Case 2: Toxicology Flashcards
(55 cards)
What is the clinical presentation of a tension headache ?
- Most common type of headache
- Exacerbated by stress, fatigue, glare and noise.
Symptoms: - Mild to moderate dull pain
- Tightness or pressure across forehead or sides of head- band like pain
- Doesn’t get worse with movement
Duration: - 30 mins to several days
What is the clinical presentation of a cluster headache ?
Symptoms:
- Severe pain on one side
- Teary and or red eyes
- Congestion of same side as pain
- Restlessness
- Periorbital swelling
Duration:
- 15 mins to 3 hours
- Can occur several times a day
What is the clinical presentation of a migraine ?
Symptoms:
- Moderate to severe throbbing pain on one or both sides
- Nausea and vomiting
- Light, smell or sound sensitivity
- Gets worse with movement
Duration:
- 4 to 72 hours
What is the clinical presentation of MOH ?
Symptoms:
- Dull, constant headache, often worse in the morning
- Present on most days
- Can be very painful and disabling
Define toxicology
The study of adverse effect of chemicals on various biological systems, including humans
Define adverse drug reaction
A response to a drug that is noxious and unintended and occurs at doses normally used in humans for the prophylaxis, diagnosis, or therapy of disease or for modification of physiological function.
They can be dose-related or idiosyncratic.
Define idiosyncratic
Peculiar or individual
Define idiopathic
Disease of unknown cause
What do we know about preventable ADRs ?
They contribute to 5-8% of unplanned hospital admissions eg. Wrong dose or drug is given by staff
These cost the NHS £1-2.5 billion a year
How does the MHRA yellow card system work ?
It is a way to monitor the satety of all healthcare products.
It collects info on:
1. Side effects(ADRs)
2. Medical device adverse incidents
3. Defective medicines
4. Counterteit or fake medicines
5. Safety concerns for e-cigarettes
It is important for post marketing surveillance.
Define medication overuse headache (MOH)
A headache occuring on 15 or more days per month developing as a consequence of regular overuse of acute or symptamatic headache medication (on 10/15 or more days a month) for more than 3 months.
What is a primary headache ?
A disease themselves
Eg. Migraine, cluster, tension etc.
What is a secondary headache ?
Symptom of another condition
Eg. Brain tumour, neck trauma, infection
What are red flags that may suggest secondary headaches ?
• New/sudden onset (“thunder clap”)
• Change in pattern
• Effort-induced pain
• Positional pain
• Onset in middle age or later
• Recent head trauma
• Setting of chronic illness (eg, cancer, AIDS, fever)
• Any neck stiffness
• Change in personality or behavior
• Neurologic findings on examination
What are criteria for low risk headaches ?
• Age younger than 30 years
• Features typical of primary headache
• History of similar headache
• No concerning change in normal headache pattern
• No high-risk comorbid conditions (for example, HIV)
• No new concerning history/physical examination
findings
• No abnormal findings on neurologic exam
What is abortive treatment ?
To stop or reduce the severity of the condition once the symptoms have started
What is prophylactic treatment ?
Taken regularly to prevent to condition from occurring or reduce to severity of it
What is the first line abortive treatment of migraines ?
Ibuprofen, Aspirin or paracetamol
What is cyclooxygenase ?
COX
Nociception
The perception of pain
What is serotonin ?
5-HT
Describe the pathway of a migraine ?
- Migraine originates deep within the brain
- Electrical impulses spread to other regions of the brain
- Changes in nerve cell activity and blood flow and may result in symptoms such as visual disturbance, numbness and dizziness
- Chemicals in the brain cause blood vessel dilation and inflammation
- The inflammation spreads across nerve supplied by the trigeminal nerve causing pain
What is cortical spreading depression (CSD) ?
Slowly propagating wave of near-complete depolarisation of neurons/glial cells.
It is thought to contribute to the underlying pathophysiology of migraine aura, and an intrinsic brain activity causing migraine headache.
If a migraine is resistant to NSAIDs what should you do ?
Sumatriptan as an abortive treatment
