[PHARMA] ANTIMIGRAINE DRUGS Flashcards
(26 cards)
progression of a migraine attack
prodorma–>aura—>headache unilateraly with nausea+vomiting+photophobia
prodorma
irritability
fatigue
muscle aches
aura
visual disturbances
scotoma
migraines are triggered by
stress
hormonal changes
weather changes
disturbed sleep
alcohol
pathophysiology of migraines
release of CGRP from trigeminal nerve endings into perivascular space—>VD of dural BV–>stretch of pain endings
CGRP
proinflammatory VD neuropeptide
mild analgesics used in acute migraine attack
NSAIDs, acetaminophen
specific antimigraine therapy of acute migraine attack
Triptans
mechanism of action
activate 5HT1B/1D on presynaptic trigeminal endings to inhibit release of VD neuropeptides–>VC of dural BV—>prevent stretch of nerve endings
sumatriptan ROI
oral
SC
nasal spray
adverse effects of sumatriptan
injection site reaction
unpleasant taste
chest pressure
paresthesia, warmth, weakness, drowsiness, malaise
CI of sumatriptan
uncontrolled HTN
ischemic stroke
IHD
pregnancy
w/ SSRIs or after 24h of ergots
1st dose of sumatriptan should be cautiously given in case of
diabetics
hypertensives
men over 40yo
postmenopausals
ergotamine tartrate ROI
sublingual
oral
rectal
DOC in prolonged or frequent headaches
ergotamine tartrate
dihydroergotamine ROI
IV
IM
SC
intranasal
adverse effects of ergots
NVD
chest pressure
vasospasms—>gangrene
CI of ergots
pregnancy
peripheral vascular disease
valvular heart disease
antiemetics
metoclopramide parenteral & oral
oral metoclopramide use
added to ergotamine to increase its absorption
parenteral metoclopramide use
monotherapy in emergency
if parenteral metoclopramide is ineffective, add
IV dihydroergotamine
resistant cases require usage of
BZDs, opioids
antimigraine therapy shouldnt exceed
10 days/month
