Flashcards in Fibromyalgia Deck (28):
What neurotransmitters are decreased in the CSF in patients with fibromyalgia?
NE, DA, and 5-HT
Describe the process of dysregulation of fibromyalgia.
The hypothalamus-pituitary axis is dysregulated. That causes an increase in Corticotropin-releasing hormone and substance P activity. This leads to an increase in proinflammation and neurosensitizing molecules.
Describe two common signs/symptoms of fibromyalgia.
Allodynia, which is increased sensitivity to stimuli that aren't normally painful.
Hyperalgesia, which is an increased sensitivity to painful stimuli.
What are some of the main assessments/indexes used to score and assess fibromyalgia?
Widespread Pain Inex (WPI)
Symptom Severity (SS)
What are the goals of therapy in relation to fibromyalgia?
Reduce pain symptoms
What are some different pharmacologic therapies to use to treat fibromyalgia?
Skeletal muscle relaxants
What are the doses for treatment of pain syndromes compared to depression/anxiety?
You will use lower doses for drugs that are being used for pain compared to when they are being used for depression/anxiety.
MOA, ADRs, Dose adjustments
Gabapentin and pregabalin
MOA: Binds to sites associated with presynaptic voltage-gated Ca channels, which modulates excitatory NT release involved in nociception.
ADRs: Dizziness, Increased weight, sedation
DA: Renal adjustments
Duloxetine, venlaflaxine, milnacipran
Inhibits reuptake of synaptic 5-HT and NE
Increased BP, HR
Nausea, sweats, HA, dry mouth
Duloxetine is a CYP1A2 substrate
Venlafaxine is a CYP3A4 and 2D6 substrate
Duloxetine/venlafaxine are CYP2D6 inhibitors
SNRI dose adjustments
Tricyclic Antidepressant (TCAs) Drugs
5HT and NE reuptake inhibition
Increased QT wave
Interacts with anticholinergic agents, MAOIs, and other serotonergic agents
Other QT prolonging agents
Amitriptyline and nortripyline are CYP2D6 substrates
TCA dose adjustments
No renal or hepatic recommendations
Skeletal Muscle Relaxant Drugs
Skeletal Muscle Relaxants MOA
Acts at the brainstem to modulate tonic somatic motor activity
Skeletal Muscle Relaxant ADRs
Increased Heart Rate
Skeletal Muscle Relaxant Interactiosn
MAOIs and other serotonergic agents
Skeletal Muscle Relaxant Dose Adjustments
DA Agonist MOA
May help modulate excessive adrenergic arousal (helps with sleep in fibromyalgia)
DA agonist ADRs
DA agonist Interactions
Ropinirole reacts with CYP1A2 Substrates