Fibromyalgia

Question 1

3 main treatment options for fibromyalgia

Answer 1

Milnicipran (Savella)

Pregabalin (Lyrica)

Duloxetene (Cymbalta)

Question 2

Milnicipran (Savella) MOA / warnings

Answer 2

SNRI (Selective serotonin / norepinephrine uptake inhibitor)

Suicidal Ideation
Serotonin Syndrome
Elevated BP
Tachycardia

Question 3

Milniciprin / Savella ADRs

Answer 3

N/V
Tachy / Palps
HA
Dizziness

Constipation
Sweating

Question 4

Muscle relaxants

Answer 4

Cyclobenzaprine - 3A4
Carisoprodol (Soma)

Metaxalone
Methocarbamol

Baclofen

Orphenadrine

Chlorzoxazone

Question 5

Natural products

Answer 5

Glucosamine Sulfate, “Cochrane”

Question 6

Cyclobenzaprine MOA

Answer 6

Similar to Tricyclic antidepressants

• Potentiates NE
• Antocholinergic

Works at Brain Stem

Question 7

Cyclobenzaprine ADRs

Answer 7

ANTICHOLINERGIC
dry mouth/eyes
urine retention
close angle glaucoma
etc

Question 8

Potentially fatal drug interaction w Cyclobenzaprine

Answer 8

MAO-I

Question 9

Carisprodol is metabolized to what in the liver

Answer 9

Meprobomate

Question 10

Carisprodol ADRs

Answer 10

Drowsy, Dizzy, Vertigo, Ataxia, Tremor

Depression, agitation

Syncope, insomnia

Tachy, hypotension

N/V

*TRANSIENT QUADRIPLEGIA**

Question 11

How to treat Carisprodol withdrawal

Answer 11

Antipsychotics and BZDs (Clonazepam, Lorazepam, Diazepam)

Question 12

Metaxolone, MOA?

Answer 12

Not clear - but works centrally. No direct muscle effect

Question 13

Metaxolone ADRs

Answer 13

(aside from standard N/V, dizzy, HA etc)

Leukopenia

Hemolytic Anemia

Jaundice

Question 14

Baclofen MOA

Answer 14

GABA analog

Inhibits reflexes at spine level

Question 15

Baclofen indications

Answer 15

Muscle spasms due to
MS
Trigeminal neuralgia
Spinal cord injury

Off label for cancer pain

Question 16

Orphenadrine MOA/ADR

Answer 16

Anticholinergic

Question 17

Chlorzoxazone MOA

Answer 17

Acts at spinal cord and subcortical brain

Inhibits multisynaptic reflex arc that produce/maintain reflex arc

Question 18

Intrathecal pain med for severe chronic pain, no opioid effect

Answer 18

Ziconotide (sea snail slime)

Question 19

Ziconotide ADRs

Answer 19

Neuropysch

CI in patients w h/o psych