Pharm 3 patho and blueprint note cards

What are the key features of tension-type headaches (TTH)?

bilateral pain, pressure/tightness, gradual onset, not worsened by activity, triggered by stress, sleep loss, or hunger

How do migraines typically present?

usually unilateral, throbbing/pulsating pain with nausea, dizziness, and sensitivity to light/sound

What are common migraine triggers?

sleep disturbance, missed meals, weather changes, stress, menstruation

How do cluster headaches differ from migraines?

cluster headaches cause severe unilateral eye pain with tearing and nasal symptoms and patients are restless/agitated (not seeking dark/quiet like migraine patients)

What is a key identifying feature of cluster headaches?

occur in cyclical patterns, often the same time each day

What is first-line treatment for cluster headaches?

100% oxygen by mask plus subQ or intranasal triptans

How do sinus headaches present?

facial pressure, purulent nasal drainage, congestion, worse when bending forward

What is first-line treatment for mild episodic tension headaches?

analgesics and NSAIDs

What is the medication of choice for chronic tension headaches?

TCAs (amitriptyline)

What is medication overuse (rebound) headache?

headache caused by frequent use of acute headache medications leading to worsening headache frequency

What is Local Anesthetic Systemic Toxicity (LAST)?

toxic blood levels of local anesthetic causing neurologic and cardiovascular symptoms

What are neurologic symptoms of LAST?

tinnitus, confusion, tremors, seizures, altered vision

What are cardiovascular symptoms of LAST?

arrhythmias, bradycardia, hypotension, cardiac arrest

What is the treatment for LAST?

IV lipid emulsion therapy (intralipid)

What is lost first during local anesthesia?

sympathetic tone

What is lost last during local anesthesia?

motor function

What is the most important history to ask before giving succinylcholine?

family history of malignant hyperthermia

Which drugs increase risk for malignant hyperthermia?

succinylcholine and volatile inhaled anesthetics

What is methohexital used for compared to phenobarbital?

methohexital is used for brief procedural sedation due to rapid onset and short duration

What effect does propofol have on intracranial pressure (ICP)?

decreases ICP

Which anesthetic has the least effect on blood pressure and heart rate?

etomidate

Why is ketamine useful in certain patients?

provides bronchodilation and maintains respiratory drive

What is spasticity?

increased muscle tone with involuntary muscle activation and hyperactive reflexes

What are complications of muscle spasticity?

pain, decreased mobility, impaired ADLs, reduced quality of life

What are the characteristics of a Grade I muscle strain?

mild injury with minimal strength loss and mild discomfort

What are the characteristics of a Grade II muscle strain?

partial tear with weakness, hematoma, and moderate functional loss

What are the characteristics of a Grade III muscle strain?

complete tear with total loss of function and severe pain

What happens with abrupt baclofen withdrawal or pump malfunction?

rebound spasticity, seizures, hyperthermia, autonomic instability, possible rhabdomyolysis

Which muscle relaxant is peripherally acting?

dantrolene

Which muscle relaxants are centrally acting?

baclofen, tizanidine, diazepam

What is a major adverse effect of dantrolene?

hepatotoxicity

What major drug interaction occurs with tizanidine?

CYP1A2 inhibitors

What causes osteoporosis?

increased bone resorption by osteoclasts leading to decreased bone density

What are complications of osteoporosis?

fractures, chronic pain, disability

What is Paget’s disease?

disorganized bone remodeling with excessive but weak bone formation

What complications can occur with Paget’s disease?

bone deformity, fractures, nerve compression, hearing loss

What is the MOA of denosumab?

blocks RANKL leading to decreased osteoclast activity and bone resorption

What is a major adverse effect of denosumab?

hypocalcemia

What serious complication can occur with denosumab and bisphosphonates?

osteonecrosis of the jaw

What is key teaching for alendronate administration?

take on empty stomach with water and remain upright for 30 minutes

What is a major risk of raloxifene?

venous thromboembolism (VTE)

What is the MOA of teriparatide?

stimulates osteoblast activity to increase bone formation

What is the pathophysiology of tension-type headaches (TTH)?

multifactorial involving central sensitization, neurotransmitter imbalance, and increased muscle tenderness causing pressure-like pain

What is the pathophysiology of migraines?

complex neurologic disorder involving vascular changes, trigeminal nerve activation, inflammation, and hormonal influences

What is the pathophysiology of cluster headaches?

trigeminal vascular activation with parasympathetic/autonomic involvement causing severe unilateral pain and autonomic symptoms

What is the pathophysiology of sinus headaches?

inflammation and congestion in sinus cavities due to infection or blockage leading to pressure and pain

How do headaches impact a patient’s quality of life?

can cause missed work, impaired social/family function, sleep disturbance, anxiety, and depression

What is a medication overuse (rebound) headache?

headache caused by frequent use of acute headache medications leading to worsening frequency and dependence

Which medications commonly cause rebound headaches?

NSAIDs, acetaminophen, triptans, combination headache medications

What is an important adverse effect of aspirin in children?

Reye syndrome

What is a key toxicity sign of aspirin?

tinnitus indicating salicylism

What is a major interaction with acetaminophen?

warfarin increasing bleeding risk and alcohol increasing hepatotoxicity

What is a major interaction with ibuprofen?

anticoagulants increasing bleeding risk and ACE inhibitors increasing kidney injury risk

What is the most dangerous interaction with pseudoephedrine?

MAOIs causing hypertensive crisis

What monitoring is required when giving propofol?

blood pressure and respiratory status due to risk of hypotension and apnea

Why must propofol be discarded after 6 hours once opened?

risk of bacterial contamination due to lipid emulsion formulation

What type of IV access is preferred for propofol?

large-bore IV due to pain on injection

Why are benzodiazepines sometimes given with ketamine?

to reduce hallucinations and emergence reactions

What is a key respiratory advantage of ketamine?

preserves respiratory drive and provides bronchodilation

What is important when administering midazolam IV?

administer slowly over at least 2 minutes and reassess sedation

What serious risk occurs when midazolam is combined with opioids?

severe respiratory depression, coma, or death

What monitoring is required with rocuronium?

train-of-four monitoring to assess degree of paralysis

Why must sedation always accompany paralytics like rocuronium?

patient can be conscious but unable to move or breathe

What must be assessed before eating after lidocaine throat use?

return of gag reflex to prevent aspiration

What is the onset and peak effect of onabotulinumtoxinA (Botox)?

onset 24–72 hours with full effect in about 1 week