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NAPLEX 25 > Chapter 59: Migraine > Flashcards

Chapter 59: Migraine Flashcards

(70 cards)

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1
Q

When should patients seek immediate medical attention for a migraine?

A

HA accompanied by fever, stiff neck, rash, confusion, seizures, double vision, weakness, numbness, chest pain, SOB or aphasia.

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2
Q

Which neurotransmitter may play a role in migraines?

A

serotonin

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3
Q

What is the treatment for menstrual-associated migraine (MAM)?

A

monophasic oral contraceptives or estradiol patch or creams.

Can use POPs for migraine with aura.

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4
Q

Women who have migraine with aura are at higher risk for ____ and should avoid ____?

A

stroke
estrogen-containing contraceptives (can use POPs).

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5
Q

What fluctuation can cause menstrual-associated migraine (MAM)?

A

estrogen

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6
Q

What are the criteria for migraine diagnosis?

A

At least 5 attacks fulfilling the following criteria:

  • HA last 4-72 hrs
  • Have >/= 2 of the following: unilateral location, pulsating, mod-severe pain and aggravated by routine physical activity
  • One of the following occurs during the HA: nausea &/or vomiting, photophobia, and phonophobia.
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7
Q

Which natural products can be used for migraines?

A

Caffeine, Butterbur, feverfew, magnesium, riboflavin

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8
Q

Which medication does Advil Migraine contain?

A

Ibuprofen

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9
Q

Which medications does Excedrin Migraine contain?

A

Aspirin, acetaminophen, and caffeine

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10
Q

Naproxen brand name?

A

Aleve

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11
Q

Rx options for acute treatment of migraine?

A
  • Serotonin receptor agonists (triptans)
  • CGRP receptor antagonist
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12
Q

Which pain meds are not recommended due to abuse/dependence issues?

A

Opioids, butalbital-containing products, tramadol and tapentadol

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13
Q

What is the mechanism of action (MOA) of triptans?

A

5-HT1 receptor agonists and cause vasoconstriction of cranial blood vessels

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14
Q

What are triptans used for?

A

First-line for acute migraine treatment

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15
Q

When are triptans most effective?

A

When used at first sign of a migraine

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16
Q

What is the brand name of Rizatriptan?

A

Maxalt-MLT

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17
Q

Sumatriptan oral dose can be repeated how many times after __ hrs?

A

1 time after 2 hrs

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18
Q

Sumatriptan SC dose can be repeated how many times after __ hrs?

A

1 time after 1 hr

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19
Q

How many times per day can Zembrace SymTouch be repeated?

A

4 times per day

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20
Q

Imitrex nasal spray can be used in one nostril and can repeat how many times after __ hrs?

A

1 time after 2 hrs

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21
Q

Onzetra Xsail powder should be used in?

A

each nostril

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22
Q

What are the contraindications for Triptans?

A

Cerebrovascular disease (stroke/TIA), uncontrolled HTN, ischemic heart disease, use within 24 hrs of another triptan

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23
Q

What are the warnings associated with Triptans?

A

risk of increased BP, serotonin syndrome

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24
Q

What are the side effects of Triptans?

A

Paresthesia (tingling/numbness), triptan sensations (pressure or heaviness in the chest or pressure in the neck region)

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25
Which triptan formulations are useful if vomiting is present?
ODT, Oral film, nasal spray and injections
26
How many doses do triptan nasal sprays contain?
1 (do not prime)
27
How must Treximet (sumatriptan + naproxen) be dispensed?
In original container
28
What should Maxalt-MLT,ODT not be used in?
Patients with phenylketonuria
29
Which triptans are approved for children 12+?
Almotriptan tabs, zolmitriptan nasal spray and Treximet
30
Which triptan is approved for children and adolescents 6-17 years?
Rizatriptan
31
Which triptan has the longest half-life?
Frovatriptan
32
Which 2 triptans are long-acting but have a slow onset?
Frovatriptan and naratriptan
33
Preferred site for sumatriptan injections?
Lateral thigh or upper arm
34
Which triptans come in ODT?
Rizatriptan (Maxalt-MLT) and Zolmitriptan (Zomig ZMT)
35
Which triptans come in nasal spray?
Sumatriptan (Imitrex) and Zolmitriptan (Zomig)
36
Which triptans come in nasal powder?
Sumatriptan (Onzetra Xsali)
37
Which triptans come in SC prefilled syringe?
Sumatriptan
38
Which triptans come in SC auto-injector?
Sumatriptan (Imitrex STATdose System, Zembrace SymTouch)
39
Which triptans are contraindicated with MAOi?
Sumatriptan, rizatriptan, and zolmitriptan
40
Which triptans are contraindicated within 2 weeks of stopping MAOi?
Sumatriptan, rizatriptan, and zolmitriptan
41
In patients with CI to triptans or who do not find benefit with triptans, which drug class can be used?
Ergotamines
42
Dihydroergotamine brand name?
Migranal
43
Dihydroergotamine formulations?
Injection (IM/SC/IV), nasal spray
44
Ergotamine BW?
CI with potent 3A4 inhibitors (e.g., protease inhibitors, azoles, macrolides) d/t serious and life-threatening peripheral ischemia
45
Ergotamine CI?
Uncontrolled HTN, pregnancy, ischemic heart disease
46
Ergotamine warnings?
Cardiovascular effects (avoid in any pt with baseline risk, cerebrovascular events), drug interactions
47
Ergotamine nasal spray must be?
Primed by pumping 4 times
48
What drugs are CGRP receptor antagonists?
Rimegepant, Ubrogepant, and Zavegepant
49
What is the effect of blocking the CGRP receptor?
Helps reduce or eliminate migraine pain
50
Which CGRP receptor antagonists are approved to treat acute migraine attacks?
Ubrogepant and Zavegepant
51
Which CGRP receptor antagonist is approved to both prevent and treat acute migraine attacks?
Rimegepant
52
Which serotonin receptor subtype does Lasmiditan selectively target?
A first-in-class serotonin agonist of 5-HTIF receptor subtype
53
How does Lasmiditan differ from triptans and ergotamine drugs?
It does not cause vasoconstriction
54
Is Lasmiditan contraindicated in patients with cardiovascular disease (CVD)?
No
55
Which meds are in Fioricet?
APAP/butalbital/caffeine
56
Which meds are in Fiorinal?
ASA/butalbital/caffeine
57
When should a patient receive migraine prophylaxis?
>= 4 migraines per month and have migraine that decreases their quality of life
58
Which medications can be used for migraine prophylaxis?
* BB (propranolol), * Topiramate (Topamax) & valproic acid, * CGRP receptor antagonists * TCAs (amitriptyline has most evidence; or venlafaxine), * Monophasic and extended cycle OCs for MAM if no aura
59
What is the brand name of Propranolol?
Inderal LA, Inderal XL
60
What is the brand name of Metoprolol tartrate?
Lopressor
61
What is the brand name of Metoprolol succinate?
Toprol XL
62
What are the warnings for beta-blockers?
Caution with bronchospastic diseases (COPD, asthma), especially with non-selective propranolol
63
What are the side effects of beta-blockers?
Bradycardia, fatigue, hypotension, dizziness, depression (more so with propranolol, the most lipophilic), impotence, can exacerbate Raynaud’s
64
What is the brand name of Divalproate?
Depakote, Depakote ER, Depakote Sprinkle
65
What is the brand name of Topiramate?
Topamax
66
What are the black box warnings for Divalproex?
Fetal harm, hepatic failure
67
What are the side effects of Divalproex?
Weight gain, thrombocytopenia, increased ammonia, alopecia
68
What are the warnings for Topiramate?
Fetal harm, metabolic acidosis, nephrolithiasis, increased ammonia, open angle glaucoma, oligohidrosis
69
What are the side effects of Topiramate?
Weight loss, somnolence, cognitive impairment
70
What is Botox used for?
Chronic migraines only

NAPLEX 25 (63 decks)

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