AntiMigraine

Question 1

pain relievers that decrease pain threshold secondary to decreased prostaglandin synthesis. For moderate pain. AE - ulcers GI bleeding and rebound headaches.

Answer 1

NSAIDs – IB, aspirin, Indomethacin, Naproxen

Question 2

Pain relievers that stimulate vasoconstriction in basal artery and vessels of the dura mater, secondary to 5HT1A stimulation.

Answer 2

Triptans – sumatriptan, zolmitriptan, naratriptan

Question 3

block release of pro-inflammatory Nts (CGRP, substance P) within perivascular space in the vicinity of the trigeminal nerve.

Answer 3

Triptans – sumatriptan, zolmitriptan, naratriptan

Question 4

for acute migraine headaches. AE – serotonin syndrome – contraindicated in coronary artery vasospasm.

Answer 4

Triptans – sumatriptan, zolmitriptan, naratriptan

Question 5

used in pts for whom triptans are not tolerated. Last resort due to addiction potential. Toxicity – respiratory distress.

Answer 5

Opioids. Moderate pain – codeine, severe pain – morphine.

Question 6

indirect inhibition of phospholipase A – anti-inflammatory effects.

Answer 6

Corticosteroids – Dexamethasone.

Question 7

usually used with other agents. Not a frequent use – increased risk of steroid toxicity.

Answer 7

Corticosteroids – Dexamethasone.

Question 8

Relaxation of (vascular) smooth muscle – secondary to increase cAMP.

Answer 8

Xanthine alkaloids – Caffeine

Question 9

used in combination with acetaminophen or aspirin for moderate migraine.

Answer 9

Xanthine alkaloids – Caffeine

Question 10

Combine with Butalbital for infrequent moderate to severe headache.

Answer 10

Acetaminophen

Question 11

similar MOA to NSAIDs, no anti-inflammatory activity. Useful when aspirin is contraindicated.

Answer 11

Acetaminophen

Question 12

combine with Isometheptene Mucate or Dichloralphenazone for moderate headache.

Answer 12

Acetaminophen

Question 13

Only viable option during pregnancy.

Answer 13

Acetaminophen and Opiods – Codeine

Question 14

Metabolite of NAPQI may be limiting if unable to metabolize – toxic. OD – give N-acetyl-cysteine

Answer 14

Acetaminophen

Question 15

CV agents that are prophylactic to migraine and have membrane stabilizing effects.

Answer 15

B-blocker – Propranolol

Question 16

CV agents that are prophylactic to migraine and relieve aura symptoms.

Answer 16

Ca2+ blockers – Verapamil

Question 17

CV agents that are prophylactic to migraine by reducing duration and severity.

Answer 17

ACE inhibitor – Lisinopril

Question 18

Preventative migraine that is antagonsitic at serotonin receptors 1, 2A, and 2C, moderately antihistamine and mildly anti cholinergic.

Answer 18

Pizotifen

Question 19

prophylactic for recurrent migraine headaches. Especially useful when B-blockers are contraindicated – COPD Asthma

Answer 19

Pizotifen

Question 20

Contraindicated with use of MAO inhibitors. AE – potentiates drowsiness of sedatives, tranquilizers, and antidepressants. Weight gain and antimuscarinic effects.

Answer 20

Pizotifen

Question 21

Preventative migraine that inhibits voltage-gated Na+ channels, AMPA/Kainate, and High voltage Ca channels. Enhances GABA transmission.

Answer 21

Anti-seizure – Topiramate

Question 22

used for general tonic-clonic, partial, and migraine prophylaxis. AE – IOP, poor concentration and memory, ataxia, somnolence, and weight loss.

Answer 22

Anti-seizure – Topiramate

Question 23

P450 inducer. Metabolism of this drug is induced by Carbamazepine and Phenytoin.

Answer 23

Anti-seizure – Topiramate

Question 24

Drugs that induce metabolism of Topiramate.

Answer 24

Carbamazepine and Phenytoin – P450 inducers

Question 25

Prophylactic for migraines with aura, Antiepileptic.

Answer 25

Lamotrigine

Question 26

Enhances GABA transmission – inhibits Na channels and T-type Ca channels. For generalized and absence seizures and migraine prophylaxis.

Answer 26

Valproate

Question 27

Antiseizure that is antimigraine. AE – weight gain, tremor, hair loss, fetal abnormality, liver abnormality, bone marrow depression.

Answer 27

Valproate

Question 28

Structural analogue of GABA – inhibits high voltage gated Ca channels (HVA).

Answer 28

Gabapentin

Question 29

For partial seizures, neuroleptic pain. AE – dizziness, sedation and peripheral edema at high dose, Withdrawal syndrome.

Answer 29

Gabapentin

Question 30

Treatment of chronic migraine headaches in adults. Injected directly into muscles of forehead and neck – reversible paralysis.

Answer 30

Type A Botulinum Toxin

Question 31

Destroys synaptic SNAP-25 – decreases NT release.

Answer 31

Type A Botulinum Toxin

Question 32

antiemetic, schizophrenia, tourrette’s, Huntington chorea, and dementia. MOA – anti-cholinergic/dopaminergic, weak anti-adrenergic/histaminergic

Answer 32

Chlorpromazine and Prochlorperazine

Question 33

AE – poikilothermic, blurry vision, constipation, agranulocytosis, phototoxicity (chlorpromazine, skin irritation to light)

Answer 33

Chlorpromazine and Prochlorperazine

Question 34

Neuroleptic malignant syndrome, tardive dyskinesia, amenorrhea, galactorrhea, false + pregnancy (women), Gynecomastia and decreased libido in men. Weakly diuretic

Answer 34

Chlorpromazine and Prochlorperazine

Question 35

Amplifies Quinidine-mediated cardiotoxicity.

Answer 35

Prochlorperazine

Question 36

5HT-4 agonist, D-2 and 5HT-3 antagonist

Answer 36

Metoclopramide

Question 37

alone or in combination with aspirin for migraines; gastric stasis – following diabetic gastric paresis; GI radiology – increases transit in barium studies; occasional lactation stimulation.

Answer 37

Metoclopramide

Question 38

AE – galactorrhea, extrapyramidal, tardive dyskinesia. Contraindicated in – Pheochromocytoma and Parkinson’s disease.

Answer 38

Metoclopramide