9. Headache PHARM Flashcards
3 drugs that are good for acute migraine treatment? (analgesic/abortive)
sumatriptan (triptan)
ergotamine tartrate
dihydroergotamine
6 drugs that are for preventative migraine treatment?
prolanolol amitryptaline valproate topiramate verapamil botulinum toxin
migraine cause: what nerve is triggered? what does it do?
trigeminal nerve (CN5): releases peptides backwards (antidromic peptide release)
migraine pain in general is from what?
cortical neuronal changes
irritated meningeal arteries
the acute migraine meds work how?
serotonin agonists, vasoconstrictors
ergotamine tartrate: how does it abort migraine? SEs? contraindications?
vasoconstrictor and serotonin agonist.
SEs: can cause MI, chest tightness, sedation, nausea.
contra: coronary disease, stroke
dihydroergotamine (DHE): how does it work? SEs? contraindications?
milder form of ergotamine tartrate.
vasoconstrictor and serotonin agonist.
SEs: can cause MI, chest tightness, sedation, nausea.
contra: coronary disease, stroke
Triptans (ex sumatriptan): how does it work? SEs? contraindications? efficacy?
serotonin 1B and 1D agonist. vasoconstrictor SEs: chest tightness, sedation, nausea. contra: coronary disease, stroke 70% improvement in 2 hours
triptans: interactions?
SSRI, SNRI
how can physicians avoid undue influence by pharma reps?
avoid all contact with pharma representatives.
indication for putting someone on a migraine med?
if using acute meds more than 2x/week (possible analgesic rebound)
if they get the type of migraine you don’t want ppl to have (causing hemiplegia, confusion)
what is propanolol? how does it work?
beta blocker (b1 and b2). vasoconstriction, also bronchoconstriction.
amitriptyline: what kind of med? mechanism? SEs?
TCA antidepressant. tertiary amine, metabolized to secondary amine. SNRI.
not used much for depression, more for pain/headache.
mech: NE, serotonin agonist.
SE: wt gain, QT prolongation
valproate: what kind of med? mech? SEs?
anti-epileptic, reduces CNS excitability. Na channel blocker.
SEs: wt gain, alopecia, liver tox. BAD side effects.
topiramate: what kind of med? mech? SEs?
anti-epileptic, reduces CNS excitability. GABA agonist (stimulates Cl entry)
SEs: cog decline, wt loss, kidney stones
Botulinum Toxin: mech? efficacy? SEs?
blocks acetylcholine release at NMJ. efficacy unclear (hard to blind studies) SEs rare (weakness)
how effective are antimigraine prophy meds?
50% reduction in migraines
what would we use for migraine tx during preg?
acetaminophen, opioids, NSAIDs in tri1, tri2,
general mech of analgesic rebound?
receptor changes and subsequent withdrawal
38 yo woman with nearly daily headaches, some associated with photophobia. takes daily NSAID and sumatriptan. Topiramate and amitryptaline have not been helpful. exam, MRI normal. pt likely has what?
migraine without aura
med overuse headache
prevention of tension-type headache?
TCAs, beta-blockers, NSAIDs, behavior changes
Cluster headaches: treatment (prophy)
need to break the cycle.
corticosteroids, ca channel blocker, lithium, valproate
Cluster headaches: treatment (acute)
02, sumatriptan, dihydroergotamine
so, similar to acute migraine tx
lithium: used for what conditions? mech? AEs?
bipolar and cluster headaches
mech unknown
many side effects (incl long QT), narrow therapeutic window (lots of side effects occur)
Verapimil: mech? AEs?
Ca channel blocker
AE: edema, decr BP, constip
benefit: anti-HTN
