All are true about treatment of migraine EXCEPT:
ANSWER: (D) Sumatryptan is used for chronic migraineREF: Harrison's 17th ed chapter 15"By chronic migraine the examiner means to say prevention of migraine and sumatryptan is not used in prevention of migraine, but in acute attackNaratriptan, administered orally, reaches its peak plasma concentration in 2-3 hours and has an absolute bioavailability of -70%. It is the longest acting of the triptans, having a tl/2 of -6 hours. REF: Goodman & Gillman 11th edition page 196Most drugs effective in the treatment of migraine are members of one of three major pharmacologic classes: anti-inflammatory agents, 5HT1B/1D receptor agonists, and dopamine receptor antagonists.Treatment of Acute migraineDrugTrade NameDosageSimple Analgesics Acetaminophen, aspirin, caffeineExcedrin migraineTwo tablets or caplets q6h (max 8 per day)NSAIDs NaproxenIbuprofenAleve, Anaprox, generic Advil. Motrin, Nuprin, generic220-550 mg PO bid400 mg PO q3-4hTolfenamic addClotam Rapid200 mg PO. May repeat x 1 after 1-2 h5-HT1 Agonists Oral ErgotamineErgomarOne 2 mg sublingual tablet at onset and q 1/2 ,,h (max 3 per day, 5 per week)Ergotamine 1 mg, caffeine 100 mgErcaf, WigraineOne or two tablets at onset, then one tablet q 1/2 h (max 6 per day, 10 per week)NaratriptanAmerge2.5 mg tablet at onset; may repeat once after 4 hRizatriptanMaxaltMaxalt-MLT5-10 mg tablet at onset; may repeat after 2 h (max 30 mg/d)SumatriptanImitrex50-100 mg tablet at onset; may repeat after 2 h (max 200 mg/d)FrovatriptanFrova2.5 mg tablet at onset, may repeat after 2 h (max 5 mg/d)AlmotriptanAxert12.5 mg tablet at onset, may repeat after 2 h (max 25 mg/d)EletriptanRelpax40 or 80 mgZolmitriptanZomigZomig Rapimelt2.5 mg tablet at onset; may repeat after 2 h (max 10 mg/d)Nasal DihydroergotamineMigranal Nasal SprayPrior to nasal spray, the pump must be primed 4 times; 1 spray (0.5 mg) is administered, followed in 15 min by a second spraySumatriptanImitrex Nasal Spray5-20 mg intranasal spray as 4 sprays of 5 mg or a single 20 mg spray (may repeat once after 2 h, not to exceed a dose of 40 mg/d)ZolmitriptanZomig5 mg intranasal spray as one spray (may repeat once after 2 h, not to exceed a dose of 10 mg/d)Parenteral DihydroergotamineDHE-451 mg IV, IM, or SC at onset and qlh (max 3 mg/d, 6 mg per week)SumatriptanImitrex Injection6 mg SC at onset (may repeat once after 1 h for max of 2 doses in 24 h)Dopamine Antagonists Oral MetoclopramideReglan,generic5-10 mg/dProchlorperazineCompazine, generic1-25 mg/dParenteral ChlorpromazineGeneric0.1 mg/kg IV at 2 mg/min; max 35 mg/ dMetoclopramideReglan, generic10 mg IVProchlorperazineCompazine, generic10 mg rvOther Oral Acetaminophen,325 mg, plus dichloralphenazone, 100 mg, plus isometheptene, 65 mgMidrin, Duradrin, genericTwo capsules at onset followed by 1 capsule qlh (max 5 capsules)Nasal ButorphanolStadol1 mg (1 spray in 1 nostril), may repeat if necessary in 1-2 hParenteral NarcoticsGenericMultiple preparations and dosagesPrevention of MigraineDrugDoseSelected Side EffectsPizotifen0.5-2 mg qdWeight gainDrowsinessBeta blocker Propranolol40-120 mg bidReduced energyTirednessPostural symptomsContraindicated in asthmaTricyclics Amitriptyline10-75 mg at nightDrowsinessDothiepin25-75 mg at night Nortriptyline25-75 mg at nightNote: Some patients may only need a total dose of 10 mg, although generally 1-1.5 mg/kgbody weight is requiredAnticonvuls ants Topiramate25-200 mg/dParesthesiasCognitive symptomsWeight lossGlaucomaCaution with nephrolithiasisValproate400-600 mg bidDrowsinessWeight gainTremor Hair lossFetal abnormalitiesHematologic or liver abnormalitiesGabapentin900-3600 mg qdDizzinessSedationSerotonergic drugs Methysergide1-4 mg qdDrowsinessLeg crampsHairlessRetroperitoneal fibrosis (1-month drug holiday is required every 6 months)Flunarizine5-15 mg qdDrowsinessWeight gainDepressionParkinsonism
Naratriptan acts longer than sumatryptan
Sumatryptan is used in acute attack of migraine
Sumatryptan acts on 5HT. B/D receptors in great vessels
Sumatryptan is used for chronic migraine
C.N.S.