Headache Medications Flashcards
(27 cards)
Analgesics
Tylenol (Acetaminophen)
Aspririn
Tylenol (Acetaminophen)
325-650 mg q4-6 hrs
Do not exceed 3250 mg/day
Watch for liver toxicity @ high doses
1st line for pregnancy and breastfeeding
Aspirin
325-650 mg q4-6 hours
Not to exceed 4000 mg/day
MOA: Inhibit prostaglandin synthesis, reduce inflammatory response and platelet aggregation
CI: Hx bleeding disorders, asthma, hypersensitivity
NSAIDS
MOA: Inhibit cyclooxygenase-2 (COX-2)
SE: Abdominal cramps, Nausea, Indigestion
BBW: Cardiovascular events
Ibuprofen, Naproxen
Ibuprofen dosing
200-400 mg
Do not exceed 2400 mg/24 hours
Naproxen Dosing
Initially 500 mg, then 250 mg q 6-8 hours
Do not exceed 1250 mg/day
Combination analgesics
Barbiturates - Florinal, Floricet
Midrin
SE: Drowsiness, N/V, Abdominal pain
Pregnancy C
Florinal
Butalbital/Caffeine/ASA
50/40/325 dose, 1-2 tabs q4hr
Max: 6 tabs/day
MOA: Inhibit prostaglandin, sedation, cerebral vasocontriction
SE: drowsiness, N/V, abdominal pain
Pregnancy: C
Floricet
Butalbital/Caffeine/Acetaminophen
50/40/325 mg dose, 1-2 tabs q 4hrs - max 6 tabs/day
MOA: inhibit prostaglandin, sedation, cerebral vasoconstriction
BBW for Hepatotoxicity
SE: Drowsiness, N/V, Abdominal pain
Pregnancy C
Midrin
Isometheptene/Dichloralphenazone/Acetaminophen
65/100/325 mg dose; 1-2 tabs q4h - max 8 tabs/day
MOA: cerebral vasoconstriction, sedation, analgesia
Antiemetics
Phenothiazines - Promethazine, Prochlorperazine
Metoclopramide (Reglan)
Promethazine (Phenergan) and Prochlorperazine (Compazine) Dosing
Phenergan - 12.5-25 mg q4-6 hrs PRN
Compazine - 5-10 mg q 4-6hrs PRN OR 10-30 mg BID PO sustained release
PO, IM, IV, Rectal for all
Phenothiazines
MOA: Non-selectively antagonizes central and peripheral histamine (H1) receptors
Pregnancy C
BBW: Respiratory depression in <2yo; Tissue necrosis w/ injections (Phenergan); Dementia-related psychosis (Compazine)
SE: Drowsiness, sedation
Metoclopramide (Reglan)
5-10 mg PO/IV/IM q 6-8hrs
MOA: Antagonize central and peripheral dopamine receptors
BBW: Tardive Dyskinesia
SE: Drowsiness, restlessness, fatigue
Pregnancy B
Triptans
MOA: Agonist effects on serotonin 5-HT1 receptors in cranial blood vessels, inhibits release of pro-inflammatory neuropeptides
CI: CAD, PVD, stroke, hemiplegic and basilar migraine, MAOIs, uncontrolled HTN
Don’t use more than 9 days/month
SE: N, Jaw/neck/chest pressure or tightness, fatigue, burning sensation
Pregnancy C
Sumatriptan (Imitrex)
PO: 25-100 mg, can repeat up to 100 mg in 2 hrs
-efficacy w/in 2 hours
SC: 6 mg, can repeat in 2 hrs
-works w/in 20 minutes
Nasal: 5-20 mg, can repeat in 2 hrs
- do not exceed 40 mg/24hrs
- efficacy w/in 2 hours
Naratriptan (Amerge)
Rizatriptan (Maxalt)
Zolmitriptan (Zomig)
Naratriptan (Amerge) - 1-2.5 mg q4hrs; max 5mg/day
-Higher bioavailability, longer acting, lower recurrence rate
Rizatriptan (Maxalt) - 5-10 mg q2hrs; max 30 mg/day
-30 minutes onset of action
Zolmitriptan (Zomig) - 2.5 mg PO/Nasal/Disintegrating tablet
- take @ onset of migraine
Ergotamaine tartrate (Ergostat)
Ergot Alkaloid - Migraine-specific drug
Nonspecific 5-HT agonist/antagonist/both -> cause peripheral and cranial vasoconstriction
Pregnancy X; BBW Peripheral ischemia, CYP3A4 inhibitor, protease inhibitor, or macrolide Abx
SE: Rebound HA, vascular occlusion, dependence
When do you use narcotics for headaches
Only used as a rescue medication for severe migraines
Infrequent migraines with contraindications to other agents
Also for HA in pregnancy
Preventative Migraine Therapy
BB 1st line: Propranolol or Timolol
-Caution w/ bradycardia, asthma, 2nd/3rd heart block, CHF
CCB 2nd/3rd line: Verapamil; 1st line for cluster HA
-CI w/ bradycardia, heart block, A-fib
Anticonvulsant Preventative therapy for headaches
Valproic acid (Depakote): May decrease HA frequency by 50%
- SE: Weight gain; CI: Liver disease, pregnancy (D)
- Need baseline CBC and LFTS
Topiramate (Topamax): Good for chronic, daily HA or HA unresponsive to other Tx
- SE: Weight loss; CI: Liver and renal impairment
- Pregnancy C
Antidepressant HA Prevention
Elavil (Amitryptiline) - TCA, only drug w/ proven efficacy
-SE: weight gain, constipation, dry mouth, sedation (take at bedtime)
Insufficient data w/ SSRIs, H/A, or other TCAS
Meningitis Definition
Swelling and inflammation of the membranes covering the brain and the spinal cord
Encephalitis Definition
Inflammation of the brain
