Exam 4 Drugs for Migrane

Question 1

what does 5-HT mean?

Answer 1

Serotonin-5-hydroxytryptamine - receptors are found pre and post synaptically for pain modulation (especially chronic pain)

Question 2

Serotonin effects
in platelets = \_\_\_\_\_
in CNS (periaqueductal gray) = modulates \_\_\_\_ on a spinal level, stimulation produced \_\_\_\_\_ in midbrain, and most projections from PAG are \_\_\_\_\_\_.

Answer 2

vasoconstriction
nociception
analgesia
tryptaminergic

Question 3

4 disorders that 5-HT are associated with

Answer 3

1. schizophrenia
2. OCD
3. Depression
4. Anxiety

Question 4

6 categories of drugs that affect 5-HT

Answer 4

1. antidepressants
2. hallucinogens
3. anxiolytics
4. antiemetics (antinausea/vomiting)
5. antimigraine agents
6. atypical antipsycholtics

Question 5

Data supports that migraines are caused by chronic 5-HT ______. In people with migraines, there is an increased____ metabolite of 5-HT in urine and _____, increase or decrease of 5-HT in ____. PET scan shows increased ____ flow in highly serotonergic dorsal raphe nucleus during a migraine.

Answer 5

5-HIAA
CSF
Urine
blood

Question 6

what are the 3 classes of migraine medication?

Answer 6

1. ergot derivatives
2. Triptans
3. iosmetheptene (Midrin)

Question 7

name 3 ergot derivatives discussed in class

Answer 7

1. ergotamine (Ergomar)
2. ergotamine and caffeine (Cafergot, Migergot)
3. dihydroergotamine (Migranal)

Question 8

7 Triptan drugs discussed in class

Answer 8

1. sumatriptan (Imitrex, Sumavel, DosePro)
2. naratriptan (Amerge)
3. zolmirtiptan (Zomig)
4. rizatriptan (Maxalt)
5. frovatriptan (Frova)
6. eletriptan (Relpax)
7. almotriptan (Axert)

Question 9

Name 6 things ergot derivatives do?

Answer 9

1. vasoconstrictors
2. mediate activity with trypaminergic/dopaminergic/alpha-adrenergic receptors
3. Inhibit depolarization of noriceptors
4. Possibly block neurogenic inflammation
5. produce depression of central vasomotor centers
6. highly active uterine stimulant

Question 10

When do you take an ergot derivative?

Answer 10

At the onset of a migraine attack - “Aborts” migrane, taking with caffeine speeds gastric absorption getting medication into system more rapidly

Question 11

2 side effects of ergotamine and caffeine

Answer 11

1. blood vessel damage

2. gangrene

Question 12

Which drug’s MOA = alph-adrenergic blocker that directly stimulates vascular smooth muscle to vasoconstrict peripheral and cerebral vessels

Answer 12

dihydroergotamine (Migranal) - nonselective antagontist at dopaminergic receptors and partial agonist/antagonist at 5-HT receptors

Question 13

How is dihydroergotamine given?

Answer 13

parenterally: IV, IM, SC, nasal spray

Question 14

Who gets dihydroergotamine?

Answer 14

people with chronic migraines or unresponsive migraines

Question 15

Which class of drug’s MOA = selective agonist of 5-HT 1B and 5-HT 1D reveptors in cranial arteries -> causes vasoconstriction and reduces neurogenic inflammation

Answer 15

triptans - also provides relief from nausea

Question 16

What are the 3 parts of isometheptene (Midrin)?

Answer 16

1. isometheptene = vasconstrictor
2. acetaminophen = analgesic
3. dichloralphenazone = mild tranquilizing effects

Question 17

When is isometheptene (midrin) taken?

Answer 17

at onset of migraines and tension headaches

Question 18

What phenothizaine derivative (antipsychotic) is given with migraines?

Answer 18

antiemetics to control nausea and gastric irritation with migraines (D2 antagonists)

Question 19

Name 4 antiemetics

Answer 19

1. prochlorperazine (Compro)
2. metoclopramide (Reglan, Metozolv)
3. promethazine (Phenergan, Phenadox, Promethegan)
4. trimethobenzamide (Tigan)

Question 20

Name 8 classes of drugs that can be used for migraine prophylaxis

Answer 20

1. tricyclic antidepressants
2. SSRIs
3. selective 5-HT and NE reuptake inhibitors (venlafazine (Effexor)
4. Beta blockers
5. antiseizure medications
6. Ca channel blockers
7. NSAIDS
8. corticosteroids

Question 21

Name 3 beta blockers used to treat migraines

Answer 21

1. propranolol
2. nadolol
3. atenolol

Question 22

Name 3 antiseizure meds used to treat migraines

Answer 22

1. topiramate
2. valproic acid
3. gabapentin

Question 23

name a ca channel blocker used to treat migraines

Answer 23

1. verapamil (Calan)

Question 24

Which category of drug that treats migraines has this MOA: Inhibits reuptake of 5-HT

Answer 24

SSRIs

Question 25

Which category of drug that treats migraines has this MOA: alters cerebral blood flow without inducing vasospasm, able to modulate cerebral blood flow

Answer 25

NSAIDS - idomethacin - antiinflammatory analgesic

Question 26

Which category of drug that treats migraines has this MOA: down regulates 5-HT receptors that are associated with down excitatory perivascular inflammation, also inhibits reuptake of both 5-HT and NE

Answer 26

tricyclic antidepressants

Question 27

Which category of drug that treats migraines has this MOA: interferes with release of Ca dependent release of substance P (a pain modulatory substance) and other NTs

Answer 27

Ca channel blockers

Question 28

What drug do you use to treat intractable migraines that have not responded to other interventions

Answer 28

Corticosteroids

Question 29

Corticosteroids MOA: Modulators of ____ receptors, suppresses neurogenic ______, Blocks neurogenic extravasation mediated by the release of ______ like substance P, and blocks effects of ___-____ activated CA+ currents by blocking Ca+ channels

Answer 29

GABA inflammation neuropeptides high-voltage