Fibromyalgia Flashcards Preview

PPS 946 > Fibromyalgia > Flashcards

Flashcards in Fibromyalgia Deck (28):
1

What neurotransmitters are decreased in the CSF in patients with fibromyalgia?

NE, DA, and 5-HT

2

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.

3

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.

4

What are some of the main assessments/indexes used to score and assess fibromyalgia?

Widespread Pain Inex (WPI)
Symptom Severity (SS)

5

What are the goals of therapy in relation to fibromyalgia?

Improve function
Reduce pain symptoms

6

What are some different pharmacologic therapies to use to treat fibromyalgia?

Gabapentin
SNRIs
TCAs
Skeletal muscle relaxants
Dopamine agonists

7

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.

8

Gabapentinoids
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

9

SNRI drugs

Duloxetine, venlaflaxine, milnacipran

10

SNRI MOA

Inhibits reuptake of synaptic 5-HT and NE

11

SNRI ADRs

Increased BP, HR
Nausea, sweats, HA, dry mouth

12

SNRI Interactions

Duloxetine is a CYP1A2 substrate
Venlafaxine is a CYP3A4 and 2D6 substrate
Duloxetine/venlafaxine are CYP2D6 inhibitors

13

SNRI dose adjustments

Renal adjustments
Hepatic adjustments

14

Tricyclic Antidepressant (TCAs) Drugs

Amitryptyline
Nortriptyline

15

TCA MOA

5HT and NE reuptake inhibition

16

TCA ADRs

Dry mouth
Increased weight
Somnolence
GI disturbances
Increased QT wave

17

TCA Interactions

Interacts with anticholinergic agents, MAOIs, and other serotonergic agents
Other QT prolonging agents
Amitriptyline and nortripyline are CYP2D6 substrates

18

TCA dose adjustments

No renal or hepatic recommendations

19

Skeletal Muscle Relaxant Drugs

Cyclobenzaprine

20

Skeletal Muscle Relaxants MOA

Acts at the brainstem to modulate tonic somatic motor activity

21

Skeletal Muscle Relaxant ADRs

Drowsiness
Dizziness
Dry Mouth
Constipation
Increased Heart Rate

22

Skeletal Muscle Relaxant Interactiosn

MAOIs and other serotonergic agents
CYP1A2 Substrate

23

Skeletal Muscle Relaxant Dose Adjustments

Hepatic Adjustment

24

Dopamine Agonists

Pramipexole
Ropinirole

25

DA Agonist MOA

May help modulate excessive adrenergic arousal (helps with sleep in fibromyalgia)

26

DA agonist ADRs

Orthostatic hypotension
Drowsiness
Dizziness
Impulse control
Extrapyramidal symptoms

27

DA agonist Interactions

Antipsychotics
Ropinirole reacts with CYP1A2 Substrates

28

DA agonist Dose Adjustments

Renal Adjustment