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Duke PA Pharmacology Headache

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.

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  


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