neuro Flashcards
abortive treatments for migraine (mild to moderate)
simple analgeisc, NSAIDS, como analgeiscs (like APAP/ASA/caffeine),
abortive txs fo rmigraine (mod to severe)
5HT receptor agonists (triptans), ergotamine preps (a little more dangerous than triptans because of ergotism)
rescue therapies for migraine
corticosteroids, opoid combos
for which drug class should you evaluate possible cardiovascular disease first?
triptans
how is headache severity classified?
Mild: Patient is aware of headache but able to continue daily routine with minimal alteration Moderate: The headache inhibits daily activities but is not incapacitating
Severe: The headache is incapacitating
Status: A severe headache that has lasted more than 72 hours
best combo analgesic for migraines
APAP/ASA/caffeien
medication overuse HA criteria
AHeadache present on ≥ 15 days/month fulfilling criteria C and D
B. Regular overuse for > 3 months of one or more drugs that can be taken for acute and/or
symptomatic treatment of headache
C. Headache has developed or markedly worsened during medication overuse
D. Headache resolves or reverts to its previous pattern within 2 months after discontinuation of
overused medication
consider prophylactic migraine tx when
Frequent headaches (>2/week)
Migraine significantly interferes with patient’s daily routines, despite acute treatment
Contraindication to, failure, adverse effects, or overuse of acute therapies
Patient preference
Presence of uncommon migraine conditions, including hemiplegic migraine, basilar
migraine, migraine with prolonged aura, or migrainous infarction
3 beta blockers that are studied and effective for migraine prophylaxis
propranolol, timolol, metoprololf
are ARBs and ACE effective for migraine prophylaxis?
possibly
AE of beta blockers for migraine prophylaxis
fatigue, depression, nausea, dizziness, insomnia, exercise intolerance
DOC for migraine prophylaxis. other options?
beta blockers; other options are TCAs (amitryptiline), SNRIs (venlafaxine), AEDs (valproic acid, topiramate)
what are some natural products that are effective for migraines?
caffeine (enhancs NSAIDS), chasteberry (PMS), magnesium (if low magnesium), butterbur extra, feverfew, riboflavin, coenzyme Q, melatonin
what is the most important thing to monitor patents migraines?
headache diary
how long should you wait for HA to be controlled before considering tapering prophylactic tx?
3-6 mo
AE of sumatriptan indication CI trade name dosage forms
ae: Dizziness, sensation of warmth chest fullness & nausea most common
Angina, arrhythmia, cerebral & myocardial ischemia rare (
1 abortive therapy for cluster HA; second line tx
oxygen; second line are triptans and ergots
prophylactic therapy for cluster HA
verapamil (best), lithium, prednisone, ergotamine (rescue)
first line tx’s for conjunctivitis (bacterial)
trimethoprim + polymyxin B; ciprofloxacin ointment , bacitracin ointment + polymyxin B
aminoglycoside drops
indication
moa, ae,
MOA: Inhibit bacterial protein synthesis Products
• Tobramycin (Tobrex®): available as generic (less expensive) and less ocular toxicity
• Gentamicin: higher ocular toxicity
• Neomycin: only available as a combo, high ocular toxicity Uses
• Most effective against G- (esp. Pseudomonas)
• Also synergy against some G+
Adverse Effects: Localized ocular toxicity and hypersensitivity, lid itching, lid swelling and conjunctival erythema (
FQ drops
moa, ae, indication
MOA: Inhibits bacterial DNA gyrase Products
• Ciprofloxacin (Ciloxan®) 2nd generation
solutionandointment
canpptoutandleaveawhitishsolid
• Ofloxacin (Ocuflox®) 2nd generation
solutiononly;moresoluble->higheraqueousconcentrations
• Levofloxacin (Quixin®) 3rd generation
• Moxifloxacin (Vigamox®) 4th generation (no-preservative)
• Gatifloxacin (Zymar®) 4th generation (BAK preservative)
• Besifloxacin (Besivance) similar to 4th generation Uses
• Corneal infections/ulcers
• Severe conjunctivitis
Adverse Effects: White crystalline precipitates; lid margin crusting; crystals/scales; foreign body sensation; conjunctival hyperemia; bad/bitter taste in mouth; corneal staining; keratopathy/keratitis; allergic reactions; lid edema; tearing; photophobia; corneal infiltrates; nausea; decreased vision; chemosis.
Comments
• Not used first-line for conjunctivitis due to poor Strep coverage, expense, and resistance concern
TMP + polymyxin
indication, moa, ae
MOA: Inhibits folic acid synthesis
Product: Trimethoprim + Polymyxin B (Polytrim®) Uses:
• G+, G- (except Pseudomonas, so add polymyxin for the Pseudomonas activity)
• Especially effective against Haemophilus influenzae and Strep. Pneumoniae Adverse Effects: Low toxicity
Comments
Good for kids
Cost-effective, first line treatment for conjunctivitis
indications for corticosteroids in eyes
allergic rhinitis, inflammation, or + antibiotic to make it clear faster but increases risk of masking infection
what eye med is good for itching?
NSAIDS
mild approaches ot allergic conjunctiivsi
1 avoid allergen, 2 artificial tears to dilute, 3 topical antihistamine +/- oral
moderate approaches to allergic conjunctivitis
mast cell stabilizers, topical NSAIDS, ST topical corticosteroids
cycloplegics indication, moa, ae
Use: For reduction of inflammation and pain
Adverse Effects: Increased intraocular pressure; transient stinging/burning; irritation with prolonged use (eg, allergic lid reactions, hyperemia, follicular conjunctivitis, blepharoconjunctivitis, vascular congestion, edema, exudate, eczematoid dermatitis).
Comments:
• All cycloplegics have red caps
• Like putting the eye in a cast
when should ointment eye drops be applied?
at hs, b/c blur vision
cosmetic agent for increasing eyelash growth, ae
bimatoprost (latisse) could darken iris and skin around eyes
drugs that can increase
Corticosteroids Ophthalmic (high) Systemic Inhaled/Nasal Ophthalmic anticholinergics Vasodilators (low) Cimetidine (low)
med for glaucoma that is dosed once/day
prostaglandin analogs (travaprost)
first line therapy for glaucoma
travoprost, beta blockers
travoprost
indications
moa
ae
Q24h dosing
IOP Lowering up to 28-30%
MOA: outflow of aqueous humor
Adverse Effects:
Common: iris pigmentation (latanoprost > travoprost > bimatoprost), growth of eyelashes and itching (15-45%)
Less common: dryness, visual disturbance, burning, eye pain, pigmentation of skin @ eye
Comments:
First-line therapy (American Academy of Ophthalmology POAG Preferred Practice Pattern, 2015)
Contact lenses: replace 15 min after dose
beta blockers eye drops
indications, moa, ae
Example: Timolol (Timoptic)
Q12-24h dosing
IOP Lowering 20-35%
Nonselective (timolol, levobunolol, metipranolol; carteolol with ISA) > selective (betaxolol)
MOA: production of aqueous humor
Adverse Effects/Contraindications:
Minimal local adverse effects: stinging on application, dry eyes, corneal anesthesia,
blepharitis, blurred vision
Systemic AE: HR & BP, bronchospasm, masked sx of hypoglycemia, CNS sedation
(one drop of timolol 0.5% in each eye equals about 10 mg orally)
Contraindications: asthma, COPD, sinus bradycardia, 2-3 heart block, HF, hypersens
Comments: First line therapy
adjunct for beta blockers or prostaglandins in eyes
alpha adrenergic agonsits (brimonidine)
are oral carbonic anhydrase inhibitors good for glaucoma?
not well tolerated
beta blocker/CAI combo example
dorzolamide/timolol (cosopt)
after starting a glaucoma med, how soon should you follow up?
2-4 weeks, assess response and adherence
