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INTRODUCTION

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carisoprodol (kar-i-sop-roe-dole)

Soma, Vanadom

Classification

Therapeutic: skeletal muscle relaxants (centrally acting)

Pharmacologic: carbamate derivative

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Indications
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Adjunct to rest and physical therapy in the treatment of muscle spasm associated with acute painful musculoskeletal conditions.

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Action
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Skeletal muscle relaxation, probably due to CNS depression. Therapeutic Effects: Skeletal muscle relaxation.

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Adverse Reactions/Side Effects
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CNS: dizziness, drowsiness, agitation, ataxia, depression, headache, insomnia, irritability, syncope. Resp: asthma attacks. CV: hypotension, tachycardia. GI: epigastric distress, hiccups, nausea, vomiting. Derm: flushing, rashes. Hemat: eosinophilia, leukopenia. Misc: ANAPHYLACTIC SHOCK, fever, psychologic dependence, severe idiosyncratic reaction.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of anaphylactic shock, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea), skin reactions (rash, pruritus, urticaria, flushed or pale skin), dizziness, fainting, tachycardia, and GI problems (nausea, vomiting, diarrhea). Seek immediate medical assistance if patient develops these signs.

  • Assess patient's pain, stiffness, and ROM to help document antispasm effects.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances such as tachycardia or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness, syncope, or other symptoms.

  • Assess symptoms of asthma attacks and bronchospasm (wheezing, coughing, tightness in chest, dyspnea). Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendices I, J, K).

  • Monitor for signs of eosinophilia (fatigue, weakness, myalgia) or leukopenia (fever, sore throat, signs of infection). Report these signs to the physician.

  • Assess dizziness and ataxia that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Be alert for agitation, irritability, depression, or other alterations in mood and behavior. Notify physician promptly if these symptoms become problematic.

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Interventions
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  • Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and wean patient off muscle relaxants as soon as possible.

  • Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

  • Implement fall-prevention strategies, especially if balance is impaired (See Appendix E).

  • Because of the risk of cardiac arrhythmias and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, unusual fatigue), or displays other criteria for exercise termination (See Appendix L).

  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

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