Migraine Pharm Flashcards
What is the Triptan MOA?
Selective Serotonin 5HT-1d/b agonists
Lower cAMP-> inhibit CGRP release
What are the contraindications of Triptans?
Hx of ischemic/vasospastic CAD, or uncontrolled HTN (b/c they cause vasoconstriction)
Taking MAO inhibitors
How can DHT be administered?
Sub-lingual, intranasal, IV, IM, SubQ
What migraine Rx should be completely avoided in pregnancy? Why?
DHT, all ergot alkaloids
Risk of spontaneous abortion
What is the BOTOX MOA?
Cleaves Snap-25 in motor neurons-> inhibits acetylcholine release at motor endplate @ nmj (presynaptic)
What Ca++ channel blocker is indicated for migraine prevention? Proposed MOA?
Verapamil- good side effect profile
Lessens Ca++ dependent vesicle fusion
What Beta-adrenergic blockers are used for migraine prevention? Contraindications?
Propranolol and Timolol
Contraindicated in asthma patients (cause bronchoconstriction)
What AED’s are used for migraine prevention? What is the risk?
Topirimate and valproate
Increased risk of suicide
What vessels are dilated and constricted in migraines?
Cerebral vasoconstriction
Cranial vasodilation
What triptan lasts the longest?
Frovatriptan- 24hr half life
What 5-HT receptors are found on cranial blood vessels and neurons, respectively?
Vessels-> 5HT-1B
Peripheral neurons-> 5HT-1D
Central neurons-> 5HT-1D/1B
What happens when a patient takes a triptan and DHE together?
Vasoconstriction-> gangrene (contraindicated, obviously)
What tricyclic antidepressants are used for migraine prophylaxis?
Amitriptylene, imipramine
What would a patient taking a 5HT-1B antagonist have a risk of?
Migraine (want a 5HT AGONIST to tx)
What anti-nausea med can be prescribed in addition to a migraine med?
Ondansetron (Zofran- 5HT3 antagonist-> blocks depolarization, emesis)
