Anti Migraine

Question 1

Anti-migraine agents are divided into two general categories, those used to _____ and those used to ____

Answer 1

treat acute migraine

prevent migraine episodes.

Question 2

Drugs classes used to treat acute migraine attacks include ….

Answer 2

triptans, NSAIDs, antiemetics and ergot alkaloids.

Question 3

Drug classes used to prevent migraine attacks include…

Answer 3

antihypertensives (β-blockers and Ca channel blockers)

antidepressants (tricyclic antidepressants and SNRI)

anti-epileptics.

Question 4

Triptans

Answer 4

Treat acute migraine - first line

Selective for migraine

Question 5

Triptans MOA

Answer 5

All members in this class of drugs are serotonin 5-HT 1b/1d agonists.

bind to presynaptic receptors and inhibit the release of vasoactive neuropeptides -CGRP, promote vasoconstriction and block pain pathways in the brainstem.

Question 6

A disadvantage of triptans is

Answer 6

that the half-life of the drugs is shorter than the duration of the migraine requiring several doses to treat a prolonged migraine attack

Question 7

Triptans Side Effects

Answer 7

Chest discomfort – contraindicated in pts with CAD and angina (promote vasoconstriction)

Question 8

Triptan Drugs (Will not have to differentiate between these)

Answer 8

Eletriptan
Naratriptan
Rizatriptan
Sumatriptan
Zolmitriptan
Almotriptan
Frovatriptan

Question 9

Ergot Alkaloids

ergot is a natural product of ___

These compounds have partial agonist or antagonist activities on…

Answer 9

Fungus

serotonin, dopamine and adrenergic receptors.

Question 10

Ergotamine

Answer 10

Ergot Alkaloid

used to treat acute migraine attacks

available in oral, sublingual, I.M., I.V., rectal suppository and inhalation formulations.

Oral formulation has poor bioavailability.

Question 11

Dihydroergotamine

Answer 11

Ergot Alk

IV and intranasal

fewer SEs (GI, Vasospasm)

contraindicated in CAD, HTN, and hepatic dz

Question 12

Med Overuse Headache

Answer 12

AKA analgesic rebound headache,

meds used to treat acute migraine attacks are used frequently.

Med becomes less effective and the headaches are more severe.

Excessive use of triptans and combination analgesics (aspirin/acetaminophen/caffeine) present a high risk for medication overuse headache.

Ergotamines and triptans are NOT to be used prophylactically.