Drugs For Fibromyalgia/SEID/CFS Flashcards
Which of the following drugs is officially approved by Health Canada for the treatment of fibromyalgia?
A) Tramadol
B) Duloxetine
C) Cyclobenzaprine
D) Gabapentin
A) Tramadol: Incorrect. Tramadol is used off-label for fibromyalgia pain, but it is not officially approved by Health Canada for this condition. It carries risks of dependence and may not target central sensitization effectively. Althought it is likely effective due to its antidepressive effect similar to venlafaxine versus its opiod effect.
B) Duloxetine: Correct. Duloxetine, an SNRI (serotonin-norepinephrine reuptake inhibitor), is approved by Health Canada for the treatment of fibromyalgia. It helps reduce pain by enhancing serotonin and norepinephrine levels, addressing central sensitization.
C) Cyclobenzaprine: Incorrect. Cyclobenzaprine is a muscle relaxant often used for short-term pain relief in fibromyalgia, but it is not officially approved for this use.
D) Gabapentin: Incorrect. While gabapentin is used to treat fibromyalgia pain, it is not specifically approved by Health Canada. Its related drug, pregabalin, is approved.
Which of the following drugs has shown no improvement in sleep or fatigue but provides a small reduction in fibromyalgia pain?
A) Amitriptyline
B) Duloxetine
C) Fluoxetine
D) Cyclobenzaprine
A) Amitriptyline: Incorrect. Amitriptyline, a tricyclic antidepressant, has been shown to improve sleep and reduce pain in fibromyalgia patients.
B) Duloxetine: Correct. Duloxetine has shown moderate pain reduction but does not significantly improve fatigue or sleep in fibromyalgia patients.
C) Fluoxetine: Incorrect. Fluoxetine is an SSRI that may reduce pain but is not typically effective for improving fatigue and sleep.
D) Cyclobenzaprine: Incorrect. Cyclobenzaprine has been shown to improve sleep but may not have strong effects on pain reduction in fibromyalgia.
What is the primary mechanism by which fibromyalgia-related pain is believed to occur?
A) Peripheral pain and inflammation
B) Central sensitization and abnormal pain signaling
C) Immune system dysfunction
D) Autonomic dysfunction
Answer: B) Central sensitization and abnormal pain signaling
A) Peripheral pain and inflammation: Incorrect. Fibromyalgia is not caused by peripheral pain or inflammation but is associated with altered central pain processing.
B) Central sensitization and abnormal pain signaling: Correct. Fibromyalgia is thought to involve central sensitization, where the central nervous system becomes hypersensitive to stimuli, leading to widespread pain.
C) Immune system dysfunction: Incorrect. Although there are immune components being studied, fibromyalgia pain is not primarily due to immune dysfunction.
D) Autonomic dysfunction: Incorrect. Autonomic dysfunction may occur in fibromyalgia, but it is not the main cause of the pain.
What is the most common adverse effect of fluoxetine when initiated in fibromyalgia patients?
A) Drowsiness
B) Insomnia and anxiety
C) Nausea
D) Sexual dysfunction
A) Drowsiness: Incorrect. Fluoxetine, being an SSRI, tends to cause insomnia and anxiety rather than sedation.
B) Insomnia and anxiety: Correct. Fluoxetine can cause insomnia and anxiety, especially when first initiated, which may exacerbate symptoms in fibromyalgia patients.
C) Nausea: Incorrect. While nausea is a common SSRI side effect, it is not the most frequent initial side effect.
D) Sexual dysfunction: Incorrect. Sexual dysfunction is a possible side effect of fluoxetine but tends to emerge after prolonged use rather than when first initiated.
- Which of the following drugs used in fibromyalgia is associated with sedation, dizziness, and peripheral edema?
A) Amitriptyline
B) Pregabalin
C) Tramadol
D) Fluoxetine
A) Amitriptyline: Incorrect. Amitriptyline can cause sedation and dizziness but is not typically associated with peripheral edema.
B) Pregabalin: Correct. Pregabalin, an anticonvulsant used to treat fibromyalgia, often causes sedation, dizziness, and peripheral edema as side effects.
C) Tramadol: Incorrect. Tramadol may cause dizziness but is less likely to cause peripheral edema or sedation at typical doses.
D) Fluoxetine: Incorrect. Fluoxetine is more likely to cause anxiety or insomnia, rather than sedation or peripheral edema.
- In the management of fibromyalgia, NSAIDs are not recommended due to which of the following reasons?
A) Increased risk of renal impairment
B) They cause central sensitization
C) Pain in fibromyalgia is due to central mechanisms rather than peripheral inflammation
D) High risk of gastrointestinal side effects
Answer: C) Pain in fibromyalgia is due to central mechanisms rather than peripheral inflammation
A) Increased risk of renal impairment: Incorrect. While NSAIDs can affect renal function, this is not the primary reason for avoiding them in fibromyalgia.
B) They cause central sensitization: Incorrect. NSAIDs do not cause central sensitization, but they are ineffective in treating it.
C) Pain in fibromyalgia is due to central mechanisms rather than peripheral inflammation: Correct. NSAIDs target peripheral inflammation, which is not a primary cause of pain in fibromyalgia. The pain stems from central sensitization and abnormal pain processing.
D) High risk of gastrointestinal side effects: Incorrect. Although NSAIDs have GI side effects, this is not the main reason they are ineffective in treating fibromyalgia pain.
- Which of the following is a monoclonal antibody trialed in chronic fatigue syndrome (CFS), but not approved for use in this condition?
A) Rituximab
B) Duloxetine
C) Fluoxetine
D) Gabapentin
A) Rituximab: Correct. Rituximab, a monoclonal antibody reducing B-cells which lowered inflammtion, was trialed in CFS but showed inconsistent results, and it is not approved for this use.
B) Duloxetine: Incorrect. Duloxetine is an SNRI used for fibromyalgia but has not been trialed as a monoclonal antibody for CFS.
C) Fluoxetine: Incorrect. Fluoxetine is an SSRI, not a monoclonal antibody, and is not trialed in CFS for this purpose.
D) Gabapentin: Incorrect. Gabapentin is an anticonvulsant, not a monoclonal antibody, and it is used to treat neuropathic pain but not typically for CFS.
Which of the following adverse effects is associated with maternal use of fluoxetine during pregnancy?
A) Congenital malformations
B) Neonatal withdrawal syndrome
C) Hypertensive crisis
D) Fetal bradycardia
A) Congenital malformations: Incorrect. Fluoxetine has not been strongly linked to an increased risk of major congenital malformations.
B) Neonatal withdrawal syndrome: Correct. Babies exposed to fluoxetine during pregnancy may experience withdrawal symptoms after birth, such as irritability, feeding difficulties, and tremors. As this drug crosses the placenta
C) Hypertensive crisis: Incorrect. Fluoxetine use does not typically cause hypertensive crisis in mothers or newborns.
D) Fetal bradycardia: Incorrect. Fetal bradycardia is not a common adverse effect of fluoxetine use during pregnancy.
- Pregabalin is one of two drugs approved by Health Canada for fibromyalgia treatment. Which of the following doses is most effective in producing pain reduction?
A) Lower than 150 mg
B) Higher than 450 mg
C) 300-450 mg
D) 200-300 mg
Answer: C) 300-450 mg
A) Lower than 150 mg: Incorrect. Lower doses of pregabalin (under 150 mg) are often insufficient to reduce fibromyalgia pain effectively and results are similar to placebo
B) Higher than 450 mg: Incorrect. Doses higher than 450 mg are not recommended due to increased risk of side effects without added benefit.
C) 300-450 mg: Correct. The dose range of 300-450 mg is considered optimal for reducing fibromyalgia pain while balancing the risk of side effects.
D) 150-300 mg: Incorrect. While doses in this range can be effective, the best pain reduction occurs with slightly higher doses (300-450 mg). This is usually the starting dose but to reach optimal pain reduction 300-450mg has been known to produce optimal levels.
Which of the following drugs may be associated with serotonin syndrome when used concomitantly with tramadol?
A) Amitriptyline
B) Duloxetine
C) Gabapentin
D) Nabilone
A) Amitriptyline: Incorrect. Amitriptyline, though an antidepressant, is less likely to cause serotonin syndrome than SSRIs or SNRIs when combined with tramadol.
B) Duloxetine: Correct. Duloxetine, an SNRI, increases serotonin levels, and when combined with tramadol (which also affects serotonin), it raises the risk of serotonin syndrome.
C) Gabapentin: Incorrect. Gabapentin does not affect serotonin levels and is not associated with serotonin syndrome.
D) Nabilone: Incorrect. Nabilone, a synthetic cannabinoid, does not influence serotonin and is not linked to serotonin syndrome.
Which of the following antidepressants is generally considered a first-line option for the treatment of fibromyalgia with concomitant depression?
A) Amitriptyline
B) Fluoxetine
C) Duloxetine
D) All of the above
A) Amitriptyline: Correct. Amitriptyline, a tricyclic antidepressant, is commonly used at low doses for short-term improvement in sleep and pain in fibromyalgia, making it a first-line option.
B) Fluoxetine: Correct. Fluoxetine, an SSRI, is used for the treatment of fibromyalgia with concomitant depression, making it a first-line option as well.
C) Duloxetine: Correct. Duloxetine, an SNRI, is approved for the treatment of fibromyalgia and can help reduce pain. It is also a first-line option.
D) All of the above: Correct. All of these antidepressants (tricyclic, SSRI, and SNRI) are generally considered first-line treatments for fibromyalgia with depression.
Which of the following is true regarding the use of low doses of amitriptyline in fibromyalgia treatment?
A) Provides long-term improvement in sleep and fatigue
B) Provides short-term improvement in sleep, pain, and fatigue
C) Causes significant improvement in all patients
D) Should be avoided as an initial treatment due to low effectiveness
A) Provides long-term improvement in sleep and fatigue: Incorrect. Amitriptyline provides short-term (up to 8 weeks) improvement, not long-term, in sleep, pain, and fatigue.
B) Provides short-term improvement in sleep, pain, and fatigue: Correct. Low doses of amitriptyline have been shown to provide short-term relief in sleep disturbances, pain, and fatigue in fibromyalgia patients.
C) Causes significant improvement in all patients: Incorrect. Only a minority of patients experience significant benefit from amitriptyline, so it does not help all patients.
D) Should be avoided as an initial treatment due to low effectiveness: Incorrect. Amitriptyline may be appropriate as an initial treatment despite its limited effectiveness for some patients.
Which of the following is a common adverse effect that leads to the discontinuation of duloxetine in some fibromyalgia patients?
A) Sedation
B) Constipation
C) Weight gain
D) Seizures
A) Sedation: Incorrect. Sedation is more commonly associated with tricyclic antidepressants like amitriptyline, not duloxetine.
B) Constipation: Correct. Constipation, along with nausea, dry mouth, and headache, is a common side effect of duloxetine and can lead to discontinuation of treatment.
C) Weight gain: Incorrect. Weight gain is not a typical side effect of duloxetine. It is more commonly seen with medications like amitriptyline or other antidepressants.
D) Seizures: Incorrect. Seizures are not commonly associated with duloxetine use.
Which of the following statements about fluoxetine use in fibromyalgia is correct?
A) It should always be used in combination with amitriptyline for the best results
B) Fluoxetine alone provides better symptom relief than in combination with amitriptyline
C) Combination of fluoxetine in the morning and amitriptyline at night was more effective than either agent alone
D) Fluoxetine is never used in fibromyalgia due to lack of effectiveness
A) It should always be used in combination with amitriptyline for the best results: Incorrect. While the combination of fluoxetine and amitriptyline was effective in one trial, it is not always necessary to use them together for good results.
B) Fluoxetine alone provides better symptom relief than in combination with amitriptyline: Incorrect. The combination of fluoxetine and amitriptyline has been shown to be more effective than either agent alone.
C) Combination of fluoxetine in the morning and amitriptyline at night was more effective than either agent alone: Correct. A controlled trial demonstrated that this combination was more effective for fibromyalgia than using either drug alone.
D) Fluoxetine is never used in fibromyalgia due to lack of effectiveness: Incorrect. Fluoxetine is used in the treatment of fibromyalgia, especially in combination with other medications.
What is a common adverse effect upon initiating fluoxetine treatment in fibromyalgia patients?
A) Weight gain
B) Drowsiness
C) Anxiety
D) Orthostatic hypotension
A) Weight gain: Incorrect. Weight gain is not a common side effect of fluoxetine; it is more often seen with tricyclic antidepressants like amitriptyline.
B) Drowsiness: Incorrect. Drowsiness is not a prominent side effect of fluoxetine; it is more commonly seen with other antidepressants like amitriptyline.
C) Anxiety: Correct. Anxiety is a common adverse effect when starting fluoxetine therapy and usually resolves after about two weeks.
D) Orthostatic hypotension: Incorrect. Orthostatic hypotension is associated with other medications, like tricyclic antidepressants, rather than fluoxetine.
