Migrane Rx

Question 1

Triptans

Answer 1

take at start of an attack
5-HT(1b/1d) agonist
works at pre-synaptic site
prevents release of: 5-HT, NE, ACh, sP 
causes vasoconstriction 
sudden attacks take: "suma" or "riza"
>24hrs attacks take: "zoli" 
never give IV, with ergots, with MAOIs,
never take more than 2x/day

Question 2

NSAIDS

Answer 2

naproxin
ibuprofen
use for acute attacks

Question 3

celecoxib

Answer 3

cox-2 inhibitor

use for acute attacks

Question 4

prochlorperazine

Answer 4

acute attacks

Anti-Psychotics

Question 5

beta-blockers

Answer 5

prophylaxis
propranolol
timolol
prevent B-2 mediated vasodilation

Question 6

Verapamil

Answer 6

prophylaxis

CCB, cardiac type

Question 7

amitriptyline

Answer 7

prophylaxis

TCA = tricyclic antidepressant

Question 8

phenelzine

Answer 8

prophylaxis

MAOIs

Question 9

divalproex sodium

Answer 9

prophylaxis

anti-convulsants

Question 10

cyproheptadine

Answer 10

5-HT2 serotinin receptor Blocker
also anti-H1
Rx = carcinoid syndrome, urticaria, serotonin syndrome

Question 11

onabotulinumtoxina

Answer 11

botulin toxin

Question 12

buspirone

Answer 12

serotonin receptor agonist: 5-HT1a

Question 13

sumatriptan

Answer 13

serotonin receptor agonist: 5-HT1b/1d

Question 14

cyproheptadine

Answer 14

serotonin receptor antagonist: 5-HT2 blocker
carcinoid syndrome
urticavia
serotonism

Question 15

Ritanserin

Answer 15

serotonin receptor antagonist: 5-HT2 blocker

psychedelic drug abuse

Question 16

ondansetron

Answer 16

serotonin receptor blocker: 5-HT3

anti-emetic

Question 17

risperidone

Answer 17

acute attacks

Anti-Psychotics

Question 18

ziprasidone

Answer 18

acute attacks

Anti-Psychotics

Question 19

topiramate

Answer 19

prophylaxis

anti-convulsants

Question 20

telcagepant

Answer 20

CGRP (calcitonin-gene related peptide) antagonsit

telcagepant as effective as zolmitriptan with fewer side effects