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Pharm II exam 3 > Headache > Flashcards

Headache Flashcards

1
Q

what is a Medication-overuse HA or Rebound HA?

A

frequent or excessive use of acute migraine medications

HA returns as the med wears off

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2
Q

How many days per month can you take acute migraine therapies in order to avoid med-overuse ha’s?

A

fewer than 10 days per month

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3
Q

Presentation for migraine ha?

A

Recurring episodes of throbbing head pain

frequently unilateral
untx’d can last from 4-72 hrs

assoc w/ N/V and sensitivity to light, sound, and/or movement

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4
Q

Pathogenesis for migraine ha’s?

A

complex dysfunctions in neuronal and broad sensory processing

Activation of trigeminal sensory nerves triggers the release of vasoactive neuropeptides –> promote vasodilation and dural plasma extravasation –> neurogenic inflammation

sensitization of central sensory neurons, producing a hyperalgesic state that responds to previously innocuous stimuli and maintains the headache

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5
Q

OTC acute migraine therapies?

A

Analgesics- Acetaminophen, and aspirin/caffeine (excedrin migraine)

NSAID’s - Aspirin, Ibu, Naproxen, diclofenac

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6
Q

What are some Rx meds to tx acute migraines?

A

TRIPTANS

serotonin agonists (triptans
sumatriptan (imitrex)
Zolmitriptan

Metoclopramide and prochlorperazine

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7
Q

what are 2 older acute migraine therapies?

A

ergotamine tartrate and dihydroergotamine

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8
Q

ergot MOA for?

A

5-HT1 receptor agonists

Constrict intracranial blood vessels and inhibit the development of neurogenic inflammation in the trigeminovascular system

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9
Q

Triptan MOA?

A

Selective agonists of the 5-HT1B and 5-HT1D receptors

  1. normalization of dilated intracranial arteries through enhanced vasoconstriction
  2. inhibition of vasoactive peptide release from perivascular trigeminal neurons
  3. inhibition of transmission through second-order neurons ascending to the thalamus
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10
Q

appropriate 1st line therapy for pt’s w/mild to severe migraines?

A

TRIPTANS

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11
Q

what is the max daily dosage for sumatriptan alone? and a combination product of sumatriptan and naproxen?

A

200mg

combo = 85/500mg

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12
Q

what dose should you given of Rizatriptan if a pt is also on propranolol?

A

5mg (15mg/day max)

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13
Q

what medication should you given along with ergotamine tartrate?

A

pretreatment of anti-emetic

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14
Q

Patient education for nasal spray dihydroergotamine?

A

prime sprayer 4x before using

do not tilt head back or inhale through nose while spraying

discard open ampules after 8 hours

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15
Q

what 2 meds are useful for acute relief of migraine in office or ER setting?

A

metoclopramide (reglan)

prochlorperazine (compazine)

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16
Q

Triptan ADE’s

A

“triptan sensations”

tightness, pressure, heaviness, or pain in the chest, neck, or throat

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17
Q

MOA for sumatriptan

A

5-HT1D agonist
• causes vasoconstriction
• modulates neurotransmitter release

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18
Q

clinical applications for triptans?

A

migraine and cluster headache

19
Q

P-kinetics for sumatriptan?

A

oral, inhaled, parental

duration = 2-4hrs

20
Q

toxicities and interactions for triptans?

A

paresthesias, dizziness, CP and possible coronary vasospasm

21
Q

triptans syndrome can cause…

A

serotonin syndrome:
neuroleptic malignant syndrome
malignant hyperthermia

22
Q

therapy if pt gets serotonin syndrome??

A

Sedation (benzodiazepines), paralysis, intubation and ventilation

23
Q

presentation of serotonin syndrome?

A

Hyperthermia, hyperreflexia, tremor, clonus, HTN, hyperactive bowel sounds, D, mydriasis, agitation, coma

onset w/in hours

24
Q

presentation of neuroleptic malignant syndrome?

A

Hyperthermia, acute severe parkinsonism; hypertension, normal or reduced bowel sounds, onset over 1–3 days

25
Q

tx for neuroleptic malignant syndrome??

A

Diphenhydramine (parenteral)

also, cooling if temp is very high, sedation w/ benzodiazepines

26
Q

presentation of malignant hyperthermia?

A

Hyperthermia, muscle rigidity, HTN, tachycardia; onset w/in minutes

27
Q

therapy for malignant hyperthermia?

A

dantrolene, cooling

28
Q

what can be used for preventative therapy for migraine headaches?

A

Butterbur

FDA approved agents
- Propranolol, Timolol, Divalproex sodium, topiramate

29
Q

when should consider preventative therapy for migraines?

A

in the setting of recurring migraines that produce significant disability despite acute therapy

  • more than 2x per week d/t risk of med overuse HA
  • sx. therapies ineffective or contraindicated
30
Q

when do you see max benefits of therapeutic trial of preventative therapy?

A

by 6 mo’s of tx

31
Q

prophylactic tx for migraines?

A

at least 6-12 mo’s after frequency and severity of ha’s have diminished

32
Q

what are some prophylactic migraine therapies?

A 
atenolol
metoprolol
nadolol
*propranolol
timolol

amitriptyline
venlafaxine
topiramate
valproic acid

*ibuprofen
ketoprofen
naproxen

frovatriptan
naratriptan
zolmitriptan

magnesium
MIG-99
riboflavin
melatonin
butterbar
33
Q

what drug is recommended for menstrual migraine prevention?

A

ibuprofen

frovatriptan - taken in perimenstrual period

34
Q

Mechanism of pain in chronic tension-type ha?

A

myofascial factors and peripheral sensitization of nociceptors

central mechanism – heightned sensitivity of pain pathways in the CNS

35
Q

nonpharm tx options for tension-type HA

A

CBT (stress, relax training, biofeedback)

heat/cold packs, U/S, massage, acupuncture, manipulations, trigger point injections

36
Q

pharm tx’s for tension ha’s?

A

simple analgesics (acetominophen) or NSAID’s

high dose NSAIDs and combo of ASA or acetaminophen w/butalbital

37
Q

Acute medications should be taken for episodic tension-type headache no more than

A

3 days (butalbital-containing)

9 days (combination analgesics)

or 15 days (NSAIDs) per month to prevent the development of chronic tension-type headache

38
Q

preventative therapy for tension-type HA’s?

A

Similar to those for migraine headache

TCAs (tricyclic antidepressants)

39
Q

cluster ha features?

A

excruciating, unilateral head pain that occur in series lasting for wks or mo’s (i.e., cluster periods) separated by remission periods usu lasting months or years

Activation of the ipsilateral hypothalamic gray area

40
Q

hallmark of cluster ha’s

A

circadian rhythm of painful attacks.

41
Q

cranial autonomic sx. assoc. w/cluster ha’s

A 
Conjunctival injection
Lacrimation
Nasal stuffiness
Rhinorrhea
Eyelid edema
Facial sweating
Miosis/ptosis
42
Q

Abortive therapy for cluster ha’s?

A

oxygen 100% by nonbreather facial mask 12L/min for 15 to 30 mins

triptan injections or sprays&raquo_space; oral

Ergotamine Derivatives–> Clinically IV dihydroergotamine , or ergotamine tartrate

43
Q

1st line prophylactic therapy for prevention of cluster ha’s?

A

Verapamil – given 2-3wks before benefit

44
Q

Prophylactic therapy options for cluster ha?

A

verapamil
lithium
corticosteroids (prednisone)

also, intranasal lidocaine, hyperbaric oxygen, subQ octreotide

Pharm II exam 3 (8 decks)

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