migraine meds

Question 1

serotonin 1 (5HT-1)

Answer 1

receptors elicit vasoconstriction

Question 2

serotonin 2 (5HT-2)

Answer 2

receptors elicit vasodialation

Question 3

vascular status & HA

Answer 3

vasoconstriction = prodromal aspects
vasodilation = the actual HA

Question 4

migraine prophylaxis drugs

Answer 4

beta-blockers, Ca channel blockers, methysergide, tricyclic antidepressants, ergotamine, anti-seizure meds

Question 5

prodromal tx

Answer 5

triptans

Question 6

actual HA pain tx

Answer 6

analgesics, anti-emetics

Question 7

propanolol/ inderal

Answer 7

non-selective beta- blocker
for HTN, angina, AMI, panic attacks, migraine HA
MOA- blocks adrenergic stim= dec HR & myocardial O2 demand, dec renin
-PO, 10-100mg/day
-SE- bronchoconstriction, hypotension, bradycardia, fatigue, impotence. rebound HTN with abrupt stop & inc risk

Question 8

amitriptyline/ elavil

Answer 8

tricyclic antidepressant(TCA)
for migraine/tension HA, chronic pain, bipolar DO, depression
MOA- CNS modulation of both serotonin & NE
PO & IM, usu taken at bedtime to min. drowsiness/dizziness
-SE- dizziness & marked drowsines. anticholinergic effect- dry mouth, constipation, urinary hesitancy, blurred vision.
do no use with MAO inhibitors
effect may take weeks to observe while SE are mroe immediate

Question 9

topiramate/ topamax

Answer 9

anticonvulsant
for epilepsy, prophylaxis of migraine. off label for bipolar DO
MOA- block voltage dependent Na channels in CNS. augments acticity of GABA
PO tablets
-SE- fatigue, dizziness, vision cahnges, acute angle glaucoma, nausea, constipation

Question 10

methylsergide/ sansert

Answer 10

ergot derivative- serotonin 2 receptor antagonist
for the prophylaxis of migraine & cluster HA
MOA- not fully known- appears to result in vasoconstriction
PO- never to be used longer than 6 mos- must be tapered to avoid rebound
SE- HTN, thrombophlebitis, N/V, pulmonary fibrosis, retroperitoneal fibrosis, heart valve thickening
CATEGORY X & contraindicated in those with peripheral vascular dz

Question 11

sumatriptan/ imitrex

Answer 11

Triptan class serotonin agonist
for migraine & cluster HA
MOA- serotonin agonist @ 5HT 1D & 1B receptors. found in peripheral nerves that innervate intracranial vasculature
PO, SQ, nasal spray- onset 10-60 minutes, max 2 doses in 24hrs
SE- dizziness, tingling, facial flushing, weakness, chest tightness/pain, arrythmias, HTN
category C

Question 12

NSAIDS

Answer 12

inhibit synthesis of prostaglandins(which are synthesized from arachadonic acid- COX 1&2)
-inhibit COX 1 & 2

Question 13

ibuprofen/ motrin, advil

Answer 13

NSAID
for inflammation, fever, pain
MOA- reversible inhinition of COX 1&2 enzymes. effect due to blockade of prostaglandin synthesis at target tissues
PO, PR

Question 14

Codeine

Answer 14

opioid analgesic
for pain relief, antitussive
MOA- opioid agonist, much weaker than morphine
PO, IV, IM, SQ- lower abuse potential. cough suppression at lower dose than analgesic dose
SE- sedation, constipation

Question 15

butorphanol stadol

Answer 15

opiod analgesic
for migraine HA that is refactory to triptans
MOA- mixed agonist-antagonist of opioid receptors
-nasal spray, IM. 1 spray in 1 nostril every 3-5hrs- marked dependency potential
SE- nasal irritation, drowsiness, dysphoria, N/V

Question 16

prochlorperazine/ compazine

Answer 16

typical neuroleptic
used as an anti-emetic for migraine HA & vertigo, anti-psychotic
MOA- H1-histamine receptor antagonist. also D2 dopaminergic & alpha-adrenergic receptor antagonist
PO, PR, IM, IV
-SE- drowsiness, dry mouth, constipation, urinary retention. lowers seizure threshold. extrapyramidal SE at high doses for long periods of time

Question 17

ondasetron/ zofran

Answer 17

antiemetic
MOA- blockade of serotonin (5HT3) receptor sites 
for severe nausea
PO, IV
-SE- dizziness, HA, gen well tolerated

Question 18

non-pharm tx’s

Answer 18

riboflavin(B2)- 400mg/day
magnesium- 600mg/day
biofeedback
acupunture
botulinum toxin(botox)

Question 19

Antiemetic for migraine

Answer 19

Diphenhydramine
Phenergan
Procperizine

Question 20

Serotonin syndrome

Answer 20

Tremor, fever, ataxia, chills