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Pass Naplex Now Book II > Migraine > Flashcards

Flashcards in Migraine Deck (29):
1

When it's indicate for migraine prophylaxis

Agents

- Indication for ppx when > 3 migraine attacks/mo or if associated with disability

Agents
- BB: Propranolol, timilol
- CCB: Verapamil
- TCA/SNRI: Amitriptyline, Venlafaxine ER - Effexor
- AntiEpileptic: Divalproex - Depakote/Stavzor
Topamax - Topiramate
- Botulinum toxin - Botox
- Feverfew, buterbur

2

Topamax

- Indication

Topiramate

- Indication: migraine ppx

3

Botox

- Indication

Botulinum toxin


=> Use in pt who have at least 15 days of migraine attacks/month and last > 4H
- Indication: migraine ppx

4

Toradol

- Indication
- Dose

Ketoralac

- Indication: tx of migraine
- Dose: 30-60mg IM/15-30mg IV/10mg q4-5H PO

5

Naprosyn

- Indication
- Dose

Naproxen

- Indication: tx of menstrual migraine
- Dose: 500mg BID

6

Indocin

- Indication
- Dose

Indomethacin

- Indication: tx of migraine
- Dose: 50mg

7

Cambia

- Indication
- Dose

Diclofenac

Voltaren
- Indication: tx of migraine
- Dose: 50mg single dose mix with water

8

Motrin

- Indication
- Dose

Ibuprofen

- Indication: tx of migraine
- Dose: 200-400 mg

9

Reglan

- Indication

Metoclopramide

- Indication: migraine

10

Compazine

- Indication

Prochloperazine

- Indication: migraine

11

Amergen

For all triptan:
- MOA
- Indication
- SEs
*Sumatriptain:
- C/I
- DDI
- Rec for kids age 6-11
- Counseling

Naratriptan

- MOA: 5HT receptor agonist
- Indication: tx of migraine
- SEs: N/HA, chest tightness, dizziness, paresthesias (numbness/tingling), sleepiness
**Sumatriptan: injection site rxn/bitter taste
- C/I: CAD, uncontrolled HTN, take with Ergots and MOAIs
- DDI:
SSRI's: very rare
MOAI's: incr systemic exposure to triptan
Ergots: vasospastic rxn
Cimetidine: Inc [ ] of Zolmitriptan
OCP: Inc plasma level of naratriptan & zolmtriptan
- Rec for kids age 6-11: rec maxalt tab or Imitrex nasal

Counseling:
- Max dose
- Relieve acute migraine but doesn't prevent or reduce the # of future attack
- If experience chest pain, SOB, heart throbbing, or skin rashes notify MD
- Do not take if pregnant (preg cat C)
- Avoid prolong sun exposure: wear sunscreen and protective clothing

12

Maxalt

- Max dose
- Form

Rizatriptan Benzoate

- Max dose: 30mg/day
- Form: PO

13

Imitrex

- Max dose of PO and NS
- Counseling of transdermal system

Sumatriptan succinate

Forms/Max Dose
- PO: Max 200mg/d
- NS: Max 40mg/d

14

Treximet

- Dose

Sumatriptan + Naproxen

- Sum 85mg and Nap 500mg
May repeat after 2H

15

ZOmig

- Forms
- Max dose

ZOLmitriptan

- Forms: tab, nasal spray
- Max 10mg/d

16

Axert

- Max dose

ALMOtriptan

Max dose: 25mg/day

17

Frova

- Max dose
- Half life

FROVAtriptan

- Max dose: 7.5mg/day
- Half life: longest

18

Relpax

- Max dose
- DDI

Eletriptan

- Max dose: 80mg/d
- CYP3A4 substrate

19

Migrana
D.H.E. 45

- Dose
- MOA
- Indication
- C/I
- SE
- DDI
- Counseling

DiHydroErgotamine Mesylate

- Migrana - 4mg/mL w/ 10mg caffeine
0.5mg/spray. Max 3mg/d = 6 sprays. 15sprays/7day period

- D.H.E. 45 injection
1mg IM. May repeat 2x at 1H interval
Max = 3mg/day and 6mg per 7day period

- MOA: Vasoconstriction, interacts with 5HT, DA, NE
- Indication:
Inj/PO: to abort/prevent vascular HA - migraine, cluster HA
Nasal spray: only for migraine

C/I
- Preg Cat X
- Hypersensitivity
- PVD
- Hepatic/renal imp
- CAD
- HTN
- Sepsis

SEs
- N/V, numbness/tingling of fingers/toes
- Pain/weakness of arms/legs

DDIs
- BB: peripheral ischemia (cold extremities), gangrene
- Inhibitors of 3A4

Counseling
- Do not exceed rec dose
- Contact MD if irregular heart beat
- N/V
- Numbness/tingling of fingers or toes
- Pain or weakness of the extremities

20

ERGOmar

- Form

ERGOtamine Tartrate

- SL tab

21

CafERGOT

- Form

Ergotamine + Caffeine

- Tab: 1mg ergo/100mg caffeine
Max: 6 tabs/attack; 10tabs/week
- Suppositories: 2mg ergo/100mg caffeine
Max: 2sup/attack; 5supp/week

22

Fioricet
Esgic

- Indication
- Dose

Butalbital + Caffeine + APAP = 50/40/325

- Indication: tension or muscle contraction HA
- Dose: 1-2 tabs or cap Q4H. Max 6 tabs/day

23

FiORINal (CS III)

- Indication
- Dose

Butalbital + Caffeine + ASA

- Indication: tension or muscle contraction HA
- Dose: 1-2 tabs or cap Q4H. Max 6 tabs/day

24

Excedrine Migraine

- Dose
- Preg cat:

APAP + ASA + Caffeine = 250/250/65

- Dose: 2 tabs PO Q6H. Max 8 tabs/day
- Preg Cat D

25

Maxalt MLT

Rizatriptan

- Form:
- Max dose: 30mg/day

Counseling:
- Phenylketonuric pt should not take Maxalt MLT
- Keep Maxalt MLT in foil package until just prior to use
- Use clean dry hands to remove Maxalt MLT from foil
- Place Maxalt MLT on top of the tongue

26

Sumavel DosePro

- Form
- Max dose:

Summartriptan

- Form: SC
- Max: 12mg/d

27

Zecuity

- Form:
- Max dose:
- Counseling

Zecuity: Iontophoretic transdermal system

- Transdermal: delivery 6.5mg over 4H. Apply to upper arm

Counseling
- Single-use, battery powered patch that actively delivers sumatriptan 6.5mg over 4H
- Once Zecuity is applied, the activation button must be pushed and the red light will turn on. When dosing is done, the sys stops operating and the activation light turns off
- It uses a mild electrical current to deliver the medicine the the skin
- Contain metal parts and must be removed b/4 MRI

28

Zomig ZMT

- Max:

Zomitriptan ODT

- Max dose: 10mg

29

Alsuma

- Form

Sumatriptan

- Form: Sol'n