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NAPLEX 2023 > 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

changes in trigeminal nerve or imbalances of neurotransmitters

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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 brand name

A

Imitrex

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19
Q

Sumatriptan oral dose can be repeated x1 after __ hrs

A

2

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20
Q

Sumatriptan SC dose can be repeated x1 after __ hrs

A

1

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21
Q

Zembrace SymTouch can be repeated how many times per day

A

4

Sumatriptan

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22
Q

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

A

2

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23
Q

Onzetra Xsail powder should be used in

A

each nostril

Sumatriptan

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24
Q

Triptan CI

A

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

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25
Triptan warnings
risk of increased BP, serotonin syndrome
26
Triptan SE
Paresthesia (tingling/numbness), triptan sensations (pressure or heaviness in the chest or pressure in the neck region)
27
Triptan nasal sprays contain how many doses
1 (do not prime)
28
How must Treximet (sumatriptan + naproxen) be dispensed
in original container
29
Maxalt-MLT, Zomig ZMT ODT should not be used in patients with
phenylketonuria
30
Which triptans are approved for children 12+
Almotriptan tabs, zolmitriptan nasal spray and Treximet (sumatriptan and naproxen)
31
Which triptan is approved for children and adolescents 6-17 years
rizatriptan (Rize up/grow up taking rizatriptan)
32
Which triptan has the longest half-life
Frovatriptan | 26h
33
Which 2 triptans are long-acting but have a slow onset
Frovatriptan and naratriptan
34
Preferred site for sumatriptan injections
Lateral thigh or upper arm
35
Which triptans come in ODT
Rizatriptan (Maxalt-MLT) Zolmitriptan (Zomig ZMT)
36
Which triptans come in nasal spray
Sumatriptan (Imitrex) Zolmitriptan (Zomig)
37
Which triptans come in nasal powder
Sumatriptan (Onzetra Xsali)
38
Which triptans come in SC prefilled syringe
Sumatriptan
39
Which triptans come in SC auto-injector
Sumatriptan (Imitrex STATdose System, Zembrace SymTouch)
40
Which triptans are CI with MAOi or within 2 weeks of stopping
Sumatriptan, rizatriptan and zolmitriptan
41
In patients with CI to triptans or who do not find benefit with triptans, which drug class can be used
Ergotamines
42
Dihydroergotamine brand name
DHE 45, Migranal
43
Dihydroergotamine formulations
Injection (IM/SC/IV), nasal spray
44
Ergotamine BW
CI with potent 3A4 inhibitors (e.g., protease inhibitors, azoles, macrolides) d/t serious and life-threatening peripheral ischemia
45
Ergotamine CI
Uncontrolled HTN, pregnancy, ischemic heart disease
46
Ergotamine warnings
cardiovascular effects (avoid in any pt with baseline risk, cerebrovascular events), drug interactions
47
Ergotamine nasal spray must be
primed by pumping 4 times
48
rimegepant and ubrogepant MOA
oral CGPR receptor antagonist
49
Rimegepant indication
both prevent and treat acute migraine
50
ubrogepant indication
to treat acute migraine attacks
51
which oral CGRP receptor antagonist is available ODT
rimegepant
52
oral CGPR antagonists are substrates of ____ and ____
CYP3A4 and pgp CI with strong 3A4 inhibitors, not recommended with inducers | (rimegepant and ubrogepant)
53
lasmiditan MOA
serotonin agonist that is selective for the 5-HT1F receptor subtype
54
Lasmiditan DEA class
C-V
55
what's in Fioricet
APAP/butalbital/caffeine
56
what's in Fiorinal?
aspirin/butalbital/caffeine
57
butalbital is a ____
barbiturate
58
Fioricet and Fiorinal are available in combination with ____
codeine
59
When should a pt receive migraine ppx
If they use acute treatment ≥ 2 days/week or ≥ 3 times per month
60
Which meds can be used for migraine ppx
- BB (propranolol, metoprolol) - Topiramate (Topamax) & valproic acid - TCAs (amitriptyline has most evidence; or venlafaxine) - Monophasic and extended cycle OCs for MAM if no aura
61
Propranolol brand name
Inderal LA, Inderal XL
62
Metoprolol tartrate brand name
Lopressor
63
Metoprolol succinate brand name
Toprol XL
64
BB warnings
Caution with bronchospastic diseases (COPD, asthma), especially with non-selective propranolol
65
BB side effects
bradycardia, fatigue, hypotension, dizziness, depression (more so with propranolol, the most lipophilic), impotence, can exacerbate Raynaud's
66
Divalproate brand
Depakote, Depakote ER, Depakote Sprinkle
67
Topiramate brand
Topamax
68
Divalproex BW
fetal harm, hepatic failure
69
Divalproex SE
weight gain, thrombocytopenia, increased ammonia, alopecia
70
Topiramate warnings
fetal harm, metabolic acidosis, nephrolithiasis, increased ammonia, open angle glaucoma, oligohidrosis
71
Topiramate SE
Weight loss, somnolence, cognitive impairment
72
injectable CGRP antagonist examples | indication
eptinezumab (IV), Aimovig (SC), Avjoy (SC), Emgality (SC) | approved for prevention of migraine headaches
73
Botox is used for
chronic migraines only | ≥15 headache days/month
74
To prevent Medication Overuse Headaches (MOH), educate patients to limit acute treatment medications to
2-3 times per week at most
75
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

NAPLEX 2023 (88 decks)

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