Add, Headache, Bipolar Flashcards

Question

Cluster ``` Gender Onset Pain location Type of pain Duration ```

Answer 1

``` Gender- M (10:1) Onset- During sleep Pain location- behind, around eye Type of pain- stabbing, boring, sweating, flushing, nasal congestion Duration- 15-90 m ```

Answer 2

``` Gender- f(2:1) Onset- variable Pain location- bilateral in band Type of pain- non-pulsating, mild photo, phono Duration- 30 m, 7d ```

Answer 3

1. ) Common: without aura. Severe unilateral, pulsating. Can be aggravated by physical activity. Accompanied by N and V, photo and phonophobia. Approx 85% of migraine sufferers do not have aura. 2. ) Classic: with aura. The aura can be visual, sensory, may cause speech or motor problems

Answer 4

Goals: be realistic Treatment: with oral meds, relief and normal function within 2 hours Prevention: total prevention unrealistic

Answer 5

-Individual management -Treatment choice depends on: Attack frequency and severity Presence and degree of disability Associated symptoms Prior response and patient preferences Coexistent conditions -Establish dosing limits (2 days/week)

Answer 6

Acetominophen-Tylenol NSAIDs: PG inhibitors (decrease serotonin release) Ergotamine ‘Triptans: serotonin system Memantine Misc. agents: Midrin, Metoclopramide, Chlorpromazine, Prochiorperazine

Answer 7

Beta blockers, Clonidine, Antidepressants, Cyproheptadine, Topiramate (anticonvulsant), Calcium channel blockers, Valproate, Anticonvulsants, NSAIDs, Methysergide

Answer 8

Short, severe, episodic, clustering pain over the eyes and the forehead. Clustering is the predominant feature with cluster periods lasting between 2-3 months in most patients. Remission may last from 2 months to 20 years (usually 2 years). Episodes more common in the spring and fall. A family history is not usually present. Usually at night.

Answer 9

1.) Abortive therapy: Ergotamine, Oxygen, Topical anesthetics, Misc agents-Capsaicin, Prednisone, leuprolide 2.) Prophylactic therapy: Lithium, Ergotamine, Methysergide, Misc agents-non Rx analgesics, B-blockers, antidepressants, Cyproheptadine, Calcium channel blockers, anticonvulsants

Answer 10

- most common cause of migraine- self propagating wave of depolarizing cortical neurons associated w a large efflux of K ions - dilates middle meningeal artery - opens blood brain barrier - cause aura in susceptible pt

Answer 11

action at several types of Rs including agonist, and antagonist actions at alpha adrenergic and serotonin Rs and agonist actions at CNS dopamine Rs. (Can make histamine, ACh) (LSD is an Ergot alkaloid)

Answer 12

variably absorbed from the GI tract; aided by administration with caffeine (100mg/mg of ergot). The ergot alkaloids are extensively metabolized in the body (caffeine increases absorption) (Inhaler)

Answer 13

2. ) Vascular Smooth M: drug, species, vessel dependent. Ergotamine constricts human blood vessels; assoc’d w partial alpha agonist effects; prolonged vasospasm possible(also contract uterine smooth m) 3. ) Uterine Smooth M: alpha agonist +serotonin effect+others. Ergovine most selective in this effect (can be used after delivery to decrease blood loss)

Answer 14

1.) GI: NVD 2.) Prolonged vasospasm: especially after overdose 3.) Fibroplastic changes 4.) Ergot Poisoning: often from infected grain (claviceps purpurea) dementia

Answer 15

-Propranolol (+ Ergot): vasoconstriction with pain and cyanosis -Macrolides (Erythromycin, Clarithromycin, Azithromycin) may exacerbate ergot toxicity

Answer 16

- Ergot decreases inflammation -Most effective when given during prodrome of an attack - May be repeated; no more than 6mg/attack and 10mg/week - Not usually as prophylaxis

Answer 17

: usually seen with anterior pituitary tumors and antipsychotics -Bromocriptine is the drug of choice -Suppress lactation also

Answer 18

3.) Postpartum Hemorrhage: never give before delivery; increases mortality of mom and baby

Answer 19

ADR: taste alterations, N, V, chest tightness, nasal discomfort, increased BP Contraindicated in ischemic heart disease, uncontrolled hypertension, coronary heart disease Don’t take with ergot (b/c additive side effects)

Answer 20

Sumatriptan, Zolmitriptan, Rizatriptan, Naratriptan, Eletriptan, Almotriptan, Frovatriptan These agents have been shown to be effective for the treatment of migraine with or without aura, but have not been studied well in the management of other types of headache. (Zolmitriptan has been shown to be a more potent agonist)

Answer 21

MOA: selective serotonin-like R agonists (5HT-1D subtype) Structurally similar to serotonin Pharmacokinetics: Sumatriptan is rapidly absorbed after oral or subQ injection. Significant 1st pass effect -Available in Nasal spray, injection, tablets

Answer 22

Onset of relief 10-90 minutes after subQ administration, 1.5 to 2 hours after oral and nasal administration (don’t need to know these times) Duration of action shorter than migraine: may need several doses before headache is over. Doesn’t decrease length of headache, makes pain go away.

Answer 23

tingling, dizziness, muscle weakness, neck pain, 5% ches pain, >10% hot flashes

Answer 24

- May exacerbate prolonged vasospasm if used with other anti-migraine drugs (ergot, propranol, etc), or MAOI’s and SSRIs - Inhibitors of CYP450-3A4 may decrease metabolism of many of these agents

Answer 25

-More selective pharmacology (so more narrow in focus) -Simple and consistent pharmacokinetics (get where they’re going to) -Evidence based prescribing instructions -Well established efficacy and safety -Fewer and less severe ADR

Answer 26

2.) MIDRIN -A combo product for patients who can’t take ergot or don’t respond to it (less effective) MOA: Isometheptane 65mg: vasoconstrictor Dichlorphenazone 100mg: mild sedative Acetaminophen 325mg: pain relief (not enough; most pt’s need 500-600mg)

Answer 27

Adverse Effects/Overdose: dizziness, insomnia, N,V, transient numbness Less Effective than ergot

Answer 28

Acetominophen, aspirin and caffeine May be as effective as sumtriptan for treatment of acute migraine in some patients Most useful in patients with infrequent, mild to moderate headaches without nausea

Answer 29

TRIPTANS | Midrin

Answer 30

- This disorder, previously know as manic depressive illness, is a cyclical disorder with recurrent fluctuations in mood, energy and behavior encompassing the extremes of human experiences. - This disorder is genetically based, environmentally influenced, and the clinical presentation differs from individual to individual.

Answer 31

- Rare before puberty and after 65, Usual age range of onset 18-44 yrs - Genetics higher genetic risk than do major depressivedisorders. Approximately80 90% of bipolar patients have a relative, parent, sibling, or child with a mood disorder.

Answer 32

Patients usually experience periods of mood elevations (called mania or hypomania) that alternate with normal mood states -Individuals can differ in symptoms, course, severity, and response to treatment

Answer 33

Bipolar I-at least one manic episode, major depression is common Bipolar II- major depression along with hypomania Cyclothymic disorder- non major depression and hypomania Bipolar NOS (not otherwise specified) usually milder features

Answer 34

Clinical presentation- Does not require a history of depression, but mania or hypomania that is not caused by any other medical condition, substance, or mental disorder. Several medications and withdrawal syndromes can mimic manic and hypomanic symptoms.

Answer 35

Lithium, valproic acid, extended release carbamazepine

Answer 36

Olanzapine, aripiprazole, riseridone, quetiapine

Answer 37

Combo mood stabilizer (olanzapine n fluoxetine)

Answer 38

Monotherapy w lithium, valproic acid, lamotrigine, aripiprazole Combinatioon w olanzapine Extended release cabamazepine

Answer 39

Manic episode - 1st episodes: lithium plus benzodiazepines (clonazepam) for sleep - if no response in 2-3 wks add a 2nd agent

Answer 40

Prophylactic therapy/ or maintenance - If 2 major episodes try maintenance therapy - For breakthrough episodes add antipsychotics, benzodiazepines (check for Li induced hypothyroidism)

Answer 41

Efficacy- 70-80% :prevents and treats both mania and depression Long term- more effective Other uses- schizophrenia, migraine impulse control, steroid induced mania, aggressive disorders

Answer 42

Solutions absorbed better than regular or slow release formulations Not affected by food Renally excreted- not metabolized Renal dysfunction can double T 1/2

Answer 43

Affects synthesis, storage, release, uptake of NE, serotonin, dopamine, ACH, and GABA Competes with Ca, Mg, K, Na in body tissues and binding sites Stabilized post synaptic receptor sensitivity Antimanic effect 10 after 28 days;antidepressant after 21 days;

Answer 44

Gi upset, nausea, polydipsia, polyuria, nocturia, dry mouth, fine hand tremor, leukocytosis, m weak, difficulty concentrating, impaired memory

Answer 45

Weigt gain, rash, acne, hypothyroidism, psoriasis, alopecia,

Answer 46

Toxicity- severe drowsiness, coarse hand tremor, m twitching, myoclonus, choreoathetosis, cogwheel rigidity, vomiting, hyperreflexia, nystagmus, seizures, coma Mid toxicity- dec memory n concentration

Answer 47

>1.5mEq agitation, confusion, headache,nystagmus, tremors | >3 mEq/L tonic/clonic twitching, seizures, irreversible brain damage, respiratory complications, coma death

Answer 48

Dialysis can help but need to correct fluid and electrolyte abnormalities

Answer 49

ECG-every 6-12 m ( >50 yrs), cardiac ds | Vital signs, CBC with differential, weight, thyroid functions, renal function and urinalysis

Answer 50

-Narrow therapeutic index -Levels every 2-3 days in patients prone to toxicity- range is 0.6-1.2mEq/L 12 hours after the last dose -In acutely manic patients levels should be at least 0.8mEq/L and as high as 1.5mEq/L toxicity

Answer 51

Acute mania, maintenance | Narrow therapeutic index, thyroid tox

Answer 52

Acute mania | Liver, pancreas tox, sedation wt gain

Answer 53

Maintenance | Rash

Answer 54

Acute mania | Sedation, heme effects