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GI/Rheumatology Module > Fibromyalgia > Flashcards

Fibromyalgia Flashcards

1
Q

What is the definition of Fibromyalgia?

A

Form of nonarticular (not joints) rheumatism characterized by widespread chronic musculoskeletal pain for >3 months

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2
Q

What are the common symptoms of FM?

A
  1. Fatigue
  2. Nonrestorative Sleep
  3. Cognitive Dysfunction
  4. Mood Distubrance
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3
Q

What is Hyperalgesia?

A

Increased response to painful stimuli

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4
Q

What is Allodynia?

A

Pain from stimuli that is not usually painful

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5
Q

What is the 2nd most common rheumatologic disorder?

A

Fibromyalgia

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6
Q

What are common etiologies of FM?

A
  1. Non-REM Sleep Disturbances
  2. Neurotransmitter abnormalities
  3. Neurotransmitter imbalance
  4. Pyschological abnormalities
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7
Q

What are some neurotransmitter abnormalities?

A
  1. Decrease NE and Serotonin
  2. Increase Substance P and Glutamate
  3. Increase CNS Endogenous Opioids
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8
Q

What are clinical characteristics of FM?

A
  1. Widespread pain
  2. Fatigue
  3. Nonrestorative sleep
  4. Morning stiffness
  5. Cognitive dysfunction
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9
Q

What is Fibro Fog and how many patients with FM are affected?

A

50-80% patients with FM
1. Learning, retaining, processing info
2. Recall
3. Finding the right word

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10
Q

1990 ACR Criteria for FM

A
  1. 11/28 tender points sites (allodynia)
  2. Widespreading pain >3 months
  3. Axial skeletal pain
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11
Q

2016 Update to 2010/2011 ACR Criteria

A
  1. Generalized pain >4 body regions
  2. Symptoms present >3 months
  3. Widespread pain index WPI and Symptom severity scale SSS
  4. No other disorder explains pain
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12
Q

What is the WPI and SSS Score for 2016 ACR Update?

A

WPI >7 and SSS >5 OR
WPI 4-6 and SSS>9

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13
Q

What is included in the SSS?

A
  1. Severity over past week on 0-3 scale
  2. Number of following symptoms in the past 6 months
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14
Q

FM diagnosis is valid regardless of other diagnoses meaning

A

May coexist with other diseases

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15
Q

2019 AAPT Diagnostic Criteria

A
  1. Multisite pain in >6 of 9 pain sites
  2. Moderate to severe sleep problems/fatigue
  3. MSP + fatigue/sleep >3 months
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16
Q

FM is more common in what gender?

A

Females

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17
Q

What is defined as effective treatment in FM?

A

Sustained improvement of >20%

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18
Q

In terms of exercise and FM, which one is superior?

A

Aerobic exercise, superior to flexibility with relaxation or stretching

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19
Q

What is Balenotherapy?

A

Warm mineral baths

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20
Q

Cognitive Behavioral Therapy is most successful in what type of FM patients?

A
  1. High level distress
  2. High FM impact on daily life
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21
Q

Acupunture in FM Non-drug treatment can what?

A
  1. Increase serotonin
  2. Can increase FM pain
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22
Q

What is the MOA of Anticonvulsants?

A

Bind to alpha-2 delta protein = decrease NT release = decrease substance P and glutamate

23
Q

What is the schedule of Lyrica?

A

Schedule V

24
Q

What are the side effects of Lyrica?

A

Dizzy
Sommolence

25
Q

Is Neurontin approved for FM treatment?

A

NO

26
Q

What is the MOA of Tricyclics?

A

Inhibit reuptake of serotonin and NE, affect other NTs

27
Q

What do you do with the tricyclic dose to decrease sedation?

A

Increase dose

28
Q

Dual Serotonin and NE Reuptake Inhibitors Counseling Points

A
  1. Do not stop abruptly
  2. Avoid alcohol
  3. Serotonin Syndrome
29
Q

What is the Black Box Warning for Tricyclics?

A

Increased suicide risk

30
Q

What is the CIs for tricyclics?

A
  1. MAOI
  2. Uncontrolled Glaucoma
31
Q

What are the side effects of Cymbalta?

A
  1. Nausea
  2. Somnolence
  3. Fatigue
32
Q

What are the pearls of Cymbalta?

A
  1. Dose adjust CrCl <30
  2. Take in AM
33
Q

What are Savella indicated for?

A

Approved ONLY for FM

34
Q

What are the side effects of Savella?

A
  1. Nausea
  2. Headache
  3. HTN
  4. Palpitations
35
Q

SSRIs Selective Serotonin Reuptake Inhibitors when used alone for FM are?

A

No better than placebo for pain, fatigue, or sleep

36
Q

Prozac is best combined with what, and when should it be given?

A

Amitriptyline or Cyclobenzaprine
Give AM

37
Q

Are benzos effective in FM?

A

NO

38
Q

What is preferred over opioids for pain in FM?

A

Ultram

39
Q

What are the risks of Ultram?

A

Serotonin Syndrome or Seizures

40
Q

What is the MOA of Ultram?

A

Inhibits serotonin and NE uptake

41
Q

Should NSAIDs and APAP be used in FM?

A

NO, not effective

42
Q

Should Opioids be used in FM?

A

NO, avoid can cause hyperalgesia, abuse potential

43
Q

Is Prednisone effective for FM?

A

NO

44
Q

What are the FM treatment goals?

A
  1. Decrease pain
  2. Improve function
  3. Increase restorative sleep
45
Q

When should non-drug therapy for FM be initiated?

A

Early before maladaptive behaviors develop
1. Aerobic exercise (aka increase sedentary time = increased pain)
2. Cognitive behavioral therapy

46
Q

What is EXPRESS?

A

EX: Exervise
P: Pyschiatric Comorbidity
R: Regaining Function
E: Education
S: Slepp Hygiene
S: Stress Management

47
Q

What are the FDA Approved drugs for FM?

A
  1. Lyrica
  2. Cymbalta
  3. Savella
48
Q

Pain and Sleep issues while on Amitriptyline, should add on what drug?

A

Fluoxetine

49
Q

Severe Pain, consider what drugs?

A
  1. Cymbalta
  2. Lyrica
  3. Ultram +/- APAP
  4. Amitriptyline
50
Q

Sleep Complaint, consider what drugs?

A
  1. Amitriptyline
  2. Cyclobenzaprine
  3. Lyrica
51
Q

Fatigue Complaint, consider what drugs?

A
  1. Milnacipran
  2. Amitriptyline
52
Q

FM Benefits take how long to be seen?

A

Weeks

53
Q

Strong Recommendations to FM in the 2016 EULAR are what?

A
  1. Aerobic and Strengthening Exercise
54
Q

Strong Against Recommendations to FM in the 2016 EULAR are what?

A
  1. Growth Hormone
  2. Sodium Oxybate
  3. Strong Opioids
  4. Glucocorticoids

GI/Rheumatology Module (18 decks)

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