This document discusses various central and peripheral acting muscle relaxants. It provides details on baclofen, diazepam, methocarbamol, cyclobenzaprine, chlorzoxazone, carisoprodol, chlorphenesin carbamate, orphenadrine citrate, metaxalone, dantrolene sodium, and quinine sulfate. For each drug, it describes the mechanism of action, medical uses, and potential side effects. The document emphasizes that central acting drugs relieve muscle spasm by acting in the spinal cord or brain, while peripheral drugs like dantrolene and quinine act directly on skeletal muscles.

1. Central Acting Muscle RelaxantsCentral Acting Muscle Relaxants
& Spasmolytics& Spasmolytics

2. Central Acting MuscleCentral Acting Muscle
RelaxantsRelaxants
Drugs That Are Used InDrugs That Are Used In
Institutional Settings Are :Institutional Settings Are :
Baclofen (Lioresal)Baclofen (Lioresal)
Diazepam (Valium)Diazepam (Valium)

3. Central Acting MuscleCentral Acting Muscle
RelaxantsRelaxants
Methocarbamol (Robaxin)Methocarbamol (Robaxin)
Cyclobenzaprine HCl (Flexeril)Cyclobenzaprine HCl (Flexeril)
Chlorzoxazone (Paraflex)Chlorzoxazone (Paraflex)
Carisoprodol (Soma)Carisoprodol (Soma)

4. Chlorphenesin Carbamate (Maolate)Chlorphenesin Carbamate (Maolate)
Orphenadrine Citrate (Norgesic)Orphenadrine Citrate (Norgesic)
Metaxalone (Skelaxin)Metaxalone (Skelaxin)

5. Central Acting Muscle RelaxantsCentral Acting Muscle Relaxants
& Spasmolytics& Spasmolytics
Baclofen (Lioresal)Baclofen (Lioresal)
Diazepam (Valium)Diazepam (Valium)
Used To RelieveUsed To Relieve ::
Muscle SpasmMuscle Spasm
SpasticitySpasticity

6. Central Acting Muscle RelaxantsCentral Acting Muscle Relaxants
Methocarbamol (Robaxin)Methocarbamol (Robaxin)
Cyclobenzaprine HCl (Flexeril)Cyclobenzaprine HCl (Flexeril)
Chlorzoxazone (Paraflex)Chlorzoxazone (Paraflex)
Carisoprodol (Soma)Carisoprodol (Soma)

7. Chlorphenesin Carbamate (Maolate)Chlorphenesin Carbamate (Maolate)
Orphenadrine Citrate (Norgesic)Orphenadrine Citrate (Norgesic)
Metaxalone (Skelaxin)Metaxalone (Skelaxin)
OnlyOnly Used To Relieve:Used To Relieve:
Muscle SpasmMuscle Spasm

8. BaclofenBaclofen
A Derivative Of Gamma-A Derivative Of Gamma-
Aminobutyric Acid (GABA)Aminobutyric Acid (GABA)

9. Acts As A GABA AgonistActs As A GABA Agonist
Binds To GABA ReceptorsBinds To GABA Receptors
Acts As An InhibitoryActs As An Inhibitory
NeurotransmitterNeurotransmitter
Has Identical Actions ToHas Identical Actions To
GABAGABA

10. Baclofen Exerts Its AntispasticBaclofen Exerts Its Antispastic
Effects In The Spinal CordEffects In The Spinal Cord
Suppresses Monosynaptic &Suppresses Monosynaptic &
Polysynaptic TransmissionPolysynaptic Transmission

11. Hyperpolarizes Neural CellsHyperpolarizes Neural Cells
Inhibits Calcium ChannelInhibits Calcium Channel
ActivityActivity
Increasing PotassiumIncreasing Potassium
Conductance Into CellsConductance Into Cells

12. Reduces The Frequency OfReduces The Frequency Of
Flexor And Extensor SpasticFlexor And Extensor Spastic
EventsEvents
Reduces The Severity Of TheReduces The Severity Of The
Spastic EpisodeSpastic Episode

13. Baclofen - Medical UsesBaclofen - Medical Uses
Used To Treat Spasticity In SCIUsed To Treat Spasticity In SCI
PatientsPatients
Used To Treat Spasticity In MSUsed To Treat Spasticity In MS
PatientsPatients

14. Baclofen - Side EffectsBaclofen - Side Effects
DrowsinessDrowsiness
InsomniaInsomnia
DizzinessDizziness
WeaknessWeakness

15. HypotensionHypotension
AtaxiaAtaxia
Mental ConfusionMental Confusion
Inability To Focus On TasksInability To Focus On Tasks

16. DiazepamDiazepam
Diazepam Is A BenzodiazepineDiazepam Is A Benzodiazepine
Has Sedative QualitiesHas Sedative Qualities
Has Anxiolytic CapabilitiesHas Anxiolytic Capabilities
Is A Spasmolytic DrugIs A Spasmolytic Drug

17. Mechanism Of ActionMechanism Of Action
Potentiates Action of GABAPotentiates Action of GABA
Increases The PresynapticIncreases The Presynaptic
And Postsynaptic Inhibition AtAnd Postsynaptic Inhibition At
All Levels In The CNSAll Levels In The CNS

18. Diazepam - Medical UsesDiazepam - Medical Uses
A SedativeA Sedative
As A HypnoticAs A Hypnotic
As An AnxiolyticAs An Anxiolytic
As A Muscle RelaxantAs A Muscle Relaxant

19. Diazepam - Medical UsesDiazepam - Medical Uses
Relieve The Spasticity ofRelieve The Spasticity of
Cerebral PalsyCerebral Palsy
Induce Mild AmnesiaInduce Mild Amnesia
Control Seizures In StatusControl Seizures In Status
Epilepticus PatientsEpilepticus Patients

20. Diazepam - Adverse Side EffectsDiazepam - Adverse Side Effects
Cardiorespiratory DepressionCardiorespiratory Depression
DrowsinessDrowsiness
FatigueFatigue
LethargyLethargy
Somnolence (Drowsy, Sleepy)Somnolence (Drowsy, Sleepy)

21. HypotoniaHypotonia
DysarthriaDysarthria
AtaxiaAtaxia
Behavioral DisturbancesBehavioral Disturbances
Lifting of InhibitionsLifting of Inhibitions

22. ChildrenChildren
Irritability & AggressionIrritability & Aggression
HyperactivityHyperactivity
AnorexiaAnorexia
Increased Production of SalivaIncreased Production of Saliva
& Bronchial Secretions& Bronchial Secretions

23. Central Acting Muscle RelaxantsCentral Acting Muscle Relaxants
Methocarbamol (Robaxin)Methocarbamol (Robaxin)
Cyclobenzaprine HCl (Flexeril)Cyclobenzaprine HCl (Flexeril)
Chlorzoxazone (Paraflex)Chlorzoxazone (Paraflex)
Carisoprodol (Soma)Carisoprodol (Soma)
Chlorphenesin Carbamate (Maolate)Chlorphenesin Carbamate (Maolate)
Orphenadrine Citrate (Norgesic)Orphenadrine Citrate (Norgesic)
Metaxalone (Skelaxin)Metaxalone (Skelaxin)

24. Mechanism Of ActionMechanism Of Action
Lack Of Controlled Clinical TrialsLack Of Controlled Clinical Trials
Makes Assessing The Efficacy OfMakes Assessing The Efficacy Of
These Medications DifficultThese Medications Difficult
However, They May Relieve:However, They May Relieve:
Muscle SpasmMuscle Spasm
Decrease Pain By RelievingDecrease Pain By Relieving
SpasmSpasm

25. Not Been Conclusively DeterminedNot Been Conclusively Determined
Research Suggests :Research Suggests :
Nonspecific CNS SedationNonspecific CNS Sedation
Suppression Of Polysynaptic SpinalSuppression Of Polysynaptic Spinal
Cord TransmissionCord Transmission

26. Decreased Alpha Motor NeuronDecreased Alpha Motor Neuron
Traffic With A Decrease In SpasmTraffic With A Decrease In Spasm
May Act As An Antidepressant -May Act As An Antidepressant -
Mood AlterationsMood Alterations

27. Medical UsesMedical Uses
Used As An Adjunct To Rest AndUsed As An Adjunct To Rest And
Physical Therapy In Patients WithPhysical Therapy In Patients With
Acute Musculoskeletal Pain AndAcute Musculoskeletal Pain And
SpasmSpasm

28. Peripheral Acting MusclePeripheral Acting Muscle
RelaxantsRelaxants

29. Peripheral Muscle RelaxantsPeripheral Muscle Relaxants
Dantrolene Sodium (Dantrium)Dantrolene Sodium (Dantrium)
Quinine Sulfate (Quinamm)Quinine Sulfate (Quinamm)

30. Dantrolene Sodium (Dantrium)Dantrolene Sodium (Dantrium)

31. Dantrolene : Peripheral MuscleDantrolene : Peripheral Muscle
RelaxantsRelaxants
Act Directly On The SkeletalAct Directly On The Skeletal
Muscle To Produce RelaxationMuscle To Produce Relaxation
Do NotDo Not Have Actions Directly OnHave Actions Directly On
The Spinal CordThe Spinal Cord

32. Dantrolene SodiumDantrolene Sodium
Mechanism Of ActionMechanism Of Action
Decreases The Amount OfDecreases The Amount Of
Calcium Released From TheCalcium Released From The
Muscle's SarcoplasmicMuscle's Sarcoplasmic
ReticulumReticulum

33. Reduces The Contractility OfReduces The Contractility Of
MuscleMuscle
Has A Greater Effect On TypeHas A Greater Effect On Type
II Skeletal Muscle Fibers (FastII Skeletal Muscle Fibers (Fast
Twitch)Twitch)

34. Side Effects - Dantrolene SodiumSide Effects - Dantrolene Sodium
FatigueFatigue
EuphoriaEuphoria
DrowsinessDrowsiness
It Can Be HepatotoxicIt Can Be Hepatotoxic
Liver Enzymes May Be ElevatedLiver Enzymes May Be Elevated
Muscle Weakness - Dose RelatedMuscle Weakness - Dose Related

35. Dantrolene - Therapeutic UsesDantrolene - Therapeutic Uses
Helps Manage SpasticityHelps Manage Spasticity
Cerebral PalsyCerebral Palsy
Multiple SclerosisMultiple Sclerosis
Spinal Cord InjurySpinal Cord Injury

36. Helps Manage SpasticityHelps Manage Spasticity
Reduces ClonusReduces Clonus
Reduces Mass Reflex MovementsReduces Mass Reflex Movements
Abnormal Resistance To PassiveAbnormal Resistance To Passive
StretchStretch
Used In Bed Bound Patients ToUsed In Bed Bound Patients To
Improve Their Bed CareImprove Their Bed Care

37. Dantrolene - UnusualDantrolene - Unusual
Therapeutic UsesTherapeutic Uses
Malignant HyperthermiaMalignant Hyperthermia
Hereditary ConditionHereditary Condition

38. Multiple Triggering MechanismsMultiple Triggering Mechanisms
AnesthesiaAnesthesia
DrugsDrugs
Illness & StressIllness & Stress
Triggering Mechanism Results InTriggering Mechanism Results In
Prolonged Calcium ReleaseProlonged Calcium Release

39. Malignant HyperthermiaMalignant Hyperthermia
Massive Muscle ContractionMassive Muscle Contraction
Excessive Lactate ProductionExcessive Lactate Production
Pronounced Increase In CorePronounced Increase In Core
TemperatureTemperature

40. Quinine Sulfate (Quinamm)Quinine Sulfate (Quinamm)

41. Quinine SulfateQuinine Sulfate
Quinine Sulfate Is Related ToQuinine Sulfate Is Related To
The Cinchona Alkaloids - AnThe Cinchona Alkaloids - An
Antimalarial Drug GroupAntimalarial Drug Group

42. Quinine Sulfate :Quinine Sulfate :
It Is An Antipyretic DrugIt Is An Antipyretic Drug
It Is A Local AnestheticIt Is A Local Anesthetic
It Is An AnalgesicIt Is An Analgesic
It Is A Muscle RelaxantIt Is A Muscle Relaxant

43. Quinine Sulfate Acts To:Quinine Sulfate Acts To:
Decreases The Excitability Of TheDecreases The Excitability Of The
Motor End-PlateMotor End-Plate
Makes The Muscle LessMakes The Muscle Less
Susceptible To Repetitive NeuralSusceptible To Repetitive Neural
StimuliStimuli
Less Responsive To AcetylcholineLess Responsive To Acetylcholine

44. Adverse Side EffectsAdverse Side Effects
For Quinine SulfateFor Quinine Sulfate
RashesRashes
SyncopeSyncope
HeadachesHeadaches
Hot, Flushed SkinHot, Flushed Skin
Ringing In The EarsRinging In The Ears

45. FeverFever
VomitingVomiting
DeliriumDelirium
ConfusionConfusion
NauseaNausea

46. Quinine Sulfate : Medical UsesQuinine Sulfate : Medical Uses
Prescribed ForPrescribed For Myotonia CongenitaMyotonia Congenita
An Inherited Disease Seen InAn Inherited Disease Seen In
ChildrenChildren
Tonic Spasms That Occur WhenTonic Spasms That Occur When
Voluntary Movement OccursVoluntary Movement Occurs
Rigidity Wears Off & MovementRigidity Wears Off & Movement
Becomes More Fluid WithBecomes More Fluid With
Repeated ContractionsRepeated Contractions

47. Quinine Sulfate Obliterates TheQuinine Sulfate Obliterates The
Spasticity OfSpasticity Of Myotonia CongenitaMyotonia Congenita

48. Clinical ConsiderationsClinical Considerations
Patients with glaucoma should notPatients with glaucoma should not
use these medicationsuse these medications
Patients with a history of urinaryPatients with a history of urinary
retention should not use theseretention should not use these
medicationsmedications

49. Patients should not be doingPatients should not be doing
hazardous activities while on thesehazardous activities while on these
medicationsmedications
A diabetic’s blood glucose should beA diabetic’s blood glucose should be
monitored closely while on thesemonitored closely while on these
medications - hypo & hyperglycemiamedications - hypo & hyperglycemia

50. Watch the patient for :Watch the patient for :
Loss of coordinationLoss of coordination
AtaxiaAtaxia
Possible seizure activityPossible seizure activity