Migraines

Question 1

Migraine Patho: What is it?

Answer 1

Vasodilation & inflammation of intracranial blood vessels

Question 2

Migraine Patho:

What does it involve?

Answer 2

Involves neurons of the trigeminal vascular system –> innervate intracranial blood vessels

Question 3

Migraine Patho:

What are the two compounds?

Answer 3

Calcitonin gene-related peptide (CGRP) & serotonin

5-HT serotonin

Question 4

Migraine Patho:

Two compounds involved: Calcitonin gene-related peptide (CGRP) & serotonin- What do they do?w
What happens to meninges?

Answer 4

Proteins that promote migraine, vasodilates

Meninges become inflamed

Question 5

Migraine Patho
2 compounds involved: 5-HT serotonin
What does it do?

Answer 5

Suppresses migraines

Question 6

Drug therapy: What are the two types?

Answer 6

Non-specific analgesics

Migraine specific drugs – the triptans

Question 7

Drug therapy:

Non-specific analgesics: What is included?

Answer 7

Acetaminophen + aspirin + caffeine (Excedrin migraine)

NSAIDs (aspirin, naproxen, ibuprofen)

Question 8

Drug therapy:

Migraine specific drugs – the triptans: What is included?

Answer 8

Selective Serotonin 1B/1D Receptor Agonists

Question 9

Drug therapy:

Migraine specific drugs – the triptans:

Selective Serotonin 1B/1D Receptor Agonists

Answer 9

Sumatriptan (Imitrex)

Zolmitriptan (Zomig)

Question 10

Selective Serotonin 1B/1D Receptor Agonists (Triptans):

Mode of Action: What is it an analog of?

Answer 10

Analog 5HT

Question 11

Selective Serotonin 1B/1D Receptor Agonists (Triptans):

Mode of Action: Analog of 5HT- What does it do?

Answer 11

Analog 5HT – activates 5HT1B/1D receptors on intracranial blood vessels to cause vasoconstriction

Question 12

Selective Serotonin 1B/1D Receptor Agonists (Triptans):

Mode of Action: How is inflammation reduced?

Answer 12

Binding on sensory trigeminal vascular system nerve receptors suppresses CGRT (compound causing inflammation)

Question 13

Selective Serotonin 1B/1D Receptor Agonists (Triptans):

Mode of Action: A combination of what actions relieves migraine pain?

Answer 13

Vasoconstriction & decreased perivascular inflammation relieve migraine pain

Question 14

Selective Serotonin 1B/1D Receptor Agonists (Triptans):

Use?

Answer 14

Abort attack

Question 15

Selective Serotonin 1B/1D Receptor Agonists (Triptans):

ADRs?

Answer 15

Chest pain

Question 16

Selective Serotonin 1B/1D Receptor Agonists (Triptans):

ADRs: How is chest pain?

Answer 16

Transient, not related to ischemic disease

Question 17

Selective Serotonin 1B/1D Receptor Agonists (Triptans):

ADRs: What are the causes of chest pain when taking this medication?

Answer 17

Causes:

pulm vasoconstriction,

bronchospasm,

intercostal muscle spasm,

bronchoconstriction

Question 18

Selective Serotonin 1B/1D Receptor Agonists (Triptans):

ADRs: What else can occur with chest pain?

Answer 18

Coronary vasospasm

Question 19

Selective Serotonin 1B/1D Receptor Agonists (Triptans)

ADRs: Coronary vasospasm- What does it cause? How often?

Answer 19

Rarely – can cause angina (Prinzmetal’s/vasospastic)

Question 20

Selective Serotonin 1B/1D Receptor Agonists (Triptans)

ADRs: Coronary vasospasm- Who should med be avoided in?

Answer 20

Avoid in pts with CAD RF (eg smokers, htn, fam hx)

Question 21

Selective Serotonin 1B/1D Receptor Agonists (Triptans)

ADRs: Coronary vasospasm- Who is med contraindicated in? Why?

Answer 21

Contraindicated in hx of ischemic heart disease,

uncontrolled htn because they cause blood vessel constriction

Question 22

Selective Serotonin 1B/1D Receptor Agonists (Triptans)

ADRs: Coronary vasospasm- What should it not be taken with?

Answer 22

Should not be taken with other meds that cause vasoconstriction (eg ergotamines, ergot alkaloids)