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
Is Mitoxantrone an immunomodulator or immunosuppressant?
Immunosuppressant
What MS medication is indicated to reduce exacerbation and delay disability, but is NOT considered first line?
This is used in combination with what medication?
What other disease is this used to treat?
Natalizumab
Used in combo with Interferon Beta
this is also used to treat Crohn’s disease
What MS medication is indicated to reduce exacerbation and delay disability in relapsing MS, but is associated with first-dose bradycardia?
Fingolimod
What MS medication is indicated for relapsing MS, but has major side effects such as hepatotoxicity, teratogencitiy, and bone marrow suppression?
Teriflunomide
What medication is indicated to improve walking in MS patients?
In what conditions is this contraindicated?
Dalfampridine
Contraindications:
Renal Impairment
Seizures
What muscle relaxant is sometimes used in MS patients which is also FIRST LINE for Malignant Hyperthermia?
Dantrolene
Which medication is first-line for treating the pseudobulbar effect of MS?
Nuedexta (Dextromethorphan/Quinidine)
What is considered first line in Parkinson’s treatment?
Levodopa + Carbidopa
What are contraindications to Levodopa use?
MAOIs
Malignant Melanoma
Narrow Angle Glaucoma
What medications can be used in combination with Levodopa and Carbidopa to “smooth out” the “on-iff” effects?
Dopamine Receptor Agonists
In lower doses of carbidopa and levodopa
Which non-ergot dopamine receptors can also be used to treat restless leg syndrome?
Pramipexole
Ropinirole
Which non-ergot DRA is given as a SubQ injection to provided temporary relief from “off periods” of akinesia?
Apomorphine
Which ABx is also a MAOI?
Linezolid
Which MAO-B inhibitor is indicated for early Parkinson’s Treatment in adjunct with Levodopa?
Rasagiline
T/F: COMT Inhibitors are monotherapy
False
they are used in adjunct with Levodopa
Should COMT inhibitors be used with MAOIs
Not really but can be OK with MAOI-Bs
What medications compose Stalevo?
Levodopa
Carbidopa
Entacapone
Which class of medications is useful in Parkinson’s patients taking neuroleptics and can be useful in improving rigidity and tremor?
Anticholinergics
Trihexyphenidyl
Benztropine
What medication is indicated to reduce hallucination and delusion in PD pyschosis?
Pimavanserin
What newly approved medication is indicated for”off” episodes in patients taking Levodopa/Carbidopa?
Safinamide
What liver condition would contraindicate giving a PD patient Safinamide?
Cirrhosis
What is considered first-line for ALZ treatment and for dementia with Lewy Bodies?
Cholinesterase Inhibitors
Donepezil
Rivastigmine
Galantamine
What medication is approved for moderate-to-severe ALZ treatment that can be used as monotherapy or with a cholinesterase inhibitor?
Memantidine
What antidepressants can be used to treat ALZ?
Citalopram
Escitalopram
Trazodone
What is indicated for Myasethnia Gravis Treatment?
Pyridostigmine Neostigmine (Faster Acting)
What are contraindications to Pyridostigmine use?
Urinary/Bowel Obstruction
Asthma/COPD
What medication is approved for ALS treatment?
What is the newest approved medication for this and commonly only used in Japan?
Riluzole
Edaravone
What medication is indicated to treat Chorea?
What are TWO contraindications to this medication?
Tetrabenazine
Contraindications:
Liver Disease
MAOIs
What should be considered first-line for mild pain treatment in pediatrics?
Ibuprofen/Acetaminophen
What should be considered first-line for moderate-to-severe pain in pediatrics?
Opiates
What are THREE indications for acetaminophen?
- Analgesic (Minor aches/pain)
- Antipyretic
- Kine/Hip OA (First-Line per ACR although meta-analysis proved this was least effective)
What medications is considered the antidote for acetaminophen OD?
N-Acetylcysteine
Which pain reliever should be recommended to marathon runners?
Why?
Acetaminophen
Because it is not renally eliminated
What are THREE uses for NSAIDs?
- Acute/Chronic Pain
- Cancer Pain
- Anti-Inflammatory
What are FOUR medications used to lower GI risks with NSAID use?
- Naproxen/Esomeprazole
- Ibuprofen/Famotidine
- ASA/Omeprazole
- Mistoprostol
What is the maximum dose of ASA?
4 grams per day
How is ASA overdose treated?
Sodium Bicarbonate
Which NSAID is first line for gout flares?
Indomethacin
Other than gout, what are two additional indications of Indomethacin?
PDA Closure
Premature Labor
Which NSAIDs are indicated for relief of OA and RA symptoms?
Meloxicam
Piroxicam
Celecoxib
Which NSAID is indicated for prevention of familial adenomatous polyposis
Celecoxib
What are uses for short-acting opioids?
Acute Pain
Incident Pain
Breakthrough Pain
Physical Therapy
What are uses for long acting pain?
Chronic Pain
Moderate-to-severe Pain
What is the most commonly used opioid?
Hydrocodone (Norco)
Which opioid is often used in a transdermal patch?
When does this reach a steady state?
Fentanyl
Reaches steady state in 3-6 days (don’t cut patch b/c dose dumping)
What class of medication should be avoided with Meperidine (Demerol)?
Why?
MAOIs because of increased risk for respiratory depression
Can Propoxyphene be used in the elderly?
No, it should be avoided
What medication is used for immediate opioid reversible?
Naloxone (Narcan)
What medication is indicated for opioid and EtOH addiction?
Can this be given to patients currently on opioids?
Naltrexone (Vivitrol)
No
What medication is as effective as morphine for labor pain?
Tramadol
What medication classes should be avoided with tramadol due to an increased risk of seizures?
SSRIs
TCAs
Opioid
MAOIs
What opioid is specifically approved for diabetic neuropathy?
Why should this be avoided with EtOH?
Tapentadol (Nucynta)
Can be fatal if taken with EtOh
What THREE medications are indicated for treatment of opioid addiction?
Methadone
Buprenorphine
Naltrexone
Should you start chronic pain management with opioids are the highest of lowest doses?
Lowest doses
Should benzodiazepines be used in treatment of chronic pain with opioids?
No, avoid these
What medications are indicated for treatment of fibromyalgia?
Milincipran
Pregabalin
Duloxetine
Is Milincipran approved to treat fibromyalgia in adults or children?
Adult
What is cyclobenzaprine (Flexeril) indicated for?
In adjunction with rest or physical therapy for relief of muscle spasms associated with acute, painful musculoskeletal conditions
Is Cyclobanzaprine (Flexeril) useful in treating spasticity associated with cerebral or spinal cord diseases?
No
Should cyclobenzaprine (Flexeril) be used in patients with urinary retention or who are at risk for acute angle closure glaucoma?
No
Should Carisoprodol (Soma) be used as monotherapy or in adjunct with rest and PT?
Does this medication have a known abuse potential?
Adjunct
Yes, High abuse potiental
Should Metaxalone (Skelaxin) be used as monotherapy or in adjunct with rest and PT?
Adjunct
What medications is indicated for treatment of muscle spams due to MS, spinal cord injuries, or trigeminal neuroaglia?
Baclofen
Chlorzoxazone
Is the a potential for Baclofen to treat Opioid, Cocaine, or EtOH addiction?
Yes
What medication was shown to improve pain and functionality in knee OA?
Glucosamine Sulfate
When would intraspinal (Intrathecal or Epidural) pain medication delivery be indicated?
What medication is only indicated for intrathecal administration?
Severe chronic pain that has been inadequately controlled
Zinconotide
What other pain medication can be given intrathecally?
Baclofen
There is also a pump, but one dose should be administered prior to determine patient’s response
T/F: Capsaicin is indicated for post-herpetic neuralgia
True
What method of pain medication administration uses ion currents to deliver charged drugs through the skin?
Iontophoresis
