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Pharm II > Exam 4 Drugs for Migrane > Flashcards

Exam 4 Drugs for Migrane Flashcards

1
Q

what does 5-HT mean?

A

Serotonin-5-hydroxytryptamine - receptors are found pre and post synaptically for pain modulation (especially chronic pain)

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2
Q 
Serotonin effects
in platelets = \_\_\_\_\_
in CNS (periaqueductal gray) = modulates \_\_\_\_ on a spinal level, stimulation produced \_\_\_\_\_ in midbrain, and most projections from PAG are \_\_\_\_\_\_.
A

vasoconstriction
nociception
analgesia
tryptaminergic

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3
Q

4 disorders that 5-HT are associated with

A
  1. schizophrenia
  2. OCD
  3. Depression
  4. Anxiety
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4
Q

6 categories of drugs that affect 5-HT

A
  1. antidepressants
  2. hallucinogens
  3. anxiolytics
  4. antiemetics (antinausea/vomiting)
  5. antimigraine agents
  6. atypical antipsycholtics
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5
Q

Data supports that migraines are caused by chronic 5-HT ______. In people with migraines, there is an increased____ metabolite of 5-HT in urine and _____, increase or decrease of 5-HT in ____. PET scan shows increased ____ flow in highly serotonergic dorsal raphe nucleus during a migraine.

A

5-HIAA
CSF
Urine
blood

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6
Q

what are the 3 classes of migraine medication?

A
  1. ergot derivatives
  2. Triptans
  3. iosmetheptene (Midrin)
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7
Q

name 3 ergot derivatives discussed in class

A
  1. ergotamine (Ergomar)
  2. ergotamine and caffeine (Cafergot, Migergot)
  3. dihydroergotamine (Migranal)
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8
Q

7 Triptan drugs discussed in class

A
  1. sumatriptan (Imitrex, Sumavel, DosePro)
  2. naratriptan (Amerge)
  3. zolmirtiptan (Zomig)
  4. rizatriptan (Maxalt)
  5. frovatriptan (Frova)
  6. eletriptan (Relpax)
  7. almotriptan (Axert)
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9
Q

Name 6 things ergot derivatives do?

A
  1. vasoconstrictors
  2. mediate activity with trypaminergic/dopaminergic/alpha-adrenergic receptors
  3. Inhibit depolarization of noriceptors
  4. Possibly block neurogenic inflammation
  5. produce depression of central vasomotor centers
  6. highly active uterine stimulant
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10
Q

When do you take an ergot derivative?

A

At the onset of a migraine attack - “Aborts” migrane, taking with caffeine speeds gastric absorption getting medication into system more rapidly

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11
Q

2 side effects of ergotamine and caffeine

A
  1. blood vessel damage

2. gangrene

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12
Q

Which drug’s MOA = alph-adrenergic blocker that directly stimulates vascular smooth muscle to vasoconstrict peripheral and cerebral vessels

A

dihydroergotamine (Migranal) - nonselective antagontist at dopaminergic receptors and partial agonist/antagonist at 5-HT receptors

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13
Q

How is dihydroergotamine given?

A

parenterally: IV, IM, SC, nasal spray

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14
Q

Who gets dihydroergotamine?

A

people with chronic migraines or unresponsive migraines

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15
Q

Which class of drug’s MOA = selective agonist of 5-HT 1B and 5-HT 1D reveptors in cranial arteries -> causes vasoconstriction and reduces neurogenic inflammation

A

triptans - also provides relief from nausea

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16
Q

What are the 3 parts of isometheptene (Midrin)?

A
  1. isometheptene = vasconstrictor
  2. acetaminophen = analgesic
  3. dichloralphenazone = mild tranquilizing effects
17
Q

When is isometheptene (midrin) taken?

A

at onset of migraines and tension headaches

18
Q

What phenothizaine derivative (antipsychotic) is given with migraines?

A

antiemetics to control nausea and gastric irritation with migraines (D2 antagonists)

19
Q

Name 4 antiemetics

A
  1. prochlorperazine (Compro)
  2. metoclopramide (Reglan, Metozolv)
  3. promethazine (Phenergan, Phenadox, Promethegan)
  4. trimethobenzamide (Tigan)
20
Q

Name 8 classes of drugs that can be used for migraine prophylaxis

A
  1. tricyclic antidepressants
  2. SSRIs
  3. selective 5-HT and NE reuptake inhibitors (venlafazine (Effexor)
  4. Beta blockers
  5. antiseizure medications
  6. Ca channel blockers
  7. NSAIDS
  8. corticosteroids
21
Q

Name 3 beta blockers used to treat migraines

A
  1. propranolol
  2. nadolol
  3. atenolol
22
Q

Name 3 antiseizure meds used to treat migraines

A
  1. topiramate
  2. valproic acid
  3. gabapentin
23
Q

name a ca channel blocker used to treat migraines

A
  1. verapamil (Calan)
24
Q

Which category of drug that treats migraines has this MOA: Inhibits reuptake of 5-HT

A

SSRIs

25
Q

Which category of drug that treats migraines has this MOA: alters cerebral blood flow without inducing vasospasm, able to modulate cerebral blood flow

A

NSAIDS - idomethacin - antiinflammatory analgesic

26
Q

Which category of drug that treats migraines has this MOA: down regulates 5-HT receptors that are associated with down excitatory perivascular inflammation, also inhibits reuptake of both 5-HT and NE

A

tricyclic antidepressants

27
Q

Which category of drug that treats migraines has this MOA: interferes with release of Ca dependent release of substance P (a pain modulatory substance) and other NTs

A

Ca channel blockers

28
Q

What drug do you use to treat intractable migraines that have not responded to other interventions

A

Corticosteroids

29
Q

Corticosteroids MOA: Modulators of ____ receptors, suppresses neurogenic ______, Blocks neurogenic extravasation mediated by the release of ______ like substance P, and blocks effects of ___-____ activated CA+ currents by blocking Ca+ channels

A

GABA
inflammation
neuropeptides
high-voltage

Pharm II (18 decks)

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