T3-Analgesics: Headaches-MJ Flashcards
What is the most common headache?
Tension
What headache is the disabling headache and needs aggressive treatment?
Migraine
Migraines cause _____ head pain
Throbbing
What percent of migraines are unilateral?
60%
What percent of migraines are bilateral?
40%
Do migraines cause N/V?
Yes
Migraines cause a person to be sensitive to ___ and ___
Light and sound
What is the average length of a migraine?
24 hours
So why do people get migraines when that is in the brain and the brain doesn’t have pain receptors (you can poke, cut through the brain and no pain)?
Vessels and arteries IN THE BRAIN DO have pain receptors
Do migranes cause vasoconstriction or vasodialiaton?
Vasodialaton
Do migraines cause inflammation?
Yes
What nerve is effected from migraines?
Trigeminal
What promotes migraines?
CGRP
What surpasses migraines?
Serotonin
If we activate ______ receptors, that will depress the migraines.
Serotonin 1B,1D receptors
Which migraine medication stops a migraine AFTER it has started?
Abortive
What are the 2 migraine specific drugs?
Serotonin 1B,1D agonists (triptans)
Ergot alkaloids
What are triptans selective to?
Serotonin 1B,1D
What nerve does triptans work on?
Trigeminal nerve complex
The triptans induce _______.
Cerebral vasoconstriction
What do triptans block?
CGRP
What are 3 examples of triptans?
Sumatriptan
Eletriptan
Rizatriptan
What are the side effects of triptans (3)?
Vasoconstriction of coronary arteries
Heavy arms and chest pressure
Serotonin syndrome
We want triptans to induce _____ vasoconstriction, but the side effects sometimes cause vasoconstriction of ______.
We want them to induce CEREBRAL vasoconstriction but a side effect of triptans is causing vasoconstriction of CORONARY ARTERIES
Should you take a triptan if you have coronary artery disease or have had a MI? Why or why not?
NO! Side effect of triptan is vasoconstriction of coronary arteries !–NOT GOOD
Is the triptan side effect of heavy arms and chest pressure something to be concerned with?
No, UNLESS there are risk factors for the patient having heart problems
Triptans can also cause serotonin syndrome. Is this common or rare?
RARE unless taking some other drug that increases serotonin levels
What are the 4 big symptoms of serotonin syndrome?
Altered mental status
Fever, sweating
Hyperreflexia
Clonus
What are three drug classes that would cause too much serotonin when taking with a triptan?
MAOI
SSRI
SNRI
If you want to take the other abortive migraine specific drug (ergot alkaloid), how long must you wait to take it after taking a triptan?
24 hours; ergot alkaloids also increase serotonin so taking it closely after a triptan could cause toxicity
Are triptans for prevention of migraines?
No
How long does it take the triptan to work?
1-2 hours
If the triptan doesn’t cause relief after 2 hours, can you take another dose?
Yes, but only ONE other dose after initial
What is important to tell the patient to report if they begin experiencing it?
Chest pain, palpitations
What is the MOA of ergot alkaloids?
Precise mechanism UNKNOWN, but are similar to triptans
What are the side effects of ergot alkaloids?
N/V (10%)
Ischemia with overdose
Why is the side effect of N/V in ergot alkaloids a problem?
Because migraines already cause N/V–taking an ergot alkaloid increases N/V even more
What are the two ergot alkaloid examples?
Ergotamine
Dihydroergotamine
What are antiemetics used for?
Treating nausea
What is the preferred antiemetic?
Metoclopramide
What does metoclopramide do?
Reduces N/V
Reduces gastric stasis caused by attack
Enhances absorption of PO meds
Can we give metoclopramide even if the patient does not have N/V?
Yes, it increases absorption so it can be given to increse the absorption of the migraine drug
What does MOH stand for?
Medication overuse headaches
What is the main take home message about medication overuse headaches?
Take the doses as prescribed!!
A client stops taking the med and it causes their headache, so they then take medication, vicious cycle.
