PODA-Migraine Flashcards
Activation of ______ receptors in cranial blood vessels causes _________.
5-HT1B; Vasoconstriction
Activation of prejunctional 5HT1D receptors on trigeminal fibers inhibits what?
CGRP release
Which serotonin receptor is located on both blood vessels and within the trigeminal ganglion, and trigeminal nucleus caudalis.
5HT1F
CGRP is a potent vasodilatory peptide, causes _________________ and modulates __________.
Inflammation and modulates pain signaling
TorF: Elevated CGRP levels are shown during migraine attacks and in pain free intervals?
True
TorF: CRGP also causes mast cell degranulation which activates nociceptors
True
What leads to photophobia in migraines?
CGRP enhancing synaptic excitability
What are the two ergot alkaloids that are used to treat migraines?
Ergotamine and dihydroergotamine
What classes of medications are used in the TREATMENT of migraines?
Ergot alkaloids, triptans, ditans, gepants
What classes of medications are used in the prophylaxis of migraines?
- Anti-CGRP monoclonal antibodies
- Onabotulinum Toxin A (Botox)
- b-adrenoceptor blockers : propranolol
- Tricyclic antidepressants: Elavil, Effexor
- Anticonvulsants: valproic acid, topiramate
- Calcium channel blockers: verapamil
TorF: Some 5HT receptors have analgesic properties?
True
Which class of medications act on serotonin receptors?
Ergot alkaloids, triptans, ditans
Ergot alkaloids act as agonists or antagonists at which receptors?
5HT1A, 5HT1D, a-, and dopamine receptors
This medication acts on 5HT1B/1D receptors on intracranial arteries to cause vasoconstriction in migraines…
Ergotamine
Ergotamine has a drug intx with what other drugs? and why?
POTENTIATED BY CPY3A4 INHIBITORS
- Macrolides(Infections)
- Fluoxetine(SSRI)
- Grapefruit juice
The triptans used for treatment of migraine headaches include:
Sumatriptan, naratriptan, rizatriptan, eletriptan, almotriptan, frovatriptan, zolmitriptan
MOA of sumatriptan:
Activation of 5HT1B/1D receptors
Sumatriptan is available in these dosage forms:
PO, SUBQ, inhalation
Drug intx w.sumatriptan:
Concomitant ergotamines, other 5HT1 agonist, MAOIs
MOA of Lasmiditan:
Activation of 5HT1F receptors in the trigeminal nucleus caudalis blocks the release of CGRP and glutamate which prevents the development of central sensitization
Activation of 5HT1F receptors in the thalamus can block the secondary central sensitization of this area associated with the progression of migraine describes which drug?
Lasmiditan
TorF: Lasmiditan can also decrease pain modulation and alleviate migraines
true
drug intx of Lasmiditan?
SSRIs, SNRIs, TCAs
Oral CGRP receptor antagonists includes:
Gepants: ubrogepant, rimegepant
