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Flashcards in Stimulatns&treatment of Headache Deck (63):
1

amphetamine like drugs

-amphetamine found to produce weight loss in early studies of pts with narcolepsy
-rate of weight loss is increased by ~ 0.5 pound per week
-efficacy is similar btwn drugs
-no long -term weight loss unless the drugs are taken continuously

2

SE of amphetamine like drugs

-potential for drug abuse and habituation
-exacerbation of HTN
-sleep disturbances
-palpitations
-dry mouth

3

MOA of methamphetamine

-releases dopamine, other biogenic amines
-inhibits neuronal and vesicular monoamine transporters
-inhibit MAO
-CNS stimulants w/ little peripheral effects at low doses compared to amphetamine
-high dose inc. BP and Inc. cardiac output

4

SE of methamphetamine

high abuse potential
HTN
Tachycardia
Increased risk of stroke, MI
Insomnia

5

indications of methamphetamine

-exogenous obesity
-short term adjunctive therapy for pts refractory to standard therapies (repeated diets and other drugs)

6

contraindications of methamphetamine

CV disease, HTN, hyperthyroidism, history of drug abuse

7

methamphetamine drug interactions

-should not be combined w/ MAOs or other NS stimulants
-decrease effectiveness of guanethidine used to treat hypertension

8

MOA of phentermine

-sympathomimetics, CNS stimulant
-increased NE release from central noradrenergic neurons

9

effectiveness of phentermine

-2-10kg loss of original wt as long as the drug is taken
-weight regained once therapy ceases- used chronically

10

AE of phentermine

-dry mouth, insomnia, constipation
-HTN, tachycardia
-abuse liability thought to be low

11

drug interactions

MAOIs, guanethidine, other CNS stimulants, alcohol, sibutramine and tricyclic antidepressants

12

contraindications of phentermine

HTN, advanced CV disease, hyperthyroidism, glaucoma, anxiety and history of drug abuse

13

MOA of Sibutramine

inhibits the reuptake of NE, serotonin, dopamine

14

effectiveness of Sibutramine

10% loss of original wt as long as the drug is taken
-wt regained once therapy ceases-used chronically

15

AE of Sibutramine

-dry mouth, insomnia, constipation and asthenia
-Hypertension and tachycardia-required monitoring

16

what are the SSRI antidepressants

-fluoxetine
-setraline
-paroxetine

17

MOA of SSRIs

-increase wt loss in combo w/ caloric restriction for up to a yr
-wt gain associated w/ long term use

18

what is Bupropion (Wellbutrin SR)

-non SSRI antidepressant
-modestly effective when added to a program of caloric restriction

19

what are the Antiepileptic drugs

Topiramate
Zonisamide

20

MOA of Topiramate

-produce wt loss in pts w/ epilepsy
-increased wt loss in combo w/ caloric restriction: up to 6.3% in 6 months
-longer durations and higher doses are more effective, but can be associated w/ adverse neurological and psychiatric effects

21

MOA of Zonisamide

-shown to produce wt loss when used in treating epilepsy
- significantly increased wt loss w/ caloric restrictions: 6 kg over 16 wks

22

what drugs are used for Narcolepsy

amphetamine
dextroampheamine
methamphetamine

23

what are the AE of narcolepsy drugs

development of tolerance, abuse, potential, irritability, depression, paranoia

24

what drugs can be used to treat ADHD

methylphenidate
dextroamphetamine
amphetamine

25

what are the AE of ADHD

insomnia, wt loss, growth impairment

26

see table on 19+20

see table on 19+20

27

how many time should acute therapy migraine medications be taken

limit to no more than 2 times per week

28

prolonged use of many acute migraine medications can lead to what

daily headache that doe snot respond to preventive therapy

29

which NSAIDS can be used for acute migraine therapy

-aspirin
-acetaminophen
-naproxen
-ibuprogen
-for mild/moderate episodes w/o nausea, disability or need for bed rest

30

what combination of analgesics can be used for acute migraine therapy

-aspirin, acetaminophen & caffeine
- acetaminophen, isometheptene (sympathomimetic) & dichloralphenazone (chloral hydrate)

31

MAO of metoclopramide

-antimetic
-5HT4 agonist
-dopamine D2 receptor antagonist
-decreases nausea and vomiting
-increases gastric motility and absorption of oral analgesics
-some sedation
-used for acute therapy migraine, nonspecific

32

what opioids can be used for acute migraine therapy

butorphanol nasal spray; tramadol & acetaminophen

33

which corticosteroid can be used for acute migraine therapy

-dexamethasone
-may reduce recurrence within 72 hrs

34

which ergot alkaloids can be used to treat acute therapy migraine

-ergotamine tartrate
-dihydroergotamine (DHE)mesylate

35

MAO of ergot alkaloids

-nonspecific serotonin agonists
-alpha-adrenergic agoinst
-vasoconstrictors

36

Indications of ergot alkaloids

moderate to severe migraine or many yrs

37

what drugs interact w/ ergot alkaloids

effects potentiated by triptans, B-blockers, dopamine, nicotine, CPY3A4 inhibitors

38

contraindications of ergot alkaloids

should not be taken within 24 hrs of a triptan

39

pharmacokinectics of ergotamine

-sublingual
-oral w/ caffeine

40

SE of ergotamine

-nausea and vomiting
-severe vasoconstriction

41

pharmacokinetics of DHE

-nasal spray
-IV
-IM
-SC

-poor oral bioavailability but less AE than ergotamine

42

which Triptans are used for acute migraine therapy

-sumatriptan
-almotriptan
-frovatriptan
-Rizatriptan
-Eletriptan
-Naratriptan
-Zolmitriptan

43

MAO of Triptans

-serotonin (5GT1) agonists
-administered early in attack for best outcome

44

pharmacokinetics of Triptans

-oral, SC, nasal spray
- onset of action more rapid w/ SC or nasal administration
-2-3 hour half life
-exception: naratriptan, frovatriptan - slower onset, longer action

45

SE of triptans

nausea & vomiting often associated w/ acute migraine

46

AE of Triptans

-flushing, tingling, feeling of fullness in head, neck, chest
-injection site discomfort
-cardiac complications - rare

47

contraindications of Triptans

w/ preexisting arterial disease of HTN

48

drug interaction with Triptans

-not to be taken within 24hrs of initial dose or within 24 hrs of an ergotamine - to avoid additive vasoconstriction
-not to be taken with MAOI (or within 2 weeks of stopping one)- Sumatriptan, rizatriptan or zolmitriptan
-serum [ ] of some increased by propranolol
-eletriptan concentration increased by CYP3A4 inhib

49

what drugs can be used as preventative therapy for migraine

-antiepileptics
-antidepressants
-B-blockers
-CCBs
-neurotoxins
-long-acting NSAIDS

50

indications for preventative migraine therapy

-2 or more attacks/month that produce disability lasting > 3 days/month
-contraindication to, or failure of, acute treatments
-use of abortive medications more than twice/week
-presence of uncommon migraine conditions

51

which anti epileptics can be used as preventive migraine therapy

-valproate*, topramate

*divalproex: sodium valproate and valproic acid, 1:1 molar

52

MAO of Valprate and topiramate in preventing migraine

-reduce firing rate of midbrain serotonergic neurone
-enhanced peripheral GABAa activity; reduced neuronal inflammation
-enhanced central GABAa activity; increased central antiociception
-decrease headache frequency
-efficacy similar to propranolol

53

which antidepressants can be used as a preventive migraine therapy

-amitriptyline, nortriptyline (tricyclic antidepressants)

54

MOA of tricyclic antidepressants as preventive migraine therapy

-effective dose lower than that for treating depression
-block reuptake of NE and serotonin; SSRIs are generally not effective at preventing migraine

55

which B-blockers can be used as a preventive migraine therapy

-propranolol and timolol approved for migraine prevention
-metoprolol, nadolol, atenolol

56

which CCBs can be used as a preventative migraine therapy

-verapamil

57

CCBs may interact with what

-ergotamine, eletriptan (CYP3A4 inhibitor)
-do not combine with B-blocker

58

which neurotoxins can be used as a preventative migraine therapy

-botulinum toxin - onabotulinumtoxinA (botox)
-approved for chronic migraine
-done administered as injections across 7 head/neck muscle sites

59

which long acting NSAIDs can be used as a preventative migraine therapy

-naproxen sodium, flurbiprofen
-short term prevention, e.g menstrual migraine
-also for aborting acute attacks

60

what drugs can be used for tension type headaches

NSAIDs, including combinations w/ propoxyphene, caffeine
-caffeine-increases NE and dopamine release; some vasoconstriction, generally increases the effectiveness of NSAIDs

61

what preventive therapy is used for tension-type headaches

amitriptyline

62

what drugs are used as acute therapy for cluster headaches

O2 - vasoconstrictive action
Triptans, SC
DHE, SC or IM
instranasal lidocaine

63

what drugs are used as preventive therapy for cluster headaches

CCBs
Lithium
Antiepiletpics
Ergotamine
Short-term corticosteroids