HA

Question 1

Pharm concept for attacking TTH

Answer 1

HIT hard and EARLY

–limit use to <9d/month of drugs to decrease risk of MOH

Question 2

what increases risk of MOH

Answer 2

combination of analgesics; caffiene, butalbital, opioids

Question 3

what decreases risk of MOH

Answer 3

long life NSAID–naproxen

Question 4

initial therapy for TTH

Answer 4

ibuprofen/naproxen + APAP

Question 5

in pt drug for TTH abortion

Answer 5

ketroalac

Question 6

combination drug for TTH abortion

Answer 6

excedrin (caffiene + APAP+ ASA)

Question 7

what should be used w/ pregnancy and TTH

Answer 7

APAP

Question 8

what is the most helpful tool w/ Migranes

Answer 8

Headache Diary

Question 9

important consideration for meds to treat migranes

Answer 9

consider non ORAL route

Question 10

abortive meds for mild-mod migranes

Answer 10

NSAID +/- APAP
Traiptan
Ergot

Question 11

what meds should be used for anti-emetics w/ migranes

Answer 11

IV dopamine if possible
metoclopramide
prochlorperazine
promethazine

Question 12

what drug should ALWAYS be avoided with migranes?

Answer 12

OPIOIDS

Question 13

Sumitriptan forumulations

Answer 13

tab
nasal spray
SQ

Question 14

Triptan drugs

Answer 14

sumitriptan

zolmitriptan

Question 15

short onset triptan

Answer 15

sumitriptan

Zolmitriptna

Question 16

long onset triptan

Answer 16

frovatriptan

Question 17

longest lasting triptan–good for repeat migranes in 1 day

Answer 17

frovatriptan and naratriptan

Question 18

MOA of triptans

Answer 18

SSRI agonist causing vasoconstriction

Question 19

what pts should not use triptans

Answer 19

HTN pts
Pheo pts
TIA history pts
Raynauds pts
"Vasculopaths"

Question 20

what is the most effective route for migranes

Answer 20

SQ

Question 21

if a pt doesn’t respond to a triptan what should you do?

Answer 21

try another one! pts can respond to different ones

Question 22

what triptan is used with cluster HA?

Answer 22

sumitriptan

Question 23

what drug do triptans interact with and should be avoided

Answer 23

with MAOI

Question 24

what drug should not be given with triptans d/t similar effects

Answer 24

ergots and SSRI

Question 25

what can propranol do if given with triptans? how should you alter your prescription?

Answer 25

increase concentration, you may need to decrease triptan doseage

Question 26

what can propranol do if given with triptans? how should you alter your prescription?

Answer 26

increase concentration, you may need to decrease triptan dosage

Question 27

what ergot do we use?

Answer 27

dihydroergotamine

Question 28

what is the MOA of ergots?

Answer 28

similar to triptan--with serotonin agonists

Question 29

when should ergots be used?

Answer 29

in pts who failed therapy with triptans

Question 30

what is a GI ADR of drihydroergotamine?

Answer 30

diarrhea

Question 31

what is a common drugs for migrane prophylaxis?

Answer 31

B-blockers AEDS Anti-depressants

Question 32

who do we avoid B-blockers in?

Answer 32

asthmatics HF pts ppl w/ exercise intolerance

Question 33

who should we use toprimate in?

Answer 33

adolescents & adults

Question 34

what is important to know about divalproxe/VPA?

Answer 34

TERATOGEN

Question 35

what anti-depressant is used?

Answer 35

amitriptyline

Question 36

what is drug helpful w/ menstrual migraines?

Answer 36

OCP and esp. w/ extended cycle to skip periods and avoid the migranes

Question 37

what can be done prophylactically for menstrual migranes

Answer 37

take triptan or nsaid 2d before menses & continue for 5-7 days

Question 38

what are the CGRP antagonists?

Answer 38

Erenumab Fremanzumab Galcanzumab

Question 39

what important about the formulation of the new CGRP drugs?

Answer 39

INJECTIONS

Question 40

what is the mOA of CGRP antagonist??

Answer 40

vasodilator | inhibits pain signalling neutrotransmission

Question 41

when do we use CGRPs?

Answer 41

when other meds AREN'T working or aren't tolerated

Question 42

what CGRP has a bad ADR? what is the ADR?

Answer 42

Erenumab--hypersensitivity rxn, angioedema, anaphylaxis

Question 43

what migrane drugs can be used in pregnancy?

Answer 43

APAP | sumitriptan--category C

Question 44

what drugs need to be avoided in pregnancy

Answer 44

nsaid--esp 3rd trimester | ergots