Anti-migraine agents Flashcards
Which drug classes are used for acute migraine management?
Triptans and ergots
Multipurpose analgesics and antiemetics too.
What are prophylactic therapies for migraines? When are they used?
Used when patients have migraines more than once per week.
Beta blockers: Propranolol is most common.
Tricyclic antidepressants: Amitriptyline is most common.
Anticonvulsants: Valproate and topiramate
Triptans: MOA
Selective agonist for 5-HT1B and 5-HT1D receptors in cranial arteries–> Vasoconstriction and reduces inflammation of trigeminovascular system.
Triptans: Indications
Treatment of migraine. Should be given early in attack. Abortive therapy for patients who do not get relief with OTC analgesics.
Triptans: Side effects
Self-limited: Dizziness, tingling, chest discomfort, non-specific unpleasant sensations
Serious: Elevation of blood pressure. MI with angina or infarction. Stroke.
Contraindications: Avoid with history of stroke/TIA
Triptans: Drug interactions
Never administer ergotamines or MAO inhibitors (used in PD and depression) with triptans.
Risk of severe toxicity caused by over-activity of serotonin (SEROTONIN SYNDROME)
Name the classic example of a triptan
Sumatriptan
Ergotamine derivatives: Name an example.
Dihyrdroergotamine (DHE)
Ergotamine derivatives: MOA
Alpha-adrenergic blocker that directly stimulates vascular smooth muscle to vaso-constrict and it is an agonist at several subtypes of serotonin receptors.
Ergotamine derivatives: Indications
Treatment of acute migraine. Given to patients who fail triptans. DHE is only used as nasal spray in outpatient. IV and IM formulations in hospital.
Ergotmaine derivatives: Side effects
Self-limited: Rhinitis, taste disorders, nausea.
Serious: Significant vasoconstriction==> Elevated blood pressure, increased risk of myocardial and cerebrovascular ischemia.
