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72 Cards in this Set
- Front
- Back
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What are the two main classes of headaches?
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Primary and Secondary
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What is a primary headache?
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a headache with no underlying organic cause
-migraine, cluster, tension |
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What is a secondary headache?
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organic cause such as tumors, malformations, etc.
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What are some examples of acute secondary headaches?
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SAH, stroke, meningitis, hematome, abscess
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What are some examples of subacute secondary headaches?
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increased intracranial pressure, mass, lesion, trigeminal neuralgia, sinusitis
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A vascular headache is a...
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migraine and cluster
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A muscular headache is a...
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tension headache
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How do triptans work?
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Agonist at serotonin 1b/1d receptors
--reduce excitability --attenuate release of neuropeptides with inflammatory/vasodilating effects |
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When can't you use triptans for headaches?
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in a patient with CAD, HTN, etc. because coronary vasculature contains 5ht 1b receptors
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Is there a max dose for triptans?
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No max dose/24 hours, dose/week, dose/month
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What is the advantage of a 2nd generation triptan over a first generation?
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increase bioavailability
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True or False: Erotamine is a cheap drug used to abort headaches.
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False: It must be given at onset of attack. It is not good to abort.
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What is the big side effect of ergotamine?
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nausea
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What is midrin a combination of?
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Isometheptene, acetaminophen, dichlorophenazone
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What does isometheptene do?
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vasoconstricts
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What does dichlorophenazone do?
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sedative to induce sleep
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True or False: Midrin has limits to be taken per day and per week.
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True
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What can be used for intractable migraine?
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DHE, NSAIDS, Phenothiazines, Narcotics
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What is given with NSAIDS for migraines to inhance absorption?
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metoclopromide
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What is a secondary benefit of using Reglan with NSAIDS for the treatment of migraine?
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a reduction of nausea
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What is a side effect of phenothiazines?
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inhibition of GI motility
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True or False: Opioids are 1st line treatment.
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False: Opioids are 2nd or 3rd line.
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Is "Emergency department treatment with narcotics for headache treatment antecedent to iatrogenic drug addiction?"
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YES...!!!
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What is considered first line for migraine prophylaxis?
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Valproate
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When propanolol is not tolerated for migraines, what else can be used?
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atenolol
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What side affect of propanolol is caused by it's lipophilic property that atenolol (hydrophilic) doesn't have?
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Depression
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What side effects does Valproate have?
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GI:
(depakene is as good as depokote, but nausea is worse) |
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How do you dose Valproate?
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250 bid and titrate
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What is the bad thing about the use of verapramil for migraines?
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Takes about 1-2 months to work.
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What is second line for the use of prophylaxis of migraines?
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Naproxen
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When is cyproheptadine use? Phenytoin?
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in children
--appetite stimulant (cyproheptadine) |
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Does clonidine have any value in treatment of migraines?
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No
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What are the side effects of topiramate?
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Glaucoma, weight loss, difficulty in concentration
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How do you treat cluster headaches?
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Sumatriptan s.c. + oxygen
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What prophylaxis can you use for cluster headaches?
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Verapramil
Valproate Lithium Ergotamine |
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How do you treat tension headaches?
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APAP, ASA, NSAIDS
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What prophylaxis is used for tension headaches?
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Amitriptyline (TCA's)
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When is ergotamine good to use for prophylaxis of cluster headaches?
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When the pattern is predictable.
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In multiple sclerosis, what drugs is used for acute exacerbations?
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Corticosteroids: Methylprednisolone or prednisone
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What are the side effects of interferon used for MS?
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Flu-like symptoms
Local skin reaction |
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How do you treat the flu-like symptoms associated with interferon treatment?
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acetaminophen or NSAID predose and q4h for 24 hours
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What do you monitor with interferon treatment?
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CBC with platelets and LFT q3 months up to 1 year and then q6 months
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How does interferon work?
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acts on bbb by interfering with t-cell adhesion to the endothelium.
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How does glatiramer acetate (Copaxone) work?
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induces t helper cells that enter CNS (antiinflammatory)
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What side effects occur with glatiramer acetate (Copaxone)?
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transient chest tightness, flushing, dyspnea
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How does mitoxantrone (Novantrone) work?
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intercalates dna, suppresses immune system
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When do you use mitoxantrone (Novantrone)?
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patients with secondary progressive, progressive relapsing, or worsening relapsing-remitting MS
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What do you get prior to mitoxantrone (Novantrone) therapy?
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LVEF
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What is the lifetime cumulative dose of mitoxantrone (Novantrone)?
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140mg/m2
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What are the adverse effects of mitoxantrone (Novantrone)?
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nausea, alopecia, mentrual disorder, leukopenia, URIs, and UTI
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What are the most effective muscle relaxants?
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Benzodiazapams
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What drugs are used for the treatment of Alzheimer's?
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Cholinesterase inhibitors: donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne)
NMDA antagonist: memantine (Namenda) |
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How is donepezil dosed?
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once a day
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What are the side effects of donepezil?
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GI-nausea, anorexia, diarrhea
Headache Bradycardia |
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What drug interactions are common in all cholinesterase inhibitors?
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NSAIDS
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How is rivastigmine (Exelon) dosed?
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twice a day
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What are the side effects of rivastigmine (Exelon)?
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GI - N//V/D, anorexia
Headache Bradycardia |
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How do you increase the tolerability of rivastigmine?
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take with food
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How do you dose galantamine (Razadyne)?
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twice
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What are the side effects of galantamine (Razadyne)?
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GI - N/V/D, anorexia
Bradycardia |
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What drugs do galantamine (Razadyne) interact with?
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antidepressants: paroxetine, fluoxetine, fluvoxamine, amitriptyline
NSAIDS |
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What are the side effects of memantine (Namenda)?
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Dizziness, headache, constipation, confusion
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What drugs does memantine (Namenda) interact with?
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Amantadine
Dextromethorphan Ketamine |
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How does aspirin work?
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irreversibly inactivating platelet cyclooxygenase
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High doses (1.3g/day) of aspirin can do what?
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increase platelet aggregation
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What is dipyridamole?
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antiplatelet drug
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What are the side effects of dipyridamole?
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headache
Gi upset/bleed |
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What is ticlopidine (Ticlid) approved for?
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for the prevention of TIA and stroke for patients with a prior cerebral thrombotic event
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What side effects does Ticlopidine (Ticlid) have?
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Neutropenia
TTP --Must monitor CBC - baseline, every 2 weeks for the 1st 3 months |
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When do you use ticlopidine (Ticlid)?
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only after a patient has failed aspirin, aspirin with dipyridamole, and clopidogrel
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What are the side effects of clopidogrel (Plavix)?
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bleeding
GI upset/ulcers Hematologic disturbacnes Rash Diarrhea |
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When is warfarin used?
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for the prevention of stroke in patients with atrial fibrillation.
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