Drug Drills, CNS Drugs Flashcards
(183 cards)
1
Q
Which type of seizure(s) does carbamazepine treat?
A
Simple Partial seizures
Complex Partial seizures
Tonic-Clonic seizures
2
Q
Which type of seizure(s) does phenobarbital treat?
A
Partial seizures
Generalized Tonic-Clonic seizures
3
Q
Which type of seizure(s) does phenytoin treat?
A
Partial seizures
Generealized Tonic-Clonic Seizures
p.155
4
Q
Which type of seizure(s) does valproic acid treat?
A
Partial seizures
Tonic-Clonic Seizures
Absence Seizures
5
Q
Which traditional anti-seizure drug(s) can be used to treat all major seizure types?
A
Valproic Acid
6
Q
Which newer anti-seizure drug can be used to treat all major seizure types?
A
Lamotrigine
7
Q
Which type of seizure(s) does gabapentin treat?
A
Partial Seizures
8
Q
Which type of seizure(s) do topiramate treat?
A
Partial Seizures
Tonic-Clonic Seizures
9
Q
Which type of seizure(s) does felbamate treat?
A
Parital Seizures
10
Q
Which type of seizure(s) does ethosuximide treat?
A
Absence Seizures
11
Q
Which anti-seizure drug(s) are associated with an increase in suicidal thoughts and behaviors?
A
Topiramate
Lamotrigine
12
Q
Which anti-seizure drug(s) decrease effectiveness of oral contraception?
A
Carbamazepine Phenytoin Phenobarbital Topiramate Lamotrigine
(Caribbean Pirates Pillage Treasure Loudly)
13
Q
Which anti-seizure drug(s) is absolutely contraindicated during pregnancy?
A
Valproic acid
14
Q
Which supplement should be taken throughout pregnancy before and in conjunction with anti-seizure medication?
A
Folic Acid
15
Q
Which class of anti-seizure medication has greater risks to developing fetus (traditional or newer)?
A
Traditional
16
Q
Which class of anti-seizure medication is less expensive (traditional or newer)?
A
Traditional
17
Q
Which class of anti-seizure medication has greater drug/drug interactions (traditional or newer)?
A
Traditional
18
Q
Which class of anti seizure medication has fewer side effects (traditional or newer)
A
Newer
19
Q
Which class of anti-seizure medication has fewer drug/drug interactions (traditional or newer)
A
Newer
20
Q
Which class of anti-seizure medication is safer during pregnancy (traditional or newer)?
A
Newer
21
Q
Which class of anti-seizure medication is generally better tolerated (traditional or newer)?
A
Newer
22
Q
What is the drug of choice for treating tonic-clonic seizures in adults and older children?
A
Phenytoin
23
Q
What is the drug of choice for treating tonic-clonic seizures in young children?
A
Carbamazepine
24
Q
Does Phenytoin have a narrow or broad therapeutic range?
A
Narrow (must be maintained between 10-20 micrograms/ml)
25
Potential serious adverse effects of Phenytoin
Gingival hyperplasia
DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), associated with HLA-B* 1502 mutation
Stevens-Johnson Syndrome
Hirsutism
26
Which demographic group is at highest risk for Stevens-Johnson as an adverse effect of Phenytoin?
Asian Decent
| Related to HLA-B* genetic mutation
27
Which genetic mutation is responsible for a higher risk for Stevens-Johnson Syndrome and Toxic Epidermal Necrolyisis (TEN) in patients taking Phenytoin?
HLA-B* 1502
28
Can Phenytoin be prescribed to pregnant women?
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
29
What is the risk to newborns of mothers who took Phenytoin during pregnancy.
Bleeding tendencies--related to decreased synthesis of Vitamin K dependent clotting factors.
30
What is the half-life of Phenytoin?
Initially short
| Extends up to 60 hours with prolonged use.
31
Can Phenytoin be given to breastfeeding women?
Yes
32
Phenytoin Black Box Warning
Related to IV use only
| Hypotension and Cardiac Dysrhythmias
33
Phenytoin Drug Interactions
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
34
Is Phenytoin used as monotherapy or adjunct therapy?
Monotherapy
35
Which anti-seizure drug is converted to Phenytoin when metabolized?
Fosphenytoin
36
When is Fosphenytoin used?
Generalized tonic-clonic seizures
Partial Seizures
*When oral Phenytoin can not be used
37
What is half-life of Carbamazepine?
Decreases as therapy progresses.
40hours during initial phase of treatment
Decreases to about 15 hours
38
What time of day should Carbamazepine be administered?
Night time to decrease CNS effects
39
Common Adverse Effects of Carbamazepine?
```
Visual disturbances (nystagnus, blurred vision, diplopia)
Ataxia
Vertigo
Unsteadiness
Headache
```
Decrease with continued used
40
Potential Serious Adverse Effects of Carbamazepine?
```
Bone marrow suppression causing:
Leukopenia
Anemia
Thrombocytopenia
*Don't withdraw use unless severe white count drop
Fatal Aplastic Anemia
```
Hepatic Failure
Renal Failure
41
Monitoring requirements for Carbamazepine?
CBC prior to treatment and periodically during treatment
42
Signs of hematologic abnormalities associated with Carbamazepine use?
```
Fever
Sore throat
Pallor
Weakness
Infection
Easy Bruising
Petechiae
```
43
Black Box Warning for Carbamazepine?
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
44
Can Carbamazepine be used in pregnancy?
Only if benefits of seizure control are deemed to outweigh risks to fetus.
Teratogenic.
2.6 fold increase for neural tube defects.
45
What electrolyte imbalance is associated with Carbamazepine?
Hyponatremia.
| Dose dependent, drug inhibits renal excretion of water
46
Carbamazepine drug reactions?
```
Oral contraceptives (decreased effect)
Warfarin (decreased effect)
```
Phenytoin & Phenobarbital (decreases effects of Carbamazepine)
47
Carbamazepine food reactions?
Grapefruit juice
| Increases peak and trough levels by 40%
48
Is Carbamazepine used as monotherapy or adjunct therapy?
Monotherapy
49
Is Valproic Acid used as monotheray or adjunct therapy?
Monotherapy
50
What anti-seizure medication is considered a first-line drug for all partial and generalized seizures?
Valproic Acid
51
Common side effects fo Valproic Acid?
Minimal sedation and cognitive impairment
| GI effects most common (minimized with enteric-coated product)
52
Possible serious adverse effects of Valproic Acid?
Hepatotoxicity
| Pancreatitis
53
Black Box warning for Valproic Acid?
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.
54
Contraindications for Valporic Acid
Use in children under 2 years in conjunction with other drugs
Preexisting liver dysfunction
Pregnancy
55
Monitoring requirements for Valporic Acid
Liver function at baseline and periodically throughout treatment.
56
Valporic Acid ok in breastfeeding women?
Yes
57
Drug interactions with Valproic Acid?
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)
58
What anti-seizure medication is devoid of significant adverse effects and interactions?
Ethosuximide
59
What is the drug of choice for absence seizures?
Ethosuximide
60
Does Ethosuximide have a short or long half life?
Long
| Allows for once a day dosing but twice daily dosing is better tolerated
61
is Phenobarbital used as monotherapy or adjunct therapy?
Monotherapy
62
Phenobarbital half life long or short?
Long...4 days
Allows for once daily dosage
Requires 2-3 weeks to reach plateau plasma levels
63
How is Phenobarbital initially dosed to overcome time required for drug to reach plateau plasma levels?
Loading doses given for first 4 days
| double dosage
64
What ages is Phenobarbital appropriate for?
All ages
65
Common side effects of Phenobarbital?
Lethargy, depression, learning impairment can be significant. Drowsiness is most common.
Confusion in older adults
Hyperexcitability in children.
66
Absolute contraindications for Phenobarbital?
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
67
Effects of Phenobarbital toxicity?
Moderately excessive dosing: nystagmus and and ataxia
Severe: Generalized CNS depression
68
Phenobarbital drug interactions?
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).
69
Phenobarbital safe in pregnancy?
No
70
Phenobarbital safe for elderly?
No
71
Phenobarbital safe for breastfeeding?
No
72
Phenobarbital safe with history of drug abuse?
No
73
What type of seizure(s) does Oxcarbazepine (Trileptal) treat?
Partial Seizures
74
Is Oxcarbazepine used as monotherapy or adjunct therapy?
Both
Monotherapy for children >/= 4
Adjunct therapy for children < 2
75
Potentially serious adverse effects of Oxcarbazepine?
Hyponatremia, esp with diuretics
SJS, TEN
Multi-organ hypersensitivity reactions
*Loss of bone density with long term use
76
Drug-drug interactions with Oxcarbazepine?
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
Is Lamotrigine (Lamictal) used as monotherapy or adjunct therapy?
Both
Monotherapy for children > 16 with partial seizures who are converting from another seizure med
Adjunct in adults and children > 2
78
Lamotrigine (Lamictal) is a preferred drug for treating which type of seizure?
Absence
79
Lamotrigine (Lamictal) common adverse effects?
dizziness, diplopia (double vision), blurred vision, nausea, vomiting and headache
80
Potential serious adverse effects of Lamotrigine (Lamictal)?
SJS, TEN and DRESS
Risk increases with Valporic Acid
**Stop immediately if pt develops a rash
Blood dycrasias
Aseptic Meningitis (rare but serious)
81
Black box warning for Lamotrigine (Lamictal)?
Serious skin reactions such as SJS, TEN
| Fatalities reported
82
Lamotrigine (Lamictal) drug interactions?
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
Is Gabapentin used as monotherapy or adjunct therapy?
Both
FDA approval is ONLY for ADJUNCTIVE therapy for partial seizures
Also used as monotherapy for partial seizures
84
Is Topiramate (Topamax) used as monotherapy or adjunct therapy?
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
Common adverse effects of Topiramate?
Somnolence, dizziness, ataxia, nervousness, diplopia, nausea, anorexia, weight loss
86
Potential Adverse Effects of Topiramate?
Metabolic acidosis (manifested by hyperventilation)
Rapid blindness
Hypohidrosis (reduced sweating), decreases exercise tolerance r/t to risk of hyperthermia
Higher risk of suicide
87
Is Topiramate safe in pregnancy?
No
88
Drug-Drug interactions with Topiramate?
Phenytoin & Carbamazepine can decrease levels of Topiramate.
Phenytoin may increase the level of Topiramate
Valproic Acid-Increases risk for hyperammonemia
89
Is Felbamate (felbatol) used as monotherapy or adjunct therapy?
Both
Mono & Adjunct in adults for partial seizures
Adjunct for children with Lennox-Gastaut syndrome
90
Black box warning for Felbamate (felbatol)
Aplastic anemia-up to 70% of useres
Acute Liver failure-rare but serious when it occurs (liver transplants required)
91
Common adverse effects of Felbamate (felbatol)
GI disturbances, CNS effects
| More common with adjunct use
92
Drug-drug Interactions of Felbamate (felbatol)
Most other anti-seizure drugs
93
Is Pregabalin (Lyrica) used as monotherapy or adjunct therapy?
Adjunct for partial seizures
94
Potential serious adverse effects of Pregabalin (Lyrica)
Hypersensitivity
Rhabdomyolysis (muscle breakdown)
Abuse potential
Reproductive risks (male and female)
95
Can Pregabalin (Lyrica) be used in Pregnancy?
No
96
Drug-Drug interactions with Pregabalin (Lyrica)?
Alcohol
Benzos
Opioids and other CNS depressants
**does not appear to interfere with other antiseizure drugs
97
Is Levetiracetam (Keppra) used as monotherapy or adjunct therapy?
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
Potential serious adverse effects of Levetiracetam (Keppra)
Renal injury
99
Common side effects of Levetiracetam (Keppra)
Minimal, generally very well tolerated
100
Drug-drug interactions with Levetiracetam (Keppra)
None known
101
Which AED is particularly sensitive to very small dosage changes, producing disproportionately large changes in serum drug levels?
Phenytoin (Dilantin)
102
Which AED is considered the drug of choice for treating all types of seizures in adults and older children?
Phenytoin (Dilantin)
103
Which AED is a derivative of carbamazepine and shares most common features with it?
Oxcarbazepine (Trileptal)
104
True or False: Pregnancy test should be administered prior to starting AED therapy?
True
105
Monitoring requirments with Carbamazepine?
```
CBC w/diff
LFT
Renal Screen
HLA-B* in Asian decent
Assess for Rash
```
106
Contraindication for Carbamazepine?
Hx of bone marrow suppression or preexisting hematologic abnormalities
HLA-B* 1502 Allele increases the risk for SJS or TEN
107
Felbamate is contraindicated for patients with what condition (s)
Anemia
| Hepatic impariment
108
Gabapentin should be used cautiously in which patients?
```
History of drug use
Renal impairment (dose adjustments may be required)
```
109
Lacosamide is not recommended for which patients?
Those with cardiac conduction disorders
Those who take drugs that can prolong PR interval
History of drug dependency or abuse
110
Oxcarbazepine may worsen which two preexisting conditions?
Osteopenia & Osteoporosis
111
Phenobarbital is contraindicated in which patients?
Personal or family history of porphyria
Patients with marked anemia
Patients with marked liver impairment
Patients with significant respiratory disease
112
Phenytoin can worsen what preexisting conditions?
Atrioventricular block
| Bradycardia
113
What are the contraindications for Valproic Acid
Significant hepatic dysfunction
Children under 3 who are taking other antiseizure drugs
Pregnancy unless LAST resort
114
What is the drug of choice for treating absence seizures?
Ethosuximide
115
Which AED is generally devoid of significant adverse effects and drug-drug interactions?
Ethosuximide
116
which AED is nearly identical in structure to Phenobarbital?
Primidone
117
Is Primadone used as monotherapy or adjunct therapy?
Primarily adjunct, usually with Phenytoin or carbamazepine.
Treats tonic-clonic seizures
Simple Partial seizures
Complex Partial Seizures
118
What type of seizure(s) does Primadone treat?
Tonic-clonic seizures
Simple Partial seizures
Complex Partial Seizures
119
Common Side effects of Primidone?
Sedation, ataxia, dizziness during initial use
Confusion in older adults
Hyperexcitability in children
120
Absolute contraindication for Primidone?
Acute intermittent porphyria
121
Potential serious adverse effects of Primidone?
Acute psychosis, leukopenia, thrombocytopenia, systemic lupus (all rare but possible)
122
Drug-Drug interactions with Primidone?
Same as Phenobarbital
CYP inducing so can decrease the effectiveness of Warfarin and oral contraceptives
CNS Depressants (enhances effect)
123
Is Tiagabine used as monotherapy or adjunct therapy?
ONLY adjunct therapy for:
| Partial seizures in patients at least 12 years old
124
What kind of seizure(s) does Tiagabine treat?
Partial seizures in patients at least 12 years old
125
Common adverse effects of Tiagabine?
Generally well tolerated
dizziness, somnolence, asthenia, nausea, nervousness, tremor
Dose-related cognitive effects
126
Potential serious effects of Tiagabine?
Can cause seizure with off-label use
127
Drug-drug interactions with Tiagabine?
Phenytoin, Phenobarbital, and Carbamazepine (all induce drug-metabolizing enzymes) will decrease levels of Tiagabine
128
Is Zonisamide used for monotherapy or adjunct therapy?
Adjunct for Partial seizures in adults
129
What kind of seizure(s) does Zonisamide treat?
Partial seizures in ADULTS
130
Potential Serious side effects of Zonisamide?
Severe psychiatric effects (severe depression, suicide attempts)
Hypersensitivity reactions-SJS, TEN, fulminant hepatic necrosis
Kidney stones
Metabolic acidosis
Hypohidrosis (decreased sweating) & hyperthermia
131
Drug-Drug Interactions with Zonisamide?
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
Tiagabine is not recommended for patients with which preexisting condition?
Hepatic Impairment
133
What antibiotic chemical family is Zonisamide the same as?
Sulfonamide antibiotics
134
What are contraindications for use of Zonisamide?
Sulfa allergy
| Conditions that contribute to metabolic acidosis
135
What term refers to a group of movement disorders of CNS origin characterized by heightened muscle tone, spasm & loss of dexterity?
Spasticity
136
What are the most common causes of spasticity?
Multiple sclerosis (MS) and cerebral palsy (CP)
137
Which 3 drugs relieve spasticity by actions through the CNS?
Baclofen
Diazepam
Tizanidine
138
Which drug relieves spasticity by acting directly on the skeletal muscle?
Dantrolene
139
Baclofen, indication for use?
Spasticity related to MS and some spinal cord injuries
140
Baclofen MOA?
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
Common adverse effects of Baclofen?
CNS and GI
142
Can baclofen be abruptly withdrawn?
No-does not cause physical dependence but the abrupt withdrawal of oral dosages can cause visual hallucinations, paranoid ideation, and seizures
143
Drug-drug interactions with Baclofen?
Other CNS depressants-increases CNS depressive effects
| Drugs that contribute to increased urinary retention
144
Possible serious adverse effects of Baclofen?
Urinary retention
145
Patients with what preexisting conditions should be cautiously prescribed Baclofen?
Benign Prostatic hypertrophy
Patients taking drugs that increase urinary retention
Patients with hx of schizophrenia or other psychiatric illnesses
146
What is the only benzodiazepine labeled for treating spasticity?
Diazepam
147
Diazepam MOA?
Acts in CNS to suppress spasticity.
| Does not directly affect skeletal muscle
148
Common Adverse effects of Diazepam
Sedation-minimize by using low doses initially
149
What drug directly acts on skeletal muscle to treat spasticity?
Dantrolene
150
Dantrolene MOA?
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
Dantrolene indications for use?
Relieves spasticity associated with MS, CP & spinal cord injury.
Management of muscle contraction and rigidity associated with malignant hyperthermia
152
Suppression of spasticity by Dantrolene has what effect on skeletal muscle strength?
Dantrolene reduces muscle strength which may reduce overall function rather than improve function.
**Risk-benefit analysis is necessary for treatment.
153
How long does it take to determine if treatment of spasticity with Dantrolene will be beneficial?
45 days
154
Black box warning for Dantrolene
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
What action should be taken to decrease the risk of hepatotoxicity from treatment with Dantrolene?
Use the lowest possible effective dose
Frequent monitoring (as the patient may be asymptomatic)
156
Common adverse effects of Dantrolene?
Muscle weakness, drowsiness, and diarrhea are the most common
Less common adverse effects are dysphagia, hoarseness, nausea, vomiting, and ERECTILE DYSFUNCTION
157
What is the term for the involuntary contraction of a muscle or muscle group which is often painful and reduces the ability to function?
Muscle Spasm
158
What two groups of medicines are used to treat acute muscle spasms?
Analgesics
| Centrally acting muscle relaxants
159
Cyclobenzaprine MOA?
Centrally acting skeletal muscle relaxant. The primary action is in the brain stem and causes reduction of tonic motor activity,
160
Cyclobenzaprine indications for use?
Relief of muscle spasm and associated pain
161
What is considered the most effective drug for the relief of muscle spasm and its associated pain?
Cyclobenzaprine
162
Cyclobenzaprine (Flexeril) adverse effects?
CNS depressive symptoms:
drowsiness, dizziness, fatigue-most intense early in treatment
ANTICHOLINERGIC effects (mostly dry mouth, blurred vision, photophobia, urinary retention, and constipation.
163
What class of drugs is Cyclobenzaprine (Flexeril) similar to?
Tricyclic antidepressants
164
Potential serious adverse effects of Cyclobenzaprine (Flexeril)?
Cardiac rhythm disturbances similar to those of tricyclic antidepressants
*Primarily sinus tachycardia and significant conduction delays.
165
Cyclobenzaprine (Flexeril) Drug-drug interactions?
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
What is the indication for use for Tizanidine (Zanaflex)
relief of Spasticity
167
Potential serious adverse reaction of Tizanidine (Zanaflex)?
Liver damage
168
Potential serious adverse effect of metaxalone (Skelaxin)
Liver damage
169
Potential serious adverse effect of Chlorzoxazone (Lorzone)
Hepatitis and potentially fatal hepatic necrosis.
| Risk generally greater than benefit with this drug
170
Chlorzoxazone (Lorzone) indication for use?
Muscle relaxant
171
Potential adverse effects of Chlorzoxazone?
Urine orange to purple-red
172
Methocarbamol indication for use?
Muscle relaxant
173
Methocarbamol contraindications for use?
Seizure disorder
174
Methocarbamol adverse effects?
Urine becomes brown, black, or dark green (dose-related, harmless)
175
Which muscle relaxants have significant anticholinergic effects?
Cyclobenzaprine
| Orphenadrine
176
Potential adverse effects of Tizanidine
dry mouth, hypotension, hallucinations, and psychotic symptoms
Hypotension
*When discontinuing the drug, may need to taper to prevent hypertension
177
Contraindication for Carisoprodol?
Intermittent porphyria
178
What side effects are common among all centrally acting muscle relaxants?
CNS depression
| Risk for physical dependence
179
Which drugs for the treatment of muscle spasms and spasticity are NOT approved for use in children?
Chlorzoxazone,
Orphenadrine
Tizanidine
180
Is Cyclobenzaprine safe for pregnant women?
Generally, yes
181
Is Diazepam safe for pregnant women?
No, it is a teratogen
182
Can drugs for muscle spasms and spasticity be safely taken by breastfeeding women?
No-can cause injury to infants
183
What drugs for muscle spasms and spasticity are listed in the Beers Criteria as potentially inappropriate for older adults?
```
Carisoprodol
Chlorzoxazone
Cyclobenzaprine
Metaxalone
Methocarbamol
Orphenadrine
```
