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My own Naplex > Migraine > Flashcards

Migraine Flashcards

1
Q

What is the MOA of triptans

A

5-HT1 receptor agonists causing vasoconstriction of the cranial blood vessels

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2
Q

When are triptans best used

A

At the 1st sign of a migraine

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3
Q

What are the natural products for a migraine

A

Caffiene, Butterbur, feverfew, magnesium, riboflavin

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4
Q

Common Migraine Triggers

A

1) Hormonal Changes - i.e. estrogen
2) Food - i.e. alchohol (beer, red wine), aged cheeses, chocolate, aspartame, caffiene overuse, MSG, salty/processed foods
3) Stress
4) Sensory stimuli i.e. flashing lights
5) Sleep Changes
6) Enviornmental Changes

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5
Q

Maxalt

A

Rizatriptan

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6
Q

Imtrex

A

Sumatriptan

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7
Q

Onzetra

A

Sumatriptan

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8
Q

Zomig

A

Zomatriptan

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9
Q

DHE

A

Dihydroergotamine

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10
Q

Migranal

A

Dihydroergotamine

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11
Q

Inderal

A

Propanolol

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12
Q

Lopressor

A

Metoprolol Tartrate

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13
Q

Torol XL

A

Metoprolol Succinate

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14
Q

Depakote

A

Divalproex

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15
Q

Topamax

A

Topiramate

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16
Q

Metoprolol Succinate is also preferred in what condition

A

Heart Failure

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17
Q

Which triptans are available ODT

A

Rizatriptan (mAxalt) and Zolmitriptan (zolmig)

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18
Q

Which triptans are available via nasal spray

A

Sumatriptan (Imirex) and Zolmitriptan (Zomig)

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19
Q

Which Triptan is available as a SC injection

A

Sumatriptan (Imitrex)

20
Q

Which triptan contains Phenylalanine and should not be used in PKU?

A

Rizatriptan (Maxalt)

21
Q

Boxed warnings for triptans

A

Vasoconstricts therefore do not use in cardiovascular disease, also contraindicated with MAO inhibitors (seritonergic)

22
Q

Side effects of triptans

A

paresthesia (tingling and numbness) and triptan sensations

23
Q

Which formulations are preferred if nausea is present?

A

ODT, nasal sprays, and injections

24
Q

Treximet

A

Sumatriptan + Naproxen

25
Q

Triptans with longer half life but with slower onset

A

Frovatriptan and Naratriptan

26
Q

Which triptans are contraindicated with MAO inhibitors

A

Sumatriptan, Rizatriptan, Zolmitriptan

27
Q

MOA of ergots

A

Nonselective agonist of seratonin receptors

28
Q

ergot boxed warning

A

do not use with potent CYP inhibitors due to life threatening peripheral ischemia

29
Q

ergot contraindications

A

pregnancy, uncontrolled hypertension, ischemic heart disease

30
Q

triptan vs ergot nasal spray

A

triptan nasal spray is just 1 dose so do not prime but for ergots you do have to prime 4 times

31
Q

Fiorcet

A

Acetaminophen/butalbital/caffiene

32
Q

Fiorinal

A

Aspirin/butalbital/caffiene

33
Q

When to recommend a prophylactic migraine to a patient

A

If they use acute treatments greater than two days per week or three days per month

34
Q

Topamax

A

topiramate

35
Q

Which antidepressant can be effective for ppx

A

tricyclic (amitriptyline) or venlafaxine

36
Q

Which antiepileptic drugs can be effective for ppx

A

Topiramate or valproic acid

37
Q

Which antihypertensive is most effective for prophylaxis?

A

BB specifically propanolol but other antihypertensive types have been used

38
Q

Warnings and side effects of beta blockers

A

Use caution with bronchospastic disease (esp propanolol and timolol non selective)

39
Q

Side effects of beta-blockers

A

Can cause bradycardia, fatigue, hypotension, dizziness, depression, impotence, and can exacerbate raynauds

40
Q

Which is the most lipophilic bb

A

propanolol, therefore, crosses the blood-brain barrier the best

41
Q

boxed warnings for Divalproex and valproic acid

A

fetal harm, hepaitc failure

42
Q

boxed warnings for topiramate

A

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

43
Q

Which CGRP receptor antagonist is given IV every 3 months and which is given ODT

A

epitinezumab (Vyepti) every three months and rimegpant ODT

44
Q

limitation for headache overuse

A

2-3 times per week for the offending agents

45
Q

how to use Onzetra Xsail

A

Sumatriptan nasal powder - blow into mouth for 2-3 seconds to deliver into nose

46
Q

Migraine diagnosis criteria

A

At least five attacks fulfilling the following:

1) headaches that last 4-72 hours
2) unilateral location, pulsating
3) nausea, and/or vomiting, photophobia (sensitivity to light) and phohophobia (sensitivity to sound)

47
Q

valproic acid/divalproex vs topiramate weight effects

A

topiramate weight loss while the other to are the opposite

My own Naplex (39 decks)

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