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PHARM II, QUIZ 3 > Headache > Flashcards

Headache Flashcards

1
Q

Tx for acute migraine headache, mild-mod intensity

A

TRIPTANS - EXPENSIVE!

ERGOT ALKALOIDS! ADRS!

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2
Q

Triptan MOA

A

Serotonin Receptor Agonists

Mediates vasoconstriction

Receptors found on

  • Cranial arteries
  • Basilar artery
  • Dura mater vasculature
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3
Q

Triptan CI

A

Basilar migraine

Vascular problems (cardiac, cerebra, peripheral)

Uncontrolled HTN

Liver disease

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4
Q

Triptan Common ADRs

A
  • Parasthesias
  • Fatigue
  • Flushing
  • Chest tightness
  • Sweating
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5
Q

Triptan Serious ADRs

A

HEART STUFF

  • Coronary artery vasospasm
  • Transient myocardial ischemia
  • MI
  • Ventricular tachycardia
  • HTN
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6
Q

Triptan drug interactions

A

Ergots alkaloids CI with all triptans

SSRI’s

Drugs that cause long Q-T interval

Amlotriptan - sulfa!

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7
Q

Which triptan can’t be used in patients w a sulfa allergy?

A

Amlotriptan

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8
Q

TRIPTANS

A

1st line tx for acute headache

Almotriptan (Elmo!) sulfa allergy

Eletriptan (Dumbo!)

Naratriptan (Nala from Lion King!)

Rizatriptan (Oral disintegrating tablets)

Frovatriptan (Frodo!)

Sumatriptan (Suma wrestler!) Sub q, nasal spray

Zolmitriptan (Nasal spray, disintegrating tablets)

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9
Q

ERGOT ALKALOIDS

A

1st line tx for acute headache

Ergotamines:

  • Ergomar (ergotamine tartrate)
  • Cafogar (ergotamine + caffeine)
  • DHE (dihydroergotamine)
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10
Q

Ergotamine indications / CI

A

Indications
- abort or prevent vascular headache

CI

  • Renal failure
  • Hepatic failure
  • Vascular disease
  • Uncontrolled HTN
  • Pregnancy / breastfeeding
  • Basilar or hemiplegic migraine*
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11
Q

Ergotamine MOA

A

Nonselective 5-HT receptor agonist
(as opposed to Triptan which is selective)

Direct vasoconstriction of peripheral smooth muscle and cranial blood vessels

**may have anti-inflammatory effects*

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12
Q

How is DHE different from other ergotamines?

A

Dihydroergotamine

Stronger vasoconstrictor than non-hydrogenated ergot amines &raquo_space;> binds 5HT and NE / DA receptors

Available as injection or nasal spray

Works for cluster headaches

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13
Q

Ergotamine ADRs

A
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Weakness
  • Fatigue
  • Chest tightness
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14
Q

Ergotamine Warnings

A

Ergotism (St Anthony’s fire)
- HA, vomitting, diarrhea, gangrene

Life-threatening ischemia
- If administered along w strong CYP3A4 inhibitors

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15
Q

Ergotamine drug interactions

A

Serotonin drugs

P450 / 3A4 inhibitors

Vasoconstrictors

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16
Q

2nd line drug for migraine tx

A

Butorphenol

Nasal spray, injection

17
Q

Butorphenol MOA

A

Partial opioid agonist, analgesic

addictive

18
Q

Butorphenol ADRs

A

Nausea
Vomitting

sleepiness OR insomnia
Dizziness

Respiratory depression

19
Q

3rd line drugs for migraine tx

A

Fiorinal
(Butalbitol, aspirin, caffeine)

Fioricet
(butalbitol, acetomenaphen, caffeine)

both have preparations w codeine

20
Q

Fiorinal / Fioricet indications

A

Tension headache, migraine

21
Q

Fiorinal / Fioricet ADRs

A

Nausea
Drowsy
Dizzy
Abdominal pain

watch for overuse - more than 2x weekly is too much

22
Q

What to do when prescription / self administered therapy fails for migraine:

A

IV !
DHE
Lorazepam
Valproic acid (Depacon)

IM Toradol (strong NSAID)

Parenteral narcotics

23
Q

Acute migraine in ED, 1st line tx

A

IV Compazine or Reglan

Sub Q Sumatriptan

24
Q

Acute migraine in ED, 2nd line tx

A

IV Acetomenaphine, Valproate

25
Q

Migraine prophylactic options

A

Valproic acid (depakote)

Topiramate

Propanalol

Metropolol

Timolol

26
Q

Butterbar, natural tx migraine

A

BUTTAH BAH

Effective prophylactic for migraines

Look for PA-free formulas (whatever that means)

Can be hepatotoxic

27
Q

How long to treat migraines prophylactically?

A

Daily for 2-6 months

Continue 3-6 months after headaches diminish

Gradually taper and discontinue

PHARM II, QUIZ 3 (1 decks)

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