Migraine Flashcards Preview

4Qpharm3-test1 > Migraine > Flashcards

Flashcards in Migraine Deck (16):
1

migraine: gender in US

18 million women>6 million men

2

Migraine ddx

Migraine
Cluster HA
tension type

3

Migraine location and duration

(U) unilateral
2-72 hours per episode

4

Common migraine vs. classic migraine

common migraine=NO aura
classic migraine=WITH AURA
-aura:visual, sensory and/or sleep disturbances
-due to reduced blood flow of the posterior part of the brain

5

what causes the pain in migraine

in both types: due to extracranial & intracranial arterial dilation & release of neuroactive molecules such as substance P

6

2 phases in migraine

first: VASOCONSTRICTION
2nd: VASODILATION & pulsation

7

Sumatriptan (Imitrex): use, MOA, half-life, how does it work

symptomatic tx for migraine HA
expensive, reserved for when nothing else works
PO or SC, 2hr half-life
HA recurs in 24-48hrs,2nd dose needed

5-HT1D agonist on small peripheral nerves:
-(P) suppresses release of sensory neuropeptides
-vasoconstriction is not as strong as w/ergotamine

8

Sumatriptan (Imitrex) toxicities

coronary artery vasospasm, cardiac arrhythmias, angina, transient MI, MI, cardiac arrest

cerebral vasospasm resultin in intractanial bleeding, subarachnoid hemorrhage, strokes, seizures

BOWEL ISCHEMIA& periph. vasc ischemia

abdominal pain, bloody diarrhea & cramping

dizziness, lightheadedness, weakness, myalgia or muscle cramps

9

Sumatriptan (Imirex) contraindications

breast-feeding
cardiac dz
CAD, DM, cerebrovasc. dz, HTN, IV admin, periph vasc dz, prego, renal impairment, seizures, tobacco smoking

10

Other "triptan"s similar to sumatriptan (5)

FRENZ
Frovatriptan (Miguard)
Risatriptan (Maxalt)
Eletriptan (Relpax)
Naratriptan (Amerge)
Zomatriptan (Zomag)

11

Ergotamine (Ergomar)
used for:
acts on/effectiveness:
admin:
intrxns:

-used for migraines
-acts on 5-HT receptors
-less specific than sumatriptan, effective in 50% of pts
-oral, sublingual, rectal, nasal
-caffeine ↑absorption, potentiates effect

12

Ergotamine (Ergotamar) SEs:
Acute:
Chronic:

acute: diarrhea, N/V, cardiovascular toxicity (sim. to sumatriptan)

chronic: ergotism-vasoconstriction+CNS [St. Anthony's fire: hallucinations (devil), gangrene, pain, death]

13

Dihydroergotamine (Microgranan)

used for migraines
similar to ergotamine
administered IV
efficacy similar to sumatriptan
nausea is a common SE

14

Analgesics used in migraine

aspirin, acetaminophen, naproxen, etc.

-if possible avoid opioids in gout or migraine HAs

15

Drugs/classes used for prophylaxis (8 classes, 9 drugs)

1. Beta-blockers: propranolol (Inderal)
2. CCBs: Verapamil (Calan, Isoptin)
3. Antidepressants:
-Amitriptyline (Elavil, Endep)
-Fluoxetine
4. Clonidine (Catapres)
5. Valproic Acid (Depakane)
6. Topiramate (Topomax)
7. Botulinum Toxin Type A & B
8. Angiotensin II receptor blockers

16

Drugs used in ACUTE migraine

at start: Triptans (such as Sumatriptan)
at prodrome: Dihydroergotamine
HA phase: Analgesics