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39 Cards in this Set
- Front
- Back
When are aspirin-like analgesics indicated?
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Aspirin-like analgesics (eg, acetaminophen, aspirin, naproxen) are effective for abortive therapy of mild to moderate migraine.
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When is ibuprofen indicated but also when is it not indicated?
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Ibuprofen is used for mild to moderate pain of migraine, but is not the drug of choice for severe migraine pain.
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• Use of abortive medications should be limited to ____________ because more frequent use can lead to____________(MOH), also known as drug-induced headache or drug-rebound headache.
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1 or 2 days per week
medication overuse headache |
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For moderate to severe symptoms, patients should take a migraine-specific drug—either an _______________or a ______________,
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ergot alkaloid (ergotamine or dihydroergotamine)
serotonin1B/1D agonist. |
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_________ are reserved for severe migraine that has not responded to other drugs.
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Opioid analgesics (eg, butorphanol)
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__________ such as ergotamine are first-line drugs for abortive therapy of severe migraine.
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Ergot alkaloids
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What can an overdose of ergotamine cause and what are characteristics of this condition?
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ergotism
a serious condition characterized by severe tissue ischemia secondary to generalized constriction of peripheral arteries. |
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Why must ergotamine not be taken daily?
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Ergotamine must not be taken routinely because physical dependence will occur.
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For which patients is ergotamine containdicated?
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prenagant women
renal impairment hepatic impairment |
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What does ergotamine induce in pregnant women?
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contractions
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• Ergotamine must not be combined with potent inhibitors of CYP3A4, owing to a risk of_________ and _________ However, there are no restrictions as to whether or not ergotamine can be taken with food.
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intense vasoconstriction and associated ischemia.
food |
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Why can't ergotamine be given in combo with Triptans?
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Ergotamine should not be combined with triptans (eg, sumatriptan, zolmitriptan) because a prolonged vasospastic reaction could occur.
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Why is ergotamine combined with caffeine commonly?
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Ergotamine is combined with caffeine in order to enhance vasoconstriction and ergotamine absorption, which in turn, enhances migraine pain relief
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Cafergot (ergotamine tartrate and caffeine): chronic use of Cafergot can lead to ______, which should be suspected when use for frequent episodes of migraines leads to subsequent ____________. Overdose can cause ________ secondary to constriction of peripheral arterioles, which can cause the extremities to become cold, pale and numb. _________and _________ may eventually result.
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overdose
numbness and tingling in the fingers and toes ischemia muscle pain gangrene |
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What are commmon side effects of Caffergot?
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Common side effects of Cafergot are nausea and vomiting.
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For what are triptans considered first line drugs for?
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Triptans (eg, sumatriptan) are first-line drugs and are the drug of choice for abortive therapy of moderate to severe migraine.
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• Triptans should not be combined with one another or with ergot derivatives because excessive __________could occur. Nursing interventions should include an assessment of whether patients have taken ergot alkaloids (or another triptan) within _______.
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vasoconstriction
24 hours. |
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________ is taken to abort an ongoing migraine attack. The drug relieves headache and associated symptoms (nausea, photophobia, phonophobia).
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Sumatriptan
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Sumatriptan should be avoided during _______..
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pregnancy
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What are the benefits of combining Sumatriptan and Noprexen (Treximet) when treating migraines?
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the superior benefits of the combination derive from attacking migraine by multiple mechanisms: naproxen reduces pain and inflammation, while sumatriptan causes vasoconstriction and inhibits release of inflammatory neuropeptides.
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Under what circumstances is prophylactic therapy appropriate?
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• Prophylactic therapy is indicated for migraineurs who have frequent attacks (two or more per month), especially severe attacks, or attacks that do not respond adequately to abortive agents.
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What are the preferred drugs for Migraine prophylaxis?
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Propranolol, divalproex, and amitriptyline are preferred drugs for migraine prophylaxis. Treatment can reduce the number and intensity of attacks in approximately 70% of patients, but it does not abort acute attacks.
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What are the preferred drugs for migraine prevention?
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Beta blockers such as propranolol (Inderal) are the preferred drugs for migraine prevention.
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What are the preferred drugs in preventive therapy for migraines?
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Verapamil is also used as preventive therapy for migraines, although not to abort the actual pain of a migraine.
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_________ _________ are more common in _____and are contrasted from migraines which are more common in _____and which are manifested by nausea and vomiting; and which can, at times, be manifested by the presence of an aura prior to the onset of headache pain (although this is not the most common manifestation).
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Cluster headaches
males females |
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_______________-(formerly called muscle-contraction headaches) are the most common headache type.
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tension type headaches
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For tension type headache prophylaxis ___________ a tricyclic antidepressant, is the drug of choice.
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amitriptyline (Elavil),
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Headaches with: Identifiable underlying causes
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Severe hypertension, hyperthyroidism, tumors, infection, and disorders of the eye, nose, sinuses, and throat
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Headaches with: No identifiable cause
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Migraine
Cluster |
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What are the different types of headaches?
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Migraine headache I: Characteristics and overview of treatment
Migraine headache II: Abortive therapy Migraine headache III: Preventive therapy (Beta blockers, TCA's, Antieleptics, Estrogens) Cluster headaches Tension-type headache |
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__________________- Prototype
First line drugs for abortive therapy of moderate to severe migraine |
Sumatriptan (Imitrex)-Prototype
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When treating a Migraine headache II: Abortive therapy what drugs are used dpending upon the severity?
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Mild-moderate headache
Aspirin-like drugs Aspirin, acetaminophen, ibuprofen, and other aspirin-like analgesics Moderate-severe Migraine-specific drug (Ergotamine, Triptans) Opioid analgesics (butorphanol nasal spray, meperidine) *Antiemetics are also given to reduce the levels of nausea and vomiting |
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When treating a Migraine Headache I what approaches can be taken to treat?
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Abort attacks with
non specific analgesics (asprin or opiod analgesics) migraine specific analgesics (triptans or Ergots) or prevent attacks from occuring (prophylaxis) with Beta blockers (propranolol), TCA's (amitriptyline), antiepileptic drugs (divalproex). |
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活用
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활용
practical use, application, making the most[best] of it. [live + lively] |
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What is a serious drawback to the use of ergotamine?
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The risk of physical dependence with routine use
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What is the DOC for to abort a severe migraine h/ache?
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Sumatriptan
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What medication is preferred for the prevention of migraine headache?
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Beta Blockers (Propanolol)
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In which pts should sumatriptan (Imitrex) be avoided?
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Pts with a hx of ischemic heart disease, myocardial infarction (MI), uncontrolled hypertension, or other heart disease due to the risk of coronary vasospasm
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What drugs should be avoided within 24 hours of the use of sumatriptan (Imitrex)?
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Other triptans, and ergot derivatives
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