7 Migraines Flashcards
5-HT1d agonist on small peripheral nerves
Sumatriptan (Imitrex)
What is the MOA for Sumatriptan (Imitrex)
5-HT1d agonist on small peripheral nerves
Suppresses release of sensory neuropeptides
Some generalized vasoconstriction but not as strong as the ergotamines
What is the most important toxicity of Sumatriptan (Imitrex) to be aware of?
Peripheral vascular ischemia and bowel ischemia
B/c of generalized vasoconstriction - Most of the side affects are because of this
Contraindications for Sumatriptan?
Breast-feeding Cardiac disease CVD CAD DM HTN IV administration PVD Pregnancy Renal impairment Seizures Tobacco use
What are the other triptans besides Sumatriptan?
Rizatriptan (Maxalt) Naratriptan (Amerge) Zolmitriptan (Zomig) Eletriptan (Relpax) Frovatriptan (Miguard)
Drug that also acts not eh 5-HT receptors but is less specific than sumatriptan
Ergotamine (Ergomar)
Effective in 50% of patients (vs 80% with sumatriptan)
MOA for Ergotamine (Ergomar)
Primarily a 5-HT receptor agonist, but not as specific as sumatriptan
Also an alpha-1 receptor agonist
______ increases absorption of ergotamine and potentiates its effect
Caffeine
Ergotamine is most effective when…
Administered early
It’s an abortive treatment for migraine
Side effects from ergotamine are due to…
VASOCONSTRICTION
Acute: N/V/D, CV toxicity
Chronic: Ergotism - vasoconstriction + CNS
Drug similar to ergotamine but administered IV
Dihydroergotamine (Migranal)
Efficacy similar to sumatriptan
What analgesics can be used to treat acute migraine pain
Aspirin
Acetaminophen
Naproxen
Propoxyphene
Drugs that can be used for migraine prophylaxis
Beta blockers: Propranolol**
CCBs: Verapamil**
Antidepressants: Amitriptyline or Fluoxetine**
Erenumab (Aimovig)**
Clonidine Valproic Acid Topiramate Botulinum Toxin Type A&B Angiotensin II receptor blockers
IgG2 monoclonal antibody that binds calcitonin gene-related peptide (CGRP)
Erenumab (Aimovig)
Indicated for migraine prophylaxis in adults
