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INTRODUCTION

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methocarbamol (meth-oh-kar-ba-mole)

Carbacot, Robaxin

Classification

Therapeutic: skeletal muscle relaxants (centrally acting)

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Indications
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Adjunctive treatment of muscle spasm associated with acute painful musculoskeletal conditions (with rest and physical therapy).

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Action
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Skeletal muscle relaxation, probably as a result of CNS depression. Therapeutic Effects: Skeletal muscle relaxation.

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Adverse Reactions/Side Effects
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CNS: SEIZURES (IV, IM ONLY), dizziness, drowsiness, lightheadedness. EENT: blurred vision, nasal congestion. CV: IV: bradycardia, hypotension. GI: anorexia, GI upset, nausea. GU: brown, black, or green urine. Derm: flushing (IV only), pruritus, rashes, urticaria. Local: pain at IM site, phlebitis at IV site. Misc: ALLERGIC REACTIONS. INCLUDING ANAPHYLAXIS (iM, IV USE ONLY), fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for new seizures or increased seizure activity, especially during IV or IM administration. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

  • Monitor signs of allergic reactions and anaphylaxis, including skin reactions such as rash, itching, burning, welts, and swelling in the face, and pulmonary symptoms such as tightness in the throat and chest, wheezing, cough, and dyspnea. Seek immediate medical assistance if these reactions occur.

  • 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 slow heart rate (bradycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

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

  • Assess dizziness 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.

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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).

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Patient/Client-Related Instruction
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  • Inform patient that long-term use can cause tolerance and physical/psychologic dependence; encourage adherence to physical therapy so that drug therapy can be discontinued as soon as possible.

  • Inform patient that this drug may cause severe drowsiness, dizziness, and reduced psychomotor skills. Patients should avoid driving or other activities that require concentration and fast reactions.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Warn patient about anticholinergic effects such as dry mouth, constipation, urinary retention, sedation, ...

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