Fibromyalgia Flashcards
what might a person with fibro feel like
they always have the flu/hurt all over
what does PE involve
tenderness in mult soft tissue anatomic locations
what side of the body is the MS pain?
both sides of the body, above and below the waist
what time is their fatigue?
all day long
what is fibro fog?
attention deficit, difficulty completing tasks (cognitive disturbances)
what are the psych sx?
depression and/or anxiety
what other sx do they experience
headache (tension and migraine), parasthesias, abdominal pain (IBS symptoms), chest wall pain
how long must the pt experience these sx?
at least 3 mo
how many tender points do they need?
11/18
how is the rest of their PE?
normal
what lab tests should you order initially?
CBC and SED rate (should be normal)
what type of nonpharmacotherapy is helpful with fibromyalgia?
exercise
is it associated with increased mortality rates?
no
what are the meds you try first and second?
(TCAs)
amitriptyline (Elavil)
cyclobenzaprine (Flexeril)
tips and SE’s of amitriptyline?
start at low dose and slowly titrate up
QHS
SE: dry mouth, dry eyes, constipation, weight gain are MC
tips and SE of cyclobenzaprine?
used as an alternative to amitriptyline
little antidepressant effects
if TCAs dont work, what other drug classes can you try
SSRIs
SNRIs
Anticonvulsants
which SNRI’s can you use
duloxetine (Cymbalta)
milnacipran (Savella)
venlaxafine (Effexor)
what are the common SE’s of SNRI’s
nausea, dry mouth, HA
which anticonvulsants can you use
pregabalin (Lyrica), gabapentin (Neurontin)
what is the MOA of the anticonvulsants we can use?
effect cellular Ca channels and may exert their analgesic effects by blocking the release of various neurotransmitters such as glutamate and glutamine which are involved in the pain pathway
what are the SE’s of the anticonvulsants
wt gain, dizziness, somnolence, periph edema, dry mouth
what is the order of the w/u of this dz
- hx of chronic widespread pain x3 mo
- r/o other conditions with these sx
- general PE, neuro exam, CBC, SED rate, sleep & mood eval
- confirm the presence of tender points (11/18)
- confirm dx of fibromyalgia
