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HA Tx
Pharm II
| Question | Answer |
|---|---|
| Migraine w/o aura | common migraine |
| Migraine w/ aura | classic migraine |
| Migraine patho proposed | compensatory overactivity in trigeminovascular system, relaease of vasoactive neuropeptides → inflammation |
| Nonpharm tx for HA’s | Pt ed: HA diary to identify triggers, therapy efficacy, need for prophylaxis? Maintain reg habits, |
| Three types of behavioral medicine | cog-behav therapy, relaxation techniques, biofeedback |
| 1st line tx for mild to moderate migraine pain | NSAIDS and APAP |
| Which drug is considered for preggo pt’s | APAP |
| Which drug is for mild to moderate migraine pain unresponsive to 1st line tx | combo analgesics: florinal/floricet |
| SE’s for florinal/floricet | sedation, insomnia, rebound HA’s MOH, withdrawal sxs |
| MOA of NSAIDS | prevent neurogenic inflammation in trigeminovascular system |
| MOA of 5-HT receptor agonists | direct vasoconstriction and blocks neurogenic inflammation |
| Name of the 5-HT receptor agonists | “triptans” : sumatriptan: Imitrex |
| MC SE’s of triptans | Dizziness, sensation of warmth, chest fullness, nausea |
| CI’s for triptans | CV dz, HTN, w/I 14 days of MAOI or 24hr of ergotamine, or w/I 6 hr os sumatriptan |
| USE of triptans | mod-sev pain, or mild unresponsive to simple analgesics and NSAIDS |
| What is ergotism | vasoconstrictive complications such as MI, hepatic necrosis, bowel/brain ischemia |
| How to we prevent ergotism | have a max does of ergotamine preperations |
| MOA of ergotamines | stimulate 5-HT receptors, blocks neurogenic inflammation, constrics IC blood vessels (more potent vasoconstrictor than triptans) |
| SE’s of ergotamines | N/V, possible vasospasms, muscle aches, tremors, tingling of extremities, rebound Has |
| CI’s of ergotamines | CV dz, PVD, preggo, cerebrovascular dz |
| Use for ergot derivatives | Dihydroergotamine, better tolerated than ergotamine w/ no MOH or rebound HA’s |
| SE’s for Dihydroergotamine | (DHE), diarrhea, muscle cramps |
| Why are there no MOH w/ ergot derivatives | longer T1/2 so no MOH |
| When do we use opioid combinations? What do we use | for rescue use only, tylonol #3, Percocet, stadol |
| Two “misc,” tx’s for HA’s | Antiemetics: metoclopramids, prochlorperazine: tx’s N/V which in turn tx’s the HA pain |
| What must we evaluate prior to starting a pt on triptans | CAD especially in postmenopausal women, M>40yo, uncontrolled CAD RF’s |
| What should be done w/ 1st dose of Triptans | pt should be kept in the clinic for the first dose for supervision usually until peak team has been reached |
| Headache is incapacitating | severe |
| Patient is aware of HA but able to continue daily routine w/ minimal alteration | mild HA |
| A severe HA that lasts more than 72 hrs | Status migrainatus |
| HA inhibits daily activities but is not incapacitating | moderate HA |
| What is the MOH dx criteria | A: HA on >15days/month +C,D, Overuse for >3m, C: HA worsened during meds, D: HA resolves or revers to its previous pattern w/I 2m after d/c of overuse meds |
| Four parts in MOH use | painful HA, Rx: analgesic ergot or triptan, HA relieved, Rx-taking reinforces a painful HA |
| Tx of MOH HA’s | complete cessation of meds often recommended, some substitutes may be needed, |
| How do we prophylactic tx HA’s | start low dose, titrate to effective dose, trial 2-3m, can use abortive against for breakthrough HA’s, |
| MOA of BB’s | May ↑ threshold by modulating 5-HT transmission |
| Which type of CCB’s are used for HA’s | non-dihydroperidines: Verapamil |
| Which two drugs are commonly not used for prophalactic HA tx now | SSRIs and CCBs |
| CI’s of BB’s | asthma, depression, CHF (unstable), raynaud’s dz, DM |
| What drug can causes serotonin syndrome w/ triptans | TCA’s |
| What drugs are good for prolonged use or atypical aura | AEDs |
| When would NSAIDs be an effective therapy for prophylaxis | intermittent, predictable HA’s (menses) |
| What is the usual drug for prophalactic tx | BB’s, |
| What are three types of future therapies for migraines | Valproic acid, ACEi, Angiotension II receptor agonist |
| What are three natural products that are likely to work | feverfew, riboflavin (B2), Coenzyme Q10 |
| When is re-evaluation therapy for HA tx | 3-6mifHA’s are well controlled, consider tapering or d/c tx |
| What is a severe unilateral orbital, supraorbital/ temporal pain lasting 15-180min that come in clusters | |
| What are signs ofcluster HA’s | conjuctival injection, lacrimation, nasalcongestion, rhinorrhea, forehead andfacial sweating, miosis, ptosis, eyelid edema |
| What is the primary tx of a cluster HA | 100% O2, x15min, |
| What other drugs besides O2 can be used as abortive therapy for a cluster HA | Triptans, DHE, or Ergotamines, steroids |
| What does prophylactic tx do for HA’s | shorten the duration, decrease frequence & severity |
| What are the tx prophylaxis guidelines | start early in cluster, take qd until HA free >2wks, taper, but restart w/ next cluster, chronic clusters may need indefininte Rx |
| What is the most common prophylactic tx for cluster HA’s | Verapamil, can use litium, prednisone, and ergotamine |
| Tx for tension HA’s | simple analgesics, ASA, APAP, NSAIDS (no more than 2days/wk) |
| Prophylactic tx for tensions HA’s guidelines | HA’s >2/wk, laonger 3-4hrs, severity may result in medication overuse |
| Prophylactic medication for tensions HA’s | TCAs most commonly prescribed |
Created by:
streetsmarts
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