HA Flashcards
Pharm concept for attacking TTH
HIT hard and EARLY
–limit use to <9d/month of drugs to decrease risk of MOH
what increases risk of MOH
combination of analgesics; caffiene, butalbital, opioids
what decreases risk of MOH
long life NSAID–naproxen
initial therapy for TTH
ibuprofen/naproxen + APAP
in pt drug for TTH abortion
ketroalac
combination drug for TTH abortion
excedrin (caffiene + APAP+ ASA)
what should be used w/ pregnancy and TTH
APAP
what is the most helpful tool w/ Migranes
Headache Diary
important consideration for meds to treat migranes
consider non ORAL route
abortive meds for mild-mod migranes
NSAID +/- APAP
Traiptan
Ergot
what meds should be used for anti-emetics w/ migranes
IV dopamine if possible
metoclopramide
prochlorperazine
promethazine
what drug should ALWAYS be avoided with migranes?
OPIOIDS
Sumitriptan forumulations
tab
nasal spray
SQ
Triptan drugs
sumitriptan
zolmitriptan
short onset triptan
sumitriptan
Zolmitriptna
long onset triptan
frovatriptan
longest lasting triptan–good for repeat migranes in 1 day
frovatriptan and naratriptan
MOA of triptans
SSRI agonist causing vasoconstriction
what pts should not use triptans
HTN pts Pheo pts TIA history pts Raynauds pts "Vasculopaths"
what is the most effective route for migranes
SQ
if a pt doesn’t respond to a triptan what should you do?
try another one! pts can respond to different ones
what triptan is used with cluster HA?
sumitriptan
what drug do triptans interact with and should be avoided
with MAOI
what drug should not be given with triptans d/t similar effects
ergots and SSRI
what can propranol do if given with triptans? how should you alter your prescription?
increase concentration, you may need to decrease triptan doseage
what can propranol do if given with triptans? how should you alter your prescription?
increase concentration, you may need to decrease triptan dosage
what ergot do we use?
dihydroergotamine
what is the MOA of ergots?
similar to triptan–with serotonin agonists
when should ergots be used?
in pts who failed therapy with triptans
what is a GI ADR of drihydroergotamine?
diarrhea
what is a common drugs for migrane prophylaxis?
B-blockers
AEDS
Anti-depressants
who do we avoid B-blockers in?
asthmatics
HF pts
ppl w/ exercise intolerance
who should we use toprimate in?
adolescents & adults
what is important to know about divalproxe/VPA?
TERATOGEN
what anti-depressant is used?
amitriptyline
what is drug helpful w/ menstrual migraines?
OCP and esp. w/ extended cycle to skip periods and avoid the migranes
what can be done prophylactically for menstrual migranes
take triptan or nsaid 2d before menses & continue for 5-7 days
what are the CGRP antagonists?
Erenumab
Fremanzumab
Galcanzumab
what important about the formulation of the new CGRP drugs?
INJECTIONS
what is the mOA of CGRP antagonist??
vasodilator
inhibits pain signalling neutrotransmission
when do we use CGRPs?
when other meds AREN’T working or aren’t tolerated
what CGRP has a bad ADR? what is the ADR?
Erenumab–hypersensitivity rxn, angioedema, anaphylaxis
what migrane drugs can be used in pregnancy?
APAP
sumitriptan–category C
what drugs need to be avoided in pregnancy
nsaid–esp 3rd trimester
ergots
