Question 1

A patient with lower back pain and right-sided sciatica has taken an NSAID and a TCA for 1 week.The patient reports some decrease in pain but is experiencing increased tingling and numbness of the right leg.The primary care NP should:

A) order a magnetic resonance imaging (MRI) study.
B) order physical therapy.
C) refer the patient to a neurologist.
D) continue the TCA for 1 more week.

Accepted Answer

Acute episodes of low back pain should be treated with an analgesic for 1 to 2 weeks.A muscle relaxant is used to treat spasms.Patients with sciatica should be treated for 6 weeks.If a neurologic deficit progresses,MRI should be ordered.Physical therapy is not indicated until serious injury is ruled out.A neurology consultation is necessary in urgent conditions and conditions with bilateral neurologic findings.The TCA may be continued,but the progression of symptoms necessitates radiologic evaluation.

Question 2

A patient who was in a motor vehicle accident has been treated for lower back muscle spasms with metaxalone (Skelaxin)for 1 week and reports decreased but persistent pain.A computed tomography scan is normal.The primary care NP should:

A) suggest ice and rest.
B) order physical therapy.
C) prescribe diazepam (Valium).
D) add an opioid analgesic medication.

order physical therapy.

Accepted Answer

Physical therapy may be used as an injury begins to heal.This patient is experiencing improvement of symptoms,so physical therapy may now be helpful.Ice and rest are useful in the first 24 to 48 hours after injury.Diazepam is used on a short-term basis only.Opioid analgesics are used for severe pain.

Question 3

A patient comes to the clinic complaining of low back pain unrelieved by NSAIDs.The patient has a history of angle-closure glaucoma and renal disease.The primary care NP should prescribe:&#10;A) tizanidine (Zanaflex).&#10;B) metaxalone (Skelaxin).&#10;C) acetaminophen (Tylenol).&#10;D) cyclobenzaprine (Flexeril).

Accepted Answer

Metaxalone may be taken by patients with angle-closure glaucoma and is metabolized by the liver,so it is safe for this patient.Tizanidine should not be given to patients with renal disease because clearance may be reduced by more than 50%.After using NSAIDs with no relief,recommendations are to change to a muscle relaxant.Cyclobenzaprine is not recommended in patients with glaucoma.

Question 4

A 70-year-old patient has low back pain and will begin taking metaxalone (Skelaxin).The primary care NP should counsel this patient to:&#10;A) drink extra fluids.&#10;B) avoid taking NSAIDs.&#10;C) get up from a chair slowly.&#10;D) take care to avoid slips and falls.

Accepted Answer

Use of any muscle relaxant puts elderly patients at risk for falls,so patients should be advised to take precautions.It is not necessary to increase fluids or avoid NSAIDs.This drug does not have hypotensive effects,so it is not necessary to provide the caution to rise out of chairs slowly.

Question 5

The primary care nurse practitioner (NP)is seeing a patient who reports chronic lower back pain.The patient reports having difficulty sleeping despite taking ibuprofen at bedtime each night.The NP should prescribe:

A) diazepam (Valium).
B) metaxalone (Skelaxin).
C) methocarbamol (Robaxin).
D) cyclobenzaprine (Flexeril).

Accepted Answer

Cyclobenzaprine (Flexeril)is indicated for chronic low back pain and provides an added benefit of aiding sleep,which is a common problem among patients with back pain.The other medications are used for acute lower back pain.

Question 6

A patient has acute low back pain caused by lifting a heavy object.The patient reports having one or two drinks with meals each day.The primary care NP should prescribe:&#10;A) an NSAID.&#10;B) diazepam (Valium).&#10;C) metaxalone (Skelaxin).&#10;D) acetaminophen (Tylenol).

Accepted Answer

Skeletal muscle relaxants should not be taken with alcohol because effects are additive.Acetaminophen has toxic effects on the liver,and patients who consume alcohol regularly should avoid acetaminophen and diazepam.

Question 7

A patient reports having an acute onset of low back pain associated with lifting a heavy object the day before.Besides advising the patient to rest and apply ice,the primary care NP should prescribe:&#10;A) an opioid analgesic.&#10;B) metaxalone (Skelaxin)&#10;C) cyclobenzaprine (Flexeril).&#10;D) a nonsteroidal antiinflammatory drug (NSAID).

Accepted Answer

NSAIDs and acetaminophen are first-line analgesic treatments for low back pain.Opioids are used for severe low back pain.The other two medications are not first-line treatments.

Deck 40: Muscle Relaxants