.
 o Nursing Responsibility
i. Obtain baseline vital sign. Notify the prescriber of any existing
cardiovascular condition.
ii. Protect patient from injury related to fall due to excessive
drowsiness
o Patient Education:
i. Do not use alcohol when taking this medication because excessive
sedation may occur
ii. Do not crush or chew the extended release capsule
iii. Do not drive or perform hazardous activity because this drug may
cause drowsiness or dizziness
iv. Use gum or hard candy to reduce symptoms of dry mouth
• 2.Baclofen
o Used to reduce muscle spasm and muscle spasticity.
• 4.Methocarbamol
• 5.Chlorzoxazone

Muscle Spasticity
o Is a condition caused by damage to the CNS in which certain muscle groups
remain in a continuous state of contraction
o Spasticity , also referred to as hypertonia, causes pain that is more intense than
muscle spasm
o Associated with neuromuscular disease that are result of damage to the motor
region in cerebral cortex, the region of the brain that controls muscle movement.
o Acute spasticity may begin only a few days following brain and spinal cord
injury.
o Drugs
o 1. Central Acting Skeletal Muscle Relaxants.
o Baclofan
 Route: PO, but it can be administered intrathecal infusion through
a lumbar puncture for severe spasticity.
 This drug is delivered in the intrathecal space, using a catheter and
a pump.This provides a direct route for the baclofen to reach its
site in the spinal cord.The pump consist of small metal disk that is
surgically placed under the skin at the waistline. The healthcare
provider determines the amount of drug to be release by the pump
and the dosing schedule. The pump is refilled every 3 months and
the battery last 5-7 years.
o

o 2.Direct Acting Muscle Relaxant Drug:

o 1. Dantrolene Sodium
  Mechanism of Action: Directly relaxes spastic muscle by
interfering with the relase of calcium ion that have been stored in
the sarcoplasmic reticulum of skeletal muscle.
 Adverse Effect: Muscle weakness and drowsiness are the most
common side effect. The most serious Adverse effect is
hepatotoxicity; death due to hepatic failure have occurred in
patient taking this drug.
 Overdose: Overdose with Dantrolene results in muscle weakness,
lethargy and coma.
 Drug of Choice for treating malignant hyperthermia, a very rare
condition that is an adverse effect of Succinylcholine.
 Treatment of Overdose: General supportive measures are
administered until the effect of the drug diminishes
 Nursing responsibility:
• Establish baseline neurologic status, specifically level for
consciouness
• Assess vital signs closely during IV administration because
the drug may cause tachycardia and erratic blood pressure

Other Directing Acting Muscle Stimulant

o 2. Botulinum toxin type A

 Route: IM, ID or Subcutaneous route
 Unusual drug because it acts as poison in large amount
 Obtain from Clostridium Botulinum, the bacteria responsible for
botulism
 Mechanism of action: this drugs acts directly on muscles by
inhibiting release of acetylcholine.
 Indicated for facial wrinkle or frown wrinkles and severe axillary
hyperhydrosis, which is excessive axillary perspiration.
o 3. Botulinum toxin type B
 Was approved in 2000 for treatment of neck pain in patient with
cervical dystonia.

Skeletal muscle Relaxant are administered during surgery in Combination with

Anesthesia
o During many surgical procedure it is necessary to produce complete skeletal
muscle relaxation in the patient.
o This skeletal muscle relaxant used as surgical adjunct have the capability of
producing complete muscle paralysis; thus Mechanical Ventilation maybe
necessary.
o This agent are administered to facilitate
o endoscopy
o control the severity of muscle contraction resulting from electroshock
therapy.
o Drug:
o Succinylcholine
o Tubocurarine