Pharm: Migraine Meds

Question 0

Indomethacin

Answer 0

Used for moderate migraine pain

MOA: increases pain threshold by decreasing prostaglandin synthesis

SE: ulcers, GI bleeding, rebound headaches

Question 1

Ibuprofen

Answer 1

Used for moderate migraine pain

MOA: increases pain threshold by decreasing prostaglandin synthesis

SE: ulcers, GI bleeding, rebound headaches

Question 2

Aspirin

Answer 2

Used for moderate migraine pain

MOA: increases pain threshold by decreasing prostaglandin synthesis

SE: ulcers, GI bleeding, rebound headaches

Question 3

Naproxen

Answer 3

Used for moderate migraine pain

MOA: increases pain threshold by decreasing prostaglandin synthesis

SE: ulcers, GI bleeding, rebound headaches

Question 4

Sumatriptan

Answer 4

Used for acute migraine headaches

MOA: 5HT1 agonist

• stimulate vasoconstriction of basilar artery and dura mater vessels
• block proinflammatory NTs like CGRP and substance P around the trigeminal nerve

SE: serotonin syndrome

Question 5

Zolmitriptan

Answer 5

Used for acute migraine headaches

MOA: 5HT1 agonist

• stimulate vasoconstriction of basilar artery and dura mater vessels
• block proinflammatory NTs like CGRP and substance P around the trigeminal nerve

SE: serotonin syndrome

Question 6

Naratriptan

Answer 6

Used for acute migraine headaches

MOA: 5HT1 agonist

• stimulate vasoconstriction of basilar artery and dura mater vessels
• block proinflammatory NTs like CGRP and substance P around the trigeminal nerve

SE: serotonin syndrome

Question 7

Codeine

Answer 7

Opioid
Used for mild to moderate pain
Used for migraines in patients that cannot tolerate triptans

MOA: metabolized to morphine for a weaker effect. Agonist at mu, kappa, and delta receptors

SE: addiction

Question 8

Morphine

Answer 8

Opioid
Used for severe pain or severe migraine headaches in patients that cannot tolerate triptans

MOA: agonist at mu, kappa, and delta receptors

SE: addiction

Question 9

Dexamethasone

Answer 9

Corticosteroid
Used in combination with other drugs as a pain reliever.

MOA: inhibition of phospholipase A for anti-inflammatory effects

SE: steroid toxicity

Question 10

Caffeine

Answer 10

Xanthine Alkaloid
Used for headaches, usually in combination with acetaminophen, aspirin for moderate migraine pain.

MOA: inhibits phosphodiesterase leading to increased cAMP levels

SE: insomnia, agitation, restlessness

Question 11

Acetaminophen

Answer 11

Used when aspirin is contraindicated.
Combined with isometheptene and dichloralphenazone for moderate headaches
Combined with butalbital for infrequent headaches with moderate to severe intensity (GABAmimetic)
!!!!!this and opioids are only viable option during pregnancy!!!

MOA: COX inhibitor without the anti-inflammatory effects

SE: toxic to liver in high continued doses

Question 12

Propranolol

Answer 12

Migraine Prophylaxis that inhibits sodium channels within membranes of neurons to prevent firing of pain signals

MOA: non-selective beta blocker

Question 13

Verapamil

Answer 13

Migraine Prophylaxis, relieves symptoms of aura

MOA: calcium channel blocker

Question 14

Lisinopril

Answer 14

Reduces duration and severity of migraines by keeping BP down

MOA: ACE inhibitor

Question 15

Amitriptyline

Answer 15

Migraine prophylaxis

MOA: 5HT and NE reuptake inhibitor

SE: AV bundle branch block, anorexia, blurred vision, dry mouth, constipation, sedation, weight gain, may precipitate MANIA in BIPOLAR disorders

Question 16

Nortriptyline

Answer 16

Migraine prophylaxis

MOA: 5HT and NE reuptake inhibitor

SE: AV bundle branch block, anorexia, blurred vision, dry mouth, constipation, sedation, weight gain, may precipitate MANIA in BIPOLAR disorders

Question 17

Pizotifen

Answer 17

Prophylaxis for recurrent migraines when beta-blockers are contraindicated.

MOA: 5HT2 antagonist and moderate histamine and cholinergic antagonist

SE: weight gain, drowsiness

Question 18

Topiramate

Answer 18

Anti-seizure meds and migraine prophylaxis

MOA: voltage gated sodium channel inhibitor, AMPA/kainate inhibitor, calcium channel inhibitor

SE: increased IOP, poor concentration, weight loss, induces P450 enzymes in liver

Question 19

Valproate (ionized form of valproic acid)

Answer 19

Used for seizures and migraine prophylaxis

MOA: enhances GABA transmission, inhibits sodium channels and T type calcium channels

SE: weight gain, fetal abnormality, hair loss, tremor

Question 20

Gabapentin

Answer 20

Used for partial seizures and neuroleptic pain

MOA: analog of GABA, inhibits voltage calcium channels

SE: dizziness, sedation, peripheral edema

Question 21

Botulinum Toxin

Answer 21

Used for chronic migraines in adults

MOA: inhibits SNAP-25, a snare protein required for vesicles containing neurotransmitters to bind and release contents into the synapse

SE: reversible paralysis

Question 22

Chlorpromazine

Answer 22

Used as an antiemetic, for schizophrenia, Tourette syndrome, huntington chorea, dementia

MOA: anticholinergic, anti-dopaminergic, anti adrenergic, anti histaminergic

SE: phototoxicity, blurred vision, constipation

Question 23

Prochlorperazine

Answer 23

Used as an antiemetic, for schizophrenia, Tourette syndrome, huntington chorea, dementia

MOA: anticholinergic, anti-dopaminergic, anti adrenergic, anti histaminergic

SE: blurred vision, constipation, amplifies quinidine mediated cardiotoxicity, weakly diuretic

Question 24

Metoclopramide

Answer 24

Used for migraines, gastric stasis, stimulate lactation

MOA: D2 and 5HT3 antagonist, agonist at 5HT4

SE: galactorrhea, extrapyramidal effects, tardive dyskinesia

Not to be used in patients with pheochromocytoma or Parkinson disease