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MS 2 - Unit 3 > Pharmacology - Headache - Luis Mejico > Flashcards

Pharmacology - Headache - Luis Mejico Flashcards

1
Q

Most migraine auras are last for how long?

A

5-20 minutes, usually not longer than 60

Most common aura is visual, thought paresthesias can also occur

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2
Q

What kind of headache are we talking about?
Usually unilateral;
throbbing;
moderate to severe pain;
aggravated by physical activity and light;
usually lasts 4-72 hours

A

Migraine headache

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3
Q

What are the migraine specific medications?

A

Ergots and triptans

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4
Q

What is status migranosis and what is the treatment?

A

A severe headache lasting longer than 72 hours;

Treat with IV DHE (dihydroergotamine)

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5
Q

T/F: Triptans are not helpful in treating the aura phase.

A

True

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6
Q

Triptans should be avoided in patients with what disease?

A

Vascular disease, uncontrolled HTN, complicated migraine syndromes

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7
Q

Name the side effects of the Triptans.

A

Flushing, tingling, dizziness, chest discomfort

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8
Q

What is the prodrome of a headache?

A

Occurs in 20% of migraine sufferers
Can be change in mental status, drowsiness, depression, irritable, hyperactive, euphoric, talkative, phono or photophobic, yawning, difficulty concentrating, dysphoria, anorexia, food craving, thirst, urination, fluid retention, diarrhea/constipation, stiff neck

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9
Q 
NSAIDS
COX-2 inhibitors
Combination analgesics
Neuroleptics/antiemetics
Corticosteroids
Opiods

These drugs all make up what HA treatment?

A

Acute nonspecific migraine treatment

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10
Q

Should DHE be used in pregnancy for migraine?

A

No

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11
Q

Why are barbiturate medications not often used for migraine?

A

Risk of overuse –> rebound headaches

Rebound HA are most common in barbiturate and caffeine containing medications

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12
Q

What is the most common cause of chronic daily HA?

A

Medication oversue

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13
Q

Why is acetominophen preferred in children for treatment of HA?

A

Risk of Reye’s syndrome in children with use of other NSAIDS

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14
Q

What are frequent side effects of barbiturates for use in treating HA?

A

Drowsiness, dizziness,

risk of overuse and withdrawal

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15
Q

Opiods for HA should not be used more than how many days per week?

A

About 2. About the same with barbiturates

Codeine, meperidine, oxycodone, hydromorphone, morphine, methadone, butorphanol.

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16
Q

What is the transnasal opiod for use in migraine headache treatment?

A

Butorphanol

Migranal is DHE in nasal spray form but it’s not an opiod.

17
Q

When are corticosteroids used in migraine headache treatment?

A

Status migranosis

Oral and parenteral can be used

18
Q

What is the MOA of Ergotamine?

A

Reduces cell activity in the trigeminovascular system

19
Q

What are the adverse reactions associated with Ergotamine (rarely used) and DHE?

A

Nausea, dizziness, paresthesia, chest pain, abdominal cramps

20
Q

Ergots should be avoided in what patients?

A

Pregnant, planning on pregnancy, uncontrolled HTN, sepsis, renal or hepatic failure, vascular disease (cardiac, cerebral, peripheral)

21
Q

Selective 5-HT 1B-D agonists describes what class of drugs?

A

Triptans
Premier migraine abortive drug
MOA is to constrict the extracerebral intracranial vessels and inhibiting the trigeminovascular system

22
Q

What tricyclic antidepressants are recommended for migraine prevention?

A

Amitryptaline
Protriptaline
Nortriptyline

All are TCAs.
Dry mouth, constipation, weight gain, cardiac toxicity and orthostatic hypotension are AEs

23
Q

What SSRIs are recommended for migraine prevention?

A

Fluoxetine
Paroxetine
Sertraline

24
Q

What beta blockers are recommended for migraine prevention?

A

Propranolol
Timolol

Nadolol and Atenolol sometimes preferres bc longer half life and tolerability

25
Q

Beta blockers should not be used in patients with what diseases?

A

Asthma
Diabetes
CHF
Raynaud’s

26
Q

What calcium channel blocker is particularly suited for treating the aura phase of migraine prevention?

A

Verapimil

Helpful in complicated migrane (ie hemiplegic migraine) or prolonged or disabling aura

27
Q

What are the side effects of Verapimil?

A

Constipation

Dizziness

28
Q

What antiepileptic drugs are recommended for migraine prevention?

A 
Valproic acid (Divalproes sodium ER)
Topiramate
29
Q

What are the common side effects of valproic acid?

A

Sedation, hair loss, weight gain, tremor, changes in cognition

30
Q

What are common side effects of topiramate?

A

Changes in cognition
Paresthesias
Weight loss

Serious side effects: acute-closure angle glaucoma, kidney stones

31
Q

What is the main site of topiramate metabolism?

A

Kidney

32
Q

When is onabotulinumtoxinA (Botox) indicated in migraine prevention?

A

FDA-approved for chronic migraine;
MOA unknown
Recommended when more than 8 of 15 headaches per month are migraines

33
Q

What are the recommended treatments for chronic tension type headaches?

A

TCA: Amitriptyline

SSRIs, muscle relaxants, Botox

34
Q

What is the epidemiology of cluster headaches?

A

Men more than women (4:1)
27-31 years old
Leonine facies possible in men, masculine-looking women

2 forms: episodic and chronic

35
Q

O2, Sumatriptan, DHE (SC and intranasal) and lidocaine nasal drops are recommended fast-acting treatments for what kind of headache?

A

Cluster headache

symptoms come on suddenly

36
Q

When are steroids like prednisone or methylprenisolone recommended in HA treatment?

A

Cluster HA, steroids can be used short-term

37
Q

What is the long-term prevention of cluster HA?

A

Verapimil
Topiramate
Valproic acid
Lithium

38
Q

What are the side effects of lithium?

A 
Weakness
Nausea
Thirst
Tremor
Lethargy
Blurred vision
Slurred speech
39
Q

What medications should be avoided if s patient if on lithium, because they will increase the amount of lithium in the body?

A

Indomethacin

Sodium-depleting diuretics

MS 2 - Unit 3 (45 decks)

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