Final pharm exam (1).docx

Reminder goal is to reduce symptoms of depression and

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Reminder: Goal is to reduce symptoms of depression and do no harm. Dosing should be highly specific and tailored to individual patients. Migraine1. NSAID, ASA (antiemetic) 2. Caffeine 3. Triptans Sumatriptan - fastest onset, shortest ½ life, may take 2 nd dose, SQ Contra: pregs, HTN, HD, CVA, PVD, liver dx, basilar, hemiplegic, retinal migraine, MAOI, ERGOT Caution: seizure, liver, SSRI, SNRI, Zolmitriptan- longer ½ life than sumatriptan, decrease dose in liver dx, ODT Interactions: cimetidine, fluvoxamine, Cipro Contra: pregs, CAD, HD, arrhythmias, MAOI, ERGOT, basilar, hemiplegic Naratriptan - slow onset (1-2hrs), longest ½ life, for recurrent HA or chest tightness, may take 2 nd dose in 4h Contra: pregs, HTN, PVD, liver/renal, ERGOT, caution in elderly Rizatriptan- ODT, up to 10 tabs/mo, rapid onset, 2 nd dose in 2h, decrease dose with propranolol Contra: ischemic HD, angina, MAOI, ERGOT, basilae/hemi, Caution: liver/renal, SSRI, SNRI, CAD risk factors Almotriptan- alternative for pt with intolerable s/e of other triptans Contra: renal and CYP3A4 inhibitor (ketocon, clarithromycin), pregs, HD, PVD, TIA, MAOI, ERGOT Caution: sulfa, cardiac risk factors, SSRI/SNRI Eletriptan- rapid onset, 2 nd dose 2h, Contra: pregs, HD, TIA, PVD, liver, Caution: SSRI/SNRI Interact: sibutramine, CYP3A4 (conivaptan, fusidic acid, azoles, DIH) Frovatriptan- longest ½ life (26h), 2day prophy for menstrual migraine, 2 nd dose 2h Contra: same as others SNOOP: systemic symptoms, neurologic, onset, older age, prior headache OLDCART: Onset Location Duration Characteristics Aggravating Factors Relieving Factors Treatment Migraine Prophy: recurring migraines that affect the patients functioning and QOL despite acute treatment, intolerance or fail of multiple acute treatments, overuse of meds, MOH, hemiplegic migraines, more than 2 per week anticonvulsants (VPA, Depakote, topomax), BBs (propranolol, timolol), TCA (amitriptyline), CCB (verapamil) TTH 1. ASA, Tylenol 2. NSAID (+antiemetic) 3. Butalbitol (no more than 3 days /mo) Prophy- >2 HA/week, amitriptyline.
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  • Summer '17
  • Selective serotonin reuptake inhibitor, Serotonin Syndrome, cimetidine, griseofulvin

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