DCPA Migraine Pharm

Description:	DCPA Migraine Pharm
Category:	Clinical Skills
Created by:	Amanda Leigh Brooks on 2009-09-19

Question	Answer
HA pathology	Vasoconstriction then massive Vasodilation
Migraine age	Begins between 10-30 y.o. (After this = something else)
Migraine FH	50%
Migraine S&S	(+/-)Aura (anorexia, visual field changes, sensitiivty (sound, light, smell), N/V, worse with physical exertion, unilateral or generalized throbbing pain.
Red flags of HA	Syncope, Mental change, vision loss, recent trauma, stiff neck, fever, thunder-horrific pain
HA triggers	Caffeine, period, red wine, cheese, processed meats, hypoglycemia, change in sleep patterns, decrease in exercise, smoking & strong odors
Limit caffeine intake	Less than 240mg/day or 2 cups
Acute Migraine Tx	Analgesics, Ergot derivatives, Triptans, Antiemetic drugs, Opiods & Barbituates
Chronic Migraine Tx	Beta blockers, Calcium channel blockers, anticonvulsants, Herbs
Analgesics SE	Rebound HA: 3 doses in 1 week
Midrin	Sympathomimetic (vasoconstriction) + sedative + analgesic
Midrin - type of HA	Tension & migraine
Midrin CI	CAD, MI, HTN, GI bleed, liver or renal dz.
Midrin SE	Sedation or dizziness
Ergot Derivatives Brands	Cafatine, Cafergot, Ercaf
Ergot Derivatives "level of use"	NOT 1st line - have good malpractice insurance
Ergot Derivatives Form	oral or suppository
Ergot Derivatives MOA	Suppresses neurogenic inflammation (vasoconstriction)
Ergot Derivatives CI	Sensitivity to ergotamine & caffeine, peripheral vascular dz., renal/liver dz., MI/CAD, Pregnancy
Ergot Derivatives Pregnancy Category	X
Ergot Derivatives SE	Tachycardia, arterial spasm, claudification, numbness in fingers/toes, drowsiness, dizziness, N/V, diarrhea
Ergotism - Over dose	Sever vomitting/cramps. Numbness. Twitching-seizures. Renal failure (no urine).
Ergot Derivatives DI	Nicotine, caffeine & grape fruit
Ergot Derivatives Increases toxicity of...	Propanolol, Erythromycin, Macrolide Ab.
Triptans	Specific Serotonin 5-HT1 agonist
Triptan Drugs	Sumatriptan (Imitrex), Zolmitriptan (Zomig), Naratriptan (Amerge), Rizatriptan (Maxalt), Almotriptan (Axert), Electriptan (Relpax), Frovatriptan (Frova)
Sumatriptan	Imitrex
Zolmitriptan	Zomig
Naratriptan	Amerge
Rizatriptan	Maxalt
Almotriptan	Axert
Eletriptan	Relpax
Triptans MOA	5HT1-Vasoconstriction. Affects trigeminal nerve.
Sumatriptan (Imitrex) Use	Stops migrain pain, allodynia, & improves migrain-induce cognitive impairment.
Triptans SE	Rebound HA (2 doses/week), dizziness, Hot flashes, Parestesias, diaphoresis, throat/chest tightness
Triptans CI	Ischemic Dz, HTN, Pregnancy
Triptans Pregnancy Category	C
Triptans DI	MAOIs, ergotamines, SSRIs
Sumatriptan (Imitrex) forms	Oral, Melt, Injection (best with N/V)
Rizatriptan (Maxalt) Forms	Orals or melts
Rizatriptan (Maxalt) DI	Propanolol (Doubles level of Maxalt)
Rizatriptan (Maxalt) Effectiveness	Very effective with Nausea
Naratriptan (Amerge) Duration	Longer duration - 6 hours
Naratriptan (Amerge) Recurrence Rate	Low
Naratriptan (Amerge) Onset	Slower - better for patients with long lasting HA
Naratriptan (Amerge) Effectiveness	Best with migrains associated with PMS
Frovatriptan	Frova
Frovatriptan (Frova) Half Life	26-30 hours
Eletriptan (Relpax) SE	Low SE profile
Treximet	Combination of Sumatriptan (Imtrex) & Naproxen Sodium (Aleve)
Antiemetic Drugs	Metoclopramide (Reglan)
Metoclopramide	Reglan
Metoclopramie (Reglan) other uses	GERD
Metoclopramie (Reglan) MOA	Blocks dopamine receptors
Metoclopramie (Reglan) Forms	Injectiong, tablet, syrup, solution
Metoclopramie (Reglan) CI	GI obstruction, perforation, hemorrhage
Metoclopramie (Reglan) SE	Restlessness, drowsiness, diarrhea, weakness, dystonic reactions (muscle spasms/rigidity), agitation
Metoclopramie (Reglan) Increases toxicity of...	Opioids
Metoclopramie (Reglan) Decreased effectiness by...	Anticholinergic drugs
Opiod Drugs	Narcotic - Demerol (brief duration - 4 hours)
Barbituates	Butabital
Barbituates (Butabital) drugs	Esgic, Fiorcet, Fiorinal, Phrenalin
Barbituates (Butabital) MOA	Depresses CNS
Barbituates (Butabital) Form	Tablets & Capsules
Barbituates (Butabital) CI	Porphyria (HBG metabolism - light sensitivity, etc.)
Barbituates (Butabital) SE	Dizziness, Drowsiness, Nausea, Heartburn, Confusion, Mental Depression, Insomnia, Nightmares
Barbituates (Butabital) Pregnancy Category	C
Barbituates (Butabital) Increased toxicity with...	Benzodiazepines (Zantax), Valproic acid & CNS depressants
Barbituates (Butabital) decreases the effect of...	Warfarin, OCPs, TCAs, Doxycycline, Beta blockers
Migraine Prophylaxis	Adults: 1HA/Wk. Kids: 2HA/Month
Prophylatic Agents	Beta blockers, Calcium channel blockers, antidepressants, anticonvulsants
High Efficacy First line - Prophylatic Agents	Beta Blockers, Divalproex, Topiramte (Topamax), TCAs (not FDA approved)
Low Efficacy First line - Prophylatic Agents	Verapamil (Calcium Channel Blocker, NSAIDs, SSRIs
Beta Blockers MOA	Act on 5HT2 receptors
Beta Blockers Use	Coexisisting Hypotension, Tremor or Palpitations
Beta Blockers SE	Hypotension, worsen asthma & CHF & Depression
Beta Blockers Drugs	Propanolol & Atenolol
Antidepressants drugs	Amitriptyline or Nortriptyline
Antidepressants drugs MOA	Increases serotonin
Antidepressants drugs Use	Coexisting depression
Antidepressants drugs SE	Worsens Palpitations, Sedative, weight gain
Calcium Channel Blockers MOA	Vasodilation
Calcium Channel Blockers Use	Co-existing HTN, Raynauds & esophogeal spasm
Anticonvulsants Drugs	Topamax (Topiramate) & Valproic Acid
Topamax	Topiramate
Topamax (Topiramate) SE	Paresthesias & Weight Loss
Valproic Acid SE	Nausea, Fatigue, Tremor, Hair loss, weight gain, PCO, lipid changes
Herbs	Feverfew, Magnesium, Riboflavin, Botulinum Toxicity