Drugs-Migraine Flashcards
Classes of drugs for migraine PROPHYLAXIS
- Anti-hypertensives (beta blockers, ca+2 channel blockers)
- Propranolol
- Verapamil - Anti-depressants
- Venlafaxine (SNRI)
- Amitryptilline (TCA) - Anticonvulsants
- Valproate
- Topiramate - CGRP Antibodies
- Erenumab (receptor)
- EFG.. zumab (CGRP itself)
Classes of drugs for migraine Abortion
- CGRP Releasing Inhibitors (5-HT 1B/1D Agonists)
- Triptans
- Ergotamines
- Ditans - CGRP Antagonists
- …gepant
MOA for Triptans
Vasoconstriction to reduce meningeal blood flow (5HT-1B/1D agonism)
Toxicities of Triptans
Triptan syndrome
Paresthesia
Chest/Neck Pain
Flushing
Since CGRP releasing inhibitors are serotonin receptor agonists, Triptans should not be used with what medications for the risk of Serotonin Syndrome?
Ergotamines
MAOIs
What NTs are considered monoamines?
Dopamine
Serotonin
NE
MOA for Dihydroergotamine
Vasoconstriction to reduce meningeal blood flow (5HT-1B/1D agonism)
What acute/abortive migraine drug is pregnancy category X?
Dihydroergotamine
- can induce uterine contraction!
Toxicities of both Triptans & Dihydroergotamine
- Temporary spike in BP
- MI
- Stroke
- due to vasoconstriction
B/c of their toxicities, Triptans and Dihydrogergotamines are contraindicated in patients with
- CAD
- HTN
- Hx of MI/stroke
Ditans don’t cause toxicities that of Triptans & Dihydroergotamines b/c
They don’t directly induce vasoconstriction