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Pharmacology (MSK + Neuroscience) > Drugs for Numbness and Weakness 1 (Peripheral Neuropathy) > Flashcards

Drugs for Numbness and Weakness 1 (Peripheral Neuropathy) Flashcards

1
Q

Name the 2 types of numbness and weakness we treat

A
  1. peripheral neuropathy
  2. vascular pathologies
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2
Q

State the 2 types of peripheral neuropathy

A
  1. neuropathic pain
  2. vitamin deficiency associated neuropathy
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3
Q

State the drug classes used to treat neuropathic pain

A
  1. gabapentinoids
  2. anti-depressants (SSNRI, tricyclic antidepressants, nutritional support)
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4
Q

State the drug classes of anti-depressants used in neuropathic pain

A
  1. selective serotonin and norepinephrine reuptake inhibitors
  2. tricyclic antidepressants
  3. nutritional support
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5
Q

Name 2 examples of gabapentinoids

A

Gabapentin and pregabalin

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6
Q

What are the key mechanism(s) of action, clinical uses, and side effects of the gabapentinoids?

A

Mechanism: GABA analogues but act at voltage-gated calcium channels, reducing tonic neural stimulation.

Clinical Uses: Neuropathic pain, chronic pain, antiepileptic for partial seizures.

Side Effects: Somnolence, dizziness, ataxia; renal elimination without metabolites therefore susceptible to drug-drug interactions with drugs altering renal function.

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7
Q

What is the MOA of Gabapentinoids?

A

GABA analogues that act at voltage-gated calcium channels instead of GABA-receptors to decrease tonic neural stimulation

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8
Q

What are the primary clinical uses of gabapentin and pregabalin?

A
  • Neuropathic pain
  • Chronic pain refractory to other treatments
  • Antiepileptic for partial seizures.
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9
Q

What are common side effects of gabapentin and pregabalin?

When should gabapentinoids be used with caution?

A

Somnolence, dizziness, and ataxia; the incidence is higher if not titrated over days to weeks.

Use in caution for patients with renal dysfunction. Renal elimination without metabolites therefore susceptible to drug-drug interactions with drugs altering renal function.

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10
Q

What is SSNRI an abbreviation of? Name TWO examples of SNRI antidepressants used for neuropathic pain

A

Selective serotonin-norepinephrine reuptake inhibitors (SSNRIs)

duloxetine and venlafaxine

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11
Q

What is the mechanism of action of SSNRI?

A

Serotonin and norepinephrine reuptake inhibitor (SNRI), which increases the levels of these neurotransmitters in the synaptic cleft.

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12
Q

In what conditions is duloxetine typically used?

A

Clinical depression and chronic or neuropathic pain, usually as an adjunct to NSAIDs or paracetamol.

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13
Q

What are common side effect associated with duloxetine?

A
  • xerostomia
  • drowsiness
  • abdominal pain
  • fatigue
  • weight loss
  • headaches
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14
Q

What are severe side effects associated with duloxetine?

A
  • Mania
  • Hypomania
  • Hyponatremia
  • Bleeding risk
  • Fragility fracture
  • Serotonin syndrome
  • Hepatotoxicity
  • Risk of suicidal ideation (especially in adolescents and children).
  • Occular effects
  • Withdrawal symptoms
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15
Q

Is duloxetine or amitriptyline more effective in treating neuropathic pain?

A

duloxetine!

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16
Q

Name an example of a tricyclic antidepressant used to treat neuropathic pain

A

Amitriptyline

17
Q

What is the mechanism of action of amitriptyline?

A

It is a tricyclic antidepressant that inhibits the reuptake of norepinephrine and serotonin.

18
Q

What are the common side effects of amitriptyline?

A

Side effects:
* Antihistamine = Sedation, weight gain
* Anticholinergic = Blurred vision, dry mouth, urinary retention, constipation, agitation, tachycardia, seating
* Alpha-1 adrenoceptor blockade = Postural hypotension, tachycardia

19
Q

State the form of nutritional support administered to treat neuropathic pain

A

Alpha-lipoic acid (ALA)

20
Q

State the MOA of ALA.

A
  • Antioxidant –> neutralises free radicals and serves as a cofactor for various enzymes
  • Enhances glucose uptake in cells –> effective in diabetic neuropathy
21
Q

Why might alpha-lipoic acid (ALA) be used in patients with diabetic neuropathy?

A

It is an antioxidant that neutralizes free radicals and enhances glucose uptake in cells, making it beneficial for diabetic neuropathy.

22
Q

What is a potential adverse effect of long-term use of alpha-lipoic acid?

A

It can deplete thiamine levels, requiring supplementation, particularly in alcoholics.

23
Q

For what patients would alpha-lipoic acid (ALA) be used?

A
  • Diabetic neuropathy patients who are refractory to or intolerant of first-line pharmacotherapies
  • A dietary or nutritional supplement, it is perceived as relatively safe and is still used even though its efficacy remains controversial.
24
Q

What are the adverse effects of alpha-lipoid acid (ALA)

A

Adverse Effects:
- GI: Nausea, vomiting, and stomach cramps are common.
- Hypoglycaemia (esp diabetics)
- Allergic Reaction (Rare) = skin rashes and pruritus.
- Thiamine Deficiency
- Overdose = neurological effects, metabolic acidosis, cardiac effects and hepatotoxicity

25
Q

What are the 2 vitamins supplemented in vitamin-deficiency associated neuropathy.

State the drug names for each vitamin.

A
  1. vitamin B12 (mecobalamin)
  2. vitamin B9 (folic acid)
26
Q

State the MOA of mecobalamin

A
  • coenzyme form of vitamin B12 which is essential for normal function of nervous system and hematopoiesis
  • facilitates synthesis of methionin from homocysteine which is crucial for formation of myelin sheaths
27
Q

What is the role of Vitamin B12 in neuropathy

A

It is essential for the normal function of the nervous system and haematopoiesis, facilitating the synthesis of myelin sheaths.

28
Q

What form of Vitamin B12 is preferred for the treatment of vitamin deficiency-associated neuropathy?

A

Mecobalamin

29
Q

How is Vitamin B12 eliminated? What is the therapeutic implication of the elimination of vitamin B12?

A

Excess is excreted through the urine thus overdose is not a concern.

30
Q

How is mecobalamin administered

A

oral, iv, im

31
Q

What are the adverse effects of Vitamin B12? Are they common or rare?

A

Generally well tolerated. Adverse effects are rare but can include hypersensitivity reactions, headache, and nausea.

32
Q

What is the clinical use of Vitamin B9 (Folic acid) in neuropathy?

A
  • Folate deficiency-related neuropathy
  • Supports DNA synthesis and repair.
33
Q

What is a unique caution when using high doses of folic acid?

A

High doses can mask Vitamin B12 deficiency, complicating diagnosis and treatment.

34
Q

What are the adverse effects of Vitamin B9 (folic acid)?

A

Adverse Effects:
- High doses may mask Vitamin B12 deficiency.
- Nausea, bloating, or sleep disturbances.
- Rare hypersensitivity reactions: Rash or anaphylaxis.

Pharmacology (MSK + Neuroscience) (8 decks)

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