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Pharmacotherapy > neuro > Flashcards

neuro Flashcards

1
Q

abortive treatments for migraine (mild to moderate)

A

simple analgeisc, NSAIDS, como analgeiscs (like APAP/ASA/caffeine),

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2
Q

abortive txs fo rmigraine (mod to severe)

A

5HT receptor agonists (triptans), ergotamine preps (a little more dangerous than triptans because of ergotism)

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3
Q

rescue therapies for migraine

A

corticosteroids, opoid combos

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4
Q

for which drug class should you evaluate possible cardiovascular disease first?

A

triptans

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5
Q

how is headache severity classified?

A

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

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6
Q

best combo analgesic for migraines

A

APAP/ASA/caffeien

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7
Q

medication overuse HA criteria

A

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

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8
Q

consider prophylactic migraine tx when

A

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

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9
Q

3 beta blockers that are studied and effective for migraine prophylaxis

A

propranolol, timolol, metoprololf

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10
Q

are ARBs and ACE effective for migraine prophylaxis?

A

possibly

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11
Q

AE of beta blockers for migraine prophylaxis

A

fatigue, depression, nausea, dizziness, insomnia, exercise intolerance

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12
Q

DOC for migraine prophylaxis. other options?

A

beta blockers; other options are TCAs (amitryptiline), SNRIs (venlafaxine), AEDs (valproic acid, topiramate)

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13
Q

what are some natural products that are effective for migraines?

A

caffeine (enhancs NSAIDS), chasteberry (PMS), magnesium (if low magnesium), butterbur extra, feverfew, riboflavin, coenzyme Q, melatonin

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14
Q

what is the most important thing to monitor patents migraines?

A

headache diary

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15
Q

how long should you wait for HA to be controlled before considering tapering prophylactic tx?

A

3-6 mo

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16
Q 
AE of sumatriptan
indication
CI
trade name 
dosage forms
A

ae: Dizziness, sensation of warmth chest fullness & nausea most common
Angina, arrhythmia, cerebral & myocardial ischemia rare (

17
Q

1 abortive therapy for cluster HA; second line tx

A

oxygen; second line are triptans and ergots

18
Q

prophylactic therapy for cluster HA

A

verapamil (best), lithium, prednisone, ergotamine (rescue)

19
Q

first line tx’s for conjunctivitis (bacterial)

A

trimethoprim + polymyxin B; ciprofloxacin ointment , bacitracin ointment + polymyxin B

20
Q

aminoglycoside drops
indication
moa, ae,

A

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 (

21
Q

FQ drops

moa, ae, indication

A

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

22
Q

TMP + polymyxin

indication, moa, ae

A

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

23
Q

indications for corticosteroids in eyes

A

allergic rhinitis, inflammation, or + antibiotic to make it clear faster but increases risk of masking infection

24
Q

what eye med is good for itching?

A

NSAIDS

25
Q

mild approaches ot allergic conjunctiivsi

A

1 avoid allergen, 2 artificial tears to dilute, 3 topical antihistamine +/- oral

26
Q

moderate approaches to allergic conjunctivitis

A

mast cell stabilizers, topical NSAIDS, ST topical corticosteroids

27
Q

cycloplegics indication, moa, ae

A

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

28
Q

when should ointment eye drops be applied?

A

at hs, b/c blur vision

29
Q

cosmetic agent for increasing eyelash growth, ae

A

bimatoprost (latisse) could darken iris and skin around eyes

30
Q

drugs that can increase

A 
Corticosteroids
 Ophthalmic (high)
 Systemic
 Inhaled/Nasal
 Ophthalmic anticholinergics
 Vasodilators (low)
 Cimetidine (low)
31
Q

med for glaucoma that is dosed once/day

A

prostaglandin analogs (travaprost)

32
Q

first line therapy for glaucoma

A

travoprost, beta blockers

33
Q

travoprost
indications
moa
ae

A

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

34
Q

beta blockers eye drops

indications, moa, ae

A

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

35
Q

adjunct for beta blockers or prostaglandins in eyes

A

alpha adrenergic agonsits (brimonidine)

36
Q

are oral carbonic anhydrase inhibitors good for glaucoma?

A

not well tolerated

37
Q

beta blocker/CAI combo example

A

dorzolamide/timolol (cosopt)

38
Q

after starting a glaucoma med, how soon should you follow up?

A

2-4 weeks, assess response and adherence

Pharmacotherapy (9 decks)

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