Final - Neuropathic Pains Flashcards
What are advantages of TCAs in neuropathic pain? (3)
have the most data, once daily, can treat concomitant insomnia and depression
What are disadvantages of TCAs in neuropathic pain? (2)
delayed onset, anticholinergic effects
What is the advantage of SS/NRIs in neuropathic pain?
can treat concomitant depression
What are disadvantages of SS/NRIs in neuropathic pain? (2)
risk of serotonin syndrome, Cis in hepatic/renal impairments
What neuropathic pains is duloxetine approved for? (2)
painful diabetic neuropathy and fibromyalgia
What neuropathic pain is milnacipran approved for?
fibromylagia
What are advantages of milnacipran in neuropathic pain? (2)
can improve fatigue and well-tolerated
What are disadvantages of milnacipran in neuropathic pain? (2)
twice daily, HTN
What neuropathic pain is gabapentin approved for?
post-herpetic neuralgia
What is the advantage of gabapentin in neuropathic pain?
few side effects
What are disadvantages of gabapentin in neuropathic pain? (2)
can cause CNS depression, renal impairments
What neuropathic pains is pregabalin approved for? (3)
painful diabetic neuropathy, post-herpetic neuralgia and fibromyalgia
What are advantages of pregabalin in neuropathic pain? (2)
few side effects, can treat concomitant anxiety
What are disadvantages of pregabalin in neuropathic pain? (3)
Scheduled drug (V), can cause CNS depression, renal impairments
What are advantages of tramadol? (2)
less respiratory depression and abuse potential
What are disadvantages of tramadol? (3)
DDIs, dizziness/GI, seizure risk
What neuropathic pain is tapentadol (Nucynta) approved for?
painful diabetic neuropathy
What is the advantage of tapentadol (Nucynta) in neuropathic pain?
weak anticholinergic effects
What is the disadvantage of tapentadol (Nucynta) in neuropathic pain?
Scheduled drug (II)
What is the MOA of capsaicin?
depletes and prevents re-accumulation of substance P in peripheral sensory neurons
What neuropathic pains is lidocaine approved for? (2)
post-herpetic neuralgia and topical anesthesia (general)
What is first-line treatment for neuropathic pain? (4)
TCAs, SNRIs, gabapentinoids, and topicals
What is second-line treatment for neuropathic pain? (2)
tramadol or combination 1st-line therapies
What is third-line treatment for neuropathic pain? (2)
after a specialist referral: SSRIs/anticonvulsants or NMDA antagonists and interventional therapies
What is fourth-line treatment for neuropathic pain?
neuromodulation
What is fifth-line treatment for neuropathic pain?
low-dose opioids
What is sixth-line treatment for neuropathic pain?
targeted drug delivery