MiGRAINES

Question 1

Amerge

Answer 1

Naratriptan

Oral tabs

MAX: 5mg/d**

NOTE: WAIT 4 hours between doses

-Slower onset HOWEVER, last long

Question 2

Maxalt

Answer 2

Rizatriptan

Tabs (5-10mg)
ODT*

MAX: 30mg/ DAY

WAIT AT LEAST 2 hours between doses

Counseling:

phenylketonurics**

Use clean dry hands

Question 3

Imitrex; Alsuma; sumavel; zembrace, Onsetra

Answer 3

Sumatriptan

Tabs
SUBQ*
NASAL*

PO: 25, 50, 100mg (works in 30 minutes) MAX DOSE: 200mg/ 24 hours wait 2 HOURS in between doses * (READ ALL OF THIS*
———————
SQ(Alsuma): 6mg each dose; MAX IS TWO SHOTS PER DAY or 12mg/d ##1 hour WAIT PERIOD##
———————
SC(Sumavel DosePro): High pressure burst of nitrogen; INJECTION free. Max: 12mg/ d.
———————
SQ(Zembrace Symtouch): 3mg/0.5mL: MAX IS 12mg/ day which means 4 SHOTS ##1 hr WAIT PERIOD##
———————
NS: MAX 40mg/ d works in 15 minutes ; Nasal Powder (Onzetra)

Question 4

Zomig

Answer 4

Zolmitriptan

Oral tabs
ODT*
Nasal*

Question 5

Axert

Answer 5

Almotriptan

Question 6

Frova

Answer 6

Frovatriptan

Oral tabs

Question 7

Relpax

Answer 7

Eletriptan

20;40mg TABS

Question 8

TRIPTANS

Answer 8

5HT AGONIST

1) increase SEROTONIN
2) VASOCONSTRICTION

Question 9

Triptans

SIDE EFFECTS

Answer 9

Nausea or HA recurrence

Chest TIGHTNESS*
Dizziness
SLEEPINESS

parathesias (NUMBNESS OR TINGLING)

Question 10

Triptans

CAUTIONS/ contraindications

Answer 10

1) CAD**
2) uncontrolled HTN
3) VASOSPASTIC ANGINA (prinzmetal)
4) pregnancy CATEGORY C
5) ischemic stroke/ heart disease

• *CONTRAINDICATED WITH ERGOTA
• *CONTRAINDICATED WITH MAOI’s

*KIDS: 6-11 recommended:MAXALT TABS OR IMITREX NASAL

Question 11

Onzetra

Answer 11

Sumatriptan Nasal Powder

Fast-Acting-NASAL

BREATH ACTIVATED NASAL FORMULATION

MAX: 44mg/ day (TWICE PER DAY)

Question 12

Treximet

Answer 12

One tablet (sumatriptan 85mg & naproxen 500mg)

-ORIGINAL CONTAINER HAS A DESICCANT

Question 13

Zomig

Answer 13

ODT
NASAL SPRAY

MAX: 10mg/ day

Wait 2 HOURS in BETWEEN

Question 14

Axert

Answer 14

Almotriptan

Tabs ONLY

Max:25mg/ d

Wait: 2 HOURS

Question 15

Frova

Answer 15

Frovatriptan

Tabs

Max 7.5mg/ day

VERY SLOW ONSET

2 hour WAIT

Question 16

Relpax

Answer 16

Eletriptan

Tabs ONLY

MAX: 80mg/ d

CYP3A4 substrate DO NOT USE WITHIN 72 hours of 3A4 INHIBITORS

Question 17

Migranal

DHE 45

Answer 17

Dihydroergotamine

Migranal (NASAL SPRAY)

DHE 45 (IV/IMSQ)

Question 18

Ergomar

Answer 18

Ergotamine SL TABLETS

Question 19

Cafergot

Answer 19

Ergotamine plus caffeine

Cafergot - tabs

Migergot - SUPP

Question 20

Ergot alkaloids

Answer 20

MOA:

Vasoconstriction

Interacts with DA/ 5HT/ NE

Question 21

Ergot alkaloids

CAUTIONS/ contraindication

Answer 21

PREGNANCY CATEGORY X

CYP3A4 substrates BLACK BOX WARNING

CAD, PVD, HEPATIC IMPAIRMENT, RENAL IMPAIRMENT

Question 22

Ergot SIDE EFFECTS

Answer 22

Nausea/ vomitting

Numbess/ tingling

**BETA BLOCKERS: peripheral ischemia

**INHIBITORS WILL INCREASE THEM

Question 23

Fioricet, esgic

Answer 23

Butalbital/ Caffeine/ APAP

INDICATION: tension/ muscle HA > 12YO

FORMS: 50/40/325 TABS
50/40/300 CAPSULES

Dose: 1-2 tabs/caps Q4H

MAX: 6 TABLETS PER DAY

SE: slow thinking, depressed mood, drowsiness, hepatotoxicity
——————————————-

Question 24

FioriNAL

Answer 24

Butalbital ; caffeine; ASA (C-III)

1-2 TABS Q4H. MAX: 6 TABS/ DAY

Question 25

Nodolor

Answer 25

Isometheptene + Dichloralphenazone + APAP

65mg/ 100/ 325mg CAPS

• Isometheptene: VASOCONSTRICTOR
• Dichloralphenazone: (1-2 mixture of antipyrine with chloral hydrate; a sedative

Apap- analgesic
———————————-

2 caps at onset then 1 CAP Q1H until PAIN relieved

• MAX 5 caps Q12H

Question 26

Nodolor DI and CAUTIONS

Answer 26

MAOIs: Severe HA, HTN, possible hypertensive crisis

Cautions:

• Renal failure/ Hepatic impairment
• HTN/ PVD/ CAD

Question 27

Excedrin MIGRAIN

Answer 27

APAP; aspirin; CAFFEINE

PREGANCY CATEGORY D

DRINK WITH WATER AND FULL GLASS OF WATER