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Pharmacy 255 > Migraines > Flashcards

Migraines Flashcards

1
Q

Who generally get migraines more?

A

young, women

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2
Q

What is the suspected mechanism of a migraine?

A

Sensitive neurons, trigger causes release of vasodilators (CGRP and NO), this causes inflammation that begets more inflammation

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3
Q

IN regards to time to treat migraine what is important?

A

faster=better

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4
Q

What are some potential migraine triggers?

A

stress, food(chocolate or cheese), alcohol (red wine), skip meals

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5
Q

What is the POUND pneumonic?

A

Pulsate headache
One day duration
Unilateral
Nausea
Disabling
*for diagnosing

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6
Q

What is the simplified steps of treatment for Migraines?

A

NSAID
Triptan
Both
SQ SUma

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7
Q

Is opioids a good option for migraines?

A

NO

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8
Q

How can we increases the efficacy of drugs for migraines? WHy does this work?

A

metoclopramide increases motility of stomach= faster onset

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9
Q

With regards to NSAIDs how can we get faster onset?

A

NO food, Liquid gels diclo potassium, Naproxen sodium

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10
Q

What form of naproxen is faster and by how much?

A

Naproxen sodium
20 min faster

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11
Q

If a triptan fails what is next step?

A

switch to a different one (try 3), add a combo, if low absorb go with SQ or nasal

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12
Q

Which triptans are slower?

A

naratriptan and frovatriptan

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13
Q

Which triptans are better tolerated?

A

Nara and frova

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14
Q

What is most efficacious triptan?

A

SQ sumatriptan

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15
Q

Why do we avoid opioids for migraines?

A

causes headaches, Acet and caffiene dose is subtherapeutic

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16
Q

What level of caffiene is needed for headaches?

A

100 mg

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17
Q

MOA of triptans?

A

vasoconstrictors b y seratonin agonists

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18
Q

True or false injection triptans do not cause nausea?

A

FALSE

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19
Q

S/e of triptans?

A

chest tightness, palpitations, dizzy, nausea

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20
Q

Who should NOT get triptans?

A

CVD, if ergot in 24 hours= vasospasm, MAO

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21
Q

What is potential s/e of metoclopramide?

A

parkinsons like because stopping dopamine

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22
Q

Which riptan is the cheapest?

A

Almotriptan

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23
Q

Which is better NSAIDs or acet for migraine?

A

NSAIDs but acet worth an add on

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24
Q

I am a patient with bad nausea from triptans. WHat are my options?

A

Add antiemetic, nasal, SQ or nava or frova

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25
Q

Are disintegrating triptans faster than regular?

A

NO it is only absorbed in SI

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26
Q

What is max days a month for triptans?

A

9

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27
Q

What is max days a month for opioids?

A

9

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28
Q

What is max days a month for NSAIDs/acet?

A

14

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29
Q

What is max days a month for combos?

A

9

30
Q

How many migraines a month indicates med over use?

A

> 15

31
Q

What should we do if menstrual migraines

A

start 2 days before

32
Q

What is an interesting prvention method for menstual induced migraines?

A

Hormonal contraception but IF THEY HAVE NO AURA

33
Q

What are the two CGRP antagonists?

A

Ubrogepant and Atogepant

34
Q

Which CGRP is approved for treat which one is only for prophylaxis?

A

Treat= ubro
prevent=atog

35
Q

How do CGRPs work?

A

stops dilations!!!!!!

36
Q

What are s/e of CGRPs

A

nausea, somnolence

37
Q

Is it okay to give CGRP in CV patients?

A

YES

38
Q

IS CGRP more effective than triptans?

A

NO because its too slow

39
Q

Are CGRPs at risk of medication induced headache?

A

NO

40
Q

Why can you not be on an ergot and triptan?

A

TOO MUCH constriction

41
Q

What patients could use prophylaxis?

A

> 6 attacks a month or severe 3x a month, or difficult to treat migraines

42
Q

How long should you remain of prophylaxis regimine for?

A

8-12 weeks

43
Q

What are the best agents for prophylaxis? What is rate of help?

A

amitriptyline, propanolol, metoprolol, topiramate
60%

44
Q

What agents are second line if adverse reaction is an issue for prophylaxis? What is rate that it helps?

A

candesartan, magnesium and riboflavin
40%

45
Q

When do side effects of prophylaxis tend to stop?

A

10 days

46
Q

What is a realistic expectation for prophylaxis?

A

decrease by 50%

47
Q

Which prophylaxis agent is best if smoking is comorbidity?

A

nortiptyline

48
Q

Which prophylaxis agent is best if insomnia is comorbidity?

A

amitriptyline

49
Q

Which prophylaxis agent is best if HTN is comorbidity?

A

B blocker, ARB

50
Q

Which prophylaxis agent is best if chronic pain is comorbidity?

A

amitriptyline, topiramate, SNRI

51
Q

Which prophylaxis agent is best if MDD is comorbidity?

A

SNRI, Amitriptyline,

52
Q

Are SSRIs a good option for prophylaxis?

A

NO

53
Q

What is the best beta blocker for prophylaxis?

A

propanolol

54
Q

What is a bad side effect of b blocker that is bad for younger people?

A

exercise intolerance

55
Q

What is the anti CGRP antibody drug and its dose and onset?

A

Fremanezumab 225 mg SQ q4weeks
days to to up to 6 months

56
Q

What is s/e of fremanezumab?

A

hypeternsion

57
Q

What are red flag signs of headache?

A

impaired speech, eye sx, headache with sex, >50 preg and other

58
Q

Duration of migraine, Tension, Cluster?

A

M= 4-72
T=7 day
C= 3 hours

59
Q

location of migraine, Tension, Cluster?

A

M=Unilat but bi possible
T=bilat
C=unilat

60
Q

type of pain of migraine, Tension, Cluster?

A

M=pulse
T=pressing
C=stabbing

61
Q

SX of migraine, Tension, Cluster?

A

M=Aura, nausea
T=Light, NO nausea
C=clusters

62
Q

Treatment of migraine, Tension, Cluster?

A

M=DUH
T=NSAIDs/acet
C=SQ sumatriptan

63
Q

Which TCA is tertiary?

A

Amitriptyline

64
Q

Of the first line prophylaxis meds which is the least tolerable?

A

Topiramate>TCA>Bblocker

65
Q

What is dose of propanolol?

A

80 mg BID

66
Q

What is dose of Metoprolol?

A

100 mg BID

67
Q

What is dose of Amitriptyline?

A

75 mg Hs

68
Q

What is dose of Nortriptyline?

A

50 mg hs

69
Q

What is dose of Topiramate?

A

50 mg BID

70
Q

What is dose of Candesartan?

A

16 mg

Pharmacy 255 (16 decks)

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