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Flashcards in Migraine Pharm Deck (15):
1

What is the Triptan MOA?

Selective Serotonin 5HT-1d/b agonists
Lower cAMP-> inhibit CGRP release

2

What are the contraindications of Triptans?

Hx of ischemic/vasospastic CAD, or uncontrolled HTN (b/c they cause vasoconstriction)
Taking MAO inhibitors

3

How can DHT be administered?

Sub-lingual, intranasal, IV, IM, SubQ

4

What migraine Rx should be completely avoided in pregnancy? Why?

DHT, all ergot alkaloids
Risk of spontaneous abortion

5

What is the BOTOX MOA?

Cleaves Snap-25 in motor neurons-> inhibits acetylcholine release at motor endplate @ nmj (presynaptic)

6

What Ca++ channel blocker is indicated for migraine prevention? Proposed MOA?

Verapamil- good side effect profile
Lessens Ca++ dependent vesicle fusion

7

What Beta-adrenergic blockers are used for migraine prevention? Contraindications?

Propranolol and Timolol
Contraindicated in asthma patients (cause bronchoconstriction)

8

What AED's are used for migraine prevention? What is the risk?

Topirimate and valproate
Increased risk of suicide

9

What vessels are dilated and constricted in migraines?

Cerebral vasoconstriction
Cranial vasodilation

10

What triptan lasts the longest?

Frovatriptan- 24hr half life

11

What 5-HT receptors are found on cranial blood vessels and neurons, respectively?

Vessels-> 5HT-1B
Peripheral neurons-> 5HT-1D
Central neurons-> 5HT-1D/1B

12

What happens when a patient takes a triptan and DHE together?

Vasoconstriction-> gangrene (contraindicated, obviously)

13

What tricyclic antidepressants are used for migraine prophylaxis?

Amitriptylene, imipramine

14

What would a patient taking a 5HT-1B antagonist have a risk of?

Migraine (want a 5HT AGONIST to tx)

15

What anti-nausea med can be prescribed in addition to a migraine med?

Ondansetron (Zofran- 5HT3 antagonist-> blocks depolarization, emesis)