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NAPLEX Prep > Migraine > Flashcards

Migraine Flashcards

(55 cards)

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1
Q

Sx of migraines

A

NV and sensitivity to light
Auras
Fever, stiff neck, rash, confusion, seizures, double vision, weakness, numbness, chest pain, SOB, aphasia

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2
Q

Causes of migraines

A

Imbalance of neurotransmitters (serotonin) and/or activation of trigeminal nerve (calcitonin gene-related peptide (CGRP))

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3
Q

Common migraine triggers

A

Hormonal changes in women (aura ↑ stroke)
Foods
Stress
Sensory stimuli
Changes in sleep pattern
Changes in environment

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4
Q

How to diagnose migraines

A

At least 5 attacks:
1. Headaches last 4-72 hrs
2. Headaches have ≥2 of the following: unilateral location, pulsating, moderate-severe pain and aggravated by physical activity
3. One of the following: N/V, photophobia, phonophobia

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5
Q

Non drug treatments for migraines

A

Headache diary to identify triggers
TENS, REN
Riboflavin (B2), Mg, butterbur, feverfew

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6
Q

OTC options for migraines

A

APAP, ASA, Advil Migraine, naproxen, Excedrin Migraine

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7
Q

Rx options for migraines

A

Triptans, CGRP receptor antagonists, Butalbital

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8
Q

MOA of triptans

A

Selective agonist of 5-HT1 receptor → vasocontrict cranial blood vessels to inhibit neuropeptide release and ↓ pain transmissionF

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9
Q

First line acute treatment

A

Triptans

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10
Q

When is the best time to take triptans

A

First sign of migraine onset

Avoid 10 per month to prevent medication overuse headache (rebound headache)

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11
Q

CI of triptans

A

CVD, uncontrolled HTN, ischemic heart disease, use within 24 hrs of another triptan or ergot

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12
Q

ADR of triptans

A

HTN, serotonin syndrome, paresthesia (tinging/numbness), triptan sensation

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13
Q

Formulations that are good for nausea

A

ODTs, PO films, nasal sprays, and injections

Nasal sprays and injections work fastest

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14
Q

Rizatriptan

A

Maxalt-MLT

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15
Q

Sumatriptan

A

Imitrex, Zembrace, Onzetra

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16
Q

Zolmitripan

A

ZOmig

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17
Q

How to administer Sumatriptan SQ injections

A

Imitrex: Can repeat once after 1 hr
Zembrace: Can repeat QID waiting 1 hr between dose

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18
Q

How to administer IN Sumatriptan

A

Spray: One nostril repeat once after 2 hrs
Power: Use in each nostril can repeat once after 2 hrs

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19
Q

Triptan that contains phenylalanine

A

Maxalt-ODT

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20
Q

Triptan formulations indicated for ≥12YO

A

Almotriptan tablets
Zolmitripan nasal spray
RizaFilm and Treximet

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21
Q

Triptan formulations indicated for ≥6YO

A

Rizatriptan tablets and ODT

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22
Q

Formulations that come in ODT

A

Rizatriptan, Zolmitriptan

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23
Q

Preferred site of SQ triptan injection

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A

Lateral thigh or upper arm

24
Q

Triptan with the longes half-life

25
Triptans that are nasal spray/powder
Sumatriptan, zolitriptan
26
DDI of triptans
Serotonin syndrome → CI with MOAI or within 2 wks of stopping
27
MOA of ergotamine
Nonselective agonist of serotonin receptors → cerebral vasoconstriction
28
Formulation of dihydroergotamine
Injection (IM/SC/IV)
29
BBW of ergots
CI with CYP3A5 inhibits → peripheral ischemia
30
CI of ergots
Uncontrolled HTN, Ischemic heart disease, pregnancy Use within 24 hrs of serotonin agonists or other ergots
31
Warning of ergots
CV effects and events → drug interations
32
How to prime dihydroergotamine nasal spray
Pumping 4 times
33
Dihydroergotamine
Migranal
34
MOA of Rimegepant
Blocks the CGRP receptor that contributes to vasodilation and neurogenic inflammation → reduce and eliminate migraine pain
35
Rimegepant
Nurtec
36
Ubrogepant
Ulbrelvy
37
Zavegepant
Zavzpret
38
MOA of Lasmiditan
Serotonin receptor (5-HT1F) agonist
39
CI of CGRP antagonists
CI: CYP3A4 inhibitors Inhibitors: Ulbrevy 50 mg Inducers: Ulbrevy 100 mg Avoid 2nd dose of Nurtec within 48 hrs for inhibitors
40
What is butalbital
Barbiturate
41
Fioricet vs Fiorinal Schedule?
Fioricet: APAP/butalbital/caffeine Fiorinal: ASA/butalbital/caffeine CIII
42
Acute treatment of migrains
Triptans, ergots, CGMP antagonist, Butalbita (not recommended due to abuse and dependence)
43
Indications for migraine prophylaxis
≥4 migraines/month
44
Drugs for migraine prophylaxis
BB Anitseizure CGRP Botox Amitriptyline, venlafaxine
45
Beta blockers indicated for migraines
Propranolol Metoprolol Timolol
46
ADR of BB
Bradycardia, hypotension, CNS effects (fatigue, dz, depression), impotence (Raynaud's) Avoid non-selective in asthma and COPD
47
Antiseizure medications indicated for migraine prophylaxis
Divalproex Topiramate
48
Divalproex
Depakote
49
Topiramate
Topamax
50
BBW of Depakote
Fetal harm, hepatic failure
51
ADR for Depakote
Weight changes (gain>los), thrombocytopenia, ↑ ammonia, alopecia
52
ADR of Topamax
Fetal harm, metabolic acidosis, nephrolithiasis, increased ammonia, secondary angle closure glaucoma, visual defects, oligohidrosis Weight loss, somnolence, cognitive impairment
53
PO CGRP indicated for migraine prophylaxis
Atogepant (Quilipta) Rimegepant (Nurtec)
54
Dosing of most inj CGRP antagonist
QM
55
Counseling on Onzestra Nasal Powder
1. Insert nosepiece deeply into the nose 2. Rotate device and place mouthpiece in mouth 3. Blow in the device for 2-3 sec to deliver medication into your nose 4. Press clear tab to remove first nose piece 5. Insert second piece and repeat in other nostril

NAPLEX Prep (70 decks)

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