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NRP507 Advanced Pharmacology

Week 6 Assignment

Patient Case Study: Migraine

Assignment Content

Karen Myers a 35-year old, who was recently promoted to CEO of a marketing company, presents to the FNP for c/o increasing migraines. She does not have a migraine today but has a past medical history (PMH) of migraines since her early 20s and was able to manage them effectively with OTC Excedrin® Migraine, however, it is no longer effective. Her job requires her to be “at the top of her game,” and she expresses frustration since she has missed work a few times over the past month due to the migraines when she had to retreat to her dark, quiet bedroom and try to sleep it off. She describes a scintillating scotoma aura she has always experienced with her migraines. The evolution of her migraines has not changed, and she describes it as always unilateral, starting in her occipital scalp and migrating retro-orbitally. 

ROS: GI: c/o mild nausea with migraines but has never vomited, Neuro: See HPI; Denies red flags. — PMH: Migraines — Meds: Excedrin Migraine prn — Allergies: NKDA — VS: 124/74, P 72, R 16 — BMI 24

Question 1Which of the following is most appropriate to prescribe first line for Karen?

Tramadol 50 mg tab, sig: 2 tabs at the onset of her migraine and repeat every 4 hours until migraine resolved

Propranolol hydrochloride LA 80 mg cap, sig: 1 cap daily

Rizatriptan 5-10 mg tab, sig: 1 tab at onset of migraine; may repeat dose every 2 hours x2

Magnesium 400 mg tab, sig: 1 tab daily

Question 2

The mechanism of action of serotonin receptor agonists is:

Vasodilation by inhibiting the release of vasoactive peptides and blocking pain pathways in the brainstem, thereby inhibiting dural nociception.

Inhibition of prostaglandin synthesis and have a central analgesic mechanism of action

Modulation of neurotransmitters and appears to affect the central serotonin receptor function

Inhibition of vasospasm of the cerebral arteries and preventing cerebral hypoxia during migraine attacks

Question 3

In a follow-up 3 weeks later, Karen reports success with using the triptan prescribed. She expressed concern over side effects she experienced shortly after taking a dose. Which of the following concerns you the most?

Warming sensation

Drowsiness

Chest tightness

Transient visual loss

Question 4

Which of the following is an unlikely risk factor contributing to Karen’s increased migraine frequency?

Work stress

Jet lag

Dark chocolate and aspartame

Acupuncture

Question 5

You determine Karen is overusing her abortive migraine treatment and want to initiate a prophylactic medication (in addition to abortive treatment). Which of the following medications is most favorable considering the concerns she verbalized above?

Topiramate

Verapamil

Amitriptyline

Candesartan

Botulinum toxin

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