Migraines (Hong)

Question 1

What is the peripheral effect of serotonin?

Answer 1

-induces blood platelet aggregation
-stimulates GI smooth muscle movement
-stimulates pain and itch sensory nerve endings
-induce contraction of vascular smooth muscle, except in skeletal muscle and the heart, where it causes vasodilation

Question 2

What cells contain serotonin neurons?

Answer 2

raphe nucleus

Question 3

What is serotonin important for what physiological functions?

Answer 3

-sleep/arousal
-mood, emotion
-appetite
-body temperature

Question 4

MOA: -triptans

Answer 4

agonists at 5HT 1b/1d receptors which inhibit synthesis and release of serotonin

Question 5

What is the first line treatment for migraines?

Answer 5

-triptans

Question 6

What causes a migraine to be with aura?

Answer 6

cortisol spreading depression (CSD), neuronal and glial activation followed by depression of neuronal firing, associated with commensurate changes in blood flow

Question 7

What is the cause of pain associated with migraines?

Answer 7

activation of the trigeminal system, which results in the release of vasoactive neuropeptides, particularly calcitonin gene-related peptide (GCRP)

Question 8

What drugs can be used to treat mild-moderate migraines?

Answer 8

-NSAIDs (naproxen) or acetaminophen
-caffeine
-metoclopramide

Question 9

What is the reasoning for using caffeine for migraines?

Answer 9

cerebral vasoconstriction beneficial but commonly used as adjuvant with other antimigraine drugs because it can potentiate analgesic effects

Question 10

What is the reasoning of using metoclopramide for migraines?

Answer 10

antagonist @ D2 in CNS and periphery= anti-emetic and enhances gastric emptying (typically used as adjuvant)

Question 11

What drugs can be used for acute treatment for severe migraines?

Answer 11

• triptans
  -ergots
  -lasmiditan
  -CGRP receptor blocker

Question 12

What are the contraindications of triptans?

Answer 12

-coronary artery disease (may cause coronary artery vasoconstriction)
-MAOIs (monoamine oxidase inhibitors) and SSRIs use due to risk of serotonin syndrome

Question 13

What are the symptoms of serotonin syndrome?

Answer 13

-agitation, hallucinations, coma
-autonomic instability, tachycardia, labile blood pressure, hyperthermia
-nausea and vomiting, diarrhea
-muscle hyperreflexia, incoordination

Question 14

What is the MOA of lasmiditan?

Answer 14

selective agonist at 5HT 1F

Question 15

What is the indication of lasmiditan?

Answer 15

acute treatment of migraine with or without aura in adults

Question 16

What are the adverse effects of lasmiditan?

Answer 16

dizziness, fatigue, paresthesia (skin tingling, itching, burning), and sedation are most common, may cause serotonin syndrome, driving impairment or euphoria/hallucinations (rare)

Question 17

What drugs are ergots?

Answer 17

ergotamine, dihydroergotamine (DHE)

Question 18

What is the MOA of ergots?

Answer 18

cerebral vasoconstrictor, nonselective 5HT agonist

Question 19

What are the side effects of ergots?

Answer 19

nausea, vomiting, dizziness, cramps, vertigo, and less commonly prolonged vasospasm causing angina, gangrene, DEPENDENCE MAY OCCUR

Question 20

What are the contraindication of ergots?

Answer 20

pregnancy, sepsis, and vascular disease

Question 21

What are the drug interactions of ergots?

Answer 21

triptans, beta blockers, nicotine

Question 22

What drugs are CGRP receptor antagonists?

Answer 22

ubrogepant, rimegepant, atogepant

Question 23

What CGRP antagonist can be used preventively?

Answer 23

atogepant

Question 24

What drugs are monoclonal antibodies that bind to CGRP?

Answer 24

-erenumab
-galcanezumab
-fremanezumab
-eptinezumab

Question 25

What drugs are used as prophylactic agents for migraines?

Answer 25

primary= beta blockers, anticonvulsants or other agents, such as=antidepressants, botox, monoclonal antibodies against CGRP, atogepant (CGRP antagonist)