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Pharm II exam I Luis > HA > Flashcards

HA Flashcards

1
Q

• What is Rebound HA?

* 1 of MC chronic headaches*

A

• A HA that occurs after the use of medication.

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2
Q
  • When are Triptans use?

* How often should Triptans be used?

A
  • In Men with frequent HA

* Used no more than 10 days / Month

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3
Q

• What HA is unilateral, lasts up to 72 hrs, and is associated with N/V and photophobia?

A

• Migraines

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4
Q

T/F: Migraines are associared with complex neural and sensory dysfunction

A

True

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5
Q

• Migraine pain and symptoms are due to _______ and __________

A

• Neural suppression and Subcortical and Trigenimal activation

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6
Q

• Afferent fibers (Peripheral) that innervate the pain-sensitive intracranial blood vessels, dura mater, and venous sinuses are associated with ________ ____

A

• Migraine Pain

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7
Q

______ Pain transmission travels from the meningeal blood vessels to CNS

A

Nociceptor

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8
Q

Activation of _______ sensory nerves triggers the release of ______ _______

A

• Trigeminal
• Vasoactive neuropeptides
(Calcitonin gene (CGRP), Neurokinin A, substance P)

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9
Q

Neuropeptides promote ______ and dural plamsa extravasation, resulting in_____ _______.

A
  • Vasodilation,

* Neurogenic inflammation

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10
Q

Sensitization of central sensory neurons produce a ________, that responds to previously ______ stimuli.

A
  • Hyperalgesic

* Innocuous

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11
Q

• Vasodilation results in ____ ___ ____ the releases ______ _______ to promote neurogenic inflammation

A
  • Perivascular trigeminal nerves

* Vasoactive neuropeptides

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12
Q

T/F: 5-HT mediates migraine HA

A

True

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13
Q

What are the goals of Long-time migraine?

A

• Reduce Migrain frequency, severity and disability.

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14
Q

What are acute OTC Migraine meds?
• Analgesic (2)?
NSAIDs (4)

A
  • Acetaminophen (tylenol), Excedrin

* ASA, Ibuprofen, Naproxen Na, Diclofenac

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15
Q

What are the older migraine therapies?

A
  • Ergotamine Tartate

* Dihydroergotaime

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16
Q

How do Ergots (non-selective 5-HT) work?

A

• non-selective 5-HT: Constrict intracranial blood vessel inhibit neurogenic inflammation of trigeminovascular system. Central inhibition of Trigeminovascular receptors

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17
Q

• What do selective agonists 5-HT b/d do?

A
  • Inhibition of vasoactive peptide

* Inhibits transmission of 2nd order neurons (ascending thalamus)

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18
Q

Sumatriptan
• IV max does = _____
• Orally mixed with ______
• How many sprays with nasal Spray?

A
  • 12mg
  • Naproxen
  • 1 spray
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19
Q

Rizatriptan’s max dose is?

A

• 5-mg (15 mg/day) if mixed propranolol

20
Q

What do you pretreat before giving Ergotamine Tartrate?

A

• Antiemetics

21
Q
  • Do you tilt you head while spraying Dihydroergotamine?

* When can you discard the ampulses?

A

Don’t tilt head

• after 8 hours.

22
Q

What to migraine therapies are used in acute relief in the office/ED?

A

Metoclopramide & Prochlorperazine

23
Q

• What are the sxs of Triptan sensation

A

• Tightness, pressure, heaviness, pain in the chest, neck, or throat.

24
Q

• What medication treats Migraines and Cluster headaches, and can cause Paresthesia, dizziness, and coronary vasospasm

A

• Sumatriptan

25
Q

What drug class can cause Serotonin Syndrome?

A

Benzos = Sedation, paralysis, intubation, and ventilation

26
Q

What drug treats Neuroleptic Malignant syndrome?

A

• Diphenhydramine - blocks D2, antipsychotic

27
Q

What drug treats Malignant Hyperthermia?

A

Dantrolene - volatile anesthetic (succinylcholine)

28
Q

• When should you give preventative therapy for migraines?

A

• when migraine HA are occuring 2+/week

29
Q

• What are the FDA approved Preventative Migraine meds?

A 
• Propranolol
• Timolol
• Divalproex Sodium
• Topiramate
(Post the damn test - Mcleod)
30
Q

• How long should prophylactic Tx be?

A

6-12 months after diminished HA

31
Q

• What med can decrease Migraine Frequencies in 3-6 months?

A

CGRP inhibitors - monoclonal antibodies ( -zumabs)

32
Q

• What prophylactic migraine drug is short acting and taken 2/3 x per day

A

Propanolol

33
Q

• When can Ibuprofen be used for Migraine HA?

A

Menstrual migraine prevention

34
Q

• What medication is taken in the perimestrual period to prevent menstrual migraines?

A

Frovatriptan

35
Q 
What type of HA is this?
• Pain behind browbone/cheeks
• Pain behind eye
• Squeezing band pain
• Pain Nausea, photophobia
A
  • Sinus
  • Cluster
  • Tension
  • Migraine
36
Q
  • what is the most common primary HA?

* what causes this HA?

A

• Tension HA
• From Myofascial and peripheral nociceptor sensitization.
* Heightened pain pathway to in CNS

37
Q

• What are the 3 major treatment options for Tension HA?

A
  • CBT
  • Analgesics (acetaminophen)
  • NSAIDS (ASA, Diclifenac, Ibuprophen, Naproxen, Ketoprofen, Ketorolac)
38
Q

What are the maximum number of days to take
• Butalbital medication
• Analgesic Combos
• NSAIDS

A
  • 3 days
  • 9 days (Anagesic = 9 letters)
  • 15/ Month
39
Q

What meds prevent Tension HA?

A
  • TCAs
  • SSRIs
  • SNRIs (only Mitrazapine and Venlafaxine)
  • Topiramate
  • Gabapentin
  • Botulism
40
Q

What HA type causes excruciating, unilateral pain that lasts for months?

A

• Cluster

41
Q
  • What part of the brain modulates Cluster HA?

* What is the Hallmark of Cluster Headaches (rhythms)?

A
  • Ispilateral hypothalamic grey area

* Circadian rhythm

42
Q

T/F: The Midbrain secondarily activates trigenimal-autonomic reflexes?

A

False

• the Hypothalamus secondarily activates.

43
Q

• What headache benefits from sitting in a quiet, dark room?

A

• Migraines,

* Cluster patients rock or pace clutching their head*

44
Q
  • What headache is treated with 100% Oxygen at 12 L/Min for 30 mins?
  • Also treated with spray triptans or oral zolmitriptan?
A

Cluster HA

45
Q
  • What is 1st Line Cluster HA treatment?
  • Why give a patient Lithium?
  • Can I give corticosteroids?
A
  • Verapamil (1st line)
  • Lithium in patients with thyroid and renal function.
  • Yes - Prednisome

Pharm II exam I Luis (5 decks)

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