Fibromyalgia Flashcards
What is Fibromyalgia?
augmented CNS pain processing leading:
- widespread muscle aches and stiffness
- fibro fog: memory loss and
- sleep disturbance
- mood impairment
- tender points
Which chemicals act to increase pain?
Glutamate
Nerve Growth factor
Substance P
Serotonin 5HT2A
*are high in the CSF of patients with fibromyalgia”
Which chemicals act to decrease pain?
NE Serotonin Opioids Cananabinioids GABA
*GABA SE and NE are low in CSF in patients with fibromylagia”
T/F Integrative approach to fibromylagia is best
T/F use exercise, CBT, drugs, TENS, and patient education to manage fibromyalgia
What are pharmacological treatments for fibromyalgia?
TCA -Amtriptyline and cyclobenzaprine
SNRI’s: Doluxetine and Milnacipran
Gabapentinoids: Pregabalin and Gagapentin
T/F Drug therapy for Fibromyalgia induces mild improvement in pain but moderate relief in sleep disturbances
TRUE
What is MOA of amitriptyline?
TCA: blocks the reuptake channels of NE and serotonin NET and SERT channels
What are ADE of amtriptyline?
dry mouth, fluid retention, constipation, cardio toxicity
What is MOA of cyclobenzaprine?
related TCA, but acts to relax muscles
What are ADE of cyclobenzaprine?
xerostomia, blurred vision, muscle weakness, drowsiness
What is MOA of SNRI’s?
blocks reuptake of Serotonin and Norepinephrine
duloxetine or milnacipran
In what clinical scenarios is it best to use duloxetine?
patients who have fibromylagia and who are depressed
-improves mental fatigue but not general fatigue
What are ADE of SNRI’s?
dry mouth, nausea, HA
In what clinical scenarios is it best to use milnacipran?
severe fatigue and pain
-improves pain, global well being, and physical function
What are ADE of milnacipran
-HA, nausea, constipation
When should you use cyclobenzaprine?
mild to moderate fibromylagia pain with only minimal relief of depression
Why is venlafaxine not used?
high withdrawal symptoms
because of short half life and missed dose can cause withdrawal symptoms
What is MOA of gabapentin?
blocks calcium channels and blocks the release of nerurotransmitters like Glutamate
What is the benefit of gabapentin?
improves sleep, QOL and reduces pain
What are ADE of gabapentin?
sedation, dizziness, weight gain,amnesia
What is MOA of pregabalin?
binds the alpha-2 delta sub unit of voltage gated Ca channels inhibiting excitatory neurotransmitter release
What is the clinical use of pregabalin?
more severe sleep disturbance in addition to pain
What are ADE of pregabalin?
peripheral edema, tremor, ataxia, xerostomia
Which medication is not approve by the FDA?
GHB
