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Clinical Pharmacology II > Insomnia and Migraine/Headache > Flashcards

Insomnia and Migraine/Headache Flashcards

1
Q

What is Buspirone?

A

ONLY an ANXIOLYTIC = doesn’t have sedation, anticonvulsant, or muscle relaxant effects

Not a CNS depressant like a benzo is

Delayed onset of action of 2-4 weeks

Must titrate dose slowly in order to avoid dizziness/drowsiness

Adjunctive therapy with antidepressants

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2
Q

What is the first line treatment for Insomnia?

A

Non-pharmacologic therapies such as:

CBT
Relaxation therapy
Enhanced Sleep hygeine

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3
Q

What is insomnia treatment?

A

Most cases are transient, chronic cases are likely secondary to some other underlying cause

Sleep onset insomnia vs. sleep maintenance insomnia

Patient comorbidities often dictate therapy = depression, chronic pain

There are no notable statistical differences in outcomes between the different classes of medications

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4
Q

What are the Insomnia treatment considerations?

A

Benzos
Non-benzos = the three Z drugs
Ramelteon
Suvorexant

Trazadone
Doxepin
Diphenhydramine
Doxylamina
Tiagabine
L-tryptophan
Valerian
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5
Q

What are the non-benzo drugs?

A

More specific for GABA-1A receptor

They have less abuse/dependence potential

Not anxiolytic

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6
Q

What is the concern with using Zolpidem?

A

Hangover effect even the day after taking the drug

Users should not drive or engage in activities requiring mental alertness during the day after taking it

Lower recommended doses in women

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7
Q

What is special about Eszopiclone?

A

Its the only agent FDA-approved for treatment > 35 days

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8
Q

What does Ramelteon used for?

A

Treatment of chronic or transient insomnia characterized by difficult with SLEEP ONSET

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9
Q

What does activation of MT1 receptor do?

A

Induces sedation

Promotes sleep

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10
Q

What does activation of MT2 receptor do?

A

Resets sleep cycles

Maintains normal circadian rhythm

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11
Q

What is Orexin A/B?

A

Wake promoting neuropeptides

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12
Q

What does antagonism of the OX1R and OX2R receptors do?

A

Supresses wake drive

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13
Q

What drugs should you NOT use to treat insomnia?

A

Atypical antipsychotics = Quetiapine and Olanzapine

Barbituates

Meprobamate

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14
Q

What is the duration of therapy for insomnia drugs?

A

Do not use longer than 12 months

Re-assess need every 2-4 weeks

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15
Q

What is a migraine?

A

Intense and throbbing headache often involving one side of the head

Related to imbalance in nervous system especially in the trigeminal nerve causing vasodilation and inflammation of blood vessels in the head

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16
Q

What is a migraine associated with?

A

Light or sound sensitivity
N/V
Women&raquo_space; Men
Can occur with or without an aura

17
Q

How should mild-moderate migraines be treated?

A

Manageable with PO meds

18
Q

How are more severe migraines treated?

A

May require parenteral therapy

19
Q

What drugs should be used for acute migraine treatment?

A

Triptans
NSAIDS
Excedrin

20
Q

What is the most commonly used triptan?

A

Sumatriptan

21
Q

What does activating the 5HT-1D receptor do?

A

Indirectly inhibits dural vasodilation and inflammation

22
Q

What does activating 5HT-1B receptor do?

A

Vasoconstriction of intracranial extra-cerebral vessels

23
Q

What does activating 5HT-1B/1D do?

A

inhibits trigeminal nuclei nociceptive neurotransmission

24
Q

When are triptans most effective?

A

When used within 1 hour of onset of migraine but up to 4 hours

25
Q

What are the ADRs of triptans?

A 
Chest discomfort/pain
Dizziness
Fatigue
Paresthesias
Flushing asthenia
Dysgeusia
26
Q

What are triptans contraindicated in?

A

CAD
PVD
CVD
Uncontrolled hypertension

27
Q

What are some non-pharmacological migraine prevention techniques?

A 
Regulated lifestyle:
Healthy diet
Regular exercise
Regular sleep patterns
Avoiding excess caffeine/alcohol
Avoiding acute changes in stress levels

Identify/manage triggers

28
Q

What are pharmacological migraine prophylaxis treatments?

A

Beta blockers = propanalol/timolol/metoprolol&raquo_space; atenolol/nadolol

AEDs = topiramate, divalproex/valproic acid

Botox

TCAs = amitriptyline, nortriptyline, imipramine

SNRIs = venlafaxine

Clinical Pharmacology II (25 decks)

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