PC 707 Module 5 Exam - Pain Q & A What qualifies for using medications for prophylactic headache treatment? -more than 2 a month -headache lasting >24 hours -headaches more than 3 days of the month and causing signific
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PC 707 Module 5 Exam - Pain Q & A What qualifies for using medications for prophylactic headache treatment? -more than 2 a month -headache lasting >24 hours -headaches more than 3 days of the month and causing significant life impact -using abortive medications more than >2 a week -using abortive medications that have failed What are the prophylactic headache treatment options? -beta blockers -anti-epileptic drugs -TCAs -Botox -CGRP monoclonal antibodies How can beta blockers be used to help reduce the frequency or intensity of headaches? -beta blockers can cause vasoconstriction--thus reducing the vasodilation that can cause a headache* -propanolol & timolol--FDA approved for migraine prophylaxis A/E and contraindications for beta blocker use? -A/E-->bradycardia, decreased CO, heart block, vasoconstriction, hypoglycemia -Contraindications-->cardiogenic shock, bradycardia, 2nd & 3rd degree heart block, bronchial asthma, allergy, caution in pregnancy BBW for beta blockers? -avoid abrupt discontinuation it could cause rebound hypertension--can cause angina, increase risk for MI Interactions with beta blockers? -Calcium channel blockers -Insulin medications Anti-epileptic medications used for headache prophylaxis: -divalproex (Depakote) -topriamate (Topamax) What are the risks associated with anti-epileptic use? BBW -life threatening reactions & hepatoxicity with fatalities (increased risk in those <2 years old & with mitochondrial disorders) -pancreatitis--fatal hemorrhagic cases -fetal risk of neural tube defects, malformations, decreased IQ What is important to monitor closely when a patient is using anti-epileptic drugs? -Liver function tests* What is the most common tricyclic antidepressant used in the prophylaxis of headaches? -amitriptyline (Elavil) How can TCAs be used in the prophylaxis of headaches? -prevents the re uptake of serotonin (serotonin can cause some vasoconstriction) -anticholinergic effects (cholinergic receptors can cause vasodilation so blocking this can cause more vasoconstriction) What is a concern with taking TCAs? -high risk for death from overdose -hard to reverse! What medications and how should they be taken if a patient is experiencing estrogen withdrawal headaches? -routine birth control that contains primarily estrogen--to maintain estrogen levels* -take triptans several days prior to onset of menstruation* When is botox usually indicated for headache prophylaxis? What is the associated BBW? -usually used if a patient has >15 headaches in a month -BBW--potential to spread from intended site & cause botulism* How does CGRP monoclonal antibodies help with headache prophylaxis? How are they given? -the antibodies bind to the calcitonin gene-related peptides (CRGP) receptors and antagonize their action* -these peptides play a role in increase inflammation particularly in the brain--which can cause vasodilation--so blocking these can help constrict the vessels* -these are given sub-Q every 1-3 months What are some omplementary/alternative therapies for headache treatment? -Riboflavin -CoQ10 enzyme -Butterbur -Magnesium--possibly effective if given at high doses (600 mg)--can cause diarrhea* -Ice packs -Dark quiet room -Life style changes--> eliminating triggers, regular sleep, regular exercise, stress reduction, alcohol cessation, elimination of tyramine-containing foods (wine) If a woman comes in with migraines--prior to prescribing, what is important to rule out? -pregnancy -most medications are contraindicated or used with caution in pregnancy* Does sumatriptan (Imitrex) increase the rate of birth defects? No What headache prophylaxis medications are considered level A evidence? -anti-epileptics -beta blockers (propanolol & mepropolol) -triptan (frovatriptan-Frova) Why is it important to monitor patients with fibromyalgia closely when starting new medications for treatment? -increased risk of adverse effects due to heightened sensitivity* -start low & go slow -try to use non-pharmacological options first What 3 medications are approved to treat fibromyalgia pain? -milnacipran (Savella) -duloxetine (Cymbalta) -pregabalin (Lyrica) Which medications are level A evidence in the treatment of pain in firbromyalgia? -TCAs (amitriptaline) -SNRIs (cymbalta & savella) -anticonvulsants (pregabalin) How do local anesthetics work? -inhibit conduction of sensory nerves by blocking sodium channels Why would epinephrine be added to a local anesthetic? -to help with vasoconstriction to achieve homeostasis (ex: limit bleeding with suturing) -to increase the duration of anesthetic action Why should EMLA cream be avoided prior to giving vaccines? -EMLA cream can interfere with viruses/bacteria What is the most common local anesthetic used? -Lidocaine -->rapid onset -->if used for regional nerve block (60-120 minutes) -->if used for local infiltration (20-30 minutes) Topical anesthetic options?
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