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18 Cards in this Set

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  • Back
Name the main non-benzodiazepine skeletal muscle relaxants
Cyclobenzaprine
Tizanidine
Metaxolone
Methocarbamol
What is the indication for using non-benzodiazepine skeletal muscle relaxants?
Short term, when acetaminophen or NSAID therapy fails.
You can also use them as adjunctive therapy to NSAIDs.
Which two agents are sedating? Which two agents are less sedating?
Cyclobenzaprine/Tizanidine

Metaxolone/Methocarbamol
What is the dose of Cyclobenzaprine and major adverse effects?
5 mg po Tid

Anti-cholinergic effects (Drowsiness, dry mouth, urinary retention, increased intraocular pressure)
What is the dose of Tizanidine and major adverse effects?
4 mg po daily

Hypotension, sedation, dry mouth
Hepatotoxicity

***Tizanidine has both anti-spasmodic and anti-spastic properties***
What is the dose and major adverse effects of Metaxolone?
800 mg po Tid

Minimal side effects, but no recommended in patients with hepatic, renal failure or a history of anemia

***This drug isn't really much better than placebo***
What is the dose and major adverse effects of Methocarbamol?
500 mg po Tid

Sedation, Dizziness, Drowsiness
In what patients do you want to avoid Cyclobenzaprine?
Eldery
Glaucoma
Patients taking Tramadol (Seizures)
Cardiovascular disease (CHF, Recent MI, Arrhythmia)
Why has Carisoprodol fallen out of favor?
Because of its abuse potential
In selecting an agent to treat back pain (who has failed NSAID therapy) in a normal healthy patient, which two agents would be best?
Either Cyclobenzaprine or Methocarbamol
What NSAID would you want to choose in combination?
You could do Ibuprofen 800 mg Tid
How would you counsel this patient?
Warn about drowsiness and sedation, especially in combination with alcohol or opiods
Caution taking before operating machinery.
Should see relief in 1-4 days - Not recommended for more than 2 weeks
How would you monitor for efficacy and toxicity?
Efficacy - Pain

Toxicity - Drowsiness, sedation
What is the difference in action between anti-spastic agents like Baclofen and the anti-spasmodic agents?
Anti-spastic agents work at the level of the spinal cord to decrease neuronal firing and relax muscles. This is why they are more beneficial in those with spinal cord related injuries.
Anti-spasmodic agents work at the level of the brain stem.
What is the dose of Baclofen?
10 mg po Tid
Which agent would you go with in a patient who you are concerned about abuse potential with?
Methocarbamol - Works well with small abuse potential.
Random Facts:
Methocarbamol has less dizziness and drowsiness than the other muscle relaxants. It also may change the color of your urine to a brown/green

Cyclobenzaprine is a pregnancy category B, where the rest are pregnancy category C
With what drugs do you want to avoid using Tizanidine?
CYP 1A2 Inhibitors (Ciprofloxacin, Fluvoxamine)