1. LT, a 28-year-old Asian-American female, is a sixth-year pharmacy student with a history of migraine without aura. She recently returned from a 1-month rotation with the Indian Health Service in Arizona where she participated in a health screening, counseling, and immunization program for a Native American community. Feeling ill since returning home, LT has been diagnosed with valley fever (coccidioidomycosis) and started on a 6-month course of ketoconazole (Nizoral). Which of the following would be the best choice as a migraine abortive therapy?

2. LT returns for a consultation 6 months later. She has stopped taking her prescription abortive agent because her copays were too expensive and now her migraines are worse, occurring 8 to 12 days per month. She has resorted to OTC tablets of an aspirin/acetaminophen/caffeine combination (Excedrin) and gets acceptable results without adverse effects. However, she requires a second dose on most treatment days to get through her workday. LT is currently taking the OTC medication 3 days per week on average, and her headaches seem to be worsening over time. Which of the following recommendations would be the most appropriate?

3. For a patient who has had an adequate trial of propranolol as their first attempt with a migraine preventive agent, but has had unacceptable adverse effects and is still having 8 migraine headache days per month, which of the following would be the most reasonable next step?

4. CS is a 35-year-old man with a history of episodic migraine. He is no longer deriving benefit from OTC NSAIDs and analgesics and wants to try a prescription abortive medication. He is HIV positive but asymptomatic. His CD4 cell counts are normal and viral load is undetectable on lopinavir/ritonavir (Keletra). Which of the following would be acceptable to prescribe for migraine abortive care?

5. KC is a 60-year-old male pharmacology professor with a history of episodic cluster headaches. He has been treating his active cluster episodes with melatonin 10 mg nightly to no avail. He went to his primary care physician 2 weeks ago and was given verapamil 240 mg daily, but he has not noticed any improvement so far. KC cannot sleep through the night, and even though his attacks are only an hour long, he is very agitated and developing symptoms of depression. Which of the following would be the least appropriate option to help treat his acute cluster attacks?

Evaluation Questions

6. How confident are in your treatment choices for the patients presented in this test?

« Return to Activity