Pressure Injuries (Pressure Ulcers) and Wound Care Medication

Updated: Mar 15, 2017
  • Author: Christian N Kirman, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Medication

Medication Summary

Relief of spasticity (if present) is essential in the treatment and prevention of pressure ulceration. The medications most commonly employed for this purpose are muscle relaxants.

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Skeletal Muscle Relaxants (Centrally Acting)

Class Summary

Centrally acting skeletal muscle relaxants inhibit reflexes at the spinal level.

Baclofen (Lioresal, Gablofen)

Baclofen may induce hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at the spinal level.

Diazepam (Valium, Diastat)

Diazepam depresses all levels of the central nervous system (CNS), including the limbic and reticular formations, possibly by increasing the activity of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter. To prevent adverse effects, the dosage should be individualized and increased cautiously.

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Skeletal Muscle Relaxants (Direct Acting)

Class Summary

Direct-acting skeletal muscle relaxants inhibit muscle contraction by decreasing calcium release from the sarcoplasmic reticulum in muscle cells.

Dantrolene (Dantrium, Revonto)

Dantrolene stimulates muscle relaxation by modulating the skeletal muscle contractions at a site beyond the myoneural junction and by acting directly on the muscle itself. Most patients respond to a dosage of 400 mg/day or less.

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Antibiotics

Class Summary

Empiric antibiotics should be started immediately. Initial antimicrobial therapy should be broad-based, to cover aerobic gram-positive and gram-negative organisms and anaerobes.

Silver sulfadiazine (Silvadene, SSD, Thermazene)

Silver sulfadiazine has broad-spectrum antibacterial activity and is associated with relatively few complications in these wounds.

The current formulation contains a lipid-soluble carrier, polypropylene glycol, which has certain disadvantages, including pseudoeschar formation. When this antibacterial agent is formulated with poloxamer 188, the silver sulfadiazine can be washed easily from the wound because of its water solubility, making dressing changes considerably more comfortable.

Mafenide (Sulfamylon)

Mafenide is an alternate agent that penetrates eschar more effectively than silver sulfadiazine. Consequently, it is frequently used on infected wounds that do not respond to silver sulfadiazine. Use mafenide with caution because it can induce metabolic acidosis.

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