Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Brain and behavior > Migraine Drugs > Flashcards

Migraine Drugs Flashcards

You may prefer our related Brainscape-certified flashcards:
The Brain flashcards
1
Q

Neurogenic inflammation cascade

A

Nerve endings release inflammatory substances, some of which activate cyclooxygenase (leading to creation of prostaglandins). These prostaglandins contribute to inflammation and excite nociceptors. Pain transmitted to central nervous system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why aren’t opioids used to treat headaches?

A

Can actually make headache worse:

Increase N/V
Contribute to mast cell degranulation (increased inflammation)
Prevents normal clearance of glutamate, exacerbating CSD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

NSAIDS

A

Unlikely to cause headache, safe in the presence of vascular disease, non-sedating, no nausea, high doses required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the role of dopamine in migraine?

A

Dopamine is responsible for the prodromal symptoms of migraine (yawning, cold hands + feet, urination, chocolate craving).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

D2 agonist in migraineurs?

A

Causes migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

D2 antagonists in migraineurs?

A

Sedative, antiemetic properties, used to treat migraine

Chlorpromazine, prochlorperazine, droperidol, metoclopramide, domperidone

(Don’t need to know these names)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Advantages of D2 antagonists in migraine treatment?

Disadvantages?

A

When used IV very effective, reduce nausea/vomiting.

Problems: Prolonged QT, orthostatic hypothension, extrapyramidal effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ergot

A

Potent vasoconstrictor found in rye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ergotamine

A

Synthetic ergot, used to treat migraines. Structurally similar to serotonin, NE, and DA. Potent vasoconstrictor – avoid in coronary disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When to avoid ergotamine?

A

In patients with coronary disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dihydroergotamine

A

Injection, intrapulmonary. IV use requires antiemetics.

Long half-life and duration of action.

Useful for medication overuse headaches, but be careful in vascular disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Effect of 5-HT IV on migraine

A

Relieves, but has completely intolerable side-effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Important serotonin receptors in migraine?

A

5HT1B (blood vessel constriction), 5HT1D (Nerves), 5HT1F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do triptans work?

A

They activate 5HT1B, 5HT1D, 5HT1F (some) autoreceptors, which decrease painful NTs (decrease neurogenic inflammation). Reduce all aspects of migraine disability, no sedation, intrinsic anti-emetics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Best acting triptan?

A

Sumatriptan (also has IV form)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Other good triptan?

A

Eletriptan, metabolized by Cyp3A4, most others by MAO.

17
Q

Triptan CNS penetration?

A

Diffuse in passively, pumped out actively by PGP pump. PGP pump inhibitors are chemically similar to CYP3A4 inhibitors, so caution.

18
Q

What to be careful administering with Sumatriptan?

A

MAO inhibitors

19
Q

What to be careful administering with eletriptan?

A

Ketoconazole, fluconazole (Both antifungals)

20
Q

Which 5HT receptors in MMA, which 5HT receptors in heart?

A

5HT1B in MMA, 5HT2 in heart

21
Q

Contraindications for triptans

A

Ischemic heart disease, uncontrolled hypertension, SSRI/SNRI

22
Q

Serotonin syndrome

A

Life-threatening condition
Classical triad:
Mental status changes
Autonomic hyperactivity (diarrhea, hypertension, fever, shivering)
Neuromuscular abnormalities (myoclonus, rigidity, hyperreflexia)

23
Q

Do many migraineurs participate in preventive therapy?

A

No <5 percent

24
Q

When to consider preventive treatment for migraines?

A

When frequency is >6x / month. Other things too, but this is most important.

25
Q

How does prevention therapy work?

A

Not too sure, but best theory maintains that it works via suppression of CSD.

26
Q

Glutamate levels with migraine and with prophylaxis

A

Glu is increased with migraines, and decreased with prophylaxis.

27
Q

Why are beta blockers effective in migraine prophylaxis?

A

Penetrate CNS, can stabilize membranes. Bind to 5HT receptors somehow.

28
Q

Beta blockers used to treat migraine?

A

Propranolol, nadolol, timolol, atenolol.

29
Q

TCAs used in migraine prophylaxis

A

Amitriptyline – but has antimuscarinic (dry mouth, tachycardia, confusion, urinary retention) and antihistaminic (sedation) effects.

30
Q

SSRIs used in migraines?

A

Little evidence

31
Q

Anti-convulsives used for migraine prophylaxis?

A

Topiramate, valproate (divalproex)

32
Q

How does divalproex work?

A

Potentiates post-synaptic effect of gaba

33
Q

Onabotulinum toxin A and migraine

A

Approved for chronic migraine, inhibits ACh release at NMJ.

Brain and behavior (55 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions