pharm-headaches

Question 1

5 drug class for symptomatic treatment of headache?

Answer 1

1. analgesic
2. antiemetics
3. triptans
4. ergot derivatives
5. calcitonin gene-related peptide monoclonal antibodies (CGRP)

Question 2

3 analgesics used for symptomatic treatment of headache?

Answer 2

ibuprofen, naproxen, acetaminophen

Question 3

1 antiemetic used for symptomatic treatment for headaches?

Answer 3

metaclopramide

Question 4

1 triptans for symptomatic treatment of headache?

Answer 4

sumatriptan

Question 5

Example of an ergot derivative (symptomatic tx)?

Answer 5

dihydroergotamine mesylate (DHE)

Question 6

5 drugs classes used for migraine prophylaxis?

Answer 6

1. B-blocker
2. TCA
3. angiotensin II R antagonist
4. anti epileptics
5. calcitonin gene-related peptide monoclonal antibodies (CGRP)

Question 7

What is considered 1st line for symptomatic tx?

Answer 7

Consider ASA + NSAIDs (Naproxen, ibuprofen, etc) as 1st line
-have greater efficacy to their anti-inflammatory properties over acetaminophen

Question 8

analgesic adverse effects?

Answer 8

• Acetaminophen is generally better tolerated but may potentially cause hepatotoxicity w/ chronic use
• NSAIDs ↑ CVD risk + mortality esp. w/ chronic use + may cause GI upset
• NSAIDs + acetaminophen should be used less than 15days/ month to minimize the development of medication overuse headache

Question 9

Triptan?

Answer 9

Sumatriptan

Question 10

CGRP R antagonist for symtomatic use?

Answer 10

Ubrogepant

Question 11

Indication for dihydroergotamine mesylate (ergot derivative)

Answer 11

can treat MOH (can also cause)

Question 12

What drug is similar to triptan but added affinity for dopamine + adrenergic R & thus increase side effect potential?

Answer 12

dihydroergotamine mesylate (ergot derivative)

Question 13

What drug is indicated for migraine attacks?

Answer 13

Sumatriptan

Question 14

What drug is reserved for tx of acute migraine when other drug options have failed?

Answer 14

ubrogepant (CGRP R antagonist)

Question 15

Adverse Effects ⚠️

• chest pain, tingling, nausea, vomiting, parenthesis, cramps, vasoconstriction occur infrequently + are of short duration
• may cause hypotension (rare)
• does not cause dependence but can cause MOH if used 10 days/ month or more

Answer 15

dihydroergotamine mesylate (ergot derivative)

Question 16

Contraindications:
- pregnancy
- cardiac disorders, hypertension, peripheral vascular disorders
- sepsis
- liver disease
- PUD
- renal disease

Answer 16

dihydroergotamine mesylate (ergot derivative)

Question 17

• chest discomfort, fatigue, dizziness, parenthesis, drowsiness, nausea, throat symptoms
• use less than 10 days/ month to avoid MOH

Answer 17

sumatriptan

Question 18

Contraindications:

• cardiac disorders, sustained hypertension, basilar + hemiplegic migraine
• Basilar migraines
  
  • originated in the brainstem + usually have aura w/ dizziness, double vision, lack of coordination prior to onset of pain
• Hemiplegic migraines
  
  • rare + mimic strokes
• Do not use w/ ergotamine-containing products
• Do not use triptan within 24 hours after another triptan
• Caution w/ serotonergic meds
  
  • small ↑ risk of serotonin syndrome
• Do not use w/ MAOIs

Answer 18

sumatriptan

Question 19

• nausea, somnolence, dry mouth
• suppression of CGRP may theoretically ↑ risk of serious cardiovascular or cerebrovascular ischemic events

Contraindications:

• concomitant use of strong CYP3A4 inhibitors

Answer 19

ubrogepant (CGRP R Antagonist)

Question 20

Example of B-blocker for prophylatic tx?

Answer 20

Propanol
(also metoprolol, nadolol)

Question 21

Example of TCA for prophylatic tx?

Answer 21

amitriptyline

Question 22

Example fo an angiotensin R blocker for prophylaxis?

Answer 22

Candesartan

Question 23

Examples of anti-epileptics for prophylaxis(4)?

Answer 23

1. Valproic acid
2. divalproex sodium
3. topiramate
4. gabapentin

Question 24

Example of CGRP monoclonal antibodies for prophylaxis?

Answer 24

Erenumab

Question 25

- fatigue, impotence, bradycardia + hypotension GI symptoms, bronchospasm, 🫀failure. depression Contraindication: - asthma, insulin dependent-diabetes, 🫀block

Answer 25

propanol (b-blocker)

Question 26

Amitriptyline is indicated for?

Answer 26

TTH

Question 27

efficacy in migraine prophylaxis due to blocking the direct vasoconstriction, ↑ sympathetic discharge, adrenal medullary catecholamine released mediated by angiotensin II

Answer 27

Candesartan (angitoten R blocker)

Question 28

modulate GABA R in trigeminovascular system & are effective in migraine prophylaxis

Answer 28

Valproic acid + divalproex sodium Anti-epileptics

Question 29

What drug is administered by subcutaneous injection and associated w/ 50% reduction in headache and must be used only went 1st line preventative agents have failed?

Answer 29

Erenumab (CGRP Monoclonal antibodies)

Question 30

Contraindication ⚠️ - significant cardiac disease, glaucoma, prostate disease, hypotension

Answer 30

Amytriptyline (TCA)

Question 31

Adverse effects ⚠️ - lower risk for adverse effects - hypotension, hyperkalaemia, renal insufficiency, headache, dizziness

Answer 31

(candesartan) Angiotensin R blocker

Question 32

injection site reactions, constipation, muscle spasms, prutius, constipation, hypersensitivity reactions (may occur within minutes or more than 1 week after tx), hypertension

Answer 32

Erenumab

Question 33

Preferred drug for pregnancy for acute tx

Answer 33

Acetaminophen

Question 34

Preferred drug for children for acute tx?

Answer 34

ibuprofen (avoid ASA in under 15)