{"id":427,"date":"2019-12-01T20:17:12","date_gmt":"2019-12-02T01:17:12","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/nursingpharmacology\/chapter\/10-8-adjuvant-analgesics\/"},"modified":"2022-02-24T12:25:47","modified_gmt":"2022-02-24T17:25:47","slug":"10-8-adjuvant-analgesics","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/nursingpharmacology\/chapter\/10-8-adjuvant-analgesics\/","title":{"raw":"10.8 Adjuvant Analgesics","rendered":"10.8 Adjuvant Analgesics"},"content":{"raw":"
\r\n\r\nMedications used as\u00a0[pb_glossary id=\"687\"]adjuvant analgesics[\/pb_glossary] were developed for other purposes but were later found to be effective to treat pain. Examples of adjuvant medications include gapapentin<\/em> (an anticonvulsant) and amitriptyline<\/em> (a tricyclic antidepressant). Additional information about these specific medications can be found in Chapter 8<\/a>. Muscle relaxants are also considered an adjuvant analgesic and are used for various musculoskeletal disorders such as multiple sclerosis. Three different types of muscle relaxants will be discussed below baclofen, cyclobenzaprine, and tizanidine.\r\n

Baclofen<\/h3>\r\nMechanism of Action<\/strong>\r\n\r\nBaclofen<\/a> inhibits reflexes at the spinal level.\r\n\r\nIndications for Use<\/strong>\r\n\r\nBaclofen is used to treat muscle symptoms, such as spasms, pain, and stiffness, caused by multiple sclerosis, spinal cord injuries, or other spinal cord disorders.\r\n\r\nNursing Considerations Across the Lifespan<\/strong>\r\n\r\nBaclofen is safe for clients 12 years and older.\r\n\r\nAdverse\/Side Effects<\/strong>\r\n\r\nAdverse effects include drowsiness, dizziness or lightheadedness, confusion, nausea, constipation, and muscle weakness.\r\n\r\nAbrupt Drug Withdrawal: Hallucinations and seizures have occurred on abrupt withdrawal of baclofen. Therefore, except for serious adverse reactions, the dose should be reduced slowly when the drug is discontinued.\r\n\r\nImpaired Renal Function: Because baclofen is primarily excreted unchanged through the kidneys, it should be given with caution, and it may be necessary to reduce the dosage.\r\n\r\nSigns and symptoms of overdose include vomiting, muscular hypotonia, drowsiness, accommodation disorders of the eye, coma, respiratory depression, and seizures.\r\n\r\nClient Teaching & Education<\/strong>\r\n\r\nThe medication should be taken as directed and abrupt withdrawal of the medication should be avoided.\u00a0 It may cause dizziness or drowsiness. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur.\u00a0 Additionally, clients should avoid concurrent use with alcohol or other CNS depressants.\r\n\r\n<\/div>\r\n
\r\n\r\nNow let's take a closer look at the medication card for baclofen Table 10.8a[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote]<\/sup>\r\n\r\n<\/div>\r\nMedication cards like this are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below.\u00a0 Prototype or generic medication examples are also hyperlinked to a free resource at Daily Med<\/a>. On the home page, enter the drug name in the search bar to read more about the medication.\r\n\r\nTable 10.7b Baclofen<\/a> Medication Card.[footnote]RNPedia. (2021). https:\/\/www.rnpedia.com<\/a>[\/footnote][footnote]DailyMed from US National Library of Medicine. www.dailymed.com[\/footnote][footnote]OpenMD.Com (2021). www.openmd.com[\/footnote][footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote][\/footnote]<\/sup><\/span>\r\n\r\n\"\"\r\n
\r\n
\r\n

Clinical Reasoning and Decision-Making Activity 10.8a\"Image<\/h2>\r\n<\/header>\r\n
\r\n\r\nA client just started taking baclofen for muscle spasticity due to multiple sclerosis.\r\n\r\nWhat teaching should the nurse provide?\r\n\r\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n
\r\n

Cyclobenzaprine<\/h3>\r\nMechanism of Action<\/strong>\r\n\r\nCyclobenzaprine<\/a> reduces tonic somatic muscle activity at the level of the brainstem. It is structurally similar to tricyclic antidepressants.\r\n\r\nIndications for Use<\/strong>\r\n\r\nCyclobenzaprine is used to treat acute muscle spasms.\r\n\r\nNursing Considerations Across the Lifespan<\/strong>\r\n\r\nCyclobenzaprine is safe for clients 15 years and older. Use cautiously with geriatric clients. In the elderly, the frequency and severity of adverse events associated with the use of cyclobenzaprine, with or without concomitant medications, are increased. In elderly clients, cyclobenzaprine should be initiated with a 5 mg dose and titrated slowly upward.\r\n\r\nShould not be used by breastfeeding women.\r\n\r\nAdverse\/Side Effects <\/strong>\r\n\r\nAdverse effects include dizziness (may cause orthostatic hypotension) drowsiness, dry mouth, urinary retention, serotonin syndrome with antidepressant use, or increased sedation with other CNS depressants.\r\n\r\nBecause of its atropine-like action, cyclobenzaprine hydrochloride should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, increased intraocular pressure, and in those taking anticholinergic medication.\r\n\r\n<\/div>\r\nSerotonin Syndrome<\/em>\r\n\r\nThe development of a potentially life-threatening serotonin syndrome has been reported with cyclobenzaprine hydrochloride when used in combination with other drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), tramadol, bupropion, meperidine, verapamil, or MAO inhibitors (MAOIs). The concomitant use of cyclobenzaprine hydrochloride with MAO inhibitors is contraindicated.\r\n\r\nSerotonin syndrome symptoms may include mental status changes (e.g., confusion, agitation, hallucinations), autonomic instability (e.g., diaphoresis, tachycardia, labile blood pressure, hyperthermia), neuromuscular abnormalities (e.g., tremor, ataxia, hyperreflexia, clonus, muscle rigidity), and\/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Treatment with cyclobenzaprine hydrochloride and any concomitant serotonergic agents should be discontinued immediately if the above reactions occur, and supportive symptomatic treatment should be initiated. If concomitant treatment with cyclobenzaprine hydrochloride and other serotonergic drugs is clinically warranted, careful observation is advised, particularly during treatment initiation or dose increases.\r\n\r\nImpaired Hepatic Function<\/em>\r\n\r\nThe plasma concentration of cyclobenzaprine is increased in clients with hepatic impairment. Cyclobenzaprine, especially when used with alcohol or other CNS depressants, may impair mental and\/or physical abilities required for the performance of hazardous tasks, such as operating machinery or driving a motor vehicle.\r\n
\r\n\r\nClient Teaching & Education<\/strong>\r\n\r\nThe medication should be taken as directed and clients should be informed about what to be aware of related to serious side effects of the medication. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur.\u00a0 Additionally, clients should avoid concurrent use with alcohol or other CNS depressants. Clients should be aware that constipation may occur as a side effect of medication therapy and increased fluid intake may assist in preventing complications.\r\n
\r\n\r\nNow let's take a closer look at the medication card for cyclobenzaprine Table 10.8b[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote]<\/sup>\r\n\r\n<\/div>\r\nTable 10.7b Cyclobenzaprine<\/a>\u00a0Medication Card.[footnote]RNPedia. (2021). https:\/\/www.rnpedia.com<\/a>[\/footnote][footnote]DailyMed from US National Library of Medicine. www.dailymed.com[\/footnote][footnote]OpenMD.Com (2021). www.openmd.com[\/footnote][footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote][\/footnote]<\/sup><\/span>\r\n\r\n\"\"\r\n\r\n<\/div>\r\n
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Clinical Reasoning and Decision-Making Activity 10.8b\"Image<\/h2>\r\n<\/header>\r\n
\r\n\r\nA client asks if they can drive their car while taking cyclobenzaprine.\r\n\r\nWhat is the nurse\u2019s best response?\r\n\r\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>","rendered":"
\n

Medications used as\u00a0adjuvant analgesics<\/a> were developed for other purposes but were later found to be effective to treat pain. Examples of adjuvant medications include gapapentin<\/em> (an anticonvulsant) and amitriptyline<\/em> (a tricyclic antidepressant). Additional information about these specific medications can be found in Chapter 8<\/a>. Muscle relaxants are also considered an adjuvant analgesic and are used for various musculoskeletal disorders such as multiple sclerosis. Three different types of muscle relaxants will be discussed below baclofen, cyclobenzaprine, and tizanidine.<\/p>\n

Baclofen<\/h3>\n

Mechanism of Action<\/strong><\/p>\n

Baclofen<\/a> inhibits reflexes at the spinal level.<\/p>\n

Indications for Use<\/strong><\/p>\n

Baclofen is used to treat muscle symptoms, such as spasms, pain, and stiffness, caused by multiple sclerosis, spinal cord injuries, or other spinal cord disorders.<\/p>\n

Nursing Considerations Across the Lifespan<\/strong><\/p>\n

Baclofen is safe for clients 12 years and older.<\/p>\n

Adverse\/Side Effects<\/strong><\/p>\n

Adverse effects include drowsiness, dizziness or lightheadedness, confusion, nausea, constipation, and muscle weakness.<\/p>\n

Abrupt Drug Withdrawal: Hallucinations and seizures have occurred on abrupt withdrawal of baclofen. Therefore, except for serious adverse reactions, the dose should be reduced slowly when the drug is discontinued.<\/p>\n

Impaired Renal Function: Because baclofen is primarily excreted unchanged through the kidneys, it should be given with caution, and it may be necessary to reduce the dosage.<\/p>\n

Signs and symptoms of overdose include vomiting, muscular hypotonia, drowsiness, accommodation disorders of the eye, coma, respiratory depression, and seizures.<\/p>\n

Client Teaching & Education<\/strong><\/p>\n

The medication should be taken as directed and abrupt withdrawal of the medication should be avoided.\u00a0 It may cause dizziness or drowsiness. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur.\u00a0 Additionally, clients should avoid concurrent use with alcohol or other CNS depressants.<\/p>\n<\/div>\n

\n

Now let’s take a closer look at the medication card for baclofen Table 10.8a[1]<\/sup><\/a><\/sup><\/p>\n<\/div>\n

Medication cards like this are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below.\u00a0 Prototype or generic medication examples are also hyperlinked to a free resource at Daily Med<\/a>. On the home page, enter the drug name in the search bar to read more about the medication.<\/p>\n

Table 10.7b Baclofen<\/a> Medication Card.[2]<\/sup><\/a>[3]<\/sup><\/a>[4]<\/sup><\/a>[5]<\/sup><\/a>[\/footnote]<\/sup><\/span><\/p>\n

\"\"<\/p>\n

\n
\n
\n

Clinical Reasoning and Decision-Making Activity 10.8a\"Image<\/h2>\n<\/header>\n
\n

A client just started taking baclofen for muscle spasticity due to multiple sclerosis.<\/p>\n

What teaching should the nurse provide?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key<\/a>” sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

\n

Cyclobenzaprine<\/h3>\n

Mechanism of Action<\/strong><\/p>\n

Cyclobenzaprine<\/a> reduces tonic somatic muscle activity at the level of the brainstem. It is structurally similar to tricyclic antidepressants.<\/p>\n

Indications for Use<\/strong><\/p>\n

Cyclobenzaprine is used to treat acute muscle spasms.<\/p>\n

Nursing Considerations Across the Lifespan<\/strong><\/p>\n

Cyclobenzaprine is safe for clients 15 years and older. Use cautiously with geriatric clients. In the elderly, the frequency and severity of adverse events associated with the use of cyclobenzaprine, with or without concomitant medications, are increased. In elderly clients, cyclobenzaprine should be initiated with a 5 mg dose and titrated slowly upward.<\/p>\n

Should not be used by breastfeeding women.<\/p>\n

Adverse\/Side Effects <\/strong><\/p>\n

Adverse effects include dizziness (may cause orthostatic hypotension) drowsiness, dry mouth, urinary retention, serotonin syndrome with antidepressant use, or increased sedation with other CNS depressants.<\/p>\n

Because of its atropine-like action, cyclobenzaprine hydrochloride should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, increased intraocular pressure, and in those taking anticholinergic medication.<\/p>\n<\/div>\n

Serotonin Syndrome<\/em><\/p>\n

The development of a potentially life-threatening serotonin syndrome has been reported with cyclobenzaprine hydrochloride when used in combination with other drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), tramadol, bupropion, meperidine, verapamil, or MAO inhibitors (MAOIs). The concomitant use of cyclobenzaprine hydrochloride with MAO inhibitors is contraindicated.<\/p>\n

Serotonin syndrome symptoms may include mental status changes (e.g., confusion, agitation, hallucinations), autonomic instability (e.g., diaphoresis, tachycardia, labile blood pressure, hyperthermia), neuromuscular abnormalities (e.g., tremor, ataxia, hyperreflexia, clonus, muscle rigidity), and\/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Treatment with cyclobenzaprine hydrochloride and any concomitant serotonergic agents should be discontinued immediately if the above reactions occur, and supportive symptomatic treatment should be initiated. If concomitant treatment with cyclobenzaprine hydrochloride and other serotonergic drugs is clinically warranted, careful observation is advised, particularly during treatment initiation or dose increases.<\/p>\n

Impaired Hepatic Function<\/em><\/p>\n

The plasma concentration of cyclobenzaprine is increased in clients with hepatic impairment. Cyclobenzaprine, especially when used with alcohol or other CNS depressants, may impair mental and\/or physical abilities required for the performance of hazardous tasks, such as operating machinery or driving a motor vehicle.<\/p>\n

\n

Client Teaching & Education<\/strong><\/p>\n

The medication should be taken as directed and clients should be informed about what to be aware of related to serious side effects of the medication. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur.\u00a0 Additionally, clients should avoid concurrent use with alcohol or other CNS depressants. Clients should be aware that constipation may occur as a side effect of medication therapy and increased fluid intake may assist in preventing complications.<\/p>\n

\n

Now let’s take a closer look at the medication card for cyclobenzaprine Table 10.8b[6]<\/sup><\/a><\/sup><\/p>\n<\/div>\n

Table 10.7b Cyclobenzaprine<\/a>\u00a0Medication Card.[7]<\/sup><\/a>[8]<\/sup><\/a>[9]<\/sup><\/a>[10]<\/sup><\/a>[\/footnote]<\/sup><\/span><\/p>\n

\"\"<\/p>\n<\/div>\n

\n
\n
\n

Clinical Reasoning and Decision-Making Activity 10.8b\"Image<\/h2>\n<\/header>\n
\n

A client asks if they can drive their car while taking cyclobenzaprine.<\/p>\n

What is the nurse\u2019s best response?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key<\/a>” sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

Media Attributions<\/h2>