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Pharm exam 5 chapters > Ch 25 highlights > Flashcards

Ch 25 highlights Flashcards

1
Q

for mild to moderate migraine symptoms

A

NSAIDS (ASA, Naproxin)

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2
Q

For moderate to severe migraine symptoms

A 
Serotonin Agonist (Triptans) - 1st line
Ergot alkaloid second line
opioid analgesic (butorphanol) if these fail
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3
Q

what 2 antiemetic meds are approved for migraine

A

Reglan and Prochlorperazine (formally known as compazine)

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4
Q

what is the recommended drug for opioid analgesics used for migraine treatment

A

Butorphanol nasal spray

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5
Q

what is first line for terminating migraine attack

A

Serotonin Receptor Agonist (Triptans)

-Sumatriptan (Imitrex)

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6
Q

What is the biggest concern when taking Sumatriptan (imitrex)

A

Coronary Vasospasm

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7
Q

Pt is taking Sumatriptan and is experiencing Heavy arms and chest pressure. Denies pain.

A

symptoms are transient and not related to ischemic heart disease. Not dangerous

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8
Q

What pt population should not take Sumatriptan

A

CAD
Angina

Rule out CAD if they are postmenopausal women, men older than 40, smokers, History of HTN, Hypercholesterolemia, diabetes or a family history of CAD

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9
Q

can you take sumatriptan while pregnant

A

no

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10
Q

sumatriptan should not be used within ____ hours of another triptan or a ergo alkaloid

A

24 hours

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11
Q

can you take Sumatriptan with an MAOI

A

No, and should not be used within 2 weeks of stopping an MAOI

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12
Q

signs of serotonin syndrome

A 
ams
incoordination
myoclonus
hyperreflexia
excessive sweating
tremor
fever
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13
Q

can you take sumatriptan with SSRI/SNRI

A

no, may cause serotonin syndrome

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14
Q

prozac is in what drug class

A

SSRI

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15
Q

cymbalta is in what drug class

A

SNRI

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16
Q 
what drug class
Isocarboxazid (marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranycypromine (Parnate)
A

MAOI

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17
Q

what drug class is second line for migraine abortion if the triptans did not work

A

Ergot Alkaloids

  • Ergotamine
  • Dihydroergotamine
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18
Q

what medication can you add to Ergotamine to help reduce nausea/vomiting

A

metoclopramide

prochlorperazine

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19
Q

ischemia secondary to constriction of peripheral arteries and arterioles: the extremities become cold, pale and numb. muscle pain develops and gangrene may eventually result

A

ergotism (toxicity from ergotamine) highest risk in sepsis, peripheral vascular disease and renal/hepatic impairment

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20
Q

pt on ergotamine prn for migraine abortion develops headache nausea, vomiting and restlessness

A

withdrawal due to physical dependence - resembles a migraine attack so the pt is likely to resume taking the drug perpetuating the cycle of dependence.

hospitalization may be required to break the physical dependence

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21
Q

what patient populations should not take ERgotamine

A 
hepatic/renal impairment
CAD
peripheral vascular disease
uncontrolled HTN
taking potent inhibitors of CYP3A4
pregnant women
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22
Q

What is a intranasal spray that is a second line drug for migraines

A

Dihydroergotamine

associated with a lower rate of migraine recurrence

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23
Q

first line drug for migraine prevention

A

B Blockers

  • propanolol
  • metoprolol
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24
Q

pt is taking propanolol for 4 days and calls because it does not seem to be preventing his migraines

A

benefits take a few weeks to develop

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25
Q

antiepileptic drugs used in migraine prevention

A

Depakote ER
Topamax
Gabapentin
Gabitril

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26
Q

side effects for Depakote

A 
nausea
fatigue
weight gain
tremor
bone loss
reversible hair loss

fatal pancreatitis and hepatitis can occur

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27
Q

can Depakote be used in pregancy

A

no

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28
Q

Tricyclic antidepressant used in migraine prevention

A

Elavil

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29
Q

side effects of Elavil (Tricyclic antidepressant)

A

hypotension
anticholinergic effects
-dry mouth, constipation, urinary retention, blurred vision, tachycardia)

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30
Q

a migraine that routinely occurs 2 days of the onset of menses

A

menstrually associated migraine (triggered by decline in estrogen levels that precede menstruation)

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31
Q

medications for menstrually associated migraines

A

estrogen
estrogen gel and patches (Divigel, climara)

perimenstrual triptans - frovatriptan, naratriptan, zolmitriptan - dosing is done for 6 days each month beginning 2 days before expected onset of menses

Naproxen sodium BID given 6 days before to 7 days after menses

32
Q

what are the 2 other drugs for migraine prevention

A

Erenumab (Aimovig) - human immunoglobulin G2 monoclonal antibody

Botulinum toxin (Botox)

33
Q

a migraine that occur in a cluster of attacks each lasting 15 min to 2 hours and characterized by severe throbbing, unilateral pain in the orbital temporal area.

A

cluster headaches

34
Q

how are cluster different from migraine

A

cluster headaches are not preceded by an aura
they do not cause n/v
they can be more debilitating
occur mostly in males
not associated with a family history of attacks

35
Q

migraine headaches occur more often in what gender

A

females

36
Q

what meds are used to prevent cluster headaches

A

glucocorticoids (prednisone, dexamethasone)
verapamil - first line
lithium - second line - serum levels require monitoring

suboccipital steroid injections are the only established effective treatment in the prophylaxis of cluster headaches

37
Q

the only treatment for Medication overuse headache is

A

to stop taking all headache medicines

38
Q

what measures can be taken to decrease the risk of developing MOH

A

limit use of abortive medicines
take abortive meds no more than 2-3 times per week
doses should be no higher than actually needed

39
Q

what triptan has effects that persist longer than other triptans and helps the 24 hour recurrence rate to be decreased

A

naratriptan

40
Q

ASA has a shorter or longer half life

A

shorter

41
Q

Are Ergotamine and Zolmitriptan short acting or long acting

A

they do not have long durations

42
Q

Beta Blockers cannot be used in what pt population

A

Asthmatics

COPD

43
Q

what effects does Reglan have on oral anti-migraine meds

A

improves absorption

44
Q

what is the first step in managing headaches for prevention

A

keep a headache diary to help identify triggers

45
Q

what is meds to rescue for cluster headaches

A

Sumatriptan or Oxygen

Inhaling oxygen 100% for 15-20 min

46
Q

abortive max use per week

A

1-2

47
Q

Sumatriptan and ASA

A

when combined with reglan, ASA may work as well as sumatriptan which is a highly effective migraine

48
Q

recommended opioid analgesic for migraine

A

butorphanol nasal spray

49
Q

Sumitriptan (imitrex) is approved for

A

migraines

cluster h/a

50
Q

contraindications for Sumitriptan (imitrex) - health conditions and why

A

coronary vasospasm is a big risk
NO cardiac history or risk of CAD
no in pregnancy

must r/o CAD if have following
postmenopausal
men older than 40
smokers
HTN
Hypercholesterolemia
DM
family history of CAD
51
Q

adverse effect for Sumitriptan (imitrex) that is not concerning

A

chest pressure or heavy arms
pulmonary vasoconstriction
esophageal spasm

not dangerous
forewarn pt

52
Q

drug interactions for Sumitriptan (imitrex)

A

Ergo alkaloids - also cause vasoconstriction so dont combine within 24 hours of each other (ergotamine, dihydroergotamine)

MAOI - toxicity - not within 2 weeks

SSRI/SNRI - risk of serotonin syndrome
(SSRI- fluoxetine - Prozac)
(SNRI- duloxetine - Cymbalta)

53
Q

s/s serotonin syndrome

A 
AMS
anxiety
hallucinations
incoordination
myoclonus
hyperreflexia
excessive sweating
tremor
fever
54
Q

antiemetic meds for migraine

A

metoclopramide (Reglan)

prochlorperazine (Compazine)

55
Q

Ergotamine is metabolized by

A

CYP3A4

56
Q

adverse effect of Ergotamine that is common and what can be given with it to help

A

n/v
metoclopramide or prochlorperazine

other
weakness in legs
myalgias
numbness and tingling in fingers and toes
angina like pain
tachycardia
bradycardia
57
Q

overdose of Ergotamine

symptoms

A

ergotism

ischemia secondary to constriction of peripheral arteries and arterioles

the extremities become cold, pale and numb, muscle pain develops and gangrene may eventually result

58
Q

what should not be combined with ERgotamine

A

triptans (sumatriptan, zolmitriptan)

prolonged vasospastic reaction

separate by 24 hours

59
Q

physical dependence and ergotamine

A

if used daily, you can develop physical dependence

s/s
h/a
n.v
restlessness
resembles a migraine attack which perpetuates the dependence cycle - hospitalization may be needed to break this cycle
60
Q

who is Ergotamine contraindicated for

A

hepatic/renal impairment

sepsis (can cause gangrene)

CAD

Peripheral vascular disease

uncontrolled HTN

taking a CYP3A4 inhibitor

pregnancy

61
Q

Dihydroergotamine (DHE) IM, IV or sub q

A

second line migraine abortive

also available intranasal

62
Q

what b blockers are approved for migraine preventative

A

propanolol
metoprolol

timolol
atenolol
nadolol

can take a few weeks to develop benefits

63
Q

antiepileptic drugs for migraine prevention

A

Divalproex (Depakote ER)
Topiramate (Topamax)
Gabapentin (Neurontin)
Tiagabine (Gabitril)

64
Q

1st line for migraine prevention

A

B Blockers

65
Q

Black box for Divalproex (Depakote)

A

fatal pancreatitis and hepatitis

teratogenic in pregnancy

66
Q

adverse effects Topiramate (Topamax)

A

paresthesias
fatigue
cognitive dysfunction (psychomotor slowing, word finding difficulty, impairment of concentration and memory)

metabolic acidosis
moderate weight loss

67
Q

TCA for migraine prevention

A

amitriptyline (elavil)

68
Q

side effect of amitriptyline (elevil)

A 
hypotension
anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision, tachycardia)
69
Q

migraine that routinely occurs within 2 days of menses

A

menstrually associated migraine

70
Q

what meds for menstrually associated migraine

A

estrogen

topical estrogen gel or patches Divigel, climara)

perimenstrual triptans also help
frovatriptan
naratriptan
zolmitriptan
6 days a month beginning 2 days before expected onset
71
Q

other meds for migraine

A 
botox
erenumab (Aimovig)  - sub q
72
Q

series of headaches lasting 15 min to 2 hours characterized by severe, throbbing, unilateral pain in the orbital temporal area

A

cluster headaches

73
Q

rules of cluster headaches

A 
not preceded by aura
do not cause n/v
can be more debilitating
less common
more common in males
not associated with familial history
74
Q

drugs prophylaxis cluster

A

glucocorticoids (prednisone, dexamethasone)
verapamil - 1 st line
lithium

75
Q

abortive for cluster

A

sumatriptan - 1st line or oxygen

Pharm exam 5 chapters (15 decks)

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