Pharmacy & Therapeutics- August 2008 - (Page 489) CONTINUING EDUCATION CREDIT Continuing Education Questions for Physicians and Pharmacists TOPIC: The Pharmacological Management of Migraine, Part 2: Preventative Therapy ACPE Program #079-000-08-019-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. As stated in the article, although beta blockers are commonly used for the prophylactic treatment of migraine headaches, of the following four choices, which one is supported by the least amount of scientific data for its use in preventing migraine? a. propranolol b. timolol c. nadolol d. atenolol According to the author, which of the following statements regarding the use of beta blockers in the prophylactic management of migraines is not correct? a. Beta blockers are effective in approximately 70% of patients. b. Beta-1 selective agents, such as atenolol, may be an appropriate option in patients with severe respiratory disease. c. Although beta blockers are usually well tolerated, reported side effects may include sedation, dizziness, vivid dreams, depression, fatigue, orthostatic hypotension, and impotence. d. Absolute contraindications do not include asthma. Which of the following statements, according to the article, is not correct regarding tricyclic antidepressants (TCAs)? a. Clinical trials have reported a 50% to 70% reduction in the number and intensity of migraine attacks. b. Trials comparing amitriptyline to the beta blocker propranolol have reported superior efficacy with amitriptyline. c. The side-effect profile may include dry mouth, constipation, urinary retention, and weight gain. d. Within the antidepressant class, the TCAs are considered a first-line option for preventing migraine in patients without contraindications. Which of the following statements is not correct for the use of anticonvulsant medications for the prophylactic treatment of migraines? a. The rationale for their use is thought to be related to common mechanisms shared in seizure disorders and migraine involving imbalances between excitatory glutamate activity and GABA-mediated inhibition in the brain. b. Valproic acid and its derivatives were the first class of anticonvulsants approved for migraine prophylaxis. c. Compared with other preventatives, valproic acid has demonstrated similar efficacy and tolerability with propranolol, as noted with the beta blockers. d. Valproic acid and its derivatives are safe for use in women planning pregnancy or in women of childbearing age. 5. Topiramate could be a first-line therapy for which of the following patients? a. patients with a history of seizure disorders b. obese patients in particular c. patients for whom beta-blockers or antidepressants are contraindicated d. all of the above According to the author, other prophylactic agents for migraine may include the following except: a. leukotriene receptor antagonists. b. calcium-channel blockers. c. aldosterone antagonists. d. skeletal muscle relaxants. Treatment of menstrual migraine includes the following strategies except: a. hormonal therapy administered around the menstrual cycle. b. short-term triptan prophylaxis. c. long-term progesterone treatment only. d. short-term NSAID prophylaxis. Which of the following statements about migraine in children and adolescents is true? a. The prevalence in children younger than 15 years of age is 3% to 11%. b. Few data are available for prophylactic treatments in children. c. Abortive treatment may include triptans or simple analgesics. d. all of the above Treatment of migraine in elderly patients may include: a. abortive treatment regardless of the patient’s comorbidities. b. use of ergots in patients with cardiovascular disease. c. abortive treatment with acetaminophen. d. use of triptans in patients with cerebrovascular disease. 6. 2. 7. 3. 8. 9. 4. 10. Multiple options exist for abortive and preventative management of migraine. Current guidelines recommend: a. combination analgesics for aborting mild-to-moderate migraine. b. triptans or ergots for aborting mild-to-moderate migraine. c. simple analgesics or NSAIDs for aborting moderate-tosevere migraine. d. triptans or ergots for aborting moderate-to-severe migraine. Vol. 33 No. 8 • August 2008 • P&T® 489
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