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NBB Test 1 > Pharmcology of Migraine Headache > Flashcards

Pharmcology of Migraine Headache Flashcards

1
Q

Effective medications for the management of many acute migraine attacks

A

Simple Analgesics and NSAIDs

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2
Q

An option when migraine-associated nausea and vomiting are severe

A

Suppository preparations of simple analgesics and NSAIDs

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3
Q

Analgesics that have demonstrated the most consistent evidence of efficacy include

A

Acetominophen and acetominophen/aspirin/caffeine (excedrin migraine)

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4
Q

NSAIDS that have demonstrated the most consistent evidence of efficacy include

A

Aspirin, Ibuprofen, Naproxen, and Diclofenac

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5
Q

Appear to prevent neurogenically-mediated inflammation in the trigeminovascular system by inhibiting cyclooxygenase (COX)-mediated prostaglandin synthesis

A

Analgesics and NSAIDs

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6
Q

Should be avoided or used cautiously in patients with previous ulcer disease, renal disease, or hypersensitivity to aspirin

A

Analgesics and NSAIDs

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7
Q

Migraine-specific medications, and their introduction represented a major advance in migraine pharmacotherapy

A

Seratonin receptor agonists (triptans)

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8
Q

They are appropriate first-line therapy for patients with mild-to-severe migraine, and are used for rescue therapy when non-specific medications (e.g., analgesics and NSAIDS) are ineffective

A

Triptans

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9
Q

The different triptans differ primarily with regard to pharmacokinetics and pharmacodynamics. Slower onset of action and reduced efficacy are seen with

A

Frovatriptan and Naratriptan

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10
Q

That said, frovatriptan and naratriptan also have the longest half-lives and therefore less

A

Headache recurrence

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11
Q

Selective agonists at serotonin 5-HT1B and 5-HT1D receptors

A

Triptans

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12
Q

Relief of migraine is the result of three key actions:

1) Normalization of dilated intracranial arteries through enhanced vasoconstriction.
2) Inhibition of vasoactive peptide release from perivascular trigeminal neurons.
3) Inhibition of transmission through second-order neurons ascending to the thalamus

A

Triptans

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13
Q

What are some of the mild adverse effects of Triptans?

A

Paresthesias, dizziness, fatigue, and flushing

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14
Q

Up to 25% of patients receiving triptans report tightness, pressure, heaviness, or pain in the

A

Chest, neck, or throat

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15
Q

The triptans are partial agonists at 5-HT coronary artery receptors, and are therefore contraindicated in patients with a history of

A

Ischemic heart disease, uncontrolled hypertension, and cerebrovascular disease

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16
Q

The triptans should not be given to patients receiving

A

SSRIs or SNRIs

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17
Q

Can be considered for the treatment of moderate-to severe migraine attacks

-Their use, however, is limited by issues of efficacy and side effects

A

Ergotamine tartrate and dihydroergotamine

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18
Q

Ergotamine is available in oral, sublingual, and rectal preparations, with dihydroergotamine being available for

A

Intranasal and parenteral administration

19
Q

Non-selective agonists at serotonin 5-HT1 receptors.

-Cause constriction of intracranial blood vessels and inhibit the development of neurogenic inflammation in the trigeminovascular system

A

Ergot Alkaloids and Derivatives (Ergotamine tartrate and dihydroergotamine)

20
Q

Central inhibition of the trigeminovascular pathway has also been reported with

A

Ergot Alkaloids and Derivatives (Ergotamine tartrate and dihydroergotamine)

21
Q

Among the most common adverse effects to Ergotamine tartrate and dihydroergotamine

A

Nausea and vomiting

22
Q

Contraindicated in patients with renal or hepatic failure; coronary, cerebral, or peripheral vascular disease; uncontrolled hypertension, and sepsis

A

Ergotamine tartrate and dihydroergotamine

23
Q

Ergotamine tartrate and dihydroergotamine are also contraindicated in women who are

A

Pregnant or nursing

24
Q

Among the most widely used drugs for migraine prophylaxis

A

B-Adrenergic antagonists (B-blockers)

25
Q

B-Blockers with established efficacy in migraine prophylaxis include:

A

Metoprolol, Propanolol, and Timolol

26
Q

Although not first-line treatment for hypertension or anxiety, may be useful along with other therapy in patients with comorbid hypertension or angina

A

B-blockers

27
Q

Adverse effects can include drowsiness, fatigue, sleep disturbances, vivid dreams, memory disturbance, depression, impotence, bradycardia, and hypotension

A

B-blockers

28
Q

B-blockers should be used with caution in patients with

A

CHF or peripheral vascular disease

29
Q

Antidepressants with established efficacy in migraine prophylaxis include the:

  1. ) Tricyclic Antidepressant
  2. ) SNRI
A
  1. ) Amitriptyline

2. ) Venlafaxine

30
Q

May be particularly useful in patients with comorbid depression or insomnia

A

Antidepressants

31
Q

Thought to be related to downregulation of central 5-HT2 receptors, increased levels of synaptic norepinephrine, and enhanced endogenous opioid receptor actions

A

Antidepressants

32
Q

Anticholinergic side effects are common with

-Limit the use of this agent in patients with benign prostatic hyperplasia and glaucoma

A

Amitriptyline

33
Q

Most common adverse effects with venlafaxine are

A

Nausea, vomitting, and drowsiness

34
Q

Have emerged as important therapeutic options for migraine prophylaxis, with valproate (Depakene®), divalproex (Depakote®), and topiramate (Topamax®) having established efficacy

A

Anticonvulsants

35
Q

May be particularly useful in patients with comorbid seizure disorder or bipolar illness

A

Anticonvulsants

36
Q

The most extensively studied medication for migraine prophylaxis

A

Topiramate (anticonvulsant)

37
Q

The benefits of topiramate are observed as early as two weeks after initiation of therapy, with significant reductions in migraine frequency within the

A

Month

38
Q

Thought to function via enhancement of GABA mediated inhibition, modulation of glutamate, and inhibition of Na+ and Ca2+ channel activity

A

Anticonvulsants

39
Q

Nausea and vomiting are the most common side effects of

-These effects are self-limited and are less common with titration of doses

A

Valproate and Divalproate

40
Q

The most serious side effect of valproate therapy is

A

Hepatotoxicity

41
Q

Contraindicated in pregnant women (potential for teratogenicity) and patients with a history of pancreatitis or chronic liver disease

A

Valproate

42
Q

Paresthesia is the most common adverse effect of

A

Topiramate

43
Q

Should be used with caution or avoided in patients with a history of kidney stones or cognitive impairment

A

Topiramate

44
Q

Useful for the prevention of migraine headaches that occur in a predictable pattern, such as menstrual migraine

A

NSAIDs and triptans

NBB Test 1 (20 decks)

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