Pharmacology of Headaches and Substance Abuse Treatments, Exams of Nursing

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PC707 Module 5 Questions | 100% Correct

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Describe a migraine headache - ✔✔Unilateral, throbbing, pulsatile, lasts 4-72 hours, includes nausea and vomiting, light sensitivity, may have auras, more common in women, and genetically linked. There are migraine variants that include focal neurologic findings Describe a tension headache - ✔✔Most common headache; treated effectively with NSAIDs Describe a cluster headache - ✔✔"Ice pick headache", unilateral, severe pain behind one eye, nasal congestion with rhinorrhea, occur in clusters over weeks to months, often at night, more common in men and blacks Describe a rebound headache - ✔✔Occur due to overuse of medications to treat headache pain. The medication causes worsening of the pain. Treatment entails discontinuing all pain medications What medications are used for abortive treatment of migraines? - ✔✔Triptans, Ergots, analgesics, NSAIDs, antiemetics, combination products What are the indications for prophylactic migraine treatment? - ✔✔>2 headaches per month, attacks last >24 hours, cause major disruption in ADLs for 3+ days a month, abortive therapies fail or are overused, use of abortive medications 2x+ per week What medications are used for prophylactic treatment of migraines? - ✔✔TCAs, BBLs, triptans, AEDs (Divalproex) Describe Serotonin 1B/1D receptor agonists - ✔✔- Sumatriptan (Imitrex)

• causes intracerebral vasoconstriction
• Used for abortive migraines
• Can cause chest tightness
• Teratogenic
• Do not take with ergots or other triptans

Describe ergot alkaloids - ✔✔- Ergotamine

• suppresses CHRP to block inflammation
• can cause toxicity What is the purpose of adding epi to lido? - ✔✔Causes vasoconstriction, allows lido effects to last longer, decreases risk of toxicity from lido What medications are used to assist in ETOH withdrawal? - ✔✔Benzos, Carbamazepine (AED), clonidine, BBLs Describe Disulfiram (antabuse) aversion therapy - ✔✔Used to refrain from drinking, causes acetaldehyde syndrome when any ETOH is involved. Patient must avoid all ETOH even sauces/cough syrups/ alcohol applied to skin (i.e. perfume) Describe Naltrexone (Revia) - ✔✔Pure opioid agonist, decreases cravings of ETOH and blocks the reinforcing effects of ETOH, does not cause aversion Describe acamprosate (Campral) - ✔✔Reduces unpleasant feelings brought on by avoiding ETOH, does not cause aversion, not safe in pregnancy What medication can help manage withdrawal symptoms? - ✔✔Clonidine (for both ETOH and opioid) What medications are used for long-term opioid addiction management? - ✔✔Opioid agonists (methadone), opioid agonist-antagonists (buprenorphine), opioid antagonists (Naltrexone) What is the only COX-2 available on the market? - ✔✔Celecoxib (Celebrex) Where should epinephrine NEVER be used? - ✔✔Fingers, toes, ears, nose (and genitalia) What should you recommend if a patient experiences gout attacks when just starting xanthine oxidase inhibitors (Allopurinol)? - ✔✔Continue Allopurinol and add NSAIDs or colchicine

What medications are used for gout management? - ✔✔Glucocorticoids (inflammation mgmt) Colchicine (decreases WBC infiltration into joint) Xanthine oxidase inhibitors (Allopurinol) (inhibits uric acid formation) uricosuric agent (Probenecid) (increased excretion of urine acid) Recombinant urine acid oxidase (Pegloticase) (last ditch, IV, reduces uric acid levels) What is a BBW for colchicine? - ✔✔Can cause rhabdo (Especially if on a statin as well) What is a BBW for recombinant uric acid oxidase (Pegloticase)? - ✔✔Anaphylaxis, infusion reactions and hemolysis/methemoglobinusia in patients with G6PD deficiency Who is able to prescribe methadone for opioid abuse management? - ✔✔Substance Abuse Mental Health Services (SAMHSA) and state-certified programs When can Buprenorphine be prescribed? - ✔✔Only after opioid withdrawal has already started, since it is a partial agonist What medications are approved by the FDA for fibromyalgia management? - ✔✔Milnacipran (SNRIs), duloxetine (SSRIs), pregabalin (anticonvulsants) When should acamprosate calcium (Campral) not be used? - ✔✔Severe renal disease What is a BBW of Naltrexone (revia)? - ✔✔Can cause hepatocellular injury What are BBWs of disulfiram (Antabuse)? - ✔✔Do not give in psychosis, severe myocardial disease, recent use of metronidazole, or active use of ETOH