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Pharm > Anti-migrane > Flashcards

Anti-migrane Flashcards

1
Q

Define migrane

A

common type of headache of unknown cause

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2
Q

Duration of the migraine attack

A

several hours or days.

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3
Q

What can the frequency of migraines be?

A

1-8 episodes per month

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4
Q

What are the known triggers of migraines? (6)

A
  • alcohol
  • chocolate
  • cheese
  • fasting
  • menstruation
  • oral contraceptives
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5
Q

Migrane patients: (3)

A
  • Family history 2/3 of the patients.
  • Age of onset: late teens or young adults.
  • More common in women.
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6
Q

Migrane characteristics? (5)

A
  • Throbbing pain.
  • Hemicraneal.
  • Moderate to severe intensity.
  • Usually accompanied by photophobia, nausea and vomiting.
  • Often preceded by aura: odors, visual disturbance-flashes
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7
Q

Frequency of migraine with aura? what else is it called?

A

15%

classic migraine

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8
Q

What is an aura?

A

feelings and symptoms you notice shortly before the

headache begins

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9
Q

Frequency of migraine without aura? what else is it called?

A

75%

common migrane

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10
Q

What is the common migrane?

A

without aura

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11
Q

What is the classic migrane?

A

with aura

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12
Q

What is status migrainous? What happens?

A
  • migraine lasts longer than 72 hours

- sometimes requires hospitalization

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13
Q

What molecules affect the aura for migranes?

A
  • Serotonin (5-Hidroxitriptamina 5-HT)

- Dopamine

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14
Q

What drug classes can we use to treat migranes? (5)

A
  1. PARACETAMOL
  2. NSAIDS
  3. MINOR OPIATES 4.TRIPTANS
  4. ERGOTAMINE
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15
Q

What drugs do we use to start treating migraines? examples? (4)

A
  1. PARACETAMOL
  2. NSAIDS - naproxen/ibuprofen/ketorolac
  3. MINOR OPIATES
  4. anti-nausea - metoclopramide
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16
Q

When is metoclopramide used with migraines?

A

15 min before to prevent nausea and vomitting

17
Q

What do you use if the first step in treatment of migraines doesn’t work?

A

serotoninergic agonists:

  1. TRIPTANS
  2. ERGOTAMINE
18
Q

Triptans and ergotamines are what type of drug? what are they used for?

A
  • anti-migrane

- serotoninergic agonists

19
Q

What are the triptan drugs? (4)

A
  • sumatriptan
  • naratriptan
  • zolmitriptan
  • rizatriptan
20
Q

What is the mechanism of action for sumatriptan?

A

-5-HT receptor agonist

21
Q

What are the effects of sumatriptan?

A
  • vasoconstriction:
  • coronaries
  • carotid
  • extracranial
22
Q

How effective is sumatriptan? (2)

A
  • very effective if given in inital phases of migrane

- repeat 1-2 hours if not completely improved

23
Q

How is sumatriptan administered? (3)

A

SC
Intranasal
oral

24
Q

What are the problems with sumatriptan? (2)

A
  • lack of response

- reoccurrence in 24hrs

25
Q

sumatriptan contraindications? (4)

A
  • coronary heart disease
  • uncontrolled hypertension
  • > 55yrs
  • pregnancy
26
Q

What effects does ergotamine have? (2)

A

-anti-migrane
-potent arterial vasoconstrictor (extracranial arteries)
-

27
Q

What happens to blood vessels during a migraine? where? (2)

A
  • vasodilation

- extracranial arteries

28
Q

What is the dosing for ergotamine?

A

earlier it is administered, the lower the dose that is required

29
Q

What is the daily maximum dose for ergotamine?

A

4-6mg

30
Q

What is the dosage for ergotamine? When is it repeated?

A
  • 1mg oral or rectal

- repeated after 30 mins if no improvement

31
Q

What is the side effect of ergotamine?

A

-higher doses, risk of ischemia

32
Q

When do you use preventative measures for migraines? (5)

A
  • Chronic daily headache
  • > 2-3 episodes/month
  • Bad response or lack of tolerance to symptomatic treatment
  • Complicated migraine
  • Disabling pain: socio-occupational impact.
33
Q

What class of drugs are used as preventative treatment for migraines? (6)

A
    • TRICYCLIC ANTIDEPRESSANTS: Amitriptyline + benzodiazepines
    • BETA BLOCKERS: Propranolol
    • METHYSERGIDE (ONLY IF FAILURE OF THE ABOVE):
    • CYPROHEPTADINE: antiserotoninergic, use in children
    • CALCIUM ANTAGONISTS: flunarizine, nimodipine, nicardipine, verapamil
    • ANTIEPILEPTICS: valproic acid, topiramate
34
Q

What beta blocker do we use as preventative migraine treatment?

A

propranolol

35
Q

When do we use methysergide as a preventative measure against migraines?

A

only if tricyclic antidepressants and beta blockers do not work

36
Q

What effect does methysergide have? (2)

A
  • antiserotoninergic

- vasoconstrictor

37
Q

What effect does CYPROHEPTADINE have?

A

antiserotoninergic

38
Q

When is CYPROHEPTADINE used in migraines? (2)

A
  • preventing migraines

- children

39
Q

Which tricyclic antidepressants do we use as a preventative measure against migraines? with what? (2)

A

Amitriptyline + benzodiazepines

Pharm (14 decks)

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