Top 200 Drugs: Neurologic Agents, NSAIDs, Opioid Analgesics, and Muscle Relaxants

Comprehensive vocabulary flashcards covering non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, opioid antagonists, and skeletal muscle relaxants from the Week 8 Top 200 drugs review.

Ibuprofen (Advil, Motrin)

A non-selective NSAID indicated for mild to moderate pain, fever, dysmenorrhea, osteoarthritis, and inflammatory/rheumatoid disorders; carries BBWs for serious cardiovascular thrombotic events (contraindicated in CABG perioperative setting) and serious GI events (bleeding, ulceration, perforation).

Naproxen (Naprosyn, Aleve)

A non-selective NSAID indicated for mild-to-moderate pain, fever, primary dysmenorrhea, and inflammatory conditions; notably associated with pseudoporphyria (skin fragility, blistering, and scarring in sun-exposed skin) and delayed-release forms not intended for initial acute pain.

Pseudoporphyria

An adverse effect associated with naproxen characterized by erythema, skin fragility, blistering, and scarring in sun-exposed skin.

Diclofenac (Voltaren, Pennsaid, Flector)

A non-selective NSAID available in oral formulations, topical gels/solutions, and a transdermal patch for arthritis and acute pain; its Flector transdermal patch contains conducting metal (aluminum) and must be removed prior to an MRI.

Flector Patch MRI Precaution

Because the transdermal patch contains conducting metal (aluminum), it must be removed prior to magnetic resonance imaging (MRI) procedures.

Meloxicam (Mobic, Qamzova)

A non-selective NSAID with relative COX-2 selectivity indicated for acute pain (IV) and osteoarthritis or rheumatoid arthritis (PO); orally disintegrating tablet (ODT) formulations are contraindicated in phenylketonuria (PKU).

Celecoxib (Celebrex)

A selective COX-2 inhibitor NSAID indicated for osteoarthritis, ankylosing spondylitis, rheumatoid arthritis, acute migraine, dysmenorrhea, and acute pain; contraindicated in patients with a sulfonamide allergy.

Tramadol (Ultram)

A phenylpropyl amine opioid analgesic indicated for moderate-to-severe acute or chronic pain; contraindicated in children younger than $12$ years and associated with risks of seizures, serotonin syndrome, and hyponatremia.

Codeine/Acetaminophen (Tylenol #2, #3, #4)

An opioid analgesic/non-opioid analgesic combination indicated for mild-to-moderate pain; contraindicated in children younger than $12$ years, in patients younger than $18$ years with ultra-rapid metabolism, and with concurrent or recent (within $14$ days) MAOI use.

Morphine (MS Contin)

A phenanthrene opioid analgesic for moderate-to-severe acute or chronic pain; carries specific BBWs warning against concurrent ethanol use with extended-release capsules and administration risks with neuraxial formulations (Duramorph, Infumorph, Mitigo).

Phenanthrene Derivative Opioid Agonists

A class of opioid agonists that includes codeine, hydrocodone, hydromorphone, levorphanol, morphine, oxycodone, and oxymorphone; patients with hypersensitivity to one agent require caution due to cross-reactivity risks.

Hydrocodone/Acetaminophen (Norco, Lortab)

An opioid analgesic/non-opioid analgesic combination indicated for moderate-to-severe pain; requires monitoring total daily acetaminophen intake to remain below $4\,\text{g}$ per day from all sources.

Oxycodone (Roxicodone, OxyContin)

A phenanthrene opioid analgesic indicated for moderate-to-severe acute or chronic pain; carries a specific FDA alert regarding medication errors resulting from confusion between milligram ($\text{mg}$) and milliliter ($\text{mL}$) dosing with oral solution.

Oxycodone/Acetaminophen (Percocet)

An opioid and non-opioid combination indicated for moderate-to-severe pain; contraindicated in active liver disease, GI obstruction, and acute/severe bronchial asthma in unmonitored settings.

Naloxone (Narcan)

An opioid antagonist indicated for opioid overdose reversal; OTC nasal spray should be administered before calling 911, and adverse effects include acute opioid withdrawal symptoms and combativeness (particularly after fentanyl reversal).

Cyclobenzaprine (Flexeril)

A CNS-acting skeletal muscle relaxant approved for short-term use ($2\text{ to }3$ weeks) for acute musculoskeletal spasms; contraindicated within $14$ days of MAOIs, in acute recovery of MI, arrhythmias, heart failure, and hyperthyroidism.

Methocarbamol (Robaxin)

A CNS-acting skeletal muscle relaxant indicated for short-term ($2\text{ to }3$ weeks) acute musculoskeletal spasm; injectable formulations should be avoided in patients with renal dysfunction.

Tizanidine (Zanaflex)

A CNS spinal cord level alpha-2 adrenergic agonist FDA-approved for spasticity; contraindicated with strong CYP1A2 inhibitors (ciprofloxacin and fluvoxamine), which can increase drug levels $10\times$.

Baclofen (Lioresal)

A CNS spinal cord level GABA-B receptor agonist FDA-approved for spasticity; carries a BBW to avoid abrupt discontinuation of intrathecal therapy, which must not be administered IV, IM, subcutaneous, or into the epidural space.

FDA-Approved Indications for Muscle Relaxants vs. Spasticity Agents

Cyclobenzaprine and methocarbamol are FDA-approved as skeletal muscle relaxants for acute spasms; tizanidine and baclofen are FDA-approved specifically for spasticity (e.g., MS, spinal cord injury) and used off-label for acute spasms.