FINAL HA and herb

Question 1

migraine tx IN PREGNANCY

Answer 1

APAP+Metoclopramide (2nd & 3rd trimester)

APAP+codeine – use intermittently

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

Question 2

1ST Line for mild to moderate HA

Answer 2

Caffeine/butalbital+ ASA or APAP

excedrine migraine

Question 3

what can occur with overuse of butalbital

Answer 3

can get overuse HA and sedating effects

Question 4

what is an advantage if indomethacin for mild HA

Answer 4

has a suppository form if you’re vomitting

Question 5

what is the dose of ibuprofen needed for migraine

Answer 5

600-1200mg

Question 6

what is a major SE of metoclopramide

what can be used to prevent incidence

Answer 6

EPA

guy who’s mouth is moving forever now

can use diphenhydramine to prevent akathisia/dystonic rxn

Question 7

opiates seen as tx for HA

Answer 7

Meperidine
Codeine
Stadol NS

NOT FIRST LINE

Question 8

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

Answer 8

Prochlorperazine

Question 9

name the ergot used for severe intractable migraines moa

Answer 9

dihydroergotamine

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

Question 10

Max dose of ergotamines

Answer 10

max 6 mg/attack or 10 mg/wk

can cause rebound

Question 11

ADE with ergotamines

Answer 11

can cause gangrene
MI
coronary spamsm
Vtach and stoke

DO NOT GIVE within 3 days of triptans or with BB

Question 12

ergotymines are CI in

Answer 12

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

Question 13

1st line for mod-severe MHA-aborptive

and MOA

Answer 13

triptans

5HT agonist that causes vasoconstriction

Question 14

triptan with the longest half life

Answer 14

Frovatriptan (Frova)

slow but lasts a long time

Question 15

triptan w/ the most delivery options

Answer 15

sumatriptan
PO
SC
NASAL spray

Question 16

triptan that is safe in pregnancy

Answer 16

rizatriptan

Question 17

rizatriptan CI with

Answer 17

propanol

Question 18

best tolerated triptan

Answer 18

Naratriptan (Amerge):

low reoccurence

Question 19

triptan with fastest onset

Answer 19

RIZA or Eletriptan (Relpax)

but shitty SE

Question 20

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

Answer 20

Zolmitriptan (Amerge): higher ability to cross BBB

Question 21

do not take triptans with

Answer 21

ergots and MAOIS anything effecting serotnin

Question 22

when would you need migraine prophylaxis

Answer 22

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

Question 23

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

Answer 23

TCA like amitriptan

Question 24

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

Answer 24

nortriptyline but has more anticholinergic SE

amitriptyline

Question 25

how long does it take to see prophylaxis with CCB

Answer 25

2-3 months

Question 26

SE with CCB

Answer 26

edema, dizziness, edema

Question 27

anticonvulsants that can be used with MHA and major SE

Answer 27

valproate - weight gain topirmate: weight loss

Question 28

Feverfew MOA

Answer 28

grad A migraine Inhibits platelet aggregation, serotonin release, leukotrienes, prostaglandin syn Caution w/ warfarin

Question 29

Riboflavin Vit B2 ADE

Answer 29

Grade C Affects mitochondrial dysfxn yellow orange urine

Question 30

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

Answer 30

More likely to benefit those with low MG levels | ADE: Diarrhea

Question 31

Coenzyme Q10

Answer 31

Affects mitochondrial fxn, might improve oxidative phosphorylation

Question 32

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

Answer 32

DO NOT USE IN PREGNANCY

Question 33

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

Answer 33

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

Question 34

St. John's word DDI

Answer 34

A LOT | but know that it interfere's with oral contraception

Question 35

S-adenosylmethionine (SAMe)

Answer 35

AA derivative made in body = incr dopamine & NE levels grade C

Question 36

Glucosamine/chondroitin

Answer 36

A: mild-mod knee OA B: gen OA, chondrointin also B for urinary incontinence, detrusor instability can't use with shellfish allergy

Question 37

Glucosamine/chondroitin ADE

Answer 37

GI UPSET | ASTHMA

Question 38

menopausal supplements

Answer 38

Black cohosh -C increased breast cancer | Soy- asians and hispanic not with estrogen receptor

Question 39

Saw Palmetto

Answer 39

BPH -A | few SE but can increase INR

Question 40

Garlic is grade A for

Answer 40

hyperlipidemia and HTN

Question 41

garlic is grade B for

Answer 41

decreased CVD risk

Question 42

what DDI do you worry about with Garlic

Answer 42

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

Question 43

Ginsing use

Answer 43

improve mental performance & incr energy Other uses: modulate immune fxn, antioxidant, analgesic, improved glucose homeostasis, reduce CA risk

Question 44

Ginsing AE

Answer 44

insomnia and nervousness

Question 45

MC form of ginsing

Answer 45

Panax MC form of ginseng used

Question 46

Echinacea:

Answer 46

Grade B uti not for CC Start w/in 24 hrs of onset of sx ADE: flu like sx, unpleasant taste, GI discomfort

Question 47

3 G’s and warfarin:

Answer 47

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

Question 48

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

Answer 48

Comfrey: