Pharm for HA, Cohen

Question 1

chronic pain

Answer 1

continuing pain >6 mo

Question 2

patients with headaches need what besides pain relief

Answer 2

explanation for the HA

Question 3

Treatment for HA depends on

Answer 3

frequency attacks and severity
presence and degree of disability
assoc symptoms
prior response to meds
comorbid and coexistant conditions

Question 4

migraine criteria

Answer 4

> 5 attacks lasting 4-72 hours
2: unilateral, pulsating, mod-severe, aggravated by routine activity
1: nausea and/or vomiting
photophobia and phonophobia
no evidence on Hx or examination of disease that may cause HA

Question 5

Tx of migraine attacks

Answer 5

OTC meds
migraine specific meds from doc
caffeine, including dark chocolate or cola drinks
getting some sleep

Question 6

when are triptans taken usualy

Answer 6

few hours after begining of migraine

Question 7

what R do triptans work on

Answer 7

5GT1B 1D and1F

Question 8

what newer triptans have better effect and fewer side effects

Answer 8

rizatriptan

electriptan

Question 9

CI triptans

Answer 9

coronary artery disease of cerebral vascular disease

Question 10

half life triptans

Answer 10

<4 hours

Question 11

what medicaiton for HA can increase BP

Answer 11

ergotamine

Question 12

what is a drug used IV or IM for migraines acutely

Answer 12

dihydroergotamine DHE

Question 13

half life DHE

Answer 13

9 hours

Question 14

what dopamine blockers are used for migraine

Answer 14

haloperidol

Question 15

what drug is common in ED for migraine to avoid opioid use

Answer 15

antihistamine

Question 16

future of migraine medication

Answer 16

long acting monoclonal Ab to CGRP

for preventative migraines

Question 17

when do we start Txing prophylactically for migraines

Answer 17

when patient cannot go a week between migraines

insufficient relief from abortives

Question 18

what are great preventative migraine meds and what do they have in common

Answer 18

amitriptyline, propanolol, topiramate

Na channel blockers!

Question 19

what are good preventative migraine drugs

Answer 19

gabapentin, zonisamide

Question 20

which drugs are FDA approved for migraine prevention

Answer 20

propanolol, topiramate

valproic acid

Question 21

half life propanolol

Answer 21

4-6 hours
needs to be taken 3x day
there are long acting formulations

Question 22

CI propanolol

Answer 22

relative in asthmatics or CHF or bradycardia from heart blocks

Question 23

effects amitryptyline

Answer 23

antihistamine

very anticholinergic!

Question 24

dosing amitriptyline

Answer 24

low dosese in evening

Question 25

side effects amitriptyline

Answer 25

tachyarrhythmias can cause suicide from overdose weight gain

Question 26

topiramate is FDA approved for what

Answer 26

prevention seizures and migrains

Question 27

half time topriamate

Answer 27

18-20 hours | take at bedtime

Question 28

side effects topiramate

Answer 28

"dopamax" because can cause difficulties with speech and cognition anorexia and weight loss loss of sensation in arms changes in serum acidity and Ca solubility

Question 29

MOA valproic acid

Answer 29

blocking Na Ch and effects of gamma aminobutyric acid

Question 30

valproic acid is FDA approved for

Answer 30

migraine prevention epilepsy bipolar disease

Question 31

half life valproic acid

Answer 31

10-20 hours | needs to be given at least 2x day

Question 32

side effects valproic acid

Answer 32

weight gain, lowering of platelet counts, tremor and hair loss

Question 33

when was botulinum toxin aproved for migraine prevention

Answer 33

2010

Question 34

how is botulinum toxin injected

Answer 34

many sites in scalp every 3 mo

Question 35

mech botulinum

Answer 35

inhibit Ach release and inhibit sensory neurons

Question 36

what are comorbidities with tension type HA

Answer 36

``` HTN depression anxiety insomnia DM/hypoglycemia other sources of pain ```

Question 37

what are prophylactic drugs for tension type HA

Answer 37

amitriptyline protriptyline topiramate

Question 38

abortive Tx cluster HA

Answer 38

sumatriptan injeciton sumatriptan or zolmitriptan nasal sprays high dose O2 nasal viscous lidocaine

Question 39

prevention for cluster HA

Answer 39

almost always necessary verapamil may cause hypotension constipation lithium-- so dangerous in suicidal patients, also cause renal and thyroid disease prednisone- works fask with many side effects limiting to only use in season of cluster if season is not very long

Question 40

drug R patients with cluster HA need what Tx

Answer 40

deep brain stimulation | implanted occipital nerve stimulator

Question 41

patient takes aspiring every day for HA

Answer 41

need to stop pain medication because thats causing it | plus with these pain pills preventative drugs will not work!!

Question 42

imagin trigeminal nerualgia

Answer 42

MRI

Question 43

Tx trigeminal neuralgia

Answer 43

carbamazepine first DOC | gabapentin or phenytoin

Question 44

if drug Resistant to trigeminal neuralgia

Answer 44

radiological or surgical ablation of trigem nerve via gamma knife, injection of glycerol or electrical ablation

Question 45

down side to surgical ablation trigem nerve

Answer 45

permanent facial numbness