1. Drug List 13 Mod 200 Pharmacology lecture

2. Centrally acting skeletal muscle relaxants Brand: Lioresal Generic: baclofen (back-lo-fen) Classification: muscle relaxant Indications: relief of muscle spasticity resulting from MS or spinal cord injury/disease. Baclofen is NOT indicated for use in rheumatic disorders, stroke, cerebral palsy or parkinsons. Off label use in intractable hiccoughs, trigeminal neuralgia (Trigeminal neuralgia is a painful condition of the nerve responsible for most facial sensation.) Action: decreases frequency and severity of muscle spasms Warnings: D/D, constipation, no alcohol. Intrathecal: should only be used if unresponsive to PO or have intolerable CNS side effects. Black box warning about sudden withdrawal causing rebound spasticity, altered mental states, even death

3. Brand : Soma Generic : carisoprodol (car-iss-oh-pro-dol) Classification : muscle relaxant Indications: relief of discomfort associated with acute, painful musculoskeletal conditions in adults. Indicated for short term use only. Action: Does not directly relax tense skeletal muscles. In animals, it depresses the CNS by blocking interneuronal activity in the spinal cord, producing sedation. Metabolizes into meprobamate (CIV) Warnings: D/D, n&v, no alcohol. Drug interactions: alcohol, TCAs, phenothiazines

4. Brand: Flexeril Generic: cyclobenzaprine (cy-cloh-benz-ah-preen) Classification: muscle relaxant Indications: relief of muscle spasm associated with acute, painful musculoskeletal conditions. Not effective for muscle spasm due to CNS disease. Off label: fibromyalgia Action: relieves muscle spasm of local origin without interfering with muscle function. Warnings: cyclobenzaprine is structurally similar to TCAs. Do not use w/in 14 days of MAOIs. Avoid abrupt cessation, taper over 1-2 weeks. Avoid alcohol, D/D.

5. Brand: Robaxin Generic: methocarbamol (meth-oh-car-bah-mol) Classification: muscle relaxant Indications: relief of muscle spasm associated with acute, painful musculoskeletal conditions. Action: works in the spinal cord causing skeletal muscle relaxation Warnings: avoid abrupt cessation, taper over 1-2 weeks. Urine discoloration of green, black or brown is possible. Avoid alcohol, D/D. IV use: recumbent position may reduce the incidence of side reactions. Rate of injection should not exceed 3ml/minute. Methocarbamol is a hypertonic solution and vascular extravasation must be avoided

6. Brand name: Skelaxin Generic name: Metaxalone Classifications: muscle relaxant Indication: relief of muscle spasm associated with acute, painful musculoskeletal conditions. Action: general CNS depression. Warnings: avoid alcohol, D/D.

7. Brand name: Zanaflex Generic name: Tizanidine Class: muscle relaxant Indication: management of muscle spasticity Action: alpha-2 adrenergic receptor agonist. Reduces facilitation of spinal motor neurons. Warnings: D/D, avoid alcohol. May cause hypotension. Drug interactions: CYP1A2 inhibitors, cipro, fluvoxamine

8. Anticonvolsants FDA medwatch bulletin on antiepileptic from 2008-refers to suicidality risk with antiepileptic medications. Brand: Depakote Generic: divalproex (div-al-pro-ex) Classification: anticonvulsant Indications: seizure control, manic episodes in bipolar disorder, migraine prophylaxis. Action: carboxylic acid antiepileptic. Exact mechanism of action is unknown, it is thought to affect brain concentrations of GABA

9. Depakote cont. Warnings: black box warning about possible liver failure, teratogenic effects ( neural tube defects), pancreatitis. Avoid alcohol, antacids, dairy products. May cause false positive urine test for ketones. Do not take medication with carbonated beverages. Drug interactions: alcohol, antacids, carbamazepine, clonazepam, diazepam, erythromycin, lamotrigine, olanzapine, phenytoin,TCAs, warfarin, AZT Do not discontinue abruptly

10. Brand: Neurontin Generic: gabapentin (gah-bah-pen-tin) Classification: anticonvulsant Indications: Epilepsy, postherpetic neuralgia. Off-label: treatment of tremors associated with MS, bipolar disorder. Postmenopausal or cancer related hot flashes, neuralgia Action: mechanism of action is unknown. Warnings: D/D, do not take with antacids, avoid alcohol Drug interactions: antacids, morphine, BCPs, alcohol Taper slowly

11. Brand: Luminal (CIV) Generic: phenobarbitol (feen-oh-bar-bih-tol) Classification : anticonvulsant Indications: anticonvulsant for the treatment of generalized and partial seizures. Emergency control of acute seizure disorders due to status epilepticus, meningitis, tetanus, eclampsia, toxicity of local anesthetics. May be used investigationally for hyperbilirubinema and chronic cholestasis Action : decreases impulse transmission and increases seizure threshold at cerebral cortex Warnings: avoid alcohol and CNS depressants. May cause pardoxic excitement in the elderly. May accentuate emotional disturbances and phobias. Irritability, hyperactivity may occur in children. Drug interactions: alcohol, MAOIs, BCPs, anticonvulsants

12. Brand: Dilantin Generic: phenytoin (fehn-ee-toyn) Classification : anticonvulsant Indications: generalized tonic-clonic (grand mal), simple partial and complex partial seizures. Prevention of seizures following head trauma/neurosurgery. Ventricular arrhythmias. Action: inhibits spread of seizure activity in the motor cortex. Warnings: avoid alcohol. Practice good dental hygiene to minimize development of gingival hyperplasia. Drug interactions : numerous! Various dosage forms are not interchangeable