Ch 30 Drugs For Headache

Front 1

When are aspirin-like analgesics indicated?

Back 1

Aspirin-like analgesics (eg, acetaminophen, aspirin, naproxen) are effective for abortive therapy of mild to moderate migraine.

Front 2

When is ibuprofen indicated but also when is it not indicated?

Back 2

Ibuprofen is used for mild to moderate pain of migraine, but is not the drug of choice for severe migraine pain.

Front 3

• 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.

Back 3

1 or 2 days per week

medication overuse headache

Front 4

For moderate to severe symptoms, patients should take a migraine-specific drug—either an _______________or a ______________,

Back 4

ergot alkaloid (ergotamine or dihydroergotamine)

serotonin1B/1D agonist.

Front 5

_________ are reserved for severe migraine that has not responded to other drugs.

Back 5

Opioid analgesics (eg, butorphanol)

Front 6

__________ such as ergotamine are first-line drugs for abortive therapy of severe migraine.

Back 6

Ergot alkaloids

Front 7

What can an overdose of ergotamine cause and what are characteristics of this condition?

Back 7

ergotism

a serious condition characterized by severe tissue ischemia secondary to generalized constriction of peripheral arteries.

Front 8

Why must ergotamine not be taken daily?

Back 8

Ergotamine must not be taken routinely because physical dependence will occur.

Front 9

For which patients is ergotamine containdicated?

Back 9

prenagant women

renal impairment

hepatic impairment

Front 10

What does ergotamine induce in pregnant women?

Back 10

contractions

Front 11

• 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.

Back 11

intense vasoconstriction and associated ischemia.

food

Front 12

Why can't ergotamine be given in combo with Triptans?

Back 12

Ergotamine should not be combined with triptans (eg, sumatriptan, zolmitriptan) because a prolonged vasospastic reaction could occur.

Front 13

Why is ergotamine combined with caffeine commonly?

Back 13

Ergotamine is combined with caffeine in order to enhance vasoconstriction and ergotamine absorption, which in turn, enhances migraine pain relief

Front 14

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.

Back 14

overdose

numbness and tingling in the fingers and toes

ischemia

muscle pain

gangrene

Front 15

What are commmon side effects of Caffergot?

Back 15

Common side effects of Cafergot are nausea and vomiting.

Front 16

For what are triptans considered first line drugs for?

Back 16

Triptans (eg, sumatriptan) are first-line drugs and are the drug of choice for abortive therapy of moderate to severe migraine.

Front 17

• 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 _______.

Back 17

vasoconstriction

24 hours.

Front 18

________ is taken to abort an ongoing migraine attack. The drug relieves headache and associated symptoms (nausea, photophobia, phonophobia).

Back 18

Sumatriptan

Front 19

Sumatriptan should be avoided during _______..

Back 19

pregnancy

Front 20

What are the benefits of combining Sumatriptan and Noprexen (Treximet) when treating migraines?

Back 20

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.

Front 21

Under what circumstances is prophylactic therapy appropriate?

Back 21

• 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.

Front 22

What are the preferred drugs for Migraine prophylaxis?

Back 22

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.

Front 23

What are the preferred drugs for migraine prevention?

Back 23

Beta blockers such as propranolol (Inderal) are the preferred drugs for migraine prevention.

Front 24

What are the preferred drugs in preventive therapy for migraines?

Back 24

Verapamil is also used as preventive therapy for migraines, although not to abort the actual pain of a migraine.

Front 25

_________ _________ 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).

Back 25

Cluster headaches

males

females

Front 26

_______________-(formerly called muscle-contraction headaches) are the most common headache type.

Back 26

tension type headaches

Front 27

For tension type headache prophylaxis ___________ a tricyclic antidepressant, is the drug of choice.

Back 27

amitriptyline (Elavil),

Front 28

Headaches with: Identifiable underlying causes

Back 28

Severe hypertension, hyperthyroidism, tumors, infection, and disorders of the eye, nose, sinuses, and throat

Front 29

Headaches with: No identifiable cause

Back 29

Migraine
Cluster

Front 30

What are the different types of headaches?

Back 30

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

Front 31

__________________- Prototype
First line drugs for abortive therapy of moderate to severe migraine

Back 31

Sumatriptan (Imitrex)-Prototype

Front 32

When treating a Migraine headache II: Abortive therapy what drugs are used dpending upon the severity?

Back 32

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

Front 33

When treating a Migraine Headache I what approaches can be taken to treat?

Back 33

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).

Front 34

活用

Back 34

활용
practical use, application, making the most[best] of it. [live + lively]

Front 35

What is a serious drawback to the use of ergotamine?

Back 35

The risk of physical dependence with routine use

Front 36

What is the DOC for to abort a severe migraine h/ache?

Back 36

Sumatriptan

Front 37

What medication is preferred for the prevention of migraine headache?

Back 37

Beta Blockers (Propanolol)

Front 38

In which pts should sumatriptan (Imitrex) be avoided?

Back 38

Pts with a hx of ischemic heart disease, myocardial infarction (MI), uncontrolled hypertension, or other heart disease due to the risk of coronary vasospasm

Front 39

What drugs should be avoided within 24 hours of the use of sumatriptan (Imitrex)?

Back 39

Other triptans, and ergot derivatives