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NAPLEX Review > Migraine > Flashcards

Migraine Flashcards

1
Q

Aura definition

A

sensory warnings s/sx

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2
Q

What can indicate a serious CV, cerebrovascular, or infectious event in someone with a migraine?

A

Fever, stiff neck, rash, confusion, seizures, double vision, weakness, numbness, chest pain, shortness of breath, or aphasia (trouble speaking)

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3
Q

What is MAM and how are they treated?

A

menstrual-associated migraine

Oral contraceptives or estradiol patch

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4
Q

Women with what types of migraines are at a higher risk of a stroke?

A

migraine with aura

should not use estrogen-containing contraceptives

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5
Q

What are common migraine triggers

A 
Hormonal changes in women
Foods
Stress
Sensory stimuli
Changes in wake-sleep pattern
Changes in the environment
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6
Q

How are migraines diagnosed?

A

After 5 attacks fulfilling the following criteria

  • HA last 4-72 hours and recur sporadically
  • HA have 2 or more of the following: unilateral location, pulsating, moderate-severe pain and aggravated by routine physical activity
  • One of the following occurs during the HA: N/V, photophobia, and phonophobia
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7
Q

What natural products have been used for migraines?

A 
Caffeine
Butterbur
Feverfew
Magnesium
Riboflavin
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8
Q

What acute drug therapies are options for people with migraines (given when HA is already present). What medications are NOT recommended

A

OTC: APAP, ibuprofen, Excedrine, Aleve (naproxen)
Rx: Serotonin receptor agonists (triptans), ergotamine-containing medications

NOT recommended but can be used: opioids, butabital-containing products, tramadol, and tapentadol

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9
Q

Triptan MOA

A

agonists for the 5-HT1 receptor causing vasoconstriction of cranial blood vessels inhibiting neuropeptide release and decrease pain transmission

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10
Q

What migraine medications are first line for acute treatment

A

Triptans

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11
Q

How often should triptans be used?

A

NO more than 3-5x per month

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12
Q

Triptan CI, warnings, SE

A

CI: Cerebrovascular disease (Stroke/TIA), uncontrolled HTN, ischemic heart disease, use within 24 hours of another triptan or ergotamine-type medication
Warnings: risk of increased BP, serotonin syndrome
SE: Paresthesia (tingling/numbness), triptan sensations (Pressure/heaviness in the chest or neck region)

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13
Q

What triptans are approved for children 12 and older and children 6-17 years old?

A

12 and older: Almotriptan tabs, zolmitiptan nasal spray and Treximet
6-17: Rizatriptan

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14
Q

What are considered long-acting triptans?

A

Frovatriptan - half-life 26 hours
Naratriptan
Onset is slower
Choose if HA recurs after dosing, lasts a long time, or can be anticipated

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15
Q

What triptans have short half-life and fast onset?

A 
Almotriptan
Eletriptan
Rizatriptan
Sumatriptan
Zolmitriptan
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16
Q

What triptans come in tablet form?

A

All of them

17
Q

What triptans come in ODT form?

A

Rizatriptan (Maxalt-MLT)

Zolmitriptan (Zomig ZMT)

18
Q

What triptans come in Nasal spray/powder

A

Spray: Sumatriptan (Imitrex), Zolmitriptan (Zomig)
Powder: Sumatriptan (Onzetra Xsail)

19
Q

What triptans come in SQ injections

A

Prefilled syringe: sumatriptan

Autoinjector: sumatriptan (Imitrex STAT dose Systemi, Zembrace SymTouch)

20
Q

Triptan drug interactions

A

Caution when combined with SSRI and SNRIs (probably safe since triptan is PRN)
Sumatriptan, rizatriptan, and zolmitriptan CI with MAOi
Eletriptan CI with strong CYP3A4 inhibitors, reduce almotriptan dose

21
Q

What migraine medications are ergotamine drugs?

A

Dihydroergotamine (DHE 45, Migranal)

Ergotamine _ caffeine

22
Q

Ergotamine medications MOA

A

Nonselective agonist of serotonin receptors which cause vasoconstriction

23
Q

What medication is used in patients who do not find benefit with a triptan or who a triptan is CI?

A

Ergotamine

24
Q

Ergotamine BBW, CI, and warnings

A

BBW: CI in patients with potent CYP3A4 inhibiotrs (PI, azols, macrolides) d/t severe life-threateninng peripheral ischemia
CI: uncontrolled HTN, pregnancy, ischemic heart disease
Warnings: CV events, Cerebrovascular events, drug interactions

25
Q

Butalbital drug class

A

barbiturate

26
Q

Components of Fioricet and Fiorinal

A

Fioricet: APAP/butalbital/caffeine - not scheduled
Fiorinal: ASA/butalbital/caffeine - C-III

27
Q

What medications are given prophylactically for migraines?

A

Beta blockers, lisinopril, verapamil, topiramate, valproic acid, TCA, venlafaxine, calcitonin Gene-related Peptide (CGRP) receptor antagonists
MAM - contraceptives

28
Q

When should a prophylactic medication be considered for a patient

A

If a patient requests it, if they use acute treatment 2 or more times per WEEK or 3 or more times per month, if migraine decreases QOL or if acute treatments are ineffective or CI

29
Q

What is the efficacy of prophylactic migraine medications

A

~50% reduction in headache days

30
Q

What beta blockers are used prophylactically for migraines?

A

Propranolol
Metoprolol
Timolol

31
Q

What antiepileptic drugs are used prophylactically for migraines?

A

Divalproex/Valproic acid

Topiramate

32
Q

Divalproex/Valproic acid BBW and SE

A

BBW: fetal harm, hepatic failure
SE: Weight gain, thrombocytopenia, increased ammonia, alopecia

33
Q

Topiramate warnings and SE

A

Warnings: Fetal harm, metaboilc acidosis, nephrolithiasis, increased ammonia, open angle glaucoma, oligohidrosis
SE: weight loss (6-13%), somnolence, cognitive impairment

34
Q

What medications are calcitonin gene-related peptide (CGRP) receptor antagonists? How often are they administered?

A 
Eptinezumab-jjmr (Vyepti)
Erenumab-aooe (Aimovig)
Fremanezumab-vfrm (Ajovy)
Galcancezumab-gnlm (Emgality)
Rimegepant (Nurtec)

Vyepti - q3m
All others monthly

35
Q

Botulinum toxin (Botox) use in migraines - when to use

A

Use for chronic migraines

15 or more headache days per month

36
Q

How many days should migraine medications be limited to per week to prevent medication overuse headaches (MOH)?

A

2-3x/week

NAPLEX Review (79 decks)

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