Head ache pharm Flashcards
head ache pharm
concept behind migrane prophylaxis
raise threshld for initiating cortical spreading depression
triptans work on which NT
5-HT/ 1D/B agonists
how do triptans work
action at 5-HT 1D recetpor stops release of CGRP which stop vasodilation/ neurogenic inflammation and action at G0HT1B causes vasoconstriction
triptans used for what
acute migraine therapy
which drugs are used for head ache prevention
beta blockers, anticonvulsants (topiramate and valproic acid), antidepressants (amitriptyline, calcium channel blocking drugs (verapamil for cluster), botulinum toxin
What is cortical spreading depression
wave of neuronal depolarization followed by a suppression of neuronal activity and gradual recovery. Blood flow changes follow in its wake
what can trigger KCl
electrical, stimulation, trauma
what is relationship b/w CSD and migraine
leads to long lasting blood flow inrease in middle meningeal artery which is dependent on trigeminal and parasympathetic activation. In addition plasma protein leakage occurs in the dura. Ie vasodilation could be linked to neurometabolic events that includ transmission of pain
What is relationshiop b/w trigeminal neuron and migraines
release substance P, neurokinin A, and CGRP which cause vasodilation and inflammation
What is most effective acute treatment for migraine
dihydroergotamine
how does ergotamiand and dihydroergotamine suppress inflammation
5-HT1B and 5HT 1D antagonism leads to vasoconstriction
avoid ergotamine and dihydroergotamine in which situation
CAD and pregnancy
ergotamine and dihydroergotamine side ffects
nausea, vomiting
ergotamine and dihydroergotamine route
IV, IM, intranasal
Triptan targets and mechanism
5HT1B on blood vessels and 5HT 1D neuron agonists= vasoconstriction and shuts off release of CGRP from trigeminal
triptans side effects
chest/neck tightness, flushing, sedation
triptan contraindications
CAD, stroke
how is 5HT1D related to migraines
stops rellease of neuropeptides and constricts blood vessels, may
5HT1D on neuron or blood vessel
neuron
5HT1B on neuron or blood vessel
vessel
sumitriptan itneractions
SSRI, SNRI, MAOs, propranol (rizatriptan), cyp450 ( eletriptan, zolmitriptan)
whens should beta blockers not be used prophalatically
depression, raynaud’s, fibromyalgia, ashtma
which anti depressant for prophylactic migraine treatment
amitryiptyline
what do you have to monitor w/ antidepresants
EKG for QTc
which drugs have best eveidence for efficacy for chronic migraine
topiramate and Botox-A
how does Botox work to prevent head aches
prevents CGRP, substance P release
what drug is used during lacation for prophylaxis
sumatriptan
first line drug for episodic TTH
NSAID
what is only proven pharmacolgoic therapy for chronic TTH
amitriptyline
amitriptyline mechanism
Potentiates endogenous opioids…blocks reuptake of serotonin and NE, blocks muscarinic aCh, histamine, and alpha adrnergic, and 5ht recetors.
are oral narcotics approprite for cluster headahces
no
1st line treatment for cluster
sumatriptan
cluster head ache other drugs
intranasal lidocaine, intranasal zolmitriptan, IV dihydroergotamine
1st line for cluster prevention
verapamil, verapamil + Lithium
other prevention for cluster
occiptial nerve block, st3eroids
