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Summer pharm 3 > Fibromyalgia > Flashcards

Fibromyalgia Flashcards

1
Q

What is fibromyalgia

A

Disengagement from noxious stimuli or healing, not associated with tissue inflammation
Chronic widespread MSK pain with no identified cause- Diffuse hyperalgesia and/or allodynia
AKA “central pain disorder”

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2
Q

In fibromyalgia, pain can be due to

A

damaged or abnormally functioning PNS and/or CNS

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3
Q

The pathophys behind fibromyalgia is

A

Disturbance in CNS pain processing

Responsive to neuroactive compounds altering levels of NT involved in pain transmission

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4
Q

In FM, patients perceive noxious stimuli as

A

heat
electrical current
pressure

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5
Q

Underlying CNS dysfunction is noted in individuals with

A

Sleep and mood disturbances

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6
Q

The 2011 FM survey criteria is scored 0-31. What are the score ranges

A

0-19: number of body parts with pain
0-3: presence and severity of fatigue and sleep and memory problems
1 point each for depression, IBS, and HA
*FM is diagnosed at 12 or 13

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7
Q

What is the sub-threshold “fibromyalgianess”

A

Indicates that more of a persons pain and other Sx are coming from the brain, not a peripheral disorder

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8
Q

Initial approach to those with FM include

A

confirm Dx
Educate patient on condition
Evaluate and treat comorbidities (mood and sleep disturbance)

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9
Q

Most patients end up doing

A

Trial with low dose TCA, selected antidepressants, or anticonvulsants
Exercise program

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10
Q

Patients that dont respond to exercise and antidepressants end up

A 
Specialty referral 
Combo drug therapies 
PT 
Psych interventions (CBT) 
Multidisciplinary programs
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11
Q

Non-pharm treatments for FM include

A 
Patient education 
Graded exercise 
CBT, OT, or psych 
CAM 
CNS neurostimulatory therapies
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12
Q

Patients taking meds for FM saw

A

moderate degree of benefit in pain and sleep, but effects on fatigue and QoL were small

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13
Q

Pharmacotherapy for FM includes

A 
Amitryptaline 
Cyclobenzaprine 
Duloxetine 
Milnacipran 
Gabapentin 
Pregabalin
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14
Q

What is the MOA of Amitriptyline

A

TCA that blocks NET and SERT channels
Start at 10mg QHS
-Alternative: Desipramine

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15
Q

ADE of Amitriptyline include

A 
dry mouth 
constipation 
fluid retention 
weight gain 
grogginess 
difficulty concentrating
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16
Q

What is the MOA of cyclobenzaprine

A

Centrally acting skeletal muscle relaxer that is similar to TCA
Can be used for mild to moderate Sx, with minimal antidepressant effect

17
Q

ADE of Cyclobenzaprine include

A 
drowsiness 
dry mouth 
change in mental acuity 
constipation 
NM and skeletal weakness 
blurred vision
18
Q

What is the MOA of Duloxetine (Cymbalta)

A

SNRI used in patients with depression- improves mental fatigue, but not general fatigue
Take in AM with breakfast

19
Q

ADE of Duloxetine include

A

nausea
HA
dry mouth
(usually w/in first 3 months of therapy)

20
Q

What is the MOA of Milnacipran and Venlafaxine

A

SNRI used for severe fatigue and pain
Improves pain, global wellbeing, and physical function
*Venlafaxine is not used much 2/2 more intense withdrawal Sx and short half life

21
Q

ADE of Milnacipran include

A

nausea
headache
constipation

22
Q

What is Gabapentin

A

anticonvulsant that acts on cellular calcium channels and blocks release of various NT to cause analgesia

23
Q

Gabapentin is used to

A

reduce pain

improve sleep and QoL

24
Q

ADE of gabapentin include

A

dizziness
sedation
light headedness
weight gain

25
Q

What is Pregabalin (Lyrica)

A

Anticonvulsant that binds alpha-2 delta subunits of voltage gated Ca channels in CNA= inhibits excitatory NT release
Reduces glutamate and glutamine levels in posterior insula
Reduces increased functional connectivity between pain regions
Structurally related to GABA, but does not bind GABA or benzo receptors

26
Q

Pregabalin is used for

A

More severe sleep disturbances

Pain relief

27
Q

ADE of pregabalin are

A 
peripheral edema 
dizziness 
ataxia
xerostomia 
tremor
blurred vision
28
Q

Less recognized treatments for fibromyalgia include (1A recommendations)

A

SSRI: Fluoxetine, Sertraline, Paroxetine
Gamma hydroxybutyrate
Cannabinoids
(Naltrexone is a level 2 evidence)

29
Q

ADE of the less used options are

A

SSRI: nausea, sexual dysfunction, weight gain, sleep disturbance
GHB: sedation, respiratory depression, death
Cannabinoids: sedation, dizziness, dry mouth

30
Q

These are NOT considered appropriate Tx for fibromyalgia

A

NSAIDs: can cause GI, renal, and cardiac s/e
Opioids: not good for treating chronic pain!

Summer pharm 3 (13 decks)

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