Off-Label Pain Mgmt Flashcards
TCA’s
Tricyclin Antidepressants
Not fully understood
Give low dose and titrate up
Dangerous, third-line
TCA SE
Anticholinergic
Neurologic
Cadriovascular
Gastrointestinal
TCA CI
Cardiac disease, conduction disturbances
obtain an EKG
Patients w/ severe GI dysfunction
Amitriptyline (Elavil)
TCA
Most widely used
Strong antocholigeneric effect
Doxepin (Sinequan)
TCA
CI: acute angle glaucoma
SE: increased apetite, weight gain, impotence
Anticonvulsants
Used for tx of neuropathic pain and other mild to mod chronic pain
Gabapentin (neurontin)
- Postherpatic neuralgia tx
- anti-convulsant
- Well tolerated and effective.
- Treats most neuropathic pain except trigeminal neuralgia.
- Can dose very high
Gabapentin SE
Somnolence, ataxia, nausea, diarrhea, dizziness, fatigue, mood swings.
Pregabalin (Lyrica)
Anti-convulsant
Uses: Peripheral Neurpathy
SE: dizziness, somnolence, blurred vision, weight gain, dry mouth, peripheral edema, must taper when DC’ing.
Lamotrigine (Lamictal)
Anti-convulsant/depressant
Stabilizes neuronal membranes through inhibition of sodium channels.
SE: Steven’s Johnson syndrome, rash, dizziness, ataxia, N/V
Topiramate (Topomax)
Anti-convulsant
Good for migraine prevention in adults
Blocks voltage dependent sodium channels.
SE: loss of appetite, weight loss, diarrhea, somnolence
Carbamazepine (Tegretol)
Anti-convulsant
- *Drug of choice for trigeminal neuralgia**
- Many drug interactions because interacts with CP450
- Can affect liver and bone marrow
- Get baseline CBC and LFT’s
Tegretol SE:
DIzziness, ataxia, N/V, Liver toxicity, rash, stevens johnson syndrome.
Duloxetine (Cymbalta)
Serotonin-norepenephrine reuptake inhibitor.
Anti-depressant
Treats diabetic peripheral neuropathy
May work with fibromyalgia and LBP
Avoid in Pt’s with severe hepatic or renal disease.
TENS unit
Transcutaneous electrical nerve stimulation
Used for nerve related pain mediation
targets cutaneous tissues and takes attention off deeper pain.
