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Acute and Chronic Muscle Spasms – Skeletal Muscle Relaxants

by Pravin Shukle, MD
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    Let's move on to the spasmolytics. We have two types of spasmolytics and we divide them up into acute use and chronic use. Acute use spasmolytics are a single agent here, cyclobenzaprine. And chronic use are other agents Let's talk about cyclobenzaprine. The prototypical agent of cyclobenzaprine. There are other agents that are available, but I think for your exam, you can just focus on cyclobenzaprine. We often use it in acute spasm due to a muscle injury. It has some sedative activity. It is a muscarinic agent. It does act at the brainstem, and that will reduce resting tone of output from the brainstem. Now, these do not work for patients who have cerebral palsy or spinal cord injury. Let's move on to those chronic use agents. These are drugs that act either through the central nervous system or act peripherally at the muscle. Diazepam is a benzodiazepine. And as you know already from our previous lectures, diazapam acts at the GABA A receptor. It works in both the brain and in the spinal cord. Baclofen acts at the GABA B receptor complex in the brain and spinal cord. We haven't talk about GABA B yet. And tizanidine acts at the alpha 2 receptor in the spinal cord. Now, let's take a look at these beutiful illustrations put together by our IT team. You've already seen the first one. That's the GABA A receptor complex. And you already know that both barbiturates and benzodiazepines, as well as the reversal agent flumazenil bind at the GABA A receptor. This GABA B receptor is a complex structure. It has two membrane spanning units that go back and forth across the membrane. It is coupled to a certain type of a G type protein and it does a couple of things. It...

    About the Lecture

    The lecture Acute and Chronic Muscle Spasms – Skeletal Muscle Relaxants by Pravin Shukle, MD is from the course CNS - Pharmacology. It contains the following chapters:

    • Chronic Muscle Spasm Agents
    • Dantrolene

    Included Quiz Questions

    1. Brainstem
    2. Peripheral muscles
    3. Pons
    4. Cerebellum
    5. Primary nerves of the spine
    1. Diazepam interacts with the GABA-A receptor to increase frequency of channel opening.
    2. Diazepam interacts with the GABA-B receptor to inhibit the G protein coupled receptor (GPCR).
    3. Diazepam interacts with the GABA-B receptor to inhibit the adenylyl cyclase.
    4. Diazepam interacts with the GABA-A receptor to increase duration of channel opening.
    5. Diazepam forces ion channels open resulting in a polarization of the muscle and then depolarization of the muscle and relaxation.
    1. A 65 year old male with history of muscle spasticity after suffering an ischemic stroke.
    2. A 74 year old male with a history of chronic back pain and metastatic prostate cancer.
    3. A 35 year old male with a history of ankylosing spondylitis and chronic lower back pain.
    4. A 24 year old female with a history of opioid and benzodiazepine dependency complaining of vague muscle pains throughout her body and demanding immediate treatment.
    5. A 67 year old female with a history of shuffling gait, pill rolling tremor and low grade dementia.
    1. Cyclobenzaprine: nicotinic-acetylcholine receptor
    2. Cyclobenzaprine: muscarinic-acetylcholine receptor
    3. Baclofen: GABA-B receptor
    4. Diazepine: GABA-A receptor
    5. Tizanidine: alpha-2 receptors

    Author of lecture Acute and Chronic Muscle Spasms – Skeletal Muscle Relaxants

     Pravin Shukle, MD

    Pravin Shukle, MD


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