NEUROMUSCULAR

AGENTS

MACP 2113

Disediakan oleh:
Pn. Nirmala Devi Tailan
Pengajar U41
Kolej Pembantu Perubatan, Ulu Kinta
 OBJEKTIF
1. Memberi definisi agen
neuromuskular.
2. Menyatakan tujuan/ indikasi ubat.
3. Menyatakan dos dan contoh ubat.
4. Menyatakan kaedah pemberian
ubat.
5. Menyatakan tindakan ubat.
6. Menerangkan kesan sampingan
dan kontraindikasi ubat.
7. Memberikan nasihat spesifik
dalam pengambilan ubat.
Neuromuscular Agent
• Ubat yang merencatkan aktiviti
sinaptik/ menghalang aktiviti
neuromuskular.
• Maka otot-otot skeletal akan
menjadi relaks.
• Juga dikenali sebagai Skeletal
Muscle Relaxants.
 Cara Tindakan

• Bertindak ke atas “motor end

plate” atau persimpangan
neuromuskular dimana transmisi
impuls disekat.
• Ini menyebabkan relaksasi otot-
otot rangka.
 Contoh Ubat
• Baclofen (Lioresal)
• Cyclobenzaprine HCl
(Flexeril)
• Dantrolene sodium
(Dantrium)
• Diazepam (Valium)
• Methocarbamol (Robaxin)
• Orphenadrine (Norflex)
• Suxamethonium (Scoline)
 1. Baclofen (Lioresal)
Category: B

Indication
• Spasticity yang disebabkan
oleh
– multiple sclerosis autoimmune disease that
affects the brain and spinal cord (central nervous system).

– spinal cord injuries

 Dose
• Adult:
– 30-75mg/day PO
• Peads:
– 10-60mg/day PO
 Kesan Sampingan
• Drowsiness (mabuk)
• Dizziness (pening)
• Hypotension
• Respiratory distress
• Frequent urination
• Headache
• Confusion (keliru)
 Contraindication

• Allergic to drug
• Skeletal muscle
spasm – rheumatic
disorder
 Cautious
• Parkinson disorder
• Seizure
• Pregnancy (hamil)
• Lactation (menyusu)
2. Cyclobenzaprine HCl
(Flexeril)
Category: B

Indication
• Mengurangkan
spasm otot
skeletal (acute)
 Dose
• 10 - 60mg/day PO (divided
dose)
 Kesan Sampingan

• Drowsiness (mabuk)
• Dizziness (pening)
• Constipation (sembelit)
• Tachycardia
• Dry mouth
• Nausea
 Contraindication
• Allergic
• Pemulihan dari fasa MI
• Heart block
• Arrhythmias
• CHF
• Hyperthyroidism
 Cautious

• Urinary retention
• Glaucoma
• Lactation
3. Dantrolene sodium
(Dantrium)

Category: B
 Indication

• Spasticity yang disebabkan oleh

– multiple sclerosis(tisu keras)
– spinal cord injuries
– Stroke
– Cerebral Palsy(complet/partial
paryls of cerebral)
 Dose

• Dos permulaan 25mg/day PO

• Kemudian 50 – 400 mg/day
PO in divided dose
• Max: 400mg/day
 Kesan Sampingan

• Drowsiness (mabuk)
• Dizziness (pening)
• Weakness (letih)
• Constipation (sembelit)
• Tachycardia
 Contraindication

• Active hepatic disease

• Lactation
 Cautious

• Patient > 35 yr (fatal &

hepatocellular disease)
• Impaired pulmonary disease
• History of liver disease
 4. Diazepam (Valium)
Category: B

Indication
• Melegakan spasm otot skeletal
• Anxiety
• Spasticity disebabkan oleh
– Cerebral palsy
– Epilepsy
 Dose

• Oral:
– 2 - 15mg od bid-qid PO
• Parenteral
– 5-10mg IM, IV
– Then 5-10mg in 3-4 hr if
necessary
 Kesan Sampingan
• Drowsiness (mabuk)
• Sedation (mengantuk)
• Hypotension
• Respiratory distress
• Bradycardia
• Diarrhea
• Rashes (ruam)
 Contraindication
• Allergic to drug
• Psychoses
• Glaucoma
• Cardiac defects
• Pregnancy (hamil)
• Lactation (menyusu)
 Cautious
• Elderly
• Impaired liver/ kidney
function
 5. Methocarbamol
(Robaxin)
Category: B

Indication
• Discomfort due to
musculoskeletal
disorders
 Dose
• Oral:
– 1.5g qid PO
– First 48-72 hr (6g/day) or
– Up to 8g/day is
recommended
• Parenteral:
– Up to 3g/day IM/ IV
 Kesan Sampingan
• Drowsiness (mabuk)
• Dizziness (pening)
• Confusion (kekeliruan)
• Headache
• Rash (ruam)
• Blurred vision
• GI upset (gangguan GIT)
 Contraindication
• Allergic to drug

Cautious
• Epilepsy
• Pregnancy
• Lactation
 6. Orphenadrine
(Norflex)
Category: A

Indication
• Discomfort due to
musculoskeletal
disorders
 Dose

• 200-300mg/day PO (divided
dose)
 Kesan Sampingan
• Drowsiness (mabuk)
• Dizziness (pening)
• Confusion (kekeliruan)
• Headache
• Rash (ruam)
• Blurred vision
• GI upset (gangguan GIT)
 Contraindication
• Allergic to drug
• Glaucoma
• Duodenal obstruction (sekatan)
• Peptic ulcer
• Cardiac spasm
• Lactation (menyusu)
 Cautious

• Cardiac arrhythmias
• Hepatic/ renal dysfunction
• Pregnancy
7. Suxamethonium
(Scoline)
Category: B

Indication

• Muscle relaxation during

surgical procedure
 Dose

• 20 - 100mg (single
dose)
 Kesan Sampingan
• Apnea
• Bradycardia
• Muscle pain

Contraindication
• Allergic to drug
 Drug Interactions

• CNS Depressants (alcohol, anti-

histamines, opiates, sedatives)
– Increased CNS depression
• Anti-histamine,
antidepressants, atropine,
haloperidol
– Additive anti-cholinergic effect
 Soalan
1. Beri definisi Neuromuscular
agent?
2. Terangkan cara tindakan
Neuromuscular agent?
3. Senaraikan agen neuromuscular
beserta dengan kesan
sampingan?