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NS2 Test 3 > Migraine Headaches--Treatment and Prevention > Flashcards

Migraine Headaches--Treatment and Prevention Flashcards

1
Q

Migraine–neural events provoke

A

-dilation of cranial blood vessels

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2
Q

Goal of therapeutic agents

A

-rescue patient from start of a migraine

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3
Q

Medication taken in prodrome phase

A
  • Triptans–5HT1B/1D Receptor agonists

- Ergot alkaloids

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4
Q

Medications taken in headache phase

A
  • NSAIDS

- Acetaminophen

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5
Q

Preventative agents

A

-B blockers
-Tricyclic antidepressants
-anticonvulsants
-Ca channels
(given in asymptomatic phase)

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6
Q

neurogenic inflammation theory of migraine

A

-wave of electrical cavity
-stimulates release of neuropeptides (CGRP, substance P) and inflammatory mediators
(NO, histamine, prostaglandins)
-dilate cranial blood vessels and sensitive nerves to pain

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7
Q

step 1

A
  • brainstem dysfunction sparks a wave of excitation/depression in Cortex–H, K, NO discharge from neurons
  • cerebral vasoconstriction
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8
Q

step 2

A
  • electrolytes and NO diffuse and dilate cranial arteries and depolarize perivascular trigeminal terminals
  • CGRP and neuropeptides promote neurogenic inflammation
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9
Q

step 3

A

neurogenic inflammation irritates TG n and transmits migraine pain

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10
Q

2 key mediators–interact throughout trigeminal neuromuscular system

A

-CGRP and NO

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11
Q

used to treat coronary a disease

A
  • Organic nitrates (NO)

- Can provoke migraine

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12
Q

cranial vessels–R

A

5HT-1B

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13
Q

peripheral neuron R

A

5HT-1 D

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14
Q

central neuron R

A

-5HT 1B/iD

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15
Q

serotonin receptor-vascular and synaptic

A
  • vascular-5HT1B R

- synaptic-5HT 1 D R

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16
Q

Triptans mechanism

A
  • selective 5HT1D/1B receptor agonist
  • 5HT-1B Receptor stimulates vasoconstriction
  • 5HT-1D Receptor inhibits pre-synaptic release of CGRP
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17
Q

Triptan prototype

A

Sumatriptan

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18
Q

Sumatriptan–p.o.

A
  • Cmax=1-2 hours
  • 15% bioavailability–unreliable in some patients
  • clearance-t/12=1-2 hours
19
Q

Sumatriptan-other delivery options

A
  • SC-Cmax=15 minutes

- nasal spray=30 minutes

20
Q

Sumatriptan-metabolized by

A

MAO-A

21
Q

Other triptans

A
  • Almotriptan
  • Naratriptan-70% bioavailability; t/12 is 6 hours
  • Zolmitriptan–active metabolite
  • Rizatriptan
  • Eletriptan
  • Frovatriptan–t1/2=24 hours
22
Q

choice of delivery route

A
  • oral-easy to take, ineffective if patient vomits
  • nasal spray–effective with vomiting, simple, works quickly; few triptans formulated as nasal sprays
  • injection–works quickly; inconvenient
23
Q

Sumatriptan–delivery options

A
  • injectable subcutaneous
  • nasal spray
  • tablets
24
Q

Zolmmitriptan-delivery options

A
  • tablets
  • orally disintegrating tablets
  • nasal spray
25
Q

Quick onset–what delivery options

A
  • nasal spray–fast

- subcutaneous–sumatriptan fastest

26
Q

is patient taking other medications? consider?

A
  • serotonin syndrome

- MAO interactions

27
Q

Triptans–contraindications

A
  • ischemic/vasospastic coronary disease
  • cardiovascular disorder
  • uncontrolled hypertension
28
Q

contraindicated in patients taking MAO inhibitors

A

-Sumatriptran
-rizatriptan
-zolmitriptan
(metabolized by MAO)

29
Q

used for severe or refractory migraine

A

-ergot alkaloids

30
Q

Ergot alkaloids

A
  • Dihydroergotamine
  • Ergotamine and caffeine
  • less specific!!
31
Q

NEVER use what together??

A

triptan and DHE

32
Q

Ergot alkaloids–side effects

A
  • strong emetic action

- vasoconstriction–St. Anthony’s fire

33
Q

migraine treatment in pregnancy

A
  • acetaminophen and codeine
  • aspirin-1 and 2nd trimester only
  • ibuprofen–1st and 2nd trimester only
  • triptans-cautiously
34
Q

migraine treatment in pregnancy–contraindicated

A
  • DIhydroergotamine

- Other ergot alkaloids

35
Q

Botox and migraines?

A
  • inhibits ACh release at motor endplates–reduce m activity

- not approved for migraines unless migraine isn’t received from other meds

36
Q

preventive agents–taken daily, asymptomatic

A
  • B blockers
  • Tricyclic antidepressants
  • Anticonvulsants
  • Ca channel blockers
37
Q

B blockers mechanism

A
  • propranolol, timolol
  • anxiolytic action
  • decrease sympathetic activity
  • blunts cortical spreading depression
  • effective in 60-80%
38
Q

B blockers–cautions

A
  • Normal well tolerated

- bronchoconstriction–contraindicated in asthma patients

39
Q

Tricyclic antidepressants

A

-amitriptylene, imipramine

40
Q

anticonvulsants

A

-topiramine, valproate

41
Q

Ca channel blockers

A

verapramil

42
Q

considerations for preventative therapy

A
  • > 2 migraines per month with disability
  • disability lasting >3 days per month
  • adverse effects from acute treatments
  • rescue medication used >2x per week
  • uncommon migraine conditions
43
Q

Ca channel blockers for migraine prevention–mechanism

A
  • Verapamil
  • Lessens Ca dependent vesicle fusion
  • normalizes vessel tone

NS2 Test 3 (14 decks)

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