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Clin Med III: MSK > Back and Neck Disorders > Flashcards

Back and Neck Disorders Flashcards

1
Q

historical red flags for neck&back exams

A
  1. Age < 20 or >50
  2. Duration > 1 month
  3. Pain unresponsive to therapy
  4. Unexplained wt loss, fever
  5. Nocturnal pain or pain at rest
  6. Neuro sx - Saddle anesthesia, bowel/bladder incontinence/urine retention
  7. Long-term steroid therapy
  8. H/o cancer
  9. H/o IVDU, addiction or immunosupp
  10. Active infection elsewhere or (+) HIV
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2
Q

Delayed pain/stiffness
consider what ddx?

A

Mechanical disorder (muscle strain)

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3
Q

Low back pain radiating down buttock, below the knee

consider what ddx?

A

Nerve root compression

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4
Q

Back pain at night, unrelieved by rest/supine

consider what ddx?

A

Malignancy, cauda equina tumor, compression fx

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5
Q

Pain worse with rest, improved with activity

consider what ddx?

A

Ankylosing spondylitis

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6
Q

Pain worse with activity, improved with rest

consider what ddx?

A

Degenerative diseases

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7
Q

Writhing pain that is unrelenting

consider what ddx?

A

Ureteral calculi or dissecting AAA

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8
Q

Pain and fever with hx of IV drug use, immunocompromised, retained hardware or recent back surgery

consider what dxx?

A

Osteomyelitis, epidural abscess, discitis

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9
Q

Significant or rapidly evolving neuro deficits

consider what ddX?

A

Cauda equina syndrome, epidural abscess, massive disk herniation

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10
Q

Pain with neurogenic claudication (intermittent leg pain)

consider what ddx?

A

Lumbar spinal stenosis

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11
Q

ROM for neck and back exam?

A
  1. Flexion: Pain → nerve root irritation from disc herniation
  2. Extension: spinal stenosis or spondylolisthesis
  3. Lateral bending: contralateral side → muscle spasm; ipsilateral → facet joint irritation, nerve root impingement, disk herniation
  4. Rotation: muscle spasm, facet joint irritation
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12
Q

nerve roots of UE?

A

C5-C8

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13
Q

Nerve roots of LE?

A

L4, L5, S1

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14
Q
  • Shoulder abduction, elbow flexion
  • Bicep
  • Lateral ½ upper arm

which nerve root?

A

C5

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15
Q
  • Elbow flexion, wrist extension
  • Brachioradialis
  • Lateral ½ lower arm

which nerve root?

A

C6

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16
Q

C7 nerve root controls what motor, reflex, and sensory?

A
  • Elbow extension, wrist flexion, finger extension
  • Tricep
  • Middle finger🖕
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17
Q

C8 controls what motor, reflex, and sensory?

A
  • Finger abduction, adduction and flexion
  • None
  • Medial aspect of lower arm
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18
Q
  • Foot dorsiflexion
  • Patellar
  • Medial foot

which nerve root?

A

L4

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19
Q

L5 controls what motor, reflex, and sensory?

A
  • Big toe extension
  • None
  • Midline ventral foot
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20
Q
  • Foot eversion
  • Achilles
  • Lateral aspect of foot

which nerve root?

A

S1

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21
Q
  • Anal sphincter tone
  • Bulbocavernosus
  • Perianal area

which nerve root?

A

S2-S4

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22
Q

what is the straight leg raise?
indications?

A
  • Passively flex hip w/ knee extended while supine
  • (+) = worsening radicular pain on affected side (not just low back or hamstring pain)
  • lumbar nerve root compression/irritation (herniated disc)
  • if seated → pt will lean back when hip flexed with knee extended = (+) test
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23
Q

what is the crossed straight leg raise?
indication?

A
  • Also the contralateral SLR
  • Performed as in SLR testing, however unaffected leg is passively elevated
  • (+) = radicular pain in affected leg when unaffected leg is elevated
  • lumbar nerve root compression/irritation (herniated disc)
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24
Q

what is the trendelenburg test?
indication?

A
  • assesses hip abductor (gluteus medius) strength
  • stand on one leg; observe level of the pelvis
  • (+) = pelvis drops below neutral on opposite side of stance limb side
  • inadequate gluteus medius strength of stance limb
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25
Q

what is the babinski test?
indication?

A
  • (+) = 1st toe extension and fanning of toes 2-4
  • long-tract spinal cord lesion
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26
Q
  • what special testing to do when achilles reflex is abnormal?
  • indication?
A
  • Ankle clonus
  • Performed by quickly placing foot in dorsiflexion
  • (+) = involuntary rhythmic beating of foot (clonus)
  • Indicates long-tract spinal cord lesion
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27
Q

What is the Waddell’s test?

A
  1. Superficial tenderness = (+) if marked pain with light touch over lower lumbar spine
  2. Axial loading
  3. Distraction testing = (+) if no pain with seated SLR when pt is distracted during exam
  4. Regional Disturbances = non-anatomic sensory or motor impairment

3/4 (+) tests = low likelihood of success with injections or surgical intervention

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28
Q

T/F: gait assessment is preferred if the pt has shoes on

A

F - best result if dogs are out

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29
Q

4 components of gait assessment

A
  • Standard gait
  • Heel-to-toe
  • Heels only (L4/L5)
  • Toes only (S1)
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30
Q

imaging for cervical spine?

A
  1. XR - initial imaging for atraumatic pt
    - 3 view: AP, Lateral, Odontoid
    3 view + AP and PA obliques (5 view)
  2. CT C-spine - trauma pts
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31
Q

what XR view provides a clearer view of the intervertebral foramina

A

3 view + AP and PA obliques (5 view)

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32
Q

Add what XR view if lateral doesn’t show down to T1 and will show the C7-T1 junction?

A

swimmers

lowers the other arm down and rotates both shoulders away = better view

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33
Q

imaging for thoracic spine?

A

XR - 2 views (AP and lateral)

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34
Q

imaging for lumbar spine?

A
  1. XR - 2 views (AP and lateral)
    - add oblique: view of articular facets and pars interarticularis; “Scottie dog” sign
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35
Q
  • injury to paravertebral spinal muscles, ligaments of facet joints, or intervertebral disk
  • MCC lost work time and disability in young adults
  • MC strained area of the body
A

acute low back pain

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36
Q

RF for acute low back pain

A
  1. Poor physical fitness
  2. Job dissatisfaction
  3. Smoking
  4. Psychosocial issues
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37
Q

s/s of acute low back pain?

A
  1. h/o repetitive lifting, twisting, fall or operating vibrating equipment
  2. Aching pain in low back - radiates, worsens with movement, transient improvement w/ freq position changing
  3. Difficulty standing upright
  4. Diffuse tenderness in the low back or SI region
  5. Dec ROM
  6. Reflexes, motor, and sensory exam are normal
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38
Q

indications for XR in acute low back pain?

A

H/o significant trauma, atypical pain, nocturnal pain, night sweats

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39
Q

normal findings found on XR for acute low back pain?

A
  1. Normal findings if < 30 y/o
  2. > 30 → physiologic evidence of aging (not necessarily pathologic)
    - Disc space narrowing
    - Bone spurs
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40
Q

mgmt for acute low back pain?

A
  1. reassurance and educate
  2. symptomatic tx - heat, NSAIDs/acetaminophen
  3. avoid intense physical activity and bed rest (min 2 d)
  4. slowly return to activity, do stretches
  5. PT if no improvement
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41
Q

indication to use muscle relaxants for low back pain?

A

only if evidence of muscle spasm on exam

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42
Q

what meds to avoid in acute low back pain

A

CS and narcotics

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43
Q

referral indications for acute low back pain?

A
  1. Evidence of neuro dysfunction on exam - MRI and refer to neurospine surgeon
  2. Unable to return to work after 4 wks
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44
Q

prognosis of acute low back pain?

A
  • resolves within 1 month
  • no improvement >4-6 wks → imaging if not previously ordered
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45
Q

definition of chronic low back pain?

A

>12 weeks
recurrent and episodic, but may be unremitting

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46
Q

MCC of chronic low back pain?

A

degeneration of the intervertebral structures

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47
Q

RF ofr chronic low back pain?

A
  1. Repetitive trauma
  2. Infection
  3. Heredity
  4. Tobacco use
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48
Q

s/s chronic low back pain?

A
  1. Pain aching +/- radiation into the posterior leg (sciatica) - Worsened by ROM; Improved by lying down
  2. MC Associated stiffness
  3. Lumbar and sacroiliac tenderness
  4. ROM may be mildly limited
  5. SLR may be slightly restricted
  6. Reflexes, motor, and sensory exams are normal
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49
Q

w/u for chronic low back pain?

A
  1. Lumbar XR - AP/Lateral
    - Age-appropriate changes: anterior osteophytes, reduced height of the intervertebral disks)
  2. R/o pathophysiologic processes if concern on H&P - Cancer, stenosis, deformity, osteoporosis and infectious etiologies
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50
Q

mgmt for chronic low back pain

A
  1. referral - Injections, biofeedback, cognitive behavioral programs, spinal cord stimulation, psychotherapy, etc
  2. Address deconditioned state, depression/anger
  3. A return-to-activity, goal oriented program
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51
Q

MCC of cervical strain?

A

whiplash mechanism/flexion-extension injury

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52
Q
  • diffuse and nonradicular pain - worsened by movement
  • anywhere from base of the skull to cervicothoracic junction
  • paraspinal spasms and occipital HA
  • Tenderness in paraspinous muscles, trapezius, SCM muscles, spinous processes, interspinous ligaments
  • Limited ROM
  • Reflexes, motor, and sensory exams are normal

dx?
w/u?
mgmt?

A
  1. cervical strain
  2. +/- cervical XR series (AP, lat, odontoid) - usually normal
  3. soft cervical collar + mild narcotic/NSAIDs; cervical pillow; massage therapy & cervical traction; +/- muscle relaxant; return to activity as tolerated
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53
Q

indication to order a cervical XR series for cervical strain?

A

h/o trauma, neuro deficit, old

  • All 7 cervical vertebrae must be seen
  • XR are nml with a simple cervical strain
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54
Q

CI intervention when there has been an acute injury in cervical strain?

A

cervical manipulation

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55
Q

prognosis of cervical strain?

A
  • resolution within 4-6 wks
  • Whiplash - 12 months possible
  • Some develop radiculopathy or intractable pain
56
Q

3 MOI of cervical spine fx?

A
  1. High-energy trauma - MVA, fall from height, diving accident
  2. Extreme ROM injury - Flexion injury, flexion-rotation injury, extension injury
  3. Vertical (axial) compression injury
57
Q

types of cervical spine fx?

A
  • C1 - Atlas
  • C2 - Axis
  • C3-7: spinous process, pedicle, transverse process, body
58
Q

ALL patients with cervical trauma should have _____ ruled out!

A

fracture

59
Q

what is the hangman’s fx?

A

C2 - Bilateral fractures of the pedicles or pars interarticularis

60
Q

what is the odontoid (dens) fx?

A

C2

61
Q

s/s of cervical spine fx?

A
  1. Severe neck pain +/- radiation after trauma
  2. Focal UE numbness or tingling (nerve root impingement)
  3. Global sensory/motor (spinal cord injury)
  4. In a c-collar and on a backboard
  5. Point tenderness over spinous processes and paraspinal spasm
  6. Neuro - Assess reflex, motor, and sensory function
62
Q

A gap or step-off between spinous processes suggests ?

A

a ligamentous injury or fractured pars (spondylolisthesis or spondylolysis)

63
Q

if spinal cord injury is suspected in a cervical spine fx, what specific neuro exams must be performed?

A
  • Perianal sensation, sphincter tone, and the bulbocavernosus reflex or anal reflex
  • Abnormal findings = lesion of spinal cord at S2-4 or higher
64
Q

how to determine who gets C-spine imaging in cervical spine fx?

A
  • NEXUS - must have GCS of 15 to utilize
  • Alternative criteria: Canadian C-spine Rules
65
Q

NEXUS critiera?

A

Imaging not needed if satisfies all 5 criteria:

  1. No posterior midline cervical-spine tenderness
  2. No evidence of intoxication
  3. A normal level of alertness
  4. No local neurologic deficit
  5. No painful distracting injuries

remove c-collar and avoid imaging

66
Q

imaging options for cervical spine fx

A
  1. CT of C-spine
  2. cervical spine series
  3. MRI +/- angiography
67
Q

indications for CT of C-spine in cervical spine fx?

A
  1. Initial modality of choice in mod-high-risk traumatized c-spine pts
  2. abnml XR
68
Q

what imaging modality is indicated for low-moderate risk trauma patients

cervical spine fx

A

Cervical spine series (AP, lateral, odontoid)

69
Q

signs of instability in Cervical spine series (AP, lateral, odontoid)

Cervical Spine Fracture

A
  • Translation of a vertebral body >3.5 mm
  • 11 degrees of angulation of adjacent vertebral bodies
70
Q

indication for MRI +/- angiography for Cervical Spine Fracture?

A

concern for spinal cord or vertebral artery injury

71
Q

mgmt for cervical spine fx?

A
  1. immobilization
  2. IV steroids
  3. consult ortho/neurosurg
    - stable fx: closed reduction w/ halo-vest
    - unstable: ORIF
  4. pain control
72
Q

mgmt for occult cervical spine fx

A
  1. soft cervical collar
  2. repeat XR in 1 wk
    - add extension-flexion lateral views and MRI if nml
    - If additional imaging is nml = PT
73
Q

MOI of Thoracolumbar Vertebral Fx

A

High-energy trauma - MVA, Fall from a height

74
Q

With Thoracolumbar Vertebral Fx, there is minimal trauma in pts with _____ or _______

A

osteoporosis
malignant bone disease

75
Q
  • in c-collar and on a backboard
  • Moderate-severe back pain following a high-energy trauma
  • neuro sx w/ nerve root or spinal cord injury (Numbness, tingling, weakness, or bowel and bladder dysfunction)
  • torso +/- swelling and ecchymosis - spinal precautions (log-roll)
  • Tenderness of area with palpation and/or percussion
  • Palpate spinous processes for step off
  • Assess all DTR, motor, and sensory function of LE and anus

dx?
w/u?

A
  • Thoracolumbar Vertebral Fx
  • Thoracic and lumbar spine series; CT w/o contrast

CT w/o contrast - May be preferred as initial imaging modality in moderate to high-risk injuries

76
Q

mgmt for thoracolumbar vertebral fx?

A
  1. Isolated - Thoracolumbar corset
  2. Stable, simple compression fx < 20° of wedge - Thoracolumbosacral orthosis (TLSO) x 8-12 wks w/ sitting and standing; Avoid twisting, bending, stooping or lifting > 20 lbs
  3. Oral narcotic analgesics
  4. IV steroids
  5. surgical decompression
77
Q

T/F: Isolated transverse process fractures do not affect stability of the spine

A

T

78
Q

indications for surgery for thoracolumbar vertebral fx?

A

Burst fractures, flexion-distraction/dislocation, more severe compression injuries

79
Q

surgical options for thoracolumbar vertebral fx?

A
  1. Kyphoplasty
  2. Vertebral fusion
  3. Corpectomy (vertebrectomy)
  4. Internal fixation with pedicle screws
80
Q

A contraction (spasm) of the neck muscles causing the head to deviate to one side

A

Torticollis

81
Q

what muscles are involved in Torticollis

A

SCM, traps, posterior cervical

82
Q

causes of torticollis?
which is MC?

A
  1. Congenital muscular torticollis (rare): Birth trauma or intrauterine malposition = damage to SCM muscle
  2. Acquired
    - Blunt trauma or sleeping in awkward position (MC); Self-limiting
    - Scarring/dz of cervical vertebrae
    - Head/neck soft tissue tumor/infections, enlarged cervical nodes
    - Meds - antipsychotics, antiemetics
83
Q

tx torticollis

A
  1. Remove/tx underlying cause
  2. Conservative - NSAIDs, Benzo’s, muscle relaxants
  3. Botox
  4. Surgical release of SCM, selective denervation, dorsal cord stimulation
84
Q

Narrowing of the intraspinal/central canal at one or more levels with subsequent compression of the nerve roots

A

Spinal Stenosis

85
Q

causes of Spinal Stenosis

A
  1. Degenerative changes: Disk degeneration, osteophyte
  2. Space occupying lesions: Lipomas, neoplasms, neural cysts
  3. Traumatic/post-op fibrosis
  4. Skeletal dz: Paget’s, Ankylosing spondylitis, RA
  5. Congenital: Dwarfism. Spina bifida
86
Q
  1. insidious or rapid onset
  2. neurogenic claudication - Discomfort, sensory loss, and weakness in the legs w/ walking, relieved w/ sitting, flexing at waist, or lying down
  3. LE pain radicular and BL - Worsened by spine extension, relieved w/ spine flexion
  4. +/- nocturnal pain, bowel bladder changes
  5. Motor and sensory exam are often normal
  6. Peripheral pulses are normal
  7. DTR’s may be diminished
  8. (+) SLR possible

dx?

A

Spinal Stenosis

87
Q

what additional physical exams should be performed for Spinal Stenosis to differentiate concomitant prostate/stress incontinence from spinal disease

A
  • GU
  • Must differentiate neurogenic from vascular claudication
88
Q

w/u for spinal stenosis

A
  1. Lumbar series: spondylolisthesis or intervertebral disk narrowing
  2. MRI (best choice)
    - Alt: CT w/ myelography
89
Q

mgmt for spinal stenosis

A
  1. Conservative, nonsurgical therapy (1st-line) - PT, water aerobics, NSAIDs; Epidural steroid injections
  2. Surgery - referral to neurospine surgical center
90
Q

indications for surgery in spinal stenosis

A
  1. difficulty ambulating or diminished quality of life
  2. neuro deficits, bowel/bladder dysfunction
91
Q

A chronic inflammatory disease of the joints of the axial skeleton of unknown etiology characterized by back pain and progressive stiffness of the spine

A

Ankylosing Spondylitis

92
Q

pathophys of Ankylosing Spondylitis

A

enthesitis w/ chronic inflammation, including CD4+ and CD8+ T-lymphocytes and macrophages

93
Q
  1. Gradual intermittent onset
  2. Back pain and AM stiffness improving w/ activity - Cephalad progression
  3. Progressive loss of ROM → fusion of entire spine → Loss of lumbar lordosis and exaggerated thoracic kyphosis
  4. Enthesopathy
  5. Peripheral arthritis possible
  6. extra-articular s/s - Anterior uveitis, Cardiac disease, Conduction, valvular dz, Pulmonary fibrosis
A

Ankylosing Spondylitis

94
Q

w/u for Ankylosing Spondylitis

A
  1. Elevated ESR/CRP
  2. HLA-B27
  3. Thoracolumbar spine XR - “Bamboo spine,” “shiny corner sign”
  4. MRI - shows evidence of dz within first 2 years when XR is normal
95
Q
  • A protein present on WBC that is supposed to help differentiate between “self” and “foreign” cells
  • Present in 50-90% of patients with AS
  • Not needed for the dx but helps support the dx
A

HLA-B27

96
Q

calcifications or heterotopic ossifications inside a spinal ligament or of the annulus fibrosus

what is this called?

A

Syndesmophytes

97
Q

mgmt for anklyosing spondylitis

A
  • NSAIDs (1st-line)
  • TNF-α antagonists - etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira)
  • PT/strength training exercises
  • Refer to rheumatologist
98
Q

A protrusion of nucleus pulposus through a weakened annulus fibrosus = compression of spinal canal

A

Herniated Nucleus Pulposus
AKA: Herniated Disk, Sciatica

99
Q

how does a Herniated Nucleus Pulposus cause pain?

A

from direct compression and from chemical irritation from substances within the nucleus pulposus

100
Q

Herniated Nucleus Pulposus MC happens at what level of the spine?

A

L4-5 and L5-S1 levels

101
Q

MOI of herniated nucleus pulposus

A

Lifting and twisting injuries

102
Q
  1. Onset abrupt and severe
  2. Pain, numbness and/or weakness in one or both LE
    - Shooting or stabbing pain into buttock and down leg - precedes back pain
    - worsen by sitting, walking, standing, coughing, and sneezing
    - Unable to find a position of comfort
  3. Limited ROM
  4. (+) SLR
  5. Eval DTR, motor, and sensory function

dx?
w/u?

A
  1. Herniated Nucleus Pulposus
  2. XR; MRI
103
Q

indications for MRI for herniated nucleus polposus

A
  1. sx > 4 wks
  2. Significant neuro deficit
  3. Progressive neuro changes
  4. Intolerable pain
104
Q

mgmt for herniated nucleus pulposus

A
  1. NSAIDs
  2. Corticosteroids - prednisone
  3. Opiates - only if severe intractable pain & unresponsive
  4. Rest/activity modification
  5. Reassurance: MC self-limiting and improve in 3-4 wks
  6. PT once pain free
  7. surgery
  8. Alt: epidural steroid injections, chiro, acupuncture
105
Q

indications for referral in herniated nucleus pulposus

A
  1. Emergent: focal neuro deficit, cauda equina syndrome
  2. Lack of improvement after 3-4 wks of conservative therapy
  3. Recurrent episodes affecting quality of life
106
Q

surgical options for nherniated nucleus pulposus

A
  1. Partial discectomy
  2. Artificial disc replacement
  3. Vertebral Fusion
107
Q

A narrowing of the spinal canal compressing the nerve roots of the cauda equina (L2-L4 nerve roots)

A

Cauda Equina Syndrome

108
Q

causes of Cauda Equina Syndrome

A
  1. Disc herniation/rupture
  2. Spinal stenosis
  3. Spinal trauma/fractures
  4. Neoplasm
  5. Spinal infection/abscess
  6. Idiopathic/Iatrogenic - Spinal anesthesia
109
Q
  1. Low back pain
  2. Radiculopathy unilateral/BL
  3. Bowel and bladder changes
    - Bladder: retention, later followed by an overflow incontinence
    - Bowel: incontinence, constipation, loss of anal tone and sensation
  4. Saddle + perineal/perianal hypoesthesia or anesthesia
  5. Weak anal sphincter tone
  6. Neuro s/s unilateral or BL
    - LE motor weakness and sensory deficits - Trouble rising from seated position, foot drop
    - Reduced or absent LE reflexes

dx?
w/u?

A
  1. Cauda Equina Syndrome
  2. CBC, CRP, ESR, BUN/Cr; emergent MRI w/ gadolinium contrast
110
Q

mgmt for cauda equina

A
  1. Emergent neurosurgical consult for surgical decompression
    - Required within 12-24 hours of onset
  2. Tx underlying cause - IV methylprednisolone, abx
111
Q

A compression of the sciatic nerve as it exits the spine

A

Sciatica

112
Q

causes of Sciatica and which is MC?

A
  1. Herniated disc (MC)
  2. Bone spur
  3. Disc degeneration
113
Q

presentation of sciatica?
w/u?
mgmt?

A
  • Same as HNP
  • tx underlying cause
114
Q

Excessive curvature of thoracic spine
“Dowager’s hump” - Hunchback
The prevalence increases with age

A

Kyphosis

115
Q

causes of Kyphosis

A
  1. Vertebral fractures
  2. Degenerative disc disease
  3. Postural changes
  4. Muscle weakness
  5. Genetic predisposition
  6. Changes in the intervertebral ligaments
116
Q

complications of Kyphosis

A
  1. Impaired pulm function
  2. Impaired physical function with inc risk for falling
  3. inc risk for fx
  4. Chronic pain
  5. GI sx → dysphagia and GERD
  6. inc mortality
117
Q

w/u for kyphosis?
finding?

A

Entire spine series
Increased kyphotic cobb angle

Nml is 20-40°

118
Q

mgmt for kyphosis

A
  1. NSAIDs and muscle relaxants
  2. Back strengthening exercises
  3. Bracing
  4. tx any underlying cause
  5. Refer to ortho or neurospine specialist for surgery
119
Q

indications for methocarbamol (Robaxin)

A

muscle spasm, tetanus

120
Q

caution & CI of methocarbamol (Robaxin)

A
  • CI: IV form: seizure d/o and renal impairment
  • Caution/DDI: CNS depressant use, elderly
  • Preg Cat: C
121
Q

MOA of methocarbamol

A

general CNS depression

122
Q

SE of methocarbamol

A

drowsiness, dizziness, bradycardia, syncope, N/V, leukopenia, extravasation/tissue damage (IV, IM only)

123
Q

indication and MOA of tizanidine (Zanaflex)

A
  • Indications: muscle spasm and/or MSK pain, spasticity
  • MOA: reduce facilitation of spinal motor neurons
124
Q

Cautions, CI, DDI of tizanidine (Zanaflex)

A
  • CI: CYP12Ai (cipro, fluvoxamine)
  • Caution: hepatic/renal impairment, elderly
  • DDI: CYP12A inhibitors, CNS depressants
  • Pregnancy/Lactation: C
  • Special considerations: taper to d/c
125
Q

SE of tizanidine

A

xerostomia, dizziness/drowsiness, weakness/decreased energy

126
Q

indications and MOA of cyclobenzaprine (Flexeril)

A
  • Indications: muscle spasm; TMJ and fibromyalgia are off-label
  • MOA: reduces motor activity influencing both alpha and gamma motor neurons
127
Q

caution, CI, DDI of cyclobenzaprine (Flexeril)

A
  • CI: hyperthyroidism, HF, arrhythmia, MI recovery phase; ER in elderly
  • Caution: acute-closure glaucoma, inc IOP, serotonin inhibitors, liver impairment, seizure disorders
  • DDI: MAOI, TCA’S
  • Pregnancy/Lactation: B
128
Q

SE of cyclobenzaprine (Flexeril)

A

drowsiness/fatigue, dizziness, xerostomia

129
Q

indication and MOA of carisoprodol (Soma)

A
  • Indications: acute muscle pain
  • MOA: unclear - CNS depression
130
Q

Which skeletal muscle relaxant is Scheduled C-IV and should avoid abrupt withdrawal?

A

carisoprodol (Soma)

131
Q

cautions, CI, and DDI of carisoprodol (Soma)

A
  • CI: acute intermittent porphyria
  • Caution: seizures, renal/liver impairment, substance abuse, elderly
  • DDI: CNS depressants
  • Pregnancy/Lactation: C
132
Q

SE of carisoprodol (Soma)

A

CNS depression, CYP2C19 Inhibitors - many PPI’s and antiepileptics

133
Q

indications and MOA of metaxalone (Skelaxin)

A
  • Indications: acute muscle pain
  • MOA: unclear - CNS depression
134
Q

CI, cautions, and DDI of metaxalone (Skelaxin)

A
  • CI: anemia, significant renal/hepatic impairment
  • Caution: renal/hepatic impairment, elderly; food inhibits absorption
  • DDI: CNS depressants, serotonergic drugs
  • Pregnancy/Lactation: C
135
Q

SE of metaxalone (Skelaxin)

A

hemolytic anemia, drowsiness, dizziness, N/V

Clin Med III: MSK (14 decks)

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