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Pharmacology > Fibromyalgia > Flashcards

Fibromyalgia Flashcards

1
Q

What is Fibromyalgia?

A

augmented CNS pain processing leading:

  • widespread muscle aches and stiffness
  • fibro fog: memory loss and
  • sleep disturbance
  • mood impairment
  • tender points
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2
Q

Which chemicals act to increase pain?

A

Glutamate
Nerve Growth factor
Substance P
Serotonin 5HT2A

*are high in the CSF of patients with fibromyalgia”

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3
Q

Which chemicals act to decrease pain?

A 
NE
Serotonin
Opioids
Cananabinioids 
GABA

*GABA SE and NE are low in CSF in patients with fibromylagia”

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4
Q

T/F Integrative approach to fibromylagia is best

A

T/F use exercise, CBT, drugs, TENS, and patient education to manage fibromyalgia

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5
Q

What are pharmacological treatments for fibromyalgia?

A

TCA -Amtriptyline and cyclobenzaprine
SNRI’s: Doluxetine and Milnacipran
Gabapentinoids: Pregabalin and Gagapentin

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6
Q

T/F Drug therapy for Fibromyalgia induces mild improvement in pain but moderate relief in sleep disturbances

A

TRUE

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7
Q

What is MOA of amitriptyline?

A

TCA: blocks the reuptake channels of NE and serotonin NET and SERT channels

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8
Q

What are ADE of amtriptyline?

A

dry mouth, fluid retention, constipation, cardio toxicity

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9
Q

What is MOA of cyclobenzaprine?

A

related TCA, but acts to relax muscles

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10
Q

What are ADE of cyclobenzaprine?

A

xerostomia, blurred vision, muscle weakness, drowsiness

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11
Q

What is MOA of SNRI’s?

A

blocks reuptake of Serotonin and Norepinephrine

duloxetine or milnacipran

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12
Q

In what clinical scenarios is it best to use duloxetine?

A

patients who have fibromylagia and who are depressed

-improves mental fatigue but not general fatigue

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13
Q

What are ADE of SNRI’s?

A

dry mouth, nausea, HA

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14
Q

In what clinical scenarios is it best to use milnacipran?

A

severe fatigue and pain

-improves pain, global well being, and physical function

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15
Q

What are ADE of milnacipran

A

-HA, nausea, constipation

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16
Q

When should you use cyclobenzaprine?

A

mild to moderate fibromylagia pain with only minimal relief of depression

17
Q

Why is venlafaxine not used?

A

high withdrawal symptoms

because of short half life and missed dose can cause withdrawal symptoms

18
Q

What is MOA of gabapentin?

A

blocks calcium channels and blocks the release of nerurotransmitters like Glutamate

19
Q

What is the benefit of gabapentin?

A

improves sleep, QOL and reduces pain

20
Q

What are ADE of gabapentin?

A

sedation, dizziness, weight gain,amnesia

21
Q

What is MOA of pregabalin?

A

binds the alpha-2 delta sub unit of voltage gated Ca channels inhibiting excitatory neurotransmitter release

22
Q

What is the clinical use of pregabalin?

A

more severe sleep disturbance in addition to pain

23
Q

What are ADE of pregabalin?

A

peripheral edema, tremor, ataxia, xerostomia

24
Q

Which medication is not approve by the FDA?

A

GHB

25
Q

T/F NSAIDS have no evidence of benefit for fibromylagia?

A

TRUE

26
Q

What is neuropathic pain?

A

malfunction of the NS often triggered by injury to the nerve

27
Q

T/F Topically applied local analgesics help in peripheral neuropathy?

A

TRUE

28
Q

Name 3 topically applied local analgesics

A

Salonpas-4 lidocaine

NSAID patch: flexor voltarin

29
Q

What drugs are helpful in treating PN?

A 
Gabapentin
Pregabalin 
TCA-Amitriptyline
SNRI: Duloxetine 
Opioids are questionable
30
Q

What is peripheral/nociceptive pain? what tx does it respond to?

A

pain due to inflammation or injury to nerve
NSAIDS, injections
Ex. DJD, RA, cancer pain

31
Q

What is neuropathic pain? what tx does it respond to?

A

damage or dysfunction of peripheral nerves
responds to peripherally acting and centrally acting meds
Ex. diabetic neuropathy

32
Q

What is centralized pain? what tx does it respond to?

A

disturbance of CNS processing

-responds to neuroactive compounds altering NT levels involved in pain transmission

33
Q

Which drugs aim to reduce glutamate levels?

A

Ketamine, Mementine, gabapentinoids

34
Q

Which drugs aim to increase GABA?

A
  • GHB

- alcohol

35
Q

Which drugs aim to reduce serotonin 5HT2A levels?

A

Triptans

cyclobenzaprine

36
Q

Which drugs aim to increase SE and NE levels?

A

SSRI’s
SNRI’s
TCA
Tramadol

Pharmacology (47 decks)

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