Flashcards in Pharm for HA, Cohen Deck (45):
1
chronic pain
continuing pain >6 mo
2
patients with headaches need what besides pain relief
explanation for the HA
3
Treatment for HA depends on
frequency attacks and severity
presence and degree of disability
assoc symptoms
prior response to meds
comorbid and coexistant conditions
4
migraine criteria
>5 attacks lasting 4-72 hours
>2: unilateral, pulsating, mod-severe, aggravated by routine activity
>1: nausea and/or vomiting
photophobia and phonophobia
no evidence on Hx or examination of disease that may cause HA
5
Tx of migraine attacks
OTC meds
migraine specific meds from doc
caffeine, including dark chocolate or cola drinks
getting some sleep
6
when are triptans taken usualy
few hours after begining of migraine
7
what R do triptans work on
5GT1B 1D and1F
8
what newer triptans have better effect and fewer side effects
rizatriptan
electriptan
9
CI triptans
coronary artery disease of cerebral vascular disease
10
half life triptans
<4 hours
11
what medicaiton for HA can increase BP
ergotamine
12
what is a drug used IV or IM for migraines acutely
dihydroergotamine DHE
13
half life DHE
9 hours
14
what dopamine blockers are used for migraine
haloperidol
15
what drug is common in ED for migraine to avoid opioid use
antihistamine
16
future of migraine medication
long acting monoclonal Ab to CGRP
for preventative migraines
17
when do we start Txing prophylactically for migraines
when patient cannot go a week between migraines
insufficient relief from abortives
18
what are great preventative migraine meds and what do they have in common
amitriptyline, propanolol, topiramate
Na channel blockers!
19
what are good preventative migraine drugs
gabapentin, zonisamide
20
which drugs are FDA approved for migraine prevention
propanolol, topiramate
valproic acid
21
half life propanolol
4-6 hours
needs to be taken 3x day
there are long acting formulations
22
CI propanolol
relative in asthmatics or CHF or bradycardia from heart blocks
23
effects amitryptyline
antihistamine
very anticholinergic!
24
dosing amitriptyline
low dosese in evening
25
side effects amitriptyline
tachyarrhythmias
can cause suicide from overdose
weight gain
26
topiramate is FDA approved for what
prevention seizures and migrains
27
half time topriamate
18-20 hours
take at bedtime
28
side effects topiramate
"dopamax" because can cause difficulties with speech and cognition
anorexia and weight loss
loss of sensation in arms
changes in serum acidity and Ca solubility
29
MOA valproic acid
blocking Na Ch and effects of gamma aminobutyric acid
30
valproic acid is FDA approved for
migraine prevention
epilepsy
bipolar disease
31
half life valproic acid
10-20 hours
needs to be given at least 2x day
32
side effects valproic acid
weight gain, lowering of platelet counts, tremor and hair loss
33
when was botulinum toxin aproved for migraine prevention
2010
34
how is botulinum toxin injected
many sites in scalp every 3 mo
35
mech botulinum
inhibit Ach release and inhibit sensory neurons
36
what are comorbidities with tension type HA
HTN
depression
anxiety
insomnia
DM/hypoglycemia
other sources of pain
37
what are prophylactic drugs for tension type HA
amitriptyline
protriptyline
topiramate
38
abortive Tx cluster HA
sumatriptan injeciton
sumatriptan or zolmitriptan nasal sprays
high dose O2
nasal viscous lidocaine
39
prevention for cluster HA
almost always necessary
verapamil
may cause hypotension constipation
lithium-- so dangerous in suicidal patients, also cause renal and thyroid disease
prednisone- works fask with many side effects limiting to only use in season of cluster if season is not very long
40
drug R patients with cluster HA need what Tx
deep brain stimulation
implanted occipital nerve stimulator
41
patient takes aspiring every day for HA
need to stop pain medication because thats causing it
plus with these pain pills preventative drugs will not work!!
42
imagin trigeminal nerualgia
MRI
43
Tx trigeminal neuralgia
carbamazepine first DOC
gabapentin or phenytoin
44
if drug Resistant to trigeminal neuralgia
radiological or surgical ablation of trigem nerve via gamma knife, injection of glycerol or electrical ablation
45