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Neuro II Drugs > Migraine Drugs > Flashcards

Migraine Drugs Flashcards

1
Q

Drugs given during prodrome phase?

A
  1. Triptans (5 HT-1B/1D Rc agonists)

2. Ergot Alkaloids

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2
Q

Drugs for headache?

A
  1. NSAIDS

2. Acetaminophen

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3
Q

Preventative agents for migraine

A
  1. Beta blockers
  2. Tricyclic depressants
  3. Anticonvulsants
  4. Ca channel blockers
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4
Q

Prevention - beta blockers

A
  1. Propranolol
  2. Timolol
    - Anxiolytic, decreases sympathetic activity, blunts cortical spreading depression, effective in 60-80% of patients, decreases frequency of attacks by 50%
    - Contraindications: asthma patients –> bronchoconstriction
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5
Q

Prevention - tricyclic depressants

A
  1. Amitriptylene

2. Imipramine

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6
Q

Prevention - anticonvulsants

A
  1. Topirimate

2. Valproate

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7
Q

Prevention - Ca channel blockers

A

Verapamil

  • 1st choice for prevention
  • normal vessel tone
  • decreases vesicle fusion
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8
Q

Neurogenic inflammation

A
  1. Neuropeptides - CGRP, Sub P
  2. Inflammatory mediators - NO, histamine, prostaglandins
    - these dilate cranial BV and sensitive nerves to pain
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9
Q

Organic nitrates (NO)

A

Treats coronary artery disease - but can provoke migraines

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10
Q

5 HT-1B

A
  • on vascular smooth muscle
  • cranial vessels
  • once triptan binds to it on dilated vessels, it will decrease cAMP –> stimulate Vc
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11
Q

5 HT-1D

A
  • peripheral neuron
  • triptan binds to it on nerve –> decrease cAMP –> inhibit presynaptic release of CGRP from trigeminal nerve by stimulating 5 HT-1D on presynaptic nerve terminal
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12
Q

Other 5 HT Rc:

A
  1. 5HT1A agonist - buspirone (anxiolytic, anti-depressant)
  2. 5HT2 - serotonin (aggregates blood platelets)
  3. 5HT3 antagonist - ondansetron (anti-emesis)
  4. 5HT4 agonist - cisapride (GI)
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13
Q

Sumatriptan

A
  • WIDELY used due to max delivery options (subcutaneous injection - fastest, nasal spray - fast onset, oral tablets)
  • however, only 15% bioavailability
  • metabolized by MAO-A (it’s an indoleamine)
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14
Q

Other triptan drugs

A
  1. Almotriptan
  2. Naratriptan (70% bioavailibity)
  3. Zolmitriptan (active metabolite, comes in tablet form, oral disintegration tablet, nasal spray - other one with many delivery options but Sumatriptan still wins)
  4. . Rizatriptan - better tolerated, better efficacy relative to sumatriptan
  5. Eletriptan - better tolerated, better efficacy relative to sumatriptan
  6. Frovatriptan
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15
Q

If taking other meds with triptans you can get?

A

BOARDS - Serotonin syndrome!!! (MAO interactions)

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16
Q

3 drugs contraindicated in patients taking MAO inhibitors?

A
  1. Sumatriptan
  2. Rizatriptan
  3. Zolmitriptan
    - all metabolized by MAO
17
Q

Ergoit Alkaloids

A
  1. Dihydroergotamine (sublingual, intranasal, IV, IM, SC)
  2. Egotamine and caffeine (oral tablet, rectal)
    - taken if triptans don’t work
    - SE: strong emetic action (Vc effects worse than triptans - St Anthony Fire)
18
Q

Migraine treatment in pregnancy

A
  1. Acetaminophen +/- Codeine
  2. Aspirin - 1/2 trimester only
  3. Ibuprofen - 1/2 trimester only
  4. Triptans - with caution
    Contraindications - DHE and other Ergoit alkaloids cuz increases abortion risk
19
Q

Drub combinations

A
  1. Triptan + analgesics (acetaminophen, ibuprofen, naproxen)
  2. Sumatriptan + naproxen = Treximet
  3. Triptan + anti-nausea
  4. DHE + anti-nausea (IV)
20
Q

5 HT-1D/1B

A
  • on central neuron of trigmeninal nucleus caudalis (brain stem)
  • modulates coming-in pain sensory info from periphery and inhibits upward transmission to thalamus and higher brain areas (where pain is perceived)

Neuro II Drugs (7 decks)

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