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DCPA Migraine Pharm

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
Created by: 147401391
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