Migraine

Question 1

What is the MOA of triptans

Answer 1

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

Question 2

When are triptans best used

Answer 2

At the 1st sign of a migraine

Question 3

What are the natural products for a migraine

Answer 3

Caffiene, Butterbur, feverfew, magnesium, riboflavin

Question 4

Common Migraine Triggers

Answer 4

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

Question 5

Maxalt

Answer 5

Rizatriptan

Question 6

Imtrex

Answer 6

Sumatriptan

Question 7

Onzetra

Answer 7

Sumatriptan

Question 8

Zomig

Answer 8

Zomatriptan

Question 9

DHE

Answer 9

Dihydroergotamine

Question 10

Migranal

Answer 10

Dihydroergotamine

Question 11

Inderal

Answer 11

Propanolol

Question 12

Lopressor

Answer 12

Metoprolol Tartrate

Question 13

Torol XL

Answer 13

Metoprolol Succinate

Question 14

Depakote

Answer 14

Divalproex

Question 15

Topamax

Answer 15

Topiramate

Question 16

Metoprolol Succinate is also preferred in what condition

Answer 16

Heart Failure

Question 17

Which triptans are available ODT

Answer 17

Rizatriptan (mAxalt) and Zolmitriptan (zolmig)

Question 18

Which triptans are available via nasal spray

Answer 18

Sumatriptan (Imirex) and Zolmitriptan (Zomig)

Question 19

Which Triptan is available as a SC injection

Answer 19

Sumatriptan (Imitrex)

Question 20

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

Answer 20

Rizatriptan (Maxalt)

Question 21

Boxed warnings for triptans

Answer 21

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

Question 22

Side effects of triptans

Answer 22

paresthesia (tingling and numbness) and triptan sensations

Question 23

Which formulations are preferred if nausea is present?

Answer 23

ODT, nasal sprays, and injections

Question 24

Treximet

Answer 24

Sumatriptan + Naproxen

Question 25

Triptans with longer half life but with slower onset

Answer 25

Frovatriptan and Naratriptan

Question 26

Which triptans are contraindicated with MAO inhibitors

Answer 26

Sumatriptan, Rizatriptan, Zolmitriptan

Question 27

MOA of ergots

Answer 27

Nonselective agonist of seratonin receptors

Question 28

ergot boxed warning

Answer 28

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

Question 29

ergot contraindications

Answer 29

pregnancy, uncontrolled hypertension, ischemic heart disease

Question 30

triptan vs ergot nasal spray

Answer 30

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

Question 31

Fiorcet

Answer 31

Acetaminophen/butalbital/caffiene

Question 32

Fiorinal

Answer 32

Aspirin/butalbital/caffiene

Question 33

When to recommend a prophylactic migraine to a patient

Answer 33

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

Question 34

Topamax

Answer 34

topiramate

Question 35

Which antidepressant can be effective for ppx

Answer 35

tricyclic (amitriptyline) or venlafaxine

Question 36

Which antiepileptic drugs can be effective for ppx

Answer 36

Topiramate or valproic acid

Question 37

Which antihypertensive is most effective for prophylaxis?

Answer 37

BB specifically propanolol but other antihypertensive types have been used

Question 38

Warnings and side effects of beta blockers

Answer 38

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

Question 39

Side effects of beta-blockers

Answer 39

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

Question 40

Which is the most lipophilic bb

Answer 40

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

Question 41

boxed warnings for Divalproex and valproic acid

Answer 41

fetal harm, hepaitc failure

Question 42

boxed warnings for topiramate

Answer 42

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

Question 43

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

Answer 43

epitinezumab (Vyepti) every three months and rimegpant ODT

Question 44

limitation for headache overuse

Answer 44

2-3 times per week for the offending agents

Question 45

how to use Onzetra Xsail

Answer 45

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

Question 46

Migraine diagnosis criteria

Answer 46

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)

Question 47

valproic acid/divalproex vs topiramate weight effects

Answer 47

topiramate weight loss while the other to are the opposite