Ch 30 Headaches

Question 1

__ is a neurovascular disorder involving dilation

and inflammation of intracranial arteries.

Answer 1

Migraine

Question 2

Antimigraine drugs are used in two ways:

Answer 2

abortive and prophylactic.

Question 3

The goal of abortive therapy is to __.

Answer 3

eliminate headache pain and associated nausea and vomiting.

Question 4

The goal of prophylactic therapy is to __.

Answer 4

reduce the incidence and intensity of migraine attacks.

Question 5

There are two kinds of drugs for abortive therapy:

Answer 5

nonspecific analgesics (aspirin-like drugs and opioids) and migraine-specific drugs (triptans and ergot alkaloids).

Question 6

__ are effective for abortive therapy of mild to

moderate migraine.

Answer 6

Aspirin-like analgesics (e.g., acetaminophen, aspirin,

naproxen)

Question 7

__ are reserved for severe migraine that has not responded to other drugs.

Answer 7

Opioid analgesics (e.g., butorphanol, meperidine)

Question 8

__ are first-line drugs for abortive therapy of moderate to severe migraine.

Answer 8

Triptans (e.g., sumatriptan)

Question 9

Triptans activate 5-HT1B/1D receptors and thereby constrict __.

Answer 9

intracranial blood vessels and suppress release of inflammatory neuropeptides

Question 10

All __ are available in oral formulations, which have

a relatively slow onset.

Answer 10

triptans

Two triptans—sumatriptan and zolmitriptan—are available in fast-acting formulations (either nasal spray, subQ injection, or both).

Question 11

Triptans can cause __.

Answer 11

coronary vasospasm,

and hence are contraindicated for patients with ischemic heart disease, prior MI, or uncontrolled hypertension.

Question 12

Triptans should not be combined with (2) because excessive vasoconstriction could occur.

Answer 12

one another or with ergot derivatives

Question 13

__ should not be combined with SSRIs or SNRIs because serotonin syndrome could occur.

Answer 13

Triptans

Question 14

__ is a second-line drug for abortive therapy of severe migraine.

Answer 14

Ergotamine

Question 15

Overdose with ergotamine can cause ergotism, a serious condition characterized by __.

Answer 15

severe tissue ischemia secondary to generalized constriction of peripheral arteries.

Question 16

Ergotamine must not be taken routinely because __.

Answer 16

physical dependence will occur.

Question 17

__ can cause uterine contractions and must not be taken during pregnancy.

Answer 17

Ergotamine

Question 18

__ must not be combined with potent inhibitors of CYP3A4, owing to a risk of intense vasoconstriction and associated ischemia.

Answer 18

Ergotamine

Question 19

__ is indicated for migraineurs who have frequent attacks (two or more a month), especially severe attacks, or attacks that do not respond adequately to abortive agents.

Answer 19

Prophylactic therapy

Question 20

(3) are preferred drugs for migraine prophylaxis.

Answer 20

Propranolol, divalproex, and amitriptyline

Question 21

__ can help prevent menstrual-associated migraine.

Answer 21

Estrogen supplements