Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Summer pharm 3 > HA > Flashcards

HA Flashcards

(56 cards)

Start Studying
1
Q

What is a med overuse headache

A

Frequent or excess use of migraine medication causing a syndrome of self-sustaining HA-Medication cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you recognize a med overuse headache

A

gradual onset of an atypical daily or near daily headache with superimposed episodic migraine attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What meds are said to cause med overuse headaches more frequently

A

Simple and combo analgesics and opiates

Triptans (in men w/ high frequency of HA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How often should you use Triptans

A

Max of 9 times per month!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a migraine headache

A

Recurring throbbing head pain
Unilateral
Lasts 4-72 hours
Associated N/V, photophobia, phonophobia, and sensitivity to movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The pathogenesis of migraine headaches is related to

A

complex dysfunctions in neuronal and broad sensory processing
Pain and Sx are 2/2 neural suppression, and activation of subcortical structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Migraine pain is 2/2

A

Activity within the trigeminovascular system (afferent fibers arising from trigeminal ganglia and projecting peripherally to innervate IC extracerebral blood vessels, dura, and large venous sinuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the pathophys of a migraine

A
  • Afferent fibers of trigeminal ganglia project centrally and terminate in the brain stem and upper cervical spinal cord
  • Activating trigeminal sensory nerves= release of vasoactive neuropeptides (CGRP, neurokinin A, substance P)
  • Neuropeptides interact with dural blood vessels= vasodilation and dural plasma extravasation= Neurogenic inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Continues afferent input can result in

A

sensitization of these central sensory neurons= hyperalgesic state that responds to previously innocuous stimuli and maintains HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is 5-HT

A

a mediator of migraine HA, involved in the pathophys and Tx of migraine HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Long story short pathophys of migraines

A

Vasodilation of extra-cerebral vessels= activation of perivascular trigeminal nerves= vasoactive neuropeptide release= neurogenic inflammation
Central pain transmission activates other brain stem nuclei= associated Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Goals of migraine Tx include

A

Long term: Reduce migraine frequency, severity, and disability
Acute: Treat rapidly, restore functional ability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Analgesics that can be used to Tx migraines are

A 
Tylenol 
Excedrin migraine (APAP250/ASA250/caffeine65)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

NSAIDs that can be used for migraine are

A

ASA
Ibuprofen
Naproxen sodium
Diclofenac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Serotonin Agonists that can be used to Tx migraines are

A

Triptans!
Sumatriptan: inject, PO, nasal spray
Zolmitriptan: PO, nasal spray
Adjunct: Metoclopramide (reglan), Prochlorperazine (compazine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Other acute migraine meds include

A

Ergotamine Tartrate: oral w/ caffeine, sublingual, rectal suppository w/ caffeine
Dihydroergotamine: injection, nasal spray
(Ergo has more potent arterial effects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Ergotamine/Dihydroergotamine

A

Non-selective 5-HT1 receptor AGONIST;
Constricts IC blood vessels and inhibits development of neurogenic inflammation in trigeminovascular system
Dopaminergic receptor agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do Triptans work

A

Selective 5-HT1b/1d receptor AGONISTS

  • Enhance IC vasoconstriction
  • Inhibit vasoactive peptide release from trigeminal neurons
  • Inhibit transmission through second order neurons ascending to thalamus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you dose Sumatriptan

A

Injection: 6mg subQ at onset. repeat after 1 hour if needed. MAX 12mg
PO: 25-100mg at onset, repeat after 2 hours if needed. MAX 200mg
Nasal: 5-20mg at onset, repeat after 2 hours if needed. MAX 40mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you dose Zolmitriptan

A

oral tab: 2.5-5mg, repeat after 2 hr if needed. MAX 10mg
*Do NOT divide ODT
Nasal: one 5mg spray at onset, repeat in 2 hr if needed. MAX 10mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do you dose the other Triptans

A

Naratriptan: 1-2.5mg, repeat in 4 hr. MAX 5mg
Rizatriptan (ODT): 5-10mg, repeat in 2 hr. MAX 30mg
Almotriptan: 6.25-12.5, repeat in 2 hr. MAX 25mg
Frovatriptan: 2.5-5mg, repeat in 2hr. MAX 7.5mg
Eletriptan: 20-40mg, repeat in 2hr. MAX 80mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

With ergotamine administration, consider

A

pre-treatment with antiemetic when dosing oral tablet or rectal suppository

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What do you need to remember about Dihydroergotamine nasal spray

Study These Flashcards
A

You start with ONE spray in each nostril, can repeat after 15 min. max dose is four sprays total
Discard open ampules after 8 hours of being opened
Prime sprayer 4 times before using
Do not tilt head back, just put up nose and inhale

24
Q

What is “Triptan Sensation”*

Study These Flashcards
A

Tightness, Pressure, Heaviness, or Pain in chest, neck or throat
Usually at the nipple level and above

25
Applications and ADE of Sumatriptan are
Good for Migraine and Cluster HA | ADE: paresthesias, dizziness, chest pain, coronary vasospasm, serotonin syndrome
26
What is Serotonin syndrome
Hyperthermia, hyperreflexia, tremors, clonus, HTN, diarrhea, mydriasis, agitation, coma Onset w/in hours of taking meds like SSRI, second gen antidepressants, tramadol, fentanyl, zofran, sumatriptan, MDMA, St. John's wort, and ginseng
27
How od you treat serotonin syndrome
``` Sedation w/ benzos Paralysis intubation ventilation -Consider 5-HT2 block with cyproheptadine or chlorpromazine ```
28
What is Neuroleptic malignant syndrome
Hyperthermia and acute severe parkinsoniam 2/2 taking D2 blocking antipsychotics and Sumatriptan
29
How do you treat neuroleptic malignant syndrome
Diphenhydramine (parenteral) Cooling Sedation with benzos
30
What is malignant hyperthermia
hyperthermia, muscle rigidity, HTN, tachycardia 2.2 taking volatile anesthetics, Succinylcholine, and sumatriptan
31
How do you treat malignant hyperthermia
Dantrolene | cooling
32
When should you consider preventive migraine therapy
In the setting of recurrign migraines that produce significant disability despite acute therapy Frequent attacks (>2x wk) Sx therapies ineffective or CI, or w/ serious ADE
33
FDA approved migraine preventive meds are
``` Propranolol Timolol Divalproex sodium Topiramate *Need 2-3 months of therapy to assess efficacy! Noticeable in 1 month, best judgement after 6 months* ```
34
Prophylactic Tx should be continued at least
6-12 months after frequency and severity of HA have diminished Then gradually taper or d/c prophylaxis
35
What are Erenumab, Fremanezumab, and Galcanezumab
CGRP MABs under review by FDA for use in migraine prevention by stopping CGRP's vasodilatory and nociception effects Log half lives mean you can take them once a month subQ
36
Ibuprofen can be used to prevent
Menstrual migraine onset! | Daily prolonged use can lead to med overuse HA and has potential toxicity
37
When should Frovitriptan be taken
in the perimenstrual period to prevent menstrual migraine
38
Riboflavin is beneficial only
after 3 months of use
39
Withdrawal of MIG99 is associated with
increased HA
40
Magnesium is more helpful in
migraine with aura and menstrual migraine
41
To be prophylactic, Frova Nara and Zolmitriptan should be taken
1-2 days before expected onset of HA and continued during the period of vulnerability
42
What is the MC and least studied primary HA
Tension headache | 1 year prevalence is rising 31 to 86%
43
Pain in a tension headache is thought to arise from
myofascial factors and peripheral sensitization of nociceptors Heightened sensitivity of pain pathways in the CNS
44
CBT treatment options for tension headaches are
Stress management Relaxation training Biofeedback
45
These treatment options offer inconsistent results, but are ok to use to treat tension HA
``` heat or cold pack US electrical nerve stimulation stretching, exercise massage acupuncture manipulations ergonomic instruction trigger point injection occipital nerve block ```
46
What are the recommended Tension HA meds
Acetaminophen (alone or with caffeine) Acute mild-mod: NSAIDs (ASA, Diclofenac, Ibu, Naprozen, Ketoprofen, Ketorolac High dose NSAID (ASA or APAP) + (Butalbital or codeine)
47
How long can you take acute medications for tension HA
Butalbital: no more than 3 days Combo analgesics: no more than 9 days NSAIDs: no more than 15 days
48
There is no evidence to support these meds in treating tension HA
Skeletal muscle relaxers
49
Preventive therapy for Tension HA is
TCA SSRI IF also with depression Chronic tension: Topiramate and Gabapentin -Botox injection into pericranial muscles NOT recommended -Limited studies on SNRI's (Mirtazapine, Venlafaxine)
50
What is the most severe primary HA disorder
Cluster HA Excruciating, unilateral head pain occurs in a series lasting weeks-months (cluster periods), separated by remission periods lasting months-years
51
What is generally the modulator of cluster headaches
``` The hypothalamus (ipsilateral grey area is activated) Hypothalamus then activates trigeminal autonomic reflexes= ipsilateral pain and cranial autonomic features ```
52
What is a hallmark of cluster HA
Circadian rhythm of painful attacks | MC episodic cluster HA (occur for 2 weeks-months, then LONG pain free period)
53
Cluster HA is often accompanied by
Cranial autonomic Sx: conjunctival injection, lacrimation, nasal stuffiness, rhinorrhea, eyelid edema, facial swelling, miosis or pitosis (resolve with resolution of HA)
54
Difference between migraine and cluster patients
Migraine retreat to a dark room | Cluster sit and rock or pace around the room clutching their head
55
Abortive therapy for a cluster HA is
Oxygen! standard acute Tx is 12L 100% O2 for 15-30 min using nonbreather facial mask - Triptans injections (or sprays) > orals (except Zolmitriptan) - IV dihydroergotamine or Ergotamine tartrate
56
Prophylactic therapy for cluster headaches is
Verapamil* (takes 2-3 weeks) Lithium (can cause lethary, nausea, diarrhea, abd discomfort) Corticosteroids (Prednisone 5 days, then taper) Misc: Intranasal lidocaine, hyperbaric oxygen, subQ octreotide

Summer pharm 3 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions