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Pharm Unit 7 > HA > Flashcards

HA Flashcards

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1
Q

<2% of office visits and <4% ER visits for HAs have ___

A

serious pathology

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2
Q

primary headache

A

not caused by secondary pathology

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3
Q

secondary HA

A

caused by secondary pathology

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4
Q

red flags of secondary HA

A 
change or progression
first/worst HA
abrupt onset
abnormal findings
neuro sx >1hr
new HA <5 and >50
new HA in patients with CA or pregnant
HA assoc w/ LOC
HA triggered by exertion, sexual activity, or Valsalva
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5
Q

pain of a tension headache is described as

A

mild-moderate dull ache

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6
Q

tension HAs generally lack:

A

signs of serious underling conditions
visual disturbances
generalized pain, fever, stiff neck or recent trauma
bruxism

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7
Q

56% of TTH tx

A

acetaminophen 1,000mg PO

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8
Q

15% of TTH tx

A

aspirin

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9
Q

12% of TTH tx

A

ibuprofen 400mg PO

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10
Q

17% of TTH tx

A

other

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11
Q

dose of ketoprofen for TTH

A

25mgPO

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12
Q

TTH analgesics should be limited to ___

A

2-3x/wk

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13
Q

limiting angelicas for TTH should prevent ___

A

medication-overuse HA

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14
Q

analgesic tx for TTH may be augmented with ___

A

sedating anthitamines
diphenhydramine
promethazine

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15
Q

if TTH tx is inadequate

A

acetaminophen of aspirin w/ caffeine and bultalbital

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16
Q

acetaminophen or aspirin w/ caffeine and butalbital for TTHs may precipitate ___

A

chronic daily HA

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17
Q

use TTH tx < ___

A

twice weekly

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18
Q

caution about sedation using butalbiatl and limit ___

A

alcohol

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19
Q

TTH prophylaxis

A

amitriptyline

SSRIs (may take 1-2mo)

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20
Q

most painful of primary HA

A

cluster

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21
Q

MC clusters of cluster headaches

A

aura
photophobia
phonophobia
osmophobia

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22
Q

key feature of cluster headache

A

recurrent bouts of near daily attacks

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23
Q

cluster headaches may last for ____

A

weeks or months

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24
Q

many cluster headache attacks begin

A

w/ REM phase sleep

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25
precipitants of a CH attack include
hypoxia (may occur w/ sleep apnea) vasodilator alcohol (nitroglycerin) carbon dioxide
26
Cluster Headaches are diagnosed by ___
history
27
Diagnostic criteria for CH
unilateral orbital, supraorbital or temporal
28
CH must be accompanied by >1 of the following
ipsilateral conjunctival injection or lacrimation ipsilateral nasal congestion or rhinorrhea ipsilateral eyelid edema, forehead and facial sweating ipsilateral mitosis or ptosis a sense of restlessness or agitation
29
acute attacks of CH must be ___ or ___
aborted; subdued
30
TOC for CH
oxygen (7L/min x 15min)
31
dose of sumatriptan for CH
sumatriptan 6mg SQ; 20mg NS
32
under prescribed tx for CH
O2 and sumatriptan
33
intranasal tx for CH
dihydroertogamine lidocaine capsaicin
34
CH ppx
``` verapamil prednisone valproic acid topiramate ergotamine ```
35
med that is NOT effective for cluster HA ppx
oral sumatriptan
36
despite effective therapies, MH is often ___ and ___
underdosed; undertreated
37
about 1/2 of patients stop medical care for MH due to ___
dissatisfaction
38
MH classification is based on ___
clinical features
39
Aura on MH includes ___
visual distortion
40
positive aura
scintillations (sparks), teichopsia (luminous appearance), phtopsia (flashes)
41
negative aura
visual field defects
42
pain of migraine is usually:
unilateral, throbbing, temporal and incapacitating
43
pain with MH is minimized in ___
dark, quiet location
44
many people with MH experience other ___
prodromal sx
45
common triggers for MH
food behavioral (psychologic) environmental
46
food triggers for migraine HA
``` alcohol caffeine chocolate MSG tyramine-containing foods nitrate0containing foods ```
47
environmental triggers
flickering lights
48
goals of pharmacotherapy for acute MH
treat attacks RAPIDLY and consistently
49
goals of pharmacotherapy for long-term MH
reduce frequency and severity of attacks | avoid escalation of medications
50
tx for mild-moderate MH or unresponsive severe attacks
oral NSAIDs combo analgesics containing caffeine isometheptene combinations (midrin)
51
tx for moderate to severe MH or mild-mod MH unresponsive to NSAIDs
migraine-specific meds (triptans, DHE) | combo tdx: (aspirin + APAP + caffeine)
52
___ are no longer widely used in MH tx
sedatives
53
____ monotherapy is NOT recommended for MH
acetaminophen
54
approaches to MH tx
step-care aproach stratified-care approach recent RCT found stratified-care approach superior
55
abortive therapy for MH
ergotamine dihydroergotamine (DHE) triptans
56
nonselective 5HT1 agonsit
ergotamine
57
DHE largely replaces ___
ergotamine, less overuse HA
58
both DHE and ergotamine are ___
oxytoxic -- contraindicated in pregnancy
59
both ergotamine and DHE cause _____
peripheral vasoconstriction -- use short term
60
triptans are specific ___
5HT1 receptor agonists
61
widely prescribed class of agents for abortive therapy MH
triptans
62
triptans are usually reserved for ___
mod-severe MH, unresponsive to other medicatiosn
63
c/I of triptans
uncontrolled HTN ischemic vascular conditions vasospastic CAD
64
subQ sumatriptan peaks in ___
15 mins
65
oral rizatriptan peans in ___
60-90min
66
oral naratriptan has ___
longest half life
67
oral naratriptan may decrease chance of ___
recurrence HA
68
principals of triptan therapy
try one for 2-3 HA episodes before changing if one is ineffective, try another match the drug characteristics to pt's need
69
several "newer" triptans offer ___
no advantage
70
consider ppx for MH if ____
>2 attacks/mo w/ disability >3 days/mo
71
consider ppx for MH if c/I to or failure of ___
abortive therapy
72
consider ppx for MH if use of abortive therapy >___
>2x/wk
73
consider ppx for MH if presence of ___
uncommon migraine conditions
74
uncommon migraine conditions
hemiplegic migraine | prolonged aura
75
MOA of onabotulinumtoxinA
neuromuscular blocking agent
76
inject 155 of onabotulinumtoxinA to ___ sites q12 wks
31 total sites

Pharm Unit 7 (3 decks)

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