Headaches, Alzhimers, Parkinsons

Question 1

Ergot Derivatives Prototype

Answer 1

Dihydroergotamine

Question 2

Ergot Derivatives TA

Answer 2

Constrict cranial vessels, decrease cranial artery pulsation, decrease hyperperfusion of basilar artery bed

Question 3

Ergot Derivatives Indications

Answer 3

Prevent or abort migraine or vascular headaches

Question 4

Ergot Derivatives Pharmaco

Answer 4

Rapid absorption
Onset 15-30 mins
Hepatic
Bile excretion

Question 5

Ergot Derivatives Contraindications

Answer 5

Known allergy
CAD, hypertension, PVD
Impaired liver function
Prego + Lactation

Question 6

Ergot Derivatives Cautions

Answer 6

Pruritus

Question 7

Ergot Derivatives AE

Answer 7

EGROTISM!!!

N/V, lightheaded, numb/tingling, hyper/hypotension, bradycardia, muscle pain + itching, chest pain

Question 8

Ergot Derivatives DD Ints

Answer 8

Beta-blockers
Triptans

Question 9

Triptans Prototype

Answer 9

Sumatriptan

Question 10

Triptans TA

Answer 10

Cause vasoconstriction of cranial vessels

Binds to selective serotonin receptor sites

Question 11

Triptans Indications

Answer 11

Treats (NOT PREVENTS) acute migraine
Also used for cluster headaches in adults

Question 12

Triptans Pharmaco

Answer 12

Rapid absorption
Hepatic
Urine excretion
Cross placenta and milk

Question 13

Triptans Contraindications

Answer 13

Known allergy
Pregnancy
CAD

Question 14

Triptans Cautions

Answer 14

Older adults
Pts with CAD risk factors
Lactation
Renal/hepatic dysfunction

Question 15

Triptans AE

Answer 15

Dizziness, drowsiness, weakness
Nausea
Flushing, sweating, tingling/numbness
Neck pain

Almotriptan reported to have fewer side effects than other triptans

Question 16

Triptans DD Interactions

Answer 16

Ergot containing drugs

Question 17

Triptans Routes and times

Answer 17

Sumatriptan: SQ, Intranasal, Oral (15 mins, 20 mins, 90 mins)

Naratriptan: Oral (1-3 hrs)

Rizatriptan: Oral (.5-2 hrs)

Zolmitriptan: Oral (1hr)

Almotriptan: Oral (1-3 hrs)

Frovatriptan: Oral (2-4 hrs)

Question 18

Indirect-Acting Cholinergic Agonists Prototypes

Answer 18

Donepezil and Rivastigmine

Question 19

Indirect-Acting Cholinergic Agonists TA

Answer 19

Slows down, not cures

Blocks acetylcholinesterase at the synaptic cleft and allows acetylcholine accumulation

Question 20

Indirect-Acting Cholinergic Agonists Indications

Answer 20

ALZHEIMERS

Myasthenia gravis, glaucoma, treatment after nerve gas exposure

Question 21

Indirect-Acting Cholinergic Agonists Pharmaco

Answer 21

Well absorbed
Some are metabolized by liver enzymes others primarily unchanged
Eliminated via kidneys

Question 22

Indirect-Acting Cholinergic Agonists Contraindications

Answer 22

Bradycardia
Intestinal or urinary tract obstruction

Question 23

Indirect-Acting Cholinergic Agonists Cautions

Answer 23

ANY CONDITION THAT COULD BE EXACERBATED BY CHOLINERGIC STIMULATION (asthma, urinary/GI obstruction)

Hepatic/renal dysfunction
Prego + lactation

Question 24

Indirect-Acting Cholinergic Agonists AE

Answer 24

CHOLINERGIC CRISIS: Dumbells (Diarrhea, urination, miosis, bradycardia, emesis, lacrimation, lethargy, salivation)

Question 25

Indirect-Acting Cholinergic Agonists DD

Answer 25

NSAIDS (increases effects) Cholinergic drugs

Question 26

Dopaminergics prototypes

Answer 26

Carbidopa-levodopa and ropinirole

Question 27

Dopaminergics TA

Answer 27

Promote dopamine synthesis, activate dopamine receptors, prevent dopamine breakdown, or decrease degradation of levodopa

Question 28

Dopaminergics Indications

Answer 28

Relieves parkinson's symptoms

Question 29

Dopaminergics Pharmaco

Answer 29

Generally well absorbed from GI Widely distributed Hepatic and peripheral cell metabolism Urine excretion Cross placenta and milk

Question 30

Dopaminergics Contraindications

Answer 30

Known allergy Angle-closure glaucoma Lactation

Question 31

Dopaminergics Cautions

Answer 31

CV disease, bronchial asthma, hx of peptic ulcers, urinary tract obstructions, psych disorders, prego

Question 32

Dopaminergics AE

Answer 32

N/V, constipation, orthostatics, headache, dizziness, arrhythmias

Question 33

Dopaminergics DD Ints

Answer 33

ALWAYS GET PT MED LIST!!!! MAOIs (never take them together) can cause hypertensive crisis Iron supplement/multivitamin (take 2hrs after one another for carb and lev) will reduce effectiveness

Question 34

Anticholinergic Agents prototype

Answer 34

Benztropine

Question 35

Anticholinergic Agents TA

Answer 35

Have greater affinity for receptor sites in CNS than for those in PNS

Question 36

Anticholinergic Agents Indications

Answer 36

Treats parkinsonism Relieves extrapyramidal disorders associated with use of some drugs

Question 37

Anticholinergic Agents Pharmaco

Answer 37

Variably absorbed from GI Hepatic Cellular pathways excretion Cross placenta and milk

Question 38

Anticholinergic Agents Contraindications and Cautions

Answer 38

Allergy, narrow-angle glaucoma, GI or GU obstruction, prostatic hypertrophy, hyper/hypotension, hepatic dysfunction, prego + lactation, patients who work in hot environments (because of AE)

Question 39

Anticholinergic Agents AE

Answer 39

Blurry vision, dry mouth, constipation, sweating, confusion, tachycardia, palpitations, hypotension, urinary retention and hesitancy, fever, hallucinations

Question 40

Anticholinergic Agents DD Ints

Answer 40

Other anticholinergics Antipsychs

Question 41

Headache med fact

Answer 41

Find out about past pain meds! MOH = a headache caused from overuse of pain meds

Question 42

Priority intervention for migraines

Answer 42

Cold compress, no lights, quiet

Question 43

Safinamide and Carbidopa-levodopa

Answer 43

Safinamide is indicated to work with carb-lev in pts with parkinsons who are having "off" episodes