22 - Neuropathic Pain Flashcards Preview

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Flashcards in 22 - Neuropathic Pain Deck (23):
1

non-pharms

-physiotherapy, mindfulness, yoga, exercise, psychotherapy, ensure enough sleep

*evidence is lacking for these but provide no harm

2

A trial of ____ months is reasonable

2-3 months

3

meds for acute phase for nerve root compression?

NSAIDs or acetaminophen may be effective

4

1st line for chronic peripheral neuropathic pain

TCAs, gabapentinoids, SNRIs

5

2nd line for chronic peripheral neuropathic pain

tramadol and topical lidocane

6

When should you do a follow-up after starting meds for neuropathic pain?

1-2 weeks (to assess tolerability and s/e)

7

3rd line for chronic peripheral neuropathic pain

opioids (morphine, hydromorphone, oxycodone, transdermal fentanyl patch)

8

____ is an opioid that is a poor choice for any pain

codeine

9

Products with codeine or tramadol not for kids < ___ years old

12

10

4th line for chronic peripheral neuropathic pain

cannabinoids, methaodne tapentadol, lamotrigine, topiramate and botox

11

Risk factors for reactivation of VZV?

> 50 yo and decreased immunologic competence

12

Oral antivirals are most effective if started within ___ hours of the onset of the rash or severe pain

72

13

Options for acute pain of PHN?

amitriptyline and/or gabapentin and if necessary, opioids or nerve blocks

corticosteroids may improve QOL but does not accelerate healing so use them sparingly - not indicated for elderly, immunosuppressed, patients with DM, HTN, or GI ulcer

14

Trigeminal neuralgia is confined to the ____

face

*almost always unilateral

15

Trigeminal neuralgia usually responds to what drug?

Carbamazepine - measuring levels is not necessary but may be helpful to assess adherence or concerns regarding toxicity

16

if CBZ doesn't work for trigeminal neuralgia, what is the next option?

oxcarbazepine

17

table 4 on page 347 has really good review

ok

18

Options for neuropathic pain in pregnancy?

-TCAs
-SNRIs
-topical lidocaine
-clonazepam prob safe but other spots say to avoid BZD in pregnancy
-opioids are safe but monitor baby once born

19

Can you use CBZ or oxcarbazepine in pregnancy?

-CBZ can cause neural tube defects
-they are unsure about oxcarbazepine

20

If person is using CBZ or oscarbazepine in pregnancy, what must they supplement with?

folic acid

21

Most of these drugs mentioned are ok for breastfeeding. Which ones are not recommended?

-chronic BZD not recommended if breastfeeding
-avoid pregabalin until we get more data
-don't recommend codeine

22

Gabapentinoids need dose adjusment if CrCl < ___

60 mL/min

23

Venlafaxine need dose adjusment if CrCl < ___

70 mL/min

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