Post Herpetic Neuralgia Flashcards Preview

year 4 - clinical > Post Herpetic Neuralgia > Flashcards

Flashcards in Post Herpetic Neuralgia Deck (38)
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1
Q

how does shingles occur

A

varicella remains dormant in dorsal root ganglion and then is reactivated and presents as shingles

2
Q

transmission of shingles

A

cant give shingles to someone but can give someone chicken pox if they have never had it before

3
Q

symptoms of shingles and the progression

A

starts as a painful maculopapular rash that follows a dermatome and often stops at the midline
days - weeks rash will start to crust over
pain subsides as rash heals

4
Q

how long for shingles to resolve

A

2-4wks

5
Q

when should you treat wtih antivirals

A

within 72hr
can be later is new lesions present
no benefit once encrusted

6
Q

benefits of antiviral treatment

A

decrease transmission
help with pain
speed healing
prevent PHN?

7
Q

antiviral regimens

A

valacyclovir 100mg tid
famciclovir 500tid
for 7 days
very well tolerated, equal efficacy

8
Q

how should the pain be treated

A

analgesics scheduled

treat early

9
Q

why treat pain

A

prevent chronic pain
decrease acute pain
improve mood and sleep

10
Q

mild pain treatmetn

A

acetaminophen
codiene
tramadol

11
Q

moderate pain treatment

A

oxycodone 5-15mg q4-6hr

12
Q

what is post herpetic neuralgia

A

pain that lasts >3-4months after resolution of rash resulting for nerve damage due to inflammation form varicella
affects ADL, QOL

13
Q

risk factors for PHN

A

old age
allodynia
severe rash or pain
prodromal pain

14
Q

symptoms of PHN

A
rash resolved
burning, stinging, throbbing 
allodynia (pain from something not normally painful) 
numbness
parathesia
15
Q

how long does PHN last

A

unknown can spontaneously resolve

mean = 3.3years

16
Q

effectiveness of treatment

A

<50% of ppl experience more than a 50% pain reduction

17
Q

why is CBT so important in PHN

A

it is a potentially long lasting condition that affects QOL/ADL for which there is incomplete pain relief with medication

18
Q

reducing risk of PHN

A

vaccination

prompt, effective antiviral and acute analgesia

19
Q

problems with amitriptyline

A

anticholinergic burden
weight gain
sedation
do not use in glaucoma, urinary retention, cardiac issues

20
Q

dosing of ami and efficacy

A

nnt =2.6

10-25mg HS increased to 75-150mg

21
Q

gabapentin AE

A

edema
sedation
dizziness
falls

22
Q

dosing of gabapentin

A

100-300mg hs increase at weekly intervals up to 1800mg/day

23
Q

pregabalin > gabapentin

A

pregab reaches target faster
once daily dosing
more reliable target dose

24
Q

pregabalin AE

A

edema, sedation, dizziness

dry mouth

25
Q

dosing and efficacy of pregabalin

A

nnt = 4.2
50-150mg in 2 divided doses
increase weekly by 50-150mg/day
up to 300-600mg/day

26
Q

dosing and efficacy of lidocaine patch

A

apply tid prn

NNT=2

27
Q

side effects of lidocaine

A

redness

28
Q

issues with tramadol

A

NNT= 5
unknown long term efficacy
dependence, constipation, drowsiness

29
Q

non pharms

A
pain diary
cool compress
exercise to improve mood 
CBT
light loose clothing
sleep hygiene
30
Q

monitoring

A

falls
pain diary
follow up in one day for side effect
improved function

31
Q

benefits of specialty compounding

A

can target multiple MOA
less systemic toxicity
good for localized pain

32
Q

counseling for compounds

A

use gloves
still can get systemic AE
if too painful to apply spray is available

33
Q

what is immunosenescence

A

general reduction in immune response as patients age

reduces vaccine efficacy

34
Q

risk of shingles recurrence

A

6-10%

35
Q

efficacy of shingrix

A

treat 333 people will prevent 10 shingles outbreaks and 1 PHN

36
Q

dosing of shingrix

A

two doses 2-6month apart

37
Q

advantages of shingrix

A

easier storage
better efficacy
non live
IM

38
Q

disadvantages of shingrix

A

increased AE - redness, flu like feeling for 1-2days

2 doses