Pharmacology - Migraine

Question 1

*3 classes of drugs that can be used for migraine

Answer 1

triptans
cgrp antagonists
dihydroergotamines

Question 2

true or false

migraines are always unilateral

Answer 2

false - not always

Question 3

differentiate between primary and secondary headaches

Answer 3

primary - no detectable underlying cause

secondary - there is an identifiable (usually) cause for it

Question 4

what are the 2 main types of migraine

Answer 4

migraine with aura and without aura

Question 5

migraine precipitating factors

Answer 5

stress, too much or too little sleep, missed meals, certain foods, alcohol, menstruation, contraceptives

Question 6

which 2 classes of migraine medication should be avoided in patients who are at risk for vascular disease or thrombosis?

Answer 6

ergots and triptans

Question 7

true or false

ergots and triptans can NOT be given together

Answer 7

true

Question 8

does family history put you more at risk for getting migraines

Answer 8

yes

Question 9

name 5 MEDS that can exacerbate migraine

Answer 9

oral contraceptives
postmenopausal hormone therapy
SSRIs
PPIs

Question 10

the chronic use of ____ may increase migraine frequency and severity

Answer 10

analgesics

get rebound migraines

Question 11

true or false

if a pt chronically takes analgesics but only once or twice a week, it is very unlikely that they will get rebound migraines

Answer 11

FALSE - they still can

Question 12

which particular analgesics are very well known to cause rebound migraines

Answer 12

opioids
barbiturate-caffeine combos

Question 13

***which receptors do triptans act on

Answer 13

5HT1B
5HT1D

Question 14

**which drug is a selective agonist at 5HT1F

Answer 14

lasmiditan

Question 15

a concern with triptans

Answer 15

angina and vasoconstriction

Question 16

true or false

the blocking of serotonin receptors is effective in the acute treatment of migraine

Answer 16

FALSE - activation

Question 17

**aside from its serotonin action, what are other actions of triptans

Answer 17

decreased cgrp and decreased substance p release
(vasoactive peptides)

Question 18

true or false

triptans bind serotonin receptors nonselectively

Answer 18

FALSE - selectively

Question 19

what is the “vascular mechanism” of triptans

Answer 19

painful arteries in the head are vasoconstricted

Question 20

what is the trigeminovascular mechanism of triptans

Answer 20

inhibit nociception in the trigeminal nerve of the brainstem and upper spinal cord

Question 21

some side effects of triptans and how you can remember

Answer 21

nausea and vomiting (ondansetron is an antiemetic and is a serotonin ANTAGONIST. serotonin mediates vomiting)

dizziness
“triptan flush” - feeling warm

sleepiness

coronary artery vasospasm! – can cause angina

Question 22

triptans should not be used with, or within ____ of, an ergot derivative or another triptan

Answer 22

within 24 hours

Question 23

true or false

triptans are teratogenic

Answer 23

false

Question 24

true or false

triptans are relatively safe

Answer 24

true

Question 25

***triptans should be used with EXTREME CAUTION with what class of drugs (answer isn't ergotamines)

Answer 25

MAO B INHIBITORS risk of serotonin syndrome

Question 26

true or false during a migraine, cgrp and substance p levels are decreased

Answer 26

FALSE - INCREASED

Question 27

what are the "pant" drugs

Answer 27

for migraine -- cgrp RECEPTOR antagonists

Question 28

what are the drugs that actually target cgrp itself (not its receptor)

Answer 28

the mabs

Question 29

true or false cgrp antagonists are used as prophylaxis for migraines

Answer 29

TRUE not acute treatment

Question 30

counseling point for cgrp receptor antagonists (the "pants")

Answer 30

there may be a brief exacerbation of migraine as the med starts to work (bc receptor is very briefly activated when the drug binds)

Question 31

when may a steroid be used in migraine treatment

Answer 31

to reduce recurrence

Question 32

antiemetics are dopamine receptor agonists or antagonsits

Answer 32

antagonists

Question 33

true or false lasmiditan is a triptan

Answer 33

FALSE - not a triptan

Question 34

**MOA lasmiditan

Answer 34

selective 5HT1F agonist inhibiting central and peripheral pain pathways

Question 35

true or false lasmiditan does NOT cause vasoconstriction

Answer 35

true

Question 36

some AE of lasmiditan

Answer 36

paresthesias (numbness and tingling) NVD driving impairment CNS depression dizziness

Question 37

**true or false dihydroergotamine binds 1 receptor subtype

Answer 37

FALSE - MULTIPLE RECEPTOR SUBTYPES serotonergic, dopaminergic, alpha and beta antagonist

Question 38

**as mentioned, dihydroergotamine blocks multiple receptor subtypes, which is problematic which receptor blocking gives it its anti migraine effect

Answer 38

5HT1A and 5HT1B

Question 39

dihydroergotamine causes a lot of _______

Answer 39

vasoconstriction issue - can cause heart attack, or if pregnant and placenta vasoconstricts bb will be lost

Question 40

"ergotism"

Answer 40

psychological dependence and chronic overdosage

Question 41

AE of dihydroergotamine

Answer 41

dependence gangrene of the extremities coronary vasoconstriction