Rx Headaches Flashcards
what are the treatment options for tension headache?
NSAIDS - Aspirin, Ibuprofen and Naproxen
Acetaminophen
muscle relaxants - benzodiazapines
certain antimuscarinics like cyclobenzaprine
tizanidine - alpha2 agonist
what are the MOA of NSAIDS - first off, list the NSAIDS
NSAIDS - Aspirin, Ibuprofen and Naproxen
Aspirin is a irreversible COX blockers
Ibuprofen and Naproxen are reversible COX blockers
what are the toxicities associated with NSAIDS?
bleeding, GI irritation - erosion and ulcers
Aspirin is a salicylate
Salicylism - increased leukotrienes seen with aspirin use, asthma/allergies
what are the MOA and toxicities of acetaminophen?
MOA - weak COX inhibitor
causes liver toxicity at high doses or alcohol consumption
N-acetylcysteine is the antidote
tension headaches
what is the MOA of benzodiazepines?
They potentiate GABA by increasing freq of Cl- Channel opening
estazolam, flurazepam and temazepam
sometimes used for tension headaches
cyclobenzaprine
methocarbamol
orphenadrine
amitripyline
what are these?
antimuscarinics
amitriptyline is a tricyclic antidepressant that works by inhibiting the reuptake of serotonin and NE
could be used for tension headaches
what are the toxicity risks associated with used of benzodiazepines?
drowsiness impaired judgement depressed motor skills anterograde amnesia tolerance dependence
what are the toxicity risks associated with used of cyclobenzaprine? what other drugs have the same adverse effects?
sedation and other typical antimuscarinic effects - dry mouth, constipation, increased AV node conduction, confusion or mydriasis
other drugs - methocarbamol
orphenadrine
amitriptyline (SSRI)
Tizanidine
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)
in what way are aspirin and NSAIDS useful for migraine? - during the migraine
for pain suppression and early intervention against platelet action
why is propranolol used for migraine prophylaxis? what are the contraindications?
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
What about amitriptyline makes it a migraine treatment possibility?
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
which migraine prophylaxis drug reduces the efficacy of oral contraceptives? what is it’s mechanism of action?
Topiramate
MOA - potentiation of GABA by blocking sodium channels and glutamate
used primarily for seizures
also, teratogenic
which migraine prophylaxis drugs are teratogenic?
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
which prophylactic migraine drugs prevent the onset of the vasoconstrictive ischemic phase of a migraine?
calcium channel blockers - Verapamil and Diltiazem
adverse effects are hypotension, constipation and gingival hyperplasia
What’s the purpose of the adjunct therapy of:
phenothiazines
prochlorperazine
in migraine?
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.
which drugs mimic parkinson disease symptoms? what are the other adverse effects?
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
How do the Ergot-derived drugs treat migraine?
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
what is the MOA of Botulinum Toxin in the prophylaxis of migraines?
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
triptan interacts with what other drugs to cause serotonin syndrome?
amytriptyline and other tricyclic anti-depressants, SSRI’s, MAOI’s, St. Johns Wort and linezolid.
Triptans are not for used in CAD patients
What are the MOA of Triptans?
A partial agonist of 5HT1d/1b receptors causing vasocontriction - to reverse the vasodilatory phase of migraines
used for migraine and cluster headaches.
what are the adverse effects of triptan drugs?
paraesthesias, dizziness, muscle, weakness, coronary vasocontriction and chest pain
what sodium channel blocker drug is used for trigeminal neuralgia?
carbamazepine
oxcarbazepine - prodrug
also used for seizures and manic episodes
what are the adverse effects of carbazepine?
toxicities include CYP3A4, drowsiness, Ataxia, agranulocytosis,
inappropriate release of antidiuretic hormone - SIADH
also, teratogen
