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Flashcards in headache 4 Deck (23)
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1

what is ergotism

side effect of constricted bloodflow to brain, heart, or extremities

2

what are the contraindications to the ergot alkaloids (5)?

1. systemic vasoconstriction
2. use of triptan within 24 hours
3. use of MAOI within two weeks
4. use with any 3A4 inhibitor (azoles, PI, macrolides)
5. pregnancy

3

why are ergot alkaloids avoided in pregnancy

1. systemic vasoconstriction
2. uterine stimulants; trigger labor

4

how is DHE used?

1. prime by spraying 4xs into the air
2. one spray into each nostril
3. use another spray after 15 minutes if needed
4. do not use more than 4 sprays for a single attack

5

what is the MOA of triptans

serotonin agonists; causing intracranial constriction

6

what is the first line therapy for moderate to severe migraines

triptans

7

what are the fastest acting triptans

sumatriptan nasal and injection
zolitriptan nasal

8

what is the slowest acting triptan

frovatriptan

9

what triptan is good for patients with rebound headaches?
why?

frovatriptan
very long half life (26 hours)

10

what triptan needs a lower dose if on a 3A4 inhibitor

almotriptan

11

what triptan is contraindicated if a 3A4 inhibitor is used within the past 3 days

eletriptan

12

what triptan is not to be used with a sulfa allergy

almotriptan

13

what triptan dose can be repeated after 4 hours (instead of 2 hours)

naratriptan

14

what triptan dose can repeated after 1 hour instead of 2 hours

sumatriptan injectable

15

arrange these in order of which can be repeated the soonest to the longest:
sumatriptan injection
sumatriptan oral
naratriptan
ergot alkaloid

1. ergot alkaloid (15 min)
2. sumatriptan injection (1 hour)
3. sumatriptan oral (2 hours)
4. naratriptan (4 hours)

16

what triptan must have dose reduced when also taking propranolol

rizatriptan

17

what is triptans are not metabolized by monoamine oxidase (MAO)

frovatriptan and eletriptan (okay with MAOI inhibitor)

18

what triptans are indicated for menstrual migraine prevention

1. frovatriptan
2. naratriptan
3. zolmitriptan

19

True/ False:
ODT triptans have faster onset than normal PO

false

20

True/ False:
Failure on one triptan does not mean failure on all triptans

True

21

what are the side effects of triptans

1. paresthesias
2. flushing
3. chest symptoms (heaviness, tightness)

22

what are the CI's for triptans?

1. ischemic heart disease
2. uncontrolled HTN
3. 24 hours of an alkaloid
4. two weeks of an MAO-I (exceptions)

23

what can increase risk of serotonin syndrome with triptans

SSRI's and SNRI's