Pharmacy & Therapeutics- July 2008 - (Page 418) CONTINUING EDUCATION CREDIT Continuing Education Questions for Physicians and Pharmacists TOPIC: The Pharmacological Management of Migraine, Part 1: Over view and Abortive Therapy ACPE Program # 079-000-08-017-H01-P CE Evaluation: Select the one best answer to each of the following questions, and record your response on the examination answer sheet. Complete the additional requested information. Forward the answer sheet, with appropriate payment, to the Department of Health Policy, Thomas Jefferson University Hospital, at the address indicated. A certificate of completion will be mailed within six to eight weeks of receipt of your exam/payment. (A minimum test score of 70% is required.) Multiple Choice Select the one correct answer. 1. Which of the following is not true regarding migraine headaches? a. Migraine is more common in females than males, with a prevalence of 19% and 7%, respectively. b. Because migraine affects people during their most productive years (in the 25- to 50-year-old age group), the direct and indirect costs have a significant impact on society. c. The direct costs are reported to be approximately $1 billion annually, and the indirect costs of lost time at work, school, and home result in an estimated $5.6 billion to $17.2 billion per year. d. The prevalence of migraine is reported to range between 2% and 5% in various countries around the world. The acute treatment of migraines is appropriate for those who experience: a. fewer than two migraines per week. b. more than 10 migraines per month. c. fewer than two migraines per month. d. none of the above According to the article, which of the following pharmacological agents should be avoided in the abortive treatment of migraine? a. barbiturates b. aspirin c. opiates d. a and c Which of the following statements is not correct regarding the pharmacological agents used in the acute treatment of migraines? a. Most patients will have already tried simple analgesics and over-the-counter anti-inflammatory medications before seeking care from a health care professional. b. Combination analgesics may have a role in moderate-tosevere cases of migraines supported by clinical trials. c. Although butalbital with APAP or ASA has a long history of use in migraine patients, no data are available that support its utility. d. The isometheptene component of Midrin has sympathomimetic properties that suggest a vasoconstriction mechanism. 5. Caffeine is added to combination therapy with the simple analgesics APAP and ASA: a. to enhance absorption. b. to possibly potentiate activity. c. a and b d. none of the above Which of the following statements regarding pharmacological activity of triptans is not true? a. Central nervous system penetration is correlated with clinical efficacy. b. Bioavailability is not correlated with clinical response. c. Triptans block pain signal transmission and vasoactive neuropeptide release. d. Headache recurrence may be affected by differences in half-life. A side effect associated with the use of ergots is: a. excitability. b. insomnia. c. chest discomfort. d. dry mouth. An advantage of triptans is: a. their more selective serotonin agonist receptor profile. b. an increased interaction at adrenergic receptors. c. their use as a drug of choice for migraine prophylaxis. d. an increased interaction at dopaminergic receptors. Triptans are contraindicated for all of the following except: a. coronary artery disease. b. cerebrovascular disease. c. diabetes mellitus. d. ischemic bowel disorders. 6. 7. 2. 8. 3. 9. 4. 10. Other abortive agents that can be used include: a. phenothiazines, butyrophenones, and oral valproic acid. b. metoclopramide, intravenous valproic acid, and haloperidol. c. droperidol, haloperidol, and gabapentin. d. chlorpromazine, methylphenidate, and prochlorperazine. 418 P&T® • July 2008 • Vol. 33 No. 7
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