Module 3 anti-migraine Flashcards
Migraine patho
cerebral vasodilation with activation of pain fibers
triptans MOA
5HT 1B/1D agonists in vasculature
- > potent vasoconstriction of intracranial blood vessels
- inhibit vasoactive peptides
- interruption of pain signal transmission
triptans drugs
sumatriptan rizatriptan almotrptan frovatriptan eletripatn zolmitriptan naratriptan
Triptan with slowest onset
naratriptan
triptan with lowest recurrence
naratriptan
triptan with fastest onset
riztriptan
triptans administration
PO orally disintegrating tablets SubQ nasal suppository
triptans use
migraines
- acute attack
triptans contra
ischemic heart disease HTN ischemic stroke pregnancy MAOI: metabolized by MAO SSRI, SNRI: risk of serotonin syndrome eletriptan: CYP3A4
Ergot drugs
ergotamine
dihydroergotamine (DHE45)
ergot MOA
5ht 1B/!D agonist
ergot use
migraines >48hr
- not used often d/t AE
ergotamine AE
worsening N/V
dose assoc. vascular occlusion
rebound HA
DHE45 AE
fewer
- use with antiemetic
ergotamine contra
CAD PVD HTN hepatic disease renal disease
DHE45 CI
HTn
ischemic heart disease
MAOI use
elderly
ergotamine administration
poor bioavailability PO/rectal
DHE45 administration
IV
IM
SubQ
nasal
other 1st line meds for migraines
NSAIDS
ASA
APAP
combo products
other agents for monotherapy or adjunct therapy for migraines
antiemetics
benzodiazapines
opiods
barbiturates
meds for prevention of migraines
beta blockers Calcium channel blockers tricyclic antidepressants anticonvulsants ergot derivatives
