Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
37 Cards in this Set
- Front
- Back
what gender is diagnosed w/ fibromyaglia most often? what is the median age at onset?
|
women (7:1)
29-37 yoa |
|
what is the criteria for classification of fibromyalgia?
|
widespread pain from their head to their toes > 3months, pain in 11 of 18 tender points sites on digital palpation
|
|
what are the three causes of fibromyalgia? Give examples of each
|
1) genetic predisposition: 1st relative --> 8x increase
2) polymorphisms: in pain receptors, neurotransmitters, and metabolism or transport of monoamines 3) specific stressors temporally association: infectious, emotional, trauma |
|
what are the five most common symptoms in pts w/ fibromyalgia?
|
muscular pain- 100%
fatigue- 96 insomia-86 joint pains- 72 headaches-60 |
|
what makes paresthesias of fibromyalgia different from generic parasthesias?
|
the parasthesia doesn't follow particular dermatomes that it should.
|
|
what is pain?
|
an unpleasant sensory and emotional experience associated w/ actual or potential tissue damage, or described in terms of such damage.
|
|
How do tenderpoint in fibromyalgia differ from tenderpoints in a healthy individual?
|
they are very symmetric in FM and the are reproducible.
|
|
what are multiple tender points often a manifestation of?
|
stress
|
|
Man w/ chronic widespread pain w/o tenderness. Dx
|
FM
|
|
what are the regional sxs and syndromes related to FM?
|
tension/ migraine headaches, affective disorders, TMJ disorders, IBS, cognitive difficulties, vestibular complaints, non-cardiac chest pain, non-dermatomal paresthesias.
|
|
what are the constitutional sxs of FM?
|
weight fluctuation
night sweats weakness sleep disturbance |
|
female pt presents w/ chronic pain, >11 Tender points and stomach pain. what else would you expect concerning the stomach pain?
|
alternating diarrhea and constipation--> IBS v common association w/ FM.
|
|
what laboratory tests will come up abnormal in FM?
|
sleep eeg studies
neuroendocrine tests vitamin D functional MRIs |
|
what is the main theory behind the association of sleep and FM?
|
these pts are unable to get into non-REM sleep. That sleep disturbance may correlate very well w/ norepi levels.
|
|
what are the four objective discovers associated in the pathogenesis of FM?
|
reduced thalamic blood flow
increased blood flow to areas of pain perception 3 fold higher substance P in CSF hyperactivity of HPA axis and sympathetic NS. |
|
what stage of sleep is disrupted in FM pts by what?
|
stage 4- NREM by alpha intrusion
|
|
what does the abn HPA axis in FM pts result in?
|
low urinary free cortisol and decreased cortisol response to CRH
|
|
what effect does FM have on CNS?
|
reduced blood flow to thalamus, caudate nucleus and pontine tectum makes the perceived stimuli seem very painful w/ less stimulation
|
|
what are the psychological abnormalitis assoc with FM?
|
30% w/ depression, anxiety, somatization and hypochondriasis
high prevalence of sexual and physical abuse and eating disorders. |
|
what hormone may be related to the increase in post exertional pain?
|
growth hormone
|
|
how can anti-depressants be useful in FM?
|
it can block the reuptake of serotonin and norepi allowing more of these chemicals to get to the nerve that they are supposed to stimulate.
|
|
The descending system of central pain is under the control of what 6 chemicals?
|
serotonin, N-epi, opiates, GABA, dopamine, cannabinoids
|
|
the ascending system of central pain is under the control of what 5 chemicals?
|
substance P, glutamate, CGRP (calcitonin-gene related polypeptide), neurotensin, NGF (nerve growth factor
|
|
what factors should be evaluated for FM?
|
patient's knowledge of FM
pt's pain (both peripheral and central) decline in physical condition psychological distress any nonrestorative sleep associated syndromes |
|
what other syndromes can FM overlap w/?
|
RA, SLE, SS, Hypothyoid, obstructive sleep apnea.
|
|
which pharmacologic therapies have the strongest evidence for FM?
|
tricyclics, dual reuptake inhibitors (duloxetine and milnacipran- FDA approved), alpha 2 delta ligans (pregabalin- FDA approved)
|
|
what are the nonpharmacologic txs for FM? which four have the strongest evidence for them?
|
pt eduction
aerobic exercise acupuncture cognitive behavioral therapy OMM **CV exercises, CBT, pt education, and multidisciplinary therapy. |
|
which pharmacologic therapies are not effective in txing FM?
|
opioids, NSAIDs, CS, Benzodiazepines, melatonin, guaifenesin, DHEA.
|
|
T/F
NSAIDs, although worthless in txing FM by themselves, might have a synergistic effect w/ other drugs. |
true
|
|
which antidepressants work the best in FM pts? why?
|
noreepi antidepressants like maprotiline, desipramine and nortriptyline becuasse norepi is better for fatigue and sleep than serotonin.
|
|
what are the adverse effects of duloxetine?
|
Nausea, dry mouth, constipation, decreased appetite, sleepiness, increased sweating
|
|
what are the adverse effects of milnacipran?
|
N/V, cephalgia, constipation, insomnia, dizziness, palpitations, hyperhidrosis, HTN, xerostomia, anxiety
|
|
what does pregabalin bind to? what does it reduce the release of?
|
binds to alph 2 delta subunit of voltage-gated calcium channel; reduces release of neurotransmitters
|
|
what are the adverse effects of pregabalin?
|
dizziness, sleepiness, blurred vision, weight gain, dry mouth, peripheral edema
|
|
what are the three drugs now FDA approved and are used as SNRIs for FM?
|
duloxetine, milnacipran, and pregabalin
|
|
what three medications do you tx FM pts w/ in order to better their non-restorative sleep?
|
tricyclics, short-acting hypnotics, muscle relaxants.
|
|
which muscle relaxant is used a lot by dean Forman?
|
cyclobenzaprine--> flexaril
|