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Pharm II > FINAL HA and herb > Flashcards

FINAL HA and herb Flashcards

1
Q

migraine tx IN PREGNANCY

A

APAP+Metoclopramide (2nd & 3rd trimester)

APAP+codeine – use intermittently

Avoid NSAIDs , Ergotamine & DHE4 (cat X), triptans – cat C ➔ minimal data exists

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2
Q

1ST Line for mild to moderate HA

A

Caffeine/butalbital+ ASA or APAP

excedrine migraine

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3
Q

what can occur with overuse of butalbital

A

can get overuse HA and sedating effects

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4
Q

what is an advantage if indomethacin for mild HA

A

has a suppository form if you’re vomitting

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5
Q

what is the dose of ibuprofen needed for migraine

A

600-1200mg

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6
Q

what is a major SE of metoclopramide

what can be used to prevent incidence

A

EPA

guy who’s mouth is moving forever now

can use diphenhydramine to prevent akathisia/dystonic rxn

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7
Q

opiates seen as tx for HA

A

Meperidine
Codeine
Stadol NS

NOT FIRST LINE

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8
Q

other than metoclopramide what other Rx can be used as an antiemetic for migraines

A

Prochlorperazine

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9
Q

name the ergot used for severe intractable migraines moa

A

dihydroergotamine

Stimulates alpha andrenergic receptor agonist causing direct contraction of smooth blood vessels

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10
Q

Max dose of ergotamines

A

max 6 mg/attack or 10 mg/wk

can cause rebound

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11
Q

ADE with ergotamines

A

can cause gangrene
MI
coronary spamsm
Vtach and stoke

DO NOT GIVE within 3 days of triptans or with BB

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12
Q

ergotymines are CI in

A

CAD, stroke, uncontrolled HTN, PVD, ischemic bowel, impaired renal/hep fxn

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13
Q

1st line for mod-severe MHA-aborptive

and MOA

A

triptans

5HT agonist that causes vasoconstriction

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14
Q

triptan with the longest half life

A

Frovatriptan (Frova)

slow but lasts a long time

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15
Q

triptan w/ the most delivery options

A

sumatriptan
PO
SC
NASAL spray

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16
Q

triptan that is safe in pregnancy

A

rizatriptan

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17
Q

rizatriptan CI with

A

propanol

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18
Q

best tolerated triptan

A

Naratriptan (Amerge):

low reoccurence

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19
Q

triptan with fastest onset

A

RIZA or Eletriptan (Relpax)

but shitty SE

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20
Q

triptan with a high ability to cross the BBB and comes in a nasal spray

A

Zolmitriptan (Amerge): higher ability to cross BBB

21
Q

do not take triptans with

A

ergots and MAOIS anything effecting serotnin

22
Q

when would you need migraine prophylaxis

A

HA>3 d/month, HA>2 days/wk or 8 days/month

or HA lasting longer than 12 hours

or if you’re aborting more than 2 days a week

23
Q

what would you use for MHA prophylaxis in a patient with asthma DM of raynaud’s

A

TCA like amitriptan

24
Q

what other TCA works for MHA but why don’t we use it

A

nortriptyline but has more anticholinergic SE

amitriptyline

25
Q

how long does it take to see prophylaxis with CCB

A

2-3 months

26
Q

SE with CCB

A

edema, dizziness, edema

27
Q

anticonvulsants that can be used with MHA and major SE

A

valproate - weight gain

topirmate: weight loss

28
Q

Feverfew MOA

A

grad A migraine

Inhibits platelet aggregation, serotonin release, leukotrienes, prostaglandin syn

Caution w/ warfarin

29
Q

Riboflavin Vit B2

ADE

A

Grade C
Affects mitochondrial dysfxn

yellow orange urine

30
Q

MHA prophylaxis herbal supplement that can be used for pts with constipation

A

More likely to benefit those with low MG levels

ADE: Diarrhea

31
Q

Coenzyme Q10

A

Affects mitochondrial fxn, might improve oxidative phosphorylation

32
Q

St john’s wart is grade A for depression but cause these SE

A

DO NOT USE IN PREGNANCY

33
Q

how long do you have to wait before giving anti depressants to someone on St. joHN’S WART

A

Allow 14 days washout period after tx w/ MAOI before starting St John’s wort

34
Q

St. John’s word DDI

A

A LOT

but know that it interfere’s with oral contraception

35
Q

S-adenosylmethionine (SAMe)

A

AA derivative made in body = incr dopamine & NE levels

grade C

36
Q

Glucosamine/chondroitin

A

A: mild-mod knee OA
B: gen OA, chondrointin also B for urinary incontinence, detrusor instability

can’t use with shellfish allergy

37
Q

Glucosamine/chondroitin ADE

A

GI UPSET

ASTHMA

38
Q

menopausal supplements

A

Black cohosh -C increased breast cancer

Soy- asians and hispanic not with estrogen receptor

39
Q

Saw Palmetto

A

BPH -A

few SE but can increase INR

40
Q

Garlic is grade A for

A

hyperlipidemia and HTN

41
Q

garlic is grade B for

A

decreased CVD risk

42
Q

what DDI do you worry about with Garlic

A

do not start or stop garlic supplements if you are on pROTEASE INHIBITORS

43
Q

Ginsing use

A

improve mental performance & incr energy

Other uses: modulate immune fxn, antioxidant, analgesic, improved glucose homeostasis, reduce CA risk

44
Q

Ginsing AE

A

insomnia and nervousness

45
Q

MC form of ginsing

A

Panax MC form of ginseng used

46
Q

Echinacea:

A

Grade B uti
not for CC

Start w/in 24 hrs of onset of sx
ADE: flu like sx, unpleasant taste, GI discomfort

47
Q

3 G’s and warfarin:

A

Gingko, garlic and ginseng = all have potential to prolong the pro-time (elevate INR).

48
Q

use w/ inflammatory d/o can cause abnormal liver fxn/damage - irreversible; deaths reported

A

Comfrey:

Pharm II (16 decks)

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