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NAPLEX 2022 > Migraine/Gout > Flashcards

Migraine/Gout Flashcards

1
Q

What other symptoms accompanied by a headache should a patient seek medical attention?

A 
Fever
Stiff neck
Rash
Confusion
Seizures
Double vision
Weakness
Numbness
Chest pain
SOB
Aphasia (trouble speaking)
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2
Q

What is a common type of migraine in women? How is it treated?

A

Menstrual-associated migraine (MAM)

Tx: oral contraceptives or estradiol patch to decrease the frequency

women who experiences migraine with aura are at a higher risk for stroke; estrogen-containing contraceptives should be avoided

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3
Q

Common migraine triggers

A
  1. Hormonal changes in women
  2. Foods (alcohol, aged cheeses, overuse of caffeine, salty & processed foods)
  3. Sensory stimuli (bright lights, sun glares, loud sounds, certain scents)
  4. Changes in Wake-Sleep Pattern
  5. Changes in the Environment
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4
Q

Diagnosis in adults

A

At least 5 attacks:

  1. Headaches lasting 4-72 hours
  2. Unilateral location, pulsating
  3. N/V, photophobia (sensitivity to light), phonophobia (sensitivity to sound)
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5
Q

Natural products used for migraines

A 
Caffeine
Butterbur
Feverfew
Magnesium
Riboflavin
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6
Q

Acute (abortive) treatment used for headache that is already present.

A

OTC:

     - acetaminophen
     - Advil Migraine (only ibuprofen)
     - Excedrin Migraine (ASA + ibu + Naproxen)
     - Aleve (Naproxen)
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7
Q

Prescription options for acute treatment

A

Serotonin receptor agonists (Triptans)

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8
Q

What types of drugs are not recommended due to abuse/dependence issues for migraines?

A

Opioids, butalbital-containing products, tramadol and tapentadol

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9
Q

Triptans MOA

A

selective agonists for the 5-HT1 receptor and can cause vasoconstriction of cranial blood vessels

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10
Q

Triptans agents (generic/brand)

A

rizatriptan (Maxalt-MLT)
sumatriptan (Imitrex)
zolmitriptan (Zomig ZMT)

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11
Q

Which triptan has the longest half life? What is the half life?

A

frovatriptan (Frova) - 26 hours

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12
Q

Triptans that have a shorter half life have a faster onset. Which are?

A 
almotriptan
eletriptan
rizatriptan
sumatriptan
zolmitriptan
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13
Q

What are the formulations available for triptans?

A

sumatriptan (nasal spray, powder, prefilled syringe & auto-injector)

zolmitriptan (nasal spray & ODT)

rizatriptan (ODT)

All Triptans are available as tablets

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14
Q

Triptan drug interactions

A

Sumatriptan, rizatriptan & zolmitriptan are contraindicated with MAOIs (or w/in 2 weeks of stopping)

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15
Q

Ergotamine MOA

A

nonselective agonist of serotonin receptors

*used if patients do not benefit triptans**

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16
Q

Ergotamine agent

generic/brand; formulation, Boxed warnings, contraindications

A

dihydroergotamine (D.H.E. 45, Migranal)

Formulations: IM/SC/IV, nasal spray

Boxed warnings: CI with potent CYP3A4 inhibitors due to peripheral ischemia

Contraindications: uncontrolled HTN, pregnancy, ischemic heart disease

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17
Q

Name the oral CGRP receptor antagonists approved to treat acute migraine attacks.

(generic/brand)

A

rimegepant (Nurtec ODT)

ubrogepant (Ubrelvy)

18
Q

What drug is a first-in-class serotonin agonist that is selective for the 5-HT1F receptor subtype?

(generic/brand)

A

lasmiditan (Reyvow)

C-V

19
Q

Fioricet generic

A

acetaminophen + butalbital + caffeine

20
Q

Fiorinal generic

A

aspirin + butalbital + caffeine

C-III

21
Q

Prophylactic drug treatment is considered when?

A

acute treatments > 2 days/week or > 3 Xs/month, if the migraine decrease their QOL

22
Q

Oral prophylactic therapies include

A

Antihypertensives: beta-blockers - propranolol

Antiepileptics: topiramate* (popular = weight loss) and valproic acid

Antidepressants: amitriptyline or venlafaxine

MAM: monophasic and extended-cycle OCs if not aura

23
Q

Monoclonal antibodies typical dosing range

eptinezumab-jjmr (Vyapti)

A

IV Q3 months

24
Q

Monoclonal antibodies typical dosing range

erenumab-aoor (Aimovig)

A

SC monthly

25
Q

Monoclonal antibodies typical dosing range

fremanezumab-vfrm (Ajovy)

A

SC month or SC Q3 months

26
Q

Monoclonal antibodies typical dosing range

galcanezumab-gnlm (Emgality)

A

SC monthly

27
Q

What agent is used for chronic migraines ONLY? What is considered as chronic?

A

Botox

> 15 headache days per month

28
Q

Why are migraine medications limited to acute treatment to 2-3 times per week, at most?

A

Medication overuse headaches (MOH) aka rebound headaches

29
Q

Counseling point for sumatriptan nasal powder

Brand?

A

Brand: Onzetra Xsail

CP: place mouthpiece into your mouth; blow into the device with your mouth for 2-3 seconds to deliver medication into your nose

30
Q

Define gout

A

build up of uric acid (UA) crystals primarily in the joints

31
Q

What is the medical name of the joint for the big toe?

A

metatarsophalangeal joint

**most common joint where gout occurs*

32
Q

Risk Factors for Gout

A

Male gender
Obesity
Excessive alcohol

33
Q

Drugs that increase uric acid

A 
Aspirin, lower doses
Calcineurin inhibitors (tacrolimus and cyclosporine)
Diuretics (loops and thiazides)
Niacin
Pyrazinamide
Select chemotherapy (with TLS)
Select pancreatic enzyme products
34
Q

Foods to avoid to prevent gout attacks

A

Organ meats
High-fructose corn syrup
Alcohol

35
Q

Prophylactic drugs are used to do what?

A

lower UA levels (goal: < 6 mg/dL)

36
Q

Gout Treatment Basics

A
  1. Treat acute pain w/ anti-inflammatory drugs
    • Colchine
    • Steroids
    • NSAIDs (often starting in high doses)
  2. Once gout has struck, treat chronically to prevent future attacks
    • Xanthine oxidase inhibitor (XOI): allopurinol** or febuxostat
    • *an acute gout flare can occur when an XOI is started, so give initially with colchicine or an NSAID
  3. if XOI didn’t work well enough and UA remains > 6 mg/dL
    • Add probenecid or lesinurad to daily XOI
    • replace the XOI with IV pegloticase (Krystexxa)
37
Q

Steroids used in gout

A

prednisone/prednisolone

methylprednisolone (Medrol, Solu-Medrol)

38
Q

NSAIDs used in gout

A

indomethacin (Indocin)
naproxen (Aleve)
celecoxib (Celebrex)

39
Q

What drug is a urate-oxidase enzyme used in the treatment of tumor lysis syndrome (TLS) and is contraindicated with G6PD deficiency?

A

rasburicase (Elitek)

40
Q

What is the MOA of pegloticase (Krystexxa)?

A

Recombinant uricase: converts uric acid to allantoin

IV formulation - must be premedicated with antihistamines and steroids due to anaphylactic reactions

Reserved for refractory disease

41
Q

Patients at risk risk of a severe Allopurinol hypersensitivity reaction should be screened what prior to drug use?

A

HLA-B*5801 allele

if positive - (esp. Asians) do not use drug

NAPLEX 2022 (25 decks)

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