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Adv Pharm > Chapter 25: Headaches > Flashcards

Chapter 25: Headaches Flashcards

1
Q

headache

A

Common symptom
Triggered by a variety of stimuli -Stress, fatigue, acute illness, and sensitivity to alcohol
Mild episodes -Relieved by over-the-counter drugs (e.g., aspirin, acetaminophen) -most will try OTC before coming to doc

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2
Q

severe headache

A

migraine, cluster, tensio

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3
Q

HA cause

A

Identifiable underlying causes
Severe hypertension, hyperthyroidism, tumor, infection, and disorders of the eye, nose, sinuses, and throat

No identifiable cause
Migraine
Cluster

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4
Q

2 ways HA drugs work

A

To abort an ongoing attack
Aspirin-like drugs, opioid analgesics, and migraine-specific drugs

To prevent attacks from occurring
Beta blockers, tricyclic antidepressants, and antiepileptic drugs

several can cause physical dependence

not all pt will response to same drug

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5
Q

migraine HA

A

Throbbing head pain of moderate to severe intensity
Nausea and vomiting
Sensitivity to light and sound
Highly debilitating

hormonal component and family hx is typical

36 mil in US have migraine
10% worldwide pop.
Females 43 % -65% of females will have first episode in late teens early 20s onset
Males 18%
60% say unilateral HA
40% have bilateral HA

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6
Q

2 forms of migrains

A

Migraine with aura
Preceded by visual symptoms (flash of light, zig zag pattern)
Only ~ 30% of pt

Migraine without aura is more common than with aura

Hyperalgesia –augmented response to painful stimuli
Can have pain response to normally inoculate stimuli
Most happen in the morning
Lkast bw 4-72 hr
Most have 1.5 attacks per month
Many Identify precipitating event

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7
Q

patho of migraine

A

Neurovascular disorder that involves the dilation and inflammation of intracranial blood vessels
Vasodilation leads to pain
Neurons of the trigeminal vascular system
Calcitonin gene–related peptide (CGRP) -Promotor of migraines
Serotonin (5-hydroxytryptamine [5-HT]) -Suppressor of migraines

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8
Q

factors than trigger migraine: emotions

A

Stress
Anticipation
Anxiety
Depression
Excitement
Frustration

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9
Q

factors that can trigger migraine HAL food

A

Tyramine (such as aged cheeses or Chianti wine)
Nitrates (such as cured meat products)
Phenylethylamine (such as chocolate)
Monosodium glutamate (such as Chinese food or canned soups)
Aspartame (such as diet sodas or artificial sweeteners)
Yellow food coloring

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10
Q

factors that can trigger migraine HA: drugs

A

Alcohol
Analgesics (excessive use or withdrawal)
Caffeine (excessive use or withdrawal)
Cimetidine (tagmet)
Cocaine
Estrogens (such as oral contraceptives)
Nitroglycerin

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11
Q

factors that can trigger migraine HA: weather

A

Low temperature and low humidity
High temperature and high humidity
Major weather change over 1 to 2 days
High or low barometric pressure

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12
Q

factors that can trigger migraine HA: other

A

Carbon monoxide
Hormonal changes
Flickering lights
Glare
Loud noises
Hypoglycemia
Change in altitude

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13
Q

migraine overview of tx

A

Aborting an ongoing attack:
Nonspecific analgesics: Aspirin-like drugs and opioid analgesics (e.g., butorphanol, meperidine)
Migraine-specific drugs: Serotonin1B/1D receptor agonists
Ergot alkaloids

Ubrogepant (ubervly) tx for acute migraine (not prevention) with or without aura in adults. Oral calcitonin gene related peptide receptor antagonist
Fda approved 2020

Preventing attacks from occurring

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14
Q

Serotonin1B/1D Receptor Agonists: Sumatriptan [Imitrex]

A

Mechanism of action:
Binds to receptors on intracranial blood vessels and causes vasoconstriction
Diminishes perivascular inflammation

Therapeutic use:
Aborting an ongoing migraine attack to relieve headache and associated symptoms

Pharmacokinetics:
Oral or intranasal administration

1st line for aborting HA

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15
Q

sumatripin ADR

A

Chest symptoms:
Transient “heavy arms” or “chest pressure” experienced by 50% of users

Coronary vasospasm:
Rare angina as a result of vasospasm

Teratogenesis

Others:
Vertigo, malaise, fatigue, and tingling sensations
Very bad taste when taken in intranasal form

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16
Q

pt to avoid sumatripin in

A

CVD, CAD, DM, HTN, smoker preg, pt

17
Q

sumatripin: drug interactions and prep/admin

A

Drug interactions:
Ergot alkaloids, sumatriptan, and other triptans (all cause vasoconstriction)

Preparations, dosage, and administration
Oral -need higher dose dt low bioavailability
Nasal spray
SQ/IM dose can be lower than PO

2.5 hr half life

18
Q

Other serotonin1B/1D receptor agonists

A

Naratriptan [Amerge]
Rizatriptan [Maxalt]
Zolmitriptan [Zomig]
Almotriptan [Axert]
Frovatriptan [Frova]
Eletriptan [Relpax]

19
Q

Ergot alkaloids: ergotamine

A

Agonist activity at subtypes of serotonin receptors, specifically 5-HT1B and 5-HT1D receptors

Suppresses release of CGRP to block inflammation associated with the trigeminal vascular system

Second-line drug for stopping an ongoing migraine attack in patients who have not responded to a triptan

Risk for dependence

Don’t take daily or long term
Oral, SL, rectal

Half life of a couple hours

ADRs: N/T in digits, some N/V, some leg weakness

20
Q

Ergot alkaloids: Ergotamine toxicity

A

ergotism

21
Q

contraindications for ergotamine

A

Liver and renal impairment
CAD, PVD, HTN
Pregnancy (contractions)
People taking medications that inhibit CYP3A4 –increase drug to dangerous levels. See vasospasms, cerebral ischemia, peripheral ischemia

22
Q

qualifies for preventative migraine therapy

A

Greater than 3 attacks a month that are very severe and/or don’t respond to abortive medications

23
Q

preventative migraine therapy: beta blockers

A

Propranolol -preferred, timolol, atenolol, metoprolol, and nadolol

Reduce number and intensity in 70% of people

Takes a few weeks to see benefits

24
Q

preventive migraine therapy: antiepileptic drugs

A

Divalproex [Depakote ER] -preferred, topiramate [Topamax], gabapentin [Neurontin], and tiagabine [Gabitril]

Decrease in number of migraines by 50% in 30-50% of people

25
Q

preventative migraine therapy: TCA

A

Amitriptyline [Elavil]

Good for migraines and tension HA

See hypotension and anticholinergic SE

26
Q

preventative migraine therapy: Estrogens and triptans for menstrually associated migraine

A

Estrogen gel and patches (e.g., Climara, Estraderm), frovatriptan, naratriptan, zolmitriptan, and naproxen sodium (550 mg 2/day for 6 -7 days) after menses is effective
Menstual asso
patches and gels

27
Q

migraine HA preventive therapy: less effective agents

A

Calcium channel blockers: Verapamil and nimodipine

Botulinum toxin A

Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers

Supplements: Riboflavin (vitamin B2) and coenzyme Q-10

Butterbur

28
Q

cluster HA characteristics

A

Occur in a series or “cluster” of attacks

Each attack lasts 15 minutes to 2 hours

Severe, throbbing, unilateral pain near the eye

Lacrimation, conjunctival redness, nasal congestion, rhinorrhea, ptosis, and miosis on the same side of the headache

One or two attacks every day for 2 to 3 months

An attack-free interval of months to years separates clusters

No aura, no N/V

More debilitating, less common, no associating with family history

See more often in males –for every 1 female see 5 males

29
Q

tx of cluster HA

A

Primary therapy directed at prophylaxis

Glucocorticoids (prednisone and dexamethasone) can do sub occipital injection of dex

Verapamil -1st line

Lithium -Require monitoring bc target level 0.4-0.8

O2 -7-10L/min for 15-20 min

can abort with sumptripin 6mg sq

30
Q

tension-type HA characteristics

A

Most common form of headache
Moderate, nonthrobbing pain
Usually located in a “headband” distribution
May be episodic or chronic

31
Q

tx of tension HA

A

Nonopioid analgesics: Acetaminophen
Nonsteroidal antiinflammatory drugs: Aspirin, ibuprofen, and naproxen
Analgesic-sedative combination: Aspirin and butalbital
Patient teaching about how to manage stress

32
Q

medication overuse HA

A

Chronic headache that develops in response to frequent use of headache medicines

Resolved by withdrawing use of overused medicine

Almost all medicines used for abortive headache therapy can cause medication overuse headache

Risk of medication overuse headache can be decreased by limiting the use of abortive medicines and implementing nondrug measures

dont use HA meds for more than 2-3 wk

Adv Pharm (76 decks)

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