30 - Headache Therapy Flashcards
MOA of nabumetone
NSAID. Reduce inflammatory stimuli that would normally upregulate MAPK and thus CGRP and SP. More effective if taken sooner than later.
MOA of ibuprofen
NSAID. Reduce inflammatory stimuli that would normally upregulate MAPK and thus CGRP and SP. More effective if taken sooner than later.
MOA of naproxen
NSAID. Reduce inflammatory stimuli that would normally upregulate MAPK and thus CGRP and SP. More effective if taken sooner than later.
MOA of butalbital
barbiturate. Has sedative-hypnotic effects via thalamic GABA enhancement.
ADE of butalbital
drowsiness, sedation, strongly linked to analgesic overuse syndrome, CYP inducer, respiratory depressant
MOA of caffeine for headaches
cerebral vasoconstriction. Useful for caffeine withdrawal headaches. mixed with NSAIDs and butalbital sometimes
ADE of caffeine for headaches
potential CV interactions
MOA of sumatriptan
triptan. Serotonin agonist with only central effects. Causes carotid vasoconstriction via 5-HT1-B.
Presynaptic inhibition of trigeminovascular system via 5-HT1d/f.
MOA of ergotamine
contraction of smooth muscle fibers of small arteries.
agonist of central 5-HT, peripheral alpha vasoconstrictor, and decreases amine reuptake.
MOA of dihydroergotamine
contraction of smooth muscle fibers of small arteries.
agonist of central 5-HT, peripheral alpha vasoconstrictor, and decreases amine reuptake.
What is fastest and most effective for migraine treatment?
subcu injection of sumatriptan
What drug is strongly linked to analgesic-overuse syndrome?
butabital
Which triptans have longest effect time?
narotriptan and frovatriptan
ADE of triptans?
dizziness, drowsy, fatigue, tightness of chest, coronary and peripheral vasospasm, serotonin syndrome with SSRIs.
Contraind in heart disease or uncontrol HTN and ishcemic bowel.
ADE of ergots?
interactions with B-blockers and DA. Contraindicated in vasospastic conditions.
large doses cause st anthony’s fire –> dry gangrene of extremeties
What migraine medicines can be given to preggers?
NSAIDs only
What drugs should be given for menstrual headaches?
NSAIDs only
MOA of metoclopramide
antiemetic. D2 central block, increase Ach
ADE of metoclopramide
risk of high prolactin and gynecomastia
MOA of prochlorperazine
antiemetic. D2 central block. cholinergic and alpha block
ADE of prochlorperazine
dyskinesia, hypotension, gluacoma, urine reten, BPH
MOA of promethazine
antiemetic. cholinergic block and H1 (weak D2)
ADE of promethazine
glaucoma, urine reten, BPH, drowsy, parkinson
MOA of chlorpromazine
antiemetic. D2 central block, cholinergic and alpha block.
ADE of chlorpromazine
dyskinesia, hypotension, glaucoma, urine reten, BPH
MOA of amitriptyline
decrease NE and serotonin reuptake. Strong anticholinergic
ADE of amitriptyline
agressiveness, weight gain, dry mouth, sedation
What is only drug approved for migraine prophylaxis in children?
propranolol
ADE of propranolol
fatigue, exercise, intolerance, asthma, diabetes, AV block
ADE of propranolol
fatigue, exercise, intolerance, asthma, diabetes, AV block
MOA of topiramate
Na and glutamate blocker, increases GABA
What migraine drug would likely interact with MAO inhibitors like phenelzine?
suamtriptan. Cant give within 2 weeks of MAOI treatment.
ADE of topriamate
paresthesis, fatigue, nausea, narrow therapeutic range
What are alternative treatments for migraine prevention?
ferverfew and butterbur but don’t use them in preggers
Can you take a triptan after taking an ergot?
no. wait at least 24 hours.
Can you use triptans in preggers?
yes. but not in heart disease, diabetes, uncontrolled HTN or cerebrovascular disease.
MOA of timolol
nonselective beta antagonist. 5-10x more potent than propanolol. Arterial constrictor so reduces NE-induced lipolysis
ADE of timolol
fatigue, exercise, intolerance, asthma, diabetes, AV block
MOA of eletriptan
triptan. reduce blood vessel swelling. 5HT-1b/d/f receptor agonist.
ADE of eletriptan
HTN, tachycardia, headache, dizzyness, chest pain.
contraindicated in cardiovascular disease or renal/hepatic impairment
requires CYP3A4 so dont’ give with CYP inhibitors.
MOA of valproate
anticonvulsant. Weak Na blocker, weak GABA transaminase inhibitor (so blocks GABA degredation)
ADE of valproate
don’t give in pregnancy.
tiredness, tremor, sedation, GI disturb, hair loss.
