Headache Flashcards
1
Q
What are over-the-counter medicines (OTCs)?
A
Medicines that are safe and effective for use by the general public without a doctor’s prescription.
Also known as non-prescription medicines, used primarily for symptomatic relief.
2
Q
What is the importance of OTC medicines?
A
- Comparatively cheaper
- Increased trend for self-care
- Time-saving for patients
- Fewer side effects compared to prescription medications
Some OTCs may still cause severe complications with long-term use.
3
Q
List types of OTC medications.
A
- Analgesics (NSAIDS)
- Antibiotics
- Antitussives
- Anti acne drugs
- Antiseptics
- Decongestants
- Antacids
- Antifungals
- Antihistamines
- Smoking cessation drugs
4
Q
What are some challenges/risks associated with OTC medications?
A
- Delay in seeking medical advice
- Drug-drug/herbal interactions
- Risk of adverse events
- Potential for dependence, misuse, and abuse
- Can mask symptoms of disease
- Risk of overdose
5
Q
What are topical antibiotics?
A
Medicines applied to the skin to kill bacteria, used to treat or prevent infections on minor cuts, scrapes, and burns.
Examples include Metronidazole, Benzoyl peroxide, neomycin.
6
Q
Define antitussives.
A
Medicines that prevent or stop coughing, used for treating dry coughs.
Cough expectorants are used in productive coughs.
7
Q
What are analgesics used for?
A
Medicines used to alleviate pain, some also possess anti-inflammatory and antipyretic properties.
Not all analgesics are NSAIDS.
8
Q
What are antiseptics?
A
Lotions, creams, or ointments used to slow or stop the growth of microbes and help prevent infections in wounds, scrapes, and burns.
9
Q
What are decongestants used for?
A
Medicines used to relieve nasal congestion during cold or catarrh.
Examples include oxymetazoline and pseudoephedrine.
10
Q
What are antihistamines used to relieve?
A
Symptoms of allergy such as itchy eyes, sneezing, and runny nose.
Examples include Promethazine and cetirizine.
11
Q
What special patient groups should pharmacists pay attention to?
A
- Children
- Pregnant or breastfeeding mothers
- Geriatric patients
- People with co-morbid conditions
- Immunocompromised individuals
12
Q
What is the primary aim of OTC counseling?
A
To provide assistance with OTC product selection and explain how to use the medication.
13
Q
Define headaches.
A
Pain in the head or upper neck, which may be associated with various diseases.
14
Q
What percentage of the global population experiences headaches at least once a year?
A
About 50%.
15
Q
What are the causes of headaches?
A
- Diseases of nearby structures
- Cardiovascular or neurologic origin
- Extracranial pain sensitive structures
- Intracranial pain sensitive structures
16
Q
What are the classifications of headaches according to ICHD III?
A
- Primary
- Secondary
- Painful cranial neuropathies
17
Q
What characterizes primary headaches?
A
They are not associated with any disease or structural problem of the brain.
Examples include tension-type headache, migraine, and cluster headache.
18
Q
What characterizes secondary headaches?
A
They are associated with diseases affecting structures of the head and brain.
Examples include ENT infections, high blood pressure, and meningitis.
19
Q
What are some symptoms of migraine?
A
- Moderate to severe unilateral pulsating headaches
- Phonophobia
- Nausea
- Photophobia
- Vomiting
20
Q
What are the phases of a migraine attack?
A
- Premonitory
- Aura
- Headache
- Postdromal
21
Q
What are common triggers for migraine headaches?
A
- Diet (e.g., gluten, caffeine)
- Hormonal changes
- Stress
- High altitudes
- Weather changes
22
Q
What is the primary aim of managing migraine?
A
To reduce the pain and duration of the attack.
23
Q
What medications are recommended for mild/acute migraine attacks?
A
- Simple analgesics (e.g., Naproxen, Paracetamol, ibuprofen)
- Anti-emetics (e.g., domperidone, metoclopramide)
24
Q
What is a first-line treatment for moderate to severe migraine?
A
Triptans (5HT1 agonist) such as sumatriptan and almotriptan.
25
What are prophylactic treatments for migraine?
* β-blockers (e.g., propranolol)
* Anticonvulsants (e.g., gabapentin, topiramate)
* Tricyclic antidepressants (e.g., amitriptyline)
26
What is prophylaxis in the management of migraine?
Used in patients with too frequent attacks, often taken daily for ≤ 3 months.
27
Name two types of β-blockers used for migraine prophylaxis.
* Propranolol 10mg q8hr
* Propranolol 40-80mg q8hr
28
Which anticonvulsants are used for migraine prophylaxis?
* Gabapentin
* Topiramate 25-200mg
* Sodium Valproate
29
What are the common tricyclic antidepressants used for migraine management?
* Amitriptyline 10-75mg
30
Which other medications are used for migraine prophylaxis?
* Candesartan
* Flunarizine
* Pizotifen (0.5mg nocte increasing to 1.5mg)
31
What role does melatonin play in migraine management?
Stimulates the hypothalamus to induce sleep and prevent migraine.
32
What dietary recommendations are beneficial for migraine sufferers?
* Low fat diet high in omega 3,6
* Low glycemic diets
* Avoiding monosodium glutamate, caffeine, alcohol
33
What are the three main OTC oral analgesics for migraine?
* Aspirin
* Ibuprofen
* Paracetamol
34
What is the primary action of aspirin and ibuprofen?
NSAIDs act locally at the site of inflammation.
35
What are common side effects of aspirin and ibuprofen?
* Gastric irritation
* Bleeding
36
In what scenarios should aspirin and ibuprofen be avoided?
* Patients with PUD
* Renal, cardiac, or hepatic disease
* During pregnancy unless benefits outweigh risks
37
What are the characteristics of chronic migraine treatment?
Botulinum toxin recommended in patients unresponsive to at least three prophylactic treatments.
38
What are CGRP inhibitors used for in migraine treatment?
New medications administered once a month, e.g., fremanezumab, erenumab.
39
What non-pharmacological treatment has shown significant outcomes in reducing migraine frequency?
Aerobics demonstrated a 70% outcome in reducing frequency, severity, and duration of attacks.
40
What is the most common cause of tension-type headache?
Pericranial muscle contraction.
41
How many people globally are affected by tension-type headaches?
Over 70 million people.
42
What is the typical presentation of tension-type headaches?
Generalized, mild-to-moderate constant dull or tight pressure pain.
43
What are common triggers for tension-type headaches?
* Stress
* Depression
* Noise
* Fumes
44
What management strategies are recommended for tension-type headaches?
* Reassurance
* Avoidance of precipitating causes
* Ice bags on temples
* Deep tissue massage
* Treatment of underlying anxiety and depression
45
What characterizes cluster headaches?
Severe, unilateral, short-acting retro-orbital pain with conjunctival injections and nasal congestion.
46
What is the typical frequency of cluster headache attacks?
1-8 times per day.
47
What are the symptoms associated with cluster headache attacks?
* Partial ptosis
* Miosis of one eye
* Agitation
* Restlessness
48
Which neurotransmitters are involved in the pathophysiology of cluster headaches?
Calcitonin gene-related peptides (CGRP) and vaso-inhibitory peptides (VIP).
49
What is the first-line treatment for acute cluster headache attacks?
Oxygen 100% at about 7-12 l/min.
50
Name two medications indicated for prophylaxis of cluster headaches.
* Lithium
* Verapamil
51
What is the response of benign paroxysmal hemicrania to indomethacin?
Responds very well compared to other medications.
52
What are the key features of secondary headaches?
* Pressure headaches due to intracranial mass lesions
* Traction inflammation or compression of the brain
53
What are the signs of giant cell arteritis?
* Jaw claudication
* Headaches
* Unilateral visual loss
* Tongue ulceration
54
What is the common treatment for idiopathic intracranial hypertension?
* Acetazolamide
* Topiramate
* Frusemide
* Mannitol
55
What is the first-line treatment for trigeminal neuralgia?
Carbamazepine.
56
What differentiates primary headaches from secondary headaches?
Primary headaches are non-life threatening, while secondary headaches can be life-threatening.
57
What are the common causes of toothache?
* Tooth decay
* Dental cavities
* Dental abscess
58
What is the common treatment for dental pain?
* Diclofenac
* Ibuprofen
* Aspirin
* Paracetamol
59
What is the typical presentation of a patient with cluster headaches?
Severe unilateral headache, conjunctival injections, facial swelling, and unproductive at work.
60
What lifestyle changes can help manage tension-type headaches?
* Good quality sleep
* Meditation
* Avoid electronics and lights in the bedroom
61
What type of headache is characterized by severe unilateral headache without aura, conjunctival injections, and facial swelling, lasting about 15 minutes?
Cluster headache
## Footnote
Cluster headaches occur in cyclical patterns or clusters, often causing severe pain.
62
What is the first-line management approach for a cluster headache?
Oxygen therapy and triptans
## Footnote
Oxygen therapy can provide rapid relief during an attack.
63
What are the components of the musculoskeletal system?
* Bones
* Joints
* Muscles
* Tendons
* Ligaments
* Bursae
## Footnote
Bursae are fluid-filled sacs that reduce friction between tissues.
64
What is a contusion?
A soft tissue injury produced by blunt force, leading to bleeding into soft tissues
## Footnote
Local symptoms include pain, swelling, and reddening.
65
How long does it typically take for most contusions to resolve?
1 to 2 weeks
## Footnote
Healing time may vary depending on the severity of the injury.
66
What is a strain?
A muscle pull caused by overuse, overstretching, or excessive stress
## Footnote
Strains are microscopic muscle tears with local tenderness.
67
Define a sprain.
An injury to ligaments surrounding a joint caused by a wrenching or twisting motion
## Footnote
Sprains can lead to joint instability and pain.
68
What are the signs and symptoms of a joint dislocation?
* Swelling
* Inability to place weight on the limb
* Extreme tenderness
* Visible deformity of the joint
* Pain during movement
## Footnote
Dislocations may require prompt medical attention to avoid complications.
69
What acronym is helpful for remembering the treatment interventions for sprains and strains?
RICE (Rest, Ice, Compression, Elevation)
## Footnote
This method helps relieve pain and reduce swelling.
70
What are common treatments for musculoskeletal pain?
* Oral analgesics
* Topical NSAIDs (e.g., Diclofenac)
* Opioids (e.g., tramadol)
## Footnote
Topical NSAIDs are used for backache, rheumatic pain, sprains, and strains.
71
What is the major cause of mortality and morbidity in children under 5 years?
Malaria
## Footnote
It is particularly deadly in children, immunocompromised individuals, and pregnant women.
72
What are the recommended interventions to curb malaria according to WHO?
* Vector control
* Chemoprevention
* Diagnostic testing
* Treatment
## Footnote
Effective treatment and prevention strategies are crucial for reducing malaria incidence.
73
What is the mode of malaria transmission?
Bite by infected female Anopheles mosquito
## Footnote
Other modes include congenital transmission and blood transfusions.
74
What are the symptoms of uncomplicated malaria?
* Fever
* Chills
* Sweating
* Headache
* Loss of appetite
## Footnote
Symptoms may vary, especially in children.
75
What is the 3T policy in malaria management?
Test, Treat, and Track
## Footnote
This policy emphasizes early diagnosis and effective treatment.
76
What is the first-line treatment for uncomplicated malaria in children and adults?
* Artesunate + Amodiaquine
* Artemether + Lumefantrine
* Artesunate + Pyronaridine
## Footnote
Treatment regimens may vary based on the patient's age and condition.
77
What are the signs of severe malaria?
* Poor oral intake
* Dark or cola-like urine
* Altered consciousness
* Severe anemia
## Footnote
Severe malaria requires immediate medical intervention.
78
What is the treatment approach for severe malaria?
* Supportive care
* IV/I.M. Artesunate
* IV Quinine
## Footnote
Treatment may involve multiple interventions to stabilize the patient.
79
What medications could be considered in suspected treatment failure of severe malaria?
i.v. artesunate + i.v. quinine
## Footnote
These medications are used when there is a suspicion of treatment failure.
80
Which parenteral preparations are safe to treat severe malaria during pregnancy?
All except artemether, which is safe only in the 2nd and 3rd trimesters
## Footnote
Artemether is contraindicated in the 1st trimester.
81
What is the preferred treatment for children under 6 years with severe malaria?
Artesunate, rectal, 10 mg/kg
## Footnote
Followed by a complete full three-day course of oral ACTs.
82
What are alternative treatment regimens in the absence of usual ACTs?
* Artesunate + Doxycycline
* Artesunate + Clindamycin
* Doxycycline + Quinine
83
What is the treatment for hypoglycemia in severe malaria?
i.v. Dextrose 10% or 50%
## Footnote
This is critical in managing hypoglycemia associated with severe malaria.
84
What is the recommended management for severe anemia in malaria?
Transfusion with screened fresh whole blood
## Footnote
Special consideration is needed for patients with blood refusal due to religious beliefs.
85
What are the recommended treatments for hyperpyrexia in severe malaria?
* Paracetamol
* Tepid sponging
## Footnote
NSAIDs should be used cautiously to prevent renal impairment and Reye’s syndrome in children.
86
How can convulsions in severe malaria be managed?
With benzodiazepines: diazepam, midazolam, lorazepam
87
What characterizes treatment failure in malaria?
Recurrence of asexual parasitemia within 4 weeks (28 days) after treatment due to recrudescence
## Footnote
Treatment failure may indicate drug resistance or inadequate exposure.
88
What factors may contribute to treatment failure in malaria?
* Inadequate exposure to the drug
* Sub-optimal dosing
* Poor adherence
* Vomiting
* Substandard medicines
* Drug-drug interactions
89
What should be added to the regimen for patients not responding to repeated doses of ACTs?
Primaquine
## Footnote
It helps to clear hypnozoites from the liver.
90
What are the contraindications for using ACT + Primaquine?
* G6PD deficient patients
* Pregnant women
* Children under 6 months
* Breastfeeding mothers feeding children < 6 months
91
What complications does malaria pose to pregnant women?
* Miscarriage
* Pre-term labor
* Post-partum hemorrhage
92
What risks does malaria pose to the fetus?
* Fetal anemia
* Prematurity
* Placental parasitemia
* Low birth weight
* Stillbirth
93
What does WHO recommend for pregnant women in areas with moderate to high malaria transmission?
* Long Lasting Insecticide Nets (LLIN)
* Indoor Residual Spraying (IRS)
* Effective case management
* IPTp - at least three SP doses in 2nd trimester
94
What is IPTp and when should it be administered?
IPTp refers to intermittent preventive treatment in pregnancy, given at least three SP doses in the 2nd trimester at one-month intervals.
95
What is the role of LLIN in malaria prevention?
To provide a barrier against mosquito bites
## Footnote
Long Lasting Insecticide Nets are crucial for preventing malaria transmission.
96
What herbal preparations are recommended by MOH/FDA for malaria?
* Cryptolepis sanguinolenta
* Morinda lucida
* Khaya senegalensis
* Cassia occidentalis
* Azadirachta indica
97
What are the characteristics of an infection?
Invasion of bodily tissue by pathogenic microorganisms resulting in tissue injury
## Footnote
An infection may be asymptomatic or symptomatic.
98
What is a primary infection?
Initial infection with an organism to host
99
What defines a secondary infection?
A new infection occurring in a host whose resistance is lowered by a pre-existing infection
100
What is a local infection?
An infection limited to a defined area or single organ with symptoms resembling inflammation
101
What is a systemic infection?
An infection that spreads throughout the whole body resulting in septicemia
102
What distinguishes an acute infection from a chronic infection?
Acute infections appear suddenly and last a short period, while chronic infections occur slowly over a long period
103
What is an iatrogenic infection?
An infection resulting from therapeutic and diagnostic procedures
104
What is a nosocomial infection?
An infection contracted from the environment or staff of a healthcare facility
105
What are the steps in the chain of infection?
* Causative Agent
* Reservoir
* Portal of Exit
* Mode of Transmission
* Portal of Entry
* Susceptible Host
106
Who is at risk of infection in a healthcare setting?
* Staff
* Clients
* Community
107
What is the first step in breaking the chain of infection?
Proper cleaning with water and mechanical action
108
What are high-level disinfectants mentioned in infection control?
* Sodium hypochloride 1%
* Carbolic solution 5%
* Bleaching powder 1%
109
What measures can control or eliminate the reservoir of infection?
Immunization
## Footnote
Other measures may include proper waste disposal and hygiene practices.
110
What precautions should be taken to prevent the portal of exit?
* Practice aseptic precautions
* Wear masks and gloves
111
What are the contact precautions to prevent mode of transmission?
* Hand hygiene
* Gloves where necessary
* Clean and disinfect non-disposable materials
112
What hygiene practices help prevent portal of entry infections?
* Personal hygiene
* Appropriate disposal of waste
113
What is the role of a community pharmacist in antibiotic stewardship?
To promote the appropriate use of antibiotics and minimize resistance
## Footnote
This includes patient education and adherence monitoring.
