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PHM701 > Exam 1 - HA/Migraine > Flashcards

Exam 1 - HA/Migraine Flashcards

1
Q

Migraine with aura usually presents in what order?

A

visual, then sensory, then language

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2
Q

Migraine distinction symptoms? (7)

A

positive visual symptoms, gradual onset, sequential progression, repetitive identical attacks, flurry of attacks midlife, duration < 60 min, headache follows ~50%

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3
Q

TIA distinction symptoms? (5)

A

visual loss, abrupt, simultaneous occurrence, duration < 15 min, headache accompaniment uncommon

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4
Q

Recommended treatment options for mild to moderate migraine attacks? (3)

A

NSAIDs, acetaminophen, caffeinated analgesic combinations

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5
Q

Recommended treatment options for moderate to severe migraine attacks? (4)

A

triptans, DHE, gepants, ditans

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6
Q

Recommended treatment options for refractory moderate to severe migraine attacks? (5)

A

triptans + NSAIDs, gepants, ditans, analgesics + codeine or tramadol, opioids

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7
Q

Recommended treatment options for migraines with N/V, etc.? (2)

A

non-oral formulations, antiemetics (e.g., prochlorperazine)

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8
Q

What are the oral NSAID solutions for acute treatment of migraines? (2)

A

diclofenac potassium (Cambia) and celecoxib (Elyxyb)

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9
Q

What are the brands of butalbital/APAP/caffeine combinations? (4)

A

Fioricet, Bac, Esgic, Zebutal

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10
Q

How long can you use barbiturate combinations drugs to avoid MOH?

A

< / = 3 days/mo

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11
Q

Which butalbital combination can cause MOH and is a controlled substance (CIII)?

A

Fiorinal

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12
Q

What is the MOA for triptans?

A

5-HT selective agonists

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13
Q

Are triptans for acute or prohpylactic treatment?

A

acute

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14
Q

What are adverse effects of triptans?

A

flushing, chest pain, palpitations, dizziness, fatigue, serotonin syndrome

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15
Q

How long can you use triptans to avoid MOH?

A

< 10 days/mo

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16
Q

What are contraindications for triptans?

A

ischemic heart disease, cerebrovascular syndromes, uncontrolled HTN, MAOIs

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17
Q

Which triptans are PO only? (4)

A

almotriptan, eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge)

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18
Q

Order of half-life for triptans that are PO only?

A

longest is frova, nara, almo, ele

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19
Q

Which triptans are not PO-only? (3)

A

rizatriptan (Maxalt), sumatriptan (Imitrex), zolmitriptan (Zomig)

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20
Q

What is the onset of action in minutes for sumatriptan’s PO, intranasal, and SQ formulations?

A

PO = 30, intranasal = 15-30, SQ = 10

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21
Q

What is the MOA for lasmitidan (Reyvow)?

A

5-HT receptor agonist

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22
Q

Are ditans for acute or prophylactic treatment?

A

acute

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23
Q

What are adverse effects of ditans?

A

MUST WAIT 8HRS, CNS depression, serotonin syndrome, decreased HR, increased BP, N/V

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24
Q

What is the MOA for gepants?

A

CGRP receptor antagonists

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25
Q

Is rimegepant (Nurtec) for acute or preventive treatment?

A

BOTH

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26
Q

What is the dosing for acute rimegepant (Nurtec)? Prevention dosing?

A

acute = 75mg PO once; 75mg PO every other day

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27
Q

When should rimegepant (Nurtec) be avoided?

A

CrCL < 15 mL/min, severe hepatic impairment

28
Q

What are adverse effects of rimegepant (Nurtec)? (3)

A

abdominal pain, dyspepsia, nausea

29
Q

Is ubrogepant (Ubrelvy) for acute or preventive treatment?

A

acute

30
Q

What is the dosing for ubrogepant (Ubrelvy)?

A

50-100mg PO once, may repeat dose after 2 hours (max 200mg/day)

31
Q

What is the MOA for ergots?

A

5-HT receptor agonists

32
Q

What are the BBWs for ergots?

A

CYP3A4 inhibitors (protease inhibitors, macrolides, azoles)

33
Q

What are adverse effects for ergots? (2)

A

cardiac valvular fibrosis, ergotism

34
Q

What are contraindications for ergots?

A

pregnancy/breastfeeding, older adults

35
Q

What should be avoided in acute or preventive migraine treatment?

A

opioids and barbiturates

36
Q

What is the MOA of topiramate? (4)

A

blocks voltage-dependent sodium channels, enhances GABA activity, antagonizes AMPA receptors, weakly inhibits carbonic anhydrase

37
Q

What are adverse effects of topiramate?

A

cognitive dysfunction, CNS effects, nephrolithiasis, metabolic acidosis, angle-closure glaucoma, oligohydrosis/hyperthermia, suicidal ideation, weight loss, paresthesia

38
Q

What are important counseling points for topiramate? (3)

A

stay hydrated, avoid in pregnancy, may take up to 2-3 months

39
Q

What are BBWs for valproic acid? (4)

A

hepatotoxicity, patients with mitochondrial disease, fetal risk, pancreatitis

40
Q

What is a contraindication for valproic acid?

A

pregnancy and childbearing potential without effective contraception

41
Q

Which beta blockers are preferred for migraine?(2)

A

propranolol, timolol

42
Q

What are adverse effects of TCAs?

A

anticholinergic effects, cardiac conduction abnormalities

43
Q

Is atogepant (Qulipta) for acute or preventive treatment?

A

preventive

44
Q

What is the dosing for atogepant (Qulipta)?

A

10, 30, 60mg po once daily

45
Q

Which mab targets the CGRP receptor? (1)

A

erenumab (Aimovig)

46
Q

Which mab is also indicated for prevention of cluster headache? (1)

A

galcanezumab (Emgality)

47
Q

Which mab is dosed IV every 3 months?

A

eptinezumab (Vyepti)

48
Q

Which mabs are SQ every month? (3)

A

erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality)

49
Q

Which mab can cause nasopharyngitis and nausea?

A

eptinezumab (Vyepti)

50
Q

Which mab can cause constipation?

A

erenumab (Aimovig)

51
Q

What is the most common peripheral nerve block, and what does it use?

A

greater occipital nerve block, lidocaine/bupivicaine/methylprednisolone

52
Q

What is a good OTC for menstrual migraines?

A

PO magnesium

53
Q

What are adverse effects of PO magnesium?

A

diarrhea, N/V

54
Q

What is a good OTC for migraine prophylaxis?

A

vitamin B2 (riboflavin)

55
Q

What are adverse effects of feverfew? Contraindications?

A

GI issues; pregnancy

56
Q

What are adverse effects of butterbur? Contraindications?

A

GI, rash, fatigue; products not labeled as free from pyrrolizidine alkaloids (PA-free)

57
Q

What is a BBW for Botox?

A

spread of toxin effect

58
Q

What are adverse effects for Botox?

A

injection site pain, neck pain, myalgia, facial paresis

59
Q

What is treatment for acute cluster headaches? (3)

A

oxygen, SQ (preferred) or intranasal sumatriptan, intranasal zolmitriptan

60
Q

What is treatment for preventive cluster headache? (1)

A

verapamil

61
Q

What is treatment for hemicrania continua?

A

indomethacin

62
Q

What medications can cause pseudotumor cerebri? (3)

A

growth hormone, tetracyclines, retinoids

63
Q

What are treatments for pseudotumor cerebri? (5)

A

withdraw offending agent, weight loss, carbonic anhydrase inhibitors, furosemide, migraine preventive meds

64
Q

What is reversible cerebral vasoconstriction syndrome also known as?

A

thunderclap headache (subarachnoid hemorrhage)

65
Q

What are the cutoffs for medication overuse headache? (5)

A

non-opioid analgesics = 15, ergots = 10, triptans = 10, opioids = 10, butalbital = 5

66
Q

Explain headache red flags SNOOP acronym?

A

systemic symptoms/signs/disease, neurologic symptoms/signs, onset sudden and after age 40, pattern change

PHM701 (14 decks)

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