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Phar 507 > Pharmacological treatment of Headache Disorders > Flashcards

Pharmacological treatment of Headache Disorders Flashcards

1
Q

What are non specific drugs to stop a migraine

A

NSAIDs, Corticoseteroids, analgesics, antiemetic’s

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2
Q

What are migraine specific drugs

A

Triptans and Ergots

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3
Q

What analgesic would be used to treat a migraine, what combo analgesic would be used

A

Acetaminopehn 325- 1000mg every 4 to 6 hours as needed/ Excedrin 2 tables every 6 hours as needed

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4
Q

What NSAIDs would be used to treat a migraine

A

Ibuprofen: 200-800 mg every 6 hours as needed, Aspirin 500- 1000 mg every 4 to 6 hours as needed, Naproxen: 550-825 mg at onset then 220 mg every 3 to 4 hours as needed, Diclofenac: 50-100mg at onset then 50 mg in 8 hours as needed

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5
Q

T/F: Opiates have great used in migraines

A

False: Generally not recommended due to no anti-inflmmatory effect due to central desentizitation

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6
Q

Which antiemetic agents are used for migraines, when are they given

A

Metoclopramide, chlorpromazine, prochlorperazine/ administer 15-30 minutes before abortive treatment

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7
Q

When are Ergot alkaloids used in migraines, MOA

A

acute therapy for moderate to severe migraine/ vasoconstriction of meningeal vessels and inhibit vasoactive neuropeptide release

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8
Q

What are the two types of ergot alkaloids, formulations, what are the Adverse effects, which is non to have dose restrictions to prevent rebound headaches

A
  • Ergotamine tartrate (with caffeine enhance GI absorption)
    • oral, rectal, sublingual
  • Dihydroergotamine (sometimes mixed with lidocaine)
    • IV, IM, SC

AEs: nausea, vomiting, abdominal pain, weakness/fatigue, diarrhea

Ergotamine tartrate

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9
Q

T/F: Ergots should not be used within 12 hours of any triptan

A

False: Ergots should not be used within 24 hours of any triptan

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10
Q

What is a rare but severe adverse effect of ergot alkaloids, what contraindications must be avoided to prevent this

A

Ergotism: peripheral iscemia due to vasoconstriction characterized by cold, numb, painful extremities, and diminished peripheral pulses

  • Coronary artery disease
  • Cerebrovascular disease
  • Peripheral vascualr disease
  • Uncontrolled hypertension
  • Pregnant or nursing
  • CYP 3A4 inhibitors (clarithromycin, azithromycin, erythromycin, ketoconazole/ protease inhibitors)
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11
Q

When are triptans used, therapeutic pharmacologic actions

A

Mild to severe migraines during an aura,

  • vasoconstriction of intracranial blood vessels
  • inhibition of vasoactive neuropeptide release
  • interruption of pain signal transmissions
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12
Q

What are contraindications of triptans

A
  • Coronary artery disease
  • Cerebrovascular disease
  • Peripheral vascular disease
  • Severe liver disease
  • Uncontrolled hypertension
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13
Q

What patients can take triptans but do have caution when recieving them

A
  • Men older than 40, women older than 55
  • Taking antidepressants (serotonin syndrome)
  • have diabetes
  • family history of heart disease or stroke
  • high cholesterol
  • menopause/pregnant
  • obese
  • Smoke
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14
Q

What is Triptan sensation

A

Chest, arm, and jay pain following triptan use (similar to a heart attack)

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15
Q

What are the short duration triptans

A

Sumatriptan, almotriptan, eletriptan, rizatriptan, zolmitriptan

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16
Q

What are the long duration triptans

A

naratriptan and frovatriptan

17
Q

Which triptans have the shortest onset (15-20 mins), which have nasal formulations

A

sumtraiptran and zolmitriptan

18
Q

Which triptans are have oral disentegrating tablet formulations

A

Rizatriptan and Zolmitriptan

19
Q

Which triptans are mostly eliminated renally

A

naratriptan and frovatriptan

20
Q

Which triptans are mostly metabolized by CYP3A4

A

almotriptan and eletriptan

21
Q

Which triptans are metabolized by CYP1A2

A

frovatriptan and zolmitriptan

22
Q

Which triptans are metabolized by MAO-A

A

rizatriptan and sumatriptan

23
Q

T/F: Triptans should be used for 3 to 4 headaches before a different triptan is used

A

True

24
Q

Which medications are used to mask migraines but NOT treat

A
  • acetaminophen compounds (codeine, hydrocodone)
  • Opiods
  • baclofen
  • Ondansetrone
  • Butalbital products
25
Q

What beta-blockers can be used as prophlatic therapy for migraines, Adverse effects

A
  • Metoprolol, Propanolol, and Timolol
  • AE: drowsiness, fatigue, vivid dreams, bradycardia, hypotension

MUST BE TITRATED

26
Q

Which antidepressants can be used in prophylactic therapy, anticonulsants, whicc class should not be used in pregnant pateints

A
  • Amitriptyline and Venlafaxine
  • Topiramate, Divalproex, Valporic acid

Anticonvulsants

27
Q

Which OTCs have shown efficacy against migraines

A
  • Magnesium Oxide
    • migraines with aura, menstrual migraines
  • Feverfew
    • withdrawal may increase headaches
  • Riboflavin
    • Benefit only after 3 months
  • Petasites
    • use only commercial preparations
28
Q

What injection is indicated for chronic migraines only

A

Botox

29
Q

What do certain monoclonal antibodies target in order to reduce migraines, what are they, benefits, what must be accomplished before they patients qualify

A

CGRP ligands or CGRP receptors

  • Erenumab (receptor)
  • Fremanezumab (ligand)
  • Glacanezumab (ligand)

No need to titratrate, dose monthly or quarterly, minimal to no side effects or DDIs, specific for migraine prophylaxis

Must fail 2 prophylactic meds

30
Q

Which medications are used to treat tension-type headaches

A

NSAIDs, Analgesics, Combination analgesics, Fioricet (butalbital, caffeine and acetaminophen), Fiorinal (butalbital, aspirin, caffeine)

31
Q

What drugs can be used as prophylaxis of tension-type headaches

A

Amitriptyline

32
Q

What drugs are used to treat cluster headaches

A
  • Oxygen 12L/min every 15 min
  • Sumatriptan
  • Zolmitriptan
  • Galcanezumab
33
Q

Which drugs can be used for prophylaxis of cluster headches

A
  • Prednisone
  • Verapamil (EKG should be checked for heart block)
  • Lithium
34
Q

How long does detoxification take for patients with medication overuse headaches,

A

1-3 months

Phar 507 (33 decks)

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