Fibromyalgia Flashcards
3 main treatment options for fibromyalgia
Milnicipran (Savella)
Pregabalin (Lyrica)
Duloxetene (Cymbalta)
Milnicipran (Savella) MOA / warnings
SNRI (Selective serotonin / norepinephrine uptake inhibitor)
Suicidal Ideation
Serotonin Syndrome
Elevated BP
Tachycardia
Milniciprin / Savella ADRs
N/V
Tachy / Palps
HA
Dizziness
Constipation
Sweating
Muscle relaxants
Cyclobenzaprine - 3A4
Carisoprodol (Soma)
Metaxalone
Methocarbamol
Baclofen
Orphenadrine
Chlorzoxazone
Natural products
Glucosamine Sulfate, “Cochrane”
Cyclobenzaprine MOA
Similar to Tricyclic antidepressants
- Potentiates NE
- Antocholinergic
Works at Brain Stem
Cyclobenzaprine ADRs
ANTICHOLINERGIC dry mouth/eyes urine retention close angle glaucoma etc
Potentially fatal drug interaction w Cyclobenzaprine
MAO-I
Carisprodol is metabolized to what in the liver
Meprobomate
Carisprodol ADRs
Drowsy, Dizzy, Vertigo, Ataxia, Tremor
Depression, agitation
Syncope, insomnia
Tachy, hypotension
N/V
*TRANSIENT QUADRIPLEGIA**
How to treat Carisprodol withdrawal
Antipsychotics and BZDs (Clonazepam, Lorazepam, Diazepam)
Metaxolone, MOA?
Not clear - but works centrally. No direct muscle effect
Metaxolone ADRs
(aside from standard N/V, dizzy, HA etc)
Leukopenia
Hemolytic Anemia
Jaundice
Baclofen MOA
GABA analog
Inhibits reflexes at spine level
Baclofen indications
Muscle spasms due to
MS
Trigeminal neuralgia
Spinal cord injury
Off label for cancer pain
Orphenadrine MOA/ADR
Anticholinergic
Chlorzoxazone MOA
Acts at spinal cord and subcortical brain
Inhibits multisynaptic reflex arc that produce/maintain reflex arc
Intrathecal pain med for severe chronic pain, no opioid effect
Ziconotide (sea snail slime)
Ziconotide ADRs
Neuropysch
CI in patients w h/o psych
