Drugs for Migraines

Question 1

Rx for tension headaches

Answer 1

NSAIDs (Ibuprofen and Naproxone)

Question 2

Rx for cluster headaches

Answer 2

Nasal or subcu triptans or ergots or prednisone

Question 3

What do you use to treat mild-moderate migraine

Answer 3

NSAIDs

Question 4

What do you use to treat moderate-severe migraine

Answer 4

Short-acting triptan (nasal spray fastest acting)

Question 5

Triptans with longest action (slower onset)

Answer 5

Naratriptan and frovatriptan

Question 6

Most effective and fastest onset triptan

Answer 6

Sumatriptan (subq)

Question 7

Beta-blockers used to treat the prophylaxis of a migraine

Answer 7

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

Question 8

What happens in analgesic overuse syndrome?

Answer 8

Worsening of clinical condition due to frequency of drug use

Question 9

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

Answer 9

Serotonin

Question 10

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

Answer 10

Reduce inflammatory signals (CGRP and substance P release decreased)

Question 11

MOA of triptans in mitigating migraine

Answer 11

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

Question 12

ADE of NSAIDs

Answer 12

Gastic irritation and nephrotoxicity

Question 13

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

Answer 13

F; contraindicated in late preggo

Question 14

Longest acting NSAID

Answer 14

Nabumetone (followed by naproxen)

Question 15

MOA of Butalbital

Answer 15

GABA enhancement (drowsiness, sedation, decreased cerebral fx)

Question 16

MOA of caffeine

Answer 16

Cerebral vasoconstriction

Question 17

What are two common drugs seen in NSAID combo pills?

Answer 17

Caffeine and butalbital

Question 18

Two triptans that are available as nasal spray

Answer 18

Sumatriptan and zolmitriptan

Question 19

ADE of triptans

Answer 19

CNS effects, chest pain, coronary and peripheral vasospasm

Question 20

Disease that would mean no use of triptans

Answer 20

HGN, heart dx, iscemic bowel, DM

Question 21

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

Answer 21

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

Question 22

Migraine med that is a no-go in preggo

Answer 22

Ergots

Question 23

Tx for menstrual migraine

Answer 23

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

Question 24

Moderate doses of ergot alkaloids causes what

Answer 24

Contraction of smooth muscle fibers in small arteries

Question 25

Large doses of ergot alkaloids can cause what

Answer 25

Paralysis of motor nerve endings

Question 26

Two ergot alkaloids

Answer 26

DihydroERGOTAMINE and ERGOTAMINE

Question 27

ERGOTAMINES affect which receptors

Answer 27

Alpha, 5-HT, and decreases amine reuptake

Question 28

Contraindicated with ERGOTAMINES?

Answer 28

Peripheral vascular dx, sepsis, MI, HTN

Question 29

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

Answer 29

Oral contraceptives and migraines w/ auras

Question 30

Which ergot can be given with a nasal spray

Answer 30

DihydroERGOTAMINE

Question 31

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

Answer 31

Ketorolac (avoids habit-forming)

Question 32

ADE of Metoclopramide

Answer 32

Increased prolactin (gynecomastia)

Question 33

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

Answer 33

Promethazine

Question 34

ADE of promethazine

Answer 34

Anti-DUMBBELS, Parkinsonism-like symptoms

Question 35

Only drug approved for pediatric migraine prophylaxis

Answer 35

Propranolol

Question 36

Criteria for analgesic overuse syndrome

Answer 36

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

Question 37

MOA of analgesic overuse syndrome (4)

Answer 37

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

Question 38

What two alternative therapies may be helpful for headaches

Answer 38

Riboflavin and coenzyme Q

Question 39

Two alternative therapies that may be used to reduce migraine frequency

Answer 39

Feverfew and butterbur

Question 40

ADE of feverfew

Answer 40

Open mouth sores and upset stomachs aka mild GI effects

Question 41

ADE for butterbur

Answer 41

Mild GI upset (pyrrolizide alkaloid free)

Question 42

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

Answer 42

True