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Junior - Pharm II - 1 > 4 - Headache > Flashcards

4 - Headache Flashcards

1
Q

Which type of headaches are described as “pulsating,” and aggravated by physical activity?

A

MIgraine

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2
Q

Which type of headache presents bilaterally, described as “pressure” or “tightening”, and no nausea?

A

Tension

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3
Q

Which headache is predominantly found in males, described as severe “boring” or “piercing” pain, and occurs exclusively unilaterally?

A

Cluster

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4
Q

“SNOOP”ing for secondary headaches:

A 
Systemic symptoms
Neurologic s/s
Onset sudden
Onset late in life
Pattern change
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5
Q

“Worst headache of my life” - must r/o:

A

Subarachnoid hemorrhage

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6
Q

The majority of migraines are with or without aura?

A

Without (85%)

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7
Q

Criteria for migraine without aura:

A

At least 5 attacks

Lasts 4-72 hrs untreated

Unilateral

Pulsating

N or V or both

Photophobia

Phonophobia

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8
Q

Criteria for migraine headache WITH aura

A

At least 2 attacks

Aura symptom (visual, sensory, speech, motor, retinal)

Aura lasts 5 to 60 mins

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9
Q

What gene mutation are migraines associated with?

A

CACNL1A4 on chromosome 19

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10
Q

What neurotransmitter is an important mediator of migraines?

A

Serotonin (5-HT)

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11
Q

APAP - use in migraines?

A

May be useful 1st choice drug for acute migraine in those with mild to moderate attacks OR in those with CI’s to NSAIDS / ASA

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12
Q

Butalbital - class?

A

Short acting barbiturate

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13
Q

In which combination is Butalbital a scheduled drug?

A

When combined with ASA and caffeine

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14
Q

Midrin - composed of?

A

APAP
Isometheptene
Dichloralphenazone

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15
Q

Midrin - clinical use?

A

Alternative choice for mild to moderate migraine attacks

Controlled (C-IV)

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16
Q

Midrin - CI’s?

A

Glaucoma
Severe renal or hepatic disease
HTN
MOAI’s

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17
Q

What OTC is a reasonable first-line tx for migraine attacks?

A

Excedrin MIgraine (APAP/ASA/caffeine)

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18
Q

NSAID’s - MOA (migraines)

A

Prevents neurogenically mediated inflammation in the trigeminovascular system

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19
Q

What is considered the DOC for mild to moderate migraine attacks?

A

NSAID’s

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20
Q

Which three NSAID’s have the most consistent evidence in the tx of migraine attacks?

A

ASA
Vit-M
Naproxen

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21
Q

Ergotamine - MOA:

A

Partial agonist activity at 5HT and D2 alpha-adrenergic receptors

Peripheral and cranial vasoconstriction

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22
Q

Ergotamine - pharmacokinetics:

A

Oral absorption is incomplete and erratic - administer with caffeine

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23
Q

Ergotamine - AE’s:

A

Ergotism - intense vasoconstriction -> ischemia

24
Q

Ergotamine - pregnancy cat?

A

X - stimulates uterus

25
Q

Ergotamine - drug interactions:

A

Don’t use within 24 hrs of a triptan

Potent CYP3A4 inhibitors

26
Q

When to give Ergotamine?

A

At the first sign of a migraine attack

27
Q

Dihydroergotamine - MOA:

A

Similar to ergotamine but with LESS POTENT A1-adrenergic vasoconstriction

Less n/v

28
Q

Dihydroergotamine - clinical considerations:

A

Not for use as a monotherapy

Try when first-lines have failed

Add anti-emetic as nause/vomiting likely SE

29
Q

Triptans - MOA:

A

5-HT1B/1D receptor agonist with add’l activity at 5-HT1F receptors

Cranial vasoconstriction, peripheral neuronal inhibition, inhibition of trigeminocervical complex

30
Q

Triptans - clinical use:

A

Appropriate 1st line therapy for moderate to severe migraine

31
Q

Triptans - AE’s:

A

Chest tightness, pressure, heaviness, or pain

Paresthesia, dizziness, somnolence

32
Q

Limit use of triptans to no more than __ days per month

A

9

33
Q

Triptans - CI’s:

A

Hx of ischemic heart disease, uncontrolled HTN, stroke

34
Q

Triptans - monitoring:

A

Pt’s at risk for CAD should have first dose of triptan in the clinic with vitals and ECG monitoring

35
Q

What is the clinic triad of symptoms of serotonin syndrome?

A
  1. Cognitive effects
  2. Neuromuscular dysfunction
  3. Autonomic dysfunction
36
Q

Sumatriptan/Naproxen (Treximet) - MOA and clinical use:

A

Targets different vascular and inflammatory processes in a migraine

Combination provides superior relief than either component by itself

37
Q

What partial Mu and Kappa agonist can be used off-label as a last resort for migraine tx?

A

Butorphanol (Stadol)

38
Q

How do antiemetics help with migraines (neuronally):

A

They act on dopaminergic receptors (antagonist)

39
Q

What is the antiemetic of choice for migraines?

A

Metoclopramide

40
Q

Strategy to avoid MOH?

A

Limit migraine therapies to 2 days/week

41
Q

What migraine med is totally contraindicated for pregnancy and breastfeeding?

A

Ergots

42
Q

Proposed etiology of tension headaches?

A

Originate from myofascial factors and peripheral sensitization of nociceptors

43
Q

Clinical presentation of tension headache - what makes it different from migraine headaches?

A

Lacks premonitory symptoms and aura

Bilateral, non-pulsatile pressure

Disability minor compared to migraine

44
Q

Acute tx of tension HA’s:

A

APAP/NSAIDS

Muscle relaxants

45
Q

Consider prophylaxis if tension headache frequency is more than __ per week

A

2

46
Q

What is the tension HA prophylaxis DOC?

A

Amitriptyline at bedtime

47
Q

What is the most severe of the primary HA’s?

A

Cluster

48
Q

Typical pt for cluster HA’s:

A

Male, mid-thirties

49
Q

When do most cluster attacks occur?

A

At night, in the spring and fall, occurring suddenly, with a rapid crescendo to excruciating pain

50
Q

In order to Dx cluster HA, what must be present?

A

Ipsilateral symptom (lacrimation, rhinorrhea, eyelid edema, ptosis, etc)

51
Q

What is a standard first line tx for cluster HA’s?

A

100% O2 via NRB @ 7-10L/min x 15-25mins

52
Q

What Ha medicine is considered first line (after oxygen) for cluster HA’s?

A

Sumatriptan

53
Q

What is the drug of choice for maintenance prophylaxis of cluster HA’s?

A

Verapamil (Calan)

54
Q

What is 2nd line prophylaxis for cluster HA’s?

A

Lithium

55
Q

What is DOC for transitional prophylaxis of cluster HA’s?

A

Prednisone

Junior - Pharm II - 1 (6 decks)

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