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NAPLEX > Migraine > Flashcards

Migraine Flashcards

1
Q

Migraine Triggers

A
  • Hormonal changes in women
  • Food: alcohol, aged cheese, chocolate, caffeine, etc.
  • Stress
  • Sensory stimuli: bright light, loud sounds, scents
  • Changes in sleep/wake patterns
  • Changes in environments: weather, barometric pressure
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2
Q

Triptans

A
  • 5HT1 agonist causes vasoconstriction of cranial blood vessels
  • First-line for acute treatment (abortive)
  • Take at first sign of a migraine
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3
Q

Maxalt-MLT

A
  • Rizatriptan

- Tablet and ODT formulations

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4
Q

Imitrex

A
  • Sumatriptan
  • Autoinjector (SQ), nasal spray, tablet, nasal powder formulations
  • Also Zembrace SymTouch (SQ autoinjector, can be used 4x/day)
  • Inject in lateral thigh or upper arm
  • Onzetra Xsail - nasal powder, each nostril
  • Treximet (+naproxen) - dispense in original container
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5
Q

Zomig ZMT

A
  • Zolmitriptan
  • Tablet, ODT, nasal spray
  • Intranasal in one nostril
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6
Q

Triptan Information

A
  • CI: cerebrovasvular disease, uncontrolled HTN, ischemic heart disease , use w/in 24 hours of other triptans/ergotamines
  • Warning: increased BP, 5HT syndrome
  • SE: Paresthesia (tingling, numbess), triptan sensations (pressure/heaviness in chest or neck region)
  • Nasal sprays don’t need priming
  • CI use within 14d of MAOI use
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7
Q

Frovatriptan

A
  • Longest half life (36 hours)
  • Long-acting but slower onset
  • Triptans with shorter half life have quickest onset
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8
Q

Migraine Tx for >= 12 yo

A
  • Almotriptan tablets
  • Zolmitriptan nasal spray
  • Treimet
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9
Q

Migraine Tx for 6-17 yo

A

-Tizatriptan

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10
Q

Which triptans contain phenylalanine?

A
  • Maxalt-MLT
  • Zomig ZMT ODT
  • DON’T use in phenylketonuria
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11
Q

DHE 45

A
  • Dihydroergotamine
  • AKA Migranal
  • Available in injection and nasal spray
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12
Q

Ergotamine Information

A
  • Nonselective agonist of 5HT receptors, only use in those w/o triptan benefit
  • Box warning: potent CYP3A4i (life-threatening peripheral ischemia)
  • CI: Uncontrolled HTN, preggo, ischemic heart disease
  • Warning: CV and cerebrovascular events, also DDI
  • Prime nasal spray by pumping 4 times
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13
Q

Nurtec

A
  • Rimegepant
  • Oral CGRP receptor antagonist for acute migraine treatment
  • ODT
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14
Q

Ubrevly

A
  • Ubrogepant
  • Oral CGRP receptor antagonist for acute migraine treatment
  • Abortive agent option
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15
Q

Lasmiditan

A
  • CV
  • Serotonin agonist selective for 5HT1F receptors
  • Abortive agent
  • DOESN’T cause vasoconstriction so okay in CVD
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16
Q

Inderal

A
  • Propranolol, non-selective
  • Prophylactic migraine tx option
  • Warning: bronchospastic disease (asthma/COPD)
  • SE: bradycardia, fatigue, hypotension, dizziness, depression, impotence, Raynaud exacerbation
17
Q

Lopressor

A
  • Metoprolol, selective
  • Toprol XL is ER formulation
  • Prophylactic migraine tx option
  • Warning: bronchospastic disease (asthma/COPD)
  • SE: bradycardia, fatigue, hypotension, dizziness, depression, impotence, Raynaud exacerbation
18
Q

Depakote

A
  • Divalproex
  • AED that can be used for migraine prophylaxis
  • Box warning: fetal harm, hepatic failure
  • Warning/SE: Weight gain, thrombocytopenia, increased ammonia, alopecia
19
Q

Depakene

A
  • Valproic acid
  • AED that can be used for migraine prophylaxis
  • Box warning: fetal harm, hepatic failure
  • Warning/SE: Weight GAIN, thrombocytopenia, increased ammonia, alopecia
20
Q

Topamax

A
  • Topiramate
  • AED that can be used for migraine prophylaxis
  • Warning: fetal harm, metabolic acidosis, nephrolithiasis, increased ammonia, open-angle glaucoma and visual field defects, oligohidrosis
  • SE: Weight LOSS, somnolence, cog. impairment (“Stupamax”)
21
Q

Vyepti

A
  • Eptinezumab
  • Monoclonal antibodies for migraine prophylaxis only
  • IV Q3mo
22
Q

Aimovig

A
  • Erenumab
  • Monoclonal antibodies for migraine prophylaxis only
  • SQ monthly
23
Q

Ajovy

A
  • Fremanezumab
  • Monoclonal antibodies for migraine prophylaxis only
  • SQ once month or higher dose Q3mo
24
Q

Emgality

A
  • Galcanezumab
  • Monoclonal antibodies for migraine prophylaxis only
  • SQ month
25
Q

Migraine Diagnosis Criteria

A

5+ attacks w/ following criteria:

  • HA lasting 4-72 hours, recur sporadically
  • 2+ HA having unilateral location (pulsating)
  • 1+ occurs: N/V, photophobia, phonophobia
26
Q

Natural Product Options

A
  • Caffeine
  • Butterbur
  • CoQ10
  • Feverfew
  • Magnesium
  • Peppermint
  • Riboflavin

HA diary or massage may help too

27
Q

Abortive Tx Options

A
  • Triptans!!
  • NSAIDs/APAP
  • Butalbital/opioids - NOT recommended (after other therapies fail)
28
Q

Consider prophylaxis if…

A
  • Patient requests it
  • Acute tx >= 2d/week or >=3x/month
  • QoL significantly decreased by migraine
  • Abortive tx CI or ineffective

Need to trial for 2-6 mo before changing meds

29
Q

Botox

A
  • Chronic migraine prophylaxis only

- Only considered for 15+ headache days per month

30
Q

Antidepressants for Migraine

A
  • TCAs - usually amitriptyline

- Venlafaxine

NAPLEX (59 decks)

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