Drugs-Migraine

Question 1

Classes of drugs for migraine PROPHYLAXIS

Answer 1

1. Anti-hypertensives (beta blockers, ca+2 channel blockers)
   - Propranolol
   - Verapamil
2. Anti-depressants
   - Venlafaxine (SNRI)
   - Amitryptilline (TCA)
3. Anticonvulsants
   - Valproate
   - Topiramate
4. CGRP Antibodies
   - Erenumab (receptor)
   - EFG.. zumab (CGRP itself)

Question 2

Classes of drugs for migraine Abortion

Answer 2

1. CGRP Releasing Inhibitors (5-HT 1B/1D Agonists)
   - Triptans
   - Ergotamines
   - Ditans
2. CGRP Antagonists
   - …gepant

Question 3

MOA for Triptans

Answer 3

Vasoconstriction to reduce meningeal blood flow (5HT-1B/1D agonism)

Question 4

Toxicities of Triptans

Answer 4

Triptan syndrome

Paresthesia
Chest/Neck Pain
Flushing

Question 5

Since CGRP releasing inhibitors are serotonin receptor agonists, Triptans should not be used with what medications for the risk of Serotonin Syndrome?

Answer 5

Ergotamines

MAOIs

Question 6

What NTs are considered monoamines?

Answer 6

Dopamine
Serotonin
NE

Question 7

MOA for Dihydroergotamine

Answer 7

Vasoconstriction to reduce meningeal blood flow (5HT-1B/1D agonism)

Question 8

What acute/abortive migraine drug is pregnancy category X?

Answer 8

Dihydroergotamine

• can induce uterine contraction!

Question 9

Toxicities of both Triptans & Dihydroergotamine

Answer 9

• Temporary spike in BP
• MI
• Stroke
• due to vasoconstriction

Question 10

B/c of their toxicities, Triptans and Dihydrogergotamines are contraindicated in patients with

Answer 10

• CAD
• HTN
• Hx of MI/stroke

Question 11

Ditans don’t cause toxicities that of Triptans & Dihydroergotamines b/c

Answer 11

They don’t directly induce vasoconstriction