Migraine Flashcards
Which neurotransmitter decreases during a migraine, which causes a chemical release of neuropeptides that trigger vasodilation in cranial blood vessels. A.) Dopamine B.) Serotonin C.) Norepinephrine D.) Acetylcholine
B
Serotonin (5-HT3)
Women who have migraine with aura are at higher risk of \_\_\_\_\_\_? A.) Infection B.) Heart disease C.) Stroke D.) Ischemic Heart disease
C.) Stroke
Which natural product is used commonly to prevent HA? A.) Saw palmetto B.) Butterfur C.) Ginger D.) SAMe
B
Common OTC treatment for migraine include: caffeine butterbur feverfew magnesium riboflavin (B2) coenzyme Q10
What is the MOA of triptans?
A.) Serotonin receptor antagonist B.) Serotonin receptor agonist C.) Dopamine receptor antagonist D.) Dopamine receptor agonsit E.) Serotonin-dopamine receptor agonist
B
Selective agonists for 5-HT1 receptor and causes vasoconstriction of cranial blood vessels, inhibit neuropeptide release and decrease pain transmission
What is the brand name of sumatriptan + naproxen? A.) Yosprala B.) Amerge C.) Frova D.) Treximet
D
Remember:
Yosprala is aspirin and omeprazole
A patient has recently been started on Zomig nasal spray , which of the following are important counseling points? (Select all that apply)
A.) Make sure to prime the nasal spray before use
B.) Do not prime prior to use
C.) Blow your nose prior to use
B, C
There is only one dose in the nasal sprayer. Do not prime (test) the nasal spray or you will lose the dose.
Triptans: which ones are long-acting but have a slower onset? (select all that apply) A.) Frovatriptan B.) Naratriptan C.) Zolmitriptan D.) Almotriptan
A, B
- Frovatriptan
- Naratriptan
Imitrex is available in many formulations EXCEPT? A.) Nasal Spray B.) SC C.) IM D.) Powder
Sumatriptan is NOT available IM.
All sumatriptan injections are SC, the preferred site is the lateral thigh or upper arm.
What is the MOA of D.H.E. 45?
A.) Selective agonists for 5-HT1 receptor and causes vasoconstriction of cranial blood vessels
B.) Nonselective agonists of serotonin receptors
C.) Selective agonists for 5-HT1 receptor and causes vasodilation of cranial blood vessels
B
Dihydroergotamine (D.H.E. 45, Migranl) is an nonselective agonists of serotonin receptors.
Dihydroergotamine
- DHE 45
- Migranal
Acetaminophen/butalbital/caffeine
Fioricet
Aspirin/butalbital/caffeine
Fiorinal
What are the criterias for prophylactic drug treatment of migraines? (3)
- ) If use acute treatments ≥ 2 days/week or ≥ 3 times/month
- ) If migraines decrease quality of life
- ) If acute treatments are ineffective or contraindicated
Which BB used for migraine prophylaxis is the most lipophilic?
A.) Timolol
B.) Propranolol
C.) Metoprolol
B
Propranolol is the most lipophilic and the most non-selective.
Triptans ODT/MLT (Maxalt-MLT and Zomig-ZMT): should be avoided in patients with \_\_\_\_\_\_? A.) a sulfa allergy B.) egg allergy C.) phenylketonuria D.) oligohidrosis
C
phenylketonuria, due to sweetener
BC is expecting her first child and has been complaining of frequent headaches. She comes into the pharmacy and states that she is 20 weeks into the pregnancy and would like to find some relief. The pharmacist can recommend occasional use of the following product:
A.) Aspirin B.) Excedrin Migraine C.) Aleve D.) Acetaminophen E.) Motrin
D
A pharmacist has a prescription for sumatriptan for a patient with following active medications:
Medications: Avapro 150mg QD Plavix 75mg QD Crestor 10mg QD Lopressor 100mg BID Nitroglycerin SL PRN Aspirin 81 mg QD
The patient just checked his blood pressure on the store’s machine. It is currently 178/102 mmHg. Should the pharmacist dispense the sumatriptan?
No, the patient cannot use sumatriptan with this degree of hypertension.
This is not a drug interaction issue
Serious but rare cerebrovascular and cardiovascular events can occur with triptans; because of this, triptans are contraindicated in patients with cerebrovascular disease (stroke,TIA), uncontrolled hypertension and ischemic heart disease (MI, angina). The patient’s current blood pressure is a contraindication. A prescription for nitroglycerin SL implies a diagnosis of angina.
SA has 2-3 migraines monthly. They reduce her ability to function for 2-3 days. Her daily medications include fosinopril for hypertension and a multivitamin. Choose the correct statement.
A.) She should start daily therapy with sumatriptan.
B.) She should start daily therapy with rizatriptan.
C.) She should begin prophylactic therapy to reduce her migraine incidence.
D.) She does not need a daily prophylactic agent she uses fosinopril.
E.) She should begin daily therapy with Fiorinal
C
If a patient uses acute treatment >twice weekly or >3 times per month, or has severe symptoms, or requests prophylaxis, an agent can be used to decrease migraine frequency.
This patient has reduced quality of life (and perhaps misses work and other activties) for >1 week per month.
What is the formulation product of Onzetra Xsail?
A.) Orally disintegrating tablet
C.) Patch
D.) Intranasal powder
E.) Injection
D
Onzetra Xsail is a (sumatriptan nasal powder).
RD has significant nausea during her migraine headaches and cannot tolerate swallowing any pills. She vomits them right back up. Which of the following formulations might provide benefit? Select ALL that apply
A.) Maxalt MLT B.) Zembrace SymTouch C.) Onzetra Xsail D.) Zomig ZMT E.) Amerge
A, B, C,D
Zembrace SymTouch
Onzetra Xsail
Zomig ZMT
Maxalt MLT
Zomig ZMT and Maxalt MLT are the ODT formulation of zolmitriptan and rizatriptan.
ODTs can be useful if nausea or dysphagia is present.
Sumatriptan is available in many unique dosage forms that avoid the oral route.
Zolmitriptan is also formulated in an intranasal spray
A pharmacist will help a patient identify common migraine triggers. Which of the following are established migraine triggers? Select ALL that apply
A.) Bright or flickering lights B.) Too little sleep C.) Stress D.) Spicy foods, hot red pepper E.) Standing for extended periods of time (>2 hours)
Bright or flickering lights
Too little sleep
Stress
Common migraine triggers include:
- ) Hormonal changes in women (fluctuations in estrogen)
- ) Foods such as cheeses, processed foods
- ) Stress
- ) Sensory stimuli
- ) Changes in sleep pattern
- ) Changes in the environment (weather)
AT complains of frequent migraines at least twice a month. She takes propranolol daily to prevent them, but still she reports not having any relief when she has an acute migraine attack.
Her doctor prescribed Imitrex STATdose to provide relief at the onset of her migraine symptoms. What is the correct route of administration and the usual injection site?
A.) SC, deltoid B.) SC, upper outside arm C.) SC, gluteus maximus D.) IM, deltoid E.) SL, underside of tongue
B
Sumatriptan injections are given subcutaneously.
Inject the medication just below the skin (always SC, never IM or IV) as soon as symptoms of a migraine appear.
The preferred site of injection is the lateral thigh or upper outside arm.
IP presents to the pharmacy with a prescription for phenelzine (Nardil) to treat her depression. She wants to refill an old prescription on file for her migraine headaches. She cannot recall the name of the migraine medication but she knows that it is a “triptan”. Which medication can she safelty take with phenelzine?
A.) Imitrex B.) Maxalt C.) Relpax D.) Zomig E.) Treximet
C.) Relpax (eletriptan HBr)
Sumatriptan, rizatriptan and zolmitriptan are contraindicated with MAO inhibitors.
The other triptans are not, though the warning about combining them with serotonergic drugs still applies.
A patient gave the pharmacist a prescription for “Maxalt 5mg PO at first sign of migraine, can repeat x 1 if migraine pain persists”. Which of the following is an appropriate generic substitution for Maxalt?
A.) Almotriptan B.) Sumatriptan C.) Rizatriptan D.) Eletriptan E.) Zolmitriptan
The generic name of Maxalt is rizatriptan.
C
