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PHA333 > Wk 28 - CNS + MSK OTC > Flashcards

Wk 28 - CNS + MSK OTC Flashcards

1
Q

Give examples of types of headaches

A
  • Migraine
  • Tension headache
  • Sinusitis
  • Cluster headaches
  • Temporal arteritis
  • Trigeminal neuralgia
  • Chronic daily headache
  • Medication overuse
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2
Q

What is a migraine?

A
  • Complex neurological condition
  • Severe/moderate headache
  • Throbbing + pulsating
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3
Q

What are the key feature that support the diagnosis of migraines?

A
  • Nausea + vomiting
  • Photophobia
  • Phonophobia
  • Disability
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4
Q

What are the causes of a migraine?

A

Vasodilation of blood vessels in brain

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5
Q

Outline the main classifications of migraines

A
  • Migraine w/ aura
  • Migraine w/o aura
  • Chronic migraine
  • Menstrual migraine
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6
Q

Give examples of migraine w/ aura

A
  • Typical aura
  • Hemiplegic migraine
  • Migraine w/ brainstem aura
  • Ocular
  • Silent
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7
Q

Outline the features of migraine w/o aura

A
  • Recurrent headache
  • Attacks last 4-72 hrs
  • Unilateral, pulsating, mod/severe
  • Aggravated by physical activity
  • Association w/ nausea, vom, photophobia + phonophobia
  • Relief from lying in darkened room
  • No neurological symptoms
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8
Q

Outline the features of migraine w/ aura

A
  • Transient, unilateral
  • Visual, sensory + other CNS symptoms that develop gradually
  • Occurs 5-20 mins before headache
  • Prodromal + post-dromal phases occur
  • Neurological symptoms precede headache
  • More common in women
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9
Q

Visual aura

A
  • Flashing lights
  • Scotoma
  • Zigzag lines (photopsia)
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10
Q

Sensory aura

A
  • Unilateral tingling or numbness in lips, fingers, face + hands
  • Difficulty in speaking (dysphasia)
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11
Q

What is the ICHD-3 diagnostic criteria for migraine w/o aura?

A
  • > 5 attacks fulfilling 3 criteria
  • Headache lasting 4-72 hrs

2/4:

  • Unilateral
  • Pulsating
  • Mod/severe pain
  • Aggravated by physical activity

During headache at least 1 present:

  • Nausea and/or vom
  • Photophobia + phonophobia
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12
Q

What is the ICHD-3 diagnostic criteria for migraine w/ aura?

A

> 2 attacks fulfilling 3 criteria

1/more:

  • Visual
  • Sensory
  • Speech
  • Motor
  • Brainstorm
  • Retinal

At least 3:

  • At least 1 aura symptom gradually over 5 mins
  • 2/more aura symptoms
  • Each symptom lasts 5-60 mins
  • 1 unilateral
  • 1 +ve
  • Aura accompanied w/in 60 mins of headache
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13
Q

Give an example of a diet trigger for migraine

A
  • Crash diet
  • Irregular meals
  • Cheese
  • Chocolate
  • Red wine
  • Tyramine containing foods
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14
Q

Give an example of an environmental trigger for migraine

A
  • Smoking
  • Bright light
  • Screen use
  • Strong smell
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15
Q

Give an example of an psychological trigger for migraine

A
  • Depression
  • Anxiety
  • Stress
  • Anger
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16
Q

Give an example of medicinal triggers for migraine

A
  • HRT

- COC

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17
Q

Give other examples of triggers for migraine

A
  • Menstruation
  • Shift pattern
  • Menopause
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18
Q

Give treatment options OTC for acute migraine

A
  • Simple analgesia
  • Anti-emetic
  • Migraine specific treatment: triptans or 5HT1 agonist
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19
Q

Give examples of simple analgesia for migraines

A
  • Paracetamol
  • Ibuprofen
  • Aspirin

Use early in attack to avoid gastric stasis

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20
Q

Give examples of anti-emetics used for migraines

A

Gastric stasis slowed in migraine (red med absorption)

  • Migraleve pink: codeine, paracetamol + buclizine
  • Buccastem M buccal: prochlorperazine 3mg - previously diagnosed migraine + adults
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21
Q

How do serotonin 5-HT1 agonists or triptans work to reduce migraines?

A
  • Imitate 5-HT
  • 5-HT causes dilated blood vessels to constrict
  • Included 1st line along simple analgesia + anti-emetic in mod/severe migraine
  • Red pain w/in 2 hrs
  • Red photophobia + phonophobia
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22
Q

Give examples of triptans

A
  • Almotriptan
  • Naratriptan
  • Sumatriptan
  • Zolmitriptan
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23
Q

What is the criteria to supply sumatriptan (imigran)?

A
  • 18-65
  • Migraine diagnosed by doc/pharmacist
  • Established pattern of migraine w//w/o aura (5/more over year)
  • Simple analgesic ineffective
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24
Q

Outline the cautions for sumatriptan use

A
  • SSRI/SNRI
  • St Johns wort
  • COC
  • Heart disease risk factors
25
What are the contraindications of sumatriptan?
- Under 18, over 65 - Pregnant + breastfeeding - 3/more cardiovascular risk factors - Aged 50 + over + experiencing migraine attack for 1st time - 1st ever migraine attack w/in previous 12 months - Fewer than 5 migraine attacks in past - Don't respond to treatment - Headache on 10/more days per month - COC - 4/more attacks per month - Migraine lasting over 24hr
26
Outline how to take sumatriptan
- One 50mg tablet - Taken asap - start of headache + not start of aura - 2nd dose taken 2 hrd after 1st if symptoms back - only if headache responded to 1st dose - Don't take more than 2 in 24hrs - Don't take more than 2 for same attack
27
When should sumatriptan be considered as a preventative treatment?
- Migraine attacks have sig impact on QoL - Acute treatments are contraindicated or ineffective - Person is risk of MOH due to frequent use of acute drugs (amitriptyline, propranolol, topiramate)
28
Give counselling point for a migraine
- Keep headache diary to identify triggers - Immediate use of simple analgesia - Dark + quiet env - Good sleep hygiene - Diet + fluid intake - COC - Cold compress
29
What is tension type headache?
- Most common type of headache - Recurrent episodes of headache that are bilateral - Pressing/tightening band around head (non-pulsating) - Mild to moderate - Relationship to neck w/ pain into/from neck - Mild nausea - Relieved by simple analgesics
30
What are the different types of TTH?
- Episodic: fewer than 15 days each month | - Chronic: more than 15 days each month + has ft of episodic TTH
31
What causes TTH?
- Anxiety - Screen time - Depression - Poor posture - Poor sleep - Stress - Muscular tightness
32
What are the treatments for TTH?
- Simple analgesics: paracetamol, ibuprofen - Syndol tabs: codeine, paracetamol, doxylamine + caffeine - Syndol headache relief: codeine, paracetamol + caffeine - Avoid codeine prods
33
Give counselling advice for TTH
- Lifestyle adjustments - Alleviate stress - Check sleep hygiene - Attention to anxiety/depression - Advice on posture - Exercise - Red use of screens - Avoid codeine - Acupuncture
34
When should you refer when experiencing a headache
- Migraine w/ COC - Headache w/ associated high temp - Frequent migraine/treatment failure - Severe headache of >4hrs - Suspected ADR - Associated drowsiness, unsteadiness, visual disturbance or vomiting - Associated neck stiffness - Suspected injury/trauma - Under 12
35
What are the different types of MSK pains?
- Myalgia from injury, infection, cramp - Bone pain: fracture, infection, tendon pain from sprain, strain or inflammation - Joint pain: RA/OA/Gout - Bursitis - Fibromyalgia: pain in tendons, muscles + joints - Nerve compression pain: put pressure on nerves (carpal tunnel syndrome)
36
Low back pain
- 60% people experience - Pain in lumbosacral area of back btw bottom of rib + top of legs - Usually due to trauma or musculoligamentous strain - Acute resolve w/in 6 wks
37
Give counselling advice for lower back pain management
- Stay active, avoid bed rest (leads to loss of muscle strength + inc stiffness) - Inc physical activities over few days or wks - Relaxation red tension - Local heat/ice pack
38
Pain analgesia for lower back pain
- Offer NSAID first line: ibuprofen 400mg TDS - Paracetamol not enough - If NSAID not tolerated or ineffective offer codeine
39
Other than pain analgesia, what can be used to manage lower back pain?
Topical NSAIDs - Less systemic absorption - Ibuprofen gel: ibuleve - Diclofenac gel: voltarol Rubefacients: heat rubs Cooling sprays
40
What is a sprain?
- Stretch/tear of ligament - Result of joint being forced suddenly outside usual range - Symptoms: pain round affected joint, tenderness, pain weight bearing - Ankles, knees, wrists + thumbs
41
What is a strain?
- Stretch/tear of muscle fibres and tendon - Stretched beyond limit + forced to contract too strongly - Symptoms: muscle pain, inflammation, spasm - Foot, hamstring + back
42
What is the management for a strain/sprain?
- Oral analgesia: paracetamol/NSAIDs + price - Oral NSAIDs: ibuprofen OTC - Topical NSAID
43
What are the red flags for MSK?
- Severe arthritis - Back pain w/ abnormal urination - Back pain radiating to leg - Suspected fracture - Head injury - Treatment failure - Suspected adverse drug reaction
44
What is insomnia?
- Unsatisfactory sleep - Difficulty in sleeping, difficulty maintaining sleep, early wakening results in impaired daytime functioning or wellbeing - Associated w/ inc age
45
What are the common complaints of daytime effects in patients w/ insomnia?
- Fatigue - Tiredness - Lack of energy - Irritability - Red work performance - Difficulty conc
46
Give physical causes of insomnia
- Pain - Nasal congestion - COPD - Pregnancy
47
Give physiological causes of insomnia
- Circadian rhythm disorders | - Poor sleep hygiene
48
Give psychological causes of insomnia
- Stress | - Bereavement
49
Give psychiatric causes of insomnia
- Anxiety - Depression - Dementia
50
Give pharmacological causes of insomnia
- Stimulants - Steroids - Decongestants - Thyroxine
51
Outline the classifications of insomnia
- Transient (days) - ST (4wks) - Chronic (>4wks - refer)
52
Give examples of non-pharmacological treatment for insomnia
- Sleep hygiene - Regular sleep schedule - Avoid napping - Caffeine avoided after midday + nicotine, alcohol + large meal w/in 2 hrs of bedtime - Exercise during day, avoid close to bedtime - Avoid clock watching - CBT - Relaxation techniques
53
Give examples of relaxation techniques for insomnia
- Relaxation before bed - Regular daily exercise but avoid w/in 4 hrs of bedtime - Stress management - Acupuncture
54
Give examples of sedative antihistamines
- Diphenhydramine | - Promethazine
55
Diphenhydramine
- Nytol original - Nytol one a night - Recommend no longer than 7 consecutive nights (SPC 14 nights) - Not for under 16 - S/e: anticholinergic, hangover effect - Contraindications: Prostatic hypertrophy, closed angle glaucoma, pregnancy + breast feeding
56
Promethazine
- Sominex - Phenergan (10mg + 25mg) - HL: 8-12hrs (longer acting + more sedative - No longer than 7 consecutive nights - Not for under 16 - S/e: anticholinergic, hangover effect - Contraindications: Prostatic hypertrophy, closed angle glaucoma, pregnancy + breast feeding
57
What are complementary therapy for insomnia?
- Herbal sleep aids: valerian root extract, hops, passion flower, jamaica dogwood, nytol herbal - Aromatherapy: lavender/camomile oil - Nasal plaster
58
Give examples of red flags for insomnia
- Suspected depression - Chronic issue (>4 wks) - Children <16 - Associated physical conditions - Suspected alcohol/drug dependence

PHA333 (35 decks)

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