Migraine HA

Question 1

NSAIDs & Acetaminophen, Nasal Butorphanol (Symptom Relief)

Answer 1

• Analgesics
• See other cards

Question 2

Ondansetron (Symptom Relief)

Answer 2

• Antiemetic, 5-HT antagonist
• Selectively blocks 5-HT type 3 receptors,maybe decr activation of chemoreceptor trigger zone
• PO or IV; t1/2 3-4 h
• AEs: headache, constipation, dizziness
• AKA Zofran

Question 3

Sumatriptan (Abortive)

Answer 3

• 5-HT1 receptor agonistàvasoconstrictor
• SC, PO, nasal •Migranes
• AEs: hypertension, ischemia. Drug interactions: MAO-A inhibitors
• AKA Imitrex

Question 4

Zolmitriptan (Abortive)

Answer 4

• Prototype: Sumatriptan
• AKA Zomig

Question 5

Ergotamine (Abortive)

Answer 5

• 5-HT1 receptor agonistàvasoconstrictor; uterine stimulant, a-adrenergic antagonist (less selective)
• Migranes
• AEs: nausea, vomiting. Contra-indicated in periph vasc dis, coronary artery disease, hypertension
• AKA Ergomar

Question 6

Propranolol (Prophylaxis)

Answer 6

• Beta-adrenergic blocker [prototype] – attenuate neurotrigger phase
• Decreases heart rate, decr LV contractility; reduces myocardial oxyg demand [cardiac prob]
• ~25% bioavailability; plasma t1/2 3-5 hrs
• AEs: lots
• AKA Inderal

Question 7

Verampemil (Prophylaxis)

Answer 7

• Ca2+ channel antagonist [prototype]àdecr Ca2+ influx (vasculature (dilate) & cardiac) •Attenuates neurotrigger & vasoconstrictive phase
• PO and IV, diff in first-pass metab, bioavailability ~20%, plasma t1/2 5 hrs, bound plasma proteins
• Migraine prophylaxis and cardiac problems
• AEs: excessive vasodilation, bradycardia
• AKA Calan

Question 8

Topiramate (Prophylaxis)

Answer 8

• Ca2+ & Na+ channel blocker; GABA-channel activator (Cl-), Glu receptor antagonist (AMPA & Kainate, not NMDA)
• Renal excretion
• Seizures
• AEs: Ataxia, dizziness, confusion, fatigue, slight risk kidney stones
• AKA Topamax

Question 9

Amitriptyline (Prophylaxis)

Answer 9

• Tricyclic Anti-Depressant blocks 5-HT reuptake
• Prototype: imipramine
• 4 wks for efficacy; Very lipid soluble, large VD, bind plasma proteins, difficult to dialyze, t1/2 ~24 hrs
• Major depressive disorder, migraine prophylaxis
• AEs: toxicity-sedation, tremor, anticholinergic side effects (dry mouth, blurred vision, urinary retention)
• AKA Elavil

Question 10

Methysergide (Prophylaxis)

Answer 10

• 5-HT receptor antagonist/partial agonist
• Ergot derivative (but little uterine stim)
• Vasoconstrictor
• Migraine prophylaxis
• AEs: retroperitoneal fibrosis
• AKA Sansert