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DU PA Pharm H/A

Duke PA Pharmacology Headache

QuestionAnswer
non-specific (symptomatic) treatment of migraines analgesics, antiemetics
reserved as a rescue medication when other treatments of a severe migraine attack are not successful opioids
specific migrain therapy includes __ which are both 5-HT(1D)receptor agonists triptans and dihydroergotamine
despite the high cost most patients prefer __ over ergot derivatives triptans
these agents rapidly and effectively abort or markedly reduce the severity of migraine headaches in about 70% of patients triptans
significant __ have been reported with triptan use elevation of blood pressure and cardiac events
triptans should not be administered to patients with risk factors for __ without evaluation coronary artery disease
__ is a common AE of dihydroergotamine nausea
therapy to prevent migraine is indicated if the attacks occur __ or more times per month and if the headaches are severe or complicated by serious neurologic signs 2
__ is the drug of choice for migraine prophylaxis propranolol
the classes of drugs that are effective in reducing the frequency and severity of migraine attacks beta-blockers, tricyclic antidepressants, anticonvulsants, calcium-channel blockers
dihydroergotamine is a vasoconstrictor. It is contraindicated in __ pregnancy, PVD, or CAD
antiemetic used during a migraine prochlorperazine
the pain of migraine may be due to __ extracranial and intracranial arterial dilation
agents used to treat an acute migraine attack triptans, dihydroergotamine, analgesics
agents best used during the prodromal stage of migraine triptans, dihydroergotamine
two major types of tension-type headaches episodic, chronic
episodic type of tension-type headache attacks occur an average of 3 days/month
chronic type of tension-type headache 15 or more attacks/month
over the counter analgesics for tension-type headache ibuprofen, naproxen, aspirin, acetaminophen, excedrin tension HA
patients with tension-type headache that don't respond to OTC analgesics may require prescription NSAIDS
if medication for tension-type headache is needed more than 2 days/week consider __ prophylaxis
chronic daily headache may occur with overuse of __ analgesics
in rare instances __ may be used for patients with intractable tension-type HA butalbital combination products (Fiornal or Fioricet), Midrin, or APAP + opioid combinations
what is in Midrin isometheptene 65mg + dichloralphenazone 100mg + APAP 325mg
what is in Excedrin Tension HA APAP 500mg + caffeine 65mg
can be used to help wean people off daily analgesic use tizanidine (Zanaflex)
prophylactic therapies for chronic or frequent tension-type HA tricyclic antidepressants (amitryptyline), skeletal muscle relaxants (methocarbamol)
__ injections into cranial muscles may be benificial in some patients with tension-type HA botulinum toxin
side effects of TCA's (Amitriptyline/Nortriptyline) are __ weight gain, dry mouth, constipation
TCA's are contraindicated in __ severe heart disease
used for patients with major depressive disorder and chronic daily headache duloxetine (Cymbalta)
__ has significant anticholinergic effects amitriptyline
__ should be taken at first sign of neck or head tension as prophylaxis, preferably at bedtime muscle relaxants
muscle relaxants used for Tension-type headaches cyclobenzaprine (flexaril), methocarbamol (robaxin), tizanidine (Zanaflex)
monitor __ periodically with chronic use of muscle relaxants LFTs
when using muscle relaxants watch drug-drug interactions with ciprofloxacin, fluconazole, famotidine, oral contraceptives, acyclovir
about __% of migraines present without aura 80
about __% of migraines present with aura 20
nonpharmacologic therapy of migraine diet, sleep, stress management, cognitive-behavioral measures
consider __ for patients with incomplete response to acute therapies prophylactic migraine therapy
abortive non-opioid therapy for migraines NSAIDS, aspirin, and acetaminophen
Excedrin Migraine is a combination of aspirin/APAP/caffeine
possible SE of non-opioid abortive migraine therapy with chronic use rebound HA
SE of NSAIDS, aspirin, APAP GI toxicity, rebound HA, sodium and water retention, renal dysfunction, exacerbation of HF, antiplatelet effects,
MOA of triptans constrict intracranial blood vessels (5-HT1B), inhibit vasoactive neuropeptide release (5-HT1D), & interrupt pain signal transmission centrally (5-HT1D)
AE's of triptans paresthesisas, fatigue, dizziness, flushing, warm sensations,somnolence, chest tightness, possible rebound HA with overuse
triptan contraindications ischemic heart disease, uncontrolled hypertension and cerebrovascular disease, basilar or hemiplegic migraines
NSAIDS, ASA, APAP contraindications h/o GI bleed, renal insufficiency, hepatic failure(APAP)
triptan drug-drug interactions MAOI's, ergot, caution with SSRI's(serotonin syndrome), some 3A4 interactions
do not give triptans to anyone with heart disease
used for menstrual migraines b/c of the predictability of the HA. this drug has a slow onset and a long duration naratriptan (amerge)
treximet is a combination of 85mg sumatriptan and 500mg of naproxen sodium
benifit of treximet combo is decreased need for rescue medication withing 24 hours compared to either drug alone
__ injection can be given to break a chronic HA cycle ergotamine
SE of Ergotamine vasoconstriction, HTN, peripheral ischemia, N, V, D, pruritus, vertigo, cramps, paresthsias, cold skin, dec. pulses in extremities; rebound HA, fibrosis long term
contraindications for ergotamine CAD, PVD, HTN, liver/kidney dz., protease inhibitors, pregnancy (X)
must stop __ 24 hours before ergotamine injection triptan
antiemetics prochlorperazine, metoclopramide
SE of antiemetics sedation, extrapyramidal effects, anticholinergic effects
other abortive therapy for migraine intranasal lidocaine, corticosteroids, droperidol, nitrous oxide, propofol
prophylactic therapy beta blockers, TCA's, SSRI's, atypical antidepressants (bupropion, venlafaxine), MAOI
FDA approved migraine prophylactic beta blockers propranolol and timolol
SE of beta blockers sedation, fatigue, dizziness, depression, orthostatic hypotension, impotence
contraindications for beta blockers asthma, CHF?, PVD, IDDM?
most studied TCA for migraine prophylaxis amitriptyline
abortive therapy for cluster headache oxygen (#1), DHE-45, sumatriptan or zolmitriptan, intranasal lidocaine
Created by: bwyche on 2009-03-10



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