Fibromyalgia Flashcards
What is FM?
Chronic dz characterized by amplification of afferent nerve conduction/NT function and diminished efferent nerve conduction
What are the Sx of FM?
Stiffness, decreased sleep, tension headache, IBS, decreased cognitive function with depression and change in mood, RLS, vaginal/menstrual/bladder pain
What is the traditional Tx of FM?
Treat Sx with NSAIDs (acetaminophen), Tricyclic antidepressants (TCA_, and cyclobenzaprine
What are the 3 FDA approved drugs for the treatment of FM?
Duloxetine, milnacipran (SSNRI’s), and Pregabalin
What are the 3 off-label use drugs for FM?
Amitriptyline, Fluoxetine, and Cycobenzaprine
What is the MOA of both Duloxetine and Mulnacipran (the SSNRI’s)?
Inhibit reuptake of serotonin/noerpi, no action on receptors/dopamine
What is Duloxetine more specific for?
Serotonin > NE
What is the metabolism/elimination of Duloxetine?
CYPs including 2D6 (DDRs) and ultimately urinary elimination
Duloxetine and MIlnacipran should not be administered in what conditions?
Severe liver dysfunction or chronic alcoholism
What are the ADE’s of Duloxetine and Milnacipran?
increase HR and BP (caution with CV dz), SIADH, BBW for suicide, contraindicated w/ Glaucoma and MAOIs
What is Pregabalin similar to?
Gapabentin (gapapentin not for FM, for seizures)
What is the MOA of pregabalin?
Inhibits presynaptic alpha-2-delta subunit of L-type calcium channels; innhibiting excitatory transmission by glutamate seeming to inibit anxiety and pain.
What schedule drug is Pregabalin?
Schedule V
How is Pregabalin met/elim?
Rapid absorption, renally eliminated virtually unchanged, dose adjust in renal failure (no metabolism)
What are the ADE’s with Pregabalin?
Rebond pain upon discontinuation, addictive, sedation, suicidal thoughts (not a BBW), dizziness, blurred vision, xerostomia
