KG - Pharm 3, Exam 1, Migraine Flashcards
types of migraine?
- common migraine (no aura)
- classic migraine (w/ aura - aura due to reduced blood flow of posterior part of brain)
two phases of migraine?
- vasoconstriction (resp for aura)
2. vasodilation & pulsation
which drugs used for symptomatic tx migraines?
“-triptans”
– Sumatriptan
Sumatriptan: moa
- 5-HT AGONIST ON SMALL PERIPHERY NERVES
sumatriptan: info
- vasoconstriction not as strong as w/ Ergotamine
- effective 80% pts
- admin = oral, SC
- half life = 2 hrs (if another headache in 24-48 hrs, another dose needed)
- $$$
- only use if no other options
sumatriptan: toxicities
b/c vasoconstrictors…
- coronary artery vasospasm
- rare arrhythmias
- angina
- transient MI
- cerebral vasospasm, hemorrhage, stroke, seizure
- peripheral vascular ischemia, BOWEL ISCHEMIA
- abd pain, bloody diarrhea, cramping
- dizziness, lightheadedness, weakness, myalgia, muscle cramps
sumatriptan: contraindications
- breastfeeding
- cardiac dz
- cerebrovascular dz
- CAD
- DM
- HTN
- IV admin
- peripheral vascular dz
- pregnancy
- renal impairment
- seizures
- tobacco smoking
Ergotamine: moa
- ACTS ON 5-HT RECEPTORS
- less specific than sumatriptan
- also alpha 1 stimulant
Ergotamine: info
- admin = oral, sublingual, rectal, nasal
- caffeine increases absorption
- most effective if given early
- effective 50% pts
Ergotamine: side effects
due to vasoconstriction….
- ACUTE = diarrhea, nausea, vomiting, cardiovascular
- CHRONIC = ergotism - vasoconstriction + CNS
Dihydroergotamine: info
- admin = IV
- efficacy like sumatriptan
- adverse effect = nausea
what analgesics given to treat migraine pain?
- aspirin
- acetaminophen
- naproxen
- etc…
which beta blocker for prophylaxis?
propranolol
which CCB for prophylaxis?
verapamil
which antidepressants for prophylaxis?
- amitriptyline
- fluoxetine
what anticonvulsants used for prophylaxis?
- valproic acid
- topiramate
what other 3 drugs used for prophylaxis?
- clonidine
- botulinum toxin type A & B
- angiotensin II receptor blockers
in which headache phase do you take triptans or ergotamine?
prodromal phase
in which phase do you take analgesics?
headache phase
