Headache Medications

Question 1

Analgesics

Answer 1

Tylenol (Acetaminophen)

Aspririn

Question 2

Tylenol (Acetaminophen)

Answer 2

325-650 mg q4-6 hrs

Do not exceed 3250 mg/day

Watch for liver toxicity @ high doses

1st line for pregnancy and breastfeeding

Question 3

Aspirin

Answer 3

325-650 mg q4-6 hours

Not to exceed 4000 mg/day

MOA: Inhibit prostaglandin synthesis, reduce inflammatory response and platelet aggregation

CI: Hx bleeding disorders, asthma, hypersensitivity

Question 4

NSAIDS

Answer 4

MOA: Inhibit cyclooxygenase-2 (COX-2)

SE: Abdominal cramps, Nausea, Indigestion

BBW: Cardiovascular events

Ibuprofen, Naproxen

Question 5

Ibuprofen dosing

Answer 5

200-400 mg

Do not exceed 2400 mg/24 hours

Question 6

Naproxen Dosing

Answer 6

Initially 500 mg, then 250 mg q 6-8 hours

Do not exceed 1250 mg/day

Question 7

Combination analgesics

Answer 7

Barbiturates - Florinal, Floricet

Midrin

SE: Drowsiness, N/V, Abdominal pain

Pregnancy C

Question 8

Florinal

Answer 8

Butalbital/Caffeine/ASA

50/40/325 dose, 1-2 tabs q4hr

Max: 6 tabs/day

MOA: Inhibit prostaglandin, sedation, cerebral vasocontriction

SE: drowsiness, N/V, abdominal pain

Pregnancy: C

Question 9

Floricet

Answer 9

Butalbital/Caffeine/Acetaminophen

50/40/325 mg dose, 1-2 tabs q 4hrs - max 6 tabs/day

MOA: inhibit prostaglandin, sedation, cerebral vasoconstriction

BBW for Hepatotoxicity

SE: Drowsiness, N/V, Abdominal pain

Pregnancy C

Question 10

Midrin

Answer 10

Isometheptene/Dichloralphenazone/Acetaminophen

65/100/325 mg dose; 1-2 tabs q4h - max 8 tabs/day

MOA: cerebral vasoconstriction, sedation, analgesia

Question 11

Antiemetics

Answer 11

Phenothiazines - Promethazine, Prochlorperazine

Metoclopramide (Reglan)

Question 12

Promethazine (Phenergan) and Prochlorperazine (Compazine) Dosing

Answer 12

Phenergan - 12.5-25 mg q4-6 hrs PRN

Compazine - 5-10 mg q 4-6hrs PRN OR 10-30 mg BID PO sustained release

PO, IM, IV, Rectal for all

Question 13

Phenothiazines

Answer 13

MOA: Non-selectively antagonizes central and peripheral histamine (H1) receptors

Pregnancy C

BBW: Respiratory depression in <2yo; Tissue necrosis w/ injections (Phenergan); Dementia-related psychosis (Compazine)

SE: Drowsiness, sedation

Question 14

Metoclopramide (Reglan)

Answer 14

5-10 mg PO/IV/IM q 6-8hrs

MOA: Antagonize central and peripheral dopamine receptors

BBW: Tardive Dyskinesia

SE: Drowsiness, restlessness, fatigue

Pregnancy B

Question 15

Triptans

Answer 15

MOA: Agonist effects on serotonin 5-HT1 receptors in cranial blood vessels, inhibits release of pro-inflammatory neuropeptides

CI: CAD, PVD, stroke, hemiplegic and basilar migraine, MAOIs, uncontrolled HTN

Don’t use more than 9 days/month

SE: N, Jaw/neck/chest pressure or tightness, fatigue, burning sensation

Pregnancy C

Question 16

Sumatriptan (Imitrex)

Answer 16

PO: 25-100 mg, can repeat up to 100 mg in 2 hrs

-efficacy w/in 2 hours

SC: 6 mg, can repeat in 2 hrs

-works w/in 20 minutes

Nasal: 5-20 mg, can repeat in 2 hrs

• do not exceed 40 mg/24hrs
• efficacy w/in 2 hours

Question 17

Naratriptan (Amerge)

Rizatriptan (Maxalt)

Zolmitriptan (Zomig)

Answer 17

Naratriptan (Amerge) - 1-2.5 mg q4hrs; max 5mg/day

-Higher bioavailability, longer acting, lower recurrence rate

Rizatriptan (Maxalt) - 5-10 mg q2hrs; max 30 mg/day

-30 minutes onset of action

Zolmitriptan (Zomig) - 2.5 mg PO/Nasal/Disintegrating tablet

• take @ onset of migraine

Question 18

Ergotamaine tartrate (Ergostat)

Answer 18

Ergot Alkaloid - Migraine-specific drug

Nonspecific 5-HT agonist/antagonist/both -> cause peripheral and cranial vasoconstriction

Pregnancy X; BBW Peripheral ischemia, CYP3A4 inhibitor, protease inhibitor, or macrolide Abx

SE: Rebound HA, vascular occlusion, dependence

Question 19

When do you use narcotics for headaches

Answer 19

Only used as a rescue medication for severe migraines

Infrequent migraines with contraindications to other agents

Also for HA in pregnancy

Question 20

Preventative Migraine Therapy

Answer 20

BB 1st line: Propranolol or Timolol

-Caution w/ bradycardia, asthma, 2nd/3rd heart block, CHF

CCB 2nd/3rd line: Verapamil; 1st line for cluster HA

-CI w/ bradycardia, heart block, A-fib

Question 21

Anticonvulsant Preventative therapy for headaches

Answer 21

Valproic acid (Depakote): May decrease HA frequency by 50%

• SE: Weight gain; CI: Liver disease, pregnancy (D)
• Need baseline CBC and LFTS

Topiramate (Topamax): Good for chronic, daily HA or HA unresponsive to other Tx

• SE: Weight loss; CI: Liver and renal impairment
• Pregnancy C

Question 22

Antidepressant HA Prevention

Answer 22

Elavil (Amitryptiline) - TCA, only drug w/ proven efficacy

-SE: weight gain, constipation, dry mouth, sedation (take at bedtime)

Insufficient data w/ SSRIs, H/A, or other TCAS

Question 23

Meningitis Definition

Answer 23

Swelling and inflammation of the membranes covering the brain and the spinal cord

Question 24

Encephalitis Definition

Answer 24

Inflammation of the brain

Question 25

Nosocomial Infection Definition

Answer 25

Originate or occur in a hospital/acquired in a hospital

Question 26

Abscess

Answer 26

Confined pocket of pus that collects in tissues, organs, or spaces inside the body