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NAPLEX > Chapter 59: Migraine > Flashcards

Chapter 59: Migraine Flashcards

1
Q

When should patients seek immediate medical attention for a migraine

A

HA accompanied by fever, stiff neck, rash, confusion, seizures, double vision, weakness, numbness, chest pain, SOB or aphasia (trouble speaking)

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2
Q

Which neurotransmitter may play a role in migraines

A

serotonin

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3
Q

Treatment for menstrual-associated migraine (MAM)

A

monophasic oral contraceptives or estradiol patch or creams

Can use POPs for migraine with aura

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4
Q

Women who have migraine with aura are at higher risk for ____ and should avoid ____

A

stroke

estrogen-containing contraceptives (can use POPs)

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5
Q

Fluctuation in ___ can cause menstrual-associated migraine (MAM)

A

estrogen

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6
Q

Migraine diagnosis

A

At least 5 attacks fulfilling the following criteria:

  • HA last 4-72 hrs
  • Have >/= 2 of the following: unilateral location, pulsating, mod-severe pain and aggravated by routine physical activity
  • One of the following occurs during the HA: nausea &/or vomiting, photophobia, and phonophobia
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7
Q

Which natural products can be used for migraines

A

Caffeine, Butterbur, feverfew, magnesium, riboflavin

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8
Q

Which medication does Advil Migraine contain

A

Ibuprofen

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9
Q

Which medications does Excedrin Migraine contain

A

aspirin, acetaminophen, and caffeine

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10
Q

Naproxen brand name

A

Aleve

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11
Q

Rx options for acute treatment of migraine

A

serotonin receptor agonists (triptans)

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12
Q

Which pain meds are not recommended due to abuse/dependence issues

A

Opioids, butalbital-containing products, tramadol and tapentadol

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13
Q

Triptan MOA

A

5-HT1 receptor agonists and cause vasoconstriction of cranial blood vessels

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14
Q

First-line for acute migraine treatment

A

Triptans

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15
Q

When are triptans most effective

A

When used at first sign of a migraine

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16
Q

Rizatriptan brand name

A

Maxalt-MLT

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17
Q

Zolmitriptan brand name

A

Zomig ZMT

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18
Q

Sumatriptan oral dose can be repeated x1 after __ hrs

A

2

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19
Q

Sumatriptan SC dose can be repeated x1 after __ hrs

A

1

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20
Q

Zembrace SymTouch can be repeated how many times per day

A

4

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21
Q

Imitrex nasal spray can be used in one nostril and can repeat x1 after __ hrs

A

2

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22
Q

Onzetra Xsail powder should be used in

A

each nostril

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23
Q

Triptan CI

A

Cerebrovascular disease (stroke/TIA), uncontrolled HTN, ischemic heart disease, use within 24 hrs of another triptan

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24
Q

Triptan warnings

A

risk of increased BP, serotonin syndrome

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25
Triptan SE
Paresthesia (tingling/numbness), triptan sensations (pressure or heaviness in the chest or pressure in the neck region)
26
Triptan nasal sprays contain how many doses
1 (do not prime)
27
How must Treximet (sumatriptan + naproxen) be dispensed
in original container
28
Maxalt-MLT, Zomig ZMT ODT should not be used in patients with
phenylketonuria
29
Which triptans are approved for children 12+
Almotriptan tabs, zolmitriptan nasal spray and Treximet
30
Which triptan is approved for children and adolescents 6-17 years
rizatriptan
31
Which triptan has the longest half-life
Frovatriptan
32
Which 2 triptans are long-acting but have a slow onset
Frovatriptan and naratriptan
33
Preferred site for sumatriptan injections
Lateral thigh or upper arm
34
Which triptans come in ODT
Rizatriptan (Maxalt-MLT) | Zolmitriptan (Zomig ZMT)
35
Which triptans come in nasal spray
Sumatriptan (Imitrex) | Zolmitriptan (Zomig)
36
Which triptans come in nasal powder
Sumatriptan (Onzetra Xsali)
37
Which triptans come in SC prefilled syringe
Sumatriptan
38
Which triptans come in SC auto-injector
Sumatriptan (Imitrex STATdose System, Zembrace SymTouch)
39
Which triptans are CI with MAOi or within 2 weeks of stopping
Sumatriptan, rizatriptan and zolmitriptan
40
In patients with CI to triptans or who do not find benefit with triptans, which drug class can be used
Ergotamines
41
Dihydroergotamine brand name
DHE 45, Migranal
42
Dihydroergotamine formulations
Injection (IM/SC/IV), nasal spray
43
Ergotamine BW
CI with potent 3A4 inhibitors (e.g., protease inhibitors, azoles, macrolides) d/t serious and life-threatening peripheral ischemia
44
Ergotamine CI
Uncontrolled HTN, pregnancy, ischemic heart disease
45
Ergotamine warnings
cardiovascular effects (avoid in any pt with baseline risk, cerebrovascular events), drug interactions
46
Ergotamine nasal spray must be
primed by pumping 4 times
47
Which meds are in Fioricet
APAP/butalbital/caffeine
48
Which meds are in Fiorinal
ASA/butalbital/caffeine
49
When should a pt receive migraine ppx
If they use acute treatment > / = 2 days/week or > / = 3 times per month
50
Which meds can be used for migraine ppx
- BB (propranolol) - Topiramate (Topamax) & valproic acid - TCAs (amitriptyline has most evidence; or venlafaxine) - Monophasic and extended cycle OCs for MAM if no aura
51
Propranolol brand name
Inderal LA, Inderal XL
52
Metoprolol tartrate brand name
Lopressor
53
Metoprolol succinate brand name
Toprol XL
54
BB warnings
Caution with bronchospastic diseases (COPD, asthma), especially with non-selective propranolol
55
BB side effects
bradycardia, fatigue, hypotension, dizziness, depression (more so with propranolol, the most lipophilic), impotence, can exacerbate Raynaud's
56
Divalproate brand
Depakote, Depakote ER, Depakote Sprinkle
57
Topiramate brand
Topamax
58
Divalproex BW
fetal harm, hepatic failure
59
Divalproex SE
weight gain, thrombocytopenia, increased ammonia, alopecia
60
Topiramate warnings
fetal harm, metabolic acidosis, nephrolithiasis, increased ammonia, open angle glaucoma, oligohidrosis
61
Topiramate SE
Weight loss, somnolence, cognitive impairment
62
Botox is used for
chronic migraines only
63
To prevent Medication Overuse Headaches (MOH), educate patients to limit acute treatment medications to
2-3 times per week at most
64
How to use Onzestra Nasal Powder (counseling)
- Insert nosepiece deeply into first nostril. Rotate device to place mouthpiece into mouth - Blow into the device with your mouth for 2-3 seconds to deliver medication into your nose

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