Fibromyalgia Flashcards Preview

Pharmacology II > Fibromyalgia > Flashcards

Flashcards in Fibromyalgia Deck (16):
1

Which substances cause pain augmentation?

-Glutamate

-Substance P

-Nerve growth factor

-Serotonin

**high levels of these cause more pain

2

Which substances inhibit pain transmission?

-GABA

-Descending antinociceptive pathways

-Norepinephrine-serotonin (ex. TCA, SNRIs, Tramadol)

-Opioids

-Cannabinoids


**Low levels of these can set stage for hyperanalgesia

3

Centralized pain

-Disturbance in CNS processing of pain

classic examples:
1. Fibromyalgia
2. Irritable bowel sydrome
3. TMJD
4. Tension headache

4

What other CNS system dysfunction is often seen with fibromyalgia

-Sleep disturbance
-Mood disturbance

Also,
-decreased activity
-isolation

5

Fibromyalgia survery criteria

Scoring 0-31

0-19: number of body parts with pain

0-3: presence of fatigue, sleep, memory problems

1: depression, irritable bowel symptoms, and headache

Above 12 or 13 is diagnosis for Fibromyalgia

6

What are the 3 parts of a stepwise approach to treating fibromyalgia

1. Initial approach (confirm diagnosis, education, treat comorbidities)

2. Medicine and exercise (graded exercise like Tai Chi)

3. If not responding to above: referral, combination drug therapy, PT, cognitive behavioral therapy

7

Which drugs are best for pain and sleep in FM?

-Amitripyline (TCA)
-Cyclobenzaprine
-Duloxetine
-Milnacipran
-Gabapentin
-Pregabalin

8

Amitriptyline

-TCA
ADE: dry mouth, constipation, fluid retention, weight gain, grogginess, difficulty concentrating
*possible cardiotoxicity limit use in older adults

9

Cyclobenzaprine

-Centrally acting skeletal muscle relaxant
Indication: mild to moderate FM

ADE: drowsiness, dry mouth, decreased mental acuity, constipation, neuromuscular and skeletal weakness, blurred vision

10

SNRIs

Duloxetine
Milnacipran
Venlafaxine

11

Duloxetine

-SNRI
-Preferred if patient has depression
-Improves mental fatigue, not general fatigue

ADE: nausea, headache, dry mouth

12

Milnacipran

-SNRI
Indications: severe fatigue and pain
-Improved pain, global wellbeing and physical function

ADE: nausea, headache, constipation

13

Venlafaxine

SNRI
-Not used so much because of withdrawal symptoms which occur commonly due to short half life

14

Gabapentin

-Anticonvulsant (blocks release of various neurotransmitters)

-Reduces pain, improves sleep, and quality of life**

ADE: dizziness, sedation, lightheadedness, weight gain

15

Pregabalin [Lyrica]

-Anticonvulsant
-prevents voltage gated calcium channels within CNS from releasing excitatory neurotransmitters

Indications: Severe sleep disturbance in addition to pain

ADE: Peripheral edema***

16

Should you use NSAIDs or Opioids for FM

NO