TMD
These drugs have questionable efficacy for TMD and are prescribed before bed due to their sedative actions
What are muscle relaxants?
(Carisoprodol, orphenadrine, methocarbamol, cyclobenzaprine, baclofen (GABA-B agonist)
Severe and sudden daily pain in tonsil region of one side and ipsilateral ear
What is Glossopharyngeal neuralgia
Severe 1-2 hours, treat same as trigeminal neuralgia
These are the three main medical conditions/risk factors when prescribing NSAIDs
These are the initial dose for analgesia with amitriptyline, prescription instructions and the max dose for depression
what are 10 mg qhs for 7-10 days, up to 10mg BID or 20mg qhs and increase gradually to max, which is 150 mg
imipramine - 10 and 200
doxepine - 10 and 150
desipramine - 10 and 300
nortriptyline - 10 and 150
This drug should be avoided in patients with suicidal tendencies
What are tricyclic antidepressants?
Also avoid in CVS disease, seizure disorders, hepatic disease, renal disease, pregnancy, and DI with CNS depressants, MAOIs, and sympathomimetics such as epi
A TMJ symptom is present in approximately this percent of the population
This bilateral pain can last for hours, weeks, or days
What is Atypical facial pain?
(Treat with psychological consultation and tricyclic antidepressants)
If pain is inflammatory, you try NSAIDs or corticosteroids first, if pain is neuropathic, you try this
What are low dose tricyclic anti-depressants and SSRIs
These are the ADRs of Opioids
What are Nausea/vomiting, constipation, respiratory depression, hypotension, acute urine retention, and tolerance and physical dependence
This drug is often started on day 4 of oral corticosteroid treatment to decrease adverse GI affects and extend anti-inflammatory effect
What is naproxen?
75% of patient with TMJ have this
What is a significant psychological abnormality
The cause of this unilateral condition is commonly treated with Dancyclovir
What is Post-herpetic neuralgia
Drugs for treatment of the pain: tricyclic antidepressants if constant pain, carbamazepine if lancing pain.
These drugs are used for treating Trigeminal Neuralgia
What are carbamazepine, baclofen, or phenytoin? (anticonvulsants/muscle relaxants)
Possibly gabapentin or valproate
These drugs act through sodium channel inactivation and decreasing repetitive firing of action potentials
What are Anticonvulsants?
volgate-gated ion channels, ligand-gated ion channels, and receptors for glutamate and GABA
What are muscle relaxants?
Also sedation, dizziness, and limited duration of use
These are the most likely components of TMD pain
What are musculoskeletal, neurologic, and anxiety components
brief sever pain in the trigeminal nerve is indicative of this disease, which is treated in this way.
What is Trigeminal neuralgia, treated by analgesics, surgery, destruction of sensory neuron and division of nerve root
These are the MOA of TCAs and it's side effects
Block presynaptic reuptake transport for norepinephrine/serotonin
Block post synaptic receptors for histamine, acetylcholine, and norepinephrine, leading to most side effects
ADR: dry mouth, sedation, agitation, blurred vision, urinary retention, constipation, insomnia, hypotension, compensatory tachycardia, weight gain, sexual dysfunction
This drug has multiple actions, including creating a blockade of phospholipase A2, which decreases prostaglandins and leukotrienes
double points for listing ADRs
What are corticosteroids?
ADRs: Acute adrenal crisis, hypertension, bone resorption, weight gain
These drugs can induce liver enzymes and increase metabolism of other drugs
what are carbamezapine, phenytoin, and valproic acid?
Valproic acid also interact with ASA
IIIIIIITS dosage time!!! Give me carbamazepine for chronic pain
initially 100 mg BID, up to a daily max or 1200 mg
IIIIIIITS dosage time!!! Give me phenytoin for chronic pain
initially 100mg TID or 300mg qhs, up to a daily max of 600mg
IIIIIIITS dosage time!!! Give me gabapentin for chronic pain
initially 300mg QD, increase to BID, TID, daily max of 3600 mg
IIIIIIITS dosage time!!! Give me valproic acid for chronic pain
initially, 250 mg
IIIIIIITS dosage time!!! Give me baclofen for trigeminal neuralgia
5mg TID, increase by 5mg TID weekly, up to 20mg TID