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28 Cards in this Set
- Front
- Back
what gender is diagnosed w/ fibromyaglia most often? what is the median age at onset? |
women (7:1) |
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what is the criteria for classification of fibromyalgia? |
widespread pain from their head to their toes > 3months, pain in 11/18 tender points sites on digital palpation |
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what are the three possible causes of fibromyalgia? |
1) genetic predisposition: 1st relative --> 8x increase |
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what are the five most common symptoms in pts w/ fibromyalgia? |
*muscular pain- 100% (*leg cramps-42) |
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How do tenderpoint in fibromyalgia differ from tenderpoints in a healthy individual? |
they are very symmetric in FM and the are reproducible.
(knees. lat epicondyle (elbow), upper buttox, cervical, superior hamstring, upper scapula, chest) |
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Man w/ chronic widespread pain w/o tenderness. Dx |
FM |
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what are the regional sxs and syndromes related to FM?
(these are not indicative of FM) |
tension/ migraine headaches, affective disorders, TMJ disorders, IBS, cognitive difficulties, vestibular complaints, non-cardiac chest pain, non-dermatomal paresthesias. |
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what are the constitutional sxs of FM? |
weight fluctuation
night sweats weakness sleep disturbance |
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what is the main theory behind the association of sleep and FM? |
these pts are unable to get into stage 4 non-REM sleep. That sleep disturbance may correlate w/ fatigue & weakness, but overall UNKNOWN mechanism |
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what are the four objective discoveries associated in the pathogenesis of FM? |
reduced thalamic blood flow
(overall inconclusive UNKNOWN path) |
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what are the psychological abnormalitis assoc with FM? |
30% w/ depression, anxiety, somatization and hypochondriasis |
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what hormone may be related to the increase in post exertional pain? |
growth hormone
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how can anti-depressants be useful in FM?
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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. |
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To treat central pain, BOTH the descending & ascending systems must be addressed.
The descending system of central pain is under the control of what 6 chemicals? |
serotonin, N-epi, opiates, GABA, dopamine, cannabinoids
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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
(there are fewer meds to act on the ascending system than the descending system) |
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what factors should be evaluated for FM?
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patient's knowledge of FM
pt's pain (both peripheral and central) decline in physical condition psychological distress any nonrestorative sleep associated syndromes |
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what other syndromes can FM overlap w/?
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RA, SLE, SS, Hypothyoid, obstructive sleep apnea. |
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which pharmacologic therapies have the strongest evidence for FM? |
tricyclics (help w/ sleep*)
dual reuptake inhibitors (duloxetine & milnacipran- FDA approved)
alpha 2 delta ligans (pregabalin- FDA approved) |
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what are the nonpharmacologic txs for FM? which four have the strongest evidence for them? |
pt eduction- pts need to take an active role |
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which pharmacologic therapies are not effective in txing FM? |
opioids, NSAIDs, CS, Benzodiazepines, melatonin, guaifenesin, DHEA. |
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T/F |
true
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which antidepressants work the best in FM pts? why? |
(SNRIs) noreepi antidepressants (milnacipran & duloxetine)
becuasse norepi is better for fatigue and sleep than serotonin. |
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what are the adverse effects of duloxetine? |
Nausea, dry mouth, constipation, decreased appetite, sleepiness, increased sweating |
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what are the adverse effects of milnacipran?
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N/V, cephalgia, constipation, insomnia, dizziness, palpitations, hyperhidrosis, HTN, xerostomia, anxiety
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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 |
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what are the adverse effects of pregabalin (anti-convulsant)? |
dizziness, sleepiness, blurred vision, weight gain, dry mouth, peripheral edema
*level 4 narcotic |
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what are the three drugs now FDA approved and are used as SNRIs for FM?
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duloxetine, milnacipran, and pregabalin
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what three medications do you tx FM pts w/ in order to better their non-restorative sleep?
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tricyclics, short-acting hypnotics, muscle relaxants.
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