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Board Review > Migraine > Flashcards

Migraine Flashcards

1
Q

MOA of Triptans

A

5HT1(serotonin) receptor agonist and cause vasoconstriction of the cranial blood vessels. inhibits neuropeptide release and decreasing pain transmission

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2
Q

non-pharmacologic interventions for migraines

A

avoiding triggers, non-stress, relaxation, applying a cold compress to the head

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3
Q

common migraine triggers

A

Hormone changes in women: fluctuations in estrogen, used (POP) Food: alcohol (beer and red wine) aged cheese, chocolate, MSG, salty and processed foods, stress, bright lights, loud noises, scents, change in weather, not enough or too much sleep

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4
Q

Natural products used for migraines

A

feverfew, willowbark, CoQ10, fish oils, mg2+, riboflavin, butterbur, and guarana

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5
Q

Migraine Prophylaxis

A

if pt has >1x/month or sever sx, prophylaxis should be tried for 2- 6 mos

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6
Q

Acute trxt of migraines

A

Triptans and some pts prefer OTC NSAIDS or excedrin migraine or using them together

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7
Q

Naratriptan

A

Amerge 1 and 2.5mg, can repeat x 1 after 4 hrs

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8
Q

Almotriptan

A

Axert 6.25 and 12.5mg, can repeat x1 after 2 hrs

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9
Q

Frovatriptan

A

Frova 2.5mg, can repeat x 1 after 2 hr

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10
Q

Sumatriptan PO KNOW DOSING

A

Imitrex PO 25, 50, 100mg can repeat x1 after 2 hrs

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11
Q

Sumatripatan injection dose

A

Needless sumatriptain injection (Sumavel Dosepro-6mg) injection by air pressure.

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12
Q

Imitrex STATdose

A

Imitrex STATdose SC; 4,6mg can repeat x1 after 1 hr

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13
Q

Nasal spray sumatriptan dose

A

NS: 5,20mg can repeat after 2 hr

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14
Q

Treximet dosing

A

Sumatriptan + Ibuprofen (Treximet) 85-500mg

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15
Q

Rizatriptan

A

Maxalt, Maxalt- MLT: 5, 10mg can repeat x1 after 2 hr

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16
Q

Maxalt MLT disint grating tablets, water needed? Dose?

A

Maxalt 5mg no water needed

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17
Q

Eletriptan brand and dosing

A

Relpax 20mg and 40mg, can repeat after 2 hr**

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18
Q

Zolmitriptan

A

Zomig, Zomig-ZLT, NS PO 2.5 and 5md can repeat after 2hr

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19
Q

zolmitriptan nasal spray, dose ?

A

NS 5mg can repeat after 2 hr

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20
Q

zolmitriptan disintegrating tablets brand? Water needed?

A

Zomig-ZMT 2.5 and 5 no water needed

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21
Q

S/E of triptans KNOW

A

somnolence**, dizziness, nausea, paresthesias (numbness/tingling) throat/neck presssure, hot/cold sensation, chest pain/tightness

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22
Q

What triptans have ODT

A

sumpatiptan, rizatriptan , zolmitriptan

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23
Q

Triptan sensations

A

pressure in the chest or heavnees pressure in the neck region that usually dissipate after administration

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24
Q

Contraindications

A

Cerebrovascular dz and uncontrolled BP

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25
Q

What are the longest acting triptans?

A

Frovatriptan (Frova) and naratriptan (Amerge): longer acting but slower onset

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26
Q

What are the triptans with the shorter half-lifes?

A

almotriptan (axert) zolmitriptan, eletriptan (relpax) rizatriptan, sumatriptan

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27
Q

Study of eletriptan vs Sumatriptan

A

eletriptan (Relpax) 40mg was more effective than Sumatriptan 100mg

28
Q

What triptans are C.I. with MAO-Is?

A

Maxalt, zomig, and imitrex. all the rest are not

29
Q

What triptan is C.I. with 3A4 inhibitors?

A

Eletriptan (Relpax)

30
Q

what formulations provide the fastest relief?

A

SC injection and nasal spray

31
Q

ODT and PKU

A

Do not use Maxalt-MLT and Zomig-ZLT in pts with Phenylketonuria due to the sweetner

32
Q

imitrex injection counseling

A

includes a carrying case and two prefilled SC syringes. Clean the area of the skin with an alcohol pad in the upper outside arm. Load the STATdose pen by inserting it into the cartridge and turning it clockwise. inject the dose and hold the pen till for 5 seconds

33
Q

Zomig nasal counseling

A

Blow your nose gently before using. There is only one dose in the nasal sprayer so do not try to prime or you will lose the dose. Do not press the plunger into you have put the tip into your nostril

34
Q

less commonly used agents for migraines

A

Fiorcet CIII- APAP, butalbital, caffiene: must taper off or will get worsening sx of tremors, HA, and risk for delirium and seizures. Fiornal, Vicodin, Butorphanol NS CIV- onset is 15 mins

35
Q

Ergotamine products, pregnancy category? CI and what? names of brands

A

Preg Cat X, do not use with strong 3A4 inhibitors due to risk of cerebral ischemia. Ergoloid mesylates (Ergomar, Ergostat) ergotamine/caffeine (Cafergot) DHE Dihydoergotamine (DHE-45, migranal NS)

36
Q

Ergotamine side effects

A

N/V, muscle pain, tingling in the periphery, angina-like pain, weakness in legs, tachycardia, bradycardia

37
Q

What is 1st line therapy for migraine prophylaxis?

A

propanolol (inderal) timolol (blocadren) amitriptyline (Elavil) divalproex (sodium valproate) and topiramate (Topamax)

38
Q

What is 2nd line therapy for migraine prophylaxis?

A

other beta blockers, ACEIs, antidepressants, natural products, birth control for menstrual associated and botulism type A (botox)

39
Q

Do not use propanolol and timolol in what dz states?

A

Asthma, COPD, emphysema because they are non-selective b-blockers

40
Q

What is the result of overuse of medications?

A

medication overuse (rebound) headaches. limit acute medication trxt to 2 or 3 times weekly

41
Q

longer duration of action naproxen or ibuprofen??

A

NAPROXEN 12 hours

42
Q

triptans are CI

A

CEREBROVASCULAR dz and uncontrolled HTN!!! b/c hey have found cardiac and cerebrovascular issues w/ the drug

43
Q

migrain with aura choose what kind of birth control

A

migrian with aura has a higher risk for clots- so we want a NO ESTROGEN birth control hence mini pills- hence NOR- QB, NOR Be, and camilla

44
Q

what is the mechanism of action of Tryptans

A

the are serotonin receptor agonists, that cause vasoconstriction

45
Q

what can you treat menstrual assocated migraines with?

A

treat with oral contraceptoves , can use NSAIDs, triptans

46
Q

when do you start the tx for menstrual migraines?

A

2 days beforehte mensies and continue fo 5-7 days

47
Q

when children get migraines , what to recommend?

A

Rec OTC, usually ibuprofen first. can use triptan in children

48
Q

what are some non pharm tx for migrains?

A

avoid triggers
mental relaxation,
apply cold compresses to the head
manage sress

49
Q

OTC recommendations for migraines?

A

NSAIDS , or excedrine which is ASA, APAP, caffeinee

50
Q

when do u start medication therapy for mgraines?

A

if patient is getting them twice per week or sigficant decrease in the quality of life

51
Q

what are some common triggers for migraines?

A 
changes in hormones during menstruation
food: etoh, cheexe, chocolate, caffeine, 
stess
bright lighs
irregular sleep pattern
52
Q

imitrex

A

sumatriptan

53
Q

alsuma

A

sumatriptan

54
Q

po dose for sumatriptan for acute attack of migraine

A

25, 50 or 100mg dose x1 and can repeat dose in 2 hours

55
Q

SC dose for sumatriptan

A

5, 20 mg and can repeat x1 in 2 hours if not releive

56
Q

maxalt

A

rizatriptan

57
Q

maxalt dosing

A

5 or 10mg x 1 and repeat 2 hours later if neessary

58
Q

relpax

A

eletriptan

59
Q

eletriptan dose

A

20 or 40mg and can repeat in 2 hours

60
Q

which patients are contraindicated form ahving triptans?

A

patietns with cerebrovasucalr diseas or uncontrolled hypertension
some are contrindicated with MAOIs

61
Q

what are the maind side effects of the tirptans?

A

somonolence , nausea,
tingling or numbness
hotcold sensations
pressure in the chest or neck region but thesese usually dissipate

62
Q

when to use rizatriptan and zolmitrpatan?

A

have disintegratin tablets that dissolve and good vor nausea vomitng or if patient cant swallow

63
Q

signs and symptoms of serotonin syndrome?

A

restlessness, sweating, poor coordination, confusion and hallucinations

64
Q

what agent is a good choice for migraine prophylaxis for young women ? which is worst and why?

A

good: topiramate cuz good side effect profile and causes weight loss. Bad is valproate because can cause Polycistic ovary syndrome by increasing testosterone levels

65
Q

topiramate dose for migraines?

A

start 25mg qhs then titrate to 50mg bid

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