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DU PA Pharm H/A
Duke PA Pharmacology Headache
| Question | 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 |
Created by:
bwyche
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