030415 headache pharm

Question 1

how is serotonin metabolized?

Answer 1

metabolized to 5 hydroxyindole acetic acid by MAO

neuronal action terminated primarily by high affinity active uptake system (SERT) and then intraneuronal conversion to 5-hydroxyindoleacetic acid

Question 2

cells bodies of serotonergic neurons in the CNS are located where

Answer 2

raphe nucleus

Question 3

serotonin’s cardiovascular effects

Answer 3

potent vasoconstriction of large arteries and veins, cranial blood vessels (5HT1D)

vasodilation in coronary, skeletal muscle, and cutaneous blood vessels

etc

Question 4

MOA of triptans for migraine

Answer 4

serotonin 1B/1D agonists
block release of CGRP (CGRP increases pain transmission)

alters neurotransmission (trigeminal and cortical)
blocks brainstem pain pathways 
promotes vasoconstriction

Question 5

abortive tx for migraine-major class of drugs used?

Answer 5

triptans

Question 6

how do TCAs work?

Answer 6

prophylaxis for migraines

block reuptake of serotonin and NE

Question 7

effectiveness of antiseizure meds for migraine prophylaxis

Answer 7

effective (compare to TCAs, which are “probably” effective)

Question 8

drugs that are migraine abortives

Answer 8

triptans 
hormonal manipulation
ergot alkaloids
caffeine containing drugs
NSAIDs

Question 9

prophylactic drugs for migraines

Answer 9

beta blockers
anti seizure meds
TCAs 
steroids
Ca ch blockers