Komiskey- HA drugs Flashcards
First Line for Acute RX of Episodic TH
OTC analgesics (acetaminophen, NSAIDS)
Triptans
Dihydroergotamine spray
Second line for Acute RX for Episodic TH
Aspirin+acetaminophen+ caffiene
Preventative RX for Chronic TH
Non Pharm: sleep hygiene, stress management, acupuncture, biofeedback, physical therapy
Pharm: TCA (better efficacy), SSRI’s ( better tolerated)
Sumatriptan
Acute Migraine RX
5HT1B/1D receptor agonist-constricts large arteries, inhibits trigeminal nerve transmission, inhibit NT release
Poor oral absorption, short duration
Contraindicated in coronary disease
Dihydroergotamine
Acute Migrane RX 5HT 1D receptor agonist alpha adrenoreceptor vasoconstricts, blocks trigeminal, inhibit NT release poorly absorbed- suppository or inhaled
FDA approved drugs for episodic migraine prevention
Propranolol (BB), timolol (BB), topiramate, divalproex sodium
Metaprolol (BB)
FDA approved drug for chronic migraine prevention
onabotulinumtoxin A
Acute Management of Migraine
Triptans, Dihydroergotamine, Diclofenac Potassium oral solution (strong NSAID, inhibits COX1 ad COX2)
Beta Blockers for migraine prevention
Propanolol, timolol, matoprolol
Good choice for pts with HTN, CAD, tremor, or anxiety
SE: fatigue, dizzy, depression, exercise intolaerance, may worsen auro
Avoid: asthma, depression, bradycardia, Raynauds, CHF
Divalporex/ sodium valproate
antiepileptic drug for migraine
SE: tremor, drowsy, N/V, easy bruising, weight gain, nystagmus
Dis: poorly tolerated, drug interactions, lab monitoring
Topiramate
Antiepileptic drug for migraine Blocks Na channel firing Potentiates GABA Depresses kainate on AMPA SE: Cognitive, dry mouth, fatigue, nausea, and mood changes, lab monitoring required, BID dosing
Onubotulinumtoxin A
Adults with chronic migraine: 4 hrs per day >15 days per month
MOA: blocks release of substance P and CGRP
inhibits peripheral signals to CNS and blocks central sensitization
SE: muscle weakness, injection site pain, spread of toxin affect
Herbal remedies for prevention of migraine
Butterbur, Riboflavin, Magnesium Oxide, Coenzyme Q, Feverfew
Short term prevention of migraine associated with menstruation
A: Frovatriptan
B: Naratriptin, Zolmitriptan
Frovatriptan
Long acting triptan
Longest half life (26 hrs)
used for the menstruation migrane
less effective than other triptans at 2 hr, same at 4 hrs
Triptans
Agonist for 5HT1 B/D receptor-inhibit adenylate cyclase
Inhibit terminal excitability- blocks SP, CGRP release
Direct vasoconstrictive action, inhibit activation of trigeminal
Pre and post migraine treatments
Contraindicated: CHD, peripheral vascular disease, uncontrolled hypertension, and complex migraine, ergots
Pregnancy category C
SE: flush/feel warm, chest pressure, throat tightness, paresthesias, dizzy/fatigue, nausea, intolerable taste with nasal formulations
Sumatriptan
Tablets, Nasal, Injection
Short acting
Razitriptan
Short acting
Oral- now in generic form
Not used within 2 weeks of MAOI
Zolmitriptan
Oral and nasal, short acting
not used within 2 weeks of MAOI
Almotriptan
Short acting, less risk of chest pain
metabolized by CYP3A4
Eletriptan
Metabolized by CYP3A4
Cannot be used within 3 days of ketoconazole, itraconazole, nefazodone, clarithromycin, ritonavir, nelfinavir
Only triptan superior to sumatriptan
Naratriptan
Long acting
Fewer adverse affects
Less effective at 2 hr, same at 4
Ergot derivatives
Sublingual or with caffeine
Avoid if pregnant (X), ischemic heart disease
NSAIDS
Low risk of causing medication overuse headache
Consider for pts: have other chronic pain conditions, frequently use short acting NSAIDS for acute treatment, are at low risk for developing complications
Cluster HA Treatment- first line
100% oxygen
Cluster HA abortive treatment
Sumatriptan
Zolmitriptan
Lidocaine: SE: nasal congestion, unpleasant taste
Octreotide- SE: bloating diarrhea
Ergotamine- SE: angina, fibrosis, MI, withdrawal
Cluster HA prevention
Verapamil: bradycardia, constipation , edema, hypotension
Steroids: hyperglycemia, hypertension, insomnia
Valproic acid- alopecia, thrombocytopenia
Topiramate
Ergotamine
Melatonin
Capascin
Treatment for chronic cluster HA
Verapamil
Lithium: hypothyrodism, nephrogenic diabetes insipidus, polyuria, tremor
Deep Brain Stimulation
