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Neuro Block 2 Pharm > Migraine Treatment > Flashcards

Migraine Treatment Flashcards

(54 cards)

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1
Q

describe migraine headache

A

unilateral, gradual onset, moderate intensity, patients wants quiet, dark room, last 4-72 hours and associated with n/v, photo/phonophobia

increased risk of stroke in aura migraine with OCs

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2
Q

describe tension headache

A

bilateral, pressure/tightness, waxes & wanes, pt may be active or may rest, variable duration

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3
Q

describe cluster headache

A

unilateral & behind/around one ye, quick onset, deep excruciating pain, patient remains active, .5-3 hr duration, associated with lacrimation, sinusitis, horners, sensitive to EtOH

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4
Q

NSAIDs for treatment of headaches

A

nabumetone, ibuprofen, naproxen

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5
Q

moa of NSAIDs

A

cox inhibition and dec sysnthesis of pro-inflammatory mediators

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6
Q

AE of NSAIDs

A

∙ gastric irritation with chronic use
∙ additive nephrotoxicity (especially elderly)
∙ fluid retention, HTN, edema, CHF
∙ potentiation of migraine-assoc nausea

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7
Q

pregnancy category for NSAIDs

A

Category C – but avoid later in pregnancy due to effects on PDA & prolonging L&D

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8
Q

order nsaids from shortest duration to longest duration

A

ibuprofen (4x/d) - naproxen (2x/d)- nabumetone (1x/d)

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9
Q

DDI of NSAIDs

A

attenuate diuretics, b-blockers, ACE inhibitors, vasodilators, central alpha-2 agonists, peripheral alpha-1 & ARBs

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10
Q

caution in NSAID combos

A

G6PD deficiency

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11
Q

triptans for HAs

A

eletriptan, sumatriptan (-triptans)

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12
Q

CI of triptans

A

CI: heart disease, uncontrolled HTN, ischemic bowel disease, <24 hrs after ergot tx

beware of serotonin syndrome with SSRIs/SNRIs

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13
Q

Triptans DDI with MAOIs

A

sumatriptan

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14
Q

triptans DDI with propanolol

A

elitriptan

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15
Q

triptans DDI with CYP3A4 inhibitors

A

elitriptan

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16
Q

which triptans have short onset, short duration

A

elitriptan and sumatriptan

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17
Q

which triptans are given for quick action against severe headache

A

sumatriptan (can be given nasal spray, suma can be given SC)

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18
Q

MOA of triptans

A

selective carotid vasoconstriction (via 5-HT1B receptors) and presynaptic inhibition of trigeminovascular inflammatory responses in migraine (via 5-HT1D/5-HT1F receptors)

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19
Q

what effects do triptans have on 5-HT(1B) agonist

A
  1. Selective intracranial/extracerebral vasoconstriction
  2. Inhibition of trigeminal nerve activation by vasoactive peptides
  3. Inhibition of trigeminal cervical complex activation
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20
Q

AE of triptans

A

∙ Most prominent in sumatriptan
∙ CNS (drowsiness, dizziness, fatigue)
∙ heaviness & tightness of chest
∙ Coronary & peripheral artery vasospasm

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21
Q

ergots for headaches

A

ergotamine, dihydroergotamine

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22
Q

moa of ergots

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A

complex agonist effects multiple receptors, central (5-HT) + peripheral (a) vasoconstriction + ↓amine reuptake

23
Q

moderate dose action of ergots

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A

contraction of smooth muscle fibers

24
Q

large dose action of ergots

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A

paralyzes motor nerve endings of sympathetic nervous system

25
AE of ergots
St. Anthony’s Fire) = mental disorientation, convulsions, muscle cramps, dry gangrene of extremities
26
CI of ergots
vasospastic predisposing conditions = peripheral vascular disease or CAD, sepsis, MI, uncontrolled HTN
27
pregnancy category of ergots
X, no breastfeeding either
28
DDI of ergots
∙ b-blocker/DA = potent vasoconstrictor ∙ CYP3A4 inhibitor =↑ ergot persistence ∙ Triptans = 24 hour rule
29
metabolism and elimination of ergots
hepatic metabolism and renal excretion
30
opiates used for migraines
hydrocodone, oxycodone, codeine
31
AE of opiates
dependence, respiratory depression, bradycardia, histamine release, QT prolongation, constipation, N/V
32
antiemetics
prochlorperazine, chlorpromazine, promethazine, metoclopramide
33
moa of prochlorperazine chlropromazine
D2 blockade centrally & also cholinergic & alpha-adrenergic blockade
34
moa of promethazine
cholinergic blockade & also H1 & weak D2 blockade
35
moa of metoclopramide
D2 blockade centrally & also prokinetic by ↑Ach effects
36
AE of prochlorperazine and chlorpromazine
dyskinesia, hypotension, glaucoma, urinary retention, BPH
37
AE of promethazie
glaucoma, urinary retention, BPH, drowsiness, Parkinson like syndromes
38
AE of metoclopramide
↑prolactin levels & gynecomastia
39
headache prophylaxis
amitryptiline, valproic acid, propanolol, timolol, topiramate
40
MOA amitriptyline
↓reuptake of NE and 5-HT & strong anticholinergic action
41
MOA valproic acid
Na channel blocker, ↑GABA activity
42
MOA propanolol & timolol
↓arterial dilation, ↓NE induced lipolysis
43
Moa of topiramate
↓Blocks Na & glutamate, ↑GABA activity
44
AE of amitryptiline
aggressiveness, ↑weight, dry mouth, sedation
45
AE of valproic acid
hepatotoxic, sedation, nausea, ↑weight | Category X
46
AE of propanolol and timolol
fatigue, exercise intolerance, problems with asthma, diabetes, AV block
47
AE of topiramate
parasthesias, fatigue, nausea, narrow therapeutic range
48
which headache prophylactic rx is highly protein bound
valproic acid
49
which is the only rx FDA approved for HA prophylaxis tx of children
propanolol
50
botulinum toxin MOA
↓release of mediators or ↓muscle activation of nerves
51
4 criteria for analgesic overuse syndrome
1. HA for > 15 days & fulfill 3 & 4 2. regular rx overuse >3 months 3. HA began or progressed in severity w/ rx 4. HA resolves or reverts in <2 months after stopping Rx
52
Mechanism of analgesic overuse syndrome
related to adaptation to drug at receptor, leading to changes in receptor density & transmitter synthesis
53
which drugs are high risk for overuse syndrome
aspirin/acetaminophen/caffeine, butalbital-containing combinations, opioids
54
prophylaxis for analgesic overuse syndrome
TCAs, SSRIs, BBs, AEDs

Neuro Block 2 Pharm (10 decks)

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