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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
General evaluation of acute headache
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
Non- pharmocologic treatment of migraine
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
Migraine - Treatment
First try NSAIDs; most effective when taken early in the attack - Acetaminophen - Naproxen Chronic: Drugs for prevention Botulinum toxin
28
Acetaminophen - Dose
1g 4 times daily
29
Acetaminophen - MoA
COX-3 inhibitor
30
Who should get preventive treatment for migraine?
Increased frequency of migraine attack, unresponsive/poorly responsive to treatment, pts with 4 or more attacks a month.
31
Tension headache - Diagnosis
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
Tension headache - Treatment
Elimination of triggers + exercise, mediation/yoga, acupuncture Acetaminophen If it coexist with migraine give triptans Chronic: Doxepine: 50 mg PO
33
Amitriptyline - Dose
10 mg PO once daily
34
Lower back pain - Diagnosis
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
Lower back pain - Causes
``` Lumbar disk pain Cauda Equina syndrome Spinal Stenosis Trauma Osteoporosis, Ostoarthritis, Osteomyelitis, RA, PsA, Ankylosing spondylitis Vertebral metastasis Psychiatric ```
36
Lower back pain - Treatment
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
Cyclobenzaprine - Dose
5 mg X3 PO
38
Cyclobenzaprine - MoA
Antispastic agent, muscle relaxant
39
Cyclobenzaprine - Adverse effect
Drowsiness, Tiredness, headache, dizziness
40
Cyclobenzaprine - Interaction
MAOI --> HTN | Benzodiazepine --> excessive sedation
41
Cyclobenzaprine - Contraindication
HF, arrythmia, hyperthyroidsm
42
Duloxetine - Dose
60 mg PO
43
Duloxetine - MoA
SNRI
44
Duloxetine - Adverse effects
Nausea, dry mouth, tiredness, drowsiness, constipation
45
Duloxetine - interaction
Inhibits Cyp2D, and increases serum levels of antipsychotics and TCA
46
Duloxetine - Contraindication
MAOI --> Serotonin syndrome
47
Prednisolone - Dose
80mg first two days, then 40 mg for 2 days, then 20mg last 2 days

Clinical Pharmacology (14 decks)

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