Prescribing Safety Assessment (PSA) Practice Exam

What is an alternate analgesic to amitriptyline for neuropathic pain?

1. Duloxetine 60mg PO OD

2. Pregabalin 75mg PO BD

3. Ibuprofen 400mg

4. Tramadol 50mg

The correct answer is: Pregabalin 75mg PO BD

Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), is also an effective treatment for neuropathic pain, similar to amitriptyline, which is a tricyclic antidepressant. While both duloxetine and pregabalin have demonstrated efficacy in treating neuropathic pain, the selection of pregabalin as an alternate analgesic in this context can be attributed to its mechanism of action and established use in managing neuropathic pain. Pregabalin works by binding to voltage-gated calcium channels in the central nervous system, inhibiting the release of excitatory neurotransmitters involved in pain pathways. This makes it particularly effective for conditions characterized by neuropathic pain, such as diabetic neuropathy and postherpetic neuralgia. The dosage indicated, 75 mg twice daily, falls within the common dosing range for initiating treatment with pregabalin, allowing for flexibility in titration based on patient response and tolerability. In contrast, while duloxetine is an appropriate choice, and has supportive evidence for its use in neuropathic pain, the specific wording of the question suggests a preference for the choice that more directly addresses first-line treatments for neuropathic pain. Other choices, such as ibuprofen