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28 Cards in this Set
- Front
- Back
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31. Contraindications to Sumatriptan (triptans)?!?
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a. CAD
b. Uncontrolled HTN c. Basilar artery migraine d. Hemiplegic migraine e. Certain meds |
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32. Meds which are contraindicated w/Triptan use?
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1. MAOI
2. SSRI 3. Lithium |
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33. What should you suspect if none of the available meds for migraines is working?
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a. It is unlikely that the pt is suffering from a migraine HA.
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34. Migraine prophylaxis (Consider prophylaxis for pts w/weekly episodes)?
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a. First line: TCAs (amitriptyline) and propranolol.
b. Second line: Verapamil, Valproic acid, methysergide) c. NSAIDs are effective for menstrual migraines. |
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35. How long does the visual aura usually last in the classic migraine?
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a. 10-20 minutes.
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36. Rebound analgesic HAs?
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a. Many pts who are labeled as having migraines actually have rebound analgesic HAs.
b. These occur more frequently (every 1-2 days) than migraines). c. These HAs do NOT respond to the drugs used to tx migraines. |
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37. Tx of Rebound Analgesic HAs?
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a. Wean pts from analgesics.
b. Do not use narcotics. |
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38. Secondary causes of Headache (VOMIT)?
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a. V: Vascular: subarachnoid haemorrhage, subdural haematoma, epidural haematoma, intraparenchymal haemorrhage, temporal arteritis).
b. O: Other causes: Malignant HTN, Pseudotumour cerebri, postlumbar puncture, Pheochromocytoma. c. M: Medication/drug-related- nitrates, ETOH withdrawal, Chronic analgesic use/abuse. d. I: Infection: meningitis, encephalitis, Sinusitis, herpes zoster, Fever e. T: Tumour |
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39. Acute Vs. Chronic Cough?
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a. < or > 3 weeks.
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40. Conditions usually associated w/cough?
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a. URI: probably most common cause of acute cough.
b. Pulmonary disease: pneumonia, COPD, Pulmonary fibrosis, lung cancer, asthma, lung abscess, TB. c. CHF w/pulmonary oedema. |
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41. 5 causes of Isolated cough in pts w/normal chest radiograph?
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a. Smoking
b. Postnasal drip- May be caused by URIs (viral infections), rhinitis (allergic or non-allergic), chronic sinusitis, or airborne irritants. c. GERD d. Asthma e. ACE inhibitors. |
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42. What may point to GERD cough?
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a. If CXR normal and especially occurs at night (when lying flat, reflux worsens due to position and decreased LES tone.
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43. Cough in asthma?
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a. May be only symptom in 5% of cases.
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44. Cough w/ACE inhibitors (characteristic and pathophys)?
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a. Dry cough (due to bradykinin production).
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45. When do order CXR w/cough?
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a. If pulmonary cause is suspected
b. If pt has hemoptysis c. If chronic cough (>3 weeks) d. Also may be appropriate in long-term smoker in whom COPD or lung cancer is a possibility. |
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46. When to order CBC w/cough?
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a. If infection is suspected
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47. When to order Pulmonary function w/cough
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a. If asthma is suspected or if cause is unclear in a pt w/chronic cough
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48. When to order Bronchoscopy w/cough?
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a. If there is no diagnosis after above workup to look for tumour, foreign body, or tracheal web.
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49. Tx of cough?
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a. Tx underlying cause, if known.
b. Smoking cessation, if smoking is cause |
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50. Tx of postnasal drip if cause of cough?
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a. First-gen antihistamine/decongestant.
b. If sinusitis is also present, consider abx. c. For allergic rhinitis, consider a non-sedating long-acting oral antihistamine (loratadine). |
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51. Non-specific antitussive tx?
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a. Unnecessary in most cases, bc cough usually resolves w/specific tx of cause.
b. May be helpful in the following situations: i. If cause is unknown (and thus specific therapy cannot be given) ii. If specific therapy is not effective) iii. If cough serves no useful purpose such as clearing excessive sputum production or secretions. |
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52. Antitussive meds for nonspecific tx?
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a. Codeine
b. Dextromethorphan c. Benzonate (Tessalon perles) capsules. |
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53. Agents used to improve the effectiveness of antitussive meds include?
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1. Expectorants such as Guaifenesin and water.
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54. Postnasal drip cough pathophys?
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a. The mucosal receptors in the pharynx and larynx are stimulated by secretions of the nose and sinuses the drain into the hypopharynx.
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55. 4 main causes of chronic cough in adults?
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1. Smoking!!!
2. Postnasal drip 3. GERD 4. Asthma |
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56. Common features of viral vs. Bacterial URI?
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a. Rhinorrhea: V
b. Myalgias: V c. HA: V d. Fever: Both e. Cough: Both f. Yellow Sputum: Bacterial. |
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57. General characteristics of acute Bronchitis?
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a. Viruses account for the majority of cases.
b. Lab tests are not indicated. c. Only obtain CXR if you suspect pneumonia; there is no infiltrate or consolidation in acute bronchitis. |
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58. What suggests pneumonia on PE?
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a. Fever
b. Tachypnea c. Crackles d. Egophony on auscultation e. Dullness to percussion. |
