Migraine Flashcards
1
Q
When it’s indicate for migraine prophylaxis
Agents
A
- Indication for ppx when > 3 migraine attacks/mo or if associated with disability
Agents - BB: Propranolol, timilol - CCB: Verapamil - TCA/SNRI: Amitriptyline, Venlafaxine ER - Effexor - AntiEpileptic: Divalproex - Depakote/Stavzor Topamax - Topiramate - Botulinum toxin - Botox - Feverfew, buterbur
2
Q
Topamax
- Indication
A
Topiramate
- Indication: migraine ppx
3
Q
Botox
- Indication
A
Botulinum toxin
=> Use in pt who have at least 15 days of migraine attacks/month and last > 4H
- Indication: migraine ppx
4
Q
Toradol
- Indication
- Dose
A
Ketoralac
- Indication: tx of migraine
- Dose: 30-60mg IM/15-30mg IV/10mg q4-5H PO
5
Q
Naprosyn
- Indication
- Dose
A
Naproxen
- Indication: tx of menstrual migraine
- Dose: 500mg BID
6
Q
Indocin
- Indication
- Dose
A
Indomethacin
- Indication: tx of migraine
- Dose: 50mg
7
Q
Cambia
- Indication
- Dose
A
Diclofenac
Voltaren
- Indication: tx of migraine
- Dose: 50mg single dose mix with water
8
Q
Motrin
- Indication
- Dose
A
Ibuprofen
- Indication: tx of migraine
- Dose: 200-400 mg
9
Q
Reglan
- Indication
A
Metoclopramide
- Indication: migraine
10
Q
Compazine
- Indication
A
Prochloperazine
- Indication: migraine
11
Q
Amergen
For all triptan:
- MOA
- Indication
- SEs
- Sumatriptain:
- C/I
- DDI
- Rec for kids age 6-11
- Counseling
A
Naratriptan
- MOA: 5HT receptor agonist
- Indication: tx of migraine
- SEs: N/HA, chest tightness, dizziness, paresthesias (numbness/tingling), sleepiness
**Sumatriptan: injection site rxn/bitter taste - C/I: CAD, uncontrolled HTN, take with Ergots and MOAIs
- DDI:
SSRI’s: very rare
MOAI’s: incr systemic exposure to triptan
Ergots: vasospastic rxn
Cimetidine: Inc [ ] of Zolmitriptan
OCP: Inc plasma level of naratriptan & zolmtriptan - Rec for kids age 6-11: rec maxalt tab or Imitrex nasal
Counseling:
- Max dose
- Relieve acute migraine but doesn’t prevent or reduce the # of future attack
- If experience chest pain, SOB, heart throbbing, or skin rashes notify MD
- Do not take if pregnant (preg cat C)
- Avoid prolong sun exposure: wear sunscreen and protective clothing
12
Q
Maxalt
- Max dose
- Form
A
Rizatriptan Benzoate
- Max dose: 30mg/day
- Form: PO
13
Q
Imitrex
- Max dose of PO and NS
- Counseling of transdermal system
A
Sumatriptan succinate
Forms/Max Dose
- PO: Max 200mg/d
- NS: Max 40mg/d
14
Q
Treximet
- Dose
A
Sumatriptan + Naproxen
- Sum 85mg and Nap 500mg
May repeat after 2H
15
Q
ZOmig
- Forms
- Max dose
A
ZOLmitriptan
- Forms: tab, nasal spray
- Max 10mg/d