LG 2.6 Pharmacology of Migraine Headache Medication Flashcards
What is the aura phase of a migraine?
Decrease in blood flow occipital lobe
What is the headache phase of the migraine?
Inflammation of meninges to trigeminal sensory nerve fibers
What is the main potent vasodilator of a migraine?
Calcitonin gene related peptide (CGRP)
What is the MOA of -triptans?
i. Vasoconstiction of painful intracranial extra cerebral vessels
ii. Inhibition of vasoactive neuropeptide
iii. Inhibition of nociceptive neurotransmission
What is the main use of -triptans?
- Migraine pain
- Nausea, vomiting, photophobia, phonophobia
What is the procedure for selecting the right Triptan?
Triptans can be chosen via the 3 F’s:
- Fast versus slow onset of activity; duration of action can be important for some patients
- Formulation (oral, injection, nasal)
- Formulary tier and availability (sumatriptan =generic)
What are the pharmockinetics of triptan?
- oral, nasal, subcutaneous (Sumatriptan)
- rapid onset of action
What are the adverse effects of triptans?
- fatigue
- dizziness
- paresthesia
- warm sensations
- tightness (neck, chest, and throat)
What are the main contraindications of triptans?
- hepatic/renal function impairment
- monoamine Oxidase Inhibitor therapy
- hemiplegic migraine (associated with paralysis of one side of the face)
- basilar migraine (associated with loss of vision, double vision, loss of balance)
- hypersensitivity to -triptans
- peripheral vascular disease or uncontrolled blood pressure
What is the main triptan in use?
Sumatriptan
What produces Ergot alkaloids?
-Produced by Claviceps pururea a fungus
What are adverse effects of Ergot alkaloids?
- Poisoning effects (hallucination)
- vasospasm (gangrene)
- Abortifacient (in pregnancy
- Decreased blood flow: brain, heart, extremities
What is the MOA of Ergot alkaloids?
- Agonist/antagonist at α1-adrenergic, at serotonin receptors (5-HT1A and 5-HT1D )
- Partial or full agonist at dopamine receptors
What are the contraindications of Ergot alkaloids?
- peripheral vascular disease or poor circulation
- arteriosclerosis
- hypertension
- angina
- history of heart attack/ silent ischemia
- liver/kidney disease
- serious infection
What are the therapeutic uses of Ergotamine?
- Migraine pain
2. Effective at beginning of attack
What are the pharmacokinetics?
- Routes of admin: oral and suppository
- High first pass effect
- Excreted by liver
What do you give with Ergotamine to increase bioavailability?
- Combined with caffeine (helps bioavailability)
What are the adverse effects of Ergotamine?
- diarrhea
- nausea
- vomiting