Migraine Meds Flashcards
Migraine HA have association with serotonin receptors. Serotonin 1 (5 HT-1) and Serotonin 2 (5 HT-2). Explain.
Serotonin 1 (5 HT-1): elicit vasoconstriction
Serotonin 2 (5 HT-2): elicit vasodilation
Which migraine medication is best for the prodromal phase?
Triptans
Which drugs are best for prophylaxis?
Propanolol/Inderal
Amitriptyline/Elavil
Methysergie/Sansert
Topiramate/Topamax
Propanolol Class: Ind: MOA: Char:
Propanolol
Class: Non-selective beta blocker
Ind: HTN, angina, AMI, panic attacks, migraine
MOA: Blocks adrenergic stimulation decreasing HR and oxygen demand, decreases renin release
Char: PO, 10 to 100 mg/day
Propanolol SE
Bronchoconstriction (non-selective beta blocker), hypotension, bradycardia, fatigue, impotence
Amitriptyline/Elavil Class: Ind: MOA: Char:
Amitriptyline/Elavil
Class: Tricyclic antidepressant TCA
Ind: Migraine/tension HA, chronic pain, bipolar disorder, depression
MOA: CNS modulation of serotonin and norepinephrine
Char: PO and IM, taken at bedtime to minimize SE of drowsiness and dizziness
Which drug is indicated for both migraine and bipolar disorder?
Amitriptyline/Elavil
When is Amitriptyline/Elavil CI?
CI with MONOAMINE OXIDASE inhibitors
(MAO - blunt production of enzymes that break down neurotransmitters)
+ effects take days to weeks
- effects noted within first several days
Amitriptyline/Elavil SE
Dizziness and drowsiness (do not take at night), dry mouth, constipation, urinary hesitancy, blurred vision
Topiramate/Topamax
Class:
Ind:
MOA:
Topiramate/Topamax
Class: Anticonvulsant
Ind: Tx epilepsy and prophylaxis of migraine HA, off label use for bipolar disorder
MOA: block voltage-dependent sodium channels in the CNS, augmenting activity of GABA
Topiramate SE
Fatigue, dizziness, vision changes, acute angle glaucoma, nausea, constipation
Methysergide/Sansert
Class:
Ind:
MOA:
Methysergide/Sansert
Class: Ergot derivative - serotonin 2 receptor antagonist
Ind: Prophylaxis of migraine and cluster HA
MOA: maybe a serotonin 2 receptor antagonist resulting in vasoconstrictor effect
Methysergide/Sansert
Char
Methysergide/Sansert
Char: PO
SHOULD NEVER BE USED BEYOND 6 MO W/O A DRUG FREE INTERVAL
Do not use within 24 hours of triptan because of increased risk of vasoconstrictive spasm
Methysergide/Sansert
SE
Methysergide/Sansert
SE:
(1) PULMONARY FIBROSIS and RETROPERITONEAL FIBROSIS, HTN, thrombophlebitis, N/V
(2) Heart valve thickening
When is Methysergide/Sansert CI?
Pregnancy (Category X)
Patients with peripheral vascular disease
Sumatriptan/Imitrex Class: Ind: MOA: Char:
Sumatriptan/Imitrex
Class: Serotonin agonist (Triptan - Prodromal phase tx)
Ind: Migraine, cluster HA
MOA: Serotonin agonist at 5-HT 1D and 1B receptors in periperhal nerves that innervate the intracranial vasculature
Char: PO/SQ/Nasal spray (aborts or reduces severity of migraines)
Sumatriptan/Imitrex
Char:
Sumatriptan/Imitrex
Char: Onset between 10-60 min. MAXIMUM of 2 doses in 24 Hrs.
Sumatriptan/Imitrex
SE:
Sumatriptan/Imitrex
SE: dizziness, tingling, facial flushing, weakness, chest tightness
What is an uncommon SE of all triptans and what are the symptoms?
Serotonin syndrome: agitation, tremor, ataxia, fever, chills and diarrhea.
What is the maximum dose of Sumatriptan/Imitrex?
2 to 3 doses/ 24 hour
12 - 18 dose max/month
Ibuprofen/Motrin, Advil
Ind:
MOA:
Char:
Ibuprofen/Motrin, Advil
Ind: Inflammation, pain, fever
MOA: REVERSIBLE inhibition of COX-1 and COX-2 enzymes
Char: PO, PR, no risk for Reye’s
Codeine Class: Ind: MOA: Char: SE:
Codeine Class: Opioid analgesic Ind: Pain relief, antitussive MOA: opioid agonist Char: PO, IV, IM, SQ SE: sedation, constipation
Butorphanol/Stadol
Class:
Ind:
MOA:
Butorphanol/Stadol
Class: Opiod analgesic
Ind: Migraine HA that is refractory to triptans
MOA: agonist/antagonist of opioid receptors
Butorphanol/Stadol
SE
Marked dependency potential exists.
SE: nasal irritation, drowsiness, dysphoria, N/V, withdrawal symptoms can be precipitated in patients with underlying addiction to opiates.
