headache 4 Flashcards
what is ergotism
side effect of constricted bloodflow to brain, heart, or extremities
what are the contraindications to the ergot alkaloids (5)?
- systemic vasoconstriction
- use of triptan within 24 hours
- use of MAOI within two weeks
- use with any 3A4 inhibitor (azoles, PI, macrolides)
- pregnancy
why are ergot alkaloids avoided in pregnancy
- systemic vasoconstriction
2. uterine stimulants; trigger labor
how is DHE used?
- prime by spraying 4xs into the air
- one spray into each nostril
- use another spray after 15 minutes if needed
- do not use more than 4 sprays for a single attack
what is the MOA of triptans
serotonin agonists; causing intracranial constriction
what is the first line therapy for moderate to severe migraines
triptans
what are the fastest acting triptans
sumatriptan nasal and injection
zolitriptan nasal
what is the slowest acting triptan
frovatriptan
what triptan is good for patients with rebound headaches?
why?
frovatriptan
very long half life (26 hours)
what triptan needs a lower dose if on a 3A4 inhibitor
almotriptan
what triptan is contraindicated if a 3A4 inhibitor is used within the past 3 days
eletriptan
what triptan is not to be used with a sulfa allergy
almotriptan
what triptan dose can be repeated after 4 hours (instead of 2 hours)
naratriptan
what triptan dose can repeated after 1 hour instead of 2 hours
sumatriptan injectable
arrange these in order of which can be repeated the soonest to the longest: sumatriptan injection sumatriptan oral naratriptan ergot alkaloid
- ergot alkaloid (15 min)
- sumatriptan injection (1 hour)
- sumatriptan oral (2 hours)
- naratriptan (4 hours)
what triptan must have dose reduced when also taking propranolol
rizatriptan
what is triptans are not metabolized by monoamine oxidase (MAO)
frovatriptan and eletriptan (okay with MAOI inhibitor)
what triptans are indicated for menstrual migraine prevention
- frovatriptan
- naratriptan
- zolmitriptan
True/ False:
ODT triptans have faster onset than normal PO
false
True/ False:
Failure on one triptan does not mean failure on all triptans
True
what are the side effects of triptans
- paresthesias
- flushing
- chest symptoms (heaviness, tightness)
what are the CI’s for triptans?
- ischemic heart disease
- uncontrolled HTN
- 24 hours of an alkaloid
- two weeks of an MAO-I (exceptions)
what can increase risk of serotonin syndrome with triptans
SSRI’s and SNRI’s
