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Nurs 5229 Clinical Pharmacotherapeutics > Headache Deck 2 > Flashcards

Headache Deck 2 Flashcards

1
Q

Drugs for Headaches

A 
Serotonin Agonist Drugs (The Triptans)
Ergot Alkaloids
Aspirin-like Drugs
Miscellaneous Drugs: Medications for prophylaxis
Antiepileptic drugs
Tricyclic antidepressants
Calcium channel blockers
Beta-blocker
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2
Q

Sumatriptan [Imitrex]

Mechanism of action

A

Binds to receptors on intracranial blood vessels and causes vasoconstriction
Diminishes perivascular inflammation

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3
Q

Sumatriptan [Imitrex] - therapeutic use

A

Aborting an ongoing migraine attack to relieve headache and associated symptoms
Prompt treatment of migraine attacks - important to successful acute therapy.

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4
Q

Sumatriptan [Imitrex] - administration

A

Oral or intranasal administration (dependent on the preparation).

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5
Q

Sumatriptan - ADR

A

Adverse effects
Chest symptoms
Transient “heavy arms” or “chest pressure” experienced by 50% of users
Coronary vasospasm
Rare angina as a result of vasospasm
Teratogenesis
Others - vertigo, malaise, fatigue, and tingling sensations

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6
Q

Sumatriptan has a

A

Very bad taste when taken in intranasal form

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7
Q

Drug interactions - ergot alkaloids, sumatriptan, and other triptans (all cause

A

Drug interactions - ergot alkaloids, sumatriptan, and other triptans (all cause vasoconstriction)

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8
Q

All triptans should be limited to

A

All triptans should be limited to no more than 10 days of use per month to avoid medication overuse headache.

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9
Q

Triptans should be avoided in patients with

A

Triptans should be avoided in patients with hemiplegic migraine, basilar migraine, ischemic stroke, ischemic heart disease, Prinzmetal’s angina, uncontrolled hypertension, and pregnancy

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10
Q

Triptans with NSAIDs - effective than using

A

Triptans with NSAIDs - effective than using

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11
Q

Eletriptan is primarily metabolized by cytochrome P-450 enzyme CYP3A4.
Should not be used within

A

at least 72 hours of treatment with other drugs that are potent CYP3A4 inhibitors such as ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, and nelfinavir.

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12
Q

Serotonin syndrome in patients who

A

who use triptans in combination with a selective serotonin reuptake inhibitor (SSRI) or a selective serotonin-norepinephrine reuptake inhibitor (SNRI) - low to non-existent - discuss risk and benefits and s/s of serotonin syndrome.

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13
Q

Intravenous (IV) metoclopramide, and IV or intramuscular (IM) chlorpromazine and prochlorperazine can be used as

A

Intravenous (IV) metoclopramide, and IV or intramuscular (IM) chlorpromazine and prochlorperazine can be used as

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14
Q

These medications act as antiemetics mainly because they are

A

dopamine receptor antagonists.

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15
Q

In contrast to IV or IM preparations, oral antiemetics should not be

A

considered as monotherapy in acute migraine

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16
Q

Antiemetics are commonly used as

A

adjunctive therapy to treat migraine

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17
Q

Opioid analgesics - when to use

A

Severe migraine – not responded to first-line medication.
Potential for abuse
Butorphanol nasal spray [Stadol NS]

18
Q

Ergot MOA

A

MOA: complex action, precise mechanism is unknown
partial agonist and/or antagonist activity against tryptaminergic, dopaminergic and alpha-adrenergic receptors depending upon their site
Highly active uterine stimulant
Causes constriction of peripheral and cranial blood vessels and produces depression of central vasomotor centers

19
Q

Ergot are

A

Second-line drug use

20
Q

Ergot SE

A

well-tolerated – n/v in about 10%, weakness in legs, myalgia, numbness and tingling in the fingers and toes, angina-like pain, tachycardia or bradycardia
Ergotism

21
Q

Ergot catuion

A

Caution in patients with CVD; pregnancy category X.

22
Q

Diphydroergotamine (DHE) - MOA

A

Alpha-adrenergic blocker
Weaker arterial vasoconstrictor and more potent venoconstrictor than ergotamine tartrate
Potent 5-HT 1b/1d receptor agonist.
Fewer side effects than ergotamine
Does not cause the development of physical dependence or rebound headaches

23
Q

Diphydroergotamine (DHE) CI

A

HTN or ischemic heart disease, in combination with MAO inhibitors, and older adults, use of CYP3A4 inhibitors

24
Q

Preventative Medications

A

Beta blockers
Antiepileptic Drugs
Tricyclic antidepressants
Calcium Channel Blockers

25
Q

Beta Blockers - are

A

First-line drugs for migraine prevention

26
Q

Beta Blockers - propranolol

A

Propranolol - two divided doses starting at 40 mg daily; dose range 40 to 160 mg daily

27
Q

Beta Blockers do not use as

A

Do not use as initial therapy in patients over 60 and in smokers.

28
Q

Beta Blockers limiuted use in

A

Used cautiously as well in patients with asthma, diabetes mellitus, or depression, and in those with cardiac conduction disturbances or sinus node dysfunction

29
Q

Beta Blockers used cautiously as

A

Used cautiously as well in patients with asthma, diabetes mellitus, or depression, and in those with cardiac conduction disturbances or sinus node dysfunction

30
Q

Calcium-Channel Blockers - Are

A

Widely used

31
Q

Calcium-Channel Blockers data support

A

Data support efficacy is limited

32
Q

Calcium-Channel Blockers example

A

Verapamil - three divided doses starting at 120 mg daily, dose range 120 to 240 mg daily

33
Q

Sodium valproate and topiramate – effective for

A

for migraine prevention; insufficient evidence to determine the effectiveness of gabapentin

34
Q

Divalproex [Depakote ER]

MOA, SE, Warning, Interactions

A

MOA: unknown, likely increases GABA
SE: nausea, fatigue, weight gain, tremor, bone loss, reversible hair loss.
Black box warning – fatal pancreatitis and hepatitis. Pregnancy category x
Drug interactions: other anticonvulsants, ASA, antacids, psychotropics, H2 blockers, BZDs, warfarin

35
Q

Topiramate [Topamax]

MOA, SE, Warning, Interactions

A

MOA: blocks sodium channels, enhances GABA in brain, reduces activity of calcium channels, blocks glutamate activity
SE are common: metabolic acidosis, moderate weight loss, paresthesias, fatigue, cognitive disinfection
Drug interactions: phenytoin and valproic acid, ethinyl estradiol, Digoxin, other CNS depressants.
Pregnancy category c, not to be used in lactation, pediatrics 2 to 16 approved for use

36
Q

Amitriptyline [Elavil]

Prevent

A

migraine and tension-headaches

37
Q

Amitriptyline - MOA

A

MOA: increases the synaptic concentration of serotonin and/or norepinephrine in the central nervous system by inhibition of their reuptake by the presynaptic neuronal membrane pump.

38
Q

Amitriptyline SE

A

SE: hypotension and anticholinergic effects (drug mouth, constipation, urinary retention, blurred vision, tachycardia)

39
Q

Amitriptyline excessive dose causes

A

dysrhythmias.

40
Q

Additional Therapies

A 
ACE inhibitors/ARBs
Botulinum toxin
Butterbur
Coenzyme Q10
Feverfew
Magnesium
Melatonin
Riboflavin
Acupunture

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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