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Year 2 neuro exam 2 > Pharm for HA, Cohen > Flashcards

Pharm for HA, Cohen Flashcards

1
Q

chronic pain

A

continuing pain >6 mo

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2
Q

patients with headaches need what besides pain relief

A

explanation for the HA

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3
Q

Treatment for HA depends on

A 
frequency attacks and severity
presence and degree of disability
assoc symptoms
prior response to meds
comorbid and coexistant conditions
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4
Q

migraine criteria

A

> 5 attacks lasting 4-72 hours
2: unilateral, pulsating, mod-severe, aggravated by routine activity
1: nausea and/or vomiting
photophobia and phonophobia
no evidence on Hx or examination of disease that may cause HA

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5
Q

Tx of migraine attacks

A

OTC meds
migraine specific meds from doc
caffeine, including dark chocolate or cola drinks
getting some sleep

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6
Q

when are triptans taken usualy

A

few hours after begining of migraine

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7
Q

what R do triptans work on

A

5GT1B 1D and1F

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8
Q

what newer triptans have better effect and fewer side effects

A

rizatriptan

electriptan

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9
Q

CI triptans

A

coronary artery disease of cerebral vascular disease

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10
Q

half life triptans

A

<4 hours

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11
Q

what medicaiton for HA can increase BP

A

ergotamine

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12
Q

what is a drug used IV or IM for migraines acutely

A

dihydroergotamine DHE

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13
Q

half life DHE

A

9 hours

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14
Q

what dopamine blockers are used for migraine

A

haloperidol

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15
Q

what drug is common in ED for migraine to avoid opioid use

A

antihistamine

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16
Q

future of migraine medication

A

long acting monoclonal Ab to CGRP

for preventative migraines

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17
Q

when do we start Txing prophylactically for migraines

A

when patient cannot go a week between migraines

insufficient relief from abortives

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18
Q

what are great preventative migraine meds and what do they have in common

A

amitriptyline, propanolol, topiramate

Na channel blockers!

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19
Q

what are good preventative migraine drugs

A

gabapentin, zonisamide

20
Q

which drugs are FDA approved for migraine prevention

A

propanolol, topiramate

valproic acid

21
Q

half life propanolol

A

4-6 hours
needs to be taken 3x day
there are long acting formulations

22
Q

CI propanolol

A

relative in asthmatics or CHF or bradycardia from heart blocks

23
Q

effects amitryptyline

A

antihistamine

very anticholinergic!

24
Q

dosing amitriptyline

A

low dosese in evening

25
Q

side effects amitriptyline

A

tachyarrhythmias
can cause suicide from overdose
weight gain

26
Q

topiramate is FDA approved for what

A

prevention seizures and migrains

27
Q

half time topriamate

A

18-20 hours

take at bedtime

28
Q

side effects topiramate

A

“dopamax” because can cause difficulties with speech and cognition
anorexia and weight loss
loss of sensation in arms
changes in serum acidity and Ca solubility

29
Q

MOA valproic acid

A

blocking Na Ch and effects of gamma aminobutyric acid

30
Q

valproic acid is FDA approved for

A

migraine prevention
epilepsy
bipolar disease

31
Q

half life valproic acid

A

10-20 hours

needs to be given at least 2x day

32
Q

side effects valproic acid

A

weight gain, lowering of platelet counts, tremor and hair loss

33
Q

when was botulinum toxin aproved for migraine prevention

A

2010

34
Q

how is botulinum toxin injected

A

many sites in scalp every 3 mo

35
Q

mech botulinum

A

inhibit Ach release and inhibit sensory neurons

36
Q

what are comorbidities with tension type HA

A 
HTN
depression
anxiety
insomnia
DM/hypoglycemia
other sources of pain
37
Q

what are prophylactic drugs for tension type HA

A

amitriptyline
protriptyline
topiramate

38
Q

abortive Tx cluster HA

A

sumatriptan injeciton
sumatriptan or zolmitriptan nasal sprays
high dose O2
nasal viscous lidocaine

39
Q

prevention for cluster HA

A

almost always necessary
verapamil
may cause hypotension constipation
lithium– so dangerous in suicidal patients, also cause renal and thyroid disease
prednisone- works fask with many side effects limiting to only use in season of cluster if season is not very long

40
Q

drug R patients with cluster HA need what Tx

A

deep brain stimulation

implanted occipital nerve stimulator

41
Q

patient takes aspiring every day for HA

A

need to stop pain medication because thats causing it

plus with these pain pills preventative drugs will not work!!

42
Q

imagin trigeminal nerualgia

A

MRI

43
Q

Tx trigeminal neuralgia

A

carbamazepine first DOC

gabapentin or phenytoin

44
Q

if drug Resistant to trigeminal neuralgia

A

radiological or surgical ablation of trigem nerve via gamma knife, injection of glycerol or electrical ablation

45
Q

down side to surgical ablation trigem nerve

A

permanent facial numbness

Year 2 neuro exam 2 (23 decks)

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