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Pharmacology > Migraines > Flashcards

Migraines Flashcards

1
Q

Migraine pathophysiology

A

neurovascular, Trigeminal nucleus caudalis, serotonin neurotransmission, calcitonin gene related peptide

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2
Q

5HT receptors

A

5HT1 agonists: migraine treatment, 5HT2 antagonists: migraine prevention, 5HT antagonists: treatment of N/V

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3
Q

Phases of the migraine

A

irritable, depressed, neck stiffness, fluid retention, thirst, drowsiness

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4
Q

Migraine aura

A

neurologic symptoms, visual and somatosensory most common, speech, language, sx evolve slowly, 20-60 min before migraine

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5
Q

Migraine attack

A

moderate to severe intensity, unilateral, throbbing pain, N/V, photophobia, phonophobia; sleep will alleviate

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6
Q

Primary vs secondary headaches

A

primary: 90%, migraine, tension, cluster; secondary: tumor, meningitis, alcohol-induced

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7
Q

Red flags of headache history

A

age of onset, time form onset to peak, intensity, pain level, aggravating factors, associated sx

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8
Q

Post headache sx

A

fatigue, mood changes, decreased appetite, muscle weakness

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9
Q

Diagnosis of migraine

A

at least 5 attacks meeting criteria of +/- aura, lasts 4-72 hours, pain 2 of 4 (moderate to severe intensity, unilateral, pulsatile/throbbing, aggravated with activity, N/V, photo/phonophobia

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10
Q

Diagnosis episodic tension-type headache

A

bilateral, 30 min-7 days, pain 2 of 4 (bilateral, pressing/tightening, intensity mild-moderate, not aggravated by activity), no nausea/vomiting, +/- photo/phonophobia

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11
Q

variable headache presentations

A

migraine +/- aura, episodic/chronic tension-type headache, menstrual migraines, sinus headache

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12
Q

migraine treatment strategies

A

all pts diagnosed w/ migraine follow similar med ladder, simple analgesics, combo treatment, specific migraine therapies

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13
Q

Non-pharm treatment

A

hydration, biofeedback, relaxation training, behavioral therapy, cold compress, sleep, cool, dark and quiet room, ha diary,

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14
Q

Complementary treatments

A

feverfew, magnesium oxide, vit B2, coenzyme Q-10, valerian root, Omega 3

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15
Q

Migraine prophylaxis

A

BB, CCB, TCA, anticonvulsants

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16
Q

Acute apisodes

A

Nonspecific treatment: NSAIDs, antiemetics, Specific treatments: triptans, dihydroergotamine

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17
Q

Lower need options

A

low-end therapy, NSAIDs, analgesics, triptans

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18
Q

Moderate need options

A

combo analgesic/NSAIDs, antiemetics, triptans, prophylactic therapy

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19
Q

high end need options

A

opiods, ergots, triptans, prophylactic therapy, consultation

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20
Q

Acute migraine meds

A

triptans, ergotamine/dihydroergotamine, NSAIDs, opiods, anti-emetics

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21
Q

Triptans MOA

A

serotonin (5HT) agonists, inhibit CGRP gene transcription, prevent release of neuropeptides which cause vasodilation/pain

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22
Q

Triptans

A

DOC for acute attacks, not best for tension HA, take as soon as possible to onset, not for prevention

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23
Q

Triptans metabolism

A

hepatic CYP450, avoid in hepatic

24
Q

Triptan interactions

A

MAOI: avoid use within 2 weeks of discontinuing MAOI, oral contraceptive potentially increase in [triptan], avoid use of ergot within 24 hours of triptans

25
Q

Triptans contraindication and precautions

A

concern for developing serotonin syndrome, concurrent admin of MAOIs, SSRIs; concern with vasoconstriction, MI, angina, silent ischemia, CAD, uncontrolled HTN, pregnancy cat C

26
Q

Serotonin syndrome interaction

A

rare, potential w/ SSRIs, & SNRIs, S/SX: agitation, confusion, muscle spasms, tachy, BP changes, N/D, diaphoresis

27
Q

Triptans ADRs

A

tingling, warmth, flushing, dizziness, somnolence, abnormal taste, pain at injection site, CX pain, neck pressure or discomfort may be serious sx

28
Q

Triptan drugs

A

Sumatriptan (Imitrex), Rizatriptan (Maxalt), Zolmitriptan (Zomig), Naratriptan (Amerge), Almotriptan (Axert), Frovatriptan (Frova), eletriptan (Relpax)

29
Q

Triptan drug with fastest onset

A

Sumatriptan (Imitrex), injectable

30
Q

Triptan drug given nasal spray

A

Sumatriptan (Imitrex),, Zolmitriptan (Zomig)

31
Q

Triptan given orally disintegrating tabs

A

Rizatriptan (Maxalt), Zolmitriptan (Zomig)

32
Q

Triptan with best tolerability and duration

A

Naratriptan (Amerge), Frovatriptan (Frova)

33
Q

Ergot derivatives

A

Ergotamine and dihydroergotamine, most affective at first sign of a migraine, all are sedating

34
Q

Ergot derivatives MOA

A

high affinity for serotonin 1 receptors, also interact with alpha adrenergic, dopaminergic, and serotonin 3 receptors

35
Q

Ergot derivatives ADRs

A

Severe sx, nonoral route preferred, N/V/D, vasoconstriction of systemic and coronary arteries

36
Q

Ergot derivatives FDA Boxed warning

A

risk of stroke and/or gangrene when taken with certain antibiotics, antiviral and antifungal drugs

37
Q

Antiemetics

A

Chlorpromazine (Thorazine), Metoclopramide (Reglan), Prochlorperazine (Compazine)

38
Q

symptomatic migraine medication

A

acetaminophen, caffeine, isometheptene (Prodrin), Acetaminophen, isometheptene, dichloralphenazone (Midrin)

39
Q

Isometheptene

A

a sympatomimetic, vasoconstrictor

40
Q

Dichloralphenazone

A

a sedative, prodrug converted to chloral hydrate

41
Q

NSAIDs drugs

A

naproxen, ibuprofen, aspirin

42
Q

NSAIDs pearls

A

beneficial in menstrual migraines, use for pt with infrequent, mild-moderate severity migraines

43
Q

Rescue medication

A

Opioids, APAP w/ codeine/hydrocodone or butorphanol, meperidine and tramadol; risk of dependency

44
Q

Prophylactic treatment

A

BB, CCBs, anticonvulsants

45
Q

Indication for prophylaxis

A

rule of 2s, HA >2 days per week or 2-4 x per month, use of acute tx >2 days/week, use of rescue > 2 x/month

46
Q

Approved prophylactic drugs

A

propranolol, topiramate, divalproex sodium, botulinum toxin A, also TCA (amitriptyline, nortriptyline), verapamil, gabapentin

47
Q

BB for prophylaxis

A

first line for prevention, chronic daily HA, modulate vascular tone, also anti HTN, contraindicated in asthma and COPD, propranolol, Atenolol, metoprolol

48
Q

Anticonvulsants drugs

A

topiramate (Topamax), Gabapentin (Neurontin), Divalproic acid (Depakote, Depakote ER)

49
Q

Topiramate (Topamax)

A

blocks Na channels, potentiates GABA activity, dose titrate to response, risk of kidney stones, ADRs: somnolence, wt loss, psychomotor slowing, tingling in extremities, difficulty concentrating, avoid in preg

50
Q

Gabapentin (Neurontin)

A

possibly effective, beneficial in pt with neuralgia

51
Q

Divalproic acid (Depakote)

A

reduces frequency, not severity, reduces excitatory amino acids, increases GABA activity, nausea, weakness, somnolence, wt gain, hair loss, liver toxicity, avoid pregnancy

52
Q

Botulinum toxin A (Botox)

A

Neurotoxin, muscle relaxant, anti-spasmotic, small doses injected in to neck every 3 months, starts working in 1 month, $$$$, droopy eyelid, anaphylactic rxn

53
Q

TCA drugs

A

amitriptyline (Elavil), Nortriptyline (Pamelor)

54
Q

TCA MOA, ADR, cautions

A

inhibition of peripheral sensitization, 5HT2 antagonism, increase GABA, sedation, anticholinergic, wt gain, glaucoma, urinary retention, no use in suicidal pts

55
Q

CCB

A

verapamil, nifedipine, MOA unknown, nifedipine may worsen HA, CT in pt with CHF, hypotension, arrhythmias

Pharmacology (61 decks)

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