Exam 2- Pharmacotherapeutics for Advanced Practice Nurse Practitioners

Exam 2: Pharmacotherapeutics for Advanced
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What are commonly used abortive therapies for a headache?
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-OTC analgesics
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-Ergot Derivatives
-Triptans
-Antiemetics
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Which OTC analgesics are recommended for management of headaches?
-Aspirin
-Tylenol
-Ibuprofen
-Naproxen
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-Excedrin Migraine
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-Advil Migraine
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How does aspirin play a role in management of HA?
-anti-prostaglandin
-antiplatelet
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-serotonergic activity
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How do NSAIDs play a role in management of HA?
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inhibits prostaglandin synthesis for central analgesia effects
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How do ergot derivatives help manage HA?
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Vasoconstriction to decrease pulsation in extra cranial arteries without reducing cerebral blood flow
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What are some factors that prevent a provider from prescribing Ergotamine?
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-Extreme nausea & vomiting
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-Unpredictable oral absorption
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How many doses per week of Ergotamine can be used? Per month?
-2/week
-12/month
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Ergotamine is contraindicated in which patients?
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Pregnant & children
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Why might dihydroergotamine (DHE) be prescribed over Ergotamine and who might be a better can
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didate for it?
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Less vasoconstrictive effects
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*May be better alternative for patients with peripheral vascular disease
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How do triptans influence HA pain?
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vasoconstriction & blockage of pain pathways to brainstem
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Why would a provider prescribe a different triptan if one is not effective?
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They each have slightly different onsets & 1/2 lives
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What are contraindications to prescribing or administering a triptan?
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-CAD, uncontrolled HTN
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-within 24 hours of an ergot derivative
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-within 2 weeks of MAOI or SSRI

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What are considerations a provider should take when prescribing antiemetics for a patient experienci
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ng HA/migraines? Why?
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Route of administration
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*Nausea & vomiting associated with episode leads to decreased gastric emptying and decreased oral
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absorption of medications
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What are preventative therapies for the management of HA/migraines?
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-beta blockers
-antidepressants
-antiepileptics
-NSAIDs
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-Ca channel blockers
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-ACE inhibitors & ARBs
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-Botulinum Toxin (A)
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What is the first beta blocker that you would prescribe for preventative management of HA/migraine
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Propranolol
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How long should a patient be monitored for after initiating a beta blocker for treatment of HA/migrai
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ne? What should be monitored?
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-3 months
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-Blood pressure & heart rate
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Propranolol is contraindicated in what types of patients?
-CHF
-asthma
-COPD
-PVD
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-Wolf-Parkinson-White syndrome
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Is propranolol recommended for pregnancy?
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No, Category C. Last line if no safer option
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What other beta blockers are considered if the patient has coexisting respiratory conditions?
-metoprolol
-atenolol
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Which antidepressants are commonly used for management of HA/migraine?
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Amitriptyline & venlafaxine
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What are the contraindications of amitriptyline?
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-narrow angle glaucoma
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-urinary retention
-pregnancy/breastfeeding
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-MAOI use
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What are the two most common anti-epileptic medications used?
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-divalproex (Depakote)
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-topiramate (Topamax)
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What monitoring is required when using divalproex?
-LFT
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-platelet counts
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-coagulation time