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Pharmacology > HEADACHE > Flashcards

HEADACHE Flashcards

1
Q

What is the cause of rebound headaches?

A

simple and combination analgesics

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2
Q

How many days should you limit medication use for migraines?

A

<10 days/month

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3
Q

POUND mnemonic

A

pulsating headache with duration of 4-72 hrs, unilateral, nausea, and vomiting and disabling

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4
Q

What are non pharmacological treatments?

A

sleep
dark room
cold compress

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5
Q

What are the 4 stages of a migraine?

A
  1. premonitory symptoms-24 hours prior to onset of migraine attack, vague and vegetative symptoms
  2. Aura-focal neurological deficits
  3. Headache-unilateral, throbbing, photophobia and phonophobia
  4. Post drome: malaise, fatigue,
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6
Q

What is cortical spreading?sensitization?

A
  • causes aura
  • prolonged activation of trigeminal nerve
  • hyper excitable trigeminal nerve release sub P and CGRP leading to vasodilation and neurogenic inflammation
  • sensitization: neuron response to nociceptive and non nocipective receptors
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7
Q

T/F Blood brain barrier is altered by metalloproteinase activation and upregulation

A

TRUE

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8
Q

What is the prototype of triptans?routes?

A

Sumatriptan

given as oral, injection, and nasal

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9
Q

What is MOA of triptans?

A
  1. Bind 5-HT1B and 5-HT1D receptors
    - enhanced vasoconstriction
    - inhibition of pain transmission
    - inhibition of vasoactive release of peptides from trigeminal neurons
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10
Q

When do you use triptans?

A

first line therapy for moderate to severe migraines

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11
Q

What is clinical use sumatriptan?

A

Migraines

Cluster headaches

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12
Q

What are ADE of triptans?

A

coronary spasm, chest pain, parasthesias, dizziness

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13
Q

What pt should avoid triptans?

A

uncontrolled HTN, PAD, brainstem or hemiplegic migraine

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14
Q

what is “triptan sensation”?

A
  • chest pain
  • chest tightness
  • chest heaviness
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15
Q

What are drug interactions with triptans?

A

MAO-I and ergotamines

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16
Q

Which triptans are used for patients that have long duration migraines?

A

Fovatriptan

Naratriptan

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17
Q

Which triptan needs to be given at 5mg if taking propanolol?

A

Rizatriptan

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18
Q

Which drugs can cause seratonin syndrome? 7

A
  • SSRI
  • fentanyl
  • meperidine
  • sumatriptan
  • St. Johns Wart
  • tramadol
  • linezolid
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19
Q

What are the symptoms of seratonin syndrome?

A
  • hyperthermia
  • clonus
  • agitation
  • tachycardia
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20
Q

What is tx for seratonin syndrome?

A
  1. benzos, intubation, ventilation

2. 5-HT2 blockers chlorpromazine or cyproheptadine

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21
Q

Which drugs cause neuroleptic malignant syndrome

A

D2 blocking anti psychotics

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22
Q

What is CP of neuroleptic malignant syndrome?

A
  • reduced bowels
  • parkinsonism
  • hyperthermia
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23
Q

what is tx for neuroleptic malignant syndrome?

A

diphenhydramine parenteral

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24
Q

What is the drug that causes malignant hyperthermia?

A
  • volatile anesthetics

- succinylcholine

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25
Q

What is tx for malignant hyperthermia?

A

Dantrolene

cooling

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26
Q

What is MOA Lasmitditan?

A

binds 5-HTF1 receptor that reduces stimulation of the trigeminal nerve but DOES NOT vasoconstrict

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27
Q

What are ADE of Lasmiditan?

A

palpitations, chest discomfort,

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28
Q

What is MOA of CGRP antagonists?

A
  • block CGRP receptors
  • blocks neurogenic inflammation
  • decreases artery vasodilation
  • blocks transmission of pain from trigeminal nerve to trigeminal nucleus accumbens
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29
Q

Name two CGRP antagonists?

A

Rimegapant

Ubrogepant

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30
Q

What are ADE of ubrogepant?

A

CNS drowsiness

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31
Q

When should you avoid use of CGRP antagonists?

A
  • hepatic impairment

- drugs that are CYP3A4-Inhibitors (increase drug concentration)

32
Q

what is ADE of both ubrogepant and rimepagant?

A

xerostomia , GI nausea

33
Q

What is clinical use of CGRP antagonists?

A

acute migraine

34
Q

Name three CGRP monoclonal antibodies?

A
  • erenumab
  • Fremanezumab
  • Glacanezumab
35
Q

What is MOA of CGRP monoclonal antibodies?

A

Ab block the CGRP ligand and blocks its binding to the receptor

36
Q

what are benefits of using CGRP antibodies?

A
  • long half lives with once monthly administration

- they act at the periphery and thus avoid CNS side effects

37
Q

what are the ADE of CGRP antibodies?

A
  • flu like symptoms
  • development of neutralizing antibodies
  • constipation
  • muscle cramps
38
Q

what is the clinical use of CGRP antibodies?

A

prevention of migraines

39
Q

What is the MOA of ergotamines?

A
  • nonselective 5-HT1 receptor agonists
  • vasconstricts intracranial blood vessels
  • central inhibition of the trigeminalvascular system
40
Q

what is clinical use of ergotamines?

A

-rescue drug

41
Q

Name two ergotamines?

A

Ergotamine tartrate

Dihydroergotamine

42
Q

What is route of Ergotamine tartrate?which are treated with an anti emetic?

A
  • rectal
  • sublingual
  • oral PO
  • rectal and oral routes are treated with anti emetics
43
Q

What is route of delivery for Dihydroergotamine?

A

Injection

Nasal spray: prime spray 4 times in nose, dont tilt head back, discard open ampule after 8 hrs

44
Q

who should avoid ergotamines?

A

PAD, HTN, people on triptans, coronary artery disease

45
Q

Who gets preventive therapy for migraines?

A
  • recurring migraines >2x/week

- symptomatic therapies that produce serious side effects

46
Q

Name 4 preventive drugs?

A
  • propanolol
  • timolol
  • topiramate
  • divalproex sodium
47
Q

T/F therapeutic drugs for prevention need a 2-3 month trial to determine reduced frequency of migraine

A

TRUE

48
Q

How long does it take for preventative therapy to reduce severity of migraines

A

6-12 months

49
Q

How long is tx continued after HA severity and frequency is reduced?

A

6-12 months

50
Q

Which drug is used for menstrual migraine prevention?

A

Ibuprofen given 2-3 days before cycle

51
Q

Which triptan can be used to prevent menstrual migraines?

A

Fovatriptan taken 1-2 days before and continued during period of vulnerability

52
Q

Which supplement may help with menstrual migraine or migraines with aura?

A

Mg

53
Q

Which drug acts as a prokinetic and can be given in cancer patients to propel the medication into the intestine and speed up the effect of sumatriptan?

A

Metoclopramide

54
Q

Which triptans have a longer duration of action and slower onset?

A

Naratriptan

Frovatriptan

55
Q

T/F PK of Lasmiditan requires no renal adjustment

A

True

56
Q

What is prophylactic tx for migraines that recur in a predictable pattern?

A

NSAID or triptan at time of vulnerability

57
Q

What is prophylactic tx if migraine with co morbid HTN or angina?

A

beta adrenergic antagonist

or verapamil if b-adrenergic contraindicated

58
Q

What is prophylactic tx if migraine with co morbid insomnia or depression?

A

TCA

59
Q

What is prophylactic tx if migraine with co morbid seizure or bipolar illness?

A
  • anti-convulsants

- use beta adrenergic antagonist or verapamil if beta adrenergic contraindicated

60
Q

What is the most common primary headache type?

A

Tension type headache-like band squeezing the head

61
Q

What is the presentation of a cluster headache?

A
  • pain is in and around one eye
  • unilateral, excruciating pain peaks within minutes and last about 3 hrs
  • lacrimation, miosis, ptosis, rhinorrhea on ipsilateral side
  • HA lasts weeks to months followed by periods of remission
62
Q

What is 1st line tx for TTHA?

A

simple analgesics:Acetaminophen +/- caffeine

63
Q

What is 2nd line tx for TTHA?

A

Aspirin, NSAIDS

64
Q

Acute TTHA tx?

A

codeine or butalbital

65
Q

What are the limits (# days) you can use butalbital,combination analgesics, or NSAIDS

A

butalbital < 3 days/month
analgesics <9 days/month
NSAIDS <15 days /month

66
Q

T/F There is no evidence to support the use of muscle relaxants in the management of TTHA?

A

TRUE

67
Q

Which drugs are not recommended for TTHA?

A
  • SSRI’s

- botulinum

68
Q

Which drug might work in TTHA?

A

SNRI: Mirtazapine
TCA
Topiramate or gabapentin

69
Q

T/F Hypothalamus might be a modulator in cluster HA

A

TRUE

70
Q

What is the hallmark sign of cluster headaches?

A

circadian rhythm of painful attacks

71
Q

T/F People with migraine headaches sit quietly while people with cluster headaches pace the room

A

TRUE

72
Q

What is the tx for acute cluster HA aka abortive therapy?

A
  • 100% oxygen non rebreather mask at 12L/min for 15-30 min

- serotonin agonist or ergotamines

73
Q

Which Triptans are highly effective for cluster HA?

A

injection or nasal Triptan

exception: oral zolmitriptan 10 mg

74
Q

Which ergotamines are helpful in the tx of cluster HA?

A

IV dihydroergotamine

ergotamine tartrate

75
Q

What is prophylactic tx for cluster HA?

A

1st: Verapamil
2nd: lithium, monitor thyroid and renal function, ADE: lethargy, nausea, diarrhea
3rd: corticosteroids (prednisone X 5 days and then tapered)
4th: Galcanezumab, binds to CGRP ligand

76
Q

What are miscellaneous agents in tx of cluster HA?

A

intranasal lidocaine
hyperbaric oxygen
subQ octreotide

Pharmacology (47 decks)

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