pain caused by a lesion or disease of the somatosensory nervous system
What is Neuropathic Pain?
ectopic activity in damaged nerve fibers and peripheral/central sensitization
What is the cause of Neuropathic Pain?
nortriptyline, amitriptyline, Despiramine
What are the TCA? (3)
duloxetine, venlafaxine, Milnacipran
What are the SNRIs? (3)
inhibit presynaptic reuptake of 5-HT and NE; activates the descending pathways
Antidepressants MOA?
act on central terminals of primary afferent fibers decreasing NT release/neuronal hyperexcitability
Antiepileptic drugs MOA?
a,c
Which drugs are modulators of VGCC?
a) pregabalin
b) carbamazepine
c) gabapentin
d) Milnacipran
b
Which drug is a Voltage-Gated Na+ modulator?
a) pregabalin
b) carbamazepine
c) gabapentin
d) Milnacipran
gabapentin, pregabalin, carbamazepine
What are the antiepileptic drugs? (3)
lidocaine, capsaicin, camphor
What are the topical adjuvants? (3)
local anesthetic; use-dependent blockade of voltage-gated Na+ channels; stabilizes nerve membranes
Lidocaine MOA?
TRPV1 agonists that cause desensitization of nociceptors through the depletion of substance P from afferent nerve fibers
Capsaicin MOA?
Spasm
-involuntary contracts of the muscle.
an upper motor neuron disorder that causes hypertonicity and involuntary spasms
What is Spasticity?
jerks, twitches, cramps
Symptoms of Spasms? (3)
stiffness, hypertonicity, hyperreflexia
Symptoms of Spasticity? (3)
musculoskeletal pain, fibromyalgia, low back pain, disc herniation
Which conditions can cause spasms? (4)
MS, cerebral palsy, spinal cord injury, stroke, traumatic brain injury
Which conditions can cause spasticity? (5)
centrally; muscle
Antispasmodics act ______ and DO NOT act in ________ directly.
1st; AE's and limited comparative efficacy
Antispasmodics are not _______ line drug options because of __________.
2nd line or adjunct therapy when initial therapy fails
When are antispasmodics used?
anticholinergic AE's; sedation, confusion, dry mouth, hallucinations
Antispasmodics AE's? (4)
carisoprodol, cyclobenzaprine, metaxalone, methocarbamol, orphenadrine, chlorzoxazone
What are the Antispasmodic agents? (6)
a,f
Which drugs have anticholinergic and antihistaminic effects?
a) Orphenadrine
b) Metaxalone
c) Carisoprodol
d) Cyclobenzaprine
e) Methocarbamol
f) Chlorzoxazone
c
Which drug is a Schedule IV?
a) Orphenadrine
b) Metaxalone
c) Carisoprodol
d) Cyclobenzaprine
e) Methocarbamol
f) Chlorzoxazone
d
Which drug is structurally similar to TCA and potentiates other CNS
depressants?
a) Orphenadrine
b) Metaxalone
c) Carisoprodol
d) Cyclobenzaprine
e) Methocarbamol
f) Chlorzoxazone
e
Which drug can cause urine to turn brown, green, or black?
a) Orphenadrine
b) Metaxalone
c) Carisoprodol
d) Cyclobenzaprine
e) Methocarbamol
f) Chlorzoxazone
b
Which can cause hepatotoxicity?
a) Orphenadrine
b) Metaxalone
c) Carisoprodol
d) Cyclobenzaprine
e) Methocarbamol
f) Chlorzoxazone