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Advanced Pharma > Headache (R) > Flashcards

Headache (R) Flashcards

1
Q

International Headache Society (IHS) classification

A

-migraine
-tension-type headache
-cluster headache

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2
Q

tx goals for migraine

A

-rapid & consistent tx
-restore functional ability
-use lowest, effective dose of abortive therapy
-minimize adverse events

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3
Q

non-pharmacological interventions: migraines

A

maintain headache diary to identify potential triggers & practice avoidance
-use of ice, rest, bio-feedback

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4
Q

urgent medical eval for “red flags”

A

-new-onset sudden +/- severe pain
-stereotyped pain pattern worsens
-systemic signs (fever, wt loss, accelerated HTN)
-focal neurologic sxs (other than typical visual/sensory aura)
-papillederma
-cough-, exertion-, or Valsalva-triggered headache
-pregnancy or postpartum state
-pts w/ cancer, HIV & other infectious & immunodeficient disorders
-seizures

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5
Q

if n/v present in migraine headache treat

A

antiemetic: consider IV, IM, SQ, or nasal formulation

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6
Q

mild-moderate migraine sxs …Rx

A

-simple, analgesics NSAIDs

-APAP alone is not recommended

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7
Q

severe migraine sxs or if no relief from NSAIDs for mild-moderate sxs .. Rx

A

combo analgesics

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8
Q

first-line tx choice for mild to moderate attacks or severe attacks that have responded in the past to similar tx

A

oral NSAIDs

&

combination analgesics w/ caffeine

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9
Q

butalbital-containing products

A

drug class: barbiturates

-limit & monitor use due to overdose
-medication-overuse headache
-withdrawal

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10
Q

acetaminophen (APAP): dosing & max

A

1000mg at onset
repeat q4-6h as needed
max=4g/day

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11
Q

APAP + ASA +caffeine

A

APAP 250mg + ASA 250mg + caffeine 65mg

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12
Q

ASA or APAP, caffeine

A

1-2 tablets q4-6h

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13
Q

isometheptene + dichloraphenazone + acetaminophen

A

isometheptene 65mg + dichloraphenazone100mg+ acetaminophen 325mg 2 capsules at onset, repeat 1 capsule every hour as needed

max 6 capsules in 24hr

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14
Q

ASA

A

500-1000 mg q 4-6hr; max 4g/day

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15
Q

ibuprofen: dose & max

A

200-800 mg q6h; avoid >2.4 g/day

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16
Q

naproxen sodium

A

550-825 mg at onset; may repeat 220mg in 3-4h

avoid > 1.375g/day

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17
Q

first-line therapy for moderate to severe migraines especially when nonspecific (OTC (Excedrin migraine)) are ineffective

A

triptans

if no response to one, try another

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18
Q

triptans contraindications

A

-hx of ischemic heart disease
-uncontrolled HTN
-CAD
-stroke
-PVD
-Prinzmetal’s angina
-MI
-pregnancy

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19
Q

moderate to severe migraine attacks when other tx failures

A

ergotamines

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20
Q

ergotamines: CIs

A

-pts w/at risk for CAD
-stroke
-PVD
-uncontrolled HTN
-liver/kidney disease
-strong inhibitors of CYP3A5
-pregnancy (cat X)

21
Q

opioids

A

moderate to severe infrequent headaches

“last resort” due to contraindications or failed response to conventional therapies

22
Q

lasmiditan

A

a selective serotonin 1F receptor agonist that lacks vasoconstrictor activity

for contraindications to triptans due to cardiovascular risk factors

23
Q

s/e of lasmiditan

A

decrease HR and/or increase BP
-dizziness, paresthesia, somnolence, fatigue, N

duration 1.5-2h

no driving, operating machinery, engage in hazardous activities for at least 8h after EACH dose

24
Q

lasmiditan: life threatening

A

serotonin syndrome

w/ [SSRIs, SNRI, triptans, TCA, fentanyl, lithium, tramadol, buspirone, St. John’s wort, tryptophan) or w/o other drug associates

-impair serotonin metabolism: MAOIs
-other contributing: MAOIs: linezolid and IV methylene blue

25
Q

serotonin syndrome: s/s

A

-mental status changes [agitation, hallucination, delirium, coma]
-autonomic instability [tachycardia, labile BP, diaphoresis]
-neuromuscular changes [tremor, rigidity, myoclonus]
-GI sxs [N/V/D]
-seizures

discontinue tx

26
Q

CGRP antagonists

A

pharmacological modulation of calcitonin-gene related peptide (CGRP) activity appears to mediate trigeminovascular pain transmission in migraines

27
Q

CGRP available for

A

“gepants”

for acute tx of migraine in patients w/ either insufficient response or contraindication (CAD) to tx w/ triptans

28
Q

ubrogepant & rimegepants

A

acute migraine tx for adults

29
Q

adjuvant therapy to relieve N/V & migraine attack

A

chlorpromazine, prochlorprezamine
-IV formulation for refractory, intractable headache
-administer 15-30m before abortive therapy

metoclopramide IV (a DA receptor blocker) effective for acute migraine tx

30
Q

prophylactic therapy considerations

A

-quality of life, business duties, or school attendance are severely impaired
-frequency of attacks are equal/greater than 2/month
-migraine attacks do not respond to acute drug tx
-frequent, very long, or uncomfortable auras occur

31
Q

beta-blockers

A

propranolol

ideal for health pts/comorbid HTN, angina, or anxiety

avoid in reactive airway disease, heart block, bradycardia

32
Q

TCAs

A

nortriptyline, amitryptiline

comorbid depression/insomnia

avoid: urinary retention, BPH, glaucoma, anticholinergic effects are problematic

33
Q

anticonvulsants

A

valproate, topirimate

for comorbid seizure disorder/manic-depressive illness (many drug interactions)

34
Q

CCBs

A

verapamil

generally considered 2nd or 3rd line for migraine headaches

first for prophylaxis of cluster type of headache

35
Q

NSAIDs

A

use for migraines w/ predictable pattern (eg. menstrual cycle)
-initiate 1-2d prior to expected onset of headache
-total duration of use limited due to risk of GI events

36
Q

triptans

A

use for migraines w/ predictable patter (eg. menstrual cycle)

-for pts that are unresponsive to NSAIDs, not considered standard of practice

37
Q

botox

A

15 or more headaches a month, each lasting 4h or more

38
Q

CGRP antagonist

A

little evidence of use

39
Q

MOH abbr

A

medication overuse headache

headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute/symptomatic headache medication for more than 3 months

40
Q

highest risk for MOH

A

-opioids
-butalbital-containing analgesics
-acetaminophen-aspirin caffeine combos

41
Q

prevention of MOH

A

limit most meds to less than 10 days per month or less than 15d for ASA, APAP, NSAIDs

42
Q

cluster headache

A

severe headache on one side of the head w/ recurrent on fixed time intervals

43
Q

cluster headache s/s

A

-swollen/drooping eye
-smaller pupil in the eye
-eye redness/watering
-running/congested nose
-red/warm face
-sweating

44
Q

cluster headache causes

A

-smoking
-alcohol
-disruptions in your circadian rhythm (sleep deprivation, jet lag)

45
Q

cluster headache tx

A

-measure to abort the acute episode w/ meds such as sumatriptan
-o2 (dec severity)
-avoid alcohol

46
Q

cluster headache: acute tx

A

-submatriptan subq inj
-zolmitripan nasal spray
-sumatriptan nasal spry
-o2
-nVNV (for ECH)

47
Q

cluster headache: interim tx

A

-oral prednisolone
-greater occipital nerve block

48
Q

cluster headache: preventative

A

-verapamil
-topiramate
-lithium
-melatonin
-nVNS
-SPG microstimulator

Advanced Pharma (27 decks)

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