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24 Cards in this Set
- Front
- Back
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What type of medications have been shown to cause medication overuse headache?
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NSAIDs, triptans, barbiturates, narcotics, tylenol (not hydroxyzine)
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How should medication overuse headache be treated?
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taper narc 15% fdaily
caffeine 5 oz daily taper barbs |
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How can you acutely treat a medication overuse headache?
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transition with steroids and a short acting daily triptan
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What are critieria for medication overuse headache?
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h/a>15days/pmonth, 10 days a month of abortive treatment
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What is the reason that triptan use should be limited less than 6 times per month.
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Insurance only pays for 6, also more than 8 triptans per month have been shown increased SE?
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What are some methods of treatmetns for cluster headache?
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Home oxygen
prophylactic verapamil short only 80 tid up to 800 (QT prolonged) Lithium (600-900) VPA TPM Melatonin |
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What are the criteria for paroxysmal hemicrania?
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Female dominant (male is cluster)
2-30 minutes 25 mg TID then 50 mg TID Indomethacin can go up to 75 tid, some response within 2-10 days |
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What percentage of MG patients develop post-partum respiratory insufficiency?
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30% can have severe respiratory insufficiecy
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What should neurologists do with Mestinon during pregnancy?
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Mestinon is consider safe during pregnancy. If on MTS-should counsel that needs to be stopped for 3 months pre pregnancy
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What is the MOA of Zonisamide?
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sulfonamide thought to act on both Na channels and Ca channels
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What are the SE of Zonisamide?
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weight loss, somnolence, fatigue, dizziness, anorexia; idiosyncratic Stevens Johnson, renal calculi, hypohidrosis
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How is Zonisamide metabollized?
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reduced and glucoronidation in liver
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How do other meds affect Zonisamide?
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enzyme inducers (CMZ & PHT) can lead to doubling of the clearance of Zonisamide (half life changes from 60 to 30 hours)
CYP 3A can affect it, like grapefruit juice |
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How does Zonisamide affect other medications?
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It does not really interact with other meds
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What is the MOA of Gabapentin?
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It was originally designed as a GABA analogue, but also thought to act on neuronal calcium channels
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What are the SE of Gabapentin?
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dizziness, weight gain, somnolence, fatigue
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Is Zonisamide approved for monotherapy?
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no partial adjunct
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Is Topiramate approved for monotherapy?
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Yes
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Is Gabapentin approved for monotherapy?
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No partial adjunct
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What is the MOA of Topiramate? (4)
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blocks Na channels
inhibits kainate/AMPA glutamate receptors carbonic anhydrase activity enhanced GABAergic inhibitory effect |
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What type of glaucoma does Topiramate cause?
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Secondary angle-closure glaucoma
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Explain the difference between OAG and ACG?
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Glaucoma is caused when the anterior chamber,with a valve being the trabecular meshwork and aq humor produced by ciliary body, the trabecular meshwork gets blocked by the iris which sticks on to it, leading to increased pressure, asians tend to have more ACG
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How does Topiramate affect other medications?
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It inhibits CY2 enzyme and has been shown to increase PHT levels by 50%
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How do other medications affect Topamax?
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Enzyme inducing medications can reduce Topamax effective dosage by up to 40%
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