Exam 4 Drugs for Migrane Flashcards Preview

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Flashcards in Exam 4 Drugs for Migrane Deck (29):
1

what does 5-HT mean?

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

2

Serotonin effects
in platelets = _____
in CNS (periaqueductal gray) = modulates ____ on a spinal level, stimulation produced _____ in midbrain, and most projections from PAG are ______.

vasoconstriction
nociception
analgesia
tryptaminergic

3

4 disorders that 5-HT are associated with

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

4

6 categories of drugs that affect 5-HT

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

5

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.

5-HIAA
CSF
Urine
blood

6

what are the 3 classes of migraine medication?

1. ergot derivatives
2. Triptans
3. iosmetheptene (Midrin)

7

name 3 ergot derivatives discussed in class

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

8

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)

9

Name 6 things ergot derivatives do?

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

10

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

11

2 side effects of ergotamine and caffeine

1. blood vessel damage
2. gangrene

12

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

13

How is dihydroergotamine given?

parenterally: IV, IM, SC, nasal spray

14

Who gets dihydroergotamine?

people with chronic migraines or unresponsive migraines

15

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

16

What are the 3 parts of isometheptene (Midrin)?

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

17

When is isometheptene (midrin) taken?

at onset of migraines and tension headaches

18

What phenothizaine derivative (antipsychotic) is given with migraines?

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

19

Name 4 antiemetics

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

20

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

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

Name 3 beta blockers used to treat migraines

1. propranolol
2. nadolol
3. atenolol

22

Name 3 antiseizure meds used to treat migraines

1. topiramate
2. valproic acid
3. gabapentin

23

name a ca channel blocker used to treat migraines

1. verapamil (Calan)

24

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

SSRIs

25

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

26

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

tricyclic antidepressants

27

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

28

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

Corticosteroids

29

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

GABA
inflammation
neuropeptides
high-voltage