Final - Neuropathic Pains

Question 1

What are advantages of TCAs in neuropathic pain? (3)

Answer 1

have the most data, once daily, can treat concomitant insomnia and depression

Question 2

What are disadvantages of TCAs in neuropathic pain? (2)

Answer 2

delayed onset, anticholinergic effects

Question 3

What is the advantage of SS/NRIs in neuropathic pain?

Answer 3

can treat concomitant depression

Question 4

What are disadvantages of SS/NRIs in neuropathic pain? (2)

Answer 4

risk of serotonin syndrome, Cis in hepatic/renal impairments

Question 5

What neuropathic pains is duloxetine approved for? (2)

Answer 5

painful diabetic neuropathy and fibromyalgia

Question 6

What neuropathic pain is milnacipran approved for?

Answer 6

fibromylagia

Question 7

What are advantages of milnacipran in neuropathic pain? (2)

Answer 7

can improve fatigue and well-tolerated

Question 8

What are disadvantages of milnacipran in neuropathic pain? (2)

Answer 8

twice daily, HTN

Question 9

What neuropathic pain is gabapentin approved for?

Answer 9

post-herpetic neuralgia

Question 10

What is the advantage of gabapentin in neuropathic pain?

Answer 10

few side effects

Question 11

What are disadvantages of gabapentin in neuropathic pain? (2)

Answer 11

can cause CNS depression, renal impairments

Question 12

What neuropathic pains is pregabalin approved for? (3)

Answer 12

painful diabetic neuropathy, post-herpetic neuralgia and fibromyalgia

Question 13

What are advantages of pregabalin in neuropathic pain? (2)

Answer 13

few side effects, can treat concomitant anxiety

Question 14

What are disadvantages of pregabalin in neuropathic pain? (3)

Answer 14

Scheduled drug (V), can cause CNS depression, renal impairments

Question 15

What are advantages of tramadol? (2)

Answer 15

less respiratory depression and abuse potential

Question 16

What are disadvantages of tramadol? (3)

Answer 16

DDIs, dizziness/GI, seizure risk

Question 17

What neuropathic pain is tapentadol (Nucynta) approved for?

Answer 17

painful diabetic neuropathy

Question 18

What is the advantage of tapentadol (Nucynta) in neuropathic pain?

Answer 18

weak anticholinergic effects

Question 19

What is the disadvantage of tapentadol (Nucynta) in neuropathic pain?

Answer 19

Scheduled drug (II)

Question 20

What is the MOA of capsaicin?

Answer 20

depletes and prevents re-accumulation of substance P in peripheral sensory neurons

Question 21

What neuropathic pains is lidocaine approved for? (2)

Answer 21

post-herpetic neuralgia and topical anesthesia (general)

Question 22

What is first-line treatment for neuropathic pain? (4)

Answer 22

TCAs, SNRIs, gabapentinoids, and topicals

Question 23

What is second-line treatment for neuropathic pain? (2)

Answer 23

tramadol or combination 1st-line therapies

Question 24

What is third-line treatment for neuropathic pain? (2)

Answer 24

after a specialist referral: SSRIs/anticonvulsants or NMDA antagonists and interventional therapies

Question 25

What is fourth-line treatment for neuropathic pain?

Answer 25

neuromodulation

Question 26

What is fifth-line treatment for neuropathic pain?

Answer 26

low-dose opioids

Question 27

What is sixth-line treatment for neuropathic pain?

Answer 27

targeted drug delivery