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Therapeutics > Thrp: Exam 6 (Sleep,Thrombosis,Neurology) > Flashcards

Thrp: Exam 6 (Sleep,Thrombosis,Neurology) Flashcards

1
Q

Alcohol

A

Improves Sleep Latency
Tolerance: w/in 6 nights

AE: inc # of awakenings and length, residual daytime sedation, abuse/ dependence *Respiratory depression
Lots of DDI

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2
Q

Diphenhydramine

A

OTC Anti-Histamine for sleep: Ant H1/ACh Receptor
t1/2=5-11hrs
Dose: 25-50mg
Tolerance=3-7 days
Tx: mild/short-term insomnia
*NOT Elderly, NOT chronically, Peds? paradoxical rxn

(Benadryl)

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3
Q

Doxylamine

A

OTC Anti-Histamine for sleep: Ant H1/ACh Receptor
t1/2=6-12hrs
Dose: 25-50mg
Tolerance=3-7 days
Tx: mild/short-term insomnia
*NOT Elderly, NOT chronically, Peds? paradoxical rxn

(Unisom)

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4
Q

Valerian

A

OTC Herbal Supp for Sleep: maybe inc GABA
Dose: 300-600mg ??->(dried root 2-3g soaked hot water)
Efficacy: dec sleep latency by less than 1min
AE: Hepatotoxicity

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5
Q

Melatonin

A 
OTC Sleep: Mimic hormone, reg circadian rhytm
Dose:0.5-5mg
AE: HA, N/V/D, dizziness/hypotension,
*cases of seizure (rare but epileptics)
Poor data
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6
Q

Ramelteon

A

Insomnia (indicated): Melatonin (MT1/MT2-selective) Receptor AGonist
t1/2=1.5-5 hrs; MET hepatic
Dose: 8mg w/in 30min of HS
(studied strengths up to 32mg: found no inc efficacy and more SE)

AE: dizziness, abnormal thinking, CNS/Resp. depression, dec libido, sleep-related activities

(Rozerem - no generic) $$$
Efficacy: Dec sleep onset latency 10-15min; total sleep time inc 10-15min
No BDZ/”z-drug” comparative trials

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7
Q

Trazodone

A

Tx: sleep (if co-morbid condition): 5-HT RUI, H1/α1 Antagonist
t1/2= 6-10hrs; MET: hepatic
Dose: 25-100mg (depression ~600mg/day)
**use in pts with SSRI/bupropion-induced insomnia and ***BEST for elderly

AE: Edema, orthostasis (elderly) priapism, seretonin syndrome

Efficacy: often used 1st line, but only 1 RCT with poor results;
1st line?? dec AE/abuse potential and no tolerance

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8
Q

Doxepin

A

TCA (only TCA indicated for insomnia): 5-HT/NE RUI, H1 ANTagonist
(theory lower doses->mostly antihistamine action)
t1/2=15-30* hrs
Dose: 3-6mg PO 30min before bedtime

AE: Cardiac Prolongation (QT) (not safe in OD), Anti-ACh, orthostasis

Efficacy: for insomnia with sleep maintenance difficulty; NOT sleep onset (t1/2): Short term use
AVOID in elderly

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9
Q

Amitriptline

A

TCA (insomnia off label): 5-HT/NE RUI, H1 ANTagonist
(theory lower doses->mostly antihistamine action)
t1/2=15-30 hrs
Dose: 10-50mg

AE: Cardiac Prolongation (QT) (not safe in OD), Anti-ACh, orthostasis

Efficacy: for insomnia with sleep maintenance difficulty; NOT sleep onset (t1/2): Short term use
AVOID in elderly

**TCA: Level B Migraine Prevention Tx:
10-200mg PO HS

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10
Q

Mirtazapine

A

TCA; α2 Antagonist (so inc NE/5-HT) and 5-HT2/3, H1 Antagonist
t1/2= ~20-40hrsl MET- hepatic
Dose: 15-45mg (*Inverse rel between dose and sedation; use low dose for sedation)

AE: Wt Gain, daytime sedation, sleep related events, suicidal

(Remeron): Efficacy unclear, use only if underlying depression

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11
Q

Triazolam

A

BDZ (sleep): GABA Ag
t1/2= 2-5hr (short)
Dose: 0.125-.25mg

Improves sleep latency by 10min; Inc total seep time by 60 min (depends on t1/2) w/ inc NREM II and dec REM/NREM III-IV

CI: Pregnancy X, sleep apnea, Substance Abuse

AE (all worse with long acting, *EtOH): *dose dependent-daytime sedation, **Anterograde amnesia, impaired mem, rebound insomnia for 1-2 nights after d/c, psychomotor incoordination, dec concentration, cognitive deficits
*Tolerance for hypnotic efficacy in 2-4wks

**AVOID IN ELDERLY

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12
Q

Estazolam

A

BDZ (sleep): GABA Ag
t1/2= 10-24hr (intermediate)
Dose: 1-2mg

Improves sleep latency by 10min; Inc total seep time by 60 min (depends on t1/2) w/ inc NREM II and dec REM/NREM III-IV

AE (all worse with long acting, *EtOH): *dose dependent-daytime sedation, **Anterograde amnesia, impaired mem, rebound insomnia for 1-2 nights after d/c, psychomotor incoordination, dec concentration, cognitive deficits
*Tolerance for hypnotic efficacy in 2-4wks

**AVOID IN ELDERLY

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13
Q

Temazepam

A

BDZ (sleep): GABA Ag
t1/2=10-40hr (intermediate)
Dose: 15-30mg

Improves sleep latency by 10min; Inc total seep time by 60 min (depends on t1/2) w/ inc NREM II and dec REM/NREM III-IV

AE (all worse with long acting, *EtOH): *dose dependent-daytime sedation, **Anterograde amnesia, impaired mem, rebound insomnia for 1-2 nights after d/c, psychomotor incoordination, dec concentration, cognitive deficits
*Tolerance for hypnotic efficacy in 2-4wks

**AVOID IN ELDERLY

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14
Q

Flurazepam

A

BDZ (sleep): GABA Ag
t1/2=40-100 hr
Dose:15-30mg (Metabolite)

Improves sleep latency by 10min; Inc total seep time by 60 min (depends on t1/2) w/ inc NREM II and dec REM/NREM III-IV

AE (all worse with long acting, *EtOH): *dose dependent-daytime sedation, **Anterograde amnesia, impaired mem, rebound insomnia for 1-2 nights after d/c, psychomotor incoordination, dec concentration, cognitive deficits
*Tolerance for hypnotic efficacy in 2-4wks

**AVOID IN ELDERLY

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15
Q

Quazepam

A

BDZ (sleep): GABA Ag
t1/2=28-100hr
Dose: 7.5-15mg (metabolite)

Improves sleep latency by 10min; Inc total seep time by 60 min (depends on t1/2) w/ inc NREM II and dec REM/NREM III-IV

AE (all worse with long acting, *EtOH): *dose dependent-daytime sedation, **Anterograde amnesia, impaired mem, rebound insomnia for 1-2 nights after d/c, psychomotor incoordination, dec concentration, cognitive deficits
*Tolerance for hypnotic efficacy in 2-4wks

**AVOID IN ELDERLY

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16
Q

Alprazolam

A

BDZ: GAGA Ag *Not indicated/avoid in insomnia Tx
t1/2=12-15

Have active Metabolites; More rapid absorbed and Higher abuse potential

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17
Q

Clonazepam

A

BDZ: GAGA Ag *Not indicated/avoid in insomnia Tx
t1/2= 18-50

Have active Metabolites; More rapid absorbed and Higher abuse potential

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18
Q

Lorazepam

A

BDZ: GAGA Ag *Not indicated/avoid in insomnia Tx
t1/2=10-14

Have active Metabolites; More rapid absorbed and Higher abuse potential

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19
Q

Diazepam

A

BDZ: GAGA Ag *Not indicated/avoid in insomnia Tx
t1/2= 50-100

Have active Metabolites; More rapid absorbed and Higher abuse potential

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20
Q

Zaleplon

A

“Z-Drug”: GABAA AGonsist->↑sedation (use 3-6mo)
t1/2= 1hr
Dose 5-10mg
NOT good for maintenance (no better than BDZ)

AE: less (but same) than BDZ; Dose dependent
Rebound insomnia 1-2nights after d/c,

(Sonata)

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21
Q

Zolpidem

A

“Z-Drug”: GABAA AGonsist->↑sedation (use 3-6mo)
t1/2= 1.5-4
Dose: 5-10mg

(Ambien)

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22
Q

Zolpidem CR

A

“Z-Drug”: GABAA AGonsist->↑sedation (use ≥6mo)
t1/2= 6.25-12.5mg
Helps with maintenance

AE: less (but same) than BDZ; Dose dependent
Rebound insomnia 1-2nights after d/c,

(Ambien CR)

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23
Q

Zolpidem SL

A

“Z-Drug”: GAGAA AGonsist->↑sedation
t1/2=1.5-6hr
Dose:1.75-3.5mg
FOR Middle of the night in >4hrs left

AE: less (but same) than BDZ; Dose dependent
Rebound insomnia 1-2nights after d/c,

(Intermezzo)

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24
Q

Zolpidem Spray

A

“Z-Drug”: GAGAA AGonsist->↑sedation
t1/2=2-8hr
Dose 5mg

AE: less (but same) than BDZ; Dose dependent
Rebound insomnia 1-2nights after d/c,

(Zolpimist)

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25
Q

Eszopiclone

A

“Z-Drug”: GABAA AGonsist->↑sedation (use ≥6mo)
t1/2=5-7hr
Dose: 1-3mg
Better for sleep maintenance

AE: less (but same) than BDZ; Dose dependent
Rebound insomnia 1-2nights after d/c,

(Lunesta)

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26
Q

Insomnia Efficacy: BDZ

A

Sleep latency dec 10min

Sleep time: inc 33min

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27
Q

Insomnia Efficacy: “Z-Drugs”

A

Sleep Latency: dec 12.8min
Sleep time: inc 12 min

Elderly: Sleep time: inc 25min
nighttime awakenings less than 1/night
5X as likely to have daytime sedation

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28
Q

Insomnia Efficacy: Antidepressants

A

Sleep latency: dec 7min

Sleep time: inc 80min

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29
Q

Modafinil

A

TX: (FDA-Labeled indications)

  • Narcolepsy-improve wakefulness for excessive daytime sleepiness
  • Obstructive Sleep Anpnea - improve sleepiness and adjunct with PAP
  • Shift work sleep disorder

Dose:200-400mg QAM

CIV, cautions inc BP, arrhythmias, CVD
SE: Insomnia

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30
Q

Armodafinil

A

Tx: narcolepsy-excessive daytime sleepiness
Dose: 150-250mg QAM

SE: Insomnia

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31
Q

Dextroamphetamine

A

Stimulent approved to Tx: narcolepsy-excessive daytime sleepiness

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32
Q

methylphenidate

A

Stimulent approved to Tx: narcolepsy-excessive daytime sleepiness

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33
Q

Venlafaxine

A

SNRI approved to Tx Narcolepsy - Cataplexy, paralysis, hypnagogic hallucinations

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34
Q

fluoxetine

A

SSRI approved to Tx Narcolepsy - Cataplexy, paralysis, hypnagogic hallucinations

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35
Q

Sodium Oxybate

A

Only FDA approved Rx to Tx Narcolepsy - Cataplexy and excessive daytime sleepiness
RESTRICTED DISTRIBUTION
C-III (Xyrem)

36
Q

Fondaparinux

A 
Synthetic Pentasaccharide (Xa only via AT) (SC)
Peak effect: 2-3hrs; **t1/2=15-18hrs
*Renal Elimination

Dosing: VTE PROPHYLAXIS
TKA,THA,HFS: 2.5mg SC Qday (-2nd line Orthopedic Surgical VTE Prophylaxis)
Medically ill: Not recommended (not FDA approved)

Dosing: VTE TREATMENT (Stratified dosing)
100kg = 10mg SC q24hr
50-100kg=7.5mg SC q25hr
<30ml/min

*(Arixtra) 2.5, 5, 7.5, 10mg pre-filled syringes

37
Q

UFH

A

SC/IV: Peak effect 1-2hr
t1/2 30-150min (dose dependent)

*DOSING
VTE Prophylaxis-TKA/THA/HFS/Trauma: NONE
VTE Prophylaxis-medically ill/general surgery: 5000 U SC q8-12hr
VTE Tx: 80U/kg IV bolus (round to 500U) Th 18U/kg/hr cont IV infusion (round to 100U)

MONITORING
aPTT (Baseline, 6hr after bolus, 6hrs after any infusion changes, once stable q24h)
Goal = 1.5-2.5X normal aPTT value(test dependent)
+ CBC w/ platelets

AE: Bleeding, osteoporosis, Hypersensitivity, Thrombocytopenia (HAT, HIT, HITT)

38
Q

Protamine

A

UFH Reversal agent

39
Q

Argatroban

A

Direct Thrombin Inhibitor (IV)
**Hepatic Elimination

DOSING:
2µg/kg/min
Hepatic dysfn = 0.5-1.2µg/kg/min

MONITORING
aPTT (Baseline, 6hr after bolus, 6hrs after any infusion changes, once stable q24h)
Goal = 1.5-2.5X normal aPTT value(test dependent)

AE: Bleeding

40
Q

Lepirudin

A

Direct Thrombin Inhibitor (IV)
Renal Elimination
Monitor aPTT

AE: Bleeding * Antibody development: IF been Tx once do not use again

41
Q

Bivalirudin

A

Direct thrombin inhibitor: (IV)
Renal/Enzymatic elimination
**FDA Approved Indication = Hx of H.I.T. and undergoing angioplasty or PCI

MONITOR: aPTT
AE: bleeding

42
Q

Vitamin K

A

Warfarin Antidote
Tx: On warfarin @time of HIT Dx
PO: 10mg
IV: 5-10mg

43
Q

Desirudin

A

Direct Thrombin Inhibitor (SC)
FDA-indication=DVT Prophylaxis w/hip replacement
*NOT for H.I.T Tx

44
Q

Enoxaparin

A

LMWH (SC)
Peak effect 3-5hr; t1/2=3-6hr
*RENAL Elimination

*Dosing: VTE PROPHYLAXIS
TKA,THA,HFS: 30mg SC q12h (Preferred Orthopedic Surgical VTE Prophylaxis)
Trauma: 30mg SC q12h
Medically ill/General Surgery: 40mg SC q24hr
*Renal impairment (CrCl<30ml/min): 1mg/kg SC q24hrs, use with caution consider another Tx

*(Lovenox) 30, 40, 60, 80, 100, 120, 150MG pre-filled syringes

45
Q

Dalteparin

A

LMWH (SC)
Peak effect 3-5hr; t1/2=3-6hr
*RENAL Elimination

Dosing PROPHYLAXIS
TKA,THA,HFS: 5000 Units SC q24hr
Trauma: NONE
Medically ill/General Surgery: 5000 Units SC q24hrs
*Renal impairment (CrCl<30ml/min): Use with caution consider alternative tx.

*(Fragmin) 2500, 5000, 7500, 10000, 12500, 15000, 18000 UNIT pre-filled syringes

46
Q

Phenytoin

A

AED: Broad Spec: Most Common
MOA: Inhibits Voltage gated Na+ Channels

DOSE: Loading dose regime

PO: 200mg Acid form = 92mg Sodium form**
Parenteral: IV (Max 50mg/min); Fosphenytoin (Max 150mg/min*)

PK: ~92% protein bound;
**Non-linear kinetics- lg pt variability in levels;
t1/2=22hrs (why loading)
*should not repeat levels for 5-7 days after dosage change

AE:
Dose deepen: Dizziness, lethargy, seizures, visual changes (sign to have levels checked)
Idiosyncratic=SJS
Chronic: Gingival hyperplasia (reversible)

47
Q

Carbamazepine

A

AED: Broad spec
MOA: Bind voltage-dependant Na+ channels

Dosing: *Titrate up
many dosage forms- (XR form = BID w/ghosts)

PK:

  • induces its own metabolism (2C9&3A4 substrate and inducer)
  • > **21-28 days to reach steady state (not due to t1/2)
  • 40-90% Protein bound

AE
Dose depen: Diplopia, dizziness, unsteadiness
Chronic: **Hyponatremia-sx=nausea,malaise,HA,obtundation (*careful to not correct Na+ too quickly => locked in syndrome), dec BMD (supp Ca++/VitD/Folic Acid)

Monitor-base line and periodic CBC w/ platelets, LFT sNa+, renal fn

48
Q

Oxcarbazepine

A

AED: Adj or mono-Tx for partial seizures (similar efficacy CBZ,PHT,VPA but better tolerated)
MOA: blocks voltage-dependant Na+ channels

Dosing: Titrate up Gradually (w/o regard to meals)

AE:

  • idiosyncratic: Rash (not SJS but stop Rx) cross-reactivity w/ CBZ
  • Chronic: **Hyponatremia more than CBZ-sx=nausea,malaise,HA,obtundation (*careful to not correct Na+ too quickly => locked in syndrome)

Monitor: sNa+

DDI: deceases OC** ; overall fewer DDI then CBZ, may induce UGT

49
Q

Valproate/Divalproex Sodium

A

AED: Broad Spec Rx - 1st line generalized seizures
MOA: Multiple

Dosing: Titrate up - Take WITH FOOD (XR/IV available)

PK: Highly Protein bound, well absorbed,
*diurnal elimination (serum levels lower in pm - monitoring)

AE:

  • Dose Depen: *GI upset (w/food)
  • idiosyncratic: acute hepatic failure
  • Chronic: *Wt gain

DDI LOTS: inhibitor, Will dec phenobarb lebels
**VPA+OC dec VPA levels due to inc met

50
Q

Lamotrigine

A

AED: OK w/ pregnancy; Tx:Broad Spec, well tolerated
MOA: blocks voltage-dependant Na+ channels

Dosing: *Dose depends on concomitant AED’s; Titrate UP (if with VPA start LOW dose 25mg QOD)

AE:
Idiosyncratic- SJS

DDI: OC-dec [OC] and dec [lamotrigine] on off weeks

51
Q

Levetiracetam

A

AED: *Best tolerated few DDI: Indicated Adjectively partial; but used 1st line broad
MOA: bocks Ca++ channel, effects glutamate vesicle

Dosing: Titrate up; high doses tolerated well w/ or w/o food

AE:
-idiosyncratic: Psychosis (profound)=DLT

Renally eliminated: dose adj

52
Q

Lacosamide

A

AED: a schedule V AED
MOA: unknown

Dosing: Titrate up
IV form available

AE:
[ ] depen: Profound vomiting

53
Q

Phenobarbital

A

AED: Broad; IV-very common, PO not used*
MOA: GABAa

Dosing: Titrate gradually (30mg q2-4wks)

Monitoring: CBC w/platelets, LFT

PK: t1/2=1-5days (total clear of drug 5 days: brain dead Pts)

AE: A lot** why dec use
idiosyncratic: *SJS
chronic: intellectual blunting, bone disease (ca++/vitD)
DLT=sedation

54
Q

Topiramate

A

AED: Broad Spec
MOA: block AMPA/kainate,Na++/Ca++ channels; enhance GABA

Dosing: Titrate up (slow) w/ or w/o food
Migraine Prophy: 50mg BID (titrate up 25mg/wk)

AE:

  • [ ] depen: concentration diff., speech/language problems,
  • idiosyncratic: metabolic acidosis(monitor)
  • chronic: kidney stones, **Wt. loss

DDI: Signifigantly dec OC efficacy at Top.doses >200mg/day (not a problem for migraine prophylaxis)

55
Q

Tiagabine

A

AED: NEVER mono therapy or 1st line, NOT used

56
Q

Zonisamide

A

AED: adj partial seizures **Teratogenic; fairly well tolerated
MOA: Block Na++/Ca++ chan and CA

Dosing: slow titrate up w/o regard to meals

AE:
Chronic: kidney stones (hydrate)
has sulfonamide chain
and carbonation taste perversion

57
Q

Gabapentin

A

AED: Not used in seizure much; larger Tx w/neuropathic pain
MOA: enhances GABA

Dosing:Titrate up w/o regard to meals

No monitoring required, but renally eliminated

58
Q

Pregabalin

A

AED: Not used in seizure much(limited experience); larger Tx w/neuropathic pain
Schedule V

Dosing: Rapid titration

59
Q

Felbamate

A

AED: Only a LAST line Tx;

lots of SE including Aplastic anemia, liver failure (MedWatch)

60
Q

Rufinamide

A

AED: Tx: adj for Lennox-Gastaut (childhood form)

61
Q

Ethosuxamide

A

AED: 1st line absence seizures ONLY (verry narrow spec)

well tolerated

62
Q

Ezogabine

A

NEW AED: adj partial onset

AE: urinary retention

63
Q

Perampanel

A

NEW AED: adj partial onset (not approved Yet)

AE: Aggressive behavior

64
Q

Methylprednisolone

A

MS Tx of relapses
1000mg IV Qday X3days (po=IV efficacy)

SE: Exacerbation of infection in pts at inc risk with DMT Rxs

65
Q

Avonex

A

RRMS Tx: Interferon Beta-1a Injection (Most common with rebif)
(Pre-filled syringes: stable 7days at RT
diluent form: stable 30days RT, use immediate after mix)

Dose: 30mcg IM once WEEKLY

PRO: weekly dosing, low Nab, pre-filled syr, less inject run
CON: efficacy < betaseron, IM, refrig req, most flu-like Sx

66
Q

Rebif

A

RRMS Tx: Interferon Beta-1a Injection (Most common with Avonex)
pre-filled syringe with injector
Store in refridge Stable 30days at RT

Dose: Target 44mcg SQ TIW*
Titrate dose gradually

PRO: pre-filled syr, titration pack available, efficacy> avonex, stable 30 days RT
CON: high Nab, most LFT eleveation, refrig, TIW dosing

67
Q

Betaseron

A

RRMS Tx: Interferon Beta-1b Injection
(Powder and diluent for reconstitution)
Store at RT; good for 3hr in refrige after mixing

DOSE: 8million Units (0.25mg) SQ QOD
Titrate dose gradually to min SE

PRO: less stinging, no refrig, efficacy>avonex
CON: QOD dose, mixing, highest NAb incidence

68
Q

Extavia

A

RRMS Tx: Interferon Beta-1b Injection
(Powder and diluent for reconstitution)
Store at RT; good for 3hr in refrige after mixing

DOSE: 8million Units (0.25mg) SQ QOD
Titrate dose gradually to min SE

69
Q

Glatiramer Acetate

A

RRMS & CIS Tx: Myelin AA mimic
(divert immune system maybe MOA: unknown but get glatiramer-specific Th2 cells-antiinflammatory)
Pre-filled injector syringes refrig store and 1 mo stable at RT

Dose: 20mg SQ QDay

SE: **Transient systemic post injection rxns= flushing, chest pain, palpitations, anxiety , dyspnea, constriction of the throat utricaria, diaphoresis, anxiety
(Copaxone)

PRO: no flu-like Sx, no labs, pre-filled syr, no Nabs
CON: post inj-rxn, Qday, refrig, lowest efficacy

70
Q

Fingolimod

A

MS Tx: 1st PO DMT: Sphingosine 1-Phosphate receptor modulation *inhibits t-cells migration out of lymph nodes

Dose: 0.5mg PO Qday

SE: inc risk of injection (influenza, *VZV, HSV) first dose bradycardia, chest pain, macular edema, resp, dysfn,
Lots of Monitoring: CBC, *VZV vaccination, ECG, LFT, ophthalmic exam,
1st dose = 6hr vital signs in clinic monitoring

D/c if serious infection, NO live vaccines, LFT q6-9mo,

71
Q

Teriflunomide

A

MS Tx: PO DMT: active metabolite of leflunomide( a RA tx) - suppression of pyrimidine synthesis and down reg t/b cells
**Add on to INF beta

Dose: 7mg or 14mg PO Qday

SE: PREGNANCY X, alopecia (Women consideration),

72
Q

Dimethyl Fumarate

A

MS Tx: Recently approved PO DMT:
AKA BG-12: induction of Th2-like cytokine and apoptosis in activated T-cell

Dose:240mg PO BID (strat 120mg BID X 1wk)

73
Q

Natalizumab

A

2nd line MS Tx

PRO: no self inj, Good efficacy, well tolerated, Q.MO dosing
CONS: unknown risk of PML, limited experience with drug, $$, TOUCH program, montherapy only

74
Q

Mitoxantrone

A

2nd line MS Tx

PRO: no self inj, good efficacy, infrequent dosing, some data to support as add-on Tx, least expensive,
CON: infusion related SE, long term SE, lab and cardiac monitoring, no home admin, max lifetime dose

75
Q

Dalfampridine SR

A 
Tx of MS Sx, abulation problems:
weak efficacy (clinical)

Dose 10mg PO BID

Avoid renal dz and seizures

76
Q

Sumatriptan

A

5-HT Agonist: Migraine (most dosage forms)
Tab: 25, 50, 100mg @ onset; repeat 2hr (Max: 200mg/day)
SL/needless inj (sumavel) 6mg SC @onset; repeat 1hr (max 12mg/day)
**t-max = ~10min

MAO Metabolism

77
Q

Eletrip

A

5-HT Agonist: Migraine; most effective
20, 40mg @onset; repeat 2hr (max 80mg/day)

3A4 metabolism (strong interaction)

78
Q

Frovatriptan

A

5-HT Agonist: Migraine; Longest duration
Used as prophylaxis
t1/2=26hrs

2.5mg @ onset; repeat 2hr (max 7.5mg/day)

met-unchanged

79
Q

Ergotamine

A

Migraine

2mg SL @onset; repeat q30min (max 6mg/day, 10mg/weak)

80
Q

Cafergot

A

Migraine: 1mg ergotomine; 100mg caffeine

2 Tablets PO @onset; repeat q30min (max 6mg/day, 10mg/weak)

81
Q

Dihydroergotamine

A

Migronal Spray: 1 sp. each nostril @onset; repeat 15 min (max 6sp/day, asp/wk)

IM/SQ; 1mg (MAx 3mg/day, 6mg/wk)

82
Q

Metoclopramide

A

Antiemetic for Migraine (inc ab of other migraine med too)
5mg at onset of migraine q46h prn

DA Agonist = dystonic rxn
PO, IM, IV (NO PR)

83
Q

Trimethobenzamide

A

Antiemetic for Migraine: PO only (inhibits chemo-triger zone, less dystonic rxn)
300mg q6h prn

84
Q

Promethazine

A

Antiemetic for Migraine: PO, IM, PR*

25, 50mg q6h prn

85
Q

Ketorolac

A

Migraine NSAID: (used in status migrainous)

30mg IV q6hr

Therapeutics (10 decks)

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