pharm 24- migraine therapy

most common treatment for tension headaches

acetominophen or NSAIDs

s/sx to document to diagnose migraine

(POUND) pulsating, hOurs (4-72 duration), unilateral, nauseating, disabling, sensitive to light and sound

migraine termination

acetominophen or NSAIDs, triptans and ergot alkaloids- selectively constrict vessels in that area of brain (if first 2 are not effective)

lasmiditan

more direct acting on the cerebral blood vessels than triptan or ergots, does not affect BP as much as others, C4 controlled substance so hard to get

-gepants

ubrogepant is used for termination, rimegapnat is used for termination and prevention of migraines, both calcitonin gene related peptides, block certain receptor to target neurological part of migraine (not vascular)

migraine prophylaxis

beta blockers (metoprolol) and calcium channel blockers (verapamil and nifedipine)- both act on vascular components of migraines, anti seizure and antidepressants can be used as well

migraine termination process

interferes with vascular component of migraines to prevent painful throbbing of migraine, constricts blood vessels, new agents are more selective for large vessels (so are less influential on blood pressure)

examples of migraine termination meds

triptans (-triptan) - used first, better tolerated and have wide variety of routes, ergot alkaloids (ergotamine)- used if triptans are ineffective

mechanism of action of triptans and ergot alkaloids

moderately selective, only for large vessels using serotonin receptors, less effect on bp, decreased throbbing of migraines

side effects of migraine termination drugs

(triptans and ergots) vasospasm- especially in coronary vessels in patients at risk for MI or angina, ergot alkalosis- dizziness and drowsiness due to interaction in CNS

nursing implications of ergots and triptans

pain assessment before and after, quiet calm environment to decrease stimuli, be alert to chest pain, help patient identify migraine trigger

patient education of migraine medications

take prophylactic medication regularly, take termination medication at first sign of migraine

anti epileptic drugs (AED) mechanism of action

delay influx of sodium, delay influx of calcium, use GABA receptors to inhibit neural activity

sodium role in seizure

movement of sodium into neurons stimulates neural activity, medications prevent this to decrease activity

calcium role in seizure

movement of calcium into neurons stimulates neural activity, medications prevent this to decrease activity

vernalized nursing implications of seizure

get patient on the floor and protect head, nothing in their mouth, loose clothes, call 911 if not in hospital

patient education of AEDs

must be seizure free for 6 months before driving, sedation can occur with these medications, no alcohol (withdrawals can precipitate a seizure), never stop abruptly, take on a regular schedule to keep blood levels regular, avoid OTC and herbal meds because many have interactions with AEDs

hydantoins examples

phenytoin- PO or elixir, fosphenytoin- IV

risk of giving phenytoin IV

high ph of 12 can change ph of blood

hydrotoins mechanism of action

delay influx of sodium into CNS, reduces spread of seizure

uses of hydrotoins

all types of epilepsy except absent seizures

side effects of hydrotoins

CNS depression due to toxicity- slurred speech and LOC changes, gingival hyperplasia, poor dental hygiene, bone marrow failure= pancytopenia

nursing implications of hydrotoins

may have loading dose and maintenance doses, if patient is NPO call physician, monitor blood levels of drug, review CBC for bone marrow failure, assess mental status for toxicity

patient education of hydrotoins

report s/sx of low CBC counts, oral care, regularly take doses, no alcohol, no driving, never stop taking medication suddenly, signs of toxicity, this therapy is often lifelong

phenytoin- like agents examples

carbamazepine, lamotrigine, valproates- divalporex sodium and valproic acid

phenytoin- like agents mechanism of action

inhibits spread of impulses by delaying sodium influx (like hydrotoins)

uses of phenytoin- like agents

tonic clonic and partial seizures, behavior disorders, mood stabilizers, migraine prevention

side effects of phenytoin- like agents

bone marrow failure, cns depression- slurred speech and altered LOC (toxicity)

nursing implications of phenytoin- like agents

may have loading dose and maintenance doses, if patient is NPO call physician, monitor blood levels of drug, review CBC for bone marrow failure, assess mental status for toxicity

GABA agents examples

barbiturates, benzodiazepines, others

GABA

major inhibitory neurotransmitter in cerebral cortex, decreases anxiety and promotes sleep, surpasses neural firings

barbiturates example

Phenobarbital

mechanism of action of barbiturates

enhances GABA action, increases seizure threshold

uses of barbiturates

wide range of seizure control except absent seizures, can also be used for pet seizures

side effects of barbiturates

drowsiness, dependence (C4 )

Benzodiazepines examples

(-zepam) diazepam (IV for status epilepticus) , lorazepam (IV for status epilepticus), clonazepam (best for long term use, slowest tolerance and dependence)

mechanism of action of Benzodiazepines

reduces cerebral excitability,

uses of Benzodiazepines

status epilepticus (IV) and prophylaxis (PO), sleep disorders, anti anxiety, antiemetics

side effects of Benzodiazepines

drowsiness, tolerance, dependence

nursing implications of Benzodiazepines and barbiturates

monitor for drug abuse, CNS depression, overdose (no reverse for barbiturates)

Benzodiazepines overdose reversal agent

flumazenil

miscellaneous GABA agents uses

increase effects of GABA, used for seizure disorders, used for pain with nerve damage

gabapentin

used for diabetic neuropathy and post hepatic neuralgia

pregabalin

used for diabetic neuropathy and post hepatic neuralgia

topiramate

anticonvulsant used to prevent migraines

succinimides examples

(-suximide) ethosuximide, methsuximide, phensuximide

mechanism of action of succinimides

delays calcium influx into neurons

uses for succinimides

absent seizures