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Pharm Exam 4 > Drug Drills, CNS Drugs > Flashcards

Drug Drills, CNS Drugs Flashcards

1
Q

Which type of seizure(s) does carbamazepine treat?

A

Simple Partial seizures
Complex Partial seizures
Tonic-Clonic seizures

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2
Q

Which type of seizure(s) does phenobarbital treat?

A

Partial seizures

Generalized Tonic-Clonic seizures

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3
Q

Which type of seizure(s) does phenytoin treat?

A

Partial seizures
Generealized Tonic-Clonic Seizures

p.155

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4
Q

Which type of seizure(s) does valproic acid treat?

A

Partial seizures
Tonic-Clonic Seizures
Absence Seizures

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5
Q

Which traditional anti-seizure drug(s) can be used to treat all major seizure types?

A

Valproic Acid

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6
Q

Which newer anti-seizure drug can be used to treat all major seizure types?

A

Lamotrigine

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7
Q

Which type of seizure(s) does gabapentin treat?

A

Partial Seizures

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8
Q

Which type of seizure(s) do topiramate treat?

A

Partial Seizures

Tonic-Clonic Seizures

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9
Q

Which type of seizure(s) does felbamate treat?

A

Parital Seizures

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10
Q

Which type of seizure(s) does ethosuximide treat?

A

Absence Seizures

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11
Q

Which anti-seizure drug(s) are associated with an increase in suicidal thoughts and behaviors?

A

Topiramate

Lamotrigine

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12
Q

Which anti-seizure drug(s) decrease effectiveness of oral contraception?

A 
Carbamazepine
Phenytoin
Phenobarbital
Topiramate
Lamotrigine

(Caribbean Pirates Pillage Treasure Loudly)

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13
Q

Which anti-seizure drug(s) is absolutely contraindicated during pregnancy?

A

Valproic acid

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14
Q

Which supplement should be taken throughout pregnancy before and in conjunction with anti-seizure medication?

A

Folic Acid

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15
Q

Which class of anti-seizure medication has greater risks to developing fetus (traditional or newer)?

A

Traditional

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16
Q

Which class of anti-seizure medication is less expensive (traditional or newer)?

A

Traditional

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17
Q

Which class of anti-seizure medication has greater drug/drug interactions (traditional or newer)?

A

Traditional

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18
Q

Which class of anti seizure medication has fewer side effects (traditional or newer)

A

Newer

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19
Q

Which class of anti-seizure medication has fewer drug/drug interactions (traditional or newer)

A

Newer

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20
Q

Which class of anti-seizure medication is safer during pregnancy (traditional or newer)?

A

Newer

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21
Q

Which class of anti-seizure medication is generally better tolerated (traditional or newer)?

A

Newer

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22
Q

What is the drug of choice for treating tonic-clonic seizures in adults and older children?

A

Phenytoin

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23
Q

What is the drug of choice for treating tonic-clonic seizures in young children?

A

Carbamazepine

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24
Q

Does Phenytoin have a narrow or broad therapeutic range?

A

Narrow (must be maintained between 10-20 micrograms/ml)

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25
Q

Potential serious adverse effects of Phenytoin

A

Gingival hyperplasia
DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), associated with HLA-B* 1502 mutation
Stevens-Johnson Syndrome
Hirsutism

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26
Q

Which demographic group is at highest risk for Stevens-Johnson as an adverse effect of Phenytoin?

A

Asian Decent

Related to HLA-B* genetic mutation

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27
Q

Which genetic mutation is responsible for a higher risk for Stevens-Johnson Syndrome and Toxic Epidermal Necrolyisis (TEN) in patients taking Phenytoin?

A

HLA-B* 1502

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28
Q

Can Phenytoin be prescribed to pregnant women?

A

Only if a safer anti-seizure medication can not produce necessary seizure control

Phenytoin is a teratogen–associated with cleft palate, heart malformations, fetal hydantoin syndrome and other physical deformities

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29
Q

What is the risk to newborns of mothers who took Phenytoin during pregnancy.

A

Bleeding tendencies–related to decreased synthesis of Vitamin K dependent clotting factors.

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30
Q

What is the half-life of Phenytoin?

A

Initially short

Extends up to 60 hours with prolonged use.

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31
Q

Can Phenytoin be given to breastfeeding women?

A

Yes

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32
Q

Phenytoin Black Box Warning

A

Related to IV use only

Hypotension and Cardiac Dysrhythmias

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33
Q

Phenytoin Drug Interactions

A

Oral Contraceptives (decreased effectiveness)
Warfarin (decreased effectiveness)
Glucocorticoids: anti-inflammatory and immunosuppressives (decreased effectiveness)

Drugs that increase Phenytoin Levels:
Diazepam
Cimetidine
Alcohol
Valproic Acid

Drugs that decrease Phenytoin Levels:
Carbamazepine
Phenobarbital
Alcohol

CNS Depressants-Add to CNS effects of Phenytoin

Enteral tube feedings-Decrease Phenytoin absorption

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34
Q

Is Phenytoin used as monotherapy or adjunct therapy?

A

Monotherapy

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35
Q

Which anti-seizure drug is converted to Phenytoin when metabolized?

A

Fosphenytoin

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36
Q

When is Fosphenytoin used?

A

Generalized tonic-clonic seizures
Partial Seizures
*When oral Phenytoin can not be used

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37
Q

What is half-life of Carbamazepine?

A

Decreases as therapy progresses.

40hours during initial phase of treatment
Decreases to about 15 hours

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38
Q

What time of day should Carbamazepine be administered?

A

Night time to decrease CNS effects

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39
Q

Common Adverse Effects of Carbamazepine?

A 
Visual disturbances (nystagnus, blurred vision, diplopia)
Ataxia
Vertigo
Unsteadiness
Headache

Decrease with continued used

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40
Q

Potential Serious Adverse Effects of Carbamazepine?

A 
Bone marrow suppression causing:
Leukopenia
Anemia
Thrombocytopenia
*Don't withdraw use unless severe white count drop
Fatal Aplastic Anemia

Hepatic Failure
Renal Failure

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41
Q

Monitoring requirements for Carbamazepine?

A

CBC prior to treatment and periodically during treatment

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42
Q

Signs of hematologic abnormalities associated with Carbamazepine use?

A 
Fever
Sore throat
Pallor
Weakness
Infection
Easy Bruising
Petechiae
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43
Q

Black Box Warning for Carbamazepine?

A

Risk for serious skin reactions (SJS & TEN), strongly associated with HLA-B* 1502 variant primarily in people of Asian decent.

Aplastic anemia and agranulocytosis is rare but possible.

*Genetic screening recommended by FDA prior to prescribing

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44
Q

Can Carbamazepine be used in pregnancy?

A

Only if benefits of seizure control are deemed to outweigh risks to fetus.

Teratogenic.
2.6 fold increase for neural tube defects.

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45
Q

What electrolyte imbalance is associated with Carbamazepine?

A

Hyponatremia.

Dose dependent, drug inhibits renal excretion of water

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46
Q

Carbamazepine drug reactions?

A 
Oral contraceptives (decreased effect)
Warfarin (decreased effect)

Phenytoin & Phenobarbital (decreases effects of Carbamazepine)

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47
Q

Carbamazepine food reactions?

A

Grapefruit juice

Increases peak and trough levels by 40%

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48
Q

Is Carbamazepine used as monotherapy or adjunct therapy?

A

Monotherapy

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49
Q

Is Valproic Acid used as monotheray or adjunct therapy?

A

Monotherapy

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50
Q

What anti-seizure medication is considered a first-line drug for all partial and generalized seizures?

A

Valproic Acid

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51
Q

Common side effects fo Valproic Acid?

A

Minimal sedation and cognitive impairment

GI effects most common (minimized with enteric-coated product)

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52
Q

Possible serious adverse effects of Valproic Acid?

A

Hepatotoxicity

Pancreatitis

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53
Q

Black Box warning for Valproic Acid?

A

Fatal hepatic failure
(young children, patents with mitochondrial disease are at increased risk)

Fatal, rapidly increasing pancreatitis has occurred (nausea, vomiting, anorexia, abdominal pain)

HIGHLY teratogenic. Neonates may have major congenital malformations and decreased mental capacity.

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54
Q

Contraindications for Valporic Acid

A

Use in children under 2 years in conjunction with other drugs
Preexisting liver dysfunction

Pregnancy

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55
Q

Monitoring requirements for Valporic Acid

A

Liver function at baseline and periodically throughout treatment.

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56
Q

Valporic Acid ok in breastfeeding women?

A

Yes

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57
Q

Drug interactions with Valproic Acid?

A

Pheonobarbital (increases level of Phenobarbital up to 40%, causing increased CNS effects)

Phenytoin (increased free Phenytoin leading to Phenytoin toxicity)

Topiramate (increases risk of hyperammonemia)

Antibiotics–Meropenem & Imipenem/Cilastatin (reduce levels of Valporic Acid)

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58
Q

What anti-seizure medication is devoid of significant adverse effects and interactions?

A

Ethosuximide

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59
Q

What is the drug of choice for absence seizures?

A

Ethosuximide

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60
Q

Does Ethosuximide have a short or long half life?

A

Long

Allows for once a day dosing but twice daily dosing is better tolerated

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61
Q

is Phenobarbital used as monotherapy or adjunct therapy?

A

Monotherapy

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62
Q

Phenobarbital half life long or short?

A

Long…4 days
Allows for once daily dosage
Requires 2-3 weeks to reach plateau plasma levels

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63
Q

How is Phenobarbital initially dosed to overcome time required for drug to reach plateau plasma levels?

A

Loading doses given for first 4 days

double dosage

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64
Q

What ages is Phenobarbital appropriate for?

A

All ages

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65
Q

Common side effects of Phenobarbital?

A

Lethargy, depression, learning impairment can be significant. Drowsiness is most common.

Confusion in older adults

Hyperexcitability in children.

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66
Q

Absolute contraindications for Phenobarbital?

A

1). Porphyria, personal or family history

Porphyria is a group of liver disorders that cause porphyrins to build up in the body, negatively affecting the skin or nervous system.

2). Significant respiratory compromise

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67
Q

Effects of Phenobarbital toxicity?

A

Moderately excessive dosing: nystagmus and and ataxia

Severe: Generalized CNS depression

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68
Q

Phenobarbital drug interactions?

A

Induces CYP drug-metabolizing enzymes, so can increase metabolism (decrease effectiveness) of ORAL CONTRACEPTIVES and others.

Other CNS depressants (intensify)

Valproic Acid-competes with phenobarbital for drug metabolizing enzymes, increasing plasma levels of phenobarbital by approximately 40% (requires dose reduction of phenobarbital when used together).

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69
Q

Phenobarbital safe in pregnancy?

A

No

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70
Q

Phenobarbital safe for elderly?

A

No

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71
Q

Phenobarbital safe for breastfeeding?

A

No

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72
Q

Phenobarbital safe with history of drug abuse?

A

No

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73
Q

What type of seizure(s) does Oxcarbazepine (Trileptal) treat?

A

Partial Seizures

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74
Q

Is Oxcarbazepine used as monotherapy or adjunct therapy?

A

Both

Monotherapy for children >/= 4
Adjunct therapy for children < 2

75
Q

Potentially serious adverse effects of Oxcarbazepine?

A

Hyponatremia, esp with diuretics
SJS, TEN
Multi-organ hypersensitivity reactions
*Loss of bone density with long term use

76
Q

Drug-drug interactions with Oxcarbazepine?

A

Phenytoin (increases phenytoin levels, decrease oxcarbazepine levels)

Valporic Acid & Phenobarbital-decreases levels of oxcarbazepine

Sodium depleting drugs (diuretics)-increase risk of hyponatremia

Oral contraceptives-decreased effect

Alcohol-increases CNS depression

77
Q

Is Lamotrigine (Lamictal) used as monotherapy or adjunct therapy?

A

Both

Monotherapy for children > 16 with partial seizures who are converting from another seizure med

Adjunct in adults and children > 2

78
Q

Lamotrigine (Lamictal) is a preferred drug for treating which type of seizure?

A

Absence

79
Q

Lamotrigine (Lamictal) common adverse effects?

A

dizziness, diplopia (double vision), blurred vision, nausea, vomiting and headache

80
Q

Potential serious adverse effects of Lamotrigine (Lamictal)?

A

SJS, TEN and DRESS
Risk increases with Valporic Acid
**Stop immediately if pt develops a rash

Blood dycrasias

Aseptic Meningitis (rare but serious)

81
Q

Black box warning for Lamotrigine (Lamictal)?

A

Serious skin reactions such as SJS, TEN

Fatalities reported

82
Q

Lamotrigine (Lamictal) drug interactions?

A

CYP enzymes-DRAMATICLLY effects half life of Lamotrigine.
Inducers (other AEDs)-decrease Lamotrigine half life to 10 hours
Inhibitors Increases-half life to about 60 hours

Estrogens-lower Lamotrigine Levels
Progestins-lowered by Lamotrigine levels

83
Q

Is Gabapentin used as monotherapy or adjunct therapy?

A

Both

FDA approval is ONLY for ADJUNCTIVE therapy for partial seizures

Also used as monotherapy for partial seizures

84
Q

Is Topiramate (Topamax) used as monotherapy or adjunct therapy?

A

Both

Monotherapy of adults and children >10 for:
Partial seizures
Primary generalized tonic-clonic seizures

Adjunctive in adults and children > 2 years old for:
Partial seizures
Primary generalized tonic-clonic seizures (Lennox-Gastaut syndrome)

85
Q

Common adverse effects of Topiramate?

A

Somnolence, dizziness, ataxia, nervousness, diplopia, nausea, anorexia, weight loss

86
Q

Potential Adverse Effects of Topiramate?

A

Metabolic acidosis (manifested by hyperventilation)
Rapid blindness
Hypohidrosis (reduced sweating), decreases exercise tolerance r/t to risk of hyperthermia
Higher risk of suicide

87
Q

Is Topiramate safe in pregnancy?

A

No

88
Q

Drug-Drug interactions with Topiramate?

A

Phenytoin & Carbamazepine can decrease levels of Topiramate.

Phenytoin may increase the level of Topiramate

Valproic Acid-Increases risk for hyperammonemia

89
Q

Is Felbamate (felbatol) used as monotherapy or adjunct therapy?

A

Both

Mono & Adjunct in adults for partial seizures
Adjunct for children with Lennox-Gastaut syndrome

90
Q

Black box warning for Felbamate (felbatol)

A

Aplastic anemia-up to 70% of useres

Acute Liver failure-rare but serious when it occurs (liver transplants required)

91
Q

Common adverse effects of Felbamate (felbatol)

A

GI disturbances, CNS effects

More common with adjunct use

92
Q

Drug-drug Interactions of Felbamate (felbatol)

A

Most other anti-seizure drugs

93
Q

Is Pregabalin (Lyrica) used as monotherapy or adjunct therapy?

A

Adjunct for partial seizures

94
Q

Potential serious adverse effects of Pregabalin (Lyrica)

A

Hypersensitivity
Rhabdomyolysis (muscle breakdown)
Abuse potential
Reproductive risks (male and female)

95
Q

Can Pregabalin (Lyrica) be used in Pregnancy?

A

No

96
Q

Drug-Drug interactions with Pregabalin (Lyrica)?

A

Alcohol
Benzos
Opioids and other CNS depressants

**does not appear to interfere with other antiseizure drugs

97
Q

Is Levetiracetam (Keppra) used as monotherapy or adjunct therapy?

A

Adjunct for:

Myoclonic seizures in adults and adolescents 12 and older.

Partial-onset seizures in adults and kids 4 and older

Primary generalized tonic-clonic seizures in adults and kids 6 and older.

98
Q

Potential serious adverse effects of Levetiracetam (Keppra)

A

Renal injury

99
Q

Common side effects of Levetiracetam (Keppra)

A

Minimal, generally very well tolerated

100
Q

Drug-drug interactions with Levetiracetam (Keppra)

A

None known

101
Q

Which AED is particularly sensitive to very small dosage changes, producing disproportionately large changes in serum drug levels?

A

Phenytoin (Dilantin)

102
Q

Which AED is considered the drug of choice for treating all types of seizures in adults and older children?

A

Phenytoin (Dilantin)

103
Q

Which AED is a derivative of carbamazepine and shares most common features with it?

A

Oxcarbazepine (Trileptal)

104
Q

True or False: Pregnancy test should be administered prior to starting AED therapy?

A

True

105
Q

Monitoring requirments with Carbamazepine?

A 
CBC w/diff
LFT
Renal Screen
HLA-B* in Asian decent
Assess for Rash
106
Q

Contraindication for Carbamazepine?

A

Hx of bone marrow suppression or preexisting hematologic abnormalities

HLA-B* 1502 Allele increases the risk for SJS or TEN

107
Q

Felbamate is contraindicated for patients with what condition (s)

A

Anemia

Hepatic impariment

108
Q

Gabapentin should be used cautiously in which patients?

A 
History of drug use
Renal impairment (dose adjustments may be required)
109
Q

Lacosamide is not recommended for which patients?

A

Those with cardiac conduction disorders
Those who take drugs that can prolong PR interval
History of drug dependency or abuse

110
Q

Oxcarbazepine may worsen which two preexisting conditions?

A

Osteopenia & Osteoporosis

111
Q

Phenobarbital is contraindicated in which patients?

A

Personal or family history of porphyria
Patients with marked anemia
Patients with marked liver impairment
Patients with significant respiratory disease

112
Q

Phenytoin can worsen what preexisting conditions?

A

Atrioventricular block

Bradycardia

113
Q

What are the contraindications for Valproic Acid

A

Significant hepatic dysfunction
Children under 3 who are taking other antiseizure drugs
Pregnancy unless LAST resort

114
Q

What is the drug of choice for treating absence seizures?

A

Ethosuximide

115
Q

Which AED is generally devoid of significant adverse effects and drug-drug interactions?

A

Ethosuximide

116
Q

which AED is nearly identical in structure to Phenobarbital?

A

Primidone

117
Q

Is Primadone used as monotherapy or adjunct therapy?

A

Primarily adjunct, usually with Phenytoin or carbamazepine.

Treats tonic-clonic seizures
Simple Partial seizures
Complex Partial Seizures

118
Q

What type of seizure(s) does Primadone treat?

A

Tonic-clonic seizures
Simple Partial seizures
Complex Partial Seizures

119
Q

Common Side effects of Primidone?

A

Sedation, ataxia, dizziness during initial use

Confusion in older adults

Hyperexcitability in children

120
Q

Absolute contraindication for Primidone?

A

Acute intermittent porphyria

121
Q

Potential serious adverse effects of Primidone?

A

Acute psychosis, leukopenia, thrombocytopenia, systemic lupus (all rare but possible)

122
Q

Drug-Drug interactions with Primidone?

A

Same as Phenobarbital

CYP inducing so can decrease the effectiveness of Warfarin and oral contraceptives

CNS Depressants (enhances effect)

123
Q

Is Tiagabine used as monotherapy or adjunct therapy?

A

ONLY adjunct therapy for:

Partial seizures in patients at least 12 years old

124
Q

What kind of seizure(s) does Tiagabine treat?

A

Partial seizures in patients at least 12 years old

125
Q

Common adverse effects of Tiagabine?

A

Generally well tolerated

dizziness, somnolence, asthenia, nausea, nervousness, tremor
Dose-related cognitive effects

126
Q

Potential serious effects of Tiagabine?

A

Can cause seizure with off-label use

127
Q

Drug-drug interactions with Tiagabine?

A

Phenytoin, Phenobarbital, and Carbamazepine (all induce drug-metabolizing enzymes) will decrease levels of Tiagabine

128
Q

Is Zonisamide used for monotherapy or adjunct therapy?

A

Adjunct for Partial seizures in adults

129
Q

What kind of seizure(s) does Zonisamide treat?

A

Partial seizures in ADULTS

130
Q

Potential Serious side effects of Zonisamide?

A

Severe psychiatric effects (severe depression, suicide attempts)
Hypersensitivity reactions-SJS, TEN, fulminant hepatic necrosis
Kidney stones
Metabolic acidosis
Hypohidrosis (decreased sweating) & hyperthermia

131
Q

Drug-Drug Interactions with Zonisamide?

A

CYP inducers (including St. John’s wort) can reduce the half-life to 27 hours or less

CYP inhibitors & Protease Inhibitors slow the metabolism and intensify/prolong Zonisamide effects
Grapefruit juice slows metabolism

132
Q

Tiagabine is not recommended for patients with which preexisting condition?

A

Hepatic Impairment

133
Q

What antibiotic chemical family is Zonisamide the same as?

A

Sulfonamide antibiotics

134
Q

What are contraindications for use of Zonisamide?

A

Sulfa allergy

Conditions that contribute to metabolic acidosis

135
Q

What term refers to a group of movement disorders of CNS origin characterized by heightened muscle tone, spasm & loss of dexterity?

A

Spasticity

136
Q

What are the most common causes of spasticity?

A

Multiple sclerosis (MS) and cerebral palsy (CP)

137
Q

Which 3 drugs relieve spasticity by actions through the CNS?

A

Baclofen
Diazepam
Tizanidine

138
Q

Which drug relieves spasticity by acting directly on the skeletal muscle?

A

Dantrolene

139
Q

Baclofen, indication for use?

A

Spasticity related to MS and some spinal cord injuries

140
Q

Baclofen MOA?

A

Acts within the spinal cord to suppress hyperactive reflexes involved in the regulation of muscle movement.

Is not a direct muscle relaxant
Does not decrease muscle strength
Reduce the discomfort of spasticity and increases performance.

141
Q

Common adverse effects of Baclofen?

A

CNS and GI

142
Q

Can baclofen be abruptly withdrawn?

A

No-does not cause physical dependence but the abrupt withdrawal of oral dosages can cause visual hallucinations, paranoid ideation, and seizures

143
Q

Drug-drug interactions with Baclofen?

A

Other CNS depressants-increases CNS depressive effects

Drugs that contribute to increased urinary retention

144
Q

Possible serious adverse effects of Baclofen?

A

Urinary retention

145
Q

Patients with what preexisting conditions should be cautiously prescribed Baclofen?

A

Benign Prostatic hypertrophy
Patients taking drugs that increase urinary retention
Patients with hx of schizophrenia or other psychiatric illnesses

146
Q

What is the only benzodiazepine labeled for treating spasticity?

A

Diazepam

147
Q

Diazepam MOA?

A

Acts in CNS to suppress spasticity.

Does not directly affect skeletal muscle

148
Q

Common Adverse effects of Diazepam

A

Sedation-minimize by using low doses initially

149
Q

What drug directly acts on skeletal muscle to treat spasticity?

A

Dantrolene

150
Q

Dantrolene MOA?

A

Makes skeletal muscle less able to contract by suppressing the release of calcium from the sarcoplasmic reticulum.

**has minimal effect on contraction of smooth muscle and cardiac muscle.

151
Q

Dantrolene indications for use?

A

Relieves spasticity associated with MS, CP & spinal cord injury.

Management of muscle contraction and rigidity associated with malignant hyperthermia

152
Q

Suppression of spasticity by Dantrolene has what effect on skeletal muscle strength?

A

Dantrolene reduces muscle strength which may reduce overall function rather than improve function.

**Risk-benefit analysis is necessary for treatment.

153
Q

How long does it take to determine if treatment of spasticity with Dantrolene will be beneficial?

A

45 days

154
Q

Black box warning for Dantrolene

A

Fatal hepatotoxicity, especially at higher doses even with short-term use.

May be asymptomatic so baseline liver function should be obtained along with frequent monitoring during treatment.

155
Q

What action should be taken to decrease the risk of hepatotoxicity from treatment with Dantrolene?

A

Use the lowest possible effective dose

Frequent monitoring (as the patient may be asymptomatic)

156
Q

Common adverse effects of Dantrolene?

A

Muscle weakness, drowsiness, and diarrhea are the most common

Less common adverse effects are dysphagia, hoarseness, nausea, vomiting, and ERECTILE DYSFUNCTION

157
Q

What is the term for the involuntary contraction of a muscle or muscle group which is often painful and reduces the ability to function?

A

Muscle Spasm

158
Q

What two groups of medicines are used to treat acute muscle spasms?

A

Analgesics

Centrally acting muscle relaxants

159
Q

Cyclobenzaprine MOA?

A

Centrally acting skeletal muscle relaxant. The primary action is in the brain stem and causes reduction of tonic motor activity,

160
Q

Cyclobenzaprine indications for use?

A

Relief of muscle spasm and associated pain

161
Q

What is considered the most effective drug for the relief of muscle spasm and its associated pain?

A

Cyclobenzaprine

162
Q

Cyclobenzaprine (Flexeril) adverse effects?

A

CNS depressive symptoms:

drowsiness, dizziness, fatigue-most intense early in treatment

ANTICHOLINERGIC effects (mostly dry mouth, blurred vision, photophobia, urinary retention, and constipation.

163
Q

What class of drugs is Cyclobenzaprine (Flexeril) similar to?

A

Tricyclic antidepressants

164
Q

Potential serious adverse effects of Cyclobenzaprine (Flexeril)?

A

Cardiac rhythm disturbances similar to those of tricyclic antidepressants

*Primarily sinus tachycardia and significant conduction delays.

165
Q

Cyclobenzaprine (Flexeril) Drug-drug interactions?

A

MAO inhibitor antidepressants (must wait two weeks after MAO inhibitor discontinued to prevent risk of serotonin sickness)

SSRIs-risk of serotonin sickness
SNRIs-risk of serotonin sickness
tricyclic antidepressants-risk of serotonin sickness

Alcohol & other CNS depressants

166
Q

What is the indication for use for Tizanidine (Zanaflex)

A

relief of Spasticity

167
Q

Potential serious adverse reaction of Tizanidine (Zanaflex)?

A

Liver damage

168
Q

Potential serious adverse effect of metaxalone (Skelaxin)

A

Liver damage

169
Q

Potential serious adverse effect of Chlorzoxazone (Lorzone)

A

Hepatitis and potentially fatal hepatic necrosis.

Risk generally greater than benefit with this drug

170
Q

Chlorzoxazone (Lorzone) indication for use?

A

Muscle relaxant

171
Q

Potential adverse effects of Chlorzoxazone?

A

Urine orange to purple-red

172
Q

Methocarbamol indication for use?

A

Muscle relaxant

173
Q

Methocarbamol contraindications for use?

A

Seizure disorder

174
Q

Methocarbamol adverse effects?

A

Urine becomes brown, black, or dark green (dose-related, harmless)

175
Q

Which muscle relaxants have significant anticholinergic effects?

A

Cyclobenzaprine

Orphenadrine

176
Q

Potential adverse effects of Tizanidine

A

dry mouth, hypotension, hallucinations, and psychotic symptoms

Hypotension
*When discontinuing the drug, may need to taper to prevent hypertension

177
Q

Contraindication for Carisoprodol?

A

Intermittent porphyria

178
Q

What side effects are common among all centrally acting muscle relaxants?

A

CNS depression

Risk for physical dependence

179
Q

Which drugs for the treatment of muscle spasms and spasticity are NOT approved for use in children?

A

Chlorzoxazone,
Orphenadrine
Tizanidine

180
Q

Is Cyclobenzaprine safe for pregnant women?

A

Generally, yes

181
Q

Is Diazepam safe for pregnant women?

A

No, it is a teratogen

182
Q

Can drugs for muscle spasms and spasticity be safely taken by breastfeeding women?

A

No-can cause injury to infants

183
Q

What drugs for muscle spasms and spasticity are listed in the Beers Criteria as potentially inappropriate for older adults?

A 
Carisoprodol
Chlorzoxazone
Cyclobenzaprine
Metaxalone
Methocarbamol
Orphenadrine

Pharm Exam 4 (8 decks)

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