NAPLEX Top Drugs > Analgesics and Pain Management > Flashcards

Analgesics and Pain Management Flashcards

Review key medications used in treating pain, including opioids, NSAIDs, and adjuvant agents, with focus on indications, safety, and dosing. (37 cards)

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1
Q

What is the common brand name(s) for:

acetaminophen

(uh-SEE-tuh-MIN-uh-fen)

A

Tylenol

Class: Non-opioid analgesic, antipyretic

Indication: Mild to moderate pain; fever; migraines

Dosage: 10–75 mg/kg/day

MOA: Likely inhibits COX enzymes in the CNS and acts on the hypothalamus to reduce fever

Side Effects: Rash; liver toxicity; anemia (oral); hypotension (IV)

Contraindications: Hypersensitivity to the drug or its components

Considerations:

  • Treat overdose with N-acetylcysteine
  • Can be used in pregnancy and breastfeeding
  • Chronic use for migraines may lead to refractory headache
  • Caution with chronic alcohol use and liver impairment

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2
Q

What is the common brand name(s) for:

acetaminophen; codeine

(uh-SEE-tuh-MIN-uh-fen; KOH-deen)

A

Tylenol #3, Tylenol #4

Class: Non-opioid analgesic, antipyretic; Opioid analgesic

Indication: Moderate to moderately severe pain; postoperative pain; injury-related pain

Dosage: 1-2 tablets/day

MOA: Acetaminophen inhibits COX in the CNS, reducing pain and fever. Codeine is metabolized into morphine, binds to mu-opioid receptors, providing pain relief and suppressing cough.

Side Effects: Nausea and vomiting; constipation; dependence; drowsiness; anxiety; hepatotoxicity

Contraindications: Respiratory depression; head injury; increased intracranial pressure (ICP); alcoholism; hepatic impairment; renal impairment

Considerations:

  • Schedule III (Tylenol #3); Schedule IV (Tylenol #4)
  • Caution in pregnancy
  • Risk of respiratory depression

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3
Q

What is the common brand name(s) for:

acetaminophen; hydrocodone

(uh-SEE-tuh-MIN-uh-fen; HYE-droe-KOH-doan)

A

Norco, Vicodin, Lortab

Class: Non-opioid analgesic, antipyretic; Opioid analgesic

Indication: Moderate to severe pain

MOA: Provides synergistic analgesia by targeting pain through different mechanisms: hydrocodone reduces pain perception at the CNS level, while acetaminophen inhibits prostaglandin production in the brain to reduce pain sensation.

Side Effects: Nausea and vomiting; constipation; dependence; drowsiness; anxiety; ototoxicity

Contraindications: MAOIs within 14 days; paralytic ileus or GI obstruction; severe hepatic or renal impairment; acute asthma or COPD without ventilatory support

Considerations:

  • Schedule II controlled substance
  • High potential for abuse, addiction, and dependence
  • Respiratory Depression Risk: Monitor for signs of slowed breathing, cyanosis, and hypoxia
  • Hepatotoxicity: Especially with high doses or chronic use
  • Risk of profound sedation, respiratory depression, coma, and death
  • Use with cytochrome P450 3A4 (CYP3A4) inhibitors can increase hydrocodone levels and risk of toxicity
  • Dose adjustments may be necessary in patients with kidney or liver dysfunction
  • Caution in pregnancy and breastfeeding

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4
Q

What is the common brand name(s) for:

acetaminophen; oxycodone

(uh-SEE-tuh-MIN-uh-fen; OX-ee-KOH-doan)

A

Percocet, Endocet, Roxicet

Class: Non-opioid analgesic, antipyretic; Opioid analgesic

Indication: Moderate to severe pain

MOA: Synergistic analgesia: oxycodone binds to mu-opioid receptors in the CNS, inhibiting pain perception; acetaminophen inhibits prostaglandin synthesis in the CNS and blocks pain impulse generation.

Side Effects: Nausea and vomiting; constipation; dependence; drowsiness; anxiety

Contraindications: Severe respiratory depression, acute or severe bronchial asthma, gastrointestinal obstruction, significant hepatic impairment, increased intracranial pressure/head trauma

Considerations:

  • Schedule II controlled substance
  • High potential for abuse, addiction, and dependence
  • Respiratory Depression Risk: Monitor for signs of slowed breathing, cyanosis, and hypoxia
  • Hepatotoxicity: Especially with chronic use or high doses
  • Risk of profound sedation, respiratory depression, coma, and death
  • Caution in pregnancy and breastfeeding

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5
Q

What is the common brand name(s) for:

baclofen

(BAK-loe-fen)

A

Lioresal

Class: Muscle relaxant - centrally acting

Indication: Spasticity; Off-label: Intractable hiccups; musculoskeletal pain; alcohol use disorder

Dosage: 5–80 mg/day

MOA: GABA-B receptor agonist that reduces motor neuron excitability and inhibits synaptic reflexes in the spinal cord

Side Effects: Confusion; constipation; depression; dizziness; fatigue; weakness; hypotension; hallucinations; erectile dysfunction

Contraindications:

  • Oral use: Active peptic ulcer
  • Intrathecal use: Coagulation disorders

Considerations:

  • Do not discontinue abruptly due to risk of withdrawal symptoms

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6
Q

What is the common brand name(s) for:

buprenorphine

(BYOO-preh-NOR-feen)

A

Subutex, Belbuca, Butrans

Class: Opioid receptor partial agonist

Indication: Outpatient treatment of opioid dependence; chronic pain

MOA: Partial agonist at mu-opioid receptor with slow dissociation, providing longer action than other opioids

Side Effects: Dependence; respiratory depression; headache; miosis; urinary retention; nausea and vomiting

Contraindications: Underlying respiratory disease; concurrent benzodiazepine use

Considerations:

  • Schedule III controlled substance
  • IV/SC administration leads to high bioavailability
  • Oral administration leads to very low bioavailability
  • Rapidly travels through the blood-brain barrier
  • Some studies show usefulness in treating treatment-resistant depression

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7
Q

What is the common brand name(s) for:

buprenorphine; naloxone

(BYOO-preh-NOR-feen; nal-OX-own)

A

Suboxone, Zubsolv

Class: Partial opioid agonist (buprenorphine); Opioid antagonist combination (naloxone)

Indication: Opioid dependence

MOA: Combination: buprenorphine acts as a partial agonist at the mu-opioid receptor and antagonist at the kappa-opioid receptor, reducing opioid craving and withdrawal symptoms without full opioid effects. Naloxone is a pure opioid antagonist at the mu-opioid receptor, deterring abuse by facilitating withdrawal symptoms if injected.

Side Effects: Headache; nausea; vomiting; constipation; insomnia; sweating; dizziness; respiratory depression; QT prolongation

Contraindications: Severe respiratory depression; gastrointestinal obstruction; severe hepatic impairment

Considerations:

  • Schedule III controlled substance
  • Caution in pregnancy
  • Risk of respiratory depression

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8
Q

What is the common brand name(s) for:

carisoprodol

(ka-RISS-oh-PRO-dol)

A

Soma

Class: Muscle relaxant - centrally acting

Indication: Muscle spasms caused by musculoskeletal conditions (short-term)

MOA: Changes interneuronal activity within the spinal cord and descending reticular formation, inducing muscle relaxation—likely through alterations to GABA function via modulation of GABA subunits.

Side Effects: Drowsiness; insomnia; anxiety; headache; dizziness; tachycardia; hypotension; pancytopenia

Contraindications: History of acute intermittent porphyria

Considerations:

  • Schedule IV controlled substance
  • Long-term use may precipitate withdrawal if stopped abruptly
  • Use caution in patients with a history of drug or alcohol abuse

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9
Q

What is the common brand name(s) for:

celecoxib

(SELL-eh-kox-ib)

A

Celebrex

Class: Nonsteroidal Anti-inflammatory Drug (NSAID)

Indication: Acute pain; primary dysmenorrhea; osteoarthritis; rheumatoid arthritis; ankylosing spondylitis

MOA: Selectively and non-competitively inhibits cyclooxygenase-2 (COX-2), reducing thromboxane and prostaglandin synthesis, thus decreasing pain sensation and inflammation.

Side Effects:

  • Common: Bruising; diarrhea; abdominal pain; nausea/vomiting; GERD; URI; sinusitis; increased LFTs
  • Less Common: GI perforation or ulceration; skin reactions; agranulocytosis; edema

Contraindications: Perioperative pain from CABG; history of adverse reactions to NSAIDs; asthma; GI bleeding or ulceration risk; bleeding disorders

Considerations:

  • Does not inhibit platelet aggregation (no effect on COX-1)
  • Teratogenic—avoid in pregnancy
  • Use caution in renal impairment; reduce dose in hepatic impairment
  • Metabolized primarily by liver enzyme CYP450 2C9
  • Use caution in the elderly, patients with severe cardiac disease, or those with hypovolemia

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10
Q

What is the common brand name(s) for:

cyclobenzaprine

(SY-kloe-BEN-zuh-preen)

A

Flexeril, Amrix

Class: Muscle relaxant - centrally acting

Indication: Muscle spasms

MOA: Central nervous system depression; acts on brainstem nuclei to reduce tonic somatic motor activity, which helps alleviate muscle spasm. Structurally related to tricyclic antidepressants (TCAs).

Side Effects: Sedation; dizziness; drowsiness; dry mouth; blurred vision; constipation; urinary retention

Contraindications: Concurrent MAOI use; caution or contraindicated in patients with significant arrhythmias, congestive heart failure, or hyperthyroidism; caution in patients with narrow-angle glaucoma

Considerations:

  • Generally recommended for short-term use (2–3 weeks) due to side effects and risk of tolerance

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11
Q

What is the common brand name(s) for:

diclofenac

(dye-KLOE-fen-ak)

A

Voltaren

Class: Nonsteroidal Anti-inflammatory Drug (NSAID)

Indication: Used to treat mild to moderate pain; migraines; osteoarthritis; primary dysmenorrhea; rheumatoid arthritis; juvenile idiopathic arthritis; ankylosing spondylitis

MOA: Reversibly inhibits COX-1 and COX-2 enzymes, reducing prostaglandin and thromboxane production—thus decreasing pain, inflammation, and fever, and inhibiting platelet aggregation.

Side Effects:

  • Common: GI ulceration and bleeding; GI distress; rash; nausea; elevated LFTs
  • Less common: Agranulocytosis; thrombocytopenia; hepatotoxicity; Stevens-Johnson syndrome

Contraindications: Perioperative pain for CABG; GI bleeding or ulceration risk; history of adverse reactions to NSAIDs

Considerations:

  • Use the lowest effective dose
  • Long-term use may require a gastro-protective agent
  • Avoid in pregnancy unless necessary
  • Avoid in severe renal or hepatic impairment
  • Caution in elderly and those with severe cardiac disease

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12
Q

What is the common brand name(s) for:

etodolac

(ee-TOE-doh-lak)

A

Lodine

Class: Nonsteroidal Anti-inflammatory Drug (NSAID)

Indication: Treats mild to moderate pain; osteoarthritis; rheumatoid arthritis; juvenile idiopathic arthritis

MOA: Inhibits COX-2 more selectively than typical NSAIDs, reducing gastrointestinal side effects

Side Effects:

  • Common: GI ulceration and bleeding; GI distress; rash; nausea; elevated LFTs
  • Less common: Agranulocytosis; thrombocytopenia; hepatotoxicity

Contraindications: Perioperative pain for CABG; GI bleeding or ulceration risk; history of adverse reactions to NSAIDs

Considerations:

  • Use the lowest effective dose
  • Long-term use may require a gastro-protective agent
  • Avoid in pregnancy unless necessary
  • Avoid in severe renal or hepatic impairment
  • Caution in elderly and those with severe cardiac disease

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13
Q

What is the common brand name(s) for:

fentanyl

(FEN-tuh-nil)

A

Duragesic, Sublimaze, Actiq

Class: Synthetic opiate agonist

Indication: Used for moderate to severe pain; surgical or obstetric analgesia and anesthesia; postoperative analgesia

MOA: Opioid agonist that binds to mu-opioid receptors with high affinity, providing spinal analgesia and respiratory depression

Side Effects: Chest wall rigidity; respiratory depression; arrhythmia; constipation; nausea; confusion

Contraindications: Respiratory depression; raised intracranial pressure (ICP); head injury; comatose patients

Considerations:

  • Schedule II controlled substance
  • Overdose can be reversed with IV naloxone
  • Highly lipid soluble

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14
Q

What is the common brand name(s) for:

hydrocodone

(HYE-droe-KOH-doan)

A

Hysingla ER, Zohydro ER

Class: Semisynthetic opioid analgesic

Indication: Used for acute mild to moderate pain

MOA: Highly selective agonist action at mu-opioid receptors

Side Effects: Nausea; vomiting; constipation; dependence; drowsiness; anxiety

Contraindications: Respiratory depression; head injury; raised intracranial pressure (ICP)

Considerations:

  • Schedule II controlled substance
  • Some conversion to more potent hydromorphone in the liver
  • Caution in pregnancy

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15
Q

What is the common brand name(s) for:

hydromorphone

(HYE-droe-MOR-foan)

A

Dilaudid, Exalgo

Class: Semisynthetic opioid analgesic

Indication: Used for severe pain

MOA: Potent opioid agonist binding to mu-opioid receptors, altering pain perception and response

Side Effects: Sedation; dizziness; euphoria; respiratory depression; nausea; constipation

Contraindications: Respiratory depression; use in non-opioid-tolerant patients

Considerations:

  • Schedule II controlled substance
  • Dose titration needed in opioid-naïve patients
  • Use caution with CNS depressants

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16
Q

What is the common brand name(s) for:

ibuprofen

(eye-BYOO-proe-fen)

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A

Advil, Motrin

Class: Nonsteroidal Anti-inflammatory Drug (NSAID)

Indication: Used for mild to moderate pain; fever; migraines

MOA: Reversibly inhibits COX-1 and COX-2 enzymes, reducing prostaglandin and thromboxane production—thus decreasing pain, inflammation, and fever

Side Effects:

  • Common: GI ulceration and bleeding; GI distress; rash; nausea; elevated LFTs
  • Less common: Agranulocytosis; thrombocytopenia; hepatotoxicity

Contraindications: Perioperative pain for CABG; GI bleeding or ulceration risk; history of adverse reactions to NSAIDs

Considerations:

  • Use the lowest effective dose
  • Long-term use may require a gastro-protective agent
  • Avoid in pregnancy unless necessary
  • Avoid in severe renal or hepatic impairment
  • Caution in elderly and those with severe cardiac disease

17
Q

What is the common brand name(s) for:

indomethacin

(in-doh-METH-uh-sin)

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A

Indocin

Class: Nonsteroidal Anti-inflammatory Drug (NSAID)

Indication: Acute pain; moderate to severe inflammatory disorders; patent ductus arteriosus closure; acute gout flares; bursitis; dysmenorrhea

MOA: Reversibly inhibits COX-1 and COX-2 enzymes, decreasing prostaglandin and thromboxane production

Side Effects: Nausea and vomiting; GI bleeding or ulceration; arrhythmias; decreased appetite

Contraindications: Perioperative pain for CABG; history of adverse reactions to NSAIDs; asthma; proctitis

Considerations:

  • Use the lowest effective dose
  • Avoid in pregnancy unless necessary
  • Avoid in severe renal or hepatic impairment
  • Caution in elderly, those with severe cardiac disease, or hypovolemia

18
Q

What is the common brand name(s) for:

ketorolac

(kee-TOE-roe-lak)

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A

Toradol

Class: Nonsteroidal Anti-inflammatory Drug (NSAID)

Indication: Short-term use for acute moderate to severe pain; anti-inflammatory following eye surgery

MOA: Reversibly inhibits COX-1 and COX-2 enzymes, decreasing prostaglandin and thromboxane production

Side Effects: GI ulceration and bleeding; GI distress; rash; nausea; elevated LFTs; ocular inflammation; retinal hemorrhage

Contraindications: Severe renal impairment; high risk of bleeding; major surgery or labor and delivery; pediatrics

Considerations:

  • Useful in neonates for severe pain where opioids cannot be used
  • Avoid in pregnancy unless necessary
  • Avoid in hepatic or renal failure
  • Use >5 days may lead to irreversible renal failure
  • Caution in elderly, low body weight, or any renal impairment

19
Q

What is the common brand name(s) for:

lidocaine

(LYE-doh-kane)

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A

Xylocaine, Lidoderm

Class: Local anesthetic

Indication: Nerve block; epidural; spinal anesthesia; relief of pain from mouth ulcers; ventricular arrhythmias

MOA: Lengthens inactivation of voltage-gated Na+ channels, delaying action potential firing

Side Effects: Nervousness; tremor; paresthesia; headache; cardiac arrest

Contraindications: Severe cardiac disease

Considerations:

  • More pronounced effect on ischemic tissue than normal tissue

20
Q

What is the common brand name(s) for:

meloxicam

(meh-LOX-ih-kam)

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A

Mobic

Class: Nonsteroidal Anti-inflammatory Drug (NSAID)

Indication: Mild to moderate pain; osteoarthritis; rheumatoid arthritis; juvenile idiopathic arthritis

MOA: Inhibits COX-2 more selectively than typical NSAIDs

Side Effects: GI ulceration and bleeding; GI distress; rash; nausea; elevated LFTs

Contraindications: Perioperative pain for CABG; history of adverse reactions to NSAIDs; asthma

Considerations:

  • Use the lowest effective dose
  • Long-term administration requires a gastro-protective agent
  • Avoid in pregnancy unless necessary
  • Avoid in severe renal or hepatic impairment
  • Caution in elderly, those with severe cardiac disease, or hypovolemia

21
Q

What is the common brand name(s) for:

meperidine

(meh-PAIR-ih-deen)

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A

Demerol

Class: Synthetic opiate agonist

Indication: Analgesia for obstetric or post-surgical analgesia; acute pain; post-operative shivering

MOA: Binds to mu-opioid receptors for analgesia, and kappa-opioid receptors to combat post-operative shivering

Side Effects: Less constipation; high doses can cause CNS excitation, convulsions, and tremors

Contraindications: Pheochromocytoma; raised intracranial pressure (ICP); head injury; respiratory depression

Considerations:

  • Schedule II controlled substance
  • Avoid in severe hepatic or renal impairment
  • Avoid abruptly stopping therapy due to withdrawal symptoms

22
Q

What is the common brand name(s) for:

metaxalone

(meh-TAX-uh-lone)

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A

Skelaxin

Class: Muscle relaxant - centrally acting

Indication: Muscle spasms

MOA: Central nervous system depression, reducing neuronal excitability and decreasing skeletal muscle hyperactivity

Side Effects: Drowsiness; dizziness; headache; nausea

Contraindications: Hypersensitivity to drug or its components

Considerations:

  • Generally recommended for short-term use (2–3 weeks)
  • Caution in liver disease
  • CNS depressant effects

23
Q

What is the common brand name(s) for:

methadone

(METH-uh-doan)

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A

Dolophine

Class: Synthetic opiate agonist

Indication: Treat opioid dependence or chronic pain; prevent craving for heroin or other opioids

MOA: Mimics endogenous opioids by binding to mu-opioid receptors

Side Effects: Arrhythmias; confusion; constipation; hyperhidrosis; hallucination; euphoria

Contraindications: Pheochromocytoma; raised intracranial pressure (ICP); head injury; respiratory depression

Considerations:

  • Schedule II controlled substance
  • Extremely soluble in fat and slowly metabolized

24
Q

What is the common brand name(s) for:

methocarbamol

(METH-oh-KAR-buh-mawl)

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A

Robaxin

Class: Muscle relaxant - centrally acting

Indication: Muscle spasm (short-term use)

MOA: Unknown mechanism of action; causes general CNS depression

Side Effects: Angioedema; bradycardia; dyspepsia; flushing; seizures

Contraindications: Brain damage; coma; epilepsy; myasthenia gravis

Considerations:

  • Advise not to drive or use heavy machinery due to heavy sedation

25
# What is the common brand name(s) for: morphine | (MOR-feen)
MS Contin, Roxanol | Class: Opioid analgesic ## Footnote **Indication:** Severe pain associated with trauma, myocardial infarction (MI), and cancer **MOA:** Full agonist at opioid receptors **Side Effects:** Arrhythmias; confusion; constipation; hyperhidrosis; hallucination; euphoria **Contraindications:** Pheochromocytoma; raised intracranial pressure (ICP); head injury; respiratory depression; acute abdomen; cor pulmonale **Considerations:** * Schedule II controlled substance * Overdose is treated with intravenous naloxone * Reduce dose in hepatic or renal impairment * Therapeutic doses are acceptable when breastfeeding
26
# What is the common brand name(s) for: nabumetone | (na-BOO-meh-tone)
Relafen | Class: Nonsteroidal Anti-inflammatory Drug (NSAID) ## Footnote **Indication:** Osteoarthritis; rheumatoid arthritis; pain **MOA:** Inhibits COX enzymes, reducing prostaglandin synthesis **Side Effects:** Dyspepsia; abdominal pain; nausea; diarrhea; GI bleeding; headache; dizziness; skin rashes; hepatotoxicity (rare) **Contraindications:** Active gastrointestinal disease; third trimester of pregnancy **Considerations:** * May have prodrug advantage of lower incidence of GI irritation * Regular monitoring is advised for long-term therapy * Take medication with food
27
# What is the common brand name(s) for: nalbuphine | (NAL-byoo-feen)
Nubain | Class: Opioid agonist-antagonist ## Footnote **Indication:** Obstetric analgesia **MOA:** Kappa-receptor partial agonist; mu-receptor partial agonist **Side Effects:** Nausea and vomiting; dizziness; euphoria; hallucinations; bradycardia; respiratory depression; urticaria **Contraindications:** Pheochromocytoma; raised intracranial pressure (ICP); head injury; respiratory depression **Considerations:** * Half-life is around 5 hours * Only opioid analgesic not a controlled substance in the US
28
# What is the common brand name(s) for: naproxen | (NAP-ruh-sen)
Aleve, Naprosyn | Class: Nonsteroidal Anti-inflammatory Drug (NSAID) ## Footnote **Indication:** Anti-inflammatory and analgesia for musculoskeletal disorders; acute gout; dysmenorrhea; migraine **MOA:** Reversibly inhibits COX-1 and COX-2 enzymes, decreasing prostaglandin and thromboxane production **Side Effects:** GI ulceration and bleeding; GI distress; rash; nausea; elevated LFTs **Contraindications:** Perioperative pain for CABG; history of adverse reactions to NSAIDs; asthma **Considerations:** * Use the lowest effective dose * Long-term administration requires a gastro-protective agent * Avoid in pregnancy unless necessary * Avoid in severe renal or hepatic impairment * Caution in elderly, those with severe cardiac disease, or hypovolemia
29
# What is the common brand name(s) for: oxycodone | (OX-ee-KOH-doan)
OxyContin, Roxicodone | Class: Semisynthetic opioid analgesic ## Footnote **Indication:** Moderate or severe pain; patient-controlled analgesia **MOA:** Selective mu-receptor agonist **Side Effects:** Anxiety; depression; hiccups; diarrhea; tremor; arrhythmias; constipation; confusion; euphoria; hyperhidrosis; respiratory depression; nausea and vomiting **Contraindications:** Raised intracranial pressure (ICP); head injury; respiratory depression; acute abdomen; cor pulmonale **Considerations:** * Schedule II controlled substance * Avoid if breastfeeding * Reduce dose by 50% in mild hepatic disease * Administer no more than 2.5 mg every 6 hours if not currently taking opioids
30
# What is the common brand name(s) for: oxymorphone | (OX-ee-MOR-foan)
Opana | Class: semisynthetic opioid analgesic ## Footnote **Indication:** Severe pain **MOA:** Potent mu-opioid receptor agonist **Side Effects:** Sedation; dizziness; confusion; euphoria; risk of respiratory depression; nausea; vomiting; constipation; dry mouth; hypotension **Contraindications:** Respiratory depression; acute or severe asthma; paralytic ileus **Considerations:** * Schedule II controlled substance * High potential for misuse and dependence * Regular monitoring for respiratory function and sedation levels is recommended * Use with other CNS depressants may potentiate adverse effects
31
# What is the common brand name(s) for: piroxicam | (peer-OX-ih-kam)
Feldene | Class: Nonsteroidal Anti-inflammatory Drug (NSAID) ## Footnote **Indication:** Osteoarthritis; rheumatoid arthritis; pain **MOA:** Non-selectively inhibits COX-1 and COX-2 enzymes **Side Effects:** Dyspepsia; nausea; abdominal pain; increased risk of GI bleeding; renal impairment; edema; skin reactions; headache; dizziness **Contraindications:** Gastrointestinal issues; severe organ impairment **Considerations:** * Long half-life allows for once-daily dosing * Consider gastroprotective strategies in at-risk patients
32
# What is the common brand name(s) for: rizatriptan | (RYE-zuh-trip-tan)
Maxalt | Class: Serotonin 5-HT1B,1D Receptor Agonist ## Footnote **Indication:** Migraine **MOA:** Selectively stimulates 5-HT1B/1D receptors, leading to cranial blood vessel vasoconstriction **Side Effects:** Dizziness; fatigue; somnolence; nausea; dry mouth **Contraindications:** History of significant cardiovascular events; cerebrovascular disease; hemiplegic or basilar migraine **Considerations:** * Cardiovascular risk factors should be carefully evaluated before initiating therapy
33
# What is the common brand name(s) for: sumatriptan | (SOO-muh-trip-tan)
Imitrex | Class: Serotonin 5-HT1B,1D Receptor Agonist ## Footnote **Indication:** Migraine headaches; cluster headaches; cyclic vomiting syndrome **MOA:** Acts as agonist at 5-HT1D/1B serotonin receptors **Side Effects:** Chest tightness; weakness; somnolence; dizziness; abnormal tingling and burning sensation **Contraindications:** Angina; uncontrolled hypertension; use of ergot within the previous 24 hours **Considerations:** * Should not be used regularly, as continued use may lead to rebound headaches
34
# What is the common brand name(s) for: tapentadol | (ta-PEN-tuh-dol)
Nucynta | Class: Opioid agonist ## Footnote **Indication:** Moderate to severe pain **MOA:** Mu-opioid receptor agonist; norepinephrine reuptake inhibitor (NRI) **Side Effects:** Nausea and vomiting; headache; fatigue; malaise; hypotension; respiratory depression; seizures **Contraindications:** Suspected raised intracranial pressure (ICP); epilepsy; history of seizures; pancreatitis; asthma **Considerations:** * Schedule II controlled substance * 18× less potent than morphine * Not enough evidence for use in pregnancy
35
# What is the common brand name(s) for: tizanidine | (tye-ZAN-ih-deen)
Zanaflex | Class: Muscle relaxant - centrally acting ## Footnote **Indication:** Muscle spasms **MOA:** Activates presynaptic α2-adrenergic receptors in the spinal cord, inhibiting the release of excitatory neurotransmitters and reducing muscle spasticity and tone **Side Effects:** Sedation; dizziness; drowsiness; hypotension; bradycardia; dry mouth; weakness; fatigue; liver enzyme elevations **Contraindications:** Significant hepatic dysfunction; severe hypotension or bradycardia **Considerations:** * Primarily metabolized by CYP1A2; drug interactions can increase plasma levels * Caution advised when combining with other CNS depressants such as alcohol
36
# What is the common brand name(s) for: tramadol | (TRAM-uh-dol)
Ultram | Class: Opioid analgesic ## Footnote **Indication:** Moderate to severe pain (especially chronic); post-operative pain **MOA:** Mu-opioid receptor agonist; serotonin/norepinephrine reuptake inhibitor (SNRI); binds to kappa and delta opioid receptors with weak affinity **Side Effects:** Lower risk of cardiovascular and respiratory depression than with other opioids (minimal risk at therapeutic doses); fatigue; blurred vision; lowers seizure threshold; increased risk of seizures; general opioid side effects such as constipation, nausea and vomiting, arrhythmias, and confusion **Contraindications:** Respiratory depression; unmonitored bronchial asthma; decreased GI motility or obstruction; MAO inhibitor use within 14 days **Considerations:** * Schedule IV controlled substance * Naloxone may be used to reverse overdose * Avoid in pregnancy and breastfeeding * Reduce dose in hepatic or renal impairment
37
# What is the common brand name(s) for: zolmitriptan | (ZOLE-muh-trip-tan)
Zomig | Class: Serotonin 5-HT1B,1D Receptor Agonist ## Footnote **Indication:** Migraine **MOA:** Acts as agonist at 5-HT1D/1B serotonin receptors leading to vasoconstriction of intracranial blood vessels; reduces inflammation due to neurogenic causes of the trigeminal system **Side Effects:** Dizziness; fatigue; somnolence; nausea; dry mouth **Contraindications:** History of significant cardiovascular events (e.g., ischemic heart disease, uncontrolled hypertension, or history of stroke); cerebrovascular disease; hemiplegic or basilar migraine **Considerations:** * Cardiovascular risk factors should be carefully evaluated before initiating therapy
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# Cards
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