Flashcards in Exam 4 Drugs for Migrane Deck (29):
what does 5-HT mean?
Serotonin-5-hydroxytryptamine - receptors are found pre and post synaptically for pain modulation (especially chronic pain)
in platelets = _____
in CNS (periaqueductal gray) = modulates ____ on a spinal level, stimulation produced _____ in midbrain, and most projections from PAG are ______.
4 disorders that 5-HT are associated with
6 categories of drugs that affect 5-HT
4. antiemetics (antinausea/vomiting)
5. antimigraine agents
6. atypical antipsycholtics
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.
what are the 3 classes of migraine medication?
1. ergot derivatives
3. iosmetheptene (Midrin)
name 3 ergot derivatives discussed in class
1. ergotamine (Ergomar)
2. ergotamine and caffeine (Cafergot, Migergot)
3. dihydroergotamine (Migranal)
7 Triptan drugs discussed in class
1. sumatriptan (Imitrex, Sumavel, DosePro)
2. naratriptan (Amerge)
3. zolmirtiptan (Zomig)
4. rizatriptan (Maxalt)
5. frovatriptan (Frova)
6. eletriptan (Relpax)
7. almotriptan (Axert)
Name 6 things ergot derivatives do?
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
When do you take an ergot derivative?
At the onset of a migraine attack - "Aborts" migrane, taking with caffeine speeds gastric absorption getting medication into system more rapidly
2 side effects of ergotamine and caffeine
1. blood vessel damage
Which drug's MOA = alph-adrenergic blocker that directly stimulates vascular smooth muscle to vasoconstrict peripheral and cerebral vessels
dihydroergotamine (Migranal) - nonselective antagontist at dopaminergic receptors and partial agonist/antagonist at 5-HT receptors
How is dihydroergotamine given?
parenterally: IV, IM, SC, nasal spray
Who gets dihydroergotamine?
people with chronic migraines or unresponsive migraines
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
triptans - also provides relief from nausea
What are the 3 parts of isometheptene (Midrin)?
1. isometheptene = vasconstrictor
2. acetaminophen = analgesic
3. dichloralphenazone = mild tranquilizing effects
When is isometheptene (midrin) taken?
at onset of migraines and tension headaches
What phenothizaine derivative (antipsychotic) is given with migraines?
antiemetics to control nausea and gastric irritation with migraines (D2 antagonists)
Name 4 antiemetics
1. prochlorperazine (Compro)
2. metoclopramide (Reglan, Metozolv)
3. promethazine (Phenergan, Phenadox, Promethegan)
4. trimethobenzamide (Tigan)
Name 8 classes of drugs that can be used for migraine prophylaxis
1. tricyclic antidepressants
3. selective 5-HT and NE reuptake inhibitors (venlafazine (Effexor)
4. Beta blockers
5. antiseizure medications
6. Ca channel blockers
Name 3 beta blockers used to treat migraines
Name 3 antiseizure meds used to treat migraines
2. valproic acid
name a ca channel blocker used to treat migraines
1. verapamil (Calan)
Which category of drug that treats migraines has this MOA: Inhibits reuptake of 5-HT
Which category of drug that treats migraines has this MOA: alters cerebral blood flow without inducing vasospasm, able to modulate cerebral blood flow
NSAIDS - idomethacin - antiinflammatory analgesic
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
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
Ca channel blockers
What drug do you use to treat intractable migraines that have not responded to other interventions