Drugs used in migraine Flashcards

Question

what is ergotamine ?

Answer 1

acute treatment for migraines - vasoconstrictor of blood vessels - serotonin and dopamine receptor agonist - used for 50 years but no longer really used due to its adverse effects

Answer 2

nausea, vomiting, abdominal pain, muscular cramps overuse headache- body will adapt to ergotamine so you have to take more and more to overcome the headache peripheral vasospasm cold extremities, gangrene - as blood supply to extremities gets cut off high first pass metabolism

Answer 3

pregnancy, CHD, peripheral vascular disease

Answer 4

serotonin 1B/D agonists such as sumatriptan highly specific for receptors in cranial blood vessels therefore very few peripheral side effects cause vasoconstriction activates serotonin receptors in trigeminal nuclei of brainstem- some of the pain associated with migraines appears to be caused by these nuclei inhibits dural neurogenic inflammation sumatriptan is effective in 60% of patients

Answer 5

they are often frequent, and short lived tingling/heat in head, neck, chest and limbs other side effects of sumatriptan - chest related symptoms- 40% of patient, pressure in chest and arms, shortness of breath, mimic angina - nausea - dizziness, - flushing - fatigue some of these effects can be avoided by taken it as a nasal spray

Answer 6

``` angina/mi uncontrolled hypertension pregnancy/lactation children and >65 also drug interactions with SSRIs, MAOIs and lithium ```

Answer 7

the triptans were a major breakthrough and therefore many variations of them were produced - enable less headache recurrence - faster acting - it meant that if one was not effective another one could be tried

Answer 8

``` naratriptan- most common because it has less interactions, fewer side effects zolmitriptan rizatriptan almotriptan eletriptan frovatriptan ```

Answer 9

2-4 attacks per month | interfering with patients lifestyle

Answer 10

daily medication for potentially 30 years may have unpleasant side effects also have to allow it time to work- 2 months

Answer 11

usually by about 50% but it may just be a short term solution

Answer 12

propranolol, metaprolol, timolol and nadolol propranolol causes more than an 50% reducton in migraine attacks in 35-60% of patients has no effect on reducing severity of duration of attacks

Answer 13

``` drowsiness fatigue, lethargy sleep disorders, nightmares depression memory disturbances hallucinations bronchoconstriction cardiac failure cold extremities hypotension exacerbation of heart failure renal failure ```

Answer 14

asthma and hypertensio

Answer 15

topiramate and sodium valporate - only topiramate is licensed in UK block voltage gated calcium cahnnels, increase GABA action at GABAa receptors and AMPA/KA antagonists

Answer 16

``` paraesthesia fatigue anorexia nausea taste disturbance diarrhoea ```

Answer 17

``` mild to moderate nausea vomiting gastrointestinal distrss infection alopecia tremor asthenia dizziness somnolence ```

Answer 18

amitriptyline not licensed in UK need much lower doses compared to depression treatment

Answer 19

``` sedation drowsiness dry mouth weight gain constipation mania dizziness tachycardia blurred vision tremor confusion arterial hypotension urinary retention akathesia ```

Answer 20

``` methysergide and pizotifen - have antihistamine and sertonin antagonistic effects - some have anticholinergic effects block serotonin 1, 2a and 2c 2nd line of medication ```

Answer 21

``` increased appetite- weight gain drowsiness antimuscarinic activity- dry mouth constipation blurred vision ```

Answer 22

``` pregnancy breast feeding glaucoma urinary retention renal impairment ```

Answer 23

``` rarely used now - only in hospitals very dangerous side effects - retroperitoneal fibrosis - fibrosis of heart valves - behavioural disturbances - arterial spasm can only be taken for 4 months before you have to have a month off ```

Drugs used in migraine Flashcards

(47 cards)