Migraine medications Flashcards Preview

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Flashcards in Migraine medications Deck (34):
1

Why is propanolol (inderal) used for migraines instead of a more cardioselective beta blocker

They are more lipid soluble, and so have greater effect on the brain

2

What is the MOA of propanolol

Blocks adrenergic stimulation which serves to decrease heart rate and myocardial oxygen demand and also decreases renin release

3

Who should not take a beta blocker

a fragile asthmatic or severe COPD may have static asthmaticus due to bronchoconstriction effect

4

What drug class is amitriptyline

Tricyclic antidepressant

5

What are the indications for amitriptyline

Migraine headache prophylaxis, chronic pain, bipolar disorder and depression

6

What is the MOA of amitriptyline

CNS modulation of both serotonin and norepinephrine

7

What should not be used with amitriptyline

monoamine oxidase inhibitors

8

what drug class is Topiramate (topamax)

Anticonvulsant

9

What are the indications for topiramate (topamax)

Epilepsy, migraine prophylaxis. Off-label: bipolar, weight loss

10

What is the MOA of topiramate (topamax)

Block voltage-dependent sodium channels in the CNS, augmenting the activity of the neurotransmitter gamma-amino butyrate (GABA) at some subtypes of the GABA-A receptor

11

What are the side effects of topiramate (topamax)

"I don't feel right" because you are blocking some neural activity. also fatigue, dizziness, vision changes, acute angle glaucoma, nausea, constipation

12

What drug class is methysergide (sansert)

Ergot derivative - serotonin 2 receptor antangonist

13

What is the MOA of methylsergide

Potent vasoconstrictor

14

What are some rules of using methylsergide

must cycle every 6 months. Must taper to avoid rebound. DO not use within 24 hours of a triptan d/t risk of vasoconstrictive spasm

15

What are severe side effects of methylsergide

Pulmonary fibrosis and retroperitoneal fibrosis, thickening of the heart valves

16

What category is methysergide (sansert)

Category X

17

What drug class is sumatriptan (imitrex)

serotonin agonist

18

What are the indications of sumatriptan (Imitrex)

Migraine and cluster headache (prodromal phase)

19

What are the administration routes of sumatriptan

PO, SQ, Nasal spray

20

How much sumatriptan can be taken

No more than 2 doses in a day, or the chances of side effects increase significantly. (12-18 doses per month)

21

What category is sumatriptan (Imitrex)

category C

22

What is a significant but rare side effect of sumatriptan

serotonin syndrome (agitation, tremor, ataxia, fever/chills, diarrhea)

23

What class is butorphanol (stadol)

opioid analgesic

24

What are the indications of butorphanol (stadol)

Migraine headache that is refractory to triptans and to other agents as well as less potent analgesics. Butorphanol may also used in other acute pain conditions

25

How is butorphanol administered

nasal spray, IM

26

What are some side effects of butorphanol

Severely addicting, nasal irritation, drowsiness, dysphoria, N/V

27

What is the MOA of ibuprofen (advil, motrin)

Reversible inhibition of COX-1 and COX-2 enzymes. Anti-inflammatory and analgesic effect largely due to blockade of prostaglandin synthesis at target tissues. No blood thinning effect

28

What is a good way to administer anti-emetics

PR is a good one for patients to have on hand

29

What drug class is prochlorperazine (Compazine)

Typical neuroleptic

30

What are the indications prochlorperazine (compazine)

Anti-emetic especially when associated with migraine, vertigo, psychosis

31

What is the MOA of prochlorperazine (Compazine)

Primarily H1-histamine receptor antagonist. Also a D2 dopaminergic receptor antagonist and an alpha-adrenergic receptor antagonist

32

What are the side effects of prochlorperazine (compazine)

Classic anti-histamine effects (dry mouth, dry eyes, dowdiness, urinary retention), lower seizure threshold, extrapyramidal effects

33

How does odansetron relate to prochlorperazine

It is a stronger anti-emetic

34

What is the MOA of odansetron

Blockade of serotonin (5HT3) receptor sites results in signifigant anti-nausea effect.