PHULWANI DI #4 (SIMULATED):
Question : Patient from local jail with a substance abuse history is being treated with sumatriptan injections and ibuprofen tablets. Sumatriptan or any other 5HT-1 agonists are non formulary. What other medications could be used in this patient?
SUBJECT : Discussion of therapies other than triptans for treatment of migraine headache in a patient with a substance abuse history.
Introduction: Opiates, ergot alkaloids, corticosteroids, dopamine antagonists or NSAIDs and analgesics and their combinations available OTC are other alternatives that can be used for treatment of migraine headaches in a patient other than triptans.
NSAIDS and OTC analgesics and /or their combination can be tried as a first step approach
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for a patient suffering from mild to moderate migraines. In case the first step does not work, the patient has to be tried on the second step that is treatment with ergots, combination products, dopamine antagonists, or triptans 1 .Since opiates are habit forming and do not specifically treat a migraine but can help relieve almost any kind of pain, their use should be discouraged or they can be used as back up or as a rescue when the second step does not work.
The opiates that are used are mainly :Butalbital compunds (Fioricet, Fiorinal) and Acetaminophen and Codeine combinations such as Tylenol with codeine .These are relatively weaker members of the narcotic class , but their use can be reserved only in case another migraine pharmacotherapy did not work. Butorphanol( Stadol) nasal spray can be used as abortive therapy for migraines. It is a mixed agonist/antagonist opoid ,but its use has to be restricted in substance abuse patients due to its high potential for …show more content…
abuse. Isometheptene/Dichloralphenazone/Acetaminophen (Midrin) can be used for mild to moderate migraine headaches Similiarly, corticosteroids can be used as rescue therapy in case the second step of treatment does not work. The pharmacotherapy of migraine is also related to type or severity of migraine headaches. Ergot alkaloids or triptans may be used as first step for patients suffering from severe migraines or those who have not responded to any other therapy. http://www.clinicaltherapeutics.com/article/S0149-2918(00)80017-X/pdf Serotonin appears to play a crucial role in the pathogenesis of migraines.
The serotonergic drugs act on the 5HT receptors. There are two types of sertonergics : the triptans which are 5HT -1 receptor agonists and the ergot alkaloids which affect 5HT -1A, 5HT-1B, 5HT-1D, AND 5HT-1E receptors.The triptans are more selective 5-HT receptor agonists than the ergot alkaloids. The ergot alkaloids act on serotonergic subtypes 5-HT1A, B,D,F and 5-HT2 which results in their effects on neuropeptide release and neurogenically induced inflammation, which is their proposed mechanism of action in migraine. They also act on the alpha adrenergic and dopaminergic pathways . The ergot alkaloids that are used as migraine abortives include ergotamine tartrate (ET) and dihydroergotamine mesylate (DHE) (Migranol, Valeant), which are available in injectable and nasal spray
formulations. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740949/#!po=12.1622 According to clinical data, 50 to 90% of patients have reported efficacy with more favorable data for DHE and also lesser headache recurrency with DHE. Sumatriptan ,though has the fastest onset of action and similar efficacy as compared to DHE and the opiate Meperidine which is also used for migraine headaches. Other Abortive Agents The phenothiazines, butyrophenones, and metoclopramide (Reglan) have shown clinical efficacy in the abortive management of migraine.The antiemetic properties of these agents, along with their IV and rectal dosage formulations, are options for patients with significant nausea and vomiting. The proposed mechanism of these agents may result from their dopamine antagonist properties and the dopamine hypersensitivity reported during a migraine. Similiarly , promethazine and prochlorperazine are mainly used for treatment of nausea but they can also play a role in the abortion of headache or even as a preventive for headache IV prochlorperazine (Compazine, GlaxoSmithKline), chlorpromazine (Thorazine, GlaxoSmithKline), promethazine (Phenergan, Wyeth), droperidol (Inapsine, Janssen), and haloperidol decanoate (Haldol, Ortho-McNeil) have shown efficacy as migraine-abortive drugs in clinical trials. The antiemetic metoclopramide has been effective, with one trial reporting efficacy similar to that of sumatriptan when used in high doses in persistent migraine. Using metoclopramide in combination with the triptans or ergots may provide additional efficacy as well as antiemetic benefits. These agents can be considered an alternative in the abortive management of migraine if they are administered in the proper setting in patients who do not respond to triptans or ergot derivatives. When these agents are administered caution needs to be exercised as potential hypotension, arrhythmias or dystonic reactions can occur. An ECG can be performed prior to the administration of these agents Other agents that may be used in the abortive management of migraine include IV valproic acid (Depacon, Abbott). This anticonvulsant was found to be more effective than placebo, and it had comparative efficacy with DHE in refractory cases. Background questions to ask about the patient : 1) What is the frequency of migraine headaches for this patient 2) Does the patient have any other co exisiting disorders, cardiovascular disorders, etc 3) What therapy has the patient already tried 4) What kind of migraine headache does the patient seem to suffer from, also whether it is acute or chronic. REFERENCES: 1) DeMaagd George. The Pharmacological Management of Migraine, Part 1. Pharmacy and Therapeutics . Jul 2008; 33(7) : 404-416 .Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740949/#!po=12.1622 2) Cunha John.Migraine headache medical treatment. Available from emedicine website . http://www.emedicinehealth.com/migraine_headache/page8_em.htm. Last updated 3/1/13. Accessed October 2, 2014.
Alternatives would be prescription of different dose of PRN and regular pain medicines and alternative pain treatment such as implanted pain pumps, nerve block therapy, massage therapy, relaxation and guided imagery , chiropractic treatment and oncology rehabilitation so that level of pain can be minimized.
Jody was born biologically with male genitals and he was brought up as a boy. Unlike his more gender-typical older brother, Jody’s childhood behavior was considered “sissy”. Jody genetically preferred the company of girls compared to boys during childhood. Jody considered herself a bisexual male until the age of 19. At 19 years of age, she became involved with a man, and her identity would be transgender, meaning that Jody was unhappy with her gender of birth and seeks a change from male to female. It would seem that there was some late-onset dissatisfaction, and late-onset is linked to attraction to women; in comparison to early childhood-onset, which are attracted to men. Jody identified herself as bisexual. The relationship with the man ended; nevertheless, Jody’s desire to become a woman consumed her, and Jody feels that’s he was born in the
Coley is a timber cutter that is addicted to crystal meth. He has three young children, two girls and a boy and a wife that he affects everyday with his crystal meth abuse. Throughout the episode Coley locks himself in the garage, so he can snort powder form of crystal meth without his children being directly in front of it. Coley thinks that if he locks himself in the garage his children do not see his behaviors. Coley's addiction stemmed from his childhood where his mother was a speed addict and alcoholic and allowed Coley to do drugs and drink with her throughout his young teens and late adult hood. After Coley married his wife and his wife recognized the problem was connected to when he was at his mother's home she asked that he not be involved with his mother. Coley does this and shortly after his mother dies. This leads Coley to more drug abuse and his addiction becomes worse, due to the guilt he feels for hurting his mother and the guilt from the fact that she died alone. Coley somewhat blames his wife for this. Coley put his family in great danger with the bills not being paid and him putting off jobs for something he thinks will become his gold mine and turns out not to.
As of today this type of treatment is one of the most widely known options for clients who have opiate issues. This treatment is a combination of two different drugs: buprenorphine and naloxone. Buprenorphine is a lower form of opiates that is given to the patient with opiate addictions because it provides them with fewer side effects when coming off the addiction. Naloxone is a blocker medication that is primarily given in emergency rooms to individuals who have overdosed wit...
Drugs: propylthiouracel, methimazole, anesthesia, barbituates, beta blockers, diuretics, lithium, narcotics, phenothiazines, phenytoin (alters binding of T4 to TBG), rifampin, tranquilizers
"NIH Study Finds Chronic Alcohol Use Shifts Brain's Control of Behavior." NIH News Release. 22 Aug. 2013: n.p. SIRS Government Reporter. Web. 19 Mar. 2014.
Treatment for substance abuse vital to reduce prison recidivism rate, The Medical News, March 14, 2008,http://www.news-medical.net/news/2008/03/14/36306.aspx
According to CDC in the year 2015 opioids played a part in 33,091 deaths. Now you may ask what an opioid is. An Opioid is a compound that binds to opioid receptors in the body to reduce the amount of pain. There are four main categories of opioids, one being natural opioid analgesics including morphine and codeine, and semi synthetic opioid analgesics, including oxycodone, hydrocodone, hydromorphone, and oxymorphone. The second category being methadone, a synthetic opioid, the third category being synthetic opioid analgesics other than methadone includes tramadol and fentanyl. The last category is an illicit opioid that is synthesized from morphine called heroin.
Potent pain medication contains the aspects of utilizing medications such as morphine or demerol, how the medications are dispensed, and t...
Jane did explain that since the history of migraine headache had been going on for years it was going to take a while prior to seen any results but it was going to take some lifestyle changes other than the acupuncture to achieve the goal. The author left the office in a great note. Unable to gauge the results of the treatment yet but with a hopeful outlook for the future.
Arias, M.D., A. J., & Kranzler, M.D, H. R. (n.d). Treatment of co-occurring alcohol and other drug Use disorders. Retrieved from http://pubs.niaaa.nih.gov/publications/arh312/155-167.htm
Dowson AJ, Charlesworth B. Review of zolmitriptan and its clinical applications in migraine. Expert Opin Pharmacother. 2002 Jul;3(7):993-1005.
My mom became a victim to this illness after she had my youngest sibling. She has now lived with primary migraines for about seven years and the cause of her condition is unknown. The possible factors that can lead to migraines include, hormones, caffeine, stress, anxiety, and many others. Similarly, the journal “Providing Care for Patients with Chronic Migraine: Diagnosis, Treatment, and Management”, by Stephen D. Silberstein states, “Other comorbid factors should be addressed, including sleep disorders, neck pain, fibromyalgia, and obesity” (Silberstein). My mother has gone through many things in her life which relate to many of these factors. Therefore, doctors have not been able to determine the cause of her
The ingestion of alcoholic beverages for their enjoyable effects is a custom which has been around for thousands of years, and alcohol continues to be a popular drug because of its short-term effects (Coleman, Butcher & Carson, 1984). An enormous amount of damage can be attributed directly to alcohol abuse as a result of lost jobs, accidents caused by drunk drivers, and so forth (Maltzman, 2000). Alcohol also compounds other problems--an estimated 25% to 40% of hospital patients have problems caused by, or recovery delayed by alcohol abuse (Maltzman, 2000). Clinical psychologists spend about one-fourth of their time dealing with people who are suffering in part from alcohol or other substance problems (Vaillant, 1995). Although alcohol problems have been around for so long, it is only recently that these problems have begun to be associated with medical or psychological difficulties.
Substance abuse is an issue that plays a major social problem in society, the effect of drugs on families and communities is destructive. This paper will discuss evidence showing how substance abuse is a specific social problem that is widespread, and is affecting every level of our judicial system. Many people turn to drugs for many different reasons, they will try just about anything to relieve the pain. In our society today many people go through devastating experiences in their life. Furthermore people turn to drugs to mask the horrible memories and find relief. Drugs can temporarily relieve the symptoms of angry, loneliness or boredom, but it may be a temporary fix to an individual problems. They may