Migranes Flashcards
1
Q
Two types of Migraines
A
- Common WITHOUT aura
- Classic WITH aura
2
Q
What is aura due to?
A
Reduced blood flow of the posterior part of the brain
3
Q
What is the pain in migraines due to?
A
Extra and intracranial arterial dilation and release of neuroactive molecules such as substance P
4
Q
What are the two phases of a migraine?
A
1 - Vasoconstriction
2 - Vasodilation and pulsaiton
5
Q
5HT Agonists (4)
A
- Sumatriptan
- All other triptans
- Ergotamine
- Dihydroergotamine
6
Q
Sumatriptan MOA (3)
A
- 5HT1D agonist on small peripheral nerves
- Probably suppresses release of sensory neuropeptides
- Vasoconstriction not as strong as with ergotamine
7
Q
Sumatriptan Admin and t 1/2
A
- PO or SC
- 2hrs (if HA recurs within 24-48 hrs, 2nd dose req)
8
Q
Sumatriptan SE (5)
A
- Coronary artery vasospasm, rare cardiac arrhythmias, angina, transient myocardial ischemia, MI, cardiac arrest
- Cerebral vasospasm resulting in intracranial bleeding, subarachnoid hemorrhage, stroke, seizures
- Peripheral vascular ischemia and bowel ischemia
- Abd pain, bloody diarrhea, cramp
- Dizziness, lightheadedness, weakness, myalgia, muscle cramps
9
Q
Sumatriptan CI
A
- Breast feeding
- Pregnancy
- Cardiac dz, CAD
- Cerebrovasc dz
- DM
- HTN
- IV admin
- PVD
- Renal impairment
- Seizures
- Tobacco smoking
10
Q
Ergotamine MOA (3)
A
- Acts on 5HT receptors
- Less specific than Sumatriptan
- Caffeine increases absorption and potentiates effects
11
Q
Ergotamine Admin
A
- Oral
- SL
- Rectal
- Nasal
12
Q
Ergotamine SE (2)
A
Due to vasoconstriction
- Acute: D/N/V, cardio tox (like sumatriptan)
- Chronic: ergotism - vasoconstrition + CNS
13
Q
Dihydroergotamine MOA
A
- 5HT agonist
14
Q
Dihydroergotamine Admin
A
- IV
15
Q
Dihydroergotamine SE (1)
A
- Nausea
