Venlafaxine Duloxetine Initial 30 mgday MD 60 120 mgday Titrate 30 mgweek

Venlafaxine duloxetine initial 30 mgday md 60 120

This preview shows page 12 - 15 out of 29 pages.

Venlafaxine Duloxetine: - Initial: 30 mg/day - MD: 60-120 mg/day - Titrate: 30 mg/week Venlafaxine: Neurology Exam 3 Study Guide | Page 12
Image of page 12
Venlafaxine - Nausea - ↑ BP at doses >150 mg;day - ER better tolerated than IR Both can improve depression - Initial: 37.5-75 mg/day (QD for ER and 2-3 divided doses for IR) - MD: 150-225 mg/day - Titrate: 75 mg/week Ca Channel α 2 δ ligands Gabapentin, pregabalin Post herpetic neuralgia and painful diabetic neuropathy Bind to voltage-gated Ca channels at the α 2 δ subunit and inhibit NT release Dose dependent dizziness and sedation Can help with sleep disturbances No clinically significant DDIs Require renal adjustment Gabapentin: - Initial: 300 mg/day - MD: 1800-3600 mg/day - Titrate: 300 mg/day Gabapentin Enacarbil - Initial: 600 mg/day - MD: 1200 mg/day - Titrate: inc. 1200 mg/day after 3 days Pregabalin: - Initial: 75-150 mg/day - MD: 150-600 mg/day - Titrate: inc. 75 mg/day every 3 days 2nd Line of Therapy Capsaicin 8% patch (topical) Postherpetic neuralgia and HIV-neuropathy Depolarization and pain signal transmission to the spinal cord → desensitization of the sensory axons and inhibition of pain transmission initiation Local erythema Local pan Active compound present in chili peppers Single application of topical 8% capsaicin (patch may be cut down in size as needed) Provides pain relief up to 3 months Admin for 30-90 min Lidocaine Patch Postherpetic neuralgia Blocks the initiation and conduction of nerve impulses by dec. the neuronal membrane’s permeability to Na ions which inhibits depolarization Erythema Rash Patches may remain in place for 12 hours in any 24-hour period Apply up to 3 patches to most painful area Tramadol Diabetic neuropathy, phantom pain Weak μ-opioid receptor agonist with 5-HT reuptake inhibitory properties Constipation Nausea Sedation Dry mouth Caution in pts with hx of epilepsy Avoid in pts with renal disease 50-100 mg every 4-5 hours (max 400 mg/day) 3rd Line of Therapy Botulinum toxin A (SQ) Peripheral neuropathic pain Neurotoxin that affects the presynaptic membrane of the neuromuscular junction preventing release of ACh → denervation Burning Erythema Photophobia BBW: distant spread of botulinum toxin beyond site of injection has been reported Long term efficacy and safety has NOT been established 50-300 units to the painful area every 3 months (admin by specialist) Strong opioids Oxycodone Painful diabetic neuropathy, phantom pain, herpetic neuralgia μ-opioid receptor agonist → inhibition of ascending pain pathways Constipation Nausea Sedation Respiratory depression Can develop tolerance and dependence Rapid onset of action Avoid long-term use Individual titration Summary of Pharmacotherapy Uses Diabetic Neuropathy Postherpetic Pain HIV Neuropathy Phantom Pain General Peripheral Neuropathic Pain TCAs SSRIs/SNRIs Ca channel α 2 δ ligands Neurology Exam 3 Study Guide | Page 13
Image of page 13
Capsaicin 8% patch Lidocaine Patch Tramadol Botulinum toxin A Opioids Review the discussion cases presented in class!
Image of page 14
Image of page 15

You've reached the end of your free preview.

Want to read all 29 pages?

  • Fall '08
  • Talluto,B

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture