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pharm 2 > Migraine medications > Flashcards

Migraine medications Flashcards

1
Q

Why is propanolol (inderal) used for migraines instead of a more cardioselective beta blocker

A

They are more lipid soluble, and so have greater effect on the brain

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2
Q

What is the MOA of propanolol

A

Blocks adrenergic stimulation which serves to decrease heart rate and myocardial oxygen demand and also decreases renin release

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3
Q

Who should not take a beta blocker

A

a fragile asthmatic or severe COPD may have static asthmaticus due to bronchoconstriction effect

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4
Q

What drug class is amitriptyline

A

Tricyclic antidepressant

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5
Q

What are the indications for amitriptyline

A

Migraine headache prophylaxis, chronic pain, bipolar disorder and depression

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6
Q

What is the MOA of amitriptyline

A

CNS modulation of both serotonin and norepinephrine

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7
Q

What should not be used with amitriptyline

A

monoamine oxidase inhibitors

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8
Q

what drug class is Topiramate (topamax)

A

Anticonvulsant

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9
Q

What are the indications for topiramate (topamax)

A

Epilepsy, migraine prophylaxis. Off-label: bipolar, weight loss

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10
Q

What is the MOA of topiramate (topamax)

A

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

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11
Q

What are the side effects of topiramate (topamax)

A

“I don’t feel right” because you are blocking some neural activity. also fatigue, dizziness, vision changes, acute angle glaucoma, nausea, constipation

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12
Q

What drug class is methysergide (sansert)

A

Ergot derivative - serotonin 2 receptor antangonist

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13
Q

What is the MOA of methylsergide

A

Potent vasoconstrictor

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14
Q

What are some rules of using methylsergide

A

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

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15
Q

What are severe side effects of methylsergide

A

Pulmonary fibrosis and retroperitoneal fibrosis, thickening of the heart valves

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16
Q

What category is methysergide (sansert)

A

Category X

17
Q

What drug class is sumatriptan (imitrex)

A

serotonin agonist

18
Q

What are the indications of sumatriptan (Imitrex)

A

Migraine and cluster headache (prodromal phase)

19
Q

What are the administration routes of sumatriptan

A

PO, SQ, Nasal spray

20
Q

How much sumatriptan can be taken

A

No more than 2 doses in a day, or the chances of side effects increase significantly. (12-18 doses per month)

21
Q

What category is sumatriptan (Imitrex)

A

category C

22
Q

What is a significant but rare side effect of sumatriptan

A

serotonin syndrome (agitation, tremor, ataxia, fever/chills, diarrhea)

23
Q

What class is butorphanol (stadol)

A

opioid analgesic

24
Q

What are the indications of butorphanol (stadol)

A

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

25
Q

How is butorphanol administered

A

nasal spray, IM

26
Q

What are some side effects of butorphanol

A

Severely addicting, nasal irritation, drowsiness, dysphoria, N/V

27
Q

What is the MOA of ibuprofen (advil, motrin)

A

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

28
Q

What is a good way to administer anti-emetics

A

PR is a good one for patients to have on hand

29
Q

What drug class is prochlorperazine (Compazine)

A

Typical neuroleptic

30
Q

What are the indications prochlorperazine (compazine)

A

Anti-emetic especially when associated with migraine, vertigo, psychosis

31
Q

What is the MOA of prochlorperazine (Compazine)

A

Primarily H1-histamine receptor antagonist. Also a D2 dopaminergic receptor antagonist and an alpha-adrenergic receptor antagonist

32
Q

What are the side effects of prochlorperazine (compazine)

A

Classic anti-histamine effects (dry mouth, dry eyes, dowdiness, urinary retention), lower seizure threshold, extrapyramidal effects

33
Q

How does odansetron relate to prochlorperazine

A

It is a stronger anti-emetic

34
Q

What is the MOA of odansetron

A

Blockade of serotonin (5HT3) receptor sites results in signifigant anti-nausea effect.

pharm 2 (18 decks)

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