Chapter 33 - Drugs for Headache Flashcards
What drugs are used to abort an ongoing headache attack?
-NSAIDs
-ASA-like drugs
-opioid analgesics (ie codeine)
-migraine specific drugs (ie. triptans, serotonin agonists, ergot alkaloids)
What drugs are used to prevent headache attacks from occurring?
-beta blockers
-tricyclic antidepressants
-antiseizure drugs (ie topiramate and divalproex)
-CCBs
-botox
-estrogen
-humanized IgG4 monoclonal antibody
Which migraine form is more common?
migraine without aura
What precedes migraines with aura?
visual or auditory symptoms
What is the pathophysiology behind migraines?
a neurovascular disorder that involves the dilation and inflammation of intracranial blood vessels
What causes the pain from migraines?
vasodilation
What kind of drug is Sumatriptan?
serotonin 1B/1D receptor agonist - TRIPTANS
How does sumatriptan act?
binds to 5-HT 1B/1D receptors in intracranial blood vessels and causes vasoconstriction
How is sumatriptan administered?
oral or intranasal (some oral dissolving or SubQ)
What are the adverse effects of sumatriptan?
-heavy arms
-chest pressure
-angina
-teratogenic
-vertigo
-malaise
-fatigue
-tingling sensation
-nausea
-bad taste (intranasal)
Who shouldn’t use sumatriptan?
clients with CAD, angina, or uncontrolled hypertension
What does sumatriptan interact with?
-other serotonergic drugs (SEROTONIN STORM)
When is oral sumatriptan taken?
at first sign of migraine symptoms - take another dose if no results after 2 hours 2 doses to start is more effective
Do you prime nasal sumatriptan?
NO
How is nasal sumatriptan taken?
-first sign of migraine
-blow nose, spray, mouth breathe
How is SubQ sumatriptan administered?
-first sign of migraine
-if after 1 dose no resolution, wait 2 hrs then take oral pill form
What type of drug is ergotamine?
an ergot alkaloid
Is ergotamine first or second line?
second-line - used when no response to triptan
How does Ergotamine act?
agonist activity at subtypes of serotonin receptors specifically 5-HT 1B/1D
What are adverse effects of ergotamine?
-N&V
-chest pain
-tingling
What kind of drug is galcanezumab?
calcitonin gene-related peptide (CGRP) receptor antagonist
How does galcanezumab act?
humanized IgG4 monoclonal antibody that binds to CGRP to prevent its action
What is galcanezumab used for?
prevention of migraine in adults who have had at least 4 migraine days per month AND triptans don’t work
How is galcanezumab administered?
SubQ - loading dose then every 4 weeks
What are the adverse effects of galcanezumab?
-injection site rxn
-constipation
