Page 165 - 2025 Ranger Medic Handbook

CYCLOBENZAPRINE (FLEXERIL)
Class: Autonomic nervous system agent – central acting; skeletal muscle relaxant
Action: Structurally and pharmacologically related to TCAs; relieves skeletal muscle spasm of local origin without
interfering with muscle function; believed to act primarily within CNS at brain stem with some action at spinal cord
level; depresses tonic somatic motor activity, although both gamma and alpha motor neurons are affected; increases
circulating norepinephrine by blocking synaptic reuptake, thus producing antidepressant effect; has sedative effect
and potent central and peripheral anticholinergic activity
Dose: 5–10mg PO tid prn muscle spasm (max: 60mg/d); do not use longer than 2–3 weeks
Indications: As adjunct to rest and physical therapy for short-term relief of muscle spasm associated with acute
musculoskeletal conditions
Contraindications: Recovery phase of MI; cardiac arrhythmias, heart block or conduction disturbances; CHF, hyper-
thyroidism; pregnancy category caution advised during pregnancy and consider alternative while breastfeeding
Adverse/Side-effects: Tongue and face edema, sweating, myalgia, hepatitis, alopecia; toxic potential of TCAs; tachy-
cardia, syncope, palpitation, vasodilation, chest pain, orthostatic hypotension, dyspnea; arrhythmias; dry mouth, in-
digestion, unpleasant taste, coated or discolored tongue, vomiting, anorexia, abdominal pain, flatulence, diarrhea, SECTION 4
paralytic ileus; drowsiness, dizziness, weakness, fatigue, asthenia, paresthesia, tremors, muscle twitching, insomnia,
euphoria, disorientation, mania, ataxia; pruritus, urticaria, rash; increased or decreased libido, impotence
Interactions: Alcohol, barbiturates, other CNS depressants enhance CNS depression; potentiates anticholinergic
effect of phenothiazine and other anticholinergics; MAOIs may precipitate hypertensive crisis
Mission Impact: GROUNDING, Causes drowsiness in most people.
K9 Dosage: DO NOT GIVE

DEXAMETHASONE (DECADRON)
Class: Hormones and synthetic substitutes – steroid; adrenocorticoid; glucocorticoid
Action: Long-acting synthetic adrenocorticoid with intense glucocorticoid activity and minimal mineralocorticoid
activity; Anti-inflammatory and immunosuppression properties; prevents accumulation of inflammatory cells at sites
of infection; inhibits phagocytosis, lysosomal enzyme release, and synthesis of selected chemical mediators of inflam-
mation; reduces capillary dilation and permeability
Dose: 0.25–4mg PO bid–qid; 8–12mg IM/IV q1–3wk. AMS: 8mg qid; HACE: Initial: 8mg as a single dose; Mainte-
nance: 4mg PO qid until symptoms resolve
Onset/Peak/Duration: Onset hours/Peak in 8–12 hours/Duration 72 hours
Indications: For inflammatory conditions, allergic states, and cerebral edema
Contraindications: Systemic fungal infection, acute infections, tuberculosis, vaccinia, varicella, live virus vaccines (to
patient, family members), amebiasis; pregnancy category caution advised during pregnancy and consider alternative
while breastfeeding
Adverse/Side-effects: Euphoria, insomnia, convulsions, increased ICP, vertigo, headache, psychic disturbances;
CHF, hypertension, edema; hyperglycemia; cushingoid state; hirsutism; cataracts, increased IOP, glaucoma, exoph-
thalmos; peptic ulcer or perforation, abdominal distension, nausea, increased appetite, heartburn, dyspepsia, pan-
creatitis, bowel perforation, oral candidiasis; muscle weakness, loss of muscle mass, vertebral compression fracture,
pathologic fracture of long bones, tendon rupture; acne, impaired wound healing, petechiae, ecchymoses, diaphore-
sis, dermatitis, hypo- or hyperpigmentation, skin atrophy
Interactions: May inhibit antibody response to vaccines and toxoids
Mission Impact: GROUNDING medication for personnel on flight status.
K9 Dosage: 3–4mg (0.5mg/kg) IV/IM

2025 RANGER MEDIC HANDBOOK 151