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Clinical Pharmacology > Headache > Flashcards

Headache Flashcards

1
Q

Acute nonpharmacologic treatments of tension type headache

A
  • Heat
  • Ice
  • Massage
  • Rest
  • Biofeedback
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2
Q

What is the goal for limiting acute treatment of TTH?

A
  • Less than 9 days/month

- Max of 2 doses/day

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3
Q

Initial monotherapy of TTH (outpatient)

What about inpatient?

A
  • Oral ibuprofen (200 or mg)
  • Naproxen (375 mg or 550mg)
  • APAP 1000mg once

Inpatient centers may give one dose of ketorolac

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4
Q

Combination analgesic used for TTH

A

Excedrin (caffeine + APAP + ASA)

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5
Q

What is the most helpful tool to assess HA pattern and response to tx for migraine patients?

A

Headache diary

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6
Q

Non-pharm treatments of Migraines

A

Abortive: Relaxation techniques, ice massage

Prophylactic: Regular exercise, relaxation techniques, stress management, biofeedback, acupuncture, PT, diet

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7
Q

Why are many oral agents ineffective in migraines?

A

Poor absorption secondary to migraine-induced gastric stasis

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8
Q

When are migraine specific agents indicated?

A
  • Moderate to severe migraine symptoms and in those whose HA’s respond poorly to NSAIDs
  • Use non-oral route if early S/S with N/V
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9
Q

What medication classes are used for Mild-Moderate migraines?

A
  • NSAIDs +/- APAP
  • ergots
  • “Triptans” ***
  • “gepants”
  • “ditans”
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10
Q

What drug is used as an acute adjunctive tx for patients with N/V?

A
  • IV dopamine antagonism

- metoclopramide, prochlorperazine, promethazine

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11
Q

Which class of medications is an agonist on many serotonin receptors? Which drug is most commonly used?

A
  • Ergots

- Dihydroergotamine

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12
Q

What is a common scenario in which we use Ergots?

A

May work for patients who have not previously responded to triptans

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13
Q

Dihydroergotamine is associated with what ADR’s?

A

N/V/D common

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14
Q

What are the ‘triptan’ drugs?

A 
Sumatriptan ***
Zolmitriptan ***
Rizatriptan  
Almotriptan
Eletriptan
Naratriptan
Frovatriptan ***
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15
Q

What is the end result of triptans agonizing serotonin receptors

A

Vasoconstriction of cranial arteries

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16
Q

What is a pearl about the use of Frovatriptan?

A
  • Takes 2 hours to work and then has a 25 hour half life

- Good for patients with slow onset of symptoms

17
Q

What is the clinical indication for the -triptans? What route is most effective?

A
  • Moderate to severe acute migraine with or without aura

- SQ route is most effective (especially when patients have N/V)

18
Q

What is a special indication for a sumatriptan injection?

A

Cluster headaches

19
Q

In what patients are the triptans generally avoided in?

A
  • Ischemic CVA/HD
  • Ischemic CAD/PAD
  • Ischemic bowel
  • Uncontrolled HTN
  • Raynaud’s
  • Pregnancy
20
Q

If triptans are an option for someone with cardiac RF, what must you do?

A

Cardiac eval before use

21
Q

Triptan metabolism

A
  • Sumatriptan and zolmitriptan are metabolized by MAO enzymes
  • Avoid MAOI
22
Q

Which drugs cannot be administered within 24 hours of triptans

A

Ergots due to enhanced vasoconstricting effects

23
Q

What drug (which is commonly used for migraine prophylaxis) increases the concentration of triptans?

A

Propranolol

24
Q

What are the ADRs associated with the three forms of sumatriptan?

A
  • PO –> well tolerated with mild nausea
  • SQ –> Burning sensation
  • Intranasal –> Unpleasant aftertaste
25
Q

What is the proposed mechanism of ‘gepants’

A

-small molecule CGRP antagonists to decrease pain signaling

26
Q

What are the two ‘gepant’ drugs?

A

Rimegepant

Ubrogepant

27
Q

What is the one “ditan” drug presented to us

A

Lasmiditan

28
Q

What is a pearl about -gepants and -ditans?

A

Less effective than triptans but can be used in patients with vascular disease

29
Q

What are the devices approved for acute treatment of migraines?

A
  • Transcranial magnetic stimulation device
  • Remote electrical neuromodulation device (band on arm)
  • Transcutaneous electrical nerve stimulation (cyclops)
  • Vagus nerve stimulation device

Clinical Pharmacology (54 decks)

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