ZJ HA therapeutics

Question 1

migraine abortive therapy should not be used more than __ days per month

Answer 1

10

Question 2

every triptan has a short duration of action except for which two?

Answer 2

frovatriptan and naratriptan

Question 3

every triptan has an average onset around 30 minutes except for which two?

Answer 3

frovatriptan and naratriptan

Question 4

what is the time of onset for naratriptan?

Answer 4

1-3 hours

Question 5

what is the time of onset for frovatriptan?

Answer 5

2-3 hours

Question 6

eletriptan is metabolized by which enzyme?

Answer 6

3A4

Question 7

why should SSRIs, SNRIs, and MAOIs be used with caution with triptans?

Answer 7

potential risk of serotonin syndrome

Question 8

are triptans contraindicated with pregnancy?

Answer 8

yes

Question 9

what diseases are triptans contraindicated with?

Answer 9

coronary artery disease, uncontrolled hypertension, and peripheral vascular disease

Question 10

what are the three antiemetics?
what drug class are they?
why can they be used for migraines?

Answer 10

chlorpromazine
prochlorperazine
metoclopramide
dopamine antagonists
they have analgesic properties

Question 11

antiemetics for migraines are only given parentally, however, they have an increased risk of?

Answer 11

EPS

Question 12

what drug is co-prescribed with antiemetics to reduce risk of dystonia?

Answer 12

diphenhydramine

Question 13

what are 2 adverse reactions from chlorpromazine and prochloperazine?

Answer 13

postural hypotension and QT prolongation

Question 14

what’s the key difference between triptans and ergot alkaloids?

Answer 14

ergot have more systemic vasoconstriction

Question 15

which of the ergot alkaloids is mainly used over the other?

Answer 15

dihydroergotamine

Question 16

what is the preferred administration route for dihydroergotamine?

Answer 16

either IV or IM

Question 17

**ergots have same contraindications as triptans

Answer 17

.

Question 18

ergot alkaloids should always be used in combination with?

Answer 18

antiemetics

Question 19

what role do corticosteroids have for treating HAs?

Answer 19

used either in combination for severe attacks or to decrease rates of HA recurrence

Question 20

corticosteroid use for HAs are only administered via what route?

Answer 20

parentally

Question 21

when is it okay to use opioids/barbiturates to treat HAs? If used, therapy should be limited to how many days?

Answer 21

last resort if other therapies have failed. use should be limited to 5 days

Question 22

what drug class is lasmiditan?

Answer 22

5HT1F receptor agonist

Question 23

T/F lasmiditan, like triptans and ergot alkaloids, can not be used in patients with CV disease

Answer 23

False, it is safe

Question 24

what are common SEs of lasmiditan?

Answer 24

dizziness and somnolence (drowsiness)

Question 25

what drug class are gepants?

Answer 25

CGRP antagonist

Question 26

when/how are gepants given?

Answer 26

orally for migraines in patients with either insufficient response or contraindication to treatment with triptans

Question 27

what are the names of the two gepant drugs?

Answer 27

ubrogepant rimegepant

Question 28

what drug classes are used as preventive therapy for migraines?

Answer 28

beta blockers and calcium channel blockers antidepressants antiepileptics CGRP antagonists

Question 29

what beta blocker/ calcium channel blocker is commonly used for preventing migraines?

Answer 29

metoprolol or propranolol, verapamil

Question 30

what class of antidepressants is most commonly used to prevent migraines?

Answer 30

SNRIs

Question 31

which antiepileptics are used to prevent migraines?

Answer 31

valproic acid and topiramate

Question 32

which CGRP antagonists are used to prevent migraines? (Every Friend Gives Ritz)

Answer 32

erenumab, fremanezumab, galcanezumab, and rimegepant

Question 33

T/F opioids and barbiturates should not be used for acute or preventative treatment of migraines

Answer 33

true

Question 34

adverse effects of metoprolol/propranolol? avoid in patients with?

Answer 34

ED, raynauds asthma, diabetes, and depression

Question 35

adverse effects of verapamil?

Answer 35

constipation

Question 36

adverse effects of topiramate?

Answer 36

weight loss, paresthesia, cognitive impairment

Question 37

adverse effects of valproic acid?

Answer 37

weight gain, thrombocytopenia, alopecia

Question 38

2 adverse effects of CGRP antagonists?

Answer 38

angioedemia and anaphylaxis

Question 39

what is botulinum toxin (botox) effective/ineffective for?

Answer 39

effective for chronic migraine prevention, ineffective for episodic migraine prevention

Question 40

how do we treat cluster HAs?

Answer 40

oxygen plus pharmacological treatment

Question 41

what is first-line therapy for cluster HAs?

Answer 41

serotonin agonists

Question 42

what are the 2 treatments for cluster HAs administered intranasally?

Answer 42

triptans and lidocaine

Question 43

what are the two meds used for long term preventative treatment of cluster HAs?

Answer 43

verapamil or lithium