Fibromyalgia Flashcards
What neurotransmitters are decreased in the CSF in patients with fibromyalgia?
NE, DA, and 5-HT
Describe the process of dysregulation of fibromyalgia.
The hypothalamus-pituitary axis is dysregulated. That causes an increase in Corticotropin-releasing hormone and substance P activity. This leads to an increase in proinflammation and neurosensitizing molecules.
Describe two common signs/symptoms of fibromyalgia.
Allodynia, which is increased sensitivity to stimuli that aren’t normally painful.
Hyperalgesia, which is an increased sensitivity to painful stimuli.
What are some of the main assessments/indexes used to score and assess fibromyalgia?
Widespread Pain Inex (WPI) Symptom Severity (SS)
What are the goals of therapy in relation to fibromyalgia?
Improve function
Reduce pain symptoms
What are some different pharmacologic therapies to use to treat fibromyalgia?
Gabapentin SNRIs TCAs Skeletal muscle relaxants Dopamine agonists
What are the doses for treatment of pain syndromes compared to depression/anxiety?
You will use lower doses for drugs that are being used for pain compared to when they are being used for depression/anxiety.
Gabapentinoids
MOA, ADRs, Dose adjustments
Gabapentin and pregabalin
MOA: Binds to sites associated with presynaptic voltage-gated Ca channels, which modulates excitatory NT release involved in nociception.
ADRs: Dizziness, Increased weight, sedation
DA: Renal adjustments
SNRI drugs
Duloxetine, venlaflaxine, milnacipran
SNRI MOA
Inhibits reuptake of synaptic 5-HT and NE
SNRI ADRs
Increased BP, HR
Nausea, sweats, HA, dry mouth
SNRI Interactions
Duloxetine is a CYP1A2 substrate
Venlafaxine is a CYP3A4 and 2D6 substrate
Duloxetine/venlafaxine are CYP2D6 inhibitors
SNRI dose adjustments
Renal adjustments
Hepatic adjustments
Tricyclic Antidepressant (TCAs) Drugs
Amitryptyline
Nortriptyline
TCA MOA
5HT and NE reuptake inhibition
TCA ADRs
Dry mouth Increased weight Somnolence GI disturbances Increased QT wave
TCA Interactions
Interacts with anticholinergic agents, MAOIs, and other serotonergic agents
Other QT prolonging agents
Amitriptyline and nortripyline are CYP2D6 substrates
TCA dose adjustments
No renal or hepatic recommendations
Skeletal Muscle Relaxant Drugs
Cyclobenzaprine
Skeletal Muscle Relaxants MOA
Acts at the brainstem to modulate tonic somatic motor activity
Skeletal Muscle Relaxant ADRs
Drowsiness Dizziness Dry Mouth Constipation Increased Heart Rate
Skeletal Muscle Relaxant Interactiosn
MAOIs and other serotonergic agents
CYP1A2 Substrate
Skeletal Muscle Relaxant Dose Adjustments
Hepatic Adjustment
Dopamine Agonists
Pramipexole
Ropinirole
DA Agonist MOA
May help modulate excessive adrenergic arousal (helps with sleep in fibromyalgia)
DA agonist ADRs
Orthostatic hypotension Drowsiness Dizziness Impulse control Extrapyramidal symptoms
DA agonist Interactions
Antipsychotics
Ropinirole reacts with CYP1A2 Substrates
DA agonist Dose Adjustments
Renal Adjustment
