Module 5 unit C Flashcards
Ergot alkaloids
Dihydroergotamine
Ergotamine
MOA of ergotamine
Alters transmission at serotonergic, dopaminergic & a-adrenergic junctions. Vasconstrictor
Ergot alkaloid indications
dihydroergotamine, ergotamine
Acute treatment of migraines
Triptan
Sumatriptan (Imitrex)
Indications of Triptans
Acute abortive treatment of migraines
MOA of triptans
Selective activation of 5HT receptors-suppresses the release of CGRP
BBW for Ergot alkaloids
Potent inhibitors of CYP34A. Risk of vasospasm.
Are ergot alkaloids okay for pregnancy?
No - contraindicated
Abortive migraine treatments
Triptans Ergot alkaloids Ditan Oral CGRP receptor antagonist (Ubrelvy) Analgesics (opioids, NSAIDs, APAP)
Ergot alkaloids contraindications
pregnancy (can cause contractions & abortion)
Do not use with triptans
Do not use in renal or liver impairment, CAD, PVD, and uncontrolled HTN
Oral CGRP receptor antagonist (acute treatment for HDA)
Ditan (Reyvow)
MOA of Ditan (Reyvow)
Activates 5HT1F receptor agonist - inhibits the release of neuropeptides, neurotransmitters, and inhibits the pain pathway.
Ditan safety
Schedule V controlled substance, CNS depression
preventive (prophylactic) treatment for migraine headaches
Beta Blockers TCAs AEDs (Depakote) Botox CGRP monoclonal antibodies
Treatment for migraine headaches given by injection monthly
CGRP monoclonal antibodies
Erenumab (Aimovig)
MOA of Botox
Prevents release of acetylcholine at neuromuscular junctions
MOA of Depakote
May augment inhibitory effects of GABA
Safety with Depakote
Contraindicated in pregnancy
BBW with Depakote
Potentially fatal pancreatitis and hepatitis Neural tube defects in developing fetus.
Used for acute gout attacks
NSAIDs, Interleukin-1 inhibitors, glucocorticoids, colchicine
used for prevention of gout
colchicine
urate-lowering therapy
xanthine oxidase inhibitors (allopurinol), uricosuric agent (probenecid),
recombinant uric acid oxidase (pegloticase)
Three FDA approved drugs for fibromyalgia
Milnacipran
Duloxetine
pregabalin
SNRIs for fibromyalgia
Milnacipran (Savella)
Duloxetine (cymbalta)
MOA for duloxetine and milnacipran
Boost serotonin and norepinephrine
Anticonvulsants for fibromyalgia
pregabalin (Lyrica) - grade A
Gabapentin - Grade B
Can cause rhabdomyolysis, especially if the patient is on a statin
colchicine
Helps degrade tophi in gout
Inhibits enzyme required for uric acid formation (xanthine)
allopurinol
Lowers plasma urate levels by increasing iexcretion of uric acid
probenecid
risk of renal stones
probenecid
Warning for pegloticase
Do not give to patients with G6PD deficiency - can cause hemolysis and methemoglobinemia
problem with muscle relaxants
Cause CNS sedation
Increase risk of falls and injury
