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Clinical Pharmacology > Headache and Lower Back Pain > Flashcards

Headache and Lower Back Pain Flashcards

1
Q

Sumatriptan - Dose and Route

A

50 mg orally, max dose 300 mg

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2
Q

Sumatriptan - MoA

A

Serotonin 5-HT1D/1B agonist

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3
Q

Sumatriptan - Advers effects

A 
Chest tightness
Weakness
Somnolence
Dizziness
Abnormal tingling and burning sensation(paresthesias)
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4
Q

Sumatriptan - Contraindications

A

Contraindicated for patients with history of angina pectoris, myocardial infarction or other coronary diseases
Increased blood pressure(should not be given to patients with uncontrolled hypertension)
Administration with ergot drugs

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5
Q

Sumatriptan - Interactions

A

MAO inhibitors, or within 24 h of adm of an ergot agent.

SSRI –> serotonin syndrome

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6
Q

Ergotamine - Dose and route

A

2mg orally, max dose 5mg

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7
Q

Ergotamine - MoA

A

Serotonin 5-HT1D/1B agonist

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8
Q

Ergotamine - Adverse effects

A 
Nausea
Vomitting
Diarrhea
Muscle cramps
Cold skin
Paresthesias
Vertigo
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9
Q

Ergotamine - Contraindications

A

Pregnancy
Coronary heart disease
Administration with triptan agents and beta-blockers

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10
Q

Ergotamine - Interactions

A

Synergistic adverse effects with triptan agents

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11
Q

Drugs for migraine prevention

A

Propranolol - beta blocker
Amitriptyline - tricyclic antidepressant
Topiramate - anticonvulsant

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12
Q

Amitriptyline - MoA

A

TCA, inhibits neuronal reuptake of serotonin and noradrenaline

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13
Q

Amitriptyline - Dose and route

A

10-75 mg at night orally

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14
Q

Amitriptyline - Adverse effects

A

Drowsiness
Tremor
Anticholinergic effects (dry mouth, blurred vision, urinary retention)

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15
Q

Amitriptyline - Contraindications

A

Combination with MAOIs
Hypersensitivity to TCAs
History of MI

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16
Q

Topiramate - Dose and route

A

50 mg x 1 orally

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17
Q

Topiramate - MoA

A

Block voltage-sensitive Na2+ channels, augumentation of GABA activation of GABAa receptors, and blockade of two types of excitatory glutamate receptors, kainate receptors and AMPA receptors

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18
Q

Topiramate - Adverse effects

A

Ataxia
Dizziness
Drowsiness
Cleft palate

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19
Q

Topiramate - Contraindications

A

Hypersensitivity, use cautiously during pregnancy, lactation, or hepatic and renal disease

20
Q

Propranolol - Dose and route

A

40mg x 2 orally

21
Q

Propranolol - MoA

A

Nonselective beta blocker

22
Q

Propranolol - Adverse effects

A

Cold extremities
Bradycardia
Hypotension
Diarrhea

23
Q

Propranolol - Contraindications

A

COPD
Diabetes
AV block

24
Q

Migraine - Diagnosis

A 
At least 2 of the following:
- Unilateral pain
- Throbbing pain
- Aggrevation by movement
- Moderate or severe intensity
Plus at least 1 of the following:
- Nausea/Vomiting
- Photophobia and phonophobia

Headache diary: helpful in making diagnosis, and assessing frequency of disability. 8 or more ep per month and at least 15 total days of headache per month –> chronic migraine

MR: suspicion of another underlying disease

25
Q

General evaluation of acute headache

A

Palpation of cranial arteries
Evaluate cervical spine by the effect of passive movement of head
Imaging, LP
Investigation of cardiovascular and renal status by BP monitoring and urine exam
Eyes- fundoscopy, intraocular pressure
Psychological state
According to the position of the headache:
Temporal: Giant cell arteritis
Facial: sinusitis
Instant onset: ruptured aneurysm

26
Q

Non- pharmocologic treatment of migraine

A

Avoid triggers, healthy diet, regular exercise, regular sleep pattern, avoid excessive alcohol and caffeine, avoid acute changes in stress level
Neuromodulation: single pulse transcranial magnetic stimulation (sTMS)
Noninvasive vagus nerve stimulation (nVNS)

27
Q

Migraine - Treatment

A

First try NSAIDs; most effective when taken early in the attack

  • Acetaminophen
  • Naproxen

Chronic:
Drugs for prevention
Botulinum toxin

28
Q

Acetaminophen - Dose

A

1g 4 times daily

29
Q

Acetaminophen - MoA

A

COX-3 inhibitor

30
Q

Who should get preventive treatment for migraine?

A

Increased frequency of migraine attack, unresponsive/poorly responsive to treatment, pts with 4 or more attacks a month.

31
Q

Tension headache - Diagnosis

A

Pain: bilateral tight, bandlike discomfort, persist for hours or days, builds slowly.
If you have headache without nausea, vomiting, photoponia/phobia, throbbing, aggregation with movement –> tension

May be episodic, if 15 days or more a months –> chronic

32
Q

Tension headache - Treatment

A

Elimination of triggers + exercise, mediation/yoga, acupuncture
Acetaminophen
If it coexist with migraine give triptans
Chronic:
Doxepine: 50 mg PO

33
Q

Amitriptyline - Dose

A

10 mg PO once daily

34
Q

Lower back pain - Diagnosis

A

Is it:
Unspecific back pain
Nerve root pain/Radiculopathy
Specific back pain

Pain referred to the back: Abdominal palpation, Goldflam’s sign
Palpation of the spine
Pain from hip may be confused with spine pain: internal/external rotation of leg (with knee and hip flexed)
Straight leg raising sign (SLR)/Lasague’s sign
Crossed SLR, Reverse SLR
Neurologic exam: search for focal atrophy, weakness, reflex loss, diminished sensation in legs
Ask if pts experiences pain during rest or activity
Lab tests:

Risk factors or nonspecific pain

  • CBC, ESR, urinalysis
  • X-ray, MRI, CT: anatomic definiton of spine disease
  • EMG and nerve conduction studies: assessment of PNS

No risk factors:
no diagnostic test necessary

35
Q

Lower back pain - Causes

A 
Lumbar disk pain
Cauda Equina syndrome
Spinal Stenosis
Trauma
Osteoporosis, Ostoarthritis, Osteomyelitis, RA, PsA, Ankylosing spondylitis
Vertebral metastasis
Psychiatric
36
Q

Lower back pain - Treatment

A

Acute (<3months):
Acetaminophen
Cyclobenzaprine
Physical therapy, massage, acupunture, traction, Ice/heat

Chronic (>12weeks):
Treat underlying cause 
Acetaminophen
Duloxetine
Exercise therapy, Physical therapy, Spinal manipulation massage

Low back pain with radiculopathy
In addition to pain killers: Glucocorticoids; Prednisolone,
Surgery

37
Q

Cyclobenzaprine - Dose

A

5 mg X3 PO

38
Q

Cyclobenzaprine - MoA

A

Antispastic agent, muscle relaxant

39
Q

Cyclobenzaprine - Adverse effect

A

Drowsiness, Tiredness, headache, dizziness

40
Q

Cyclobenzaprine - Interaction

A

MAOI –> HTN

Benzodiazepine –> excessive sedation

41
Q

Cyclobenzaprine - Contraindication

A

HF, arrythmia, hyperthyroidsm

42
Q

Duloxetine - Dose

A

60 mg PO

43
Q

Duloxetine - MoA

A

SNRI

44
Q

Duloxetine - Adverse effects

A

Nausea, dry mouth, tiredness, drowsiness, constipation

45
Q

Duloxetine - interaction

A

Inhibits Cyp2D, and increases serum levels of antipsychotics and TCA

46
Q

Duloxetine - Contraindication

A

MAOI –> Serotonin syndrome

47
Q

Prednisolone - Dose

A

80mg first two days, then 40 mg for 2 days, then 20mg last 2 days

Clinical Pharmacology (14 decks)

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