Migraines Flashcards

1
Q

What are the main types of drugs used to treat migraines?

A
  1. Triptans (5-HT 1D/1B agonists)
  2. Ergot alkaloids
  3. Non-steroidal anti-inflammatory analgesics
  4. Tricyclic antidepressants (TCA)
  5. Selective Serotonin Reuptake Inhibitors (SSRI)
  6. Migraine prophylaxis (not for acute)
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2
Q

MOA: Vaso constrictor actions, may act on presynaptic terminals to inhibit release of vasodilation peptides; bind to serotonin receptors found on blodvessels in the cerebrum and meninges

A

Triptans (5-HT 1D/1B agonists)

  • sumatriptan = first line
  • should not be used for pts at risk for CAD
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3
Q

MOA: vasoconstrictor actions; tend to have multiple actions in the NS (alpha receptors, DA receptors, 5-HT receptors); highly specific for migraines;

A

Ergot alkaloids

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4
Q

MOA: inhibit the presynaptic terminals

A

Anti-seizure medication

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5
Q

MOA: control pain

A

NSAIDS and ibuprofen

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6
Q

ADRs of this drug: Altered sensations (warmth, tingling, etc.), Dizziness, Muscle weakness, Neck pain; contraindicated for patients with CAD or angina

A

Triptans

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7
Q

Contraindications for specific triptan: Patients with severe hepatitis or renal impairments, or peripheral vascular syndromes

A
  • Naratriptan

- Eletriptan

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8
Q

Contraindications for specific triptan: Patients with peripheral vascular disease

A

Frovatriptan

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9
Q

Contraindications for specific triptan: Patients with Wolff-Parkinson-White Syndrome (Disorder of the electrical conduction system of the heart)

A

Zolmitriptan

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10
Q

What are the different types of triptan

A
  1. Eletriptan
  2. Frovatriptan
  3. Naratriptan
  4. Rizatriptan
  5. Sumatriptan
  6. Zolmitriptan
  7. Almotriptan
    - see ppt for dose, max does, half life
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11
Q

What are some concerns for pts taking triptans?

A
  • expensive
  • Duration of the drug’s actions often shorter than the duration of the migraine (May require several sequential doses during a prolonged attack; ADRs can limit the maximal safe dose)
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12
Q

What are the types of ergot alkaloids

A
  1. Ergotamine

2. Dihydroergotamine

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13
Q

Ergot alkaloid: less effective when given past produce (feeling that migraine is going to occur); long half-life can lead to overdose; A: PO, sublingual, rectal suppository, inhaler, IV

A

Ergotamine

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14
Q

Ergot alkaloid: Preferred by come clinicians for intractable migraines; Usually i.v.; Can be intranasally

A

Dihydroergotamine

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15
Q

What are the types of migraine prophylaxis drugs?

A
  1. Propranolol – beta-blocker
  2. Amitryptyline – TCA
  3. Anti-seizure medications (Topiramate; Valproic acid)
  4. Verapamil – Calcium channel blocker
  5. Flunarizine – CCB used in Europe
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16
Q

Since migraine prophylaxis drugs do not benefit acute migraines and have no affect after they’ve started, what are they used for?

A
  1. Reduces severity of acute attacks

2. Prevent recurrences

17
Q

What other drugs are used migraine attacks?

A
  1. Parenteral opioids for refractory cases
  2. Parenteral metoclopramide for severe nausea and vomiting
    Dopamine antagonist