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Pharm exam 5 chapters > Ch 25 highlights > Flashcards

Ch 25 highlights Flashcards

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1
Q

for mild to moderate migraine symptoms

A

NSAIDS (ASA, Naproxin)

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2
Q

For moderate to severe migraine symptoms

A 
Serotonin Agonist (Triptans) - 1st line
Ergot alkaloid second line
opioid analgesic (butorphanol) if these fail
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3
Q

what 2 antiemetic meds are approved for migraine

A

Reglan and Prochlorperazine (formally known as compazine)

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4
Q

what is the recommended drug for opioid analgesics used for migraine treatment

A

Butorphanol nasal spray

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5
Q

what is first line for terminating migraine attack

A

Serotonin Receptor Agonist (Triptans)

-Sumatriptan (Imitrex)

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6
Q

What is the biggest concern when taking Sumatriptan (imitrex)

A

Coronary Vasospasm

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7
Q

Pt is taking Sumatriptan and is experiencing Heavy arms and chest pressure. Denies pain.

A

symptoms are transient and not related to ischemic heart disease. Not dangerous

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8
Q

What pt population should not take Sumatriptan

A

CAD
Angina

Rule out CAD if they are postmenopausal women, men older than 40, smokers, History of HTN, Hypercholesterolemia, diabetes or a family history of CAD

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9
Q

can you take sumatriptan while pregnant

A

no

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10
Q

sumatriptan should not be used within ____ hours of another triptan or a ergo alkaloid

A

24 hours

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11
Q

can you take Sumatriptan with an MAOI

A

No, and should not be used within 2 weeks of stopping an MAOI

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12
Q

signs of serotonin syndrome

A 
ams
incoordination
myoclonus
hyperreflexia
excessive sweating
tremor
fever
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13
Q

can you take sumatriptan with SSRI/SNRI

A

no, may cause serotonin syndrome

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14
Q

prozac is in what drug class

A

SSRI

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15
Q

cymbalta is in what drug class

A

SNRI

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16
Q 
what drug class
Isocarboxazid (marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranycypromine (Parnate)
A

MAOI

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17
Q

what drug class is second line for migraine abortion if the triptans did not work

A

Ergot Alkaloids

  • Ergotamine
  • Dihydroergotamine
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18
Q

what medication can you add to Ergotamine to help reduce nausea/vomiting

A

metoclopramide

prochlorperazine

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19
Q

ischemia secondary to constriction of peripheral arteries and arterioles: the extremities become cold, pale and numb. muscle pain develops and gangrene may eventually result

A

ergotism (toxicity from ergotamine) highest risk in sepsis, peripheral vascular disease and renal/hepatic impairment

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20
Q

pt on ergotamine prn for migraine abortion develops headache nausea, vomiting and restlessness

A

withdrawal due to physical dependence - resembles a migraine attack so the pt is likely to resume taking the drug perpetuating the cycle of dependence.

hospitalization may be required to break the physical dependence

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21
Q

what patient populations should not take ERgotamine

A 
hepatic/renal impairment
CAD
peripheral vascular disease
uncontrolled HTN
taking potent inhibitors of CYP3A4
pregnant women
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22
Q

What is a intranasal spray that is a second line drug for migraines

A

Dihydroergotamine

associated with a lower rate of migraine recurrence

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23
Q

first line drug for migraine prevention

A

B Blockers

  • propanolol
  • metoprolol
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24
Q

pt is taking propanolol for 4 days and calls because it does not seem to be preventing his migraines

A

benefits take a few weeks to develop

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25
antiepileptic drugs used in migraine prevention
Depakote ER Topamax Gabapentin Gabitril
26
side effects for Depakote
``` nausea fatigue weight gain tremor bone loss reversible hair loss ``` fatal pancreatitis and hepatitis can occur
27
can Depakote be used in pregancy
no
28
Tricyclic antidepressant used in migraine prevention
Elavil
29
side effects of Elavil (Tricyclic antidepressant)
hypotension anticholinergic effects -dry mouth, constipation, urinary retention, blurred vision, tachycardia)
30
a migraine that routinely occurs 2 days of the onset of menses
menstrually associated migraine (triggered by decline in estrogen levels that precede menstruation)
31
medications for menstrually associated migraines
estrogen estrogen gel and patches (Divigel, climara) perimenstrual triptans - frovatriptan, naratriptan, zolmitriptan - dosing is done for 6 days each month beginning 2 days before expected onset of menses Naproxen sodium BID given 6 days before to 7 days after menses
32
what are the 2 other drugs for migraine prevention
Erenumab (Aimovig) - human immunoglobulin G2 monoclonal antibody Botulinum toxin (Botox)
33
a migraine that occur in a cluster of attacks each lasting 15 min to 2 hours and characterized by severe throbbing, unilateral pain in the orbital temporal area.
cluster headaches
34
how are cluster different from migraine
cluster headaches are not preceded by an aura they do not cause n/v they can be more debilitating occur mostly in males not associated with a family history of attacks
35
migraine headaches occur more often in what gender
females
36
what meds are used to prevent cluster headaches
glucocorticoids (prednisone, dexamethasone) verapamil - first line lithium - second line - serum levels require monitoring suboccipital steroid injections are the only established effective treatment in the prophylaxis of cluster headaches
37
the only treatment for Medication overuse headache is
to stop taking all headache medicines
38
what measures can be taken to decrease the risk of developing MOH
limit use of abortive medicines take abortive meds no more than 2-3 times per week doses should be no higher than actually needed
39
what triptan has effects that persist longer than other triptans and helps the 24 hour recurrence rate to be decreased
naratriptan
40
ASA has a shorter or longer half life
shorter
41
Are Ergotamine and Zolmitriptan short acting or long acting
they do not have long durations
42
Beta Blockers cannot be used in what pt population
Asthmatics | COPD
43
what effects does Reglan have on oral anti-migraine meds
improves absorption
44
what is the first step in managing headaches for prevention
keep a headache diary to help identify triggers
45
what is meds to rescue for cluster headaches
Sumatriptan or Oxygen Inhaling oxygen 100% for 15-20 min
46
abortive max use per week
1-2
47
Sumatriptan and ASA
when combined with reglan, ASA may work as well as sumatriptan which is a highly effective migraine
48
recommended opioid analgesic for migraine
butorphanol nasal spray
49
Sumitriptan (imitrex) is approved for
migraines | cluster h/a
50
contraindications for Sumitriptan (imitrex) - health conditions and why
coronary vasospasm is a big risk NO cardiac history or risk of CAD no in pregnancy ``` must r/o CAD if have following postmenopausal men older than 40 smokers HTN Hypercholesterolemia DM family history of CAD ```
51
adverse effect for Sumitriptan (imitrex) that is not concerning
chest pressure or heavy arms pulmonary vasoconstriction esophageal spasm not dangerous forewarn pt
52
drug interactions for Sumitriptan (imitrex)
Ergo alkaloids - also cause vasoconstriction so dont combine within 24 hours of each other (ergotamine, dihydroergotamine) MAOI - toxicity - not within 2 weeks SSRI/SNRI - risk of serotonin syndrome (SSRI- fluoxetine - Prozac) (SNRI- duloxetine - Cymbalta)
53
s/s serotonin syndrome
``` AMS anxiety hallucinations incoordination myoclonus hyperreflexia excessive sweating tremor fever ```
54
antiemetic meds for migraine
metoclopramide (Reglan) prochlorperazine (Compazine)
55
Ergotamine is metabolized by
CYP3A4
56
adverse effect of Ergotamine that is common and what can be given with it to help
n/v metoclopramide or prochlorperazine ``` other weakness in legs myalgias numbness and tingling in fingers and toes angina like pain tachycardia bradycardia ```
57
overdose of Ergotamine symptoms
ergotism ischemia secondary to constriction of peripheral arteries and arterioles the extremities become cold, pale and numb, muscle pain develops and gangrene may eventually result
58
what should not be combined with ERgotamine
triptans (sumatriptan, zolmitriptan) prolonged vasospastic reaction separate by 24 hours
59
physical dependence and ergotamine
if used daily, you can develop physical dependence ``` s/s h/a n.v restlessness resembles a migraine attack which perpetuates the dependence cycle - hospitalization may be needed to break this cycle ```
60
who is Ergotamine contraindicated for
hepatic/renal impairment sepsis (can cause gangrene) CAD Peripheral vascular disease uncontrolled HTN taking a CYP3A4 inhibitor pregnancy
61
Dihydroergotamine (DHE) IM, IV or sub q
second line migraine abortive also available intranasal
62
what b blockers are approved for migraine preventative
propanolol metoprolol timolol atenolol nadolol can take a few weeks to develop benefits
63
antiepileptic drugs for migraine prevention
Divalproex (Depakote ER) Topiramate (Topamax) Gabapentin (Neurontin) Tiagabine (Gabitril)
64
1st line for migraine prevention
B Blockers
65
Black box for Divalproex (Depakote)
fatal pancreatitis and hepatitis | teratogenic in pregnancy
66
adverse effects Topiramate (Topamax)
paresthesias fatigue cognitive dysfunction (psychomotor slowing, word finding difficulty, impairment of concentration and memory) metabolic acidosis moderate weight loss
67
TCA for migraine prevention
amitriptyline (elavil)
68
side effect of amitriptyline (elevil)
``` hypotension anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision, tachycardia) ```
69
migraine that routinely occurs within 2 days of menses
menstrually associated migraine
70
what meds for menstrually associated migraine
estrogen topical estrogen gel or patches Divigel, climara) ``` perimenstrual triptans also help frovatriptan naratriptan zolmitriptan 6 days a month beginning 2 days before expected onset ```
71
other meds for migraine
``` botox erenumab (Aimovig) - sub q ```
72
series of headaches lasting 15 min to 2 hours characterized by severe, throbbing, unilateral pain in the orbital temporal area
cluster headaches
73
rules of cluster headaches
``` not preceded by aura do not cause n/v can be more debilitating less common more common in males not associated with familial history ```
74
drugs prophylaxis cluster
glucocorticoids (prednisone, dexamethasone) verapamil - 1 st line lithium
75
abortive for cluster
sumatriptan - 1st line or oxygen

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