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What Are the Acute Treatments for Migraine and How Are They Used?
2. Acute Treatment CQ II-2-1 What are the acute treatments for migraine and how are they used? Recommendation The mainstay of acute treatment for migraine is pharmacotherapy. The drugs used include (1) acetaminophen, (2) non-steroidal anti-inflammatory drugs (NSAIDs), (3) ergotamines, (4) triptans and (5) antiemetics. Stratified treatment according to the severity of migraine is recommended: use NSAIDs such as aspirin and naproxen for mild to moderate headache, and use triptans for moderate to severe headache, or even mild to moderate headache when NSAIDs were ineffective in the past. It is necessary to give guidance and cautions to patients having acute attacks, and explain the methods of using medications (timing, dose, frequency of use) and medication use during pregnancy and breast-feeding. Grade A Background and Objective The objective of acute treatment is to resolve the migraine attack completely and rapidly and restore the patient’s normal functions. An ideal treatment should have the following characteristics: (1) resolves pain and associated symptoms rapidly; (2) is consistently effective; (3) no recurrence; (4) no need for additional use of medication; (5) no adverse effects; (6) can be administered by the patients themselves; and (7) low cost. Literature was searched to identify acute treatments that satisfy the above conditions. Comments and Evidence The acute treatment drugs for migraine generally include (1) acetaminophens, (2) non-steroidal anti-inflammatory drugs (NSAIDs), (3) ergotamines, (4) triptans, and (5) antiemetics. For severe migraines including status migrainosus and migraine attacks refractory to treatment, (6) anesthetics, and (7) corticosteroids (dexamethasone) are used (Tables 1 and 2).1)-9) There are two approaches to the selection and sequencing of these medications: “step care” and “stratified care”. -
Menstrually Related and Nonmenstrual Migraines in A
MENSTRUALLY RELATED AND NONMENSTRUAL MIGRAINES IN A FREQUENT MIGRAINE POPULATION: FEATURES, CORRELATES, AND ACUTE TREATMENT DIFFERENCES A dissertation presented to the faculty of the College of Arts and Sciences of Ohio University In partial fulfillment of the requirements for the degree Doctor of Philosophy Brenda F. Pinkerman March 2006 This dissertation entitled MENSTRUALLY RELATED AND NONMENSTRUAL MIGRAINES IN A FREQUENT MIGRAINE POPULATION: FEATURES, CORRELATES, AND ACUTE TREATMENT DIFFERENCES by BRENDA F. PINKERMAN has been approved for the Department of Psychology and the College of Arts and Sciences by Kenneth A. Holroyd Distinguished Professor of Psychology Benjamin M. Ogles Interim Dean, College of Arts and Sciences PINKERMAN, BRENDA F. Ph.D. March 2006. Clinical Psychology Menstrually Related and Nonmenstrual Migraines in a Frequent Migraine Population: Features, Correlates, and Acute Treatment Differences (307 pp.) Director of Dissertation: Kenneth A. Holroyd This research describes and compares menstrually related migraines as defined by recent proposed guidelines of the International Headache Society (IHS, 2004) to nonmenstrual migraines in a population of female migraineurs with frequent, disabling migraines. Migraines are compared by frequency per day of the menstrual cycle, headache features, use of abortive and rescue medications, and acute migraine treatment outcomes. In addition, this study explores predictors of acute treatment response and headache recurrence within 24 hours following acute migraine treatment for menstrually related migraines. Participants are 107 menstruating female migaineurs who met IHS (2004) proposed criteria for menstrually related migraines and completed headache diaries using hand-held computers. Diary data are analyzed using repeated measures logistic regression. The frequency of migraines is significantly increased during the perimenstrual period, and menstrually related migraines are of longer duration and greater frequency with longer lasting disability than nonmenstrual migraines. -
Isoflurane Produces Antidepressant Effects and Induces Trkb Signaling in Rodents
bioRxiv preprint doi: https://doi.org/10.1101/084525; this version posted July 11, 2017. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Isoflurane produces antidepressant effects and induces TrkB signaling in rodents Hanna Antilaa, Maria Ryazantsevaa,b, Dina Popovaa, Pia Sipiläa, Ramon Guiradoa, Samuel Kohtalaa,b, Ipek Yalcinc, Jesse Lindholma, Liisa Vesaa, Vinicius Satod, Joshua Cordeirae, Henri Autioa, Mikhail Kislina, Maribel Riose, Sâmia Jocad, Plinio Casarottoa, Leonard Khirouga, Sari Lauria,b, Tomi Tairaa,f, Eero Castréna* and Tomi Rantamäkia,b* aNeuroscience Center, P.O. Box 56, FI-00014 University of Helsinki, Helsinki, Finland. bDivision of Physiology and Neuroscience, Department of Biosciences, Faculty of Biological and Environmental Sciences, P.O. Box 66, FI-00014 University of Helsinki, Helsinki, Finland. cInstitut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, FR-67084 Strasbourg Cedex, France. dSchool of Pharmaceutical Sciences of Ribeirão Preto 14040-903, Brazil. eTufts University, Boston, MA, USA. fDepartment of Veterinary Biosciences, Faculty of Veterinary Medicine P.O. Box 66, FI-00014 University of Helsinki, Helsinki, Finland. *To whom correspondence should be addressed at: Eero Castrén ([email protected]) or Tomi Rantamäki ([email protected]) A brief burst-suppressing isoflurane anesthesia has been shown to rapidly alleviate symptoms of depression in a subset of patients, but the neurobiological basis of these observations remains obscure. We show that a single isoflurane anesthesia produces antidepressant-like behavioural effects in the learned helplessness paradigm and regulates molecular events implicated in the mechanism of action of rapid-acting antidepressant ketamine: activation of brain-derived neurotrophic factor (BDNF) receptor TrkB, facilitation of mammalian target of rapamycin (mTOR) signaling pathway and inhibition of glycogen synthase kinase 3β (GSK3β). -
Use of Analgesics in Exotic Felids Edward C. Ramsay, DVM Professor, Department of Small Animal Clinical Sciences, University Of
Use of Analgesics in Exotic Felids Formatted: Centered Edward C. Ramsay, DVM Professor, Department of Small Animal Clinical Sciences, University of Tennessee, and Consulting Veterinarian, Knoxville Zoological Gardens, Knoxville, Tennessee. Corresponding address: Ed Ramsay Dept. of Sm Animal Clin Sci C247, Veterinary Teaching Hospital University of Tennessee Knoxville, TN 37996-4544 Phone: 865-755-8219 FAX: 865-974-5554 Email: [email protected] 2 Treatment of pain in domestic and non-domestic cats has been a challenge for the clinician. Many cat species are stoic and show few or very subtle external signs of pain. Additionally, the adverse effects of nonsteroidal antiinflammatory drugs (NSAIDs) in domestic cats are well documented and have discouraged many practitioners from trying novel NSAID’s in exotic felids. As in other animals, each cat’s response to pain and analgesics will vary, necessitating an individualized treatment plan. As a rule, always treat painful felids to effect, and not by rote reliance on published dosages. It is frequently necessary to try different agents and combinations to find which produces the optimal analgesic effect in exotic felids. In order to minimize adverse effects, it is desirable to work toward treatment with the lowest effective dose when treating chronic pain. Non-steroidal Antiinflammatory Drugs NSAIDs are antiinflammatory drugs which act both centrally and peripherally. The primary effects are believed to be caused by their ability to inhibit cyclooxygenase (COX) enzymes in the arachidonic acid metabolism cascade. The COX-1 isoform is regarded as constitutive (continuously expressed) and is responsible for many homeostatic processes, such as maintenance of gastric mucosal integrity, platelet function, and renal autoregulation. -
Acute Migraine Treatment
Acute Migraine Treatment Morris Levin, MD Professor of Neurology Director, Headache Center UCSF Department of Neurology San Francisco, CA Mo Levin Disclosures Consulting Royalties Allergan Oxford University Press Supernus Anadem Press Amgen Castle Connolly Med. Publishing Lilly Wiley Blackwell Mo Levin Disclosures Off label uses of medication DHE Antiemetics Zolmitriptan Learning Objectives At the end of the program attendees will be able to 1. List all important options in the acute treatment of migraine 2. Discuss the evidence and guidelines supporting the major migraine acute treatment options 3. Describe potential adverse effects and medication- medication interactions in acute migraine pharmacological treatment Case 27 y/o woman has suffered ever since she can remember from “sick headaches” . Pain is frontal, increases over time and is generally accompanied by nausea and vomiting. She feels depressed. The headache lasts the rest of the day but after sleeping through the night she awakens asymptomatic 1. Diagnosis 2. Severe Headache relief Diagnosis: What do we need to beware of? • Misdiagnosis of primary headache • Secondary causes of headache Red Flags in HA New (recent onset or change in pattern) Effort or Positional Later onset than usual (middle age or later) Meningismus, Febrile AIDS, Cancer or other known Systemic illness - Neurological or psych symptoms or signs Basic principles of Acute Therapy of Headaches • Diagnose properly, including comorbid conditions • Stratify therapy rather than treat in steps • Treat early -
Effects of in Vitro Amitriptyline, Fluoxetine, Tranylcypromine and Venlafaxine on Saphenous Vein Grafts
ORIGINAL ARTICLE Braz J Cardiovasc Surg 2019;34(3):290-6 Effects of in vitro Amitriptyline, Fluoxetine, Tranylcypromine and Venlafaxine on Saphenous Vein Grafts Melek Akinci1, MD; Cetin Hakan Karadag2, MD; Serhat Huseyin3, MD; Cagatay Oltulu4, MD; Suat Canbaz3, MD; Ozgur Gunduz2, MD; Ruhan Deniz Topuz2, MD DOI: 10.21470/1678-9741-2018-0338 Abstract Objective: In this study, we aimed to examine the effects of (Log M) was 74.6%, the response at -6.32 (Log M) was 75.5%. amitriptyline, fluoxetine, tranylcypromine and venlafaxine on While the relaxation response at -6.46 (Log M) of fluoxetine was saphenous vein grafts in coronary artery bypass graft surgeries. 68.02%, the response at -6.02 (Log M) was 72.12%. While the Methods: 59 patients (40 males and 19 females; mean age relaxation response of tranylcypromine at -7.53 (Log M) was 65.1 years, distribution: 45-84 years) who had coronary artery 61.13%, the response at -7.23 (Log M) was 65.53%. While the bypass graft surgery between February 2014 and May 2016 were relaxation response of venlafaxine at -6.21 (Log M) was 29.98%, included in the study. After the saphenous vein grafts with intact the response at -5.90 (Log M) was 32.96%. and denuded endothelium were precontracted with 3×10-6M Conclusion: The maximum relaxation at minimum and phenylephrine, amitriptyline, fluoxetine and tranylcypromine maximum therapeutic concentrations was obtained with were cumulatively added to isolated organ baths in the range of amitriptyline, fluoxetine and tranylcypromine, and the minimum 10-11-3x10-5M, while venlafaxine was added in the range of 10-9- relaxation was obtained with venlafaxine. -
Psychotropic Drugs: Sedatives/Hypnotics, Antidepressants, and Antipsychotics
PSYCHOTROPIC DRUGS: SEDATIVES/HYPNOTICS, ANTIDEPRESSANTS, AND ANTIPSYCHOTICS INSTIs NNRTIs PIs RTI xBICTEGRAVIR xELVITEGRAVIR/ x DORAVIRINE x EFAVIRENZ xATAZANAVIR • TENOFOVIR • TENOFOVIR (Biktarvy) COBICISTAT (Pifeltro, (Sustiva, Atripla) (Reyataz/Norvir, ALAFENAMIDE, DISOPROXIL, TDF (Stribild, Genvoya) Delstrigo) Evotaz) TAF (Descovy, (Viread,Truvada, DOLUTEGRAVIR ETRAVIRINE x x Biktarvy, Genvoya, Atripla, Complera, (Tivicay, Triumeq, RILPIVIRINE (Intelence) DARUNAVIR x x Odefsey, Symtuza) Delstrigo, Stribild) Juluca) (Edurant, (Prezista/Norvir, x NEVIRAPINE Complera, Prezcobix, x RALTEGRAVIR (Viramune) •ABACAVIR (Kivexa, Odefsey, Juluca) Symtuza) (Isentress) Ziagen, Triumeq) xLOPINAVIR (Kaletra) SEDATIVES/HYPNOTICS xLorazepam, oxazepam, temazepam xAlprazolam, Potential for n Potential for p Potential for n bromazepam, benzodiazepine benzodiazepine benzodiazepine buspirone, clonazepam, estazolam, flurazepam, diazepam, nitrazepam, zolpidem, zopiclone xMidazolam, Potential for n Potential for p Potential for n triazolam benzodiazepine benzodiazepine benzodiazepine PSYCHOTROPICS INSTIs NNRTIs PIs RTI xBICTEGRAVIR xELVITEGRAVIR/ x DORAVIRINE x EFAVIRENZ xATAZANAVIR • TENOFOVIR • TENOFOVIR (Biktarvy) COBICISTAT (Pifeltro, (Sustiva, Atripla) (Reyataz/Norvir, ALAFENAMIDE, DISOPROXIL, TDF (Stribild, Genvoya) Delstrigo) Evotaz) TAF (Descovy, (Viread,Truvada, DOLUTEGRAVIR ETRAVIRINE x x Biktarvy, Genvoya, Atripla, Complera, (Tivicay, Triumeq, RILPIVIRINE (Intelence) DARUNAVIR x x Odefsey, Symtuza) Delstrigo, Stribild) Juluca) (Edurant, (Prezista/Norvir, -
Disproportionality Analysis of Antiretrovirals
Conference on Retroviruses and Opportunistic Infections (CROI), Boston, Massachusetts, March 3–6 2014 Poster #761 Disproportionality Analysis of Antiretrovirals with Suicidality using FDA Adverse Event Reporting System (FAERS) Data Daniel Seekins Andrew Napoli1, John Coumbis2, Jennifer Wood2, Amit Soitkar2, Daniel Seekins1 Bristol-Myers Squibb, Plainsboro, NJ, USA 1Bristol-Myers Squibb, Plainsboro, NJ, USA, 2Bristol-Myers Squibb, Hopewell, NJ, USA Email: [email protected] INTRODUCTION Statistical Analysis Suicide Attempt CONSIDERATIONS n A disproportionality analysis was performed for the selected drug and selected AE using the MGPS method Efavirenz (n = 107) Antiretrovirals n Psychiatric events, including depression, suicidal ideation, suicide attempts, and completed Antidepressants Strengths suicide have been reported in patients receiving efavirenz since 19981 Etravirine (n = 4) n The disproportionality measure, Empirical Bayesian Geometric Mean (EBGM), and the EB05 n FAERS is a large, independent, public dataset containing real-world data that can enable corresponding 90% CI (EB05, EB95) were estimated Nevirapine (n = 41) EBGM n Recently, a pooled analysis of four AIDS Clinical Trials Group (ACTG) studies (A5095, A5142, EB95 identification of potential signals for rare AEs A5175, A5202), identified an increased rate of suicidality with efavirenz-containing regimens n The threshold score above which a drug-event disproportionality signal is likely to be present Atazanavir (n = 13) compared to efavirenz-free regimens: is an EB05 -
Pharmacokinetics and Pharmacology of Drugs Used in Children
Drug and Fluid Th erapy SECTION II Pharmacokinetics and Pharmacology of Drugs Used CHAPTER 6 in Children Charles J. Coté, Jerrold Lerman, Robert M. Ward, Ralph A. Lugo, and Nishan Goudsouzian Drug Distribution Propofol Protein Binding Ketamine Body Composition Etomidate Metabolism and Excretion Muscle Relaxants Hepatic Blood Flow Succinylcholine Renal Excretion Intermediate-Acting Nondepolarizing Relaxants Pharmacokinetic Principles and Calculations Atracurium First-Order Kinetics Cisatracurium Half-Life Vecuronium First-Order Single-Compartment Kinetics Rocuronium First-Order Multiple-Compartment Kinetics Clinical Implications When Using Short- and Zero-Order Kinetics Intermediate-Acting Relaxants Apparent Volume of Distribution Long-Acting Nondepolarizing Relaxants Repetitive Dosing and Drug Accumulation Pancuronium Steady State Antagonism of Muscle Relaxants Loading Dose General Principles Central Nervous System Effects Suggamadex The Drug Approval Process, the Package Insert, and Relaxants in Special Situations Drug Labeling Opioids Inhalation Anesthetic Agents Morphine Physicochemical Properties Meperidine Pharmacokinetics of Inhaled Anesthetics Hydromorphone Pharmacodynamics of Inhaled Anesthetics Oxycodone Clinical Effects Methadone Nitrous Oxide Fentanyl Environmental Impact Alfentanil Oxygen Sufentanil Intravenous Anesthetic Agents Remifentanil Barbiturates Butorphanol and Nalbuphine 89 A Practice of Anesthesia for Infants and Children Codeine Antiemetics Tramadol Metoclopramide Nonsteroidal Anti-infl ammatory Agents 5-Hydroxytryptamine -
(12) United States Patent (10) Patent No.: US 6,221,377 B1 Meyer (45) Date of Patent: Apr
USOO6221377B1 (12) United States Patent (10) Patent No.: US 6,221,377 B1 Meyer (45) Date of Patent: Apr. 24, 2001 (54) ADMINISTRATION MEDIA FOR (56) References Cited ANALGESIC, ANTI-INFLAMMATORY AND ANT-PYRETC DRUGS CONTAINING FOREIGN PATENT DOCUMENTS NITROUS OXDE AND PHARMACEUTICAL 2 277 264 10/1994 (GB). COMPOSITIONS CONTAINING SUCH MEDIA AND DRUGS OTHER PUBLICATIONS (75) Inventor: Petrus Johannes Meyer, Randburg Chemical ABstracts AN 1985:464783, Hertz et al., Jan. (ZA) 1985.* Chemical Abstracts AN 1978:44978, Berkowitz et al., Jan. (73) Assignee: Pitmy International N.V., Bonaire 1977.* (NL) International Publication No. WO93/25213, published Dec. 23, 1993. (*) Notice: Subject to any disclaimer, the term of this Mikrochim. Acta, vol. 2, No. 5-6, 1980 pp. 464–474, Stahl patent is extended or adjusted under 35 et al., Extraction of natural Substances using Supercritical U.S.C. 154(b) by 0 days. and liquified gases. (21) Appl. No.: 09/068,543 Reynolds J.E.F. et al., “Martindale', 1989, The Pharmaceu tical Press. (22) PCT Filed: Nov. 13, 1996 Science, vol. 194, No. 4268, 1976, pp. 967–968, Berkowitz (86) PCT No.: PCT/IB96/01366 et al., "Nitrous oxide “analgesia': resemblance to opiate action'. S371 Date: May 13, 1998 Steinegger et al., “Lehrbuch der Pharmakognosie und Phy S 102(e) Date: May 13, 1998 topharmazie', Edition 4, 1988. (87) PCT Pub. No.: WO97/17978 * cited by examiner PCT Pub. Date: May 22, 1997 Primary Examiner Jyothsna Venkat (30) Foreign Application Priority Data ASSistant Examiner-Grace Hsu (74) Attorney, Agent, or Firm-Arent Fox Kintner Plotkin Nov. 13, 1995 (ZA) ................................................... -
Effects of Osteoarthritis and Chronic Pain Management for Companion Animals Rebecca A
Southern Illinois University Carbondale OpenSIUC Research Papers Graduate School 2014 Effects of Osteoarthritis and Chronic Pain Management for Companion Animals Rebecca A. Cason Southern Illinois University Carbondale, [email protected] Follow this and additional works at: http://opensiuc.lib.siu.edu/gs_rp Recommended Citation Cason, Rebecca A., "Effects of Osteoarthritis and Chronic Pain Management for Companion Animals" (2014). Research Papers. Paper 521. http://opensiuc.lib.siu.edu/gs_rp/521 This Article is brought to you for free and open access by the Graduate School at OpenSIUC. It has been accepted for inclusion in Research Papers by an authorized administrator of OpenSIUC. For more information, please contact [email protected]. EFFECTS OF OSTEOARTHRITIS AND CHRONIC PAIN MANAGEMENT FOR COMPANION ANIMALS By Rebecca A. Cason B.S., Southern Illinois University Carbondale, 2012 A Research Paper Submitted in Partial Fulfillment of the Requirements for the Master of Science. Department of Animal Science, Food and Nutrition In the Graduate School Southern Illinois University Carbondale May 2014 RESEARCH PAPER APPROVAL EFFECTS OF OSTEOARTHRITIS AND CHRONIC PAIN MANAGEMENT FOR COMPANION ANIMALS By Rebecca A. Cason A Research Paper Submitted in Partial Fulfillment of the Requirements for the Degree of Masters in Science in the field of Animal Science Approved by: Rebecca Atkinson, Chair Amer AbuGhazaleh Nancy Henry Graduate School Southern Illinois University Carbondale March 18, 2014 TABLE OF CONTENTS Page LIST OF FIGURES.……………………………………………………………………………....ii -
Treatment for Acute Pain: an Evidence Map Technical Brief Number 33
Technical Brief Number 33 R Treatment for Acute Pain: An Evidence Map Technical Brief Number 33 Treatment for Acute Pain: An Evidence Map Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-0000-81 Prepared by: Minnesota Evidence-based Practice Center Minneapolis, MN Investigators: Michelle Brasure, Ph.D., M.S.P.H., M.L.I.S. Victoria A. Nelson, M.Sc. Shellina Scheiner, PharmD, B.C.G.P. Mary L. Forte, Ph.D., D.C. Mary Butler, Ph.D., M.B.A. Sanket Nagarkar, D.D.S., M.P.H. Jayati Saha, Ph.D. Timothy J. Wilt, M.D., M.P.H. AHRQ Publication No. 19(20)-EHC022-EF October 2019 Key Messages Purpose of review The purpose of this evidence map is to provide a high-level overview of the current guidelines and systematic reviews on pharmacologic and nonpharmacologic treatments for acute pain. We map the evidence for several acute pain conditions including postoperative pain, dental pain, neck pain, back pain, renal colic, acute migraine, and sickle cell crisis. Improved understanding of the interventions studied for each of these acute pain conditions will provide insight on which topics are ready for comprehensive comparative effectiveness review. Key messages • Few systematic reviews provide a comprehensive rigorous assessment of all potential interventions, including nondrug interventions, to treat pain attributable to each acute pain condition. Acute pain conditions that may need a comprehensive systematic review or overview of systematic reviews include postoperative postdischarge pain, acute back pain, acute neck pain, renal colic, and acute migraine.