Migraine Meds

Question 1

what are two key players in migraine med targets?

Answer 1

serotonin and CGRP

Question 2

what serotonin receptor plays role in migraine meds?

Answer 2

5HT-2A

Question 3

does serotonin increase or decrease during migraine?

Answer 3

decrease

Question 4

what does CGRP receptor activation lead to in cranial arterioles?

Answer 4

vasodilation

Question 5

aside from vasodilation, what else does CGRP induce that contributes to migraine symptoms?

Answer 5

inflammation

Question 6

what are the two cardio med classes used in migraine Rx?

Answer 6

beta block

ca channel blockers

Question 7

what beta blockers are indicated for migraine use?

Answer 7

metoprolol and propanolol

Question 8

what is Beta blocker target in migraine rx?

Answer 8

B2

Question 9

what is normal action of B2 stimulation in cranial arterioles?

Answer 9

relaxation when B2 is stimulated

Question 10

explain how B2 blockers help in migraine rx

Answer 10

B2 normally causes relaxation and contributes to vasodilation, so beta blockers doesnt allow for the relaxation

Question 11

what are SEs of beta blockers used in migraine?

Answer 11

aryhtmias

hypotension

Question 12

what ca blockers are used for migraines?

Answer 12

verapamil

nimodipine

Question 13

what is MoA of ca channel blockers in migraines?

Answer 13

who the hell knows

Question 14

name two antidepressants used for migraines

Answer 14

amitryptyline and venlafaxine

Question 15

what is MoA of amitryptyline and venlafaxine in migraine Rx?

Answer 15

increase serotonin by inhib reuptake and serotonin can lead to vasoconstriction

Question 16

what is main SE of amitryptyline and venlafaxine in migraine use?

Answer 16

anticholinergic effects…blurred vision
xerostomia
constipation
urinary retention

Question 17

what are the two anti seizure meds used for migraine?

Answer 17

topiramate and valproic acid

Question 18

what is MoA of topiramate and valproic acid in migraine?

Answer 18

who the hell knows

Question 19

what is MoA of fremanezumab and galcanezumab?

Answer 19

they bind to and inhibit CGRP

Question 20

what is MoA of erenumab?

Answer 20

binds to and inhibits the CGRP receptor

Question 21

name the three drugs that inhibit CGRP and its receptor directly

Answer 21

erenumab
fremanezumab
galcanezumab

Question 22

name two drugs used for acute treatment of migraine?

Answer 22

dihydroergotamine

sumatriptan

Question 23

what is sumatriptan an analog of?

Answer 23

serotonin

Question 24

what is the MoA of sumatriptan?

Answer 24

agonizes serotonin receptors on cranial arterioles
and
inhibits CGRP release from trigeminal sensory neruon

Question 25

what is the MoA of dihydroergotamine?

Answer 25

inhibits CGRP release from trigeminal sensory neuron
and
increase vasoconstriction by agonizing alpha 1 receptors on cranial arterioles
and
serotonin agonist

Question 26

what is a common SE with sumatriptan?

Answer 26

paresthesias

Question 27

what acute migraine med is contraindicated in pregnancy?

Answer 27

dihydroergotamine

Question 28

what is worrisome toxicities of dihydroergotamine and sumatriptan?

Answer 28

temporary BP spike, MI and stroke

Question 29

sumatriptan and dihydroergotamine stimulate what NT receptor? what can this lead to?

Answer 29

serotonin…serotonin syndrome

Question 30

what is the MoA of ubrogepant/rimegepant?

Answer 30

block CGRP binding on smooth muscle