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Anti-migrane Flashcards

(39 cards)

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1
Q

Define migrane

A

common type of headache of unknown cause

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2
Q

Duration of the migraine attack

A

several hours or days.

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3
Q

What can the frequency of migraines be?

A

1-8 episodes per month

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4
Q

What are the known triggers of migraines? (6)

A
  • alcohol
  • chocolate
  • cheese
  • fasting
  • menstruation
  • oral contraceptives
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5
Q

Migrane patients: (3)

A
  • Family history 2/3 of the patients.
  • Age of onset: late teens or young adults.
  • More common in women.
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6
Q

Migrane characteristics? (5)

A
  • Throbbing pain.
  • Hemicraneal.
  • Moderate to severe intensity.
  • Usually accompanied by photophobia, nausea and vomiting.
  • Often preceded by aura: odors, visual disturbance-flashes
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7
Q

Frequency of migraine with aura? what else is it called?

A

15%

classic migraine

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8
Q

What is an aura?

A

feelings and symptoms you notice shortly before the

headache begins

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9
Q

Frequency of migraine without aura? what else is it called?

A

75%

common migrane

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10
Q

What is the common migrane?

A

without aura

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11
Q

What is the classic migrane?

A

with aura

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12
Q

What is status migrainous? What happens?

A
  • migraine lasts longer than 72 hours

- sometimes requires hospitalization

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13
Q

What molecules affect the aura for migranes?

A
  • Serotonin (5-Hidroxitriptamina 5-HT)

- Dopamine

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14
Q

What drug classes can we use to treat migranes? (5)

A
  1. PARACETAMOL
  2. NSAIDS
  3. MINOR OPIATES 4.TRIPTANS
  4. ERGOTAMINE
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15
Q

What drugs do we use to start treating migraines? examples? (4)

A
  1. PARACETAMOL
  2. NSAIDS - naproxen/ibuprofen/ketorolac
  3. MINOR OPIATES
  4. anti-nausea - metoclopramide
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16
Q

When is metoclopramide used with migraines?

Study These Flashcards
A

15 min before to prevent nausea and vomitting

17
Q

What do you use if the first step in treatment of migraines doesn’t work?

Study These Flashcards
A

serotoninergic agonists:

  1. TRIPTANS
  2. ERGOTAMINE
18
Q

Triptans and ergotamines are what type of drug? what are they used for?

Study These Flashcards
A
  • anti-migrane

- serotoninergic agonists

19
Q

What are the triptan drugs? (4)

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A
  • sumatriptan
  • naratriptan
  • zolmitriptan
  • rizatriptan
20
Q

What is the mechanism of action for sumatriptan?

Study These Flashcards
A

-5-HT receptor agonist

21
Q

What are the effects of sumatriptan?

Study These Flashcards
A
  • vasoconstriction:
  • coronaries
  • carotid
  • extracranial
22
Q

How effective is sumatriptan? (2)

Study These Flashcards
A
  • very effective if given in inital phases of migrane

- repeat 1-2 hours if not completely improved

23
Q

How is sumatriptan administered? (3)

Study These Flashcards
A

SC
Intranasal
oral

24
Q

What are the problems with sumatriptan? (2)

Study These Flashcards
A
  • lack of response

- reoccurrence in 24hrs

25
sumatriptan contraindications? (4)
- coronary heart disease - uncontrolled hypertension - >55yrs - pregnancy
26
What effects does ergotamine have? (2)
-anti-migrane -potent arterial vasoconstrictor (extracranial arteries) -
27
What happens to blood vessels during a migraine? where? (2)
- vasodilation | - extracranial arteries
28
What is the dosing for ergotamine?
earlier it is administered, the lower the dose that is required
29
What is the daily maximum dose for ergotamine?
4-6mg
30
What is the dosage for ergotamine? When is it repeated?
- 1mg oral or rectal | - repeated after 30 mins if no improvement
31
What is the side effect of ergotamine?
-higher doses, risk of ischemia
32
When do you use preventative measures for migraines? (5)
- Chronic daily headache - > 2-3 episodes/month - Bad response or lack of tolerance to symptomatic treatment - Complicated migraine - Disabling pain: socio-occupational impact.
33
What class of drugs are used as preventative treatment for migraines? (6)
1. - TRICYCLIC ANTIDEPRESSANTS: Amitriptyline + benzodiazepines 2. - BETA BLOCKERS: Propranolol 3. - METHYSERGIDE (ONLY IF FAILURE OF THE ABOVE): 4. - CYPROHEPTADINE: antiserotoninergic, use in children 5. - CALCIUM ANTAGONISTS: flunarizine, nimodipine, nicardipine, verapamil 6. - ANTIEPILEPTICS: valproic acid, topiramate
34
What beta blocker do we use as preventative migraine treatment?
propranolol
35
When do we use methysergide as a preventative measure against migraines?
only if tricyclic antidepressants and beta blockers do not work
36
What effect does methysergide have? (2)
- antiserotoninergic | - vasoconstrictor
37
What effect does CYPROHEPTADINE have?
antiserotoninergic
38
When is CYPROHEPTADINE used in migraines? (2)
- preventing migraines | - children
39
Which tricyclic antidepressants do we use as a preventative measure against migraines? with what? (2)
Amitriptyline + benzodiazepines

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