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NAPLEX review 2024 RXPrep Book > Pain/Related Conditions: Migraine > Flashcards

Pain/Related Conditions: Migraine Flashcards

1
Q

Common migraine triggers

A

Hormone changes in women
foods
stress
sensory stimuli
Changs in wake-sleep pattern
changes in environment

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2
Q

Migraine diagnosis

A

headaches last 4-72hrs and recur randomly

headaches have >2 of following (unilateral location, pulsating, mod/severe pain, aggrevated by routine physical activity)

during headache: nausea, vomiting, sensitivity to light/sound

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3
Q

Triptan mechanism of action

A

selective agonists for the 5-HT1 receptor

vasoconstriction cranial blood vessels, inhibit neuropeptide release and dec pain transmision

1st line for acute txm

should be taken at first sign of headache, but limit to 3-5 headaches per month

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4
Q

Medication overuse headaches

A

“rebound” headaches

can occur due to overuse of acute headache meds
limit acute headache treatment to 2-3 times per week to avoid

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5
Q

Triptan meds

A

Eletriptan (Relpax)
Rizatriptan (Maxalt)
Sumatriptan (Imitrex)
Zolmitriptan (Zomig)

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6
Q

Triptan Contraindications

A

Cerebrovascular disease (stroke, TIA)
uncontrolled HTn
heart disease
use within 24hrs of other triptan or ergotamine-type med

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7
Q

Triptan warnings

A

risk of inc BP, serotonin syndrome

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8
Q

Triptan side effects

A

parathesia (tingling/numbness)
Triptan sensations (pressure or heaviness in chest or pressure in neck region)

dizziness
hot/cold sensations
overuse headaches

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9
Q

Triptan notes

A

ODT, nasal, injections = useful if nausea present
Nasal/injections work faster
Nasal = 1 dose, dont prime

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10
Q

Which triptans should not be used in phenylketonuria patients

A

Maxalt MLT
Zomig ZMT ODTs

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11
Q

Which triptans can be used in children > 12yrs old

A

almotriptan tablets
zolmitriptan nasal spray
Treximet (Sumatriptan+ naproxen)

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12
Q

Which triptan approved ages 6-17

A

Rizatriptan

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13
Q

Triptan duration of action

A

Frovatriptan = longest half life
Frovatriptan + naratriptan = long acting but slow onset

other triptans have faster onset but shorter half life

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14
Q

Which triptans come as ODT

A

Rizatriptan (Maxalt-MLT)
Zolmitriptan (Zomig ZMT)

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15
Q

Which triptans come as nasal spray

A

Sumatriptan (Imitrex)
Zolmitriptan (Zomig)

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16
Q

Which triptans contraindicated with MAOi or within 2 weeks of stopping

A

Sumatriptan
Rizatriptan
Zolmitriptan

17
Q

Ergotamine drugs

A

for patients who dont get benefit with triptans, ergotamine used next

Dihydroergotamine (D.H.E 45, Migrant)
Ergotamine + caffeine (Cafergot, Migergot)

18
Q

Ergotamine boxed warnings

A

CI with potent CYP3A4 inhibitors due to life threatening peripheral ischemia

19
Q

Ergotamine Contraindications

A

uncontrolled HTN
ischemic heart disease
pregnancy

20
Q

Ergotamine warnings

A

Cardiovascular effects
cerebrovascular events
many drug interactions

21
Q

Ergotamine side effects

A

nausea
vomiting

22
Q

Using Ergotamine nasal spray

A

requires priming

23
Q

Oral CGRP receptor antagonists

A

Nurtec
Ubrelvy

24
Q

Ubrelvy (ubrogepant) is approved to….

A

treat acute migraines

25
Q

Nurtec (rimegepant) is approved to…

A

treat and prevent migraines

26
Q

Reyvow (Lasmiditan) is class….

A

V

27
Q

Fioricet is….

A

tylenol/butalbital/caffeine

its not control, but the one with aspirin/butalbital/caffeine is

28
Q

migraine preventative treatment should be considered in pts

A

pts who use acute treatments > 2 days/week or > 3 times per month
migraines have decreased the quality of life
acute treatments ineffective or CI

29
Q

Beta-Blockers for migraines

A

Propranolol
Metoprolol

30
Q

Antiepileptic for migraines ppx

A

Divalproex (Depakote)
Topiramate (Topamax)

31
Q

Divalproex (Depakote) boxed warnings and side effects

A

Boxed warnings: fetal harm, hepatic failure
Warnings/SE: Weight gain, thrombocytopenia, inc ammonia, alopecia

32
Q

Topiramate (Topamax) boxed warnings and side effects

A

Warnings: fetal harm, metabolic acidosis, nephrolithiasis, inc ammonia, open angle glaucoma and visual field defects, oligohidrosis

SE: weight loss, somnolence, cognitive impairment

33
Q

2 oral CGRP antagonists approved for migraine prevention

A

Nurtec
Qulipta

34
Q

Which CGRP antagonist injection is once every 3 months

A

Vyepti

35
Q

Which CGRP antagonist injection is once every month

A

Aimovig
Emgality

36
Q

How is Ajovy given?

A

can be given monthly or every 3 months depending on dose

37
Q
A

NAPLEX review 2024 RXPrep Book (78 decks)

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