PHARM - headache Flashcards
trigeminal nerves release what substances antidromically, related to cortical spreading depression?
- CGRP
- substance P
- neurokinin A
non-specific acute NSAID treatment options for migraine
- aspirin
- acetominophen
- caffeine
- naproxen
- ibuprofen
risk of opioids in migraine treatment
- addiction/rebound
- patient now refractory to other treatment because glutamate is left in the synapse
where do ergots come from?
- claviceps purpurea - rye fungus
ergots caution
- pregnancy
- CAD
ergots and triptan mechanism
- activate receptors broadly
- inhibit neurogenic inflammation (agonists at 5-HT1B “blood vessels” and G-HT1D “nerve terminals”)
triptans caution
- CAD
- stroke
triptan pharm
Sumatriptan 2 2.5 15%
Zolmitriptan 3 2.5 40%
Naratriptan 6 3-4 70%
Rizatriptan 2 1-1.5 40%
Eletriptan 4-5 2.8 50%
Frovatriptan 25 3 30%
Almotriptan 3.5 1.5? 70%
triptans safe with MAOIs
naratriptan
almotriptan
eletriptan
frovatriptan
FANE
what triptan’s levels are raised by propranolol?
rizatriptan
what triptans could present a problem in liver failure?
eletriptan
zolmitriptan
EZ
good and bad times for b-blockers in prevention of migraine
good - MVP, HTN, anxiety, tremor
bad - depression, reynaud’s, fibromyalgia, asthma
which antidepressant has the best data for migraine prevention? when is it best used?
amitriptyline
- sleep disturbance, neck pain
treatment of cluster headache
- lithium
- sumatriptan
- oxygen
- lidocaine or zolmitriptan intranasaly
- DHE IV
best preventer of cluster headaches
verapamil
methysergide
