4 - Migraine Drugs Flashcards Preview

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Flashcards in 4 - Migraine Drugs Deck (15):
1

What are serotonin (5-HT) receptors?

Important for pain modulation - especially chronic pain

2

What modulates pain/nociception in descending pathways?

Serotonin and serotonergic neurons

3

What is known to be a cause of migraines?

5-HT dysregulation

4

How do ergot derivatives work against migraines?

  • Vasoconstricts peripheral and cranial vessels
  • Inhibits depolarization of dural blood vessel-associated nociceptors
  • Possibly blocks neurogenic inflammation
  • Taken at onset of migraine attack

5

Why is caffeine added to ergot derivatives?

Caffeine speeds gastric absorption getting medication into system more rapidly

6

What are the ergot derivative drugs?

  • ergotamine (Ergomar)
  • ergotamine and caffeine (Cafergot, Migergot)
  • dihydroergotamine (Migranal) - longer half life for chronic migraine, protracted, unresponsive migraine

7

What anti-migraine drugs cause vasoconstriction and reduces neurogenic inflammation, and also provides relief from nausea "antiemetic"?

Triptans

8

What was the first triptan?

sumatriptan

9

What are the other triptans to treat migraines?

  • sumatriptan (Imitrex)
  • zolmitriptan (Zomig)

10

What are some characteristics of isometheptene (Midrin)?

  • Contains acetaminophen and dichloralphenazone
  • Migraines and tension headaches

11

What are some characteristics of antiemetics?

  • Phenothiazine derivatives (antipsychotics)
  • May cause extrapyramidal effects

12

What are the antiemetics?

  • prochlororperazine (Compro)
  • metoclopramide (Reglan)
  • promethazine (Phenergan)

13

What are the different drugs for migraine prophylaxis?

  • Tricyclic antidepressants
  • SSRI's
  • Selective 5-HT and NE reuptake inhibitor
  • Beta Blockers 
  • Anti-seizure medications
  • Calcium channel blockers
  • NSAIDS - indomethacin (Indocin)
  • Corticosteroids 

14

What drug treats intractable migraine that has not responded to other interventions?

Corticosteroids

15

What are the mechanisms of action for corticosteroids against migraines?

  • Modulation of GABA receptors
  • Suppresses neurogenic inflammation
  • Block neurogenic extravasation mediated by release of neuropeptides like substance P
  • Block effects of high-voltage activated Ca++ currents by blocking Ca++ channels