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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

down side to surgical ablation trigem nerve

permanent facial numbness