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NUR 613 Final Exam Questions And Answers
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NUR 613 Final Exam Questions AndAnswers
EASTON
, NUR 613 Final Exam Questions
And Answers
Migraine Headache Characteristics
•Throbbing head pain of moderate to severe intensity
•Nausea & vomiting
•Sensitivity to light & sound
•Highly debilitating
•Hormonal component
•Family history typical
Two primary forms
•Migraine with aura
- Preceded by visual symptoms
•Migraine without aura
- More common than with aura
Migraine Headache Pathophysiology
•Neurovascular disorder that involves dilation & inflammation of intracranial blood
vessels
•Vasodilation leads to pain
•Exact cause of a migraine is not totally understood.
•Two compounds- calcitonin gene-related peptide (CGRP) and serotonin (5-HT)-
play important roles.
Migraine Headache Treatment- •Aborting an ongoing attack
Nonspecific analgesics
•Aspirin-like drugs
•Opioid analgesics
Migraine-specific drugs
•Serotonin1B/1D receptor agonists (Triptans)
•Ergot alkaloids
Migraine Headache Treatment- •Preventing attacks from occurring
•Beta blockers (propranolol)
•TCAs (amitriptyline)
•Antiepileptic drugs (divalproex)
Migraine Headache- •Nondrug measures
,•Adequate sleep
•Exercise
•Avoiding triggers
•Once headache begins
- Dark room with ice pack to neck
Migraine Headache: Abortive Therapy
•Eliminate headache pain & suppress associated nausea/vomiting
•Earliest treatment possible
Route of administration
•Oral may not be effective owing to GI distress.
•Injection, inhalation, or rectal suppository may be more effective.
•Use should be limited to 1 or 2 days a week to prevent drug-rebound headaches.
Antiemetics
•Metoclopramide (Reglan)
•Prochlorperazine (Compazine)
•Mild to moderate headache tx
Aspirin-like drugs
•Aspirin
•Acetaminophen
•NSAIDs
•Moderate to severe headache tx
Migraine-specific drug
•Serotonin-1B/1D agonist (Triptans)- first-line drugs for aborting a migraine
•Ergot alkaloid (ergotamine & dihydroergotamine)
•Opioid analgesics
Antiemetics
Serotonin1B/1D Receptor Agonist
•Sumatriptan (Imitrex)
•Zolmitriptan (Zomig)
•Naratriptan (Amerge)
•Rizatriptan (Maxalt)
•Almotriptan (Axert)
•Frovatriptan (Frova)
•Eletriptan (Relpax)
Sumatriptan (Imitrex) MOA
•Binds to 5-HT1B/1D (serotonin) receptors on intracranial blood vessels and
causes vasoconstriction
•Diminishes perivascular inflammation
Sumatriptan (Imitrex) use
•Aborting an ongoing migraine attack to relieve headache and associated symptoms
, •Sumatriptan is also approved for cluster headaches.
Sumatriptan (Imitrex) AE
•Chest symptoms
Transient "heavy arms" or "chest pressure"
•Coronary vasospasm
Rare angina secondary to vasospasm
•Teratogenesis- Avoid use during pregnancy
•Vertigo, malaise, fatigue, tingling sensations
Very bad taste when taken in intranasal form
Sumatriptan (Imitrex) drug interactions
•Ergot alkaloids & other triptans (vasoconstriction)
•MAOIs (suppresses hepatic degradation --> TOXICITY)
•SSRIs/SNRIs (Serotonin Syndrome)
Sumatriptan (Imitrex) contraindications
•Triptans can cause vasoconstriction & coronary vasospasm and should NOT be
given to patients with CAD, current symptoms of angina, ischemic heart disease,
history of MI, or uncontrolled HTN.
Ergot Alkaloids
•Ergotamine
•Dihydroergotamine
Ergotamine use
•Stops an ongoing migraine- Second-line therapy in patients that do not respond to a
triptan
•Should not be taken daily on a long term basis due to risk of dependence!
•Ergotamine AE
•N/V, weakness in the legs, myalgia, numbness and tingling in fingers or toes,
angina-like pain, tachycardia or bradycardia
•Ergotamine overdose
Ergotism
Overdose can cause ischemia secondary to constriction of peripheral arteries and
arterioles: the extremities become cold, pale, and numb; muscle pain develops; and
gangrene may eventually results. If these symptoms occur, patients should seek
immediate medical attention.
Ergotism
Gangrene, nervous spasm, burning sensations, hallucinations, and temporary
insanity in humans caused by rye plants containing ergots that were milled into flour
Ergotamine overdose
•Ergotamine drug interactions
•Triptans- prolonged vasospastic reaction
•CYP3A4 inhibitors- increases ergotamine...risk of intense vasospasm (eg, HIV
protease inhibitors, azole antifungals, macrolides, grapefruit juice)
•Ergotamine dependence
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