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Pathopharmacology II > Wk 3 Migraines > Flashcards

Wk 3 Migraines Flashcards

1
Q

How long does a migraine last?

A

Between 4 and 72 hours

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2
Q

To diagnose a migraine, the patient must have TWO of these features… (4)

A

Unilateral head pain
Throbbing pain
Worsens with activity
Moderate/Severe pain

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3
Q

In addition, to diagnose a migraine, the patient must also have ONE of these symptoms… (3)

A

N/V
Photophobia
Phonophobia

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4
Q

What is photophobia?

A

Sensitivity to light

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5
Q

What is phonophobia?

A

Sensitivity to sound

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6
Q

Migraines are typically classified in three ways, which are…?

A

Migraine with aura
Migraine without aura
Chronic migraine

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7
Q

What does aura mean?

A

Visual, sensory, or motor symptoms

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8
Q

What are chronic migraines?

A

Typically occur as episodic and increase in frequency in time

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9
Q

What is the duration of chronic migraines?

A

At least 15 days a month for 3 months

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10
Q

In women, migraines occur more frequently during…

A

menstruation, before and after

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11
Q

In women, migraines decrease in frequency during…

A

pregnancy and menopause

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12
Q

How is estrogen and progesterone believed to trigger migraines in women?

A

The cyclic withdrawal of these hormones

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13
Q

What are 3 risk factors for migraines?

A

Family history
Estrogen and progesterone
Genetic and environmental factors

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14
Q

List 8 potential triggers for migraines

A 
Fatigue
Oversleeping
Missing meals
Overexertion 
Weather change
Stress
Hormonal changes 
Bright lights or strong smells
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15
Q

What is the pathophysiology of migraines?

A

There is no identifiable pathophysiology

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16
Q

What are 2 physiologic associations with migraines?

A

Brain metabolism

Blood flow

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17
Q

Describe the CNS neurotransmitter change theory of migraines

A

There is an increase in neuronal depolarization which results in hyperactivity

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18
Q

Describe the blood vessel tone theory of migraines

A

Release of excitatory neurotransmitters activates the vascular system which stimulates vasodilation

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19
Q

1/3 of migraine sufferers have __ symptoms

A

premonitory

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20
Q

What are the 4 phases of migraines?

A

Premonitory
Migraine aura
Headache phase
Recovery phase

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21
Q

What are the 5 potential symptoms of the premonitory phase?

A 
Fatigue
Irritability
Loss of concentration
Stiff neck
Food cravings
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22
Q

How long do aura symptoms last?

A

Up to 1 hour

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23
Q

How many migraine sufferers experience aura?

A

Up to 1/3

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24
Q

Aura symptoms can be… (3)

A

Visual, sensory, or motor

25
Q

Throbbing pain in the headache phase usually starts with…

A

One side of the head and then spreads to the entire head

26
Q

How long does the headache phase last?

A

4-72 hours

27
Q

What are the symptoms of the headache phase?

A 
Throbbing pain
Fatigue
Nausea
Vomiting
Dizziness
Hypersensitivity to anything touching the head
28
Q

What are the symptoms of the recovery phase?

A

Irritability
Fatigue
Depression

29
Q

How long does the recovery phase last?

A

Hours to days before it resolves

30
Q

What is the first line therapy for migraines?

A

NSAIDs
Aspirin
Acetaminophen

31
Q

What is abortive therapy?

A

Symptomatic therapy

32
Q

What is first line therapy for migraines used for?

A

Mild to moderate attacks without severe nausea and vomiting

33
Q

Why are NSAIDs, aspirin, and acetaminophen tried first?

A

They can be effective and are less expensive

34
Q

What are triptans?

A

serotonin (1b/1d) receptor agonists

35
Q

Triptans are often coupled with what type of drug?

A

NSAIDs

36
Q

If the migraine is accompanied with severe nausea and vomiting, what can be added?

A

Anti-emetic

37
Q

What is used to moderate-severe attacks without nausea and vomiting?

A

Oral migraine specific agents as our first line of treatment, sumatriptan and naproxen

38
Q

If the patient cannot tolerate triptans, what is the alternative medication?

A

Calcitonin Gene-related Peptide (CGRP) Agonists

39
Q

What drug represents the class of serotonin receptor agonists for migraines?

A

Sumatriptan

40
Q

What class of drug does sumatriptan belong to?

A

serotonin receptor agonists

41
Q

What are the 3 MOA of sumatriptan?

A
  • Constrict intracranial blood vessels
  • Suppress release of inflammatory neuropeptides
  • Block brain pathways for pain
42
Q

What 3 routes can sumatriptan be give?

A

PO
Intranasal
SQ

43
Q

Sumatriptan should be avoided in patients with what 3 conditions?

A

Heart disease
Ischemic stroke
Angina

44
Q

What are the major adverse reaction of sumatriptan? (6)

A

Injection site reaction, chest pain, flushing, weakness, headache, bad taste (nasal)

45
Q

What is the brand name of sumatriptan?

A

Imitrex

46
Q

What type of drug is rigemepant?

A

CGRP agonist

47
Q

What drug represents the drug class CGRP agonists?

A

rigemepant

48
Q

When is rigemepant used?

A

When triptans aren’t tolerated or are contraindicated

49
Q

What is the MOA of rigemepant?

A

Mediates pain transmission

50
Q

What route is rigemepant given?

A

PO

51
Q

What is the major adverse reaction of rigemepant?

A

GI upset

52
Q

What is a nursing consideration of rigemepant?

A

CYP substrate, use with caution with medications that are inhibitors/inducers of CYP system

53
Q

When is preventative therapy recommended?

A

When someone suffers more than 4 migraines per month or their migraines last longer than 12 hours, or has chronic migraines

54
Q

What are 4 classes of drugs that are used in preventative therapy for migraines?

A

Beta-blockers
Tricyclic antidepressants
Anti-epileptic drugs
Estrogens

55
Q

What beta blocker is typically used for preventative migraine therapy?

A

Propanolol

56
Q

What tricyclic antidepressants are typically used for preventative migraine therapy?

A

Amitriptyline

Venlafaxine

57
Q

What is the initial preventative therapy for migraines?

A

Propanolol and amitriptyline/venlafaxine

58
Q

What are anti-epileptic drugs that are use in preventative treatment of migraines?

A

divaloprex

topiramate

Pathopharmacology II (12 decks)

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