NAPLEX Migraine + Gout

Maxalt

rizatriptan

Imitrex

sumatriptan

Lasmiditan drug class

serotonin receptor (5-HT1F) agonist

Lasmiditan indication

abortive agent for migraines

Onzetra Zsail

sumatriptan nasal powder

Zembrace Symtouch

sumatriptan SC autoinjector

Imitrex STATdose System

sumatriptan SC autoinjector

Zomig

zolmitriptan

Migranal

dihydroergotamine

Nurtec

rimegepant

Ubrelvy

ubrogepant

Qulipta

atogepant

Nurtec drug class

CGRP receptor antagonist

Qulipta drug class

CGRP receptor antagonist

Ubrelvy drug class

CGRP receptor antagonist

Migranal drug class

ergotamine (nonselective agonist of serotonin receptor)

Colcrys

colchicine

Medrol

methylprednisolone

Solu-Medrol

methylprednisolone

Zyloprim

allopurinol

Aloprim

allopurinol

Triptans are selective agonists for _____ receptors, to vasoconstrict cranial blood vessels, inhibit neuropeptide release and decreas pain transmission

5-HT1

Triptans should be taken at ______ for the best results

first sign of a migraine

_______ are recommended for menstrual migraines with aura to avoid additive stroke risk with estrogen-containing contraceptives

progestin-only, nonhormonal contraceptives

What are contraindications for triptans?

cerebrovascular disease (stroke/TIA), uncontrolled HTN, ischemic heart disease

What is this? pressure or heaviness in the chest or pressure in the neck region?

triptan sensation

________ ODT contains phenylalanine and should not be used in patients with phenylketonuria

maxalt-MTL

Which migraine products are approved for children and adolescents ≥ 12 years?

almotriptan, zolmitriptan, treximet

Treximet

sumatriptan + naproxen

Which triptan is approved for ages ≥ 6 years?

rizatriptan

Which triptan has the longest half-life?

frovatriptan

Which are the long-acting triptans?

frovatriptan, naratriptan

Sumatriptan injections are SC and are injected on the ______

lateral thigh, upper arm

________ are not recommended due to decreased efficacy, abuse/dependence potential and risk of medication overuse headaches

butalbital-containing products, opioids, tramadol, trapentadol

Which triptans come in tablet formulation?

all triptans

Which triptans come in ODT formulation?

rizatriptan, zolmitriptan

Which triptans come in nasal spray formulation?

sumatriptan, zolmitriptan

Which triptans come in nasal powder formulation?

sumatriptan

Which triptans come in SC injection formulation?

sumatriptan

Which triptans are contraindicated with MAO inhibitors (or within 2 weeks of stopping) due to increased triptan concentrations when used together?

sumatriptan, rizatriptan, zolmitriptan

Which type of migraine medication is contraindicated with potent CYP3A4 inhibitors due to serious and life-threatening peripheral ischemia?

ergotamine (nonselective agonist of serotonin receptors)

Which type of migraine medication is contraindicated in pregnancy?

ergotamine (nonselective agonist of serotonin receptors)

Which abortive agent for migraines is approved to treat acute migraine attacks?

ubrogepant, zavegepant

Which abortive agent for migraines is approved to both prevent + treat acute migraine attacks?

rimegepant

Preventive treatment should be considered in patients who have ≥ ____ migraines per month, have migraines that decrease QOL, if acute treatments are ineffective, contraindicated, overused, or not tolerated or if patients request it

4

What are the 1st-line options for prophylactic migraine treatment?

beta-blockers, TCAs, SNRIs, topiramate, CGRP receptor antagonist, valproic acid

Which beta-blocker has the best evidence for migraine ppx?

propranolol

Which natural products are used to prevent migraines?

riboflavin (vitamin B2), magnesium, butterbur, feverfew

Which antiseizure meds are used for migraine ppx?

valproic acid, topiramate

Which CGRP receptor antagonists are approved for migraine ppx?

atogepant, rimegepant

________ injections are used for ppx of chronic migraines only (≥ 15 headache days per month)

onabotulinumtoxinA (botox)

What are the risk factors for gout?

male, obesity, excessive alcohol

Which foods should be avoided to lower the risk of gout?

organ meats, high-fructose corn syrup, alcohol, red meat, seafood

Prophylactic drugs, sometimes called urate-lowering therapy (ULT), are used to lower UA levels, with a goal UA level of < _____ mg/dL

6

Gout treatments for treating acute pain with anti-inflammatory drugs

colchicine, steroids, NSAIDs, interleukin-1 antagonists

Gout treatments for treating chronically to prevent future attacks

xanthine oxidase inhibitor

If xanthine oxidase inhibitors didn’t work well enough and UA remains > 6 mg/dL, add ______ or replace with IV pegloticase

probenecid

If xanthine oxidase inhibitors didn’t work well enough and UA remains > 6 mg/dL, add probenecid or replace with _________

IV pegloticase

Canakinumab drug class

interleukin-1 antagonist

Canakinumab indication

acute gout attacks when first line treatments are inadequate

Colchicine is started within ____ hours of symptom onset for gout treatment

36

Which gout treatment can cause myelosuppression?

colchicine

Which gout treatment should be avoided with cyclosporine, diltiazem, verapamil, gemfibrozil, or statins due to increased myopathy risk?

colchicine

Side effects of colchicine: _____

diarrhea, nausea, myopathy, neuropathy

Wait ____ hours after a treatment dose of Colchicine before resuming prophylactic dosing

12

Pegloticase drug class

recombinant uricase enzyme

Pegloticase converts UA to an inactive metabolite that can be easily excreted and is reserved for _____

severe, refractory gout

Which gout treatment is reserved for severe, refractory gout?

pegloticase

What are the chronic urate lowering therapies?

allopurinol, febuxastat, probenecid, pegloticase

Febuxostat drug class

xanthine oxidase inhibitor

Do NOT use _____ in combo with Allopurinol, Febuxostat, or Probenecid (increased risk of anaphylaxis

pegloticase

Which ULT has a hepatotoxicity warning? (increases LFTs)

febuxostat

Due to the high rate of gout attacks when beginning ULT, use ________ with Colchicine (0.6 mg once or twice daily) or an NSAID for the first 3-6 months

allopurinol, febuxostat

Which ULT can increase beta-lactam levels?

probenecid

Do NOT use ______ with Mercaptopurine or Azathioprine (increases the concentration or mercaptopurine, the active metabolite of azthioprine)

allopurinol, febuxostat

______ is a uricosuric that inhibits reabsorption of uric acid in the kidneys, which increases uric acid excretion to treat gout

probenecid

Which ULT has a BW for anaphlyactic reactions and should be monitored and premedicated with antihistamines and steroids

pegloticase

Which ULT has a contraindication for G6PD deficiency

pegloticase