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
16
Q
Axert
- Max dose
A
ALMOtriptan
Max dose: 25mg/day
17
Q
Frova
- Max dose
- Half life
A
FROVAtriptan
- Max dose: 7.5mg/day
- Half life: longest
18
Q
Relpax
- Max dose
- DDI
A
Eletriptan
- Max dose: 80mg/d
- CYP3A4 substrate
19
Q
Migrana
D.H.E. 45
- Dose
- MOA
- Indication
- C/I
- SE
- DDI
- Counseling
A
DiHydroErgotamine Mesylate
- Migrana - 4mg/mL w/ 10mg caffeine
- 5mg/spray. Max 3mg/d = 6 sprays. 15sprays/7day period
- D.H.E. 45 injection
1mg IM. May repeat 2x at 1H interval
Max = 3mg/day and 6mg per 7day period - MOA: Vasoconstriction, interacts with 5HT, DA, NE
- Indication:
Inj/PO: to abort/prevent vascular HA - migraine, cluster HA
Nasal spray: only for migraine
C/I
- Preg Cat X
- Hypersensitivity
- PVD
- Hepatic/renal imp
- CAD
- HTN
- Sepsis
SEs
- N/V, numbness/tingling of fingers/toes
- Pain/weakness of arms/legs
DDIs
- BB: peripheral ischemia (cold extremities), gangrene
- Inhibitors of 3A4
Counseling
- Do not exceed rec dose
- Contact MD if irregular heart beat
- N/V
- Numbness/tingling of fingers or toes
- Pain or weakness of the extremities
20
Q
ERGOmar
- Form
A
ERGOtamine Tartrate
- SL tab
21
Q
CafERGOT
- Form
A
Ergotamine + Caffeine
- Tab: 1mg ergo/100mg caffeine
Max: 6 tabs/attack; 10tabs/week - Suppositories: 2mg ergo/100mg caffeine
Max: 2sup/attack; 5supp/week
22
Q
Fioricet
Esgic
- Indication
- Dose
A
Butalbital + Caffeine + APAP = 50/40/325
- Indication: tension or muscle contraction HA
- Dose: 1-2 tabs or cap Q4H. Max 6 tabs/day
23
Q
FiORINal (CS III)
- Indication
- Dose
A
Butalbital + Caffeine + ASA
- Indication: tension or muscle contraction HA
- Dose: 1-2 tabs or cap Q4H. Max 6 tabs/day
24
Q
Excedrine Migraine
- Dose
- Preg cat:
A
APAP + ASA + Caffeine = 250/250/65
- Dose: 2 tabs PO Q6H. Max 8 tabs/day
- Preg Cat D
25
Q
Maxalt MLT
A
Rizatriptan
- Form:
- Max dose: 30mg/day
Counseling:
- Phenylketonuric pt should not take Maxalt MLT
- Keep Maxalt MLT in foil package until just prior to use
- Use clean dry hands to remove Maxalt MLT from foil
- Place Maxalt MLT on top of the tongue
26
Q
Sumavel DosePro
- Form
- Max dose:
A
Summartriptan
- Form: SC
- Max: 12mg/d
27
Q
Zecuity
- Form:
- Max dose:
- Counseling
A
Zecuity: Iontophoretic transdermal system
- Transdermal: delivery 6.5mg over 4H. Apply to upper arm
Counseling
- Single-use, battery powered patch that actively delivers sumatriptan 6.5mg over 4H
- Once Zecuity is applied, the activation button must be pushed and the red light will turn on. When dosing is done, the sys stops operating and the activation light turns off
- It uses a mild electrical current to deliver the medicine the the skin
- Contain metal parts and must be removed b/4 MRI
28
Q
Zomig ZMT
- Max:
A
Zomitriptan ODT
- Max dose: 10mg
29
Q
Alsuma
- Form
A
Sumatriptan
- Form: Sol’n
