Caution in pts with CHF PVD AV conduction disturbances asthma depression DM

Caution in pts with chf pvd av conduction

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Caution in pts with CHF, PVD, AV conduction disturbances, asthma, depression, DM Precautions: Asthma COPD DM Heart block Don’t want to use beta-blockers that have ISA activity (ie. acebutolol): partial agonist activity on the same receptors Antidepressants Probably effective: Amitriptyline (TCA), Related to the down regulation of central 5HT 2 and Precautions: TCAs - anticholinergic, sedation SSRIs (fluoxetine) - not extensively Neurology Exam 3 Study Guide | Page 20
venlafaxine (SNRI) Conflicting efficacy: protriptyline, fluoxetine, fluvoxamine adrenergic receptors studied MAOIs - many DDI, tyramine free diet Methysergide (Sansert) Most effective for px, last line, no longer available in US Potent peripheral inhibitor of 5HT, central 5HT agonist Precautions Retroperitoneal, endocardial & pulmonary fibrosis Consider drug-free holidays of 3-4 weeks after 6 months of tx Must taper to avoid rebound HA Additional Therapies Anticonvulsants Valproic acid, divalproex (be cautious of indigestion, weight gain, hepatotoxicity, alopecia, tremor) Topiramate: FDA approval for migraine px (be cautious of flushing, diarrhea, weight loss, paresthesia) Gabapentin (not used as often) CCB Verapamil is DOC Chlorpromazine (Thorazine) IM or IV Herbal therapies Feverfew Few studies have been conducted NOT RECOMMENDED Cautions w/ NSAID, anticoagulants, not recommended in pregnancy (abortifacient) Allergies to chrysanthemums, marigolds, ragweed, chamomile Headon Homeopathic primarily made of wax “Chapstick for your forehead” No clinical benefit Tension Headache Prevalence Most common primary HA disorder Peak incidence is 20-55 yo More common in women in adulthood Occurs in up to 75% of the population Clinical Presentation Premonitory sx and aura are absent Pain is mild-mod intensity Commonly bilateral, “hat-band” region Usually frontal and temporal Mild photophobia or phonophobia Not as debilitating as migraine Nonpharmacologic Therapy Relaxation training Stress management Heat/cold packs Pharmacologic Therapy NSAIDs/analgesics 1st line and mainstay No evidence to support the use of muscle relaxants Prophylaxis Consider when: Frequency > 2x/week, Duration >3-4 hours, Medication overuse Substantial disability Pharmacological interventions TCAs are most often used Cluster Headache Prevalence Most severe primary HA disorder Relatively uncommon More common in males Ratio is approx. 4:1 Higher incidence in late 20s, but can occur at any age Genetic predisposition Neurology Exam 3 Study Guide | Page 21
Clinical Presentation Characteristics Can be episodic or chronic Occurs in series (cluster periods) lasting for weeks or months May have periods of remission (months to years) Pain is excruciating, penetrating, non-throbbing Clinical presentation Pain near the eye (occipital region) Unilateral, orbital, supraorbital & temporal location

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