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EXAM > Migraine > Flashcards

Migraine Flashcards

1
Q 
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
A

B

Serotonin (5-HT3)

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2
Q 
Women who have migraine with aura are at higher risk of \_\_\_\_\_\_? 
A.) Infection
B.) Heart disease 
C.) Stroke 
D.) Ischemic Heart disease
A

C.) Stroke

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3
Q 
Which natural product is used commonly to prevent HA? 
A.) Saw palmetto
B.) Butterfur
C.) Ginger
D.) SAMe
A

B

Common OTC treatment for migraine include: 
caffeine 
butterbur
feverfew
magnesium 
riboflavin (B2) 
coenzyme Q10
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4
Q

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
A

B

Selective agonists for 5-HT1 receptor and causes vasoconstriction of cranial blood vessels, inhibit neuropeptide release and decrease pain transmission

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5
Q 
What is the brand name of sumatriptan + naproxen?
A.) Yosprala 
B.) Amerge
C.) Frova
D.) Treximet
A

D

Remember:
Yosprala is aspirin and omeprazole

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6
Q

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

A

B, C

There is only one dose in the nasal sprayer. Do not prime (test) the nasal spray or you will lose the dose.

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7
Q 
Triptans: which ones are long-acting but have a slower onset? (select all that apply) 
A.) Frovatriptan
B.) Naratriptan
C.) Zolmitriptan 
D.) Almotriptan
A

A, B

  • Frovatriptan
  • Naratriptan
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8
Q 
Imitrex is available in many formulations EXCEPT? 
A.) Nasal Spray
B.) SC
C.) IM
D.) Powder
A

Sumatriptan is NOT available IM.

All sumatriptan injections are SC, the preferred site is the lateral thigh or upper arm.

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9
Q

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

A

B

Dihydroergotamine (D.H.E. 45, Migranl) is an nonselective agonists of serotonin receptors.

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10
Q

Dihydroergotamine

A
  • DHE 45

- Migranal

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11
Q

Acetaminophen/butalbital/caffeine

A

Fioricet

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12
Q

Aspirin/butalbital/caffeine

A

Fiorinal

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13
Q

What are the criterias for prophylactic drug treatment of migraines? (3)

A
  1. ) If use acute treatments ≥ 2 days/week or ≥ 3 times/month
  2. ) If migraines decrease quality of life
  3. ) If acute treatments are ineffective or contraindicated
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14
Q

Which BB used for migraine prophylaxis is the most lipophilic?
A.) Timolol
B.) Propranolol
C.) Metoprolol

A

B

Propranolol is the most lipophilic and the most non-selective.

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15
Q 
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
A

C

phenylketonuria, due to sweetener

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16
Q

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
A

D

17
Q

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?

A

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.

18
Q

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

A

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.

19
Q

What is the formulation product of Onzetra Xsail?

A.) Orally disintegrating tablet
C.) Patch
D.) Intranasal powder
E.) Injection

A

D

Onzetra Xsail is a (sumatriptan nasal powder).

20
Q

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

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

21
Q

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)
A

Bright or flickering lights
Too little sleep
Stress

Common migraine triggers include:

  1. ) Hormonal changes in women (fluctuations in estrogen)
  2. ) Foods such as cheeses, processed foods
  3. ) Stress
  4. ) Sensory stimuli
  5. ) Changes in sleep pattern
  6. ) Changes in the environment (weather)
22
Q

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
A

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.

23
Q

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
A

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.

24
Q

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
A

The generic name of Maxalt is rizatriptan.

C

25
Q

Dihydroergotamine is a popular migraine drug that can be administered by the following routes and delivery methods ( Select ALL that apply)

A.) Oral
B.) Intramuscular
C.) Subcutaneous
D.) Nasal
E.) IV
A

B, C, D, E

It not available in oral.

26
Q

A patient came into the pharmacy and asked for a refill on her Imitrex. The patient states that these headaches really “wipe me out” and reports that although she has them approximately once monthly, when a migraine occurs, she has to miss work and feels terrible for 2-3 days. Is this patient a candidate for migraine prophylaxis treatment?

A.) No, she needs to have 3 or more migraines weekly.
B.) No, she needs to have 3 or more migraines monthly.
C.) No she needs to have 4 or more migraines weekly.
D.) No, she needs to have 4 or more migraines monthly.
E.) Yes, she is a candidate for prophylactic treatment.

A

Yes, she is a candidate for prophylactic treatment.

She is a candidate for prophylactic therapy because her migraines decrease her quality of life.

27
Q

A pharmacist is counseling a new patient on the appropriate use of a Zomig Nasal Spray. Please select the following counseling point that does NOT apply?
A.) Prime the nasal spray before use.
B.) Blow nose gently before use.
C.) Do not press the plunger until the tip of the device is inserted into the nostril.
D.) May repeat in 2 hours, if needed.
E.) Remove the protective cap.

A

A

Remember: Usually nasal sprays are primed since it takes a few sprays to get the medication to come out. With one-time devices, including the Zomig and Imitrex nasal sprays, if they are primed, the dose is lost.

28
Q

SR is an 18 year-old patient with asthma, iron-deficiency anemia, heavy menstrual bleeding and monthly migraines (without aura) that occur predictably right before her period. She does not experience headaches at other times of the month. SR is in misery when she has a migraine and usually misses several days of school. Choose a reasonable prophylactic option to help her control her migraines.

A.) Sumatriptan
B.) Propranolol
C.) Seasonique
D.) Metipranolol
E.) Fioricet
A

Seasonique

A birth control pill could reduce or even eliminate the menstural-associated migraine that many women experience.

In this case, it would also provide benefit in reducing blood loss and hopefully improving the patient’s anemia.

Since the patient does not have aura, any OCP is a viable option.

Other options are either not used for prophylaxis or are not the best choice based on the patient’s medical history.

29
Q

Which of the following contraceptive options is recommended to treat menstrual-associated migraine (MAM) with aura in a female patient? Select ALL that apply.

A.) Amethyst
B.) Nor-QD
C.) Nora-BE
D.) Sprintec 28
E. )Camila
A

Nor-QD
Nora-Be
Camila

If the migraine is associated with aura and a birth control pill will be used to help control the migraines, a progestin only pill should be choosen.

Migraine with aura has a higher risk of stroke and estrogen should be avoided.

30
Q 
SG is a 25 year old female who presents to the pharmacy with a prescription for Migranal Nasal Spray. 
Medications
Lisinopril 10mg QD
Cimetidine 400mg HS
Metformin 1g BID
Atenolol 100mg QD
Cholorthalidone 25mg QD
Xanax 0.5mg BID

Which of the following actions should the pharmacist take at this time? Select ALL that apply

A.) Verify whether the patient is pregnant; do not fill if pregnant
B.) Recommend changing the cimetidine to Pepcid
C.) Recommend changing the prescription to Cafergot
D.) Fill as written
E.) No changes. Fill as written after confirming that the patient has tried and failed triptan therapy.

A

A, B

Verify whether the patient is pregnant; do not fill if pregnant

Recommend changing the cimetidine to Pepcid

The ergot products are pregnancy Category X and contain a boxed warning not to use with strong/moderate CYP 3A4 inhibitors and a warning to avoid use with lesser inhibitors ( such as cimetidine) due to the risk of cerebral ischemia with higher drug levels. Cafergot, as you may have guessed from the name, contains caffeine and ergotamine. It has the same warnings as other ergotamine products

31
Q

Which of the following drugs used for migraine prophylaxis is best avoided in a female of child-bearing age?

A.) Propranolol
B.) Timolol
C.) Valproic acid
D.) Topiramate
E.) Amitriptyline
A

C

Of the list above, valproic acid is the most teratogenic and should be avoided in this patient population. Many pregnancies are not planned at the time of conception.

32
Q

A patient presents to the pharmacy with a prescription for Fiorinal. Choose the correct statement concerning Fiorinal.

A.) It contains a barbiturate
B.) It is a C-IV agent
C.) Risk of physiological dependence is low.
D.) It is a C-II agent
E.) It is the preferred treatment for migraine prophylaxis

A

A

It contains a barbiturate

The agent has risk for physiological dependence.

EXAM (17 decks)

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