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Migraine Flashcards

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1
Q

MOA of Triptans

A

5HT1(serotonin) receptor agonist and cause vasoconstriction of the cranial blood vessels. inhibits neuropeptide release and decreasing pain transmission

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2
Q

non-pharmacologic interventions for migraines

A

avoiding triggers, non-stress, relaxation, applying a cold compress to the head

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3
Q

common migraine triggers

A

Hormone changes in women: fluctuations in estrogen, used (POP) Food: alcohol (beer and red wine) aged cheese, chocolate, MSG, salty and processed foods, stress, bright lights, loud noises, scents, change in weather, not enough or too much sleep

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4
Q

Natural products used for migraines

A

feverfew, willowbark, CoQ10, fish oils, mg2+, riboflavin, butterbur, and guarana

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5
Q

Migraine Prophylaxis

A

if pt has >1x/month or sever sx, prophylaxis should be tried for 2- 6 mos

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6
Q

Acute trxt of migraines

A

Triptans and some pts prefer OTC NSAIDS or excedrin migraine or using them together

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7
Q

Naratriptan

A

Amerge 1 and 2.5mg, can repeat x 1 after 4 hrs

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8
Q

Almotriptan

A

Axert 6.25 and 12.5mg, can repeat x1 after 2 hrs

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9
Q

Frovatriptan

A

Frova 2.5mg, can repeat x 1 after 2 hr

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10
Q

Sumatriptan PO KNOW DOSING

A

Imitrex PO 25, 50, 100mg can repeat x1 after 2 hrs

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11
Q

Sumatripatan injection dose

A

Needless sumatriptain injection (Sumavel Dosepro-6mg) injection by air pressure.

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12
Q

Imitrex STATdose

A

Imitrex STATdose SC; 4,6mg can repeat x1 after 1 hr

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13
Q

Nasal spray sumatriptan dose

A

NS: 5,20mg can repeat after 2 hr

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14
Q

Treximet dosing

A

Sumatriptan + Ibuprofen (Treximet) 85-500mg

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15
Q

Rizatriptan

A

Maxalt, Maxalt- MLT: 5, 10mg can repeat x1 after 2 hr

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16
Q

Maxalt MLT disint grating tablets, water needed? Dose?

A

Maxalt 5mg no water needed

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17
Q

Eletriptan brand and dosing

A

Relpax 20mg and 40mg, can repeat after 2 hr**

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18
Q

Zolmitriptan

A

Zomig, Zomig-ZLT, NS PO 2.5 and 5md can repeat after 2hr

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19
Q

zolmitriptan nasal spray, dose ?

A

NS 5mg can repeat after 2 hr

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20
Q

zolmitriptan disintegrating tablets brand? Water needed?

A

Zomig-ZMT 2.5 and 5 no water needed

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21
Q

S/E of triptans KNOW

A

somnolence**, dizziness, nausea, paresthesias (numbness/tingling) throat/neck presssure, hot/cold sensation, chest pain/tightness

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22
Q

What triptans have ODT

A

sumpatiptan, rizatriptan , zolmitriptan

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23
Q

Triptan sensations

A

pressure in the chest or heavnees pressure in the neck region that usually dissipate after administration

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24
Q

Contraindications

A

Cerebrovascular dz and uncontrolled BP

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25
What are the longest acting triptans?
Frovatriptan (Frova) and naratriptan (Amerge): longer acting but slower onset
26
What are the triptans with the shorter half-lifes?
almotriptan (axert) zolmitriptan, eletriptan (relpax) rizatriptan, sumatriptan
27
Study of eletriptan vs Sumatriptan
eletriptan (Relpax) 40mg was more effective than Sumatriptan 100mg
28
What triptans are C.I. with MAO-Is?
Maxalt, zomig, and imitrex. all the rest are not
29
What triptan is C.I. with 3A4 inhibitors?
Eletriptan (Relpax)
30
what formulations provide the fastest relief?
SC injection and nasal spray
31
ODT and PKU
Do not use Maxalt-MLT and Zomig-ZLT in pts with Phenylketonuria due to the sweetner
32
imitrex injection counseling
includes a carrying case and two prefilled SC syringes. Clean the area of the skin with an alcohol pad in the upper outside arm. Load the STATdose pen by inserting it into the cartridge and turning it clockwise. inject the dose and hold the pen till for 5 seconds
33
Zomig nasal counseling
Blow your nose gently before using. There is only one dose in the nasal sprayer so do not try to prime or you will lose the dose. Do not press the plunger into you have put the tip into your nostril
34
less commonly used agents for migraines
Fiorcet CIII- APAP, butalbital, caffiene: must taper off or will get worsening sx of tremors, HA, and risk for delirium and seizures. Fiornal, Vicodin, Butorphanol NS CIV- onset is 15 mins
35
Ergotamine products, pregnancy category? CI and what? names of brands
Preg Cat X, do not use with strong 3A4 inhibitors due to risk of cerebral ischemia. Ergoloid mesylates (Ergomar, Ergostat) ergotamine/caffeine (Cafergot) DHE Dihydoergotamine (DHE-45, migranal NS)
36
Ergotamine side effects
N/V, muscle pain, tingling in the periphery, angina-like pain, weakness in legs, tachycardia, bradycardia
37
What is 1st line therapy for migraine prophylaxis?
propanolol (inderal) timolol (blocadren) amitriptyline (Elavil) divalproex (sodium valproate) and topiramate (Topamax)
38
What is 2nd line therapy for migraine prophylaxis?
other beta blockers, ACEIs, antidepressants, natural products, birth control for menstrual associated and botulism type A (botox)
39
Do not use propanolol and timolol in what dz states?
Asthma, COPD, emphysema because they are non-selective b-blockers
40
What is the result of overuse of medications?
medication overuse (rebound) headaches. limit acute medication trxt to 2 or 3 times weekly
41
longer duration of action naproxen or ibuprofen??
NAPROXEN 12 hours
42
triptans are CI
CEREBROVASCULAR dz and uncontrolled HTN!!! b/c hey have found cardiac and cerebrovascular issues w/ the drug
43
migrain with aura choose what kind of birth control
migrian with aura has a higher risk for clots- so we want a NO ESTROGEN birth control hence mini pills- hence NOR- QB, NOR Be, and camilla
44
what is the mechanism of action of Tryptans
the are serotonin receptor agonists, that cause vasoconstriction
45
what can you treat menstrual assocated migraines with?
treat with oral contraceptoves , can use NSAIDs, triptans
46
when do you start the tx for menstrual migraines?
2 days beforehte mensies and continue fo 5-7 days
47
when children get migraines , what to recommend?
Rec OTC, usually ibuprofen first. can use triptan in children
48
what are some non pharm tx for migrains?
avoid triggers mental relaxation, apply cold compresses to the head manage sress
49
OTC recommendations for migraines?
NSAIDS , or excedrine which is ASA, APAP, caffeinee
50
when do u start medication therapy for mgraines?
if patient is getting them twice per week or sigficant decrease in the quality of life
51
what are some common triggers for migraines?
``` changes in hormones during menstruation food: etoh, cheexe, chocolate, caffeine, stess bright lighs irregular sleep pattern ```
52
imitrex
sumatriptan
53
alsuma
sumatriptan
54
po dose for sumatriptan for acute attack of migraine
25, 50 or 100mg dose x1 and can repeat dose in 2 hours
55
SC dose for sumatriptan
5, 20 mg and can repeat x1 in 2 hours if not releive
56
maxalt
rizatriptan
57
maxalt dosing
5 or 10mg x 1 and repeat 2 hours later if neessary
58
relpax
eletriptan
59
eletriptan dose
20 or 40mg and can repeat in 2 hours
60
which patients are contraindicated form ahving triptans?
patietns with cerebrovasucalr diseas or uncontrolled hypertension some are contrindicated with MAOIs
61
what are the maind side effects of the tirptans?
somonolence , nausea, tingling or numbness hotcold sensations pressure in the chest or neck region but thesese usually dissipate
62
when to use rizatriptan and zolmitrpatan?
have disintegratin tablets that dissolve and good vor nausea vomitng or if patient cant swallow
63
signs and symptoms of serotonin syndrome?
restlessness, sweating, poor coordination, confusion and hallucinations
64
what agent is a good choice for migraine prophylaxis for young women ? which is worst and why?
good: topiramate cuz good side effect profile and causes weight loss. Bad is valproate because can cause Polycistic ovary syndrome by increasing testosterone levels
65
topiramate dose for migraines?
start 25mg qhs then titrate to 50mg bid

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