Question

Case 1: Spencer, a 21-year-old male Subjective: • The patient presents today for upper back pain, shoulder pain, and a headache • He is a college athlete and swims competitively. He reports that he slipped and fell on the pool deck last night during practice and hit his head • He was evaluated by the student health center last night on campus and was determined to not have an active head bleed, but does have cervical whiplash • Medications: Prozac (fluoxetine) 20mg qd, Ventolin (albuterol) 90 mcg inhaler, and a Multivitamin • Allergies: Cats, Penicillins, Sulfa drugs Objective: • HR 100, RR 12, BP 125/70, Temp 98.6 F The patient is A&Ox3, there is a notable bruise on this upper back and shoulders from where he fell There is also a sizeable muscle spasm of the trapezius muscle bilaterally His x-ray in office ruled out a fracture or slipped disc of the lumbar and thoracic spines Plan: Robaxin (methocarbamol) 500mg tabs, Initial dose: 1.500 mg PO QID x2 days, then 1000mg PO QID x3 days • Aleve (Naproxen sodium) 500mg tabs: 500mg q12 hour po PRN for pain • Referral to Brattleboro Memorial Hospital Orthopedics 1. What is the correct pharmacologic category of Robaxin? a. Centrally acting muscle relaxant b. Peripherally acting muscle relaxant c. Neuroleptic agent d. Non-steroidal anti-inflammatory drug 2. Which of the following would be a comparable second option as an alternative to Robaxin based on the pharmacologic category? a. Feldene (piroxicam b. Lioresal (baclofen) c. Voltaren (diclofenac) d. Cozaar (losartan) 3. The synthesis of what compound(s) are inhibited, thus resulting in the desired effects of NSAID medications? a. Leukotrienes b. Acetylcholine c. Cortisone d. Prostaglandins 4. What are the most common side effects of NSAIDs medications? a. Asthma exacerbation, rash, and jaundice b. Nausea, vomiting, and abdominal discomfort c. Nausea, rash, and sedation d. Vomiting, sedation, and hypotensive crisis 5. NSAIDs, such as Aleve, have a black box warning for which of the following: a. Tendon rupture b. Increased mortality in elderly patients with dementia c. Cardiovascular thrombolytic event d. Increased risk of suicidal thinking 6. Aleve (Naproxen) is an Analgesic-Antipyretic medication. This means that it can: a. Increase pain and increase a fever b. Relieve pain and reduce serum pyrroles c. Relieve pain and reduce a fever 111

Answer 1

1. a. Centrally acting muscle relaxant

Reason: These are central nervous system depressant with sedative and has muscle relaxant properties

2. Lioresal ( baclofen)

Reason: It is an alternative for robaxin and when it is not tolerated for old age group.

3. d. Prostaglandins

Reason: NSAIDs inhibits the cyclooxygenase which inhibits the synthesis of prostaglandins.

4.b. Nausea, vomiting and abdominal discomfort