non opiates 2 Flashcards
what neurotransmitters are involved in the neuropathic pain pathway?
serotonin (inhibits and promotes pain perception) and norepinephrine (primarily inhibitory)
SNRIs
serotonin-norepinephrine reuptake inhibitors
antidepressant drugs that are used as analgesics
doxepin, milnacipran (fibromyalgia), amitrityline, duloxetine
antiseizure drugs used as analgesics
phenytoin, carbamazepine, pregabalin
which is better for pain: antiseizure drugs, antidepressants
antidepressants - antiseizure drugs focus on Na channels
what did carbamazepine begin treating?
trigeminal neuralgia (better for pain)
do SSRIs help relieve pain?
not as well as SNRIs
how do antiseizure drugs decrease pain experienced?
decrease excitatory transmission, inactivate Na channels (not a class effect)
which antiseizure/antidepressant drugs are albeled for use to decrease pain?
minacipran, gabapentin, duloxetine, carbamazepine, pregabalin
MOA of pregabalin
effect on presynaptic N-type channels, sits in GAMA receptor sites (doesn’t mimic it)
ADRs of pregabalin
dizziness, sleepiness, peripheral edema, weight gain, suicide risk warning (screen for this!), slow taper when d/c
max dose of pregabalin?
450mg/day
Duloxetine MOA
serotonin and NE reuptake
ADR of duloxetine
CNS sxs like sleepiness, fatigue, eadache, nausea, xerostomia, suicide risk warning
Goals of treating osteoarthritis
control pain/swelling, minimize disability, improve QOL, educate on disease mgmt (lifestyle)
what is osteoarthritis AKA?
degenerative joint disease
What is osteoarthritis?
involves cartilage and bone destruction accompanied by osteophyte formation and other changes to the joint that result in pain and limited mobility
Compare/contrast osteoarthritis and RA in terms of site affected
OA: joint localization, RA: articular, systemic and extra-articular manifestations
Compare/contrast OA and RA in terms of pathogenesis
OA: biomechanical; leads to loss of cartilage matrix, RA: autoimmune response and extra-articular manifestations
compare/contrast OA and RA in terms of sxs
OA: pain, stiffness > 20mins, limited motion, RA: pain, joint swelling, stiffness >1 hours, limited motion