Restless Leg Syndrome Flashcards
(23 cards)
Another name for this syndrome
Willis-Ekbom disease
Symptoms
-desire to move limbs
-creepy-crawly sensation
-itchy
-aching
-cramps/ pain
-motor restlessness, that worsens at rest
-relieved by activity
Relieving Factors of RLS
shifting positions, shaking out the leg
Ruling out during investigation
iron deficiency
peripheral neuropathy
akathisia (drug-induced or positional)
nocturnal leg cramps
Risk factors of RLS
fam history, pregnancy, obesity, female gender, peripheral neuropathy
Primary RLS
genetic component
low iron
dopaminergic transmission
secondary causes of RLS
renal disease
diabetes
spinal cord pathology
spinal cord block
MS
parkinson’s
tremors
smoking
alcohol
caffeine intake
high carb diet
lack of sleep
prolonged inactivity
extreme temperatures
hypokalemia
hypomagnesemia
hypocalcemia
Non-pharm treatment
smoking cessation, avoid alcohol and caffeine
adequate sleep
moderate stretching exercises
relaxation therapy
hot bath
staying mentally active
First line drugs for treatment
Selective dopamine agonists -
ropinirole 0.5-3 mg
pramipexole 0.12-0.15 mg
Second line drugs for RLS treatment (resistant cases)
baclofen
clonidine
amantadine
Intermittent RLS treatment options
L-dopa
BZDs
Codeine
A patient presents to the clinic with RLS symptoms. What should be checked in blood work?
Ferritin levels in all new cases. It ferritin <75, give iron.
Chronic RLS treatment options
Dopamine agonists (pramipexole, ropinirole, rotigotine)
GABA derivatives (gabapentin, pregabalin)
In Chronic RLS, if first line agents are INEFFECTIVE or not tolerated, the next step is to…
switch WITHIN class (i.e. prami –> ropi)
In Chronic RLS, if first changing WITHIN first line agents are INEFFECTIVE or not tolerated, the next step is to…
switch to a different class ex. ropi –> gabapentin
if changing to a new class of drugs is ineffective/intolerant and symptoms still persist (i.e. refractory RLS), the next step is to…
combine the drugs (GABA derivatives + dopamine agonists) OR benzo + low potency opioid
At what point of treatment should a high potency opioid be added?
If treatment for refractory RLS is ineffective with low potency opioids combined with benzo, then switch to high potency opioid (ex. codeine, oxycodone, methadone)
Treatment for RLS in pregnancy
non-drug measures are 1st line
-monitor Iron, Mg, Folic Acid deficiency
Drug measures for severe RLS in pregnancy?
opioids are the only option (but not near term)
AVOID dopamine agonists
What is the effect of dopamine agonists in breastfeeding?
decrease in breast milk production
A patient is experiencing insomnia and RLS. What is the preferred drug?
GABA Derivatives - gabapentin or pregabalin
