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Pharm I: Exam 2 > HA > Flashcards

HA Flashcards

1
Q

What are the Four phases of a typical migraine?

A
  1. The prodrome
  2. The aura
  3. The headache
  4. The postdrome
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2
Q

What are nonpharmacological TX for HA?

A
  • Ice to head w/ period of rest and sleep in dark/quiet environment
  • Avoid triggers
  • Behavioral interventions
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3
Q

What is the difference between the ACP-ASIM 1st LINE TX and USHC 1st LINE TX?

A

ACP-ASIM features NSAIDs/Combo first and a Step-therapy, whereas USHC features a Stratified therapy

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4
Q

What is considered Non-specific Drug therapy for HA?

A
  • NSAIDs
  • Analgesics
  • Antiemetics
  • Corticosteroids
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5
Q

What is considered Migraine-specific Drug TX?

A
  • Ergot derivatives
  • Triptans (selective 5-HT1B/1D agonist)
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6
Q

What NSAIDs TX are considered for migraines?

A

1st LINE for MILD to MODERATE migraines

  • ASA
  • Naproxen
  • Ibuprofen
  • APAP+ASA+Caffenine
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7
Q

Why would intranasal Lidocaine be considered for treatment of migraines?

A

Can numb sinus cavities

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8
Q

What Opioids are utilized for TX migraine HA?

A

Butorphanol (reserved for SEVERE migraine HA that are unresponsive to other treatment)

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9
Q

What barbituates are utilized for Migraine HA?

A

Butalbital (combined with analgesics or codeine) cause depressant effect on CNS for MODERATE to SEVERE migraines

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10
Q

How do Antiemetics function for TX Migraine HA?

A

Commonly used as adjuncts (DEC N/V) but also used as monotherapy for migraine TX

  • Metoclopramide (IV)
  • Chlorpromazine (IV/IM)
  • Prochlorperazine (IV/IM)
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11
Q

How do Ergot Alkaloids function?

A

5-HT1 agonist; activity at alpha/beta adrenergic and D receptors

  • constrict intracranial blood vessels
  • inhibit neurogenic inflammation in the trigeminovascular system
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12
Q

What are ADRs (Acute) associated with Ergot Alkaloids?

A
  • N/V (pre-treat w/ antiemetics)
  • Diarrhea
  • Abdominal pain
  • Weakness
  • Leg cramps
  • Tremor
  • Dizziness
  • Syncope
  • CP
  • Intermittent claudication
  • Syndrome of ergotism
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13
Q

What may be observed in Syndrome of ergotism?

A
  • Peripheral ischemia
  • Cold
  • Numb extremities
  • Diminished peripheral pulses
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14
Q

What are ADRs (chronic) associated with Ergot Alkaloids?

A
  • Cerebral/Peripheral ischemia disorders
  • HTN
  • Tachy/bradycardia
  • Medication overuse HA
  • Renal disorders
  • Withdrawal signs
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15
Q

What are contraindications of Ergot Alkaloids?

A
  • Sepsis
  • Renal/hepatic failure
  • Pregnancy/lactation
  • Glaucoma
  • Peptic ulcer disease
  • Uncontrolled HTN
  • CHD/stroke/PVD
  • Potential interactions with protease inhibitors
  • Use of Triptans with 24 hrs (addictive vasoconstrictive effects)
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16
Q

How do Triptans function for migraine TX?

A

Selective 5-HT agonists cause (1st LINE for MODERATE to SEVERE migraine TX):

  • Intracranial vasoconstriction
  • Inhibit neuropeptide release from trigeminovascular nerves
  • Interrupt pain signal within brain stem (trigeminal nuclei)
17
Q

What medications are classified as Triptans?

A
  • Sumatriptan
  • Rizatriptan
  • Zolmitriptan
18
Q

What are ADRs associated with Triptans?

A
  • Dizziness
  • Fatigue
  • Flushing
  • Nausea
  • Chest tightness/pressure/heaviness
  • Injection reaction
  • Taste perversion (nasal spray)
19
Q

What are drug interactions with Triptans?

A
  • MAOI (inhibit clearance)
  • SSRI
  • Ergotamine-containing products (INC vasconstrictive effects)

RISK OF SEROTONIN SYNDROME

20
Q

What is Serotonin syndrome observed as?

A
  • Hyperthermia
  • Muscle rigidity
  • Myoclonus
  • Rapid change in mental status and vitals
21
Q

What beta-blockers are utilized in prophylactic TX Migraine?

A
  • Propanolol
  • Metoprolol
  • Atenolol
  • Nadolol
22
Q

What tricyclic antidepressants are utilized in prophylactic TX migraine?

A
  • Imipramine
  • Nortriptyline
  • Amitriptyline
23
Q

What Anticonvulsants are utilized in prophylactic TX migraine?

A
  • Valproate
  • Divalproex
  • Carbmazepine
  • Topiramate
  • Gabapentin
24
Q

How does Methysergide function in prophylactic TX migraine?

A

Peripheral 5-HT inhibitor and central 5-HT agonist

(ADR: Fatal pulmonary fibrosis)

25
Q

How does Botulinum function in Prophylactic TX migraine?

A

Inhibits ACh release at presynaptic junction (possible modulator of Substance P)

Pharm I: Exam 2 (7 decks)

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