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Musculoskeletal System > Numbness & Weakness Pharm > Flashcards

Numbness & Weakness Pharm Flashcards

1
Q

What are 3 general drug classes used to treat peripheral neuropathy?

A

1) Gabapentinoids
- Gabapentin, Pregabalin

2) Antidepressants
a) SSRIs, NERIs:
- Duloxetine, Venlafaxine
b) TCAs:
- Amitriptyline

3) Nutritional support for diabetic neuropathy
- α-lipoic acid

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2
Q

What is the moa of gabapentinoids used in the treatment of peripheral neuropathies?

A

GABA analogues → act at voltage-gated Ca channels rather than GABAR
→ ↓tonic neural stimulation managing neuropathic pain

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3
Q

What are 3 indications for Gabapentinoids?

A

1) Neuropathic pain
2) Chronic pain refractory to other treatments
3) Antiepileptic for partial seizures

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4
Q

What are 3 AEs of Gabapentinoids?

A

1) Somnolence
2) Dizziness
3) Ataxia (esp if not titrated over days/weeks)

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5
Q

What is the main DDI for Gabapentinoids?

A

Drugs altering renal f(x)
- Gabapentinoids undergo renal elimination w/o metabolites → propensity for toxic accumulation

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6
Q

What are 2 examples of Gabapentinoids?

A

1) Gabapentin
2) Pregabalin

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7
Q

What is the moa of Duloxetine?

A

Serotonin (5-HT) and Norepinephrine (NE) reuptake inhibitor (SNRI) antidepressant

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8
Q

What are 3 clinical indications for Duloxetine?

A

1) Clinical depression
2) Chronic/Neuropathic pain (usually adjunct w NSAID/paracetamol)

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9
Q

What are 5 AEs of Duloxetine?

A

Common:
1) Xerostomia
2) Abdo pain
3) Drowsiness
4) Fatigue
5) Headache
6) Weight loss

Severe:
7) Mania/Hypomania
8) Easy bleeding
9) Fragility fractures
10) Hepatotoxicity
11) HypoNa
12) Ocular effects
13) Serotonin syndrome
14) Sexual dysfunction
15) Suicidal ideation
16) Withdrawal syndrome

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10
Q

What is the moa of Amitriptyline?

A

Tricyclic antidepressant inhibits reuptake of NE and Serotonin

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11
Q

What are 2 clinical indications for amitriptyline?

A

1) Clinical depression
2) Chronic/neuropathic pain (adjunct to NSAID/paracetamol)

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12
Q

What are 5 AEs of amitriptyline?

A

Antihistaminergic:
1) Sedation
2) Weight gain

Anticholinergic:
3) Blurred vision
4) Xerostomia
5) Urinary retention
6) Constipation
7) Agitation
8) Tachycardia
9) Sweating

α1-receptor blockade:
10) Postural hypotension
11) Tachycardia

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13
Q

What is the main indicati0on for α-lipoic acid?

A

Diabetic neuropathy px who are refractory/intolerant to first-line pharmacotherapies

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14
Q

What is the moa of α-lipoic acid in treating peripheral neuropathies?

A

1) Antioxidant
- neutralise free radicals
- serve as co-factor to several enzymes

2) ↑ glucose uptake in cells

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15
Q

What are 5 AEs of α-lipoic acid?

A

1) Hypogly in diabetic px
2) N&V
3) Abdo pains
4) Allergic rxn
5) Thiamine deficiency (esp in alcoholics)

Overdose:
6) Neurological effects
7) Metabolic acidosis
8) Cardiac effects
9) Hepatotoxicity

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16
Q

In which patients taking α-lipoic acid, would thiamine supplementation be needed?

A

Alcoholics

17
Q

What are 2 forms of vitamin related deficiency-related neuropathy?

A

1) B12
2) Folate (B9)

18
Q

What is the moa of Mecobalamin in treating vitamin deficiency-related neuropathy?

A

Coenzyme form of B12
- facilitates synthesis of methionine from homocysteine → myelin sheath formation

19
Q

What are 3 AEs of Mecobalamin?

A

Rare:
1) HS rxns
2) Headache
3) Nausea

20
Q

True or false:
Mecobalamin overdose is not a concern in all patients.

A

False.
Excess is excreted through urine

21
Q

How is mecobalamin adminstered?

A

1) Oral
2) IV
3) IM

22
Q

What is the moa of Folic acid in treating vitamin deficiency-related neuropathy?

A

1) precursor needed for DNA synthesis and repair.
2) involved in the conversion of homocysteine to methionine, similar to Vitamin B12, and is crucial for the production of red blood cells and neuroprotection

23
Q

What are 3 AEs of Folic acid?

A

1) Nausea
2) Bloating
3) Sleep disturbances
4) High doses may mask B12 deficiency
5) HS rxns (Rare)

24
Q

How is folic acid administered?

A

Oral

25
Q

What are 4 drugs used to treat peripheral artery disease?

A

Anti-hypertensives:
1) ACEi (eg. captopril)
2) ARBs (eg. candesartan)

Anti-lipid therapy:
3) Statins (eg. Atorvastatin)

Anti-platelet therapy:
4) ADP P2Y21 receptor inhibitor (eg. clopidogrel)

Xanthine derivatives:
5) Pentoxifylline

26
Q

What is the moa of pentoxifylline in treating peripheral artery disease?

A

1) Non-selective PDE inhibitor
2) Adenosine 2 receptor antagonist
3) Haemorheologic mechanisms not clear
- ↑deformability of RBC
- ↓ blood viscocity
- ↓ platelet aggregation

27
Q

What are 4 AEs of pentoxifylline?

A

Common:
1) Belching
2) Bloating
3) Abdo pain
4) N&V
5) Indigestion
6) Dizziness
7) Flushing

Rare:
8) Angina
9) Palpitations
10) Bleeding
11) Arrhythnmias
12) Anxiety
13) Hallucinations

28
Q

What are 2 pharmacological treatments for varicose veins?

A

1) Mucopolysaccharide polysulphate
- inflamed & swollen varicose veins

2) Polidocanol
- sclerotherapy to narrow lumen of varicose veins and force blood flow elsewhere

29
Q

What is the moa of mucopolysaccharide polysulphate in treating varicose veins?

A

1) Antithrombotic:
- Inhibits clotting factors by potentiating antithrombin activity

2) Anti-inflammatory:
- ↓ capillary permeability and inflammatory mediators

3) ↑ Microcirculation:
- ↑ blood flow and tissue oxygenation

4) Fibroblast Modulation:
- ↑ fibroblast activity and collagen synthesis,
supporting wound healing

5) Analgesic:
- Provides mild pain relief by modulating local inflammation

30
Q

What are 4 AEs of mucopolysaccharide polysulphate?

A

Local:
1) Mild skin irritation (erythema, pruritus)
2) Contact derm (prolonged use)

Systemic: (Rare)
3) HS rxn
4) Systemic anticoagulation

31
Q

How is Polidocanol administered?

A

IV foam

32
Q

What are 4 drug options for deep vein thrombosis?

A

1) Rivaroxaban/Apixaban monotherapy
2) LMW Heparin + Warfarin
3) LMW Heparin then Dabigatran & Edoxaban

33
Q

What is the moa of polidocanol in treating varicose veins?

A

1) Surface-active agent:
- acts as non-ionic surfactant

2) Endothelial damage:
- localised endothelial cell destruction → inflammation & fibrosis

3) Vessel occlusion
- induces thrombus formation within vein → sclerosis → obliteration of vessel

4) Minimal pain perception
- mild anaesthetic

34
Q

What are 5 AEs of polidocanol?

A

Local:
1) Inflammation/skin rxn @ injection site
2) Skin discoloration

Systemic:
3) Allergic rxn/anaphylaxis
4) Nausea
5) Headache
6) Thromboembolism
7) Ulceration/tissue necrosis (if extravasation occurs)

Musculoskeletal System (22 decks)

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