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• Muscle relaxants are used to manage disorders such as pain, spasms, abnormal contraction, or impaired mobility.
• Side effects of muscle relaxants include drowsiness, dizziness, or dry mouth, weakness, tremor, ataxia, and seizures, confusion and nervousness, slurred speech, blurred vision, hypotension.
• Adverse effects of muscle relaxants include liver toxicity, sedation, dizziness, risk of dependence, constipation, nausea, jaundice, headache, insomnia.
• Muscle relaxants have the potential for abuse.
• Patient education for muscle relaxants includes potential side effects such as drowsiness, dizziness, weakness, tremor, blurred vision, hypotension, respiratory distress, or gastrointestinal disorders, and the importance of avoiding other CNS depressants at the same time.
• Muscle relaxants should be taken only as long as absolutely necessary and caution should be observed regarding prolonged use, which could lead to physical or psychological dependence and withdrawal symptoms.
• Disease-modifying antirheumatic drugs (DMARDS) are used for rheumatoid arthritis, psoriasis, lupus, and certain cancers.
• Methotrexate (Trexall, Rheumatrex) and hydroxychloroquine (Plaquenil) are examples of DMARDS.
• DMARDS aggressively affect the process of inflammation and are started early in disease processes (before damage to joints).
• The mechanism of action (MOA) of DMARDS is to stop folic acid metabolism which stops cellular reproduction in fastest replicating cells and suppresses B and T lymphocytes.
• Patients with cerebrovascular, heart, liver, and renal disease, children under 16, pregnancy and lactation, and those who are suicide prone should avoid MAOIs.
• Potential side effects of SSRIs should be reviewed.
• Schizophrenia patients with delusions should be aware of potential considerations such as PT education on SSRIs.
• Narcan is used in the treatment of heroin and other opioids.
• Lorazepam (Ativan) is used in the treatment of alcohol withdrawal.
• Methadone (Dolophine) is used in the treatment of opioid withdrawal.
• Flumazinel is used in the treatment of benzodiazepine withdrawal.
• Varenicline (Chantix) is used in the treatment of nicotine withdrawal.
• Buspirone is an anxiolytic used for the treatment of generalized anxiety disorder (GAD) but not other anxiety disorders.
• Disulfiram (Antabuse) is used in the treatment of alcohol abstinence.
• Buspirone has no activity against depression.
• Alprazolam is used as an ADHD medication reversal agent.
• Medication contraindications for SSRIs include liver or renal impairment, suicide prone individuals, diabetes, bipolar disorder, underweight individuals, eating disorders, pregnancy, lactation, and abrupt discontinuation.
• Selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of suicidality, and patients and their family members or caregivers should be instructed to immediately report any sudden changes in mood, behaviors, thoughts, or feelings.
• Adverse effects of DMARDS include immunosuppression, bleeding (low platelet count), and fetal abnormalities.
• Non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and immunosuppressants (tumor necrosis factor blockers) are also used for rheumatoid arthritis, psoriasis, and certain cancers.
• Side effects of antipsychotics can include anticholinergic effects, extrapyramidal symptoms, acute dystonia, parkinsonism, akathisia, tardive dyskinesia.
• These adverse effects of psychotropic medications can be managed with propranolol for tremors, and thyroid issues can be treated with hypothyroidism or goiter.
• Drug classes of psychotropic medications include CNS stimulants, ADHD agents, antidepressants, anti-mania, anxiolytic, and antipsychotic agents.
• In pregnancy, use birth control to prevent thrombocytopenia and avoid melena, purpura, hematemesis, and bleeding gums.
• Side effects of antipsychotics can also include hyperlipidemia, DM, weight gain, metabolic syndrome, QTC prolongation, seizures, EPS, myocarditis, agranulocytosis, cataracts, sexual side effects, orthostatic hypotension, and sedation.
• Psychotropic medications can cause contraindications such as seizure disorders and parkinsonism, cardiovascular and kidney disorders, older adults and debilitated patients, and thyroid disease.
• Haloperidol is an antipsychotic medication used for agitation.
• Psychotropic medications can interact with other CNS depressants, including alcohol, and should never be taken concurrently with MAOIs.
• Adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), and infliximab (Remicade) are examples of tumor necrosis factor blockers.
• Glucocorticoids have a black box warning for fatal infections, lymphoma, other cancers, MI, MS.
• Biologic medications such as infliximab (Remicade) are administered subcutaneously (SQ) or intravenously (IV).
• The mechanism of action (MOA) of biologic medications is to stop folic acid metabolism which stops cellular reproduction in fastest replicating cells and suppresses B and T lymphocytes.
• Candidiasis treatment includes antifungals such as fluconazole (Diflucan), ketoconazole (Nizoral), and nystatin (Biostatin).
• Antidiarrheal medications can cause abdominal pain, distention, bloody stools, and no bowel sounds.