T3-Analgesics: Headaches-MJ

Question 1

What is the most common headache?

Answer 1

Tension

Question 2

What headache is the disabling headache and needs aggressive treatment?

Answer 2

Migraine

Question 3

Migraines cause _____ head pain

Answer 3

Throbbing

Question 4

What percent of migraines are unilateral?

Answer 4

60%

Question 5

What percent of migraines are bilateral?

Answer 5

40%

Question 6

Do migraines cause N/V?

Answer 6

Yes

Question 7

Migraines cause a person to be sensitive to ___ and ___

Answer 7

Light and sound

Question 8

What is the average length of a migraine?

Answer 8

24 hours

Question 9

So why do people get migraines when that is in the brain and the brain doesn’t have pain receptors (you can poke, cut through the brain and no pain)?

Answer 9

Vessels and arteries IN THE BRAIN DO have pain receptors

Question 10

Do migranes cause vasoconstriction or vasodialiaton?

Answer 10

Vasodialaton

Question 11

Do migraines cause inflammation?

Answer 11

Yes

Question 12

What nerve is effected from migraines?

Answer 12

Trigeminal

Question 13

What promotes migraines?

Answer 13

CGRP

Question 14

What surpasses migraines?

Answer 14

Serotonin

Question 15

If we activate ______ receptors, that will depress the migraines.

Answer 15

Serotonin 1B,1D receptors

Question 16

Which migraine medication stops a migraine AFTER it has started?

Answer 16

Abortive

Question 17

What are the 2 migraine specific drugs?

Answer 17

Serotonin 1B,1D agonists (triptans)

Ergot alkaloids

Question 18

What are triptans selective to?

Answer 18

Serotonin 1B,1D

Question 19

What nerve does triptans work on?

Answer 19

Trigeminal nerve complex

Question 20

The triptans induce _______.

Answer 20

Cerebral vasoconstriction

Question 21

What do triptans block?

Answer 21

CGRP

Question 22

What are 3 examples of triptans?

Answer 22

Sumatriptan
Eletriptan
Rizatriptan

Question 23

What are the side effects of triptans (3)?

Answer 23

Vasoconstriction of coronary arteries
Heavy arms and chest pressure
Serotonin syndrome

Question 24

We want triptans to induce _____ vasoconstriction, but the side effects sometimes cause vasoconstriction of ______.

Answer 24

We want them to induce CEREBRAL vasoconstriction but a side effect of triptans is causing vasoconstriction of CORONARY ARTERIES

Question 25

Should you take a triptan if you have coronary artery disease or have had a MI? Why or why not?

Answer 25

NO! Side effect of triptan is vasoconstriction of coronary arteries !--NOT GOOD

Question 26

Is the triptan side effect of heavy arms and chest pressure something to be concerned with?

Answer 26

No, UNLESS there are risk factors for the patient having heart problems

Question 27

Triptans can also cause serotonin syndrome. Is this common or rare?

Answer 27

RARE unless taking some other drug that increases serotonin levels

Question 28

What are the 4 big symptoms of serotonin syndrome?

Answer 28

Altered mental status Fever, sweating Hyperreflexia Clonus

Question 29

What are three drug classes that would cause too much serotonin when taking with a triptan?

Answer 29

MAOI SSRI SNRI

Question 30

If you want to take the other abortive migraine specific drug (ergot alkaloid), how long must you wait to take it after taking a triptan?

Answer 30

24 hours; ergot alkaloids also increase serotonin so taking it closely after a triptan could cause toxicity

Question 31

Are triptans for prevention of migraines?

Answer 31

No

Question 32

How long does it take the triptan to work?

Answer 32

1-2 hours

Question 33

If the triptan doesn't cause relief after 2 hours, can you take another dose?

Answer 33

Yes, but only ONE other dose after initial

Question 34

What is important to tell the patient to report if they begin experiencing it?

Answer 34

Chest pain, palpitations

Question 35

What is the MOA of ergot alkaloids?

Answer 35

Precise mechanism UNKNOWN, but are similar to triptans

Question 36

What are the side effects of ergot alkaloids?

Answer 36

N/V (10%) | Ischemia with overdose

Question 37

Why is the side effect of N/V in ergot alkaloids a problem?

Answer 37

Because migraines already cause N/V--taking an ergot alkaloid increases N/V even more

Question 38

What are the two ergot alkaloid examples?

Answer 38

Ergotamine | Dihydroergotamine

Question 39

What are antiemetics used for?

Answer 39

Treating nausea

Question 40

What is the preferred antiemetic?

Answer 40

Metoclopramide

Question 41

What does metoclopramide do?

Answer 41

Reduces N/V Reduces gastric stasis caused by attack Enhances absorption of PO meds

Question 42

Can we give metoclopramide even if the patient does not have N/V?

Answer 42

Yes, it increases absorption so it can be given to increse the absorption of the migraine drug

Question 43

What does MOH stand for?

Answer 43

Medication overuse headaches

Question 44

What is the main take home message about medication overuse headaches?

Answer 44

Take the doses as prescribed!! A client stops taking the med and it causes their headache, so they then take medication, vicious cycle.