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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
Q

Triptan warnings

A

risk of increased BP, serotonin syndrome

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26
Q

Triptan SE

A

Paresthesia (tingling/numbness), triptan sensations (pressure or heaviness in the chest or pressure in the neck region)

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27
Q

Triptan nasal sprays contain how many doses

A

1 (do not prime)

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28
Q

How must Treximet (sumatriptan + naproxen) be dispensed

A

in original container

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29
Q

Maxalt-MLT, Zomig ZMT ODT should not be used in patients with

A

phenylketonuria

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30
Q

Which triptans are approved for children 12+

A

Almotriptan tabs, zolmitriptan nasal spray and Treximet (sumatriptan and naproxen)

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31
Q

Which triptan is approved for children and adolescents 6-17 years

A

rizatriptan

(Rize up/grow up taking rizatriptan)

32
Q

Which triptan has the longest half-life

A

Frovatriptan

26h

33
Q

Which 2 triptans are long-acting but have a slow onset

A

Frovatriptan and naratriptan

34
Q

Preferred site for sumatriptan injections

A

Lateral thigh or upper arm

35
Q

Which triptans come in ODT

A

Rizatriptan (Maxalt-MLT)
Zolmitriptan (Zomig ZMT)

36
Q

Which triptans come in nasal spray

A

Sumatriptan (Imitrex)
Zolmitriptan (Zomig)

37
Q

Which triptans come in nasal powder

A

Sumatriptan (Onzetra Xsali)

38
Q

Which triptans come in SC prefilled syringe

A

Sumatriptan

39
Q

Which triptans come in SC auto-injector

A

Sumatriptan (Imitrex STATdose System, Zembrace SymTouch)

40
Q

Which triptans are CI with MAOi or within 2 weeks of stopping

A

Sumatriptan, rizatriptan and zolmitriptan

41
Q

In patients with CI to triptans or who do not find benefit with triptans, which drug class can be used

A

Ergotamines

42
Q

Dihydroergotamine brand name

A

DHE 45, Migranal

43
Q

Dihydroergotamine formulations

A

Injection (IM/SC/IV), nasal spray

44
Q

Ergotamine BW

A

CI with potent 3A4 inhibitors (e.g., protease inhibitors, azoles, macrolides) d/t serious and life-threatening peripheral ischemia

45
Q

Ergotamine CI

A

Uncontrolled HTN, pregnancy, ischemic heart disease

46
Q

Ergotamine warnings

A

cardiovascular effects (avoid in any pt with baseline risk, cerebrovascular events), drug interactions

47
Q

Ergotamine nasal spray must be

A

primed by pumping 4 times

48
Q

rimegepant and ubrogepant MOA

A

oral CGPR receptor antagonist

49
Q

Rimegepant indication

A

both prevent and treat acute migraine

50
Q

ubrogepant indication

A

to treat acute migraine attacks

51
Q

which oral CGRP receptor antagonist is available ODT

A

rimegepant

52
Q

oral CGPR antagonists are substrates of ____ and ____

A

CYP3A4 and pgp
CI with strong 3A4 inhibitors, not recommended with inducers

(rimegepant and ubrogepant)

53
Q

lasmiditan MOA

A

serotonin agonist that is selective for the 5-HT1F receptor subtype

54
Q

Lasmiditan DEA class

55
Q

what’s in Fioricet

A

APAP/butalbital/caffeine

56
Q

what’s in Fiorinal?

A

aspirin/butalbital/caffeine

57
Q

butalbital is a ____

A

barbiturate

58
Q

Fioricet and Fiorinal are available in combination with ____

59
Q

When should a pt receive migraine ppx

A

If they use acute treatment ≥ 2 days/week or ≥ 3 times per month

60
Q

Which meds can be used for migraine ppx

A
  • 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
Q

Propranolol brand name

A

Inderal LA, Inderal XL

62
Q

Metoprolol tartrate brand name

63
Q

Metoprolol succinate brand name

64
Q

BB warnings

A

Caution with bronchospastic diseases (COPD, asthma), especially with non-selective propranolol

65
Q

BB side effects

A

bradycardia, fatigue, hypotension, dizziness, depression (more so with propranolol, the most lipophilic), impotence, can exacerbate Raynaud’s

66
Q

Divalproate brand

A

Depakote, Depakote ER, Depakote Sprinkle

67
Q

Topiramate brand

68
Q

Divalproex BW

A

fetal harm, hepatic failure

69
Q

Divalproex SE

A

weight gain, thrombocytopenia, increased ammonia, alopecia

70
Q

Topiramate warnings

A

fetal harm, metabolic acidosis, nephrolithiasis, increased ammonia, open angle glaucoma, oligohidrosis

71
Q

Topiramate SE

A

Weight loss, somnolence, cognitive impairment

72
Q

injectable CGRP antagonist examples

indication

A

eptinezumab (IV), Aimovig (SC), Avjoy (SC), Emgality (SC)

approved for prevention of migraine headaches

73
Q

Botox is used for

A

chronic migraines only

≥15 headache days/month

74
Q

To prevent Medication Overuse Headaches (MOH), educate patients to limit acute treatment medications to

A

2-3 times per week at most

75
Q

How to use Onzestra Nasal Powder (counseling)

A
  • 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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