Pharmacology - Migraine Flashcards
*3 classes of drugs that can be used for migraine
triptans
cgrp antagonists
dihydroergotamines
true or false
migraines are always unilateral
false - not always
differentiate between primary and secondary headaches
primary - no detectable underlying cause
secondary - there is an identifiable (usually) cause for it
what are the 2 main types of migraine
migraine with aura and without aura
migraine precipitating factors
stress, too much or too little sleep, missed meals, certain foods, alcohol, menstruation, contraceptives
which 2 classes of migraine medication should be avoided in patients who are at risk for vascular disease or thrombosis?
ergots and triptans
true or false
ergots and triptans can NOT be given together
true
does family history put you more at risk for getting migraines
yes
name 5 MEDS that can exacerbate migraine
oral contraceptives
postmenopausal hormone therapy
SSRIs
PPIs
the chronic use of ____ may increase migraine frequency and severity
analgesics
get rebound migraines
true or false
if a pt chronically takes analgesics but only once or twice a week, it is very unlikely that they will get rebound migraines
FALSE - they still can
which particular analgesics are very well known to cause rebound migraines
opioids
barbiturate-caffeine combos
***which receptors do triptans act on
5HT1B
5HT1D
**which drug is a selective agonist at 5HT1F
lasmiditan
a concern with triptans
angina and vasoconstriction
true or false
the blocking of serotonin receptors is effective in the acute treatment of migraine
FALSE - activation
**aside from its serotonin action, what are other actions of triptans
decreased cgrp and decreased substance p release
(vasoactive peptides)
true or false
triptans bind serotonin receptors nonselectively
FALSE - selectively
what is the “vascular mechanism” of triptans
painful arteries in the head are vasoconstricted
what is the trigeminovascular mechanism of triptans
inhibit nociception in the trigeminal nerve of the brainstem and upper spinal cord
some side effects of triptans and how you can remember
nausea and vomiting (ondansetron is an antiemetic and is a serotonin ANTAGONIST. serotonin mediates vomiting)
dizziness
“triptan flush” - feeling warm
sleepiness
coronary artery vasospasm! – can cause angina
triptans should not be used with, or within ____ of, an ergot derivative or another triptan
within 24 hours
true or false
triptans are teratogenic
false
true or false
triptans are relatively safe
true
***triptans should be used with EXTREME CAUTION with what class of drugs
(answer isn’t ergotamines)
MAO B INHIBITORS
risk of serotonin syndrome
true or false
during a migraine, cgrp and substance p levels are decreased
FALSE - INCREASED
what are the “pant” drugs
for migraine – cgrp RECEPTOR antagonists
what are the drugs that actually target cgrp itself (not its receptor)
the mabs
true or false
cgrp antagonists are used as prophylaxis for migraines
TRUE
not acute treatment
counseling point for cgrp receptor antagonists (the “pants”)
there may be a brief exacerbation of migraine as the med starts to work (bc receptor is very briefly activated when the drug binds)
when may a steroid be used in migraine treatment
to reduce recurrence
antiemetics are dopamine receptor agonists or antagonsits
antagonists
true or false
lasmiditan is a triptan
FALSE - not a triptan
**MOA lasmiditan
selective 5HT1F agonist
inhibiting central and peripheral pain pathways
true or false
lasmiditan does NOT cause vasoconstriction
true
some AE of lasmiditan
paresthesias (numbness and tingling)
NVD
driving impairment
CNS depression
dizziness
**true or false
dihydroergotamine binds 1 receptor subtype
FALSE - MULTIPLE RECEPTOR SUBTYPES
serotonergic, dopaminergic, alpha and beta antagonist
**as mentioned, dihydroergotamine blocks multiple receptor subtypes, which is problematic
which receptor blocking gives it its anti migraine effect
5HT1A and 5HT1B
dihydroergotamine causes a lot of _______
vasoconstriction
issue - can cause heart attack, or if pregnant and placenta vasoconstricts bb will be lost
“ergotism”
psychological dependence and chronic overdosage
AE of dihydroergotamine
dependence
gangrene of the extremities
coronary vasoconstriction
