CC Nov 2015 Triptans for migraines

echoecho's version from 2015-11-30 19:01


Question Answer
Migraine headaches are estimated to afflict almost 1 in ____ women and 1 in ____ men in the Western world?5; 20
Headaches may last from ___ to ___ hours and may occur ____ times a week?4; 72; multiple
Migraine headaches are also associated with a significant reduction in patients' ______ of life, significant ____ and significant source of ___ ___?1) quality 2) cost 3) lost work
Treatment of migraines involves what?1) avoidance of triggers (sleep deprivation, dehydration, excessive caffeine use) 2) use of prophylactic medications 3) acute treatment medications
The acute treatment medications include what?1) NSAIDS 2) acetaminophen 3) antiemetics 4) serotonin 5-HT 1B/1D receptor agonists (triptans)
What are the proposed mechanisms of action for the triptans?1) cranial vasoconstrition 2) inhibition of peripheral and central trigeminal nerve transmission 3) peripheral and central trigeminal nerve transmission 4) altered modulation of nociceptive processing
When should triptans be given to the patient?at the onset of migraine
What are the modalities that triptans are available in?1) orally 2) subcutaneously 3) intranasally 4) rectally
A 2014 Cochrane review of sumatriptan (Imitrex) concluded that it was ____ at reducing the pain of migraines?effective
*** What modality of sumatriptan reduced pain from moderate/severe to none by 2 hours after use in 59% of patients (compared to 15% of patients taking placebo), with a number needed to treat (NNT) of 2.3; the oral dose reduced pain in 28% of patients over 2 hours with a NNT of 6?subcutaneou
What are the advantages and disadvantages of using subcutaneous sumitriptans?1) advantage was faster onset of action 2) disadvantage was being more expensive and associated with increased side effects (nausea, chest presure, palpitations, fatigue)
List the triptans available?1) almotriptan (Axewrt) 2) eletriptan (Relpax) 3) frovatriptan (Frova) 4) naratriptan (Amerge) 5) rizatriptan (Maxalt) 6) sumatriptan (Imitrex) 7) zolmitriptan (Zomig)
Which one of the triptans was most likely to produce pain relief at 2 hours (68%) and 24 hours (54%)?eletriptan (Relpax)
Was there any direct comparison studies with injectable sumatriptan?no
Is the cose of most of the oral triptans roughly equivalent?yes
Which triptans have nasal preparations?1) sumatriptan (Imitrex) 2) zolmitriptan (Zomig)
Nasal preparations cost about ____% more than the oral tablets?50
The cost of subcutaneous sumatriptan is about ___ times that of oral tablets?3
List the contraindications of triptan use?1) CAD 2) CVA 3) PVD 4) Wolff-Parkinson White syndrome 5) hx of CVA or TIA 6) uncontrolled blood pressure
Comment on Treximet?1) Treximet is a combination of sumatriptan 85 mg plus naproxen 500 mg 2) cost is significantly higher than if meds are given seperately (sumatriptan 50 or 100 mg with naproxen 550 mg) 3) the combination was superior to either agent given alone 4) increased benefit at 2 and 24 hours was relatively small compared to sumatriptan alone but was considerable compared to naproxen alone 4) it is thought that the 2 classes of meds work on different neural pathways involved in migraines
*** SUMMARY = When should triptans be given?at the onset of migraine
*** SUMMARY = List the modalities that triptans be given?1) orally 2) subcutaneously 3) intranasally 4) rectally
*** SUMMARY = _______ sumatriptan (Imitrex) has a faster onset of action and provides better pain relief at 2 hours than oral sumatriptan?subcutaneous
*** SUMMARY = A recent review comparing various triptans found that _____ was most likely to produce pain relief at 2 hours and 24 hours?eletriptan (Relpax)
*** SUMMARY = The combination of ______ and _______ provided slightly better pain relief at 2 and 24 hours than ______ alone and significantly better pain relief than _____ alone?1) sumatriptan and naproxen 2) sumatriptan 3) naproxen