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PHRM 845 > Exam 3: Migraine > Flashcards

Exam 3: Migraine Flashcards

1
Q

Migraine without Aura

A

most common

at least five attacks

headaches lasting 4-72 hours

unilateral location, pulsating quality, moderate/severe pain, aggravation by routine activity

N/V, photophobia, phonophobia

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2
Q

Migraine with Aura

A

classic

at least 2 attacks

at least one fully reversible aura

no aura lasting more than 60 minutes

headache follows aura within 60 minutes

visual, sensory, speech/language, motor, brainstem, retinal

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3
Q

Migraine Headache Phases: Prodrome

A

hours or days before onset of headache

may experience euphoria, depression, irritability, food craving, constipation, neck stiffness, yawning

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4
Q

Migraine Headache Phases: Aura (15-30% of patients)

A

commonly visual, may be sensory, verbal, or motor

before or during migraine, lasts less than 60 minutes

photopsia, scotoma, zigzag lines, numbness/tingling in arms, legs, face

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5
Q

Migraine Headache Phases: Migraine Headaches

A

dull ache that intensifies

unilateral and throbbing

phonophobia, photophobia

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6
Q

Migraine Headache Phases: postdromal

A

may last several days after headache has ended

tiredness, head pain, GI distress, weakness, cognitive difficulties

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7
Q

Migraine Triggers: Medication Overuse

A

associated with analgesics, ergots, triptans: rebound headaches from medications overuse more than 2x per headache or two times per week chronically

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8
Q

Migraine Triggers: Medications

A

oral contraceptives
hydralazine
nitroglycerine
nifedipine
cocaine

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9
Q

Migraine Triggers: Diet

A

chocolate
oranges
tomatoes
onions
aged cheese
processed meats
cultured dairy
alcohol (red wine and champagne)
caffeine

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10
Q

Migraine Triggers: additives/preservatives

A

aspartame
monosodium glutamate

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11
Q

Migraine Triggers: environment

A

altitude/weather changes
perfume
tobacco smoke
loud noises
flickering lights

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12
Q

Migraine Triggers: Other

A

too little/too much sleep
skipping meals
stess
hormone changes

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13
Q

General Treatment Overview

A

avoid analgesic overuse

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14
Q

Abortive Treatment

A

education to avoid medication overuse

mild to moderate: NSAIDs, acetaminophen

moderate-severe: triptans/ergots

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15
Q

Preventative Treatment

A

four or more attacks/month with disability at least 3 days/month

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16
Q

Abortive Treatment First Line

A

triptans, NSAIDS

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17
Q

Abortive Treatment Second Line

A

NSAIDs

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18
Q

Prevention Treatment First Lines

A

monotherapy

valproate, topiramate, metoprolol, propranolol, frovatriptan

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19
Q

Prevention Treatment Second line

A

monotherapy

amitriptyline

20
Q

NonPharm

A

Biofeedback and relaxation therapy

CBT

Diet

Sleep

Transcutaneous electrical nerve stimulation device

exercise, massage, acupuncture, thermal, biofeedback, heat/cold applications

headache diary

21
Q

Contraindications of Triptans for Abortive Treatment

A

recent use (within 24 hours) of an ergot or other triptan

MAO-A inhibitor use in the last 2 weeks (frovatriptan, rizatriptan)

ischemic heart disease, angina, stroke, TIA, hemiplegic/basilar migraine, arrhythmias, peripheral vascular disease, uncontrolled hypertension, ischemic bowel disease, sevvere hepatic impairment

22
Q

Warnings/precautions for abortive treatment

A

MI, pain, pressure, tightness in chest/throat/neck/jaw, CVA, HTN, GI ischemic reactions or peripheral vasospasm, medication overuse headache, serotonin syndrome,

sulfa allergy (almotriptan)

corneal opacities (almotriptan)

seizures (use with caution)

23
Q

Side Effects of Triptans

A

oral tingling

dizziness

drowsiness

fatigue

chest tightness/pressure

flushing

24
Q

Drug interactions Triptans

A

SSRIs/SNRIs theoretically the use of a triptan with SSRI/SNRI can increas the risk of serotonin syndrome. This drug interaction is extremely rare and may not be due to the triptans

avoid strong 3A4 inhibitors with eletriptan

25
Q

Erogt Alkaloids in Abortive Treatment Warnings/Precaution

A

boxed warning for serious/life-threatening peripheral ischemia

warnings for cardiac valvular fibrosis, vasospasms, or vasoconstriction, cerebrovascular events, ergotism (overdose of ergot-containing medications: cramps, spasms, dry gangrene from vasoconstriction)

26
Q

Ergot Alkaloids Side Effect

A

retroperitoneal, pleuropulmonary and valvular fibrosis

ergotism

vasoconstriction complications (ischemia, cyanosis, cold in extremeites, numbness, weakness, N/V)

27
Q

Ergot Alkaloids Drug Interactions

A

3A4 Inhibitors ergot toxocity `

28
Q

Which CGRP Antagonists are FDA approved for abortive treatment

A

rimegepant
ubrogepant
zavegepant

29
Q

Contraindications with CGRP Antagonists

A

contraindicated with strong 3A4

30
Q

Drug interactiosn CGRP Antagonists

A

moderate/strong 3A4 inducers and inhibitors, pgp inhibitors

31
Q

Lasmiditan warnings/precuations

A

medication overuse headaches

sedation

dizziness

serotonin syndrome

driving impairment (avoid at least 8 hours after dose)

32
Q

Side Effects Lasmiditan

A

dizziness, fatigue, parasthesia, sedation

33
Q

Drug interactions Lasmiditan

A

use with caution with other CNS depressants and serotonergic medications; avoid use with pgp or BRCP substrates, other medications tha can decrease heart rate

34
Q

monitor lasmiditan

A

LFTs
blood pressure
heart rate

35
Q

Other abortive therapies

A

butorphanol nasal spray as resuce medication

36
Q

Beta Blockers

A

FDA approved

propranolol 80-240 mg/day

metoprolol 100-200 mg/day

contraindicated in asthma and raynaud’s syndrome

37
Q

Tricyclic antidepressants

A

not FDA approved

amitryptiline 25-150 mg/day (mixed migraine/tension type)

38
Q

Preventative: CGRP Antagonists

A

atogepant: nausea, constipation, fatigue

rimegepant: nausea, rash, dyspnea

39
Q

Preventative Therapy: Antiseizure Drugs

A

valproate topiramate approved

val: 500-1500 mg/day

topiramate 50-100 mg/day

not recommended in people of child-bearing age unless using contraception

40
Q

Preventative Therapy Miscellaneous and Natural Products

A

Butterbur/petasites 150 mg/day

41
Q

Almotriptan FDA approval

A

for children 12 years of age and older

42
Q

Rizatriptan FDA approval

A

6 years of age and older as abortive therapy

43
Q

Zolmitriptan Nasal Spray

A

approved for children 12 years of age and older

44
Q

Sumatriptan Nasal spray

A

not FA approaved in children

45
Q

Sumatripatn/naproxen combination

A

12 years and older

46
Q

topiramate approval

A

12 years of age and old

47
Q
A

PHRM 845 (14 decks)

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