Migrane pharmacology Flashcards
(30 cards)
Treatment for mild migrane
NSAIDS
Caffeine
Combination preps for migrane
butalbital + NSAID + caffeine +/- codeine
Concerns with combination preps
rebound headaches
may convert episodic migranes to chronic migranes
Dependence
Antiemetics for migrane
metoclopramide
Advantages of metoclopramide
antiemetic and enhances GI motility
Side effects of metoclopramide
RESTLESSNESS, ANXIETY, drowsiness, fatigue
D2 receptor antagonist
Prototype triptans
sumitriptan
MOA of triptans
5HT1B, 5HT1D receptor agonist, selective for cerebral vasculature
Advantages of triptans
reduces nausea and vomiting
increases GI motility
Metabolism of triptans
MAO-A
Side effects of triptans
associated with vasoconstriction heaviness in head warmth, drowsiness, dizziness chest discomfort increase blood pressure
Drug interactions of triptans
anything that causes vasoconstriction (propranalol)
MAO-A blockers
Contraindications of triptans
ischemic heart disease
angina
MAO-A inhibitors
General considerations for triptans
30-40% recur in 24 hrs, give second dose
rebound headaches can occur
Prototype Ergot alkaloid
dihydroergotamine
MOA of ergots
5HT1B and 5HT1D receptor agonists, not as selective
Side effects of ergots (6)
nausea, vomiting muscle weakness, numbness angina hypersensitivity fibrosis gangrene
Drug interactions with ergots
potentiate Beta blockers
Contraindications of ergots
pregnancy
cardiovascular disease
poor hepatic, renal function
cyp3A4 inhibitors, ischemia
Treatment for children with migranes
ibuprofen, acetominophen
sumatriptan, effective, but not approved
Opiate used for migranes
Stadol NS
MOA of Stadol NS
kappa receptor agonist
Therapeutic use of Stadol NS
use only when triptans and ergots are ineffective
may convert to chronic migrane
Treatment for severe migranes
prophylactic therapy
