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Pharmacology

Migraine Qs

QuestionAnswer
1. What drugs relieve mild migraines? Ibuprofen (advil, motrin,) aspirin
2. What drugs relieve moderate migraines? Combination of caffeine, acetaminophen and aspirin (Exceddrin, Migraine)
3. What is the mechanisms of action of Triptans? Selective serotonin agonists
4. What is DOC for severe migraine attacks? Triptans
5. What was the first drug specifically developed to treat migraines? Sumatriptan
6. What is serotonin? 5-hydrotryptamine
7. What receptors do Triptans bind to? 5 HT1B, 5HT1D receptors
8. How do Triptans function? When tripatans bind to receptors Intra-cranial blood vessels lead to vasoconstriction and intracranial nerve terminals inhibit vasoactive/nociceptive neuropeptide release.
9. What symptoms of migraines are relieved by Triptans? Pain, nausea, sensitivity to light and sound.
10. Are Triptans considered safe and well tolerated? Yes
11. What are the ADR’s of Triptans? Flushing, Diapohresis, Nausea (not as pronounced as ergotamine), Dizziness, Paresthesis, Muscle weakness, HTN episodes, Coronary vasospasm angina, MI, arrhythmia, stroke
12. What is a property of serotonin receptor antagonists like odasterone? Antiemetics
13. What are the contraindications of Triptans? Coronoary, cerebrovascular or peripheral vascular disease, uncontrolled HTN, within 14days of MAOA inhibitor use
14. Why is Triptan contraindicated when pt is using MAOA? Because MAOA is responsible for the metabolism of Triptan
15. What type of Triptan is safe for a lactating mother? Subcutaneous sumatripran.
16. Is breasfeeding safe after taking subcutaneous sumatripran? Discard milk during the 4hrs after injection.
17. What single tablet combination therapy relieves migraine? Sumatriptan and Naproxen sodium relieved migraine Sx more effectively than did either individual medication
18. What is the cheaper, older migraine medication before Triptans? Ergot alkaloids, also less effective than Triptans
19. What type of agonist is Ergot alkaloids? Partial 5HT agonist
20. What pathway does Ergot alkaloids function? Vaso-constrict intracranial and extracerebral blood vessels through the 5HT1B receptor suppressing meningeal nociception pathways
21. What derivative of Ergotamine has less ADR but more effective? Dihydroergotamine
22. What is Ergonavine’s and Methylergonovine’s association with pregnancy? They cause marked uterine smooth muscle contraction which is contraindicated in pregnancy. However in postpartum these Rx stop hemorrhage.
23. What is intracoronary ergonovine used to test? To classify pts of Prinzmetal’s angina
24. What is a migraine prophylactic Ergotamine? Methysergide 5HT2 antagonist
25. What are the Rx of the class Ergotamine? Dihydroergotamine, Ergonovine, Methylergonavine, Methysergide, Bromocriptine, LSD
26. What Rx act as antagonists/agonists for Migraine Tx? Ergotamines are 5HT2 antagonists vs. Triptans are 5HT1B and 5HT1D agonists
27. What are the ADR of Ergotamine? N/V due to 5HT activation, coronary artery vasospasm, paresthesia, myalgia, uterine smooth muscle contraction
28. What are the contraindications of Ergotamines? Pregnancy, uncontrolled HTN, Vascular Dz
29. Are Triptans and DHE widely used Rx with excellent safety profiles? Yes
30. What intermediate acting barbiturate is combined to Tx migraines? Sedative butalbital with aspirin or acetaminophen are sometimes used
31. What are the combination Rx with Butalbital? Caffeine or codeine, aspirin or acetaminophen
32. Why are butalbital not used frequently? Given high risk of rebound HA and withdrawals Sx
33. What Rx are used when pts can’t take ergotamine or triptans? Opiates
34. Why are Opiates not DOC? Habit forming and used as last resort
35. What anti nauseating Rx are frequently prescribed? Metoclopramide or prochlorperazine.
36. What are the anti nauseating Rx for migraine Tx? Domperidone, Metoclopramide(reglan), Promethazine(phenegren), Chlorpromazine
37. When are preventive medications taken? Daily or only when predictable trigger such as menstruation is approaching
38. Is migraine prophylaxis Tx benign? No
39. What is the role of β blockers in migraine prophylaxis? It has established efficacy and safety in migraine prophylaxis, specially preferred if HTN or anxiety co-exist.
40. What do you Tx a HTN pt who has migraine? β blockers
41. How do β blockers help migraines? Reduce the frequency and severity of migraines and is among the first line Tx
42. What types of cardiovascular Rx prevent migraines? β blockers (propranolol), Ca++ channel blockers (verapamil), anti HTN Rx (lisinopril & candesartan)
43. What is the MOA of propranolol? Vasoconstriction, Anxiolytic, decreased sympathetic activity
44. What type of anti depressant is most effective in preventing all types of headaches, including migraines? TCA (amitriptyline, nortriptyline, protriptyline) are among first line agents
45. Are newer anti depressants effective in migraine prevention? No, not as effective
46. What anti seizure agent for epilepsy and bipolar dz is used to prevent migraine? Divalproex sodium, topiramate
47. What anti seizure agent is considered the 2nd line Tx for Migraines? Gabapentin
48. What are the ADR of anti seizure Rx that are used for migraines? N/V/D, cramps, hair loss, dizziness
49. What migraine Rx is used for children as preventive measure? Cyprohepatadine
50. What are some properties of Cyprohepatadine? 5HT2 receptor antagonist, antihistaminergic, and blocks Ca++
Created by: sap_213
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