Headaches Flashcards
What are the preventatives
medications for headaches?
5
- Beta Blockers
- Anticonvulsants
- Antidepressants
- Calcium channel blockers
- Serotonin antagonists
Abortive Medications for headaches?
6
- Analgesics
- NSAIDS
- Combination analgesics
- Antiemetics
- Triptans (5-HT agonists)
- Ergot Alkaloids
- Dosing of tylenol (acetometaphen)?
- Do not exceed how many per day?
- What should we watch for in high doses?
- 1st line for what pt populations? 2
- 325mg–650mg every 4-6 hours
- Not to exceed 3250 mg/day
- Watch liver toxicity at these high doses
- 1st choice during PG and breastfeeding
- Aspirin dosing?
- Do not exceed how many per day?
- MOA? 3
- Contraindications? 3
- 325-650 mg every 4-6 hours
- Not to exceed 4000 mg/day
3.
- Inhibits prostaglandin synthesis, - reducing inflammatory response - platelet aggregation - Contraindications
-History of bleeding disorders
-Asthma
-Hypersensitivity
- NSAIDS MOA?
- SE? 3
- BBW?
1. MOA Inhibits the enzyme cyclooxygenase-2 (COX-2) 2. SE -Abdominal cramps -Nausea -Indigestion
- Contain Black-Box Warning for cardiovascular events
Ibuprofen (Motrin)
- Dosing?
- Do not exceed how much in a day?
Naproxen (Naproxen)
- Dosing?
- Do not exceed?
- 200-400mg
- Don’t exceed 2400mg/24hrs
- Initial 500mg then,
250mg every 6-8 hours - Not to exceed 1250mg /day
What are the barbiturates?
2
- Fiorinal
2. Fioricet
- What medications are in Florinal? 3
- MOA? 3
- Preg Cat?
- SE? 3
- Butalbital/Caffeine/ASA
- MOA:
- inhibit prostaglandin,
- sedation,
- cerebral vasoconstriction - Preg C
- SE
- Drowsiness
- N/V
- Abdominal pain
- What medications are in Floricet?
- MOA? 3
- Preg cat?
- BBW?
- SE? 3
- Butalbital/Caffeine/Acetaminophen
- MOA:
- inhibit prostaglandin,
- sedation,
- cerebral vasoconstriction - Preg C
- Black-Box Warning: Hepatotoxicity
- SE
- Drowsiness
- N/V
- Abdominal pain
What is the Combination analgesics?
Midrin
- What medications are in midriff?
- MOA? 3
- Preg Cat?
- SE? 3
1.Isometheptene/dichloralphenazone/acetaminophen
- MOA:
- cerebral vasoconstriction,
- sedation,
- analgesia - Preg C
- SE
- Drowsiness
- N/V
- Abdominal pain
What are the Antiemetics?
4
- Phenothiazines
- Promethazine (Phenergan)
- Prochlorperazine (Compazine) - Metoclopromide (Reglan)
Phenothiazines
- MOA?
- Preg cat?
- BBW? 3
- MOA
Non-selectively antagonizes central & peripheral histamine H1 receptors - Preg C
- Black Box:
- Respiratory depression in less than 2 y/o and
- Tissue Necrosis with injections (Phenergan)
- Dementia-Related Psychosis (Compazine)
Metoclopromide (Reglan)
- MOA?
- Preg Cat?
- BBW?
- MOA
antagonizes central and peripheral dopamine receptors - Preg B
- Black Box: Tardive Dyskinesia
Triptans are what category of drug?
Name the drugs in this class? 7
5-HT1 Receptor Agonists
- Sumatriptan (Imitrex)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Zolmitriptan (Zomig)
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
Triptans
- MOA?
- Contraindications?4
- Preg cat?
- Triptans SE? 4
- Agonist effects on serotonin 5-HT1 receptors in cranial blood vessels and subsequent inhibition of pro-inflammatory neuropeptide release
- Contraindications
- CAD
- PVD
- Stroke
- Hemiplegic and basilar migraine - Preg C
- Nausea
- Jaw, neck, or chest pressure or tightness
- Fatigue
- Burning sensation of the skin
Sumatriptan (Imitrex)
administrations?
3
PO
SC
Nasal
How is Naratriptan (Amerge)
different from Sumatriptan (Imitrex)?
2
What makes Rizatriptan (Maxalt)
different?
Which triptan works well for menstrually related migraines?
- has higher bioavailability, longer acting
- Lower rate of headache recurrences
- Early onset of action (30min)
- Eletriptan (Relpax) more rapid onset - Frovatriptan (Frova)
All efforts should be made to initiate therapy as soon as possible after the first symptoms of the attack are noted, since success is proportional to rapidity of treatment. Why is this important?
lower dosages will be effective with less side-effects.
Ergot Alkaloids
- Specific drug for what?
- What are the two drugs in this category?
- MOA? 2
- Preg cat?
- BBW 2
- First migraine-specific drug
- -Have fallen out of favor d/t unpredictable patient response - Dihydroergotamine (DHE)
- Ergotamine
- MOA
- Nonspecific 5-HT agonist, antagonist, or both types of activity for serotonergic, dopaminergic, and alph-adrenergic receptors
- This results in constriction of periheral and cranial vessels. - Preg X
- Black Box Warning
- Life-threatening peripheral ischemia
- Effects are worse with administration with potent CYP3A4 inhibitors, protease inhibitors, and macrolide antibiotics
Ergotamine tartrate (Ergostat, Ergomar) is associated with significant SE such as? 3
- REBOUND HEADACHE
- Vascular occlusion
- Dependence
DHE Adverse effects more common adverse affects?
11
1. Burning or tingling sensation dry mouth 2. Dryness, soreness or pain in the nose 3. runny and or stuffy nose 4. change in sense of taste 5, Diarrhea 6. Dizziness 7. Fatigue 8. Headache 9. increased sweating 10. nausea and or vomiting 11. muscle stiffness
When would we use narcotics for heaches?
2
- Rescue med for severe migraine
- Infrequent migraines with contraindications to other agents
Meperidine (Demerol) Morphine Oxymorphone Hydromorphone (Dilaudid) Hydrocodone + acetaminophen (Norco) Oxycodone + acetaminophen (Percocet) Oxycodone Hydrocodone Fentanyl
What are some common combination therapies for headaches?
3
- Triptan + OTC Naprosyn (Aleve) 220mg x 1 with onset of headache
- NSAID w/ antiemetic
- Moderate narcotic w/ antiemitc
When would we use preventative medications for headaches?
4
- Recurring headache that significantly interferes with daily routine in patient’s opinion.
- Contraindications or failure of overuse of acute therapies.
- Adverse reaction with acute therapies.
- Patient preference.
Goals of Preventative Therapy
3
- Decrease attack frequency and duration.
- Improve responsiveness to treatment of acute attacks.
- Improve function and decrease disability.
- What are Betablockers we can use? 2
- What are the anticonvulsants we can use? 2
- What are the antidepressants we can use? 2
- What are the calcium channel blockers we can use?
Beta-blockers
- Propranolol (Inderal)
- Timolol
Anticonvulsants
- Valproic Acid (Depakote)
- Topromax (Topiramide)
Antidepressants
- TCA’s
- SSRI’s
Calcium Channel Blockers
1. Calan (Verapamil)
What is the first line agent for prophylactic treatment of migraines?
Propranolol (Inderal) & Timolol
Propranolol (Inderal) & Timolol have been approved by FDA for what?
migraine prophylaxis
Who should these be used in caution with?
4
- Baseline bradycardia
- Asthma
- 2nd or 3rd degree AV block
- CHF
Calcium Channel blockers
- MOA?
- Contraindicated in who?
- What line treatment is this considered?
- MOA
Inhibition of serotonin release - Contraindicated with
- Bradycardia
- Heart block
- A-fib - Considered 2nd or 3rd line treatment
Verapamil (Calan)
Valproic acid (Depakote)
- May decrease H/A frequency by as much as ?
- Effects of therapy seen how long after initiation of therapy?
- Preg cat?
- 50%
- Effects seen within first 4 weeks of therapy
- D
Topiramate (Topamax)
- Preg cat?
- Contraindications? 2
- Pregnancy Category C
- Contraindications:
- Liver
- Renal impairment
Which antidepressants are found to be the most effective?
What is the main limiting factor with these medications?
name them 4
TCA’s
-Elavil (Amitryptiline) is the only TCA with proven efficacy
- Side effects are main limiting factor
- Sedation,
- dry mouth,
- constipation,
- weight gain
Whats the only SSRI with proven efficacy?
SNRI venlafaxine (Effexor)