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#Pharmacotherapeudics > Headache > Flashcards

Headache Flashcards

1
Q

what are the three high risk HAs

A

subarach hemorrhage
stroke
bacterial meningitis

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2
Q

Medications that cause _______ commonly trigger migraines

A

vasodilation

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3
Q

abortive migraine therapies work best if given ______(when), with __________(dose); however many oral agents are ineffective d/t __________

A

best if given early on in the course of the HA
Large single dose more effective than repetitive small doses
migraine induced gastric stasis

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4
Q

Use ________ meds in severe migraines or those who don’t respond to ________

A

migraine specific medications

or those who don’t respond the NSAIDs

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5
Q

What are the 2 migraine specific drug txs

A

ergot derivatives

5-HT1B/1D agonists

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6
Q

what 4 migraine non-specific txs are there

A

NSAIDs
Analgesics
Antiemetics
Corticosteroids

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7
Q

______ are 1st line for mild-mod migraines

A

NSAIDs

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8
Q

what are the 3 NSAIDs used for mild-mod migraine

A

ASA
naproxen
ibuprofen
(excedrin migraine)= APAP + ASA +caffeine

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9
Q

Intranasal _________ is a nonspecific (not 1st line) tx for migraine

A

lidocaine

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10
Q

_______ are reserved for severe migraines unresponsive to other txs

A

opioids (butorphanol nasal spray)

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11
Q

barbiturates in combo with _______ or _______ may be used for mod-severe migraine, but have a high potential for overuse

A

analgesics or codeine

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12
Q

what is the barbiturate used with asprin and caffeine for migraine tx? what are the possible drug interactions?

A

butalbital
(causes CNS depression)

effects reduced by barbiturates: phenothiazide, quinidine, cyclosporine, theophylline, and beta blockers
effects increased by barbiturates: chloramphenicol, benzodiazepines, CNS depressants.

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13
Q

what 3 antiemetics can be used as a monotherapy to tx migraine

A

metoclopramide (IV)
chlorpromazine (IV/IM)
prochlorperazine

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14
Q

antiemetic MOA and sfx(also how to manage these).

A

MOA: dopamine antagonist

sfx: QT prolongation, sedation, and dystonia and akathisia(restlessness)
mgmt: for dystonia and akathisia use diphenhydramine IV

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15
Q

MOA of Erot alkaloids

A

nonselective 5-HT(serotonin) agonist causes vasoconstriction of cranial blood vessels

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16
Q

name the 2 ergot alkaloids

A 
Ergotamine tartate (PO, SL, rectal)
dihydroergotamine (injection or spray)
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17
Q

Ergotamine acute sfx (3)

A

N/V (pretreat with antiemetic)
chest tightness
diminished periph pulses

18
Q

ergotamine chronic sfx (4)

A

ischemia
HTN
renal DO
tachy/brady

19
Q

CI for ergotamine (5)

A 
coronary or periph vasc dz
sepsis
pregnancy
renal/hepatic failure
*use of triptans w/in last 24hrs (b/c both vasoconstrict)
20
Q

triptans MOA

A

selective 5-HT agonist (vasoconst in brain)

21
Q

______ are 1st line for mod-severe migraine

A

Triptans

22
Q

name the 3 Triptans

A

Sumatriptan (PO, SQ, nasal)
Rizatriptan (oral)
Zolmitriptan (Oral nasal)
(taste perversion from nasal spray)

23
Q

triptan sfx (4)

A

chest tightness
dizziness
fatigue
nausea

24
Q

5 CI for triptans

A

Ergot in last 24hrs (inc vasoconstriction)
MAOI in last 2 wks (inhib clearance of triptan=serotonin syndrome)
Ischemic heart/CV dz
uncontrolled HTN
SSRI (serotonin syndrome)

25
Q

5 sx of serotonin syndrome

A

hyperthermia
musc rigidity
myoclonus
rapid change in mental status and vitals

26
Q

_______ and _______ are 1st line prophylactic tx for migraines

A 
beta blockers (esp propranolol)
TCAs (esp amitriptyline)
27
Q

Beta blockers CI (3)

A

periph vasc dz
depression
asthma

28
Q

TCA CI

A

glaucoma
pregnancy
(black box: inc suicide risk in teens)

29
Q

Venlafaxine MOA

A

SNRI (inhib SE and NE reuptake)

30
Q

Venlafaxine CI and cautions

A

BLACK BOX: suicide

CI: MAOI

31
Q

Valproic acid and divalproex sodium are ________ drugs which can treat migraine (NOT 1st line)

A

anticonvulsants

32
Q

MOA of anticonvulsants and CI

A

inc GABA availability

CI:liver dz

33
Q

Carbamazepine, topiramate, gabapentin

A

anticonvulsants that may be used to tx migraine

34
Q

Methylsergide

A

reserved for SEVERE migraines
perph SERotonin inhib but CENTRAL SERotonin agonist

Serious sfx: fatal pulm fibrosis

35
Q

Botulinum Toxin

A

not FDA approved (but shows promise for migraine)

inhib Ach release at presynaptic cholinergic jxn

36
Q

name 5 tx for intractable migraines

A 
DHE
Sumatriptan
Prochlorperazine or chlorpromazine
narcotics
corticosteroids
37
Q

3 drug tx classes for tension-type HA

A
  • analgesic +/- caffeine
  • sedatives (butalbital)
  • prophylactic (TCA)
38
Q

what 4 analgesics are used +/- caffeine for tension-type HA

A

APAP
ASA
Ibuprophen
Naproxen

39
Q

5 tx for acute cluster HA

A 
100% oxygen
Imitrex SQ
Ergotamine+/- caffeine
DHE-45
lidocaine nasal spray
40
Q

5 prophylactic txs for cluster HA

A 
verapamil
prednisone
ergotamine
methylsergide
lithium

#Pharmacotherapeudics (15 decks)

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