ZJ HA therapeutics Flashcards
migraine abortive therapy should not be used more than __ days per month
10
every triptan has a short duration of action except for which two?
frovatriptan and naratriptan
every triptan has an average onset around 30 minutes except for which two?
frovatriptan and naratriptan
what is the time of onset for naratriptan?
1-3 hours
what is the time of onset for frovatriptan?
2-3 hours
eletriptan is metabolized by which enzyme?
3A4
why should SSRIs, SNRIs, and MAOIs be used with caution with triptans?
potential risk of serotonin syndrome
are triptans contraindicated with pregnancy?
yes
what diseases are triptans contraindicated with?
coronary artery disease, uncontrolled hypertension, and peripheral vascular disease
what are the three antiemetics?
what drug class are they?
why can they be used for migraines?
chlorpromazine
prochlorperazine
metoclopramide
dopamine antagonists
they have analgesic properties
antiemetics for migraines are only given parentally, however, they have an increased risk of?
EPS
what drug is co-prescribed with antiemetics to reduce risk of dystonia?
diphenhydramine
what are 2 adverse reactions from chlorpromazine and prochloperazine?
postural hypotension and QT prolongation
what’s the key difference between triptans and ergot alkaloids?
ergot have more systemic vasoconstriction
which of the ergot alkaloids is mainly used over the other?
dihydroergotamine
what is the preferred administration route for dihydroergotamine?
either IV or IM
**ergots have same contraindications as triptans
.
ergot alkaloids should always be used in combination with?
antiemetics
what role do corticosteroids have for treating HAs?
used either in combination for severe attacks or to decrease rates of HA recurrence
corticosteroid use for HAs are only administered via what route?
parentally
when is it okay to use opioids/barbiturates to treat HAs? If used, therapy should be limited to how many days?
last resort if other therapies have failed. use should be limited to 5 days
what drug class is lasmiditan?
5HT1F receptor agonist
T/F lasmiditan, like triptans and ergot alkaloids, can not be used in patients with CV disease
False, it is safe
what are common SEs of lasmiditan?
dizziness and somnolence (drowsiness)
what drug class are gepants?
CGRP antagonist
when/how are gepants given?
orally for migraines in patients with either insufficient response or contraindication to treatment with triptans
what are the names of the two gepant drugs?
ubrogepant
rimegepant
what drug classes are used as preventive therapy for migraines?
beta blockers and calcium channel blockers
antidepressants
antiepileptics
CGRP antagonists
what beta blocker/ calcium channel blocker is commonly used for preventing migraines?
metoprolol or propranolol, verapamil
what class of antidepressants is most commonly used to prevent migraines?
SNRIs
which antiepileptics are used to prevent migraines?
valproic acid and topiramate
which CGRP antagonists are used to prevent migraines? (Every Friend Gives Ritz)
erenumab, fremanezumab, galcanezumab, and rimegepant
T/F opioids and barbiturates should not be used for acute or preventative treatment of migraines
true
adverse effects of metoprolol/propranolol?
avoid in patients with?
ED, raynauds
asthma, diabetes, and depression
adverse effects of verapamil?
constipation
adverse effects of topiramate?
weight loss, paresthesia, cognitive impairment
adverse effects of valproic acid?
weight gain, thrombocytopenia, alopecia
2 adverse effects of CGRP antagonists?
angioedemia and anaphylaxis
what is botulinum toxin (botox) effective/ineffective for?
effective for chronic migraine prevention, ineffective for episodic migraine prevention
how do we treat cluster HAs?
oxygen plus pharmacological treatment
what is first-line therapy for cluster HAs?
serotonin agonists
what are the 2 treatments for cluster HAs administered intranasally?
triptans and lidocaine
what are the two meds used for long term preventative treatment of cluster HAs?
verapamil or lithium
