DCPA Migraine Pharm
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| HA pathology | Vasoconstriction then massive Vasodilation
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| Migraine age | Begins between 10-30 y.o. (After this = something else)
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| Migraine FH | 50%
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| Migraine S&S | (+/-)Aura (anorexia, visual field changes, sensitiivty (sound, light, smell), N/V, worse with physical exertion, unilateral or generalized throbbing pain.
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| Red flags of HA | Syncope, Mental change, vision loss, recent trauma, stiff neck, fever, thunder-horrific pain
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| HA triggers | Caffeine, period, red wine, cheese, processed meats, hypoglycemia, change in sleep patterns, decrease in exercise, smoking & strong odors
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| Limit caffeine intake | Less than 240mg/day or 2 cups
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| Acute Migraine Tx | Analgesics, Ergot derivatives, Triptans, Antiemetic drugs, Opiods & Barbituates
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| Chronic Migraine Tx | Beta blockers, Calcium channel blockers, anticonvulsants, Herbs
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| Analgesics SE | Rebound HA: 3 doses in 1 week
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| Midrin | Sympathomimetic (vasoconstriction) + sedative + analgesic
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| Midrin - type of HA | Tension & migraine
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| Midrin CI | CAD, MI, HTN, GI bleed, liver or renal dz.
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| Midrin SE | Sedation or dizziness
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| Ergot Derivatives Brands | Cafatine, Cafergot, Ercaf
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| Ergot Derivatives "level of use" | NOT 1st line - have good malpractice insurance
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| Ergot Derivatives Form | oral or suppository
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| Ergot Derivatives MOA | Suppresses neurogenic inflammation (vasoconstriction)
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| Ergot Derivatives CI | Sensitivity to ergotamine & caffeine, peripheral vascular dz., renal/liver dz., MI/CAD, Pregnancy
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| Ergot Derivatives Pregnancy Category | X
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| Ergot Derivatives SE | Tachycardia, arterial spasm, claudification, numbness in fingers/toes, drowsiness, dizziness, N/V, diarrhea
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| Ergotism - Over dose | Sever vomitting/cramps. Numbness. Twitching-seizures. Renal failure (no urine).
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| Ergot Derivatives DI | Nicotine, caffeine & grape fruit
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| Ergot Derivatives Increases toxicity of... | Propanolol, Erythromycin, Macrolide Ab.
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| Triptans | Specific Serotonin 5-HT1 agonist
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| Triptan Drugs | Sumatriptan (Imitrex), Zolmitriptan (Zomig), Naratriptan (Amerge), Rizatriptan (Maxalt), Almotriptan (Axert), Electriptan (Relpax), Frovatriptan (Frova)
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| Sumatriptan | Imitrex
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| Zolmitriptan | Zomig
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| Naratriptan | Amerge
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| Rizatriptan | Maxalt
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| Almotriptan | Axert
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| Eletriptan | Relpax
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| Triptans MOA | 5HT1-Vasoconstriction. Affects trigeminal nerve.
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| Sumatriptan (Imitrex) Use | Stops migrain pain, allodynia, & improves migrain-induce cognitive impairment.
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| Triptans SE | Rebound HA (2 doses/week), dizziness, Hot flashes, Parestesias, diaphoresis, throat/chest tightness
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| Triptans CI | Ischemic Dz, HTN, Pregnancy
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| Triptans Pregnancy Category | C
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| Triptans DI | MAOIs, ergotamines, SSRIs
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| Sumatriptan (Imitrex) forms | Oral, Melt, Injection (best with N/V)
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| Rizatriptan (Maxalt) Forms | Orals or melts
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| Rizatriptan (Maxalt) DI | Propanolol (Doubles level of Maxalt)
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| Rizatriptan (Maxalt) Effectiveness | Very effective with Nausea
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| Naratriptan (Amerge) Duration | Longer duration - 6 hours
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| Naratriptan (Amerge) Recurrence Rate | Low
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| Naratriptan (Amerge) Onset | Slower - better for patients with long lasting HA
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| Naratriptan (Amerge) Effectiveness | Best with migrains associated with PMS
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| Frovatriptan | Frova
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| Frovatriptan (Frova) Half Life | 26-30 hours
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| Eletriptan (Relpax) SE | Low SE profile
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| Treximet | Combination of Sumatriptan (Imtrex) & Naproxen Sodium (Aleve)
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| Antiemetic Drugs | Metoclopramide (Reglan)
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| Metoclopramide | Reglan
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| Metoclopramie (Reglan) other uses | GERD
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| Metoclopramie (Reglan) MOA | Blocks dopamine receptors
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| Metoclopramie (Reglan) Forms | Injectiong, tablet, syrup, solution
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| Metoclopramie (Reglan) CI | GI obstruction, perforation, hemorrhage
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| Metoclopramie (Reglan) SE | Restlessness, drowsiness, diarrhea, weakness, dystonic reactions (muscle spasms/rigidity), agitation
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| Metoclopramie (Reglan) Increases toxicity of... | Opioids
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| Metoclopramie (Reglan) Decreased effectiness by... | Anticholinergic drugs
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| Opiod Drugs | Narcotic - Demerol (brief duration - 4 hours)
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| Barbituates | Butabital
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| Barbituates (Butabital) drugs | Esgic, Fiorcet, Fiorinal, Phrenalin
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| Barbituates (Butabital) MOA | Depresses CNS
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| Barbituates (Butabital) Form | Tablets & Capsules
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| Barbituates (Butabital) CI | Porphyria (HBG metabolism - light sensitivity, etc.)
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| Barbituates (Butabital) SE | Dizziness, Drowsiness, Nausea, Heartburn, Confusion, Mental Depression, Insomnia, Nightmares
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| Barbituates (Butabital) Pregnancy Category | C
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| Barbituates (Butabital) Increased toxicity with... | Benzodiazepines (Zantax), Valproic acid & CNS depressants
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| Barbituates (Butabital) decreases the effect of... | Warfarin, OCPs, TCAs, Doxycycline, Beta blockers
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| Migraine Prophylaxis | Adults: 1HA/Wk. Kids: 2HA/Month
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| Prophylatic Agents | Beta blockers, Calcium channel blockers, antidepressants, anticonvulsants
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| High Efficacy First line - Prophylatic Agents | Beta Blockers, Divalproex, Topiramte (Topamax), TCAs (not FDA approved)
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| Low Efficacy First line - Prophylatic Agents | Verapamil (Calcium Channel Blocker, NSAIDs, SSRIs
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| Beta Blockers MOA | Act on 5HT2 receptors
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| Beta Blockers Use | Coexisisting Hypotension, Tremor or Palpitations
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| Beta Blockers SE | Hypotension, worsen asthma & CHF & Depression
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| Beta Blockers Drugs | Propanolol & Atenolol
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| Antidepressants drugs | Amitriptyline or Nortriptyline
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| Antidepressants drugs MOA | Increases serotonin
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| Antidepressants drugs Use | Coexisting depression
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| Antidepressants drugs SE | Worsens Palpitations, Sedative, weight gain
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| Calcium Channel Blockers MOA | Vasodilation
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| Calcium Channel Blockers Use | Co-existing HTN, Raynauds & esophogeal spasm
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| Anticonvulsants Drugs | Topamax (Topiramate) & Valproic Acid
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| Topamax | Topiramate
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| Topamax (Topiramate) SE | Paresthesias & Weight Loss
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| Valproic Acid SE | Nausea, Fatigue, Tremor, Hair loss, weight gain, PCO, lipid changes
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| Herbs | Feverfew, Magnesium, Riboflavin, Botulinum Toxicity
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