Quiz 1- pain

Tier 1- brand/generic, therapeutic class, dea class schedule (1 point), Tier 2-dosage forms, indications, efficacy monitoring parameters, MOA, pt counsult (points), Tier 3-

baclofen

lioresal

carisoprodol

soma

cyclobenzaprine

flexeril, amrix, fexmid

methocarbamol

robaxin

tizanidine

zanaflex

celecoxib

celebrex

diclofenac

voltaren

ibuprofen

Motrin, advil

meloxicam

mobic

naproxen

naprosyn

baclofen therapeutic class

centrally acting skeletal muscle relaxant

carisoprodol therapeutic class

centrally acting skeletal muscle relaxant

cyclobenzaprine therapeutic class

centrally acting skeletal muscle relaxant

methocarbamol therapeutic class

centrally acting skeletal muscle relaxant

tizanidine therapeutic class

centrally acting skeletal muscle relaxant

celecoxib therapeutic class

COX-2 inhibitor

diclofenac therapeutic class

NSAID

ibuprofen therapeutic class

NSAID

meloxicam therapeutic class

NSAID

naproxen therapeutic class

NSAID

centrally acting skeletal muscle relaxant drugs

baclofen, carisoprodol, cyclobenzaprine, methocarbamol, tizanidine

COX-2 inhibitor

celecoxib

NSAID drugs

diclofenac, ibuprofen, meloxicam, naproxen

carisoprodol DEA drug class

C-4

baclofen dosage forms

tablet, injectable

carisoprodol dosage forms

tablet

cyclobenzaprine dosage forms

tablet, capsule ER

methocarbamol dosage forms

tablet, injectable

tizanidine dosage forms

tablet, capsule

celecoxib dosage forms

capsule

diclofenac dosage forms

tablet ER, capsule, powder for oral solution

ibuprofen dosage forms

tablet, suspension, capsule, chewable tablet

meloxicam dosage forms

tablet, capsule, suspension

naproxen dosage forms

tablet, tablet DR, tablet ER, capsule, suspension

baclofen indications

muscle spasms, musculoskeletal pain

carisoprodol indications

disorders of the musculoskeletal systems

cyclobenzaprine indications

skeletal muscle spams

methocarbamol indications

muscle spasm, musculoskeletal pain

tizanidine indications

muscle spasticity

celecoxib indications

osteoarthritis, rheumatoid arthritis, acute pain

diclofenac indications

osteoarthritis, rheumatoid arthritis, acute pain

ibuprofen indications

fever, acute pain, headache, osteoarthritis, rheumatoid arthritis, acute gout flare

meloxicam indications

osteoarthritis, rheumatoid arthritis

naproxen indications

fever, acute pain, osteoarthritis, rheumatoid arthritis, acute gout flare

drugs tablet

baclofen, carisoprodol, cyclobenzaprine, methocarbamol, tizanidine, diclofenac (ER), ibuprofen (+ chewable), meloxicam, naproxen (+DR/ER)

drugs capsule

cyclobenzaprine (ER), tizanidine, celecoxib, diclofenac, ibuprofen, meloxicam, naproxen

drugs injectable

baclofen, methocarbamol,

drugs powder for oral solution

diclofenacd

drugs suspension

ibuprofen, meloxicam, naproxen

drugs indication for muscle spasms

baclofen, cyclobenzaprine, methocarbamol, tizanidine

drugs indication for osteoarthritis

celecoxib, diclofenac, ibuprofen, meloxicam, naproxen

drug indication for rheumatoid arthritis

celecoxib, diclofenac, ibuprofen, meloxicam, naproxen

drug indication for acute pain

celecoxib, diclofenac, ibuprofen, naproxen

drug indication for acute gout flare

ibuprofen, naproxen

baclofen EMP

reduction in pain and muscle spasm

carisoprodol EMP

reduction in pain and muscle spasm

methocarbamol EMP

reduction in pain and muscle spasm

tizanidine EMP

reduction in pain and muscle spasm

celecoxib EMP

decreased pain and improved range of motion

ibuprofen EMP

decreased pain and improved range of motion

meloxicam EMP

decreased pain and improved range of motion

naproxen EMP

decreased pain and improved range of motion

baclofen MOA

inhibits monosynaptic and polysynaptic reflexes at the spinal level

carisoprodol MOA

blocks interneuronal activity in descending reticular formation and spinal cord

cyclobenzaprine MOA

relieves local skeletal muscle spasms w/o interfering with muscle function

tizanidine MOA

a2 adrenergic agonist, decreases spasticity by increasing presynaptic inhibition

celecoxib MOA

COX-2 selective inhibitor

diclofenac MOA

nonselective inhibitor of COX1 and COX2

ibuprofen MOA

nonselective inhibitor of COX1 and COX2, reversibly alters platelet function and prolongs bleeding time

meloxicam MOA

nonselective inhibitor of COX1 and COX2, decreased formation of prostaglandin precursor, antipyretic analgesic, and anti-inflammatory, reversibly alters platelet function/prolongs bleeding time

naproxen MOA

nonselective inhibitor of COX1 and COX2

baclofen counseling points

\-do not stop abruptly due to rebound effects

\-additive effect with alcohol and other CNS depressants

carisoprodol counseling points

\-additive effects with alcohol and other CNS depressants

\-pts should be monitored for withdrawal symptoms including seizures

cyclobenzaprine counseling points

\-additive effects with alcohol and other CNS depressants

methocarbamol counseling points

\-additive effects with alcohol and other CNS depressants

tizanidine counseling points

\-additive effects with alcohol and other CNS depressants

\-rise slowly from lying/sitting position bc it can cause hypotension

\-may cause xerostomia and asthenia

celecoxib, diclofenac, ibuprofen, meloxicam, and naproxen counseling points

\-take with food or milk

\-counsel HF pts on NSAID avoidance

\-pregnant women should talk to dr before using

baclofen AE

asthenia, somnolence, confusion

slowed breathing when used in combo with opioids

carisoprodol AE

somnolence, dizziness

slowed breathing when used in combo with opioids

seizure, dependence, withdrawal symptoms upon dc after chronic use

cyclobenzaprine AE

xerostomia, headache, somnolence

slowed breathing when used in combo with opioids

methocarbamol AE

somnolence

slowed breathing when used in combo with opioids

tizanidine AE

hypotension, xerostomia, asthenia, somnolence

slowed breathing when used in combo with opioids

celecoxib AE

**HYPERtension**

GI ulcers/bleeding, thrombosis, elevated LFTs, acute renal failure

diclofenac AE

**SJ syndrome**, GI ulcers/bleeding, thrombosis, elevated LFTs, acute renal failure, **AMI,** anemia

ibuprofen AE

GI bleeding, thrombosis, elevated liver function, acute renal failure, CHF, anemia

meloxicam AE

GI ulcers/bleeding, elevated LFTs, acute renal failure, CHF, anemia

naproxen AE

GI ulcers/bleeding, thrombosis, elevated LFTs, acute renal failure, CHF, anemia

baclofen TMP

severe dizziness, confusion, sedation, or rebound spasticity

carisoprodol TMP

extreme weakness, dizziness, or confusion

cyclobenzaprine TMP

symptoms of hepatic failure during therapy

methocarbamol TMP

extreme weakness, dizziness, or confusion

monitor patient vital signs

tizanidine TMP

monitor BP and other vital signs

celecoxib TMP

monitor CBC, LFTs, CSR, BP, skin rash, black stools

**swelling or weight gain**

diclofenac TMP

monitor CBC, LFT, SCr, skin rash, black stools

**chest pain**

ibuprofen TMP

monitor CBC, LFT, CSr, skin rash, black stools, weight gain, chest pain

meloxicam TMP

monitor CBC, LFT, SCr, skin rash, black stools

chest pain

naproxen TMP

monitor CBC, LFT, SCr, skin rash, black stool, chest pain, and BP if pt has HTN

baclofen, carisoprodol, methocarbamol, and tizandine drug interactions

cns depressants

cyclobenzaprine drug interactions

cns depressants

**anticholinergic agents**

celecoxib, diclofenac, ibuprofen, and meloxicam drug interactions

aspirin, LMWH, SSRI, NSAID

ACEI/ARB, BB, Loop/Thiazide diuretics