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Pharmacology Exam 7 > Migraine Headaches > Flashcards

Migraine Headaches Flashcards

1
Q

Analgesics used to treat migraine?

A 
ASA
APAP
Ibuprofen
Naproxen
\+/- Caffeine
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2
Q

Anti-emetic agents

A

Dopamine receptor antagonists

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3
Q

Dopamine receptor antagonists

A

Metocloproamide

Prochlorperazine

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4
Q

Effects of DA receptor antagonists

A

Relieve N/V

Increase GI motility

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5
Q

Problem with administering DA receptor antagonists

A

Decreased gastric emptying means that parenteral route may be needed

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6
Q

MOA of Metoclopramide

A

D2 Receptor antagonist

Muscarinic receptor stimulator

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7
Q

Blackbox warning of Metoclopromide

A

Tardive dyskinesia (Parkinsonian symptoms) due to decreased DA

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8
Q

Which DA receptor antagonist only has effect at the D2 receptor?

A

Prochlorperazine

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9
Q

Which DA receptor antagonist does not have persistalsis activity?

A

Prochlorperazine

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10
Q

Use of Prochlorperazine

A

Alternative to Metoclorpramide

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11
Q

Which drugs are the migraine specific 5-HT1 agonists?

A

Triptans and Ergot alkaloids

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12
Q

What is the mechanism of action of Triptans?

A

5HT1 receptor agonist selective for 1B and 1D (vasoconstriction, block release of CGRP)

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13
Q

What are the effects of triptans?

A

relieve pain, reduce N/V, increase GI motility

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14
Q

Which migraine specific meds are not good for migraines with aura?

A

triptans

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15
Q

Why do you need to use NSAID adjuncts with Triptans?

A

Triptans have a short half life and usually do not last long enough to cover the headache

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16
Q

Contraindication of Triptans?

A

CAD - vasospasm (angina)

MAOIs (serotonin syndrome - 5HT1 agonist)

17
Q

Why should Triptans not be given by IV?

A

Because they cause vasospasm (angina)

18
Q

Which drug is the first line for ACUTE migraine?

A

Sumatriptan

19
Q

Which drug is used as prophylaxis for menstrual migraines?

A

Frovatriptan

20
Q

which triptan has a long half life of 26 hours?

A

Frovatriptan

21
Q

Which drugs are used as an alternative to triptans?

A

Ergot alkaloids (Dihydroergotamine)

22
Q

What is the main side effect of Ergot Alkaloids?

A

Ergotism - intense vasoconstriction of coronary arteries and peripheral arteries, angina, gangrene

23
Q

What is the main Ergot Alkaloid used?

A

Dihydroergotamine

24
Q

What is the MOA of Dihydroergotamine?

A

Non-specific agonist, partial agonist and antagonist on 5HT-1, A-adrenergic, DA receptors

25
Q

What patients should avoid Dihydroergotamine because of higher risk of Ergotism?

A

Patients on CYP34A inhibitors

26
Q

What are the prophylactic agents used for migraine?

A

Propanolol
Amitriptylline
Valproic acid
Botox

27
Q

What is the main reason prophylactic agents are used?

A

To prevent progression of episodic migraines to becoming chronic migraines

28
Q

How does Propanolol relieve migraine symptoms?

A

Decrease HR and BP, less pounding sensation

29
Q

What is a disadvantage of using propanolol?

A

It takes several weeks to show results

30
Q

What are the common side effects of amytriptylline?

A

Anticholinergic

31
Q

What is the main use of Valproic acid?

A

Anti-seizure

32
Q

What are the contraindications of Valproic Acid

A

Pregnancy women in childbearing years

33
Q

What drug is FDA approved for 2nd line treatment of CHRONIC migraines?

A

Botox

34
Q

What is the MOA of Botox

A

Flaccid paralysis of skull

35
Q

Is botox effective for episodic migraines?

A

No

Pharmacology Exam 7 (8 decks)

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