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MSK > Fibromyalgia, Muscle Relaxers, Spasticity Drugs > Flashcards

Fibromyalgia, Muscle Relaxers, Spasticity Drugs Flashcards

1
Q

Duloxetine

A

Inhibits uptake of SER > NE.

CYP metabolism, esp. CYP2D6.

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2
Q

Milnacipran

A

Inhibits uptake of NE > SER (3x)

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3
Q

Side effects of duloxetine & milnacipran

A

↑ HR & BP
Contraindicated with uncontrolled closed-angle glaucoma & in conjunction with MAOIs.
SIADH, BBW for suicidal ideation.

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4
Q

Pregabalin

A

Inhibits the presynaptic alpha2delta subunit of L-type calcium channels → inhibit excitatory transmission by glutamate.

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5
Q

Side effects of pregabalin

A

Rebound after withdrawal, can cause dependence.
Additive sedation, worsening depression/suicidal ideation.
Dizziness, sedation, blurred vision, xerostomia, esp in elderly.

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6
Q

Drugs for fibromyalgia

A

Duloxetine, milnacipran, pregabalin

Amitriptyline (TCA) & fluoxetine (SSRI) & cyclobenzaprine (muscle relaxer)

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7
Q

Carisoprodol

A

Central CNS action in reticular activating system & spinal cord → sedation and ↓ perception of pain. No direct effect on neuronal conduction.

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8
Q

Side effects of Carisoprodol

A

CYP2C19 metabolism

Drowsiness, dizziness, agitation, insomnia, vertigo, ataxia, asthenia, mydriasis, orthostatic hypotension.

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9
Q

Monitoring with pregabalin

A

serum creatinine

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10
Q

Monitoring with carisoprodol

A

serum creatinine/BUN

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11
Q

Cyclobenzaprine

A

Similar to amitriptyline. Central action, maybe at brain stem.
For muscle spasm & fibromyalgia.

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12
Q

Side effects of cyclobenzaprine

A

CYP3A4, CYP1A2, CYP2D6 metabolism.
Significant anticholinergic action.
Additive CNS depression & anticholinergic activity. GI problems most significant.
Can prolong QT interval.

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13
Q

Methocarbamol

A

Oral, IM, or IV.
Generalized sedative action, altered pain perception.
For muscle spasm & tetanus.

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14
Q

Side effects of methocarbamol

A

Additive CNS depression. Drowsiness, dizziness, lightheadedness, blurred vision, HA, irritability.

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15
Q

Tizanidine

A

Agonist on presynaptic alpha2 receptor → decreased activation of polysynaptic spinal cord motor neurons and reduction in muscle tone.
For MS, spasticity, spinal cord trauma.

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16
Q

Side effects of tizanidine

A

Caution in elderly and renal dz pts.
Hepatocellular toxicity.
Rebound hypertonicity, tachycardia, & HTN after cessation.
Additive CNS depression & hypotension (w/centrally acting agents).

17
Q

Monitoring with tizanidine

A

LFTs

18
Q

Baclofen

A

GABAb agonist in spinal cord → inhibition of excitatory pathways. Inhibition of substance P → pain relief. Higher doses → sedation.
For MS, muscle spasm, spasticity, spinal cord trauma.

19
Q

Side effects of baclofen

A 
BBW: rebound neural activity → seizures, confusion, hallucinations, psychiatric disturbances, spasticity. Taper over 2 weeks. 
Additive CNS depression & hypotension.
↑ blood glucose.
Drowsiness, asthenia, confusion, HA.
CNS toxicity in renal failure.
20
Q

Dantrolene

A

Directly interferes with the ryanodine receptor and calcium release from SR to decrease striated muscle contraction. Uncouples the excitation-contraction process.
For malignant hyperthermia, MS, neuroleptic malignant syndrome, spasticity.

21
Q

Side effects of dantrolene

A 
Can cross placenta → floppy child syndrome if used during C-section. 
Maybe hepatic toxicity.
Additive CNS depression.
IV + CCB can cause Vfib & CV collapse.
Muscle weakness.
22
Q

Monitoring of dantrolene

A

LFTs

23
Q

Drugs used for spasticity

A

Baclofen, botulinum toxin, dantrolene, tizanidine

24
Q

Muscle relaxants

A

Carisoprodol, cyclobenzaprine, methocarbamol, tizanidine

25
Q

Isoquinoline derivative non-depolarizing agents

A

Atracurium, cisatracurium, D-tubocurarine

26
Q

Steroid derivative non-depolarizing agents

A

pancuronium, rocuronium, vecurionium

27
Q

Depolarizing NMB drug

A

succinylcholine

28
Q

NMB drug reversal agents & their anticholinergic

A

Neostigmine - Glycopyrrolate
Edrophonium - atropine
Pyridostigmine - glycopyrrolate

MSK (6 decks)

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