Fibromyalgia Flashcards

1
Q

What is FM?

A

Chronic dz characterized by amplification of afferent nerve conduction/NT function and diminished efferent nerve conduction

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2
Q

What are the Sx of FM?

A

Stiffness, decreased sleep, tension headache, IBS, decreased cognitive function with depression and change in mood, RLS, vaginal/menstrual/bladder pain

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3
Q

What is the traditional Tx of FM?

A

Treat Sx with NSAIDs (acetaminophen), Tricyclic antidepressants (TCA_, and cyclobenzaprine

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4
Q

What are the 3 FDA approved drugs for the treatment of FM?

A

Duloxetine, milnacipran (SSNRI’s), and Pregabalin

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5
Q

What are the 3 off-label use drugs for FM?

A

Amitriptyline, Fluoxetine, and Cycobenzaprine

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6
Q

What is the MOA of both Duloxetine and Mulnacipran (the SSNRI’s)?

A

Inhibit reuptake of serotonin/noerpi, no action on receptors/dopamine

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7
Q

What is Duloxetine more specific for?

A

Serotonin > NE

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8
Q

What is the metabolism/elimination of Duloxetine?

A

CYPs including 2D6 (DDRs) and ultimately urinary elimination

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9
Q

Duloxetine and MIlnacipran should not be administered in what conditions?

A

Severe liver dysfunction or chronic alcoholism

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10
Q

What are the ADE’s of Duloxetine and Milnacipran?

A

increase HR and BP (caution with CV dz), SIADH, BBW for suicide, contraindicated w/ Glaucoma and MAOIs

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11
Q

What is Pregabalin similar to?

A

Gapabentin (gapapentin not for FM, for seizures)

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12
Q

What is the MOA of pregabalin?

A

Inhibits presynaptic alpha-2-delta subunit of L-type calcium channels; innhibiting excitatory transmission by glutamate seeming to inibit anxiety and pain.

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13
Q

What schedule drug is Pregabalin?

A

Schedule V

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14
Q

How is Pregabalin met/elim?

A

Rapid absorption, renally eliminated virtually unchanged, dose adjust in renal failure (no metabolism)

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15
Q

What are the ADE’s with Pregabalin?

A

Rebond pain upon discontinuation, addictive, sedation, suicidal thoughts (not a BBW), dizziness, blurred vision, xerostomia

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16
Q

What must you monitor in patients receiving Pregabalin?

A

Serum Creatinine

17
Q

What is Cyclobenzprine?

A

A muscle relaxer that will be covered elsewhere