Migraine Meds Flashcards
what are two key players in migraine med targets?
serotonin and CGRP
what serotonin receptor plays role in migraine meds?
5HT-2A
does serotonin increase or decrease during migraine?
decrease
what does CGRP receptor activation lead to in cranial arterioles?
vasodilation
aside from vasodilation, what else does CGRP induce that contributes to migraine symptoms?
inflammation
what are the two cardio med classes used in migraine Rx?
beta block
ca channel blockers
what beta blockers are indicated for migraine use?
metoprolol and propanolol
what is Beta blocker target in migraine rx?
B2
what is normal action of B2 stimulation in cranial arterioles?
relaxation when B2 is stimulated
explain how B2 blockers help in migraine rx
B2 normally causes relaxation and contributes to vasodilation, so beta blockers doesnt allow for the relaxation
what are SEs of beta blockers used in migraine?
aryhtmias
hypotension
what ca blockers are used for migraines?
verapamil
nimodipine
what is MoA of ca channel blockers in migraines?
who the hell knows
name two antidepressants used for migraines
amitryptyline and venlafaxine
what is MoA of amitryptyline and venlafaxine in migraine Rx?
increase serotonin by inhib reuptake and serotonin can lead to vasoconstriction
what is main SE of amitryptyline and venlafaxine in migraine use?
anticholinergic effects…blurred vision
xerostomia
constipation
urinary retention
what are the two anti seizure meds used for migraine?
topiramate and valproic acid
what is MoA of topiramate and valproic acid in migraine?
who the hell knows
what is MoA of fremanezumab and galcanezumab?
they bind to and inhibit CGRP
what is MoA of erenumab?
binds to and inhibits the CGRP receptor
name the three drugs that inhibit CGRP and its receptor directly
erenumab
fremanezumab
galcanezumab
name two drugs used for acute treatment of migraine?
dihydroergotamine
sumatriptan
what is sumatriptan an analog of?
serotonin
what is the MoA of sumatriptan?
agonizes serotonin receptors on cranial arterioles
and
inhibits CGRP release from trigeminal sensory neruon
what is the MoA of dihydroergotamine?
inhibits CGRP release from trigeminal sensory neuron
and
increase vasoconstriction by agonizing alpha 1 receptors on cranial arterioles
and
serotonin agonist
what is a common SE with sumatriptan?
paresthesias
what acute migraine med is contraindicated in pregnancy?
dihydroergotamine
what is worrisome toxicities of dihydroergotamine and sumatriptan?
temporary BP spike, MI and stroke
sumatriptan and dihydroergotamine stimulate what NT receptor? what can this lead to?
serotonin…serotonin syndrome
what is the MoA of ubrogepant/rimegepant?
block CGRP binding on smooth muscle
