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Thp III Exam 1 > Headaches > Flashcards

Headaches Flashcards

1
Q

migraine, tension, cluster

A

primary headache

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2
Q

head trauma, vascular disorders, substance

use

A

secondary headache

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3
Q

Recurring severe throbbing unilateral headache interfering with normal functioning

A

migraine

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4
Q

migraine without aura

A

common migraine

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5
Q

migraine with aura

A

classic migraine

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6
Q

migraine prevalence

A

female, white, lower socio, genetic

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7
Q

neuropeptides released in migraines

A

Calcitonin gene-related peptide (CGRP)
Substance P
Neurokinin A

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8
Q

Trigeminovascular System regulated by

A

serotonin

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9
Q

migraine dgx

A 
5+ HA lasting 4-72 hr
at least two: unilateral, throbbing, worsened by movement, moderate to severe
PLUS
nausea or vomiting
or photophobia AND phonophobia
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10
Q

migraine with aura dgx

A 
At least one (reversible):
-Positive (flickering lights)
-Negative (loss of vision)
-Speech disorder
-CANNOT BE WEAKNESS
Develops gradually and lasts less than 1 hr
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11
Q

SNOOP

A 
systemic signs or symptoms
neurologic
onset
old age
progression of existing HA disorders
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12
Q

Migraine test

A

MIDAS (MIgraine Disability Assessment Test)

Scored by 5’s as I, II, III or IV (0-5, 6-10, etc)

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13
Q

Classes used for migraines

A 
Analgesics
NSAIDS
Ergot Alkaloids
Serotonin Agonists (Triptans)
Opiates
Antiemetics
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14
Q

Use caution with Analgesics/NSAIDs

A

Ulcer dz
Renal Dz
Cardiac Dz
Hypersensitivity

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15
Q

Analgesic/NSAID DOC for migraines

A

Ibuprofen and naproxen
Aspirin
Combination: Acetaminophen, aspirin, caffeine

2nd Line:
Acetaminophen, isometheptene, dichloralphenazone
Acetaminophen, butabital, caffeine

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16
Q

Analgesic/NSAID MOA

A

Inhibition of prostaglandin synthesis

17
Q

Ergot Alkaloids MOA

A

5HT1 agonists – constrict intracranial blood vessels
Inhibition of the trigeminovascular system
-Activation of 5-HT1 receptors on sensory nerve endings of
the trigeminal system results in the inhibition of pro-
inflammatory neuropeptide release
-Prevention of neurogenic inflammation

18
Q

Severity of migraine to use Analgesics/NSAIDs

A

Mild - Moderate

19
Q

Severity of migraine to use Ergot Alkaloids

A

Moderate - Severe

20
Q

Analgesic/NSAID ADE’s

A

Renal, GI (bleeding, dyspepsia, nausea), CNS (dizziness)

21
Q

Ergot Alkaloids used in migraines

A 
Ergotamine Tartrate (more potent arterial constrictor)
Dihydroergotamine (DHE) - (less potent)
22
Q

Ergotamine Tartrate routes

A

Oral
SL
Rectal

23
Q

Dihydroergotamine (DHE) routes

A

Nasal

Parenteral

24
Q

Ergotamine Tartrate can be combined with:

A

Caffeine

  • Enhances absorption
  • Aides in analgesia
25
Q

Dosing for Ergot Alkaloids

A

Ergotamine Tartrate has strict dosing to prevent rebounds
-Daily and weekly dose
PR 4 mg/day 10 mg/wk
PO 6 mg/day 10 mg/wk

26
Q

Ergot Alkaloids ADE’s

A

Nausea/Vomiting
-Stimulation of the chemoreceptor trigger zone
-Pretreatment with antiemetic needed:
Ergotamine tartrate
IV DHE
Systemic constriction
-Paresthesias, chest tightness, cold hands
Severe systemic constriction – (rarely)
-Ischemia: brain, bowel, heart, extremities (ergotism)
-Less with DHE

27
Q

Ergot Alkaloids Contraindications

A

Systemic vasoconstriction
-MI, angina, coronary vasospasm, PVD, hemiplegic migraine, uncontrolled HTN, ischemic CVA, sepsis
Use of triptan within 24 hours
Use of MAOI within 2 weeks
Use with any potent CYP 3A4 inhibitor
-Azole antifungals, PI, macrolide antibiotics
-The risk for vasospasm leading to cerebral ischemia
and/or ischemia of the extremities is increased.  Pregnancy

28
Q

DHE Nasal Pt Education

A
  • Before using each nasal spray vial, prime the pump by spraying 4 times into the air, away from the face
  • Use 1 spray into each nostril
  • Do NOT tilt your head back, sniff through your nose, or blow your nose while spraying or immediately after. Use another spray into each nostril 15 minutes after the first sprays if needed
  • Do not use more than 4 sprays for a single attack
29
Q

Serotonin Agonists (Triptans) MOA

A

5HT1 agonists – constrict intracranial blood vessels
Inhibition of the trigeminovascular system
-Activation of 5-HT1 receptors on sensory nerve endings of the trigeminal system results in the inhibition of pro- inflammatory neuropeptide release
-Prevention of neurogenic inflammation

30
Q

Serotonin Agonists on mkt

A 
Almotriptan 
Eletriptan
Frovatriptan
Naratriptan 
Rizatriptan 
Sumatriptan
Zolmitriptan
31
Q

DOC for mod - severe migraines

A

Serotonin Agonists (Triptans)

32
Q

Selection of Triptans

A 
Onset
-Injection vs nasal vs oral
-ODT – faster onset?
Duration
-Prevention of recurrence 
-Menstrual migraines
Drug Interactions - metabolism
Patient variability to response
-Can not be predicted 
-Failure on one does NOT mean class
-12 week trial
33
Q

Triptan ADE’s

A

Usually mild to moderate
Paresthesias, flushing, warm sensation
Local side effects based on route
-Injection site reactions
-Nasal irritation
“chest symptoms”: heaviness, pressure, tightness
-5HT2A receptors within the coronary vessels
-Isolated cases of cardiac events have been reported
-Unlikely in patients with normal coronary vessels

34
Q

Reason for migraines during menstruation

A

lowest levels of estrogen during cycle

Thp III Exam 1 (15 decks)

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