Migraine/Neuropathic pain Flashcards
(18 cards)
What are the treatment options for migraines?
simple analgesics: 1st line
triptans: sumatriptan, zolmitriptan, rizatriptan - 2nd line, acute attacks
NSAIDs: tolfenamic acid - acute attacks
ergot alkaloids (rarely used): ergotamine
What are the treatment options for migraine prophylaxis?
beta blockers: propranolol, atenolol, metoprolol
anti-epileptics: topiramate, sodium valproate, gabapentin
TCAs
valproic acid
pizotifen
What medications are used for nausea/vomiting in migraine?
metoclopramide
domperidone
antihistamines: buclizine
phenothiazine: prochlorperazine
What is counselling for triptans?
stop if intense tingling, heat, heaviness, pressure or tightness in any part of the body
What is the licensing for sumatriptan?
18-65 years
What is the treatment for trigeminal neuralgia?
carbamazepine
phenytoin
What is the treatment for nicotine dependence?
1st: dual NRT
2nd: varenicline
3rd: mono NRT
What is the MHRA warning for varenicline?
risk of suicidal behaviours: report agitation, depression, suicidal thoughts
What are the treatment options for opioid dependence?
1st: opioid agonist
- methadone: longer acting, more sedating
- buprenorphine: less likely to cause overdose, less sedating, milder withdrawal reaction
naloxone
naltrexone (opioid antagonists)
What is a side effect for buprenorphine?
precipitates withdrawal reaction
When is naltrexone CI?
if the patient is still taking opioids: test for dependence with naloxone first
What are the rules for missed doses in methadone use?
> 3 missed doses - overdose risk due to reduced tolerance
> 5 missed doses - check for misuse
What is the treatment for alcohol withdrawal?
chlordiazepoxide or diazepam
- fixed dose reducing regimen
carbamazepine
clomethiazole
What is the treatment for alcohol withdrawal seizures?
lorazepam
What is the treatment for delirium tremens?
oral lorazepam
When is clomethiazole CI?
in patient who still drink alcohol
- risk fatal respiratory depression
What are treatment options for alcohol dependence?
acamprostate
naltrexone
disulfiram
nalmefen: for patient who have high drinking risk levels but do not need immediate detoxification
What is the treatment for Wernicke’s encephalopathy?
parenteral thiamine then oral thiamine and lactulose
