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SUMPHARM > Migraine > Flashcards

Migraine Flashcards

1
Q

What is a primary HA?

A

MC-No identifiable underlying cause.

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2
Q

What is a secondary HA?

A

Organic cause. 2. Dental infx 3. Brain Tumor 4. Subarachnoid hemorr

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3
Q

What is diff btwn cluster

A

severe- U/L lacrimating temporal TX- verapamil, prednisone

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4
Q

What is diff btwn Tension

A

MC- B/L TX-OTC

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5
Q

What is diff btwn migrain?

A

debilitating- U/L, W 15-30yo-Trigger-trigeminal nerve-vasodilation-inflammation-nociceptive-peripheral sensitization. Prodrome- mood, food. Aura- tingling lips, motor speech. HA- UL throbbing 4-72hrs, pain INC activity HA- reverts to vomiting spontaneous, Postdrome-fatigue, AN (pseudo seizure)

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6
Q

What are trigger for Migraine?

A

Stress, mood, light, hunger, MSG, tyramine, Nitrites, chocolate, menses,

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7
Q

What is best method for Acute Migraine tX?

A

Large single dose. 2. parenteral best

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8
Q

What is benefit of caffeine in Excedrin OTC used for acute migraine?

A

helps absorb faster- NOT REC for single agent. OK for peds and Pregs

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9
Q

What is ideal for tension HA?

A

Fiorinal-caffeine+aspirin/APAP

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10
Q

How are NSAIDs use in HA?

A

Mild to mod 2. Avoid 3rd trimester 3. Metoclopramide for absorption 4. Avoid excess d.t rebound HA

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11
Q

What can be used as monotherapy for HA antiemetic?

A

Injection-prochlorperazine, metoclopramide, chlorpromazine 2. Used with diphenhydramine to prevent ADEs akathisia/dystonic rxn

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12
Q

What are ADEs and use of metoclopramide?

A
  1. USE- delay gastric emptying so better absorption. 2. ADE- sedation, confusion dyskinesia
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13
Q

What is not first line for migraine HA?

A

Opioids- INC rebound HA- meperidine, codeine, Stadol

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14
Q

What is REC for intractable severe migraine?

A

Ergot-Dihydroergotamine DHE-LONG LAST HA ADE-n/v rebound HA, NEVER MONO, Used in ED, poor absorption

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15
Q

Which ERgot interacts with serotonin and cause vasoconstriction and vasodilation?

A

Ergotamine Tartrate- LAST RESORT-FOR MIGRAINE AND CLUSTER RECURRENCE OR PROLONGED ATTACKS

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16
Q

What are ADE of ergotamine

A

GI, *peripheral vasoconstriction: cold, DEC pulses, tingling. AVOID in PVD and CAD, PregX, Ischemic bowel dz, CVA, . BB may INC effects. TX OD- Nitroglycerin

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17
Q

What are DI of ergotamine tartrate?

A

Triptains! and CYPs INC Ergo TARTRAte in serum, INC toxicity

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18
Q

This MOA is 5HT1b, 1d agonist receptors located in CNS, PNS that stimulate vasoconstriction in cranial vessels, and inhib trigeminal nerve 1d, dec neuropeptides responsible for vasodilation and reduce transmission?

A

Triptans- suma, riza, nara, zolmi, frova, ele. The IRanian triptans

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19
Q

WHich triptan should be avoided in elderly, short t 1/2, quickers relief SC?

A

Sumatriptan- GMa suma like natural

20
Q

What are ADE of SUMA?

A

1st GEN GMa- gets chest to throat pressure, SOB, Signs of GAD. Anxious Grandma. Resolves in 30 min. Patch scars

21
Q

What is concern with Suma in women?

A

PREG C- excreted in breastmilk.

22
Q

What BB inhibits Rizatriptan and thus Riza must be DEC by 50% if pt on BB?

A

Propranolol- “Aunt Riza and her CHF”. Riza- has a fast onset w/ good response. “But Riza so helpful”

23
Q

Which triptan is best tolerated, LOWEST recurrence?

A

Aunt Nara- “nice and slow Aunt Nara”

24
Q

Which triptan has CYP many DI, short duration bc INC lipo, Well tolerated, LOW recurrence?

A

Almotriptan- “Crazy Aunt Almo never getting along with family bc her short tempe with wt talks”

25
Q

Which triptan is ideal for AURAs LONGEST t/1/2, slow relief, low HA recurrence?

A

FRovatriptan- “Aunt Frova forever long mystical stories but she never repeats?

26
Q

Which triptan is avoid 72 hr with other drugs due to CYP inhib?

A

Eletriptan- “Aunt Ele is live 72hr away”

27
Q

Which Triptans have consistent success?

A

Riza, Ele, Almo- Trials said oral are effective. Choice individualized. Switch if one not working

28
Q

Which drugs have least ADE?

A

Nara and Frova

29
Q

Which drug has most delivery options?

A

Sumatriptan- GMa got all the recipes

30
Q

Which Triptan CANNOT be repeated 2hrs?

A

Nara-Slow AUNTy. All other can repeat 2 or >2hrs. EXCEPT Sumatriptan SC- 1hr

31
Q

What have nasal spray option?

A

Zolmi and Suma

32
Q

What RX can be used in 2-3 trimester for migraine?

A

APAP+metoclopramide. AVOID-nsaid, ergos, triptans preg c

33
Q

When can prophylaxis be used?

A

HA > 3day/mo, or >2 day/week or severe long lasting >12hr

34
Q

How should prophylaxis be dosed?

A

Lowest effective dose, slowly, Trial 2-3mo, Avoid other RX meds. Re-evaluate 1 yr via slow taper

35
Q

What BB is most studies, but overall any BB has 60-80 complete or partial relief, DOC bc safe, effective, tolerable?

A

Propranolol- may take 3-6 mo of max. Titrate to max dose 325 mg

36
Q

What are ADEs of BB?

A

AVOID asthma,DM, cardiac arrhythmias. Fatigue, exercise intolerance, MDD, ortho hypotension

37
Q

What CCB is used in migraines?

A

Verapamil- 50% relief ADE- dizzy, edema, flushing, constipation, tolerance

38
Q

What is the most effective prophylaxis antidepressant?

A

Amitriptyline-TCA ADE- sedation, wt gain, anticholinergic (dry as dessert). USE- best if PMH of MDD, GAD, insomnia, tension HA. AT NIGHT

39
Q

Which AED meds are used in migraines, but are PREG X?

A

Valproate and Topiramate-

40
Q

Which ADE is double whammy with prevent migraines and WT LOSS?

A

Topiramate- Kids age 12+ ADE- birth defect

41
Q

What new prophylaxis is LAST resort?

A

Calcitonin gene related peptide- for trigeminovascular pain- Drug Mabs-ADE- cardiovascular, pulmonary, psych. AVOID- children, preg, elderly. 3 deaths

42
Q

Should transcranial magnetic stimulation be used on epilepsy migraine pts?

A

NO- 2nd for pt w/ intolerances

43
Q

What is prophylaxis for cluster HA?

A

Verapamil, Steroids, Topiramate, Lithium

44
Q

What is ideal Tx for cluster HA?

A

Oxygen. Triptans-Suma, Zolmi, Nasal Lidocaine

45
Q

What can be used has prophylaxis of Tension HA?

A

TCA-amitriptyline.

SUMPHARM (26 decks)

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