HAPharm Flashcards
What are the 3 primary HA?
Migraine, tension, cluster
What is the most prevalent primary HA
Tension
Which HA affects men more
Cluster
What is the pathophysiology behind migraines
1) vascular hypothesis: migraine pain is a result of cranial artery vasodilation
2) neuronal dysfunction: trigeminovascular system promotes inflammation
What are nonmodifiable risk factors for migraines
Gender, head injuries, level of education?
What are common medication triggers for migraine
Cocaine, nicotine, NTG, hormones, NSAIDS, cimetidine, nifedipine, fluoxetine
To be classified as a migraine without aura, it must have at least 3 symptoms. What are the 2 symptom categories
1) need 2.. aggravated by physical activity, pulsating, UL, moderate or severe pain
2) need 1…. N/V or photo/phonophobia
How do you diagnose a migraine w/ aura?
1) 2 lifetime attacks
2) 2 of the following….. homologous visual symptoms, UL sensory system, @ least one aura symptom over >/= 5 min or different aura symptoms developing in succession
3) one of the following, aura: fully reversible visual symptom, fully reversible dysphasic speech disturbance, fully reversible sensory symptom
What is the goal of short term and long term migraine treatment
ST: decrease severity and duration, restore ability to function
Lt: decrease number and severity of future migraine, improve quality of life
What is ACP-ASIM 1st line therapy recommendations for migraines
NSAID or combo
Step Therapy
What is USHC 1st line therapy?
Migraine specifics agents
stratified therapy
Nonspecific pharmacologic treatment for migraines includes what?
NSAIDS, analgesics, antiemetic, corticosteroids
Migraine specific tx for migraines includes what?
Ergot derivatives, 5-HT IB/ID agonist
When are NSAIDS 1st line? How do they help migraines?
Mild to moderate migraines
Inhibit prostaglandin synthesis, inhibits inflammation
What are the drug interactions w/ barbiturate combo treatments?
Decrease effect: phenothiazine, quinidine, cyclosporine, theophylline, beta blockers
Increase effects: chloramphenicol, benzos, CNS depressants
What are the ergot alkaloids?
MAO, ergotamine tartrate, dihydroergotamine
What are the ergotamine acute side effects ?
N/V, diarrhea, abdominal pain, weakness, leg cramp, tremor, dizzy, syncope, chest pain, intermittent claudication
What is syndrome of ergotism?
Peripheral ischemia, cold/ numb extremities, diminished peripheral pulses
Are ergotamines a 1st line choice? Why or why not?
No, because they are super constrictors SYSTEMICALLY
What are chronic side effects of ergotamines
Central/peripheral ischemic disorders, HTN, Tachy/brady, medicine overuse HA, renal D/O, withdrawal signs
What are ergotamine drug interactions?
CYP3A4 substrate SO interacts with strong w/ 3A4 inhibitors ( azole antifungals, macrolides, protease inhibitors) , triptans(additive vasoconstrictive effects) and fluoxetine, fluvoxamine (compete for metabolism)
What is 1st line tx for mod-severe migraines?
Triptans
How do triptans work?
Inhibit neuropeptide release from trigenimovascular nerves, interrupt pain signal with brain stem trigeminal nuclei
What are triptan drug interactions?
MAO-I/ SSRIs: inhibits clearance, increased risk of serotonin syndrome
Ergotamines: increased vasoconstrictive effects
What is serotonin syndrome? Is it a medical emergency?
Hyperthermia, muscle rigidity, myoclonus, rapid change in mental status and vitals- yes it is a medical emergency
When can you start prophylactic therapy for migraines?
If they are 2-3x month MINIMUM, predictive pattern, long lasting with severe impairment
What are 2st line prophylactic treatment? ADRS?
A)beta blockers: fatigure, vivid dreams, depression, impotence, bradycardia, hypotension
B) TCAs: sedation, constipation, blurred vision, hypotension,
How do anticonvulsants help with migraines?
Increased availability of GABA-inhibitory transmitter,
Anticonvulsant ADRS?
Tremor, wt gain, nausea, hair loss
What is the premise for CA channel blocker use? Examples?
Initial constriction that leads to HA
Verapamil, nimodipine, diltiazem
What drug can only be used for 6 months d/t side effect of fatal pulmonary fibrosis?
Methysergide- peripheral serotonin inhibitor and central serotonin agonist
What are some possible effective prevention natural treatments?
Butterbur, coenzyme Q10, feverfew, magnesium, and riboflavin
What is the pharmalogical treatment for tension HA?
Analgesics +/- caffeine, sedative, prophylactic
Which HA are UL, occur at night, and is often accompanied by ptosis and miosis
Cluster
Acute treatment for cluster HA?
Imitrex, O2, ergotamine +/- caffeine, DHE- 45, lidocaine nasal spray,
Is prophylaxis 1st line tx for cluster HA? What types?
NO, verapamil, prednisone, ergotamine, methysergide, lithium
