30 - Headache Therapy

Question 1

MOA of nabumetone

Answer 1

NSAID. Reduce inflammatory stimuli that would normally upregulate MAPK and thus CGRP and SP. More effective if taken sooner than later.

Question 2

MOA of ibuprofen

Answer 2

NSAID. Reduce inflammatory stimuli that would normally upregulate MAPK and thus CGRP and SP. More effective if taken sooner than later.

Question 3

MOA of naproxen

Answer 3

NSAID. Reduce inflammatory stimuli that would normally upregulate MAPK and thus CGRP and SP. More effective if taken sooner than later.

Question 4

MOA of butalbital

Answer 4

barbiturate. Has sedative-hypnotic effects via thalamic GABA enhancement.

Question 5

ADE of butalbital

Answer 5

drowsiness, sedation, strongly linked to analgesic overuse syndrome, CYP inducer, respiratory depressant

Question 6

MOA of caffeine for headaches

Answer 6

cerebral vasoconstriction. Useful for caffeine withdrawal headaches. mixed with NSAIDs and butalbital sometimes

Question 7

ADE of caffeine for headaches

Answer 7

potential CV interactions

Question 8

MOA of sumatriptan

Answer 8

triptan. Serotonin agonist with only central effects. Causes carotid vasoconstriction via 5-HT1-B.
Presynaptic inhibition of trigeminovascular system via 5-HT1d/f.

Question 9

MOA of ergotamine

Answer 9

contraction of smooth muscle fibers of small arteries.

agonist of central 5-HT, peripheral alpha vasoconstrictor, and decreases amine reuptake.

Question 10

MOA of dihydroergotamine

Answer 10

contraction of smooth muscle fibers of small arteries.

agonist of central 5-HT, peripheral alpha vasoconstrictor, and decreases amine reuptake.

Question 11

What is fastest and most effective for migraine treatment?

Answer 11

subcu injection of sumatriptan

Question 12

What drug is strongly linked to analgesic-overuse syndrome?

Answer 12

butabital

Question 13

Which triptans have longest effect time?

Answer 13

narotriptan and frovatriptan

Question 14

ADE of triptans?

Answer 14

dizziness, drowsy, fatigue, tightness of chest, coronary and peripheral vasospasm, serotonin syndrome with SSRIs.
Contraind in heart disease or uncontrol HTN and ishcemic bowel.

Question 15

ADE of ergots?

Answer 15

interactions with B-blockers and DA. Contraindicated in vasospastic conditions.
large doses cause st anthony’s fire –> dry gangrene of extremeties

Question 16

What migraine medicines can be given to preggers?

Answer 16

NSAIDs only

Question 17

What drugs should be given for menstrual headaches?

Answer 17

NSAIDs only

Question 18

MOA of metoclopramide

Answer 18

antiemetic. D2 central block, increase Ach

Question 19

ADE of metoclopramide

Answer 19

risk of high prolactin and gynecomastia

Question 20

MOA of prochlorperazine

Answer 20

antiemetic. D2 central block. cholinergic and alpha block

Question 21

ADE of prochlorperazine

Answer 21

dyskinesia, hypotension, gluacoma, urine reten, BPH

Question 22

MOA of promethazine

Answer 22

antiemetic. cholinergic block and H1 (weak D2)

Question 23

ADE of promethazine

Answer 23

glaucoma, urine reten, BPH, drowsy, parkinson

Question 24

MOA of chlorpromazine

Answer 24

antiemetic. D2 central block, cholinergic and alpha block.

Question 25

ADE of chlorpromazine

Answer 25

dyskinesia, hypotension, glaucoma, urine reten, BPH

Question 26

MOA of amitriptyline

Answer 26

decrease NE and serotonin reuptake. Strong anticholinergic

Question 27

ADE of amitriptyline

Answer 27

agressiveness, weight gain, dry mouth, sedation

Question 28

What is only drug approved for migraine prophylaxis in children?

Answer 28

propranolol

Question 29

ADE of propranolol

Answer 29

fatigue, exercise, intolerance, asthma, diabetes, AV block

Question 30

ADE of propranolol

Answer 30

fatigue, exercise, intolerance, asthma, diabetes, AV block

Question 31

MOA of topiramate

Answer 31

Na and glutamate blocker, increases GABA

Question 32

What migraine drug would likely interact with MAO inhibitors like phenelzine?

Answer 32

suamtriptan. Cant give within 2 weeks of MAOI treatment.

Question 33

ADE of topriamate

Answer 33

paresthesis, fatigue, nausea, narrow therapeutic range

Question 34

What are alternative treatments for migraine prevention?

Answer 34

ferverfew and butterbur but don't use them in preggers

Question 35

Can you take a triptan after taking an ergot?

Answer 35

no. wait at least 24 hours.

Question 36

Can you use triptans in preggers?

Answer 36

yes. but not in heart disease, diabetes, uncontrolled HTN or cerebrovascular disease.

Question 37

MOA of timolol

Answer 37

nonselective beta antagonist. 5-10x more potent than propanolol. Arterial constrictor so reduces NE-induced lipolysis

Question 38

ADE of timolol

Answer 38

fatigue, exercise, intolerance, asthma, diabetes, AV block

Question 39

MOA of eletriptan

Answer 39

triptan. reduce blood vessel swelling. 5HT-1b/d/f receptor agonist.

Question 40

ADE of eletriptan

Answer 40

HTN, tachycardia, headache, dizzyness, chest pain. contraindicated in cardiovascular disease or renal/hepatic impairment requires CYP3A4 so dont' give with CYP inhibitors.

Question 41

MOA of valproate

Answer 41

anticonvulsant. Weak Na blocker, weak GABA transaminase inhibitor (so blocks GABA degredation)

Question 42

ADE of valproate

Answer 42

don't give in pregnancy. | tiredness, tremor, sedation, GI disturb, hair loss.