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pha 333 > CNS OTC > Flashcards

CNS OTC Flashcards

1
Q

what are the types of headaches?

A
  • Migraine
  • Tension headache
  • Sinusitis
  • Cluster headaches
  • Temporal arteritis
  • Trigeminal neuralgia
  • Chronic daily headache
  • Medication overuse
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2
Q

what is a migrane?

A

•Migraine is a complex neurological condition with a wide variety of symptoms.
•It is is characterized by moderate or severe headaches
which are commonly, but not always unilateral.
•The headache is often described as throbbing or
pulsating in nature.

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3
Q

what are the key features that support the diagnosis of a migrane?

A

nausea and

vomiting, photophobia, phonophobia and disability.

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4
Q

how do you classify a migrane?

A 
–Migraine without aura 
–Migraine with aura
•Typical aura
•Hemiplegic migraine 
•Migraine with brainstem aura
•Ocular migraine
•Silent migraine
–Chronic migraine 
–Menstrual migraine
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5
Q

what are the symptoms of a migrane without aura>

A

•Recurrent headache disorder where attacks last 4–72 hours
•Headache is unilateral location, pulsating quality, moderate or severe intensity and aggravated by
physical activity
•Association with nausea, vomiting and/or photophobia
and phonophobia.
•Relief from lying in a darkened room
•No neurological symptoms
–No Aura

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6
Q

what are the symptoms of migrane with aura?

A

Transient, unilateral neurological symptoms of visual, sensory or other central nervous system symptoms that
usually develop gradually.
•Occurs 5-20 minutes before the headache.
–Visual aura: flashing lights, scotoma or zigzag lines (photopsia)Sensory aura: Unilateral tingling or numbness, in the lips, fingers, face or hands and occasionally have difficulty in speaking (dysphasia)
•Prodromal and post-dromal phases can occur
•Neurological symptoms usually precede the headache
•More common in women

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7
Q

what are the 5 phases of a migrane?

A 
1-premonitory stage
2- aura
3- headache or main attack stage
4- resolution
5-recovert or postdrome stage
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8
Q

what are triggers for a migrane?

A

•Diet: crash diet, irregular meals, cheese, chocolate,
red wine, tyramine containing foods, dehydration
•Environmental: Smoking, bright lights, screen use,
loud noise, strong smells
•Psychological: Depression, anxiety, stress, anger,
tiredness
•Medicines: HRT and COC
•Other: menstruation, shift patterns and
menopause

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9
Q

what are the treatment options OTC for an acute migrane?

A

•Simple analgesia
•Anti-emetics
•Migraine specific treatment
–Serotonin (5-HT1) agonists or ‘Triptans’

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10
Q

why would you give anti-emetics in migrane treatment?

A

•Gastric stasis is slowed in migraine
–Nausea/vomiting and reduced medication absorption
•Migraleve pink
–Combination product - Codeine, paracetamol and
Buclizine (anti-emetic)
•Buccastem M Buccal
–Prochlorperazine 3mg
•Previously diagnosed migraine and adults (>18 years old)

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11
Q

how do triptans work?

A
  • They work by imitating the action of 5-HT.
  • 5-HT causes the dilated blood vessels to constrict.
  • Include:almotriptan,naratriptan, sumatriptan, zolmitriptan
  • Often included 1st line alongside simple analgesia and anti-emetics (if required) in mod-severe migraine.
  • Reduce the pain of migraine within two hours
  • They can reduce photophobia and photophonia.
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12
Q

what is the availible triptan OTC?

A

Sumatriptan

•Imigran recovery – OTC

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13
Q

what criteria is required to supply sumatriptan?

A

•Age 18 years to 65 years.
•Migraine must be diagnosed by a doctor or pharmacist
•Established pattern of migraine with/without aura
–History of five or more migraine attacks occurring over a
period of at least one year.
•Simple analgesics tried and ineffective.

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14
Q

what cauiouns would you have for sumatriptan?

A 
Concomitant use:
–SSRI/SNRI
–St John’s wort (Hypericum perforatum)
–combined oral contraceptives
•Heart disease risk factors (contraindicated in 
patients who have three or more risk factors 
i.e. diabetes, high cholesterol levels, 
smoking/use of NRT).
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15
Q

what contraindications are there for OTC treatmemt?

A

•Aged under 18 years or over 65 years.
•Pregnant or breastfeeding.
•Patients with three or more cardiovascular risk factors.
•Those aged 50 years or over and experiencing migraine
attacks for the first time.
•Patients who had their first ever migraine attack within
the previous 12 months.
•Patients who have had fewer than five migraine attacks
in the past.
•Patients who do not respond to treatment.
•Patients who have a headache (of any type) on 10 or
more days per month.
•Women with COC
Potentially suitable for OTC sumatriptan but referral is
required for evaluation and management.
•Migraine headache lasts for longer than 24 h
•Patients who experience four or more attacks per
month

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16
Q

how should you take sumatriptan?

A

•Dose - one 50mg tablet; should be taken as soon as possible
–It should be taken at the start of the headache and notat the start of the aura (unless the aura and headache start simultaneously).
•A second dose can be taken at least 2 h after the first if
symptoms come back.
–A second dose should be taken only if the headache
responded to the first dose.
•Don’t take more than two tablets in 24 hours.
•Don’t take more than two tablets for the same attack.

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17
Q

what are the prescribed treatments for migranes?

A

Triptans of varying formulation

•Preventive/prophylactic treatments

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18
Q

when should you consider preventative treatment?

A

•Migraine attacks are having a significant impact on quality of life
and daily function,.
•Acute treatments are either contraindicated or ineffective.
•The person is at risk of MOH due to frequent use of acute drugs.
•Includes: amitriptyline, propranolol, topiramate and others off
license.

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19
Q

what counselling advise should you give for migranes?

A 
•Keep a headache diary to identify triggers
–Avoid triggers once known 
•Immediate use of simple analgesia 
•Dark and quiet environment room 
•Good sleep hygiene
•Diet and fluid intake
•COCs
•Cold compress
–OTC kool and soothe strips
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20
Q

what is a TTH?

A

•The most common type of headache
•Characterised by recurrent episodes of headache that are usually bilateral and have a pressing or tightening quality
(non-pulsating) that is mild to moderate in intensity.
–Described as pressure/tightness, like a vice or tight band
around the head
•There is often a relationship to the neck, with pain into or
from the neck.
•Mild nausea may occur, especially if there is medication-induced headache, but profound nausea and vomiting do
not occur.
•Usually relieved by simple analgesics.

21
Q

how can TTH be divdided?

A

TTH can be divided into
•Episodic TTH.
–This occurs on fewer than 15 days each month. It
can evolve into the chronic variety.
•Chronic TTH.
–This occurs on more than 15 days each month and
has all the features of the episodic TTH.

22
Q

what causes a TTH?

A
  • Anxiety.
  • Screen time
  • Depression.
  • Poor posture.
  • Poor sleep.
  • Stress.
  • Muscular tightness (as above).
23
Q

how do you treat TTH?

A 
•Simple analgesics
–Paracetamol, Ibuprofen
•Syndol tablets
–Combination product: codeine. Paracetamol, 
doxylamine and caffeine
•Syndol headache relief
–Codeine, paracetamol and caffeine
•Less suitable 
•Avoid codeine products where possible
24
Q

what counselling advise would you give for TTH?

A 
•Lifestyle adjustments
•Alleviate stress
•Check sleep hygiene
•Attention to anxiety/depression
•Advice on posture
•Exercise
•Reduce use of screens if known cause
–I.e regular breaks 
•Avoid use of codeine/dihydrocodeine
•Acupuncture
25
Q

what are the red flags to refer for a headache?

A 
Refer 
•Migraine with COC 
•Headache with associated high temperature (>38oC)
•Frequent migraine/treatment failure 
•Severe headache of > 4 hrs duration 
•Suspected ADR 
•Associated drowsiness, unsteadiness, visual disturbances or vomiting. 
•Associated neck stiffness 
•Suspected  injury/trauma 
•Children under 12 years
26
Q

what does MSK pain refer to?

A

•MSK pain refers to pain in the muscles, bones,
ligaments, tendons, bursae and nerves
–Pain is the most common symptom of most
musculoskeletal disorders.
–It ranges from mild to severe and from acute to chronic
and may be local or widespread

27
Q

what is the pain caused by MSK?

A

Myalgia from an injury, infection, cramp or spasm, loss of blood flow to the muscle, or tumour.
–Back pain, sprain/strain
•Bone pain- i.e an injury such as a fracture, infection, tumor, tendon and ligament pain, such as from a sprain, strain, or
inflammation from tendonitis
•Joint pain - RA/OA/Gout
•Bursitis
•Fibromyalgia - pain in tendons, muscles, and joints throughout the body
•Nerve compression pain- conditions that put pressure on nerves, such as carpal tunnel syndrome, cubital tunnel
syndrome, and tarsal tunnel syndrome

28
Q

where does the lower back pain affect?

A

Pain in the lumbosacral area of the back, between the bottom of
the ribs and the top of the legs

29
Q

what is the usual cause of lower back pain?

A

It usually results from a problem with one or more parts of the
lower back, such as: ligaments, muscles, nerves or vertebrae
•Most commonly an nonspecific cause
–Cases of sudden-onset (acute) low back pain
–The pain is not due to any specific or underlying disease.
–Usually attributed to trauma, or musculoligamentous strain.
•Acute episodes of back paint typically resolve within 6 weeks.

30
Q

what self management advise should they be given OTC?

A

•Ensure patients understand the role of medications for the treatment of low back pain
•Staying active and avoiding bed rest is recommended when experiencing back pain.
–Bed rest can lead to a loss of muscle strength and may increase muscle stiffness, adding to pain and discomfort.
•Advise to increase their physical activities over a few days or weeks
•Relaxation to reduce tension
•Local heat/ICE packs (ensuring that the skin is
protected) may relieve pain and muscle spasm.

31
Q

what otc management should be given?

A 
•Offer an NSAID such as ibuprofen first line.
–Ibuprofen 400mg - tds
no evidence for paractemaol
•Topical NSAIDs
–Less systemic absorption
–Ibuprofen gel – Ibuleve
–Diclofenac gel – Voltarol
•Rubefacients – heat rubs 
–Deep heat
•Cooling sprays/gels
–Deepfreeze/biofreeze
32
Q

what is a sprain?

A

•A sprain is a stretch and/or tear of a ligament
–A result of the joint being forced suddenly outside its usual range of movement.
•Ankles, knees, wrists, and thumbs.
–Symptoms - pain around the affected joint, tenderness, swelling, bruising, pain on weight-bearing, and decreased function.

33
Q

what is a strian?

A

•A strain (or ‘pull’) is a stretch and/or tear of muscle fibres and/or tendon
–Either because a muscle has been stretched beyond its limits or
it has been forced to contract too strongly
•The foot, hamstring, and back.
–Symptoms - muscle pain, cramping, and spasm; muscle weakness, inflammation and/or bruisng

34
Q

what are MSK red flags?

A
  • Severe Arthritis
  • Back pain associated with abnormal urination
  • Back pain radiating to leg
  • Suspected fracture
  • Head injury
  • Treatment failure
  • Suspected Adverse Drug Reaction
35
Q

what is insonmia?

A

•A condition of unsatisfactory sleep.
•Characterised by difficulty in getting to sleep,
difficulty maintaining sleep, early wakening, or
non-restorative sleep which results in
impaired daytime functioning or wellbeing.
•Often associated with increasing age
•Can be primary/secondary

36
Q

what are the common complains with insomnia?

A
  • Fatigue
  • Tiredness
  • Lack of energy
  • Irritability
  • Reduced work performance
  • Difficulty concentrating
37
Q

what are the causes of insmonia?

A

–Physical – pain, nasal congestion, cough, cramps, COPD,
CHF, Parkinson’s, pregnancy etc
–Physiological –circadian rhythm disorders, poor sleep
hygiene/environment
–Psychological – stress, bereavement
–Psychiatric – anxiety, depression, dementia etc.
•Anxiety- often difficulty in falling asleep
•Depression – early morning
–Pharmacological – medication related sleep disturbances –
Stimulants, BBs, steroids, decongestants, thyroxine,
alcohol, caffeine, substance abuse etc.

38
Q

what are the classifications of insomnia?

A

•Transient (days)
•Short-term (up to 4 weeks)
•Chronic (>4weeks)
–Chronic should always be referred

39
Q

what treatment options are there availible for insomnia?

A 
•Non pharmacological
–Sleep hygiene
–CBT for insomnia
–Relaxation techniques
•OTC management
–Sedative antihistamines
–Complementary therapy
40
Q

what is sleep hygeine advice?

A

Sleep hygiene advice
•Create a comfortable sleep environment that is
conducive to sleep.
–Comfortable bed, right temperature, avoid bright light etc
•Regular sleep schedules
–Only go to bed when tired, avoid napping during the day,
regular sleep pattern, only go to bed for sleep etc.
•Limiting/avoidance of caffeine, nicotine and alcohol
–Caffeine should be avoided after midday and nicotine,
alcohol, and large meals within 2 hours of bedtime.
Exercise during the day can be beneficial but avoid close to bedtime
•Set regular waking times 7 days a week and only go
to bed when sleep
•If unable to sleep for what feels like more than 20
minutes, leave the bedroom and find a quiet activity.
Do not attempt alerting activities. Only return to bed
when you fell sleepy
•Avoid clock watching, turn the clock to face the
other way

41
Q

what does CBT for insomnia involve?

A

It includes behavioural interventions (such as stimulus control and sleep restriction), cognitive therapy and relaxation training.

42
Q

when is CBT for insomnia recommended first line?

A

•In short term insomnia where sleep hygiene measures fail, daytime impairment is severe causing significant distress, and insomnia is not likely to resolve soon.
•Chronic insomnia.
–Pharmacological therapy should be avoided
in the long-term management of insomnia

43
Q

what are relaxation techniques for insomnia?

A

•Relaxation before going to bed
–For example reading a book or having a bath
•Regular daily exercise can help improve sleep
but avoid within 4 hours of bedtime
•Stress management strategies
•Accupuncture

44
Q

what are sedative antihistamines?

A

•Diphenhydramine –
–Nytol original
–Nytol one a night

45
Q

how long is diphenhydramine recommended for?

A

Recommend no longer than 7 consecutive nights

–SPC states 14 nights

46
Q

what are the side effects of diphenhydramine?

A

anticholinergic, hang over effect (Less likely than with promethazine)

47
Q

what are the c/i for diphenhydramine?

A

Contraindications - prostatic hypertrophy, closed angle glacuoma, pregnancy and breast feeding

48
Q

what are some complimentary therapies for insomnia?

A

•Herbal sleep aids
–Valerian root extract, hops, passion flower, Jamaica
dogwood
–Nytol herbal, Nytol herbal simply sleep, Kalms night
•Aromatherapy – Lavender/camomile oil
•Nasal plaster

49
Q

what are the insomnia red flags?

A
  • Suspected depression
  • Chronic issue (>4 weeks)
  • Children <16 y.o
  • Associated physical conditions
  • Suspected alcohol/drug dependence

pha 333 (42 decks)

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