Indications / First-Line / Contraindications Flashcards
(93 cards)
What is indicated for mild to moderate HA treatment?
Acetaminophen
NSAIDs
What class of medications is considered first-line for headache treatment?
Triptans
Erogotamines
Triptans are specifically first line for treatment of migraines with and without what?
Aura
What are contraindications to Triptan use?
Basilar Migraine
Ischemic Events
Unctonrlled HTN
Liver Disease
What are TWO indications for DHE use?
Acute migraine with or without aura
Cluster Headaches
T/F: Ergotamines can be used as both abortive and prophylaxis in vascular headache treatment
True
Should ergotamines be used in patients with Renal Failure, Hepatice Failure, or Vascular disease?
No
Are ergotamines safe in pregnancy or breast feeding?
No
What is considered second line for headache treatment?
Butorhpanol
What is considered third line for headache treatment?
Fiorinal (Butalbital, aspirin, caffeine)
Fioricet (Butalbital, acetaminophen, caffeine)
Fiorinal and Fioricet are indicated to treat which type of headache?
Tension-type headache
Which for medications have the highest level of evidence for migraine treatment (considered Class A)?
NSAIDs
Triptans
Opiates
Nasal DHE
If at home treatment or typical remedies for headache fail…….
What medications can be given?
- IV DHE + Metoclopramide
- IV/IM Lorazepam (Ativan)
- IV Divalproex
- IM Ketorolac
- Steroids
What is the “typical” first line headache remedy in the ED?
IV Metoclopramide
SubQ Sumatriptan
What is the “typical” second line headache remedy in the ED?
What should be avoided?
IV APAP, ASA, Diclofenac, or Ketorolac
Avoid:
Diphenhydramie Hydromorphone Lidocaine Morphine Octreotide
What can be used to treat migraines in pediatric patients?
NSAIDs
Sumatriptan (Nasal, SubQ)
Oral Zolmitriptan or Rizatriptan
What medications are considered for migraine prophylaxis?
Divalproex Sodium
Topiramate
Propanolol, Metoprolol, Timolol (Oral)
What medication is used for prophylaxis of menstrual migraines?
Frovatriptan
What is the most commonly used natural treatment for migraine prophylaxis?
How is this dosed?
Butterbur
- 75 mg daily for 2-6 months until headaches diminish
- Then 3-6 months after headaches diminish
- Gradual taper to discontinuation following that
What is first-line for relapsing-remitting MS attacks?
Interferon Beta
Dimethyl Fumarate
Glatiramer Acetate
Which MS drug is indicated for……
Reducing neurologic disability
Reducing relapse frequency
RRMS and progressive MS
AND….
Hormone-refractory prostate CA
Acute nonlymphocytic Leukemia in adults
Mitoxantrone
What is first line for acute MS attacks?
Glucocorticoids
What is first-line for Secondary Progressive or Progressive Relapsing MS?
Interferon beta
Natalizumab
Mitroxantrone
Is Glatiramer Acetate an immunomodulator or immunosuppressant?
Immunomodulator