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Pharm collaboration: Musculoskeletal/Rheumatology > Drugs for Fibromyalgia > Flashcards

Drugs for Fibromyalgia Flashcards

1
Q

What are the labeled drugs for fibromyalgia?

A

duloxetine
Milnacipran
Pregbalin

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2
Q

What are the off label drugs for fibromyalgia?

A

Amitriptyline
Cyclobenzaprine
Fluoxetine

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3
Q

What is the cause of fibromyalgia?

A

More neurotransmitter activity in the ascending spinal pathways and less neurotransmitter activity in the descending pathway. This leads to amplification of signals arriving in the brain from peripheral tissues

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4
Q

What is the MOA for duloxetine and Milnacipran?

A

They are serotonin-norepinephrine reuptake inhibitors. Usually used as anti-depressants.They do not have action on the muscarinic, dopaminergic, histaminergic, alpha adrenergic, or opioid receptors.

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5
Q

What are the differences in MOA between duloxetine and milnacipran?

A

Duloxetine preferentially inhibits Serotonin reuptake

Milnacipran preferentially inhibits norepinephrine reuptake

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6
Q

How is Duloxetine metabolized?

A

Extensive CYP metabolism (CYP 2D6)

Moderate inhibitor of CYP 2D6

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7
Q

How is Duloxetine eliminated?

A

Duloxetine is eliminated by the kidney

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8
Q

How is milnacipran eliminated?

A

Milnacipran is eliminated in the urine

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9
Q

What medical conditions are contraindications for the administration of duloxetine and milnacipran?

A

Severe liver dysfunction

Chronic alcoholism

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10
Q

What adverse effects are associated with Duloxetine and milnacipran?

A
  1. Increased HR and BP
  2. Contraindicated in closed angle glaucoma
  3. Contraindicated with MAOIs
  4. Hyponatremia with SIADH
  5. Suicidal ideation (BBW)
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11
Q

What is the MOA of Pregabalin?

A

Inhibits presynaptic alpha-2-delta subunits of L-type calcium channels. This inhibits excitatory transmission by glutamate. Alleviates neuropathic pain and anxiety.

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12
Q

Is Pregabalin addictive?

A

Pregabalin is a schedule V drug meaning that it has a low (but potential) risk of addiction

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13
Q

How is Pregabalin eliminated?

A

Pregabalin is eliminated renally

reduce dose with renal dysfunction

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14
Q

What ADEs are associated with Pregabalin?

A
  1. Rebound symptoms after drug withdrawal
  2. Dependance
  3. CNS: sedation, dizziness, blurred vision, xerostomia
  4. Depression/suicidal ideation
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15
Q

What parameter should be monitored in a patient taking pregabalin?

A

serum creatinine

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Pharm collaboration: Musculoskeletal/Rheumatology (5 decks)

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