FIBROMYALGIA_FARM

Question 1

MOA duloxetine

Answer 1

SSNRIs antidepressants, no action on receptors/dopamine

Question 2

duloxetine has more specificity in blocking what receptors?

Answer 2

Ser>NE

Question 3

Duloxetine is metabolized by what CYP enzyme?

Answer 3

CYP2D6

Question 4

what is the must know BBW for duloxetine?

Answer 4

suicidal ideation

Question 5

Both duloxetine & milnacipran are eliminated by what mechanism?

Answer 5

urinary

Question 6

MOA pregabalin

Answer 6

works by inhibiting presynaptic alpha-2-delta subunits of L-type Ca2+ channels

• as a result they inhibit excitatory transmission by glutamate
• seems to alleviate neuropathic pain

Question 7

pregabalin is a schedule ___________ drug

Answer 7

V

Question 8

how is pregabalin eliminated?

Answer 8

renal elimination unchange (adjust dose in renal failure)

Question 9

What are the notable cautions of pregabalin?

Answer 9

rebound w/ drug withdrawal (may cause depend.)
Additive sedation
Monitor pts for depression, suicidal thoughts
In elderly: dizziness sedation, blurred vision, xerostomia

Question 10

which side effects should you be looking for in the elderly taking pregabalin?

Answer 10

dizziness
sedation
blurred vision
xerostomia

Question 11

what are the monitoring parameters for pregabalin?

Answer 11

serum creatinine (makes sense because it is eliminated by the kidneys)

Question 12

Cyclobenzaprine MOA

Answer 12

central action; possibly at the level of the brain stem (related to amitriptyline)

Question 13

what are the FDA indications for cyclobenzaprine?

Answer 13

muscle spasm

FM (off label use)

Question 14

how is cyclobenzaprine eliminated?

Answer 14

enterohepatic recirculation & extensive hepatic metabolism

Question 15

cyclobenzaprine has reduced clearance in the __________ population and in pts w/ _____________ dysfunction

Answer 15

elderly, liver

Question 16

Amitriptyline and cyclobenzaprine both have significant _________________ action

Answer 16

anticholinergic

Question 17

describe the anticholinergic effects of cyclobenzaprine

Answer 17

drowsiness
xerostomia
dizziness
fatigue
N/V/C
blurred vision

Question 18

which pts taking cylclobenzaprine are at risk for confusion & cardiac effects & may lead to falling?

Answer 18

elderly

Question 19

what are some of the cautions for cylcobenzaprine?

Answer 19

additive CNS depression (depressants & EtOH)
additive anticholinergics (GI problems)

Question 20

what is the most significant GI problem with pts taking cyclobenzaprine?

Answer 20

GI–>paralytic ileus

Question 21

TCAs have been reported to have what CV adverse effect?

Answer 21

QT prolongation (caution w/ antiarrhythmics)

Question 22

Tizanidine MOA

Answer 22

agonist at pre-synaptic alpha-2 receptor–>decreased activation of polynaptic spinal cord motor neurons w/ concomitant reduction in muscle tone but NOT MUSCLE STRENGTH

Question 23

which drug reduces muscle tone but not muscle strength?

Answer 23

tizanidine

Question 24

how is tizanidine metbolized & excreted?

Answer 24

extensive 1st pass metab., short t1/2 w/ extensive renal excretion of long lasting metabolites

Question 25

how would you treat pts w/ tizanidine so as to avoid excessive drug toxicity in elderly and renal pts?

Answer 25

dose should be titrated up to effect

Question 26

what are the monitoring parameters of tizanidine?

Answer 26

LFTs (hepatocellular toxicity is reported) | -remember extensive 1st pass metab. in liver

Question 27

what are the adverse effects of tizanidine?

Answer 27

hepatotoxicity tapered cessation to avoid rebound hypertonicity additive CNS depression additive hypotension common side effects related to MOA of drug: asthenia, xerostomia, dizziness, sedation, hypotension

Question 28

Baclofen MOA

Answer 28

acts as GABAb agonist at multiple levels in spinal cord, producing either inhibitor signals or hyperpolarizing & and so reducing the excitatory (aspartate & glutamate) polysynaptic pathways - pain relief in spinal cord comes from inhib. of substance P action - sedation at high doses

Question 29

what are the FDA indications for baclofen?

Answer 29

multiple sclerosis muscle spasm spasticity spinal cord trauma

Question 30

how is baclofen eliminated?

Answer 30

extensive renal elimination

Question 31

what could happen if you give baclofen in pts with renal failure?

Answer 31

``` drug accumulation can lead to: encephalopathy abdominal pain seizures respiratory depression ```

Question 32

what could happen if a pt suddenly stops taking baclofen?

Answer 32

BBW of rebound neural activity: - seizures - confusion - hallucinations - psychiatric disturbances (esp. in pts w/ previous CNS conditions) - increased spastcity (maybe-->rhabdomylolysis, MODS, death)

Question 33

dose adjustment of antidiabetic agents may be necessary for which drug that treats spasticity?

Answer 33

baclofen (can cause increased BG)

Question 34

what do you have to remember about taking pts off of baclofen?

Answer 34

tapered dosing over 2 wks

Question 35

Dantrolene MOA

Answer 35

decreases muscle contraction by directly interfering (ryanodine receptor) w/ Ca2+ release from the SR w/i skeletal muscle cells -effectively uncouples the excitation-contraction process

Question 36

what are the FDA indications for dantrolene?

Answer 36

malignant hyperthermia multiple sclerosis neuroleptic malignant syndrome spasticity

Question 37

why does dantroline have a delay in immediate administration?

Answer 37

it has to be reconstituted

Question 38

how is dantrolene metabolized & eliminated?

Answer 38

hepatically metab. renally eliminated

Question 39

what are the monitoring parameters for dantrolene?

Answer 39

LFTs

Question 40

IV dantrolene combined w/ CCB in treatment of malignant hyperthermia may produce what?

Answer 40

Vfib & CV Collapse

Question 41

what are some common adverse effects of dantrolene?

Answer 41

muscle weakness-->drooling, dysarthria, enuresis, myalgias & backache