A male client has a history of painful, continuous muscle spasms. He has taken several skeletal muscle relaxants without experiencing relief. His physician prescribes diazepam (Valium), two (2) mg P.O. twice daily. In addition to being used to relieve painful muscle spasms, Diazepam also is recommended for:
A. Long-term treatment of epilepsy.
B. Postoperative pain management of laminectomy clients.
C. Postoperative pain management of diskectomy clients.
D. Treatment of spasticity associated with spinal cord lesions.
Correct Answer: D. Treatment of spasticity associated with spinal cord lesions.
In addition to relieving painful muscle spasms, Diazepam also is recommended for treatment of spasticity associated with spinal cord lesions. Diazepam’s use is limited by its central nervous system effects and the tolerance that develops with prolonged use. It is a fast-acting, long-lasting benzodiazepine commonly used in the treatment of anxiety disorders, as well as alcohol detoxification, acute recurrent seizures, severe muscle spasm, and spasticity associated with neurologic disorders.
Option A: The parenteral form of diazepam can treat status epilepticus, but the drug’s sedating properties make it an unsuitable choice for long-term management of epilepsy. Diazepam HAs FDA approval for the management of anxiety disorders, short-term relief of anxiety symptoms, spasticity associated with upper motor neuron disorders, adjunct therapy for muscle spasms, preoperative anxiety relief, management of certain refractory epilepsy patients and adjunct in severe recurrent convulsive seizures, and an adjunct in status epilepticus.
Option B: Diazepam is not used for pain management. Specifically, the allosteric binding within the limbic system leads to the anxiolytic effects seen with diazepam. Allosteric binding within the spinal cord and motor neurons is the primary mediator of the myorelaxant effects seen with diazepam. Mediation of the sedative, amnestic, and anticonvulsant effects of diazepam is through receptor binding within the cortex, thalamus, and cerebellum.
Option C: Diazepam isn’t an analgesic agent. Benzodiazepines have largely replaced barbiturates in the treatment of anxiety and sleep disorders because of their improved safety profile, fewer side effects, and the availability of the antagonist flumazenil to reverse oversedation and benzodiazepine intoxication.
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