3. Triptans

Question 1

MOA of triptans

Answer 1

selective agonists for the 5-HT1 receptor; causes vasoconstriction of cranial blood vessels, inhibit neuropeptide release and decrease pain transmission

Question 2

naratriptan (brand, dosing)

available as a tablet

Answer 2

Amerge

Initial: 1-2.5 mg, can repeat x1 after 4 hrs (max 5 mg/day)

Question 3

almotriptan (brand, dosing)

available as a tablet

Answer 3

Axert

Initial: 6.25-12.5 mg, can repeat x1 after 2 hrs (max 25 mg/day)

Question 4

frovatriptan (brand, dosing)

available as a tablet

Answer 4

Frova

Initial: 2.5 mg, can repeat x1 after 2 hrs (max 7.5 mg/day)

Question 5

SUMAtriptan (brand names, formulations)

available as a tablet, SC injection, needle-free SC delivery, nasal spray, transdermal patch

Answer 5

Imitrex: tablet, nasal spray
Imitrex STATdose: SC injection

Alsuma: SC injection

Sumavel DosePro: needle-free SC delivery

Zecuity: iontophoretic transdermal patch

Question 6

Imitrex dosing for tablet

Answer 6

25, 50, 100 mg, can repeat x1 after 2 hrs (max 200 mg/day)

Question 7

Imitrex dosing for nasal spray

Answer 7

5, 10, 20 mg in one nostril, can repeat x1 after 2 hrs (max 40 mg/day)

Question 8

Imitrex and Alsuma dosing for SC injection

Answer 8

4, 6 mg, can repeat x1 after 1 hr (max 12 mg/day)

inject on thigh or arm; hold against skin and press blue button, hold for 5 seconds

Question 9

Zecuity dosing for iontophoretic transdermal patch

Answer 9

apply 1 patch, may apply 2nd patch after 2 hrs

runs on lithium batteries, will need to pull tabs to expose batteries and push button to activate drug release

Question 10

rizatriptan (brand, dosing)

available as a tablet, ODT

Answer 10

Maxalt, Maxalt MLT
Initial 5-10 mg, can repeat x1 after 2 hrs
ODT: 5 mg, no water needed
(max 30 mg/day)

Question 11

eletriptan (brand, dosing)

available as a tablet

Answer 11

Relpax

initial: 20-40 mg, can repeat x1 after 2 hrs (max 80 mg/day)

Question 12

ZOLMItriptan (brand, dosing)

available as a tablet, ODT, nasal spray

Answer 12

Zomig, Zomig-ZMT
PO: 1.25-5 mg, can repeat x1 after 2 hrs
Intranasal: 5 mg, can repeat x1 after 2 hrs
(max 10 mg/day)

Question 13

Triptan CI: CV related (4)

Answer 13

–cerebrovascular disease (stroke/TIA)
–uncontrolled HTN
–ischemic heart disease
–peripheral vascular disease

Question 14

Triptan CI: hx of _____ or ______ migraine

Answer 14

hemiplegic

basilar

Question 15

Triptan CI: severe _______ impairment

Answer 15

hepatic

Question 16

Triptan CI: which 3 are CI with MAO-Is?

Answer 16

–sumatriptan
–rizatriptan
–zolmitriptan

Question 17

Triptan CI: which one is CI with strong CYP3A4 inhibitors?

Answer 17

eletriptan

Question 18

Triptan SEs

Answer 18

somnolence, nausea, paresthesias (tingling/numbness), throat/neck pressure, dizziness, hot/cold sensations, chest pain/tightness

triptan sensations (pressure in the chest or heaviness or pressure in the neck region) that usually dissipate after administration - may feel like a heart attack

Question 19

What dosage forms are useful if nausea present?

Answer 19

ODT, nasal spray, injections

Question 20

Which dosage forms work faster?

Answer 20

nasal sprays, injections

Question 21

Imitrex and Zomig nasal sprays contain _____ dose(s) and [should/should not] be primed

Answer 21

one

should not

Question 22

Triptans approved for children and adolescents ≥12 yo (2)

Answer 22

–almotriptan tablets

–zolmitriptan nasal spray

Question 23

Triptan approved for children and adolescents 6-17 yo

Answer 23

rizatriptan

Question 24

SUMAtriptan + naproxen (brand, dosing)

Answer 24

Treximet
85-500 mg
1 tab, may repeat x1 after 2 hrs (max 2 tab/day)

Question 25

Treximet needs to be kept in original container (contains _______)

Answer 25

dessicant

Question 26

The longest-acting triptan is _______ and ______. Longer acting = ______ _______. Choose if HA recurs after dosing or lasts a long time.

Answer 26

–frovatriptan (t1/2=26hrs)
–naratriptan
–slower onset

Question 27

Triptans with a shorter half-life have a faster onset. (5)

Answer 27

–almotriptan
–eletriptan
–rizatriptan
–sumatriptan
–zolmitriptan

Question 28

Triptan DDI: with SSRIs and SNRIs

Answer 28

some risk for serotonin syndrome, however keep in mind triptans are PRN and risk is low if taken sporadically
(SS sx: restlessness, sweating, poor coordination, confusion, hallucinations)

Question 29

Migraine prophylaxis should be considered if… (4)

Answer 29

–pt requests it
–acute tx is used ≥2 days/wk or ≥3 times/month
–migraines decrease quality of life
–acute tx is ineffective or contraindicated