Anesthesia Student Survival Guide.pdf - Index of

PerioPerAtive ACute And ChroniC PAin MAnAGeMent ● 421
of addictive behaviors are buying street drugs, stealing money to obtain drugs,
attempting to obtain opioids from multiple sources, acts of prostitution to
obtain drugs, forging prescriptions, and selling prescription drugs.
Alpha-2-Agonist: (tizanidine)
The alpha-2-agonist tizanidine is commonly used in pain medicine as a muscle
relaxant. It causes less significant blood pressure changes compared to clonidine,
but can lead to drowsiness.
Anticonvulsants: (Gabapentin, Carbamazepine,
and oxcarbamazepine, Pregabalin)
The anticonvulsants work through very diverse mechanisms of actions, including
modulation of voltage-gated calcium channels, sodium channels, GABA,
and glutamine receptors. FDA-approved pain indications include trigeminal
neuralgia (carbamazepine), post herpetic neuralgia (gabapentin, pregabalin),
diabetic neuropathy (pregabalin), fibromyalgia (pregabalin), and migraine prophylaxis
(divalproex, topiramate).
tricyclic Antidepressants: (nortiptyline, Amitriptyline)
Tricyclic antidepressants (TCA) contribute to the improvement in pain symptoms
through their actions on multiple sites, including serotonergic, noradrenergic,
opioidergic, NMDA receptors, adenosine receptors, sodium channels, and calcium
channels. The effects of TCAs can include elevation of mood, normalization of sleep
patterns, and muscle relaxation. These agents are used for the treatment of neuropathic
pain syndromes such as postherpetic neuralgia, diabetic neuropathy, pain
secondary to spinal cord injury, cancer-related neuropathic pain, and other pain
syndromes such as low back pain, osteoarthritis, and fibromyalgia. The side effects
of this class of medications can include dry mouth, drowsiness, dizziness, weight
gain, orthostatic hypotension, and lethargy.
serotonin-norepinephrine reuptake inhibitors: (venlafaxine, duloxetine)
Serotonin-norepinephrine reuptake inhibitors (SNRI), as their class implies,
block the reuptake of norepinephrine and serotonin. Duloxetine is the first
antidepressant to have a specific pain indication (diabetic neuropathy) in the
United States. These medications have also been demonstrated to be useful in
the treatment of fibromyalgia. The side effect profile tends to be lower in the
SNRIs than the TCAs.