Week 6 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain

Week 6 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain Question: What is abortive therapy? Answer The objective is to eliminate headache pain and suppress associated nausea and vomiting (alleviating pain during the aura phase (if present) or soon after the headache has started) Question: When is abortive therapy used for migraines? Answer Treatment should commence at the earliest sign of an attack & limited to 1-2 days a week Question: When should preventative medication be used? Answer - for patients who have frequent attacks (three or more a month) - attacks that are especially severe, or - attacks that do not respond adequately to abortive agents Question: Abortive treatment for migraines, mild to moderate symptoms: Answer NSAID (aspirin, naproxen) Abortive treatment for migraines, moderate to severe symptoms: migraine-specific drug Serotonin1B/1D Receptor Agonist (Triptans) or Ergot Alkaloids Question: Frequent use of abortive treatment can lead to: Answer Medication overuse headaches (MOH) which will resolve days to weeks after overused drug is withdrawn Question: When symptoms of a migraine are severe and NSAIDS, Triptans, and Ergot Alkaloids don't work, what may be needed? Answer Opioid analgesic such as Butrophanol ***RESERVED unless migraine is resistant to all other treatment. Question: First line drug for TERMINATING a migraine? Answer Triptans Sumatriptan Question: What is the primary use of Reglan and Compazine with migraines? Answer N/V associated with migraines Question: Which medications are used as first-line treatment for migraine prevention? Answer Beta-blockers are the first-line drug for migraine prevention. (Propranolol, metoprolol) Question: What constitutes a diagnoses for chronic migraines? Answer Defined as having 15 or more headache days per month With at least 8 days of having headaches with migraine features for more than 3 months. Question: First-line treatment for acute, mild to moderate migraines without nausea or vomiting include: Answer NSAIDs. Aspirin, naproxen, diclofenac, and other aspirin-like analgesics/combos can provide adequate relief of mild to moderate migraine attacks. When combined with metoclopramide, aspirin may work as well as sumatriptan *triptans also work for mild treatment Question: Moderate treatment of migraines without nausea/vomiting include: Answer DHE, Ergotamine, Triptan, NSAID combo Question: Severe treatment of migraines without nausea/vomiting: Answer DHE, ergotamine, NSAID, triptans, metoclopromine Question: When is preventative therapy for migraines appropriate? Answer Preventive treatment is indicated for patients who have: frequent attacks (three or more a month) attacks that are especially severe attacks that do not respond adequately to abortive agents Question: What is an example of an opioid analgesic that is reserved for severe migraines that do not respond to first-line medications? Answer Butorphanol nasal spray Question: naproxen sodium at a dosage of 550 mg twice daily, given _____ days before to ____ days after menses, has demonstrated effectiveness in the prevention of migraine. Answer 6 days before 7 days after Question: What is the MOA of triptans? Answer Reduces release of inflammatory neuropeptides and thereby diminishes perivascular inflammation & causes vasoconstriction Binds to 5-HT1B/1D receptors on intracranial blood vessels causes vasoconstriction. Binding to 5-HT1B/1D receptors on sensory nerves of the trigeminal vascular system suppresses the release of CGRP, a compound that promotes release of inflammatory neuropeptides. Question: What is the most commonly prescribed triptan for migraines? Answer Sumatriptan Question: What are the contraindications to prescribing Triptans? Answer Ischemic heart disease Myocardial infarction Uncontrolled HTN Can cause birth defects in laboratory animals and must not be used during pregnancy. Question: What is the most common side effect of Sumatriptan? Answer Bad taste in the mouth **most common concern is coronary vasospasm Why should the first dose of any triptans be monitored by a provider? Answer Due to the possibility of unknown underlying cardiac disease, or coronary vasospasm. Examples of Analgesics for Migraines include Answer Acetaminophen Excedrine Butorphanol nasal spray Examples of Serotonin 1B/1D Receptor Agonists Answer -Triptans Sumatriptan Answer Eletriptan Frovatriptan Examples of Ergot Alkaloid Answer Ergotamine sublingual Dihydroergotamine intranasal Ergotamine + caffeine (Cafergot, Migergot) Examples of medication used to prevent migraines β Blockers Antiepileptics Tricyclic antidepressants Erenumab Botulinum toxin Consider hormonally related migraine in females CGRP receptor antagonists NSAIDs Triptans Prophylaxis with estrogen Patient education and lifestyle modifications CNS Disorders topics and concepts include Parkinson's Alzheimer's Seizure Management of headaches Alzeheimer's Disease (AD) is characterized by Progressive memory loss and decreasing brain function. Genetic and environmental factors in AD cause Abnormal protein deposits to build up in the brain. Cell death in AD leads to Atrophy of brain tissue causing spaces in the brain, called ventricles, to grow larger. Which areas of the brain are primarily affected in AD? Hippocampus Cerebral cortex Parkinson's Disease is characterized by Involuntary muscle movements and tremors. What causes the characteristic muscular symptoms in PD? Dopamine-producing neurons in the brain are damaged leading to progressively decreasing levels of the neurotransmitter dopamine, as well as a neurotransmitter imbalance. How can damage to dopamine-producing neurons in PD be observed? As a diminished and faded appearance of the substantia nigra. A seizure is an episode of Abnormal, hyperactive brain activity. Seizures disrupt normal brain activity and cause periods of unusual symptoms such as Staring blankly, loss of consciousness, loss of sensation, or uncontrollable twitching and jerking. The most common migraine symptom is Unilateral, pulsating head pain. *Other- n/v, irritability, attention deficits, and increased sensitivity to light, sound, and other non painful stimuli. What is one of the major contributors to pain in migraines? Peripheral sensitization (PS) When and where does PS occur? When branches of the trigeminal nerve are stimulated near the forehead, paranasal sinuses (air filled spaces near the nose), and the temporomandibular joint. Some patients with migraine experience visual or auditory distrubances (aura) preceding their head pain which may be caused by Reduced oxygen supply to certain parts of the brain. *Occipital (blurry vision), sensory (numbness, tingling), or motor (muscle weakness) cortex. Alzheimer's Disease (AD) is a Progressive neurodegenerative disease What parts of the brain are affected in AD? Hippocampus and cerebral cortex *Also leads to enlarged ventricles AD is characterized by Progressive memory loss and decreasing brain function AD is currently diagnosed through The exclusion of other causes of dementia No specific symptom is unique to the disease; therefore, a comprehensive health history is key to gather clues T or F- there is no cure for AD True *Meds can slow progression 10 early warning signs and symptoms of Alzheimer's Memory loss Challenges in planning or solving problems Trouble understanding visual and spatial relationships Difficulty completing familiar tasks Disorientation Problems with word finding Misplacing things Impaired judgment Social withdrawal Changes in mood Treatment for AD includes Cholinesterase inhibitors (ChEIs) - Donepezil (Aricept) Memantine Cholinesterase Inhibitors (ChEIs) Increase levels of the neurotransmitter acetylcholine Ex. Donepezil (Aricept) Donepezil (Aricept) MOA Inhibits centrally active acetylcholinesterase Donepezil (Aricept) AE Gastrointestinal symptoms (nausea and diarrhea), headache, dizziness, muscle weakness Donepezil (Aricept) precautions Sick sinus syndrome and seizure disorder Donepezil (Aricept) is approved to treat Moderate to severe AD at 23 mg/day dose, but there is minimal improvement in cognitive functioning when compared to a 10 mg/day dose. At the higher dose, donepezil has a higher incidence of adverse effects. When Donepezil (Aricept) is added to CYP2D6 or CYP3A4, there is a possibility of Peripheral side effects, and inducers of CYP2D6 and CYP3A4 may increase the rate of elimination Revastigmine (Exelon) MOA Acts centrally for both acetylcholinesterase and butyrylcholinesterase, thereby potentially increasing its efficacy Revastigmine (Exelon) AE Gastrointestinal symptoms (anorexia, nausea, vomiting, or diarrhea), weakness, dizziness, tremor Revastigmine (Exelon) precautions Asthma or COPD, sick sinus syndrome, GI Bleeding, weight 50 kg How is Rivastigmine (Exelon) administered? Orally or topically (transdermal patch) The Rivastigmine (Exelon) transdermal patch is used for Dementia associated with Parkinson's T or F: Medications that induce or inhibit CYP450 metabolism will NOT modify rivastigmine (Exelon) metabolism True Galantamine (Razadyne, Razadyne ER) MOA Elevating acetylcholine (Ach) in the cerebral cortex, modulating the nicotinic Ach receptors to increase Ach release from existing presynaptic nerve terminals. It also increases glutamate and serotonin levels; however, the benefits of this action are unknown at this time Galantamine (Razadyne, Razadyne ER) AE Gastrointestinal symptoms (nausea, vomiting, diarrhea, anorexia, and weight loss), headache, dizziness, fatigue Galantamine (Razadyne, Razadyne ER) precautions NSAID use, GI bleed, asthma or COPD, concurrent use with medications that slow or decrease heart rate Galantamine (Razadyne, Razadyne ER) contraindications Severe hepatic or renal impairment What two major metabolizing enzymes increase galantamine (Razadyne, Razadyne ER) concentrations? CYP3A4 and CYP2D6 Memantine (Namenda) is the only N-methyl-D-aspartate (NMDA) Receptor Antagonist approved for Management of moderate to severe AD *Improvement is modest with this treatment Memantine (Namenda) MOA Prevents glutamate, an excitatory neurotransmitter, from binding at the receptor site NMDA receptors control activity throughout the brain by regulating how much calcium enters the nerve cell Overproduction of the NMDA receptor and excess glutamate can lead to excessive calcium entering the cell and disrupting information processing Blocking NMDA receptors protects neurons from the effects of too much glutamate without affecting normal neurotransmission Memantine (Namenda) AE GI (constipation, diarrhea, and weight gain), urinary frequency, confusion, dizziness, headache, cough Memantine (Namenda) precautions Concurrent use with amantadine, rimantadine, ketamine, or dextromethorphan and severe renal or hepatic impairment Memantine (Namenda) is used as Monotherapy or in conjunction with ChEIs When Memantine (Namenda) is given with ChEIs, what type of pecautions are required? Fall precautions Driving is forbidden due to delayed reactions Are there pharmacokinetic interactions with Memantine (Namenda)? No Minimal inhibition of CYP450 enzymes (CYP1A2, CYP2A6, CYP2C9, CYP2D6, CYP2E1, and CYP3A4) Increased life expectancy for dementia associated memantine vs donepezil? Memantine If treatment failure occurs for AD what action should be taken? Try another agent as 50% of individuals respond to a different agent Can AD medications halt or reverse the progression of Alzheimer's disease? No Educate clients and families on this What treatment goals will inform selection of an agent for AD? Are you focusing on a specific symptom or behavior? Is the associated risk of the medication worth the potential benefit? Donepezil at a higher dose has a higher Incidence of adverse effects WITHOUT increased cognitive benefit What forms is Rivastigmine (Exelon) available in? Oral form or transdermal patch What is the Rivastigmine (Exelon) transdermal patch is used for? Dementia associated with PD Will medications that induce or inhibit CYP450 metabolism modify rivastigmine (Exelon) metabolism? No Are antipsychotics recommended for treatment of dementia related to agitation and behavioral symptoms? No *Donepezil is recommended Cleo is a 65-year-old male diagnosed with mild cognitive changes related to Alzheimer's disease (AD). He also has anxiety, chronic obstructive pulmonary disease (COPD), and smokes cigarettes. Which of the following medications is appropriate for Cleo? Donepizil *Donepezil is approved for the treatment of mild dementia and is NOT affected by nicotine Donepezil also treats psychological symptoms of AD such as anxiety, depression, apathy, delusions, and pacing A client diagnosed with Alzheimer's disease has decided to stop treatment. The FNP educated the client that medication discontinuation will result in the return of cognitive symptoms and may not work as well if restarted. The client would still like to stop the med due to GI side effects. Which of the following medications requires tapering? Donepezil *Rivastigmine and Galantamine do NOT require tapering Alzheimer's Disease (AD) is a ______ ______ disease Progressive irreversible Are there medications which can stop the progression or reverse the disease? No The available AD medications can provide some symptomatic improvement, but the improvements will _______ as the disease progresses Fade If an AD medication is discontinued, the medication may NOT be as effective if restarted The current gold standard of treatment for cognitive symptoms includes pharmacologic management with a Cholinesterase (ChE) inhibitor and an NMDA antagonist *Donepezil or memantine Which of the following is a relevant risk factor for Mimi for Alzheimer's Disease? Female gender Risk factors for Alzheimer's disease (AD) include Female gender, previous family history, onset at 65 years or older, lower education, sedentary lifestyle, and smoking Which of Mimi's symptoms support a diagnosis of Alzheimer's disease? Select all that apply. Anxiety, difficulty sleeping, inability to name familiar objects Symptoms of Alzheimer's disease include Confusion, memory loss, disorientation, feeling lost in a familiar situation, impaired judgment, anxiety, insomnia, and other personality changes What is the treatment goal for Mimi? Slow her memory loss *Current pharmacologic agents are unable to stop or restore memory or cognitive function. Drugs cannot reverse the pathophysiologic disease process Which of the following stages best describes the severity of Mimi's disease process? Moderate *Mimi is presenting with anxiety, agitation, and difficulty recognizing family and familiar people (e.g., church friends) What symptoms are indicative of moderate stage Alzheimer's disease? Anxiety, agitation, and difficulty recognizing family and familiar people (e.g., church friends) Which of the following is the most appropriate treatment for Mimi? Donepezil monotherapy For patients diagnosed with moderate AD, the drug of choice is A cholinesterase inhibitor plus consideration of memantine It is not recommended to combine 2 cholinesterase inhibitors Which of the following is the appropriate starting dose for oral rivastigmine (Exelon)? 1.5 mg twice daily Which of the following agent works by blocking the NMDA receptor? Memantine How many drugs are approved for treating AD dementia? 4 Which of the 4 approved drugs for AD are cholinesterase inhibitors? Donepezil Galantamine Rivastigmine Which of the 4 approved drugs for AD is a NMDA? Memantine Which of the following conditions or diseases raise concern if acetylcholinesterase inhibitors were used to treat Mimi's AD? COPD Acetylcholine inhibitors can lead to bronchoconstriction. Caution warranted in patients with concomitant asthma or COPD Which of the following agents has not demonstrated symptom improvement in mild AD? Memantine *Memantine is not indicated for mild AD as studies have not demonstrated symptom improvement. It is indicated in patients with mild-moderate AD. Memantine is indicated in patients with Mild-moderate AD Which of the following agents is NOT metabolized by CYP-450 enzymes? Rivastigmine *Rivastigmine is metabolized by AChE in the brain. The other agents are metabolized by CYP 450 enzymes Which of the following clinical and/or laboratory parameters are necessary to evaluate therapeutic effects? Select all that apply. The patient's cognitive function, the level of disease severity, activities of daily living, patient's level of behavioral disturbances or quality-of-life Which of the following antipsychotics has demonstrated a reduction in neuropsychiatric symptoms with their use? Select all that apply. Olanzapine and risperidone *There is convincing evidence that neuropsychiatric symptoms can be reduced with two atypical antipsychotics: risperidone (Risperdal) and olanzapine (Zyprexa) *Benefits are modest Neuropsychiatric symptoms with AD *Cholinesterase inhibitors may offer modest help *Little or no evidence for a benefit from conventional antipsychotics (e.g., haloperidol, chlorpromazine), mood stabilizers (valproate, carbamazepine, lithium), antidepressants, or memantine Parkinson's disease (PD) is a slow, progressive neurodegenerative disease that affects The extrapyramidal motor system The hallmark features of PD are Resting tremors, rigidity, akinesia/bradykinesia, and postural instability Is there a cure for PD? No *Treatment targets to control symptoms and maintain the quality of life (QOL) or functioning Pharmacological interventions for PD include Levodopa Dopamine agonists MAO-B inhibitors COMT inhibitors Amantadine (Symmetrel) Anticholinergics: Benztropine (Cogentin) Dopamine agonists may cause excessive Daytime sleepiness in 50% of PD patients *Sudden sleep attacks are potentially dangerous during driving Rescue therapy acute hypo-mobility attacks in PD Apomorphine (Apokyn) *Injected SQ What are patients pre-medicated with before administering apomorphine (Apokyn)? An antiemetic to prevent n/v Patients should be educated on dopamine dysregulation syndrome (DDS), which manifests as Drug-seeking and impulse control disorders (ICDs) such as gambling or compulsive spending Selegiline ODT (Zelapar), an orally disintegrating tablet, helps Insomnia *Helps avoid first-pass metabolism to improve the bioavailability and decrease serum concentrations of its amphetamine-like metabolite that causes insomnia What may occur in patients using PD medications with opioid analgesics, antidepressants, and other serotonergic agents, or sympathomimetic amines (cold and weight loss products)? Serotonin syndrome and hypertensive crisis What is used in patients who do not tolerate or respond to entacapone (Comtan)? Tolcapone (Tasmar) *Only time this med is used Why is tolcapone not used much? Hepatotoxicity *Serum function tests should be monitored A decrease in the levodopa dose can improve Dyskinesias T or F: Dopamine agonists are the most effective medications for Parkinson's Disease False *Levodopa Combining _______ medications with levodopa in early treatment may delay motor complications MAO-B inhibitors Patients should be educated on dopamine dysregulation syndrome (DDS) which can manifest as Impulse control disorder What is the therapeutic goal for Helen and others with Parkinson's Disease (PD)? Symptom management Helen's family asks why marked symptom improvement is not seen since she was started on three medications for PD at the time of diagnosis. Which of the following education points will help Helen's family understand the pharmacological approach to symptom management in PD? Medications increase the level of dopamine and decrease the level of acetylcholine in CNS responses can take several months to occur Helen's family asks why she is receiving the combination drug, levodopa/carbidopa, and not just levodopa. Which of the following education points will help Helen's family understand the desired effects of carbidopa in the combined levodopa/carbidopa therapy? Carbidopa reduces cardiovascular responses to levodopa *Carb reduced card *Also reduces n/v Helen and her family have heard of other medications that are used to treat PD and inquire if they may help control Helen's symptoms. Which of the following medications may be used for symptom management in PD? Donepezil *Donepezil may be used for symptom management in PD. Dementia occurs in 40% of PD patients. AAN guidelines recommend treatment with two drugs: donepezil and rivastigmine. Both drugs are cholinesterase inhibitors developed for Alzheimer's disease Which of the following statements best describes the mechanism of action of rasagiline? Inhibit the breakdown of dopamine by MAO-B inhibitors *Both rasagiline and selegiline are MAO-B inhibitors and work by inhibiting the breakdown of dopamine by MAO-B Which of the following is needed to monitor the effects of carbidopa/levodopa therapy? Select all that apply. Orthostatic vital signs, reports of palpitations, and motor function assessments Which of the following education points is required to help preserve the therapeutic effects of carbidopa/levodopa therapy? Take the medication with low protein food *Levodopa is administered orally and undergoes rapid absorption from the small intestine. Food delays absorption by slowing gastric emptying Which of Helen's medications is contraindicated with selegiline? Sertraline 75mg PO daily *Selegiline should not be combined with selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac). The combination of an MAO-B inhibitor plus an SSRI can cause fatal serotonin syndrome *Withdraw at least 5 weeks before giving selegiline Seizures may be categorized as Focal Generalized Seizures are typically a result of a dysfunction of the central nervous system, a treatable systemic process, or an underlying brain pathology, including: Brain lesions or disorders Migraines TIAs Metabolic derangement Encephalitis Head injury Drug/alcohol withdrawal Syncope Infections Fever Patients presenting with an initial seizure should be evaluated to determine if the activity resulted from a Reversible or correctable cause (i.e.: hypoglycemia or hyponatremia) and if there is a risk for further seizure activity. Acute seizures are typically treated with IV or rectal benzodiazepine and supportive care What are the common drug choices for acute seizures? IV lorazepam or rectal diazepam Anticonvulsant drugs include Hydantoins Iminostilbenes Succinimides Lamotrigine What is first-line treatment for tonic-clonic and partial complex seizures? Phenytoin (Dilantin) *Available in chewable, suspension, IV and extended-release caps Which anticonvulsant medications have a Black Box warning for causing Blood Dyscrasias? IMINOSTILBENES Examples: Carbazepine (Tegretol, Tegretol XR, Carbatrol) Oxcarbazepine (Trileptal) Valproic acid (Depakote, Depakene) Avoid grapefruit juice with which meds? IMINOSTILBENES Examples Carbazepine (Tegretol, Tegretol XR, Carbatrol) Oxcarbazepine (Trileptal) Valproic acid (Depakote, Depakene) Which anticonvulsants are used for treatment of absence seizures in children and adults? SUCCINIMIDES Examples: Ethosuzimide (Zarontin) Methsuximide (Celontin) Succinimides are absorbed in the gastrointestinal tract and they suppress seizures by Delaying calcium influx into neurons. Which anticonvulsant is used in the adjunctive treatment of primary generalized tonic-clonic seizures and partial seizures in adults and children older than 2 years? Lamotrigine (Lamictal) Do not use Lamotrigine (Lamictal) with Valproic acid or enzyme inducers Controversy if discontinuing medications after a few years of being seizure-free: Needs neurologist to make decision. After having an EEG. Amaya is diagnosed with partial complex seizure. What is the first line of treatment for this diagnosis? Valproic acid (Depakene, Depakote, Depakote ER, Depakote Sprinkles, Depacon) is the first line of treatment for partial complex seizures and is used widely to treat all major seizure types. Also used for migraines and bipolar. Which of the following baseline data are recommended before starting Amaya on valproic acid? Select all that apply. Pregnancy tests, liver function tests, seizure frequency assessment, and depression screening are recommended before starting valproic acid. What medication is teratogenic? Valproic acid Neg preg test required for baseline Amy is of child-bearing age; therefore, which nutritional supplement should be encouraged with valproic acid therapy? Folic acid *First-trimester exposure to valproic acid has been associated with an increased risk of neural tube defects and other structural abnormalities. Amy and her parents ask how antiseizure drugs work. Which of the following describes the mechanisms of action of antiseizure medications? Select all that apply. The mechanisms of action of antiseizure medications include suppression of sodium influx, suppression of calcium influx, promotion of potassium efflux, blockade of glutamate receptors, and an increase of gamma-aminobutyric acid (GABA) Antiseizure drugs are known to suppress the discharge of neurons within a seizure focus and suppress the propagation of seizure activity to other areas of the brain Amaya is Asian. When considering a change in antiseizure medications, which of the following medications carry a higher risk for Amaya? Carbamazepine and phenytoin *Carry a higher risk for Steven Johnson's Syndrome (SJS) or toxic epidermal necrolysis (TEN) for Asians Amaya shares her concern about running out of medication due to a busy life, forgetting to refill her prescription, and not liking the idea of having to take medicine every day for the rest of her life. Which of the following education points will help encourage Amaya to take her medication as prescribed? Select all that apply. Abrupt discontinuation of antiseizure drugs can lead to status epilepticus; medication should be withdrawn slowly (over 6 weeks to several months). Traditional anti-seizure drugs (7) carbamazepine ethosuximide fosphenytoin phenytoin phenobaribital primidone valproic acid Newer anti-seizure drugs (13) pregabalin rufinamide tiagabine topiramate vigabatrin zonisamide ezogabine felbamate gabapentin lacosamide lamotrigine levetiracetam oxcarbazepine Newer antiseizure drugs are Equally good, less clinical experience, evolving, better tolerated, less complex, limited interactions, safer in preg, more expensive Types of headaches include Sinus Cluster (eye) Neck (top/back head) Tension (forehead) Migraine (unilateral) TMJ (temple) Migraine headaches are marked by Moderate to severe pain that is made worse by light, noise, and motion. N/v associated. How long do migraines last? May last a few hours or persist for up to three days. Men or women more affected? Women *Puberty/childbearing years Migraines have four distinct phases which include Prodrome, aura, actual headache, and postdrome What drug decreases the release of inflammatory neuropeptides thereby diminishing perivascular inflammation? Both actions (vasoconstriction and decreased perivascular inflammation) help relieve migraine pain. Sumatriptan Aagonist activity at subtypes of serotonin receptors, blocks inflammation associated with trigeminal vascular system, promotes constriction to reduce amplitude of pulsation, depresses the vasomotor center. Ergotamine Triptans therapeutic goal Termination of migraine headache Ergot alkaloids therapeutic goal Termination of migraine or cluster headache Contraindicated in patients with ischemic heart disease, prior MI, or uncontrolled hypertension Triptans Contraindicated in patients with hepatic or renal impairment, CAD, and PVD Ergot alkaloids Birth defects are seen in laboratory animals; therefore, this drug class must not be used during pregnancy. Interactions with ergot alkaloids, SSRIs, SNRIs, MAOIs may occur. Triptans Toxicity may result from acute or chronic overdose and include signs of muscle pain, paresthesia, and cold extremities. Ergot alkaloids