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Neuro Pharm > Drugs for Migraines > Flashcards

Drugs for Migraines Flashcards

1
Q

Rx for tension headaches

A

NSAIDs (Ibuprofen and Naproxone)

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2
Q

Rx for cluster headaches

A

Nasal or subcu triptans or ergots or prednisone

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3
Q

What do you use to treat mild-moderate migraine

A

NSAIDs

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4
Q

What do you use to treat moderate-severe migraine

A

Short-acting triptan (nasal spray fastest acting)

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5
Q

Triptans with longest action (slower onset)

A

Naratriptan and frovatriptan

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6
Q

Most effective and fastest onset triptan

A

Sumatriptan (subq)

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7
Q

Beta-blockers used to treat the prophylaxis of a migraine

A

Non-selective beta blockers (propranolol, metoprolol, timolol)

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8
Q

What happens in analgesic overuse syndrome?

A

Worsening of clinical condition due to frequency of drug use

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9
Q

Most effective current drugs used in the tx of migraine act upon what receptors?

A

Serotonin

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10
Q

MOA of NSAIDs in preventing a migraine/mitigating the pain.

A

Reduce inflammatory signals (CGRP and substance P release decreased)

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11
Q

MOA of triptans in mitigating migraine

A

Selective carotid vasoconstriction (serotonin 5HT1B receptor) and presynaptic inhibition of the trigeminovascular inflamm response (5-HT1D/1F)

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12
Q

ADE of NSAIDs

A

Gastic irritation and nephrotoxicity

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13
Q

T/F: NSAIDs are safe to use throughout a pregnancy.

A

F; contraindicated in late preggo

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14
Q

Longest acting NSAID

A

Nabumetone (followed by naproxen)

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15
Q

MOA of Butalbital

A

GABA enhancement (drowsiness, sedation, decreased cerebral fx)

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16
Q

MOA of caffeine

A

Cerebral vasoconstriction

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17
Q

What are two common drugs seen in NSAID combo pills?

A

Caffeine and butalbital

18
Q

Two triptans that are available as nasal spray

A

Sumatriptan and zolmitriptan

19
Q

ADE of triptans

A

CNS effects, chest pain, coronary and peripheral vasospasm

20
Q

Disease that would mean no use of triptans

A

HGN, heart dx, iscemic bowel, DM

21
Q

DO NOT GIVE TRIPTANS OR ERGOT FOLLOWING THE USE OF ANY OF THESE DRUGS WITHIN 24 HOURS. Name them

A

MAOI, Propranolol, CYP3A4 inhibitors, SSRI/SNRI, each other, respectively

22
Q

Migraine med that is a no-go in preggo

A

Ergots

23
Q

Tx for menstrual migraine

A

NSAID 2-3 days before period starts and then throughout the bleeeeeeding

24
Q

Moderate doses of ergot alkaloids causes what

A

Contraction of smooth muscle fibers in small arteries

25
Q

Large doses of ergot alkaloids can cause what

A

Paralysis of motor nerve endings

26
Q

Two ergot alkaloids

A

DihydroERGOTAMINE and ERGOTAMINE

27
Q

ERGOTAMINES affect which receptors

A

Alpha, 5-HT, and decreases amine reuptake

28
Q

Contraindicated with ERGOTAMINES?

A

Peripheral vascular dx, sepsis, MI, HTN

29
Q

What two risk factors, when in the same patient, have a multiplicative effect of increasing the risk of ischemic stroke?

A

Oral contraceptives and migraines w/ auras

30
Q

Which ergot can be given with a nasal spray

A

DihydroERGOTAMINE

31
Q

If you are going to use a narcotic (last resort) to tx a migraine, which should be used

A

Ketorolac (avoids habit-forming)

32
Q

ADE of Metoclopramide

A

Increased prolactin (gynecomastia)

33
Q

Which antiemetic that can be used in migraine tx works on H1 and weakly on D2 through cholinergic action?

A

Promethazine

34
Q

ADE of promethazine

A

Anti-DUMBBELS, Parkinsonism-like symptoms

35
Q

Only drug approved for pediatric migraine prophylaxis

A

Propranolol

36
Q

Criteria for analgesic overuse syndrome

A

Headache >15 days/mo; overuse of medication; headaches getting worse and gets better when stopping chronic drug use

37
Q

MOA of analgesic overuse syndrome (4)

A

Trigeminovascular sensitization, reduced 5-HT levels (increased 5-HT2), cellular adaptation, ROS damage in periaqueductal grey matter

38
Q

What two alternative therapies may be helpful for headaches

A

Riboflavin and coenzyme Q

39
Q

Two alternative therapies that may be used to reduce migraine frequency

A

Feverfew and butterbur

40
Q

ADE of feverfew

A

Open mouth sores and upset stomachs aka mild GI effects

41
Q

ADE for butterbur

A

Mild GI upset (pyrrolizide alkaloid free)

42
Q

T/F: Riboflavin, feverfew, and butterbur are NOT recommended for preggos

A

True

Neuro Pharm (10 decks)

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