Comfort/Stress/Sleep

Question 1

Direct-Acting skeletal muscle relaxants

Answer 1

Cyclobenzaprine, methocarbamol

• Directly prevent muscle contraction
• used for muscle spasms/spasticity
• Interferes with release of calcium from muscle tubules

Treats: muscle pain, spasms, upper motor neuron syndromes

Contraindications: Seizures, Cardiac dysfunctions, muscle weakness, alcohol (further depress CNS), opioids, SSRI’s/SSNRI’s (cause serotonin syndrome), MAOI (seizures, death), may cause Constipation

Question 2

Opioid agonists

Answer 2

Morphine, oxycodone, fentanyl

• Drugs that react w/ opioid receptors
• Cause analgesia, sedation, or euphoria

Contraindicated: GI obstruction, Respiratory dysfunction (asthma, emphysema), alcohol use disorder, SSRIs/MAOIs/TCAs/Saint John’s Wort (Cause serotonin syndrome), Antihypertensives/muscle relaxants, anticholinergics (urinary retention), diuretics (less effective)

Question 3

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer 3

Ibuprofen, ketorolac (hard on kidneys)

• Provide strong anti-inflammatory and analgesic effects
• inhibits prostaglandin synthesis
• Block COX-1 and COX-2 enzymes

Treats:
rheumatoid arthritis/osteoarthritis, Mild/moderate pain

Contraindications: CV dysfunction, peptic ulcer, GI bleeding, warfarin (increase effects), antihypertensives/digoxin (have decreased effects), SSNRI’s/SSRI’s (increased risk for GI bleed), ACE/ARB’s (renal dysfunction), alcohol (GI adverse effects)

Cause: Increased photosensitivity,

Question 4

benzodiazepines

Answer 4

alprazolam, lorazepam, clonazepam (ALC)

• Act in the limbic system and the RAAS to make GABA more effective
  ○ GABA causes interference w/ neuron firing
• CNS depressor

Treats: Anxiety, seizures

Contraindications: history of substance abuse, alcohol, med must be tapered off, opioids/alcohol/cannabis/grapefruit (increase effects), digoxin (levels may increase), TCA’s (may increase effects)

Question 5

opioid antagonists

Answer 5

Naloxone

• Block effects of opioid receptors
• Reverse the effects of opioids

Treats: Opioid OD

Contraindications: Caution with pregnancy/breastfeeding women

Administer if:
- decreased respirations and/or apnea
- decreased level of consciousness and/or unresponsive
- bradycardia
- hypotension
- flaccid skeletal muscles

Question 6

salicylate (NSAID)

Answer 6

aspirin

• Anti-inflammatory, antipyretic, analgesic agents
• inhibit the synthesis of prostaglandin
• Antipyretic effect related to blocking of a prostaglandin mediator of pyrogens at the thermoregulatory center
• Blocks against platelet aggregation

Treats: inflammatory bowel disease, rheumatoid arthritis, and osteoarthritis

Contraindications:
- Bleeding abnormalities
- Chickenpox/influenza (may cause Reye’s syndrome)
- Surgery or other invasive procedure (Decreased blood clotting)

Interactions:
- Alcohol, smoking - risk of GI bleed
- concurrent use of glucocorticoids, anticoagulants, alcohol - risk of bleeding
- Nutrition (Ginger, garlic, ginkgo bilboa) - increased bleeding

Question 7

Antigout/Hyperuricemia drugs

Answer 7

Allopurinol

• Decrease inflammation or lower blood uric acid levels
• Inhibits xanthine oxidase
• Lowers uric acid in blood stream

Treats: acute gout, arthritis flares

Contraindications: may cause Steven-Johnson Syndrome, warfarin (increase effects), theophylline (levels may increase)

Question 8

Acetaminophen

Answer 8

• Hard on liver
  -Antipyretic, analgesic
• Has no anti-inflammatory actions (not an NSAID)
• Inhibits prostaglandins and other substances that sensitive pain receptors
• interferes with the pain receptors in the body

Contraindications: St. John’s Wort (decrease effectiveness), may cause Steven-Johnson’s syndrome