Rx Headaches

Question 1

what are the treatment options for tension headache?

Answer 1

NSAIDS - Aspirin, Ibuprofen and Naproxen

Acetaminophen

muscle relaxants - benzodiazapines

certain antimuscarinics like cyclobenzaprine

tizanidine - alpha2 agonist

Question 2

what are the MOA of NSAIDS - first off, list the NSAIDS

Answer 2

NSAIDS - Aspirin, Ibuprofen and Naproxen

Aspirin is a irreversible COX blockers

Ibuprofen and Naproxen are reversible COX blockers

Question 3

what are the toxicities associated with NSAIDS?

Answer 3

bleeding, GI irritation - erosion and ulcers

Aspirin is a salicylate
Salicylism - increased leukotrienes seen with aspirin use, asthma/allergies

Question 4

what are the MOA and toxicities of acetaminophen?

Answer 4

MOA - weak COX inhibitor

causes liver toxicity at high doses or alcohol consumption

N-acetylcysteine is the antidote

tension headaches

Question 5

what is the MOA of benzodiazepines?

Answer 5

They potentiate GABA by increasing freq of Cl- Channel opening

estazolam, flurazepam and temazepam

sometimes used for tension headaches

Question 6

cyclobenzaprine
methocarbamol
orphenadrine
amitripyline

what are these?

Answer 6

antimuscarinics

amitriptyline is a tricyclic antidepressant that works by inhibiting the reuptake of serotonin and NE

could be used for tension headaches

Question 7

what are the toxicity risks associated with used of benzodiazepines?

Answer 7

drowsiness 
impaired judgement
depressed motor skills 
anterograde amnesia
tolerance 
dependence

Question 8

what are the toxicity risks associated with used of cyclobenzaprine? what other drugs have the same adverse effects?

Answer 8

sedation and other typical antimuscarinic effects - dry mouth, constipation, increased AV node conduction, confusion or mydriasis

other drugs - methocarbamol
orphenadrine
amitriptyline (SSRI)

Question 9

Tizanidine

Answer 9

Centrally acting alpha2 agonist

Any drug that inhibits/interacts with CYP1A4 can raise serum levels of Tizanidine -> enhanced CNS effects
(fluoroquinolones)

used for tension headache is possible, but also for prophylaxis of migraine, ALS or MS (muscle relaxant)

Question 10

in what way are aspirin and NSAIDS useful for migraine? - during the migraine

Answer 10

for pain suppression and early intervention against platelet action

Question 11

why is propranolol used for migraine prophylaxis? what are the contraindications?

Answer 11

It prevents trigeminal nerve excitement

asthma is a contraindication because of blocking B2 receptors causes bronchoconstriction

causes and both masks the signs of hypoglycemia

causes vasoconstriction

Question 12

What about amitriptyline makes it a migraine treatment possibility?

Answer 12

This drug blocks the reuptake of 5-HT maintaining serotonin levels during the vasodilation phase of migraines

Adverse effects - are anticholinergic (M3), orthostatic (from alpha1 block) and sedation from H1 block

Question 13

which migraine prophylaxis drug reduces the efficacy of oral contraceptives? what is it’s mechanism of action?

Answer 13

Topiramate

MOA - potentiation of GABA by blocking sodium channels and glutamate

used primarily for seizures

also, teratogenic

Question 14

which migraine prophylaxis drugs are teratogenic?

Answer 14

Topiramate

Valproate - a broad spectrum seizure drug that blocks both sodium and calcium channels, reduces degradation of GABA and decreasing the amount of glutamate around NMDA receptors.

other adverse effects of valproate are hepatitis, weight gain and upset GI. Inhibits CYP.

Benzodiazepine - fetal malformations

Question 15

which prophylactic migraine drugs prevent the onset of the vasoconstrictive ischemic phase of a migraine?

Answer 15

calcium channel blockers - Verapamil and Diltiazem

adverse effects are hypotension, constipation and gingival hyperplasia

Question 16

What’s the purpose of the adjunct therapy of:

phenothiazines
prochlorperazine

in migraine?

Answer 16

nausea and vomiting is a common symptoms of migraine headaches - these drugs are antiemetics

These drugs are dopamine receptor antagonists that also block M3 and H1.

Question 17

which drugs mimic parkinson disease symptoms? what are the other adverse effects?

Answer 17

phenothiazines and prochlorperazine

They mimic PD because of their DA-R antagonism property. Also increases prolactin production and blocks M3 and H1 (histamine)

elevates QT interval

Question 18

How do the Ergot-derived drugs treat migraine?

Answer 18

prophylaxis for migraine

Ergotamine, ergotamine tartrate and caffeine

These drugs counteract the vasodilating phase of migraine by vasocontriction at 5-HT1b/1d

contraindicated in coronary artery disease and atherosclerosis

Question 19

what is the MOA of Botulinum Toxin in the prophylaxis of migraines?

Answer 19

cleaves SNAP-25 protein which prevents the cell from releasing vesicles of acetylcholine

adverse effects are absence of muscarinic actions, loss of muscle tone, fatigue, paralysis and respiratory arrest

Question 20

triptan interacts with what other drugs to cause serotonin syndrome?

Answer 20

amytriptyline and other tricyclic anti-depressants, SSRI’s, MAOI’s, St. Johns Wort and linezolid.

Triptans are not for used in CAD patients

Question 21

What are the MOA of Triptans?

Answer 21

A partial agonist of 5HT1d/1b receptors causing vasocontriction - to reverse the vasodilatory phase of migraines

used for migraine and cluster headaches.

Question 22

what are the adverse effects of triptan drugs?

Answer 22

paraesthesias, dizziness, muscle, weakness, coronary vasocontriction and chest pain

Question 23

what sodium channel blocker drug is used for trigeminal neuralgia?

Answer 23

carbamazepine

oxcarbazepine - prodrug

also used for seizures and manic episodes

Question 24

what are the adverse effects of carbazepine?

Answer 24

toxicities include CYP3A4, drowsiness, Ataxia, agranulocytosis,

inappropriate release of antidiuretic hormone - SIADH

also, teratogen