Migraine medications Flashcards
Why is propanolol (inderal) used for migraines instead of a more cardioselective beta blocker
They are more lipid soluble, and so have greater effect on the brain
What is the MOA of propanolol
Blocks adrenergic stimulation which serves to decrease heart rate and myocardial oxygen demand and also decreases renin release
Who should not take a beta blocker
a fragile asthmatic or severe COPD may have static asthmaticus due to bronchoconstriction effect
What drug class is amitriptyline
Tricyclic antidepressant
What are the indications for amitriptyline
Migraine headache prophylaxis, chronic pain, bipolar disorder and depression
What is the MOA of amitriptyline
CNS modulation of both serotonin and norepinephrine
What should not be used with amitriptyline
monoamine oxidase inhibitors
what drug class is Topiramate (topamax)
Anticonvulsant
What are the indications for topiramate (topamax)
Epilepsy, migraine prophylaxis. Off-label: bipolar, weight loss
What is the MOA of topiramate (topamax)
Block voltage-dependent sodium channels in the CNS, augmenting the activity of the neurotransmitter gamma-amino butyrate (GABA) at some subtypes of the GABA-A receptor
What are the side effects of topiramate (topamax)
“I don’t feel right” because you are blocking some neural activity. also fatigue, dizziness, vision changes, acute angle glaucoma, nausea, constipation
What drug class is methysergide (sansert)
Ergot derivative - serotonin 2 receptor antangonist
What is the MOA of methylsergide
Potent vasoconstrictor
What are some rules of using methylsergide
must cycle every 6 months. Must taper to avoid rebound. DO not use within 24 hours of a triptan d/t risk of vasoconstrictive spasm
What are severe side effects of methylsergide
Pulmonary fibrosis and retroperitoneal fibrosis, thickening of the heart valves
What category is methysergide (sansert)
Category X
What drug class is sumatriptan (imitrex)
serotonin agonist
What are the indications of sumatriptan (Imitrex)
Migraine and cluster headache (prodromal phase)
What are the administration routes of sumatriptan
PO, SQ, Nasal spray
How much sumatriptan can be taken
No more than 2 doses in a day, or the chances of side effects increase significantly. (12-18 doses per month)
What category is sumatriptan (Imitrex)
category C
What is a significant but rare side effect of sumatriptan
serotonin syndrome (agitation, tremor, ataxia, fever/chills, diarrhea)
What class is butorphanol (stadol)
opioid analgesic
What are the indications of butorphanol (stadol)
Migraine headache that is refractory to triptans and to other agents as well as less potent analgesics. Butorphanol may also used in other acute pain conditions
How is butorphanol administered
nasal spray, IM
What are some side effects of butorphanol
Severely addicting, nasal irritation, drowsiness, dysphoria, N/V
What is the MOA of ibuprofen (advil, motrin)
Reversible inhibition of COX-1 and COX-2 enzymes. Anti-inflammatory and analgesic effect largely due to blockade of prostaglandin synthesis at target tissues. No blood thinning effect
What is a good way to administer anti-emetics
PR is a good one for patients to have on hand
What drug class is prochlorperazine (Compazine)
Typical neuroleptic
What are the indications prochlorperazine (compazine)
Anti-emetic especially when associated with migraine, vertigo, psychosis
What is the MOA of prochlorperazine (Compazine)
Primarily H1-histamine receptor antagonist. Also a D2 dopaminergic receptor antagonist and an alpha-adrenergic receptor antagonist
What are the side effects of prochlorperazine (compazine)
Classic anti-histamine effects (dry mouth, dry eyes, dowdiness, urinary retention), lower seizure threshold, extrapyramidal effects
How does odansetron relate to prochlorperazine
It is a stronger anti-emetic
What is the MOA of odansetron
Blockade of serotonin (5HT3) receptor sites results in signifigant anti-nausea effect.
