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D2 receptor blocker
0%
0/10
Beta-blocker
20%
2/10
GABA transaminase inhibitor
5-HT1B/D agonist
70%
7/10
Cyclooygenase inhibitor
10%
1/10
Select Answer to see Preferred Response
Triptan medications are recommended in patients who have moderate-to-severe migraine headaches, or are unresponsive to analgesics. Migraine headache is a recurrent disorder that can be recognized by its Pulsating nature, lasting 4-to-72 hOurs, Unilateral, presence of Nausea or vomiting, and being Disabling (POUND mnemonic). Abortive therapy for migraine headaches include the analgesics (i.e., NSAIDs, acetaminophen), triptans, antiemetics, and ergotamines (less commonly). Triptan medications act on 5-HT1 B/D receptors, and are considered migraine-specific medications. Gilmore and Michael present a review on the treatment of acute migraine. Patients typically present to the physician after trying many nonprescription medications that have failed. Nonsteroidal anti-inflammatory drugs (NSAIDs), or combination caffeine-containing analgesics can be considered first-line in mild-to-moderate migraines, or in patients who have severe migraine headache that have responded to those medications. However, in patients who present with moderate-to-severe migraines, or in those who have mild migraines that do not respond to nonprescription medications, triptans are considered the treatment of choice. Tepper and Rapoport discuss the mechanism of action of triptans. Triptans are 5-HT1B/D receptor agonists which subsequently lead to cerebrovascular vasoconstriction, inhibition of trigeminal nerve release of vasoactive neuropeptides, and nociceptive neutrotransmission inhibition. Incorrect Answers: Answer 1: Antipsychotic medications, such as haloperidol, have the ability to antagonize D2 receptors. These medications are used to treat the positive symptoms in schizophrenia, psychosis, bipolar disorder, and so forth. Answer 2: Beta blockers, such as propranolol, can be used in the prophylactic treatment of migraine headaches. This is not an abortive migraine agent, such as triptans and ergotamines. Answer 3: Valproic acid has the ability to inhibit GABA transaminase. This agent is used in the prophylactic treatment of migraine headaches. Answer 5: Cyclooxygenase inhibitors include the nonsteroidal anti-inflammatory drugs (NSAIDs). Since this patient did not respond to over-the-counter medications, triptans are next in line.
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