Nerve based pn tx

Question 1

Gabapentin AE

Answer 1

• N
• wt gain
• lower leg edema
• confusion
• dizziness

Question 2

Neurontin monitoring/dose tips

Answer 2

NOT nephrotoxic
 (no need to monitor hepatic function)

• check baseline renal function (adj. dose by CrCl)
• wean to avoid rebound seizure
• benefit of doses 2400 mg is ?

Question 3

General CNS AE:

Answer 3

• lightheadedness
• dizzy
• confusion

Question 4

Lyrica AE

Answer 4

• N
• Wt gain
• confusion

Question 5

Lyrica dose adj

Answer 5

C-V

• wait 2-4 wks b/w dose adjs.

Question 6

Topamax dosing

Answer 6

initial: 25 mg QD, incr weekly by 25
target: 100-200
* we dont just jump to 100 mg bc SIGNIFICANT dizziness & confusion would occur

Question 7

Topamax vs Lyrica/Neurontin MOA

Answer 7

Topamax: Na-gated Channel blocker

Lyrica & Neurontin: Ca Channel blocker

Question 8

Topamax AE

Answer 8

• dizziness
• wt LOSS
• KIDNEY STONES

Question 9

Pts we should avoid Topamax in:

Answer 9

• elderly (topiramate fog)
• pregnancy
• also need relatively good renal function
• -> CrCl (> 70 mL/min)

(make sure the drain is open so the med does not get stuck and cause SE bc of increased exposure time)

Question 10

Duloxetine AE

Answer 10

• headache
• dry mouth
• dizziness
• confusion
• upset stomach
• BP incr.

Question 11

Amitriptyline

Answer 11

pn, mood, sleep

anticholinergic effects:
- fatigue
- sleep
… morning hangover effect

HS dosing

Question 12

topical agent tips

Answer 12

lidocaine

• patch (can cut)
• ointment (less expens., & covered by insurance usually)

Capsaicin Cream (OTC)

• use in diabetic pts
• multiple applications x wks to see effects
• incr. burning sensation @ application, wash hands after

DO NOT WRAP