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Flashcards in MIGRAINE Deck (15)
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1
Q

MIGRAINE

A
  • a common EPISODIC disorder
  • disabling headache generally associated with NAUSEA and/or LIGHT + SOUND SENSITIVITY
  • most migraine suffereres require pharmacologic treatment
2
Q

DRUGS FOR MILD-MODERATE ATTACKS

A

either = DOC

1) ACETAMINOPHEN
2) NSAIDS

–> for mild-moderate attacks NOT ASSOCIATED with vomiting/severe nausea

3
Q

TRIPTANS

A

drugs used for MODERATE-SEVERE ATTACKS

TRIPTANS = DOC for moderate-severe migraines

-Triptans are selective agonists at 5-HT1D and 5-HT1B receptors

Combination of sumatriptan and naproxen provides better pain relief than either drug alone.

SC sumatriptan is the fastest-acting and most effective triptan formulation.

ADVERSE EFFECTS:

1) tingling, flushing, dizziness, fatigue
2) Chest tightness
3) RARE: angina, MI, arrhythmia, stroke, and death

CONTRAINDICATIONS:

-in coronary, cerebrovascular, or other arterial disease, or uncontrolled HTN

4
Q

ERGOTAMINE

DIHYDROERGOTAMINE

A

ERGOT ALKALOIDS: DRUGS USED TO TREAT MODERATE-SEVERE ATTACKS

ER GROSS AMINE –> agonist at a few receptors, but can cause GANGRENE (er gross) d/t vascular occlusion (contraindicated in arterial disease or uncontrolled HT)

-Ergotamine acts as an agonist at α-adrenoceptors, 5-HT and D2 receptors

• The agonist actions of ergot alkaloids at 5-HT1B/1D receptors likely mediate their anti-migraine effects.

ADVERSE EFFECTS:

1) Nausea and vomiting. Can be prevented with an antiemetic such as metoclopramide.
2) Serious adverse effects: vascular occlusion and gangrene. Rare. Usually associated with overdosage.
3) Dihydroergotamine is a weaker vasoconstrictor than ergotamine and causes fewer AE.

CONTRAINDICATIONS:

1) arterial disease or 2) uncontrolled hypertension.

5
Q

DRUGS FOR PREVENTOIN OF MIGRAINE

A
  • Patients with frequent or severe disabling migraine headaches should receive prophylactic treatment.
  • The mechanisms of action of drugs used for migraine prophylaxis are diverse.
  • No single drug has emerged as a clear treatment of choice.

FIRST LINE AGENTS: BETA BLOCKERS, VALPROATE, TOPIRAMATE (Val’s at the top with Beta) –> they are the top of the prophylatic choices

SECOND LINE AGENTS: Tricyclic AntiD’s, SNRI’s, Calcium Channel Blockers, Gabapentin, ACEIs/ARBs, Botulinum Toxin, NSAIDS

6
Q

BETA BLOCKERS

A

FIRST LINE AGENTS FOR PREVENTION OF MIGRAINS

PROPANOLOL, TIMOLOL, METOPROLOL, NADOLOL, ATENOLOL

–> for continuous prophylaxis, beta blockers are commonly used

7
Q

VALPROATE

A

FIRST LINE AGENT FOR PREVENTION OF MIGRAINE

Val (james’s girlfriend) may be a little crazy (biopolar, epilepsy), but she sometimes gives him a headache –> she inhibits Na and Ca from his diet –> can strangle him also and give him THROMBOCYTOPENIA

  • indicated for BIPOLAR DISORDER, EPILSEPY, + MIGRAINE PROPHYLAXIS
  • valproate inhibits voltage gated Na+ channels and T-type Ca2+ channels

ADVERSE EFFECTS:

-GI side effects, Thrombocytopenia, rarely hepatotoxicity, teratogenic

8
Q

TOPIRAMATE

A

FIRST LINE AGENT FOR PREVENTION OF MIGRAINE

Like Val, also used for epilepsy, also blocks Na+ but is a GABA AGONIST, Glut antagonist (unlike val, who works out) –> affects your Top ie your Two eyes –> acute myopia, glaucoma

  • indicated for 1) EPILEPSY and 2) MIGRAINE PROPHYLAXIS
  • inhibits voltage-gated Na+ channels
  • GABAA receptor agonist and glutamate receptor antagonist.

AE: Somnolence, fatigue, cognitive slowing, nervousness, confusion. Acute myopia (nearsightednes) , glaucoma. Hyperthermia, renal stones. Teratogenic.

9
Q

AMITRIPTYLINE

NORTRIPTYLINE

IMIPRAMINE

A

TRICYCLIC ANTI-D’S: 2ND OR 3RD LINE AGENTS

-are TCAs that inhibit NE or Serotonin reuptake

AE: sedation, dry mouth, weight gain

10
Q

VENLAFAXINE

A

SEROTONIN NE RUPTUAKE INHIBITOR (SNRI’s): 2nd-3rd line agent

AE: nausea, constipation, insomnia, headaches, sexual dysfunction

11
Q

VERAPAMIL

A

CALCIUM CHANNEL BLOCKER (2ND OR 3RD LINE AGENT)

  • are used for prevention of migraine, but evidence for their effectiveness is WEAK
  • Verapamil is the CCB with the most evidence of efficacy
12
Q

GABAPENTIN

A

-gabapentin decreases glutamate release by blocking presynaptic voltage-gated Ca2+ channels

GABAPENT –> makes a tent in the presynaptic cleft and BLOCKS the GLUTAMATE RELEASE

AE: sleepiness, dizziness, fatigue (B/C IN A TENT)

13
Q

LISINOPRIL

CANDESARTAN

A

2nd/3rd line ACEI’s or ARBs

Lisinopril and Candesartan have reduced migrine fequency by about 30%

14
Q

BOTULINUM TOXIN

A

2nd-3rd line prophylactic agent

-pericranial injections of botulinum toxin is marginaly fffective for prophylaxis of headaches in adult patients with chronic migraine (patients with 15 or more headache days/month)

15
Q

NAPROXEN

IBUPROFEN

A

2ND/3RD LINE AGENT: PROPHYLACTIC USE NSAIDS

1) NAPROXEN

2) IBUPROFEN

–> have been used for short-term pervention of migraine