FINAL HA and herb Flashcards
migraine tx IN PREGNANCY
APAP+Metoclopramide (2nd & 3rd trimester)
APAP+codeine – use intermittently
Avoid NSAIDs , Ergotamine & DHE4 (cat X), triptans – cat C ➔ minimal data exists
1ST Line for mild to moderate HA
Caffeine/butalbital+ ASA or APAP
excedrine migraine
what can occur with overuse of butalbital
can get overuse HA and sedating effects
what is an advantage if indomethacin for mild HA
has a suppository form if you’re vomitting
what is the dose of ibuprofen needed for migraine
600-1200mg
what is a major SE of metoclopramide
what can be used to prevent incidence
EPA
guy who’s mouth is moving forever now
can use diphenhydramine to prevent akathisia/dystonic rxn
opiates seen as tx for HA
Meperidine
Codeine
Stadol NS
NOT FIRST LINE
other than metoclopramide what other Rx can be used as an antiemetic for migraines
Prochlorperazine
name the ergot used for severe intractable migraines moa
dihydroergotamine
Stimulates alpha andrenergic receptor agonist causing direct contraction of smooth blood vessels
Max dose of ergotamines
max 6 mg/attack or 10 mg/wk
can cause rebound
ADE with ergotamines
can cause gangrene
MI
coronary spamsm
Vtach and stoke
DO NOT GIVE within 3 days of triptans or with BB
ergotymines are CI in
CAD, stroke, uncontrolled HTN, PVD, ischemic bowel, impaired renal/hep fxn
1st line for mod-severe MHA-aborptive
and MOA
triptans
5HT agonist that causes vasoconstriction
triptan with the longest half life
Frovatriptan (Frova)
slow but lasts a long time
triptan w/ the most delivery options
sumatriptan
PO
SC
NASAL spray
triptan that is safe in pregnancy
rizatriptan
rizatriptan CI with
propanol
best tolerated triptan
Naratriptan (Amerge):
low reoccurence
triptan with fastest onset
RIZA or Eletriptan (Relpax)
but shitty SE
triptan with a high ability to cross the BBB and comes in a nasal spray
Zolmitriptan (Amerge): higher ability to cross BBB
do not take triptans with
ergots and MAOIS anything effecting serotnin
when would you need migraine prophylaxis
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
what would you use for MHA prophylaxis in a patient with asthma DM of raynaud’s
TCA like amitriptan
what other TCA works for MHA but why don’t we use it
nortriptyline but has more anticholinergic SE
amitriptyline
how long does it take to see prophylaxis with CCB
2-3 months
SE with CCB
edema, dizziness, edema
anticonvulsants that can be used with MHA and major SE
valproate - weight gain
topirmate: weight loss
Feverfew MOA
grad A migraine
Inhibits platelet aggregation, serotonin release, leukotrienes, prostaglandin syn
Caution w/ warfarin
Riboflavin Vit B2
ADE
Grade C
Affects mitochondrial dysfxn
yellow orange urine
MHA prophylaxis herbal supplement that can be used for pts with constipation
More likely to benefit those with low MG levels
ADE: Diarrhea
Coenzyme Q10
Affects mitochondrial fxn, might improve oxidative phosphorylation
St john’s wart is grade A for depression but cause these SE
DO NOT USE IN PREGNANCY
how long do you have to wait before giving anti depressants to someone on St. joHN’S WART
Allow 14 days washout period after tx w/ MAOI before starting St John’s wort
St. John’s word DDI
A LOT
but know that it interfere’s with oral contraception
S-adenosylmethionine (SAMe)
AA derivative made in body = incr dopamine & NE levels
grade C
Glucosamine/chondroitin
A: mild-mod knee OA
B: gen OA, chondrointin also B for urinary incontinence, detrusor instability
can’t use with shellfish allergy
Glucosamine/chondroitin ADE
GI UPSET
ASTHMA
menopausal supplements
Black cohosh -C increased breast cancer
Soy- asians and hispanic not with estrogen receptor
Saw Palmetto
BPH -A
few SE but can increase INR
Garlic is grade A for
hyperlipidemia and HTN
garlic is grade B for
decreased CVD risk
what DDI do you worry about with Garlic
do not start or stop garlic supplements if you are on pROTEASE INHIBITORS
Ginsing use
improve mental performance & incr energy
Other uses: modulate immune fxn, antioxidant, analgesic, improved glucose homeostasis, reduce CA risk
Ginsing AE
insomnia and nervousness
MC form of ginsing
Panax MC form of ginseng used
Echinacea:
Grade B uti
not for CC
Start w/in 24 hrs of onset of sx
ADE: flu like sx, unpleasant taste, GI discomfort
3 G’s and warfarin:
Gingko, garlic and ginseng = all have potential to prolong the pro-time (elevate INR).
use w/ inflammatory d/o can cause abnormal liver fxn/damage - irreversible; deaths reported
Comfrey:
