HAPharm

Question 1

What are the 3 primary HA?

Answer 1

Migraine, tension, cluster

Question 2

What is the most prevalent primary HA

Answer 2

Tension

Question 3

Which HA affects men more

Answer 3

Cluster

Question 4

What is the pathophysiology behind migraines

Answer 4

1) vascular hypothesis: migraine pain is a result of cranial artery vasodilation
2) neuronal dysfunction: trigeminovascular system promotes inflammation

Question 5

What are nonmodifiable risk factors for migraines

Answer 5

Gender, head injuries, level of education?

Question 6

What are common medication triggers for migraine

Answer 6

Cocaine, nicotine, NTG, hormones, NSAIDS, cimetidine, nifedipine, fluoxetine

Question 7

To be classified as a migraine without aura, it must have at least 3 symptoms. What are the 2 symptom categories

Answer 7

1) need 2.. aggravated by physical activity, pulsating, UL, moderate or severe pain
2) need 1…. N/V or photo/phonophobia

Question 8

How do you diagnose a migraine w/ aura?

Answer 8

1) 2 lifetime attacks

2) 2 of the following….. homologous visual symptoms, UL sensory system, @ least one aura symptom over >/= 5 min or different aura symptoms developing in succession
3) one of the following, aura: fully reversible visual symptom, fully reversible dysphasic speech disturbance, fully reversible sensory symptom

Question 9

What is the goal of short term and long term migraine treatment

Answer 9

ST: decrease severity and duration, restore ability to function

Lt: decrease number and severity of future migraine, improve quality of life

Question 10

What is ACP-ASIM 1st line therapy recommendations for migraines

Answer 10

NSAID or combo

Step Therapy

Question 11

What is USHC 1st line therapy?

Answer 11

Migraine specifics agents

stratified therapy

Question 12

Nonspecific pharmacologic treatment for migraines includes what?

Answer 12

NSAIDS, analgesics, antiemetic, corticosteroids

Question 13

Migraine specific tx for migraines includes what?

Answer 13

Ergot derivatives, 5-HT IB/ID agonist

Question 14

When are NSAIDS 1st line? How do they help migraines?

Answer 14

Mild to moderate migraines

Inhibit prostaglandin synthesis, inhibits inflammation

Question 15

What are the drug interactions w/ barbiturate combo treatments?

Answer 15

Decrease effect: phenothiazine, quinidine, cyclosporine, theophylline, beta blockers

Increase effects: chloramphenicol, benzos, CNS depressants

Question 16

What are the ergot alkaloids?

Answer 16

MAO, ergotamine tartrate, dihydroergotamine

Question 17

What are the ergotamine acute side effects ?

Answer 17

N/V, diarrhea, abdominal pain, weakness, leg cramp, tremor, dizzy, syncope, chest pain, intermittent claudication

Question 18

What is syndrome of ergotism?

Answer 18

Peripheral ischemia, cold/ numb extremities, diminished peripheral pulses

Question 19

Are ergotamines a 1st line choice? Why or why not?

Answer 19

No, because they are super constrictors SYSTEMICALLY

Question 20

What are chronic side effects of ergotamines

Answer 20

Central/peripheral ischemic disorders, HTN, Tachy/brady, medicine overuse HA, renal D/O, withdrawal signs

Question 21

What are ergotamine drug interactions?

Answer 21

CYP3A4 substrate SO interacts with strong w/ 3A4 inhibitors ( azole antifungals, macrolides, protease inhibitors) , triptans(additive vasoconstrictive effects) and fluoxetine, fluvoxamine (compete for metabolism)

Question 22

What is 1st line tx for mod-severe migraines?

Answer 22

Triptans

Question 23

How do triptans work?

Answer 23

Inhibit neuropeptide release from trigenimovascular nerves, interrupt pain signal with brain stem trigeminal nuclei

Question 24

What are triptan drug interactions?

Answer 24

MAO-I/ SSRIs: inhibits clearance, increased risk of serotonin syndrome

Ergotamines: increased vasoconstrictive effects

Question 25

What is serotonin syndrome? Is it a medical emergency?

Answer 25

Hyperthermia, muscle rigidity, myoclonus, rapid change in mental status and vitals- yes it is a medical emergency

Question 26

When can you start prophylactic therapy for migraines?

Answer 26

If they are 2-3x month MINIMUM, predictive pattern, long lasting with severe impairment

Question 27

What are 2st line prophylactic treatment? ADRS?

Answer 27

A)beta blockers: fatigure, vivid dreams, depression, impotence, bradycardia, hypotension B) TCAs: sedation, constipation, blurred vision, hypotension,

Question 28

How do anticonvulsants help with migraines?

Answer 28

Increased availability of GABA-inhibitory transmitter,

Question 29

Anticonvulsant ADRS?

Answer 29

Tremor, wt gain, nausea, hair loss

Question 30

What is the premise for CA channel blocker use? Examples?

Answer 30

Initial constriction that leads to HA Verapamil, nimodipine, diltiazem

Question 31

What drug can only be used for 6 months d/t side effect of fatal pulmonary fibrosis?

Answer 31

Methysergide- peripheral serotonin inhibitor and central serotonin agonist

Question 32

What are some possible effective prevention natural treatments?

Answer 32

Butterbur, coenzyme Q10, feverfew, magnesium, and riboflavin

Question 33

What is the pharmalogical treatment for tension HA?

Answer 33

Analgesics +/- caffeine, sedative, prophylactic

Question 34

Which HA are UL, occur at night, and is often accompanied by ptosis and miosis

Answer 34

Cluster

Question 35

Acute treatment for cluster HA?

Answer 35

Imitrex, O2, ergotamine +/- caffeine, DHE- 45, lidocaine nasal spray,

Question 36

Is prophylaxis 1st line tx for cluster HA? What types?

Answer 36

NO, verapamil, prednisone, ergotamine, methysergide, lithium