Agents for Headaches and Migraines - Kinder Flashcards
classic migraine
30%
has aura
common migraine
70%
no aura
path of migraine
trigem nerve
- CGRP - vasodilator
- also substance P and neurokinin A
dural plasma extravasation - neurogenic inflammation
MC primary HA
tension
serotonin
5-hydroxytryptamine
precursor to serotonin
tryptophan
majority of serotonin
90% in GI tract - enterochromaffin cells
also in platelets
inactivation of serotonin
monoamine oxidase
measure of serotonin synthesis
5-HIAA
24 hour urine - diagnostic test for tumors synthesizing serotonin
vomiting reflex
5-HT3 serotonin receptor
pain/itching
sensory nerve endings - serotonin
contraction of vascular smooth muscle
serotonin to 5-HT2
vasoconstriction - except skeletal and cardiac m
GI tone and peristalsis
serotonin 5HT2 receptor
prokinetic GI
serotonin 5HT2 receptor
5-HT 1D/1B agonist
triptan
tx of migraine
sumatriptan MOA
activate 5-HT 1D/1B receptor - presynaptic trigeminal nerve
inhibit release vasodilating peptide
-stimulate vasoconstriction
1st line mild to severe migraine
sumatriptan
do not use within 24 hours of ergotamine use
sumatriptan
ergotamine MOA
constriction of peripheral and cranial blood vesels
agonist at 5-HT 1D/1B receptors
agonist, partial agonist, antagonist - at various receptors
clinical use of ergotamine
reserved for pt with prolonged migraine (>48 hours)
ADRs and uncertain efficacy
gangrene and amputation
over-dosage of ergotamine
prolonged vasospasm
NSAIDs
inhibit PG synthesis
acetaminophen, asprin, ibuprofen, naproxen
metoclopramide
antiemetic
block D2 receptors
prochlorperazine
antiemetic
block D2 receptors