Exam 5 pt. 2 Flashcards
Three Types Migraines ?
Migraine with aura (classic migraine)
Migraine without aura (common migraine)
Migraine with focal neurological deficits
-especially ocular migraines
Goal is to minimize the impact that the ________ has on quality of life
headache
Migraines treatment (general) ?
Abortive therapy
Prophylactically
Migraine HEADACHES first line therapy ?
NSAIDS
ASA
Acetaminophen
Only ____________ respond to triptans and ergotamine’s
migraine headaches
_________ is the key to treatment is it truly a HA or a cluster HA ( M are unilateral, and usually photophobia)
History
Serotonin Receptor Agonists (Triptons) examples ?
Rizatripton (Maxalt)
Zolmitripton (Zomig)
Sumatripton (Imatrex)
Eletripton (Reelpax)
Almotripton (Axert)
Naratriptom (Amerge)
**great for preventative and some use for abortive **
Serotonin Receptor Agonists (Triptons) pharmacokinetics ?
Rapid absorption (30 min)
Metabolism by liver
Excreted urine
Half-Life 2.5-6 hours
depending on specific drug
Serotonin Receptor Agonists (Triptons) adverse reactions ? especially in female
Chest pain
Hypotension
Visual disturbances
Nausea / vomiting / diarrhea
throat discomfort
-angioedema ( no)
Allergic rhinitis
Vertigo / dizziness
**women on these for a long period of time - it can cause prizmental type sxs. **
Serotonin Receptor Agonists (Triptons) interactions ?
May interact with SSRI’s causing Serontonin syndrome
Do not use with MAOI’s
Zolmitriptan (Zomig) and naratripton (Amerge) interact with OCP and cimetidine (deceasing effect)
Serotonin Receptor Agonists (Triptons) contraindicated ?
pregnancy / ischemic heart disease
____________________ interact with OCP and cimetidine (deceasing effect)
Zolmitriptan (Zomig)
Naratripton (Amerge)
Triptons may be used by __________ with Pediatric Neurology following, No more than ____ doses in 24 hours
children
two
Alkaloids from the ergot plant ?
Ergotamines
Ergotamine trade ?
Ergostat, Ergomar
________________
Used in the aborting of 70% migraines
Dihydroergotamine (DHE45, Migranol)
Ergotamines phramacokinetics ?
Oral absorption is erratic but enhanced with caffeine
Metabolized by the liver
Excreted by urine
Half-life 2 hours
Ergotamines adverse reaction ?
Rhinitis from nasal spray
Nausea / vomiting
Hot flashes
Dizziness
somnolence
Ergotamines contrindication ?
uncontrolled HTN,
ischemic heart disease,
renal impairment
Avoid what when on Ergotamines ?
Avoid grapefruit juice, coffee, tea may increase absorption and lead to toxicity
Ergotamines preg. cat ?
X
Causes constriction uterine contractions
Helps with the dyskinesia and tremor associated with Parkinson’s disease ? Early course in middle-aged patients most successful ?
Dopamine pre-cursors
Anti-Parkinson’s Treatments
Corrects the brains imbalance of dopamine to acetylcholine, what is the medication ?
Dopamine pre-cursors
Anti-Parkinson’s Treatments
Carbidopa/Levodopa (Sinemet)
pharmacokinetics ?
Metabolized CYP=450
Excreted urine 70%, feces 30%
Half-life ¾ to 1.5 hours
Carbidopa/Levodopa (Sinemet)
indications ?
Parkinson’s disease
Carbidopa/Levodopa (Sinemet) advere effects /caution ?
glaucoma, angle-closure
avoid abrupt withdrawal
high-protein diet
cardiovascular disease, arrhythmias w/ MI hx
psychosis
hepatic / renal impairment
Amantadine (Symmetrel)
Pharmacokinetics ?
Metabolized liver
Excreted urine
Half-life 34-51 hours
Amantadine (Symmetrel)
adverse reactions / caution ?
Foods containing Kava (root, tea herbal) and pyridoxine (Vit B6) reverse effect of levodopa
Narrow angle glaucoma
Undiagnosed skin lesions (proliferation)
Twitching eye-lid early sign toxicity
Cautions with anti-psychotics and benzo’s
Ropinirole (Requip) pharmacokinetics ?
Metabolized liver CYP-450
Excreted Urine
Half-life 6 hours
Ropinirole (Requip)
adverse reactions ?
hypotension, orthostatic bradycardia syncope mental status alterations hallucinations dyskinesia
Ropinirole (Requip)
interactions ?
Orthostatic hypotension bradycardia syncope mental status alterations / hallucinations dyskinesia melanoma risk
Benztropine (Cogentin) pharmacokinetics ?
Poorly absorbed 28%, Only 6% reaching circulation
Metabolized Liver
Excreted urine
Half-Life 4 hours
Benztropine (Cogentin)
adverse effects ?
Dry mouth Blurred vision Tachycardia Psychosis (in overdose) Urinary retention Anorexia
very narrow therapeutic window!
Donepezil (Aricept) and
Memantine (Namenda) pharmacokinetics ?
Absorbed GI tract completely
Metabolized liver CYP-450
Excreted as glucuronide in urine
-to see if they are metabolizing it off and to see if it is working or not
Half-life 60-80 hours
Donepezil (Aricept) and
Memantine (Namenda) adverse reactions / caution ?
Confusion / somnolence / hallucinations
Liver Failure
Dosage adjusted for renal disease
Urine under pH 8 may lead to accumulation
HTN / AV block / cardiac failure
Cataracts / conjunctivitis
Fatigue / Back pain
**urine pH is the key
get EKG prior **
