Neuropathic Pain and Adjunctive Agents

diabetic, DM, HIV, antiretroviral, nerve, feet

Neuropathic Pain

• __________ peripheral neuropathy common symptomatic, long term complications in pts with both type 1 and type 2 __

• Complication of ___ infection and ______________ therapy

• Originates from direct injury to a _______ and often described as

  • Burning/stabbing/electrical shock/shooting/tingling beginning in the _____ and later affecting the legs and hands

amitriptyline

What TCA can be used to tx neuropathic pain?

anticholinergic, dry, blurred, orthostatic, bleeding, natremia, suicidal

Amitriptyline

• ADRs

  • Associated with _____________ ADRs

    • Constipation

    • ___ mouth

    • _________ vision

    • Sedation

    • ___________ Hypotension

    • Urinary Retention

  • Other ADRs

    • _________ risk

    • CNS depression

    • Hypo__________

    • Serotonin Syndrome

    • Withdrawal syndrome

• BBW

  • Increased _________ thinking and behavior

Amitriptyline

MoA

• Increases the presynaptic concentration of serotonin and/or norepinephrine in the CNS by inhibition of their reuptake

Gabapentin, respiratory, hypersensitivity, suicidal, pregabalin, edema, visual, gain

Anticonvulsants → Gabapentin and Pregabalin

• ___________ → FDA approved for post-herpetic neuralgia and used off label for diabetic neuropathy

  • ADRs → CNS and _________ depression, _____________ reactions, neuropsychiatric effects, __________ ideation

• ___________ → Approved for tx of neuropathic pain associated with post-herpetic neuralgia and diabetic peripheral neuropathy

  • ADRs → CNS and respiratory depression, hypersensitivity reaction, peripheral ______, suicidal ideation, ________ disturbances, weight ____

GABA, brain, 2, calcium, excitatory, seizures

Anticonvulsants → Gabapentin and Pregabalin

• MoA

  • Structural analog of gamma-aminobutyric acid (____) but doesn’t bind to GABA or GABA Receptors

  • Binding site throughout the ______

  • Binds to Alpha-_-delta subunit of voltage gated _________ channels within the CNS thereby inhibiting ____________ neurotransmitter release

• Also approved for adjunctive therapy of partial onset _________ in adults with epilepsy

mu, anticonvulsants, TCAs, gabapentin

Tramadol and Tramadol/Acetaminophen

• Acts as an analgesic by __ opioid receptor agonism and weak inhibition of serotonin and norepinephrine

• Watch for drug-drug interactions with _______________, SSRIs, and ____

• Recommended for those unable to tolerate __________ or anticonvulsants

postherpetic, initiation, conduction, block

Lidocaine Patch 5%

• Approved for _____________ neuralgia

• Blocks _________ and ___________ of nerve impulses

  • Provides analgesic effects but not complete sensory _____