Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm > migraine > Flashcards

migraine Flashcards

1
Q

Ergotamine tartrate (Ergomar)

ergotamine tartrate/caffeine/l-belladona alkaloids/sodium pentobarbital (30mg) (Ercaf, Wigraine); ergotamine/caffeine (Cafergot suppository)

A

Ergot Alkaloids and drugs that act at 5-HT1B receptors and 5HT1D (inhib. rel of pro-inflamm. NTs) SLD

-potent vasocontrictors
(ha due to vasodilation)

  • caffiene may help absorption
  • “dirty” drug: interacts with serotonin, dopamine, and adrenergic receptors
  • only use after triptans fail
  • GI upset (use with metoclopramide- anti-emetic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sumatriptan (Imitrex)

A 
Specific 5-HT1B/1D agonists,*FLDs*
first generation (SubQ, nasal spray, oral, transdermal patch)

-use for acute tx mod-sev. migraine if OTC analgesic/NSAIDs fail, relieve N/V, photo/phonophob

vasoconstriction of dilated intracranial arteries, inhibit rel. of vasodilator/proinflamm. mediators from trigeminal nerve endings

  • metab. by MAO
  • SE: peripheral vasoconstriction, MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Zolmitriptan (Zomig, Zomig ZMT)

A 
Specific 5-HT1B/1D agonists
second generation (*nasal or oral*)

acts at peripheral trigeminal (vasoconstriction, inhib. vasodilator release)
AND acts centrally: inhibits pain transmission in trigeminal nucleus
-access deep within CNS (more lipophilic) @ 5HT rec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Metoclopramide (Reglan)

A

Dopamine Antagonists – Antiemetics (IV, IM or oral)

  • tx N/V and ha
  • use when unresponsive to triptans or oral analgesics
  • can give in combo with NSAIDs or sumitriptan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prochlorperazine (Compazine)

A

Dopamine Antagonists – Antiemetics (IV, IM or oral)

  • tx N/V and ha
  • use when unresponsive to triptans or oral analgesics
  • can give in combo with NSAIDs or sumitriptan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Chlorpromazine (Thorazine)

A

Dopamine Antagonists – Antiemetics (IV, IM or oral)

  • tx N/V and ha
  • use when unresponsive to triptans or oral analgesics
  • can give in combo with NSAIDs or sumitriptan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ASA

A

analgesic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acetaminophen

A

analgesic
-effective at tx photophobia, phobia, pain

excedrin: combo of acetaminophen, NSAID (ASA) and caffeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ibuprofen

A

analgesic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

propranolol

A

B-blocker

  • ppx to prev. migraines
  • ones that lack partial agonist activity have best effect

tox: B-blockers may augment vasoconstriction from ergotamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

timolol

A

B-blocker

-ppx to prev. migraines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

atenolol

A

B-blocker

-ppx to prev. migraines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

amitriptylin (Elavil)

A

antidepressant

  • ppx to prev. migraines
  • down-reg of central 5-HT2 and adrenergic receptors (essentially like up-regulating 5-HT1)

-SEs: sedation, anticholinergic SEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Valproate (Depakote)

A

anticonvulsant
-similar global brain affect btw seizure and ha

  • many drug interactions, only use for severe
  • dec. neuronal activity: facilitate GABA NT, modulate glutamate, inhib. Na+ and Ca2+ channels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

topiramate (Topamax)

A

anticonvulsant

-similar global brain affect btw seizure and ha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

gabapentin

Neurontin

A

anticonvulsant

-similar global brain affect btw seizure and ha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Botulinum toxin type A (Botox)

A

migraine tx, inhib. rel. ACh
effect may last up to 3 months
only med good for medication rebound/overuse ha

18
Q

migraine prevalence

A

44.5 million US
F>M
genetic factors
$13 billion lost due to dec. work productivity

19
Q

migraine effects

A

decrease oral absorption of drugs during migraines
dec. GI motility
*caffeine helps
90% N/V -consider parenteral admin

20
Q

migraine prodrome

A
21
Q

migraine aura

A

migraine w.out aura (common migraine)

migraine w. aura (classic migraine)

visual disturbance-“fortification” spectrum-light disturbance, looks like a fort
narrowing of visual fields

22
Q

headache characteristics

A 
dull ache--intense pulsations
typ. Unilat
N/V
photophob/phonophobia
lasts 4-72 hrs
improve w. resting in dark room
worse with physical activity
W>M
23
Q

postdrome

A

During this phase some patients may feel tired/depressed or refreshed/euphoric

24
Q

menstrual migraine

A

onset of menstruation, due to hormone changes

25
Q

tension type

A

muscle contraction headaches - Dull persisting, non-pulsating, non-debilitating, bilateral pain (hatband pattern), not aggravated by physical activity, usually an absence of nausea/vomiting, and absence of aura and photophobia/phonophobia

26
Q

cluster ha tx

A

abortive:
O2 inhalation
ergotamine tartrate, dihydroergotamine
subcutaneous sumatriptan

ppx: 
verapamil
lithium carbonate
ergotamine tartrate
prednisone
27
Q

physio of migraines

A

dilated/enlarged BVs–>sensory to brain–>pain perception

(Ergot alkaloids/sumatriptan, zolmiltriptan)
drugs act on 5HT receptors to constrict
AND
5HT1D to inhibit release of pro-inflammatory NTs:
CGRP, NKA, SP

28
Q

vascular theroy

A

aura: vasoconstric
pain: vasodil

29
Q

spreading depression

A

spreading dec. in cortical e- activity

30
Q

serotonergic abnormalities

A

IV inj. of 5-HT can abort spontan./drug-ind. migraine

act at level of serotonin type 1 receptors

31
Q
A

abortive tx
OTC NSAIDs, excedrin, tylenol, advil

home: triptans–>ergot alkaloids, dihydroergotamine–>butorphanol nasal spray (last resort)

ER: IV NSAID + metoclopramide–>dihydroegotamine + metoclopramide–>metaclopramide + dexamethasone

32
Q

> 3 attacks per wk

A

ppx tx

33
Q

rebound ha

A

med overuse ha, can’t take >2x week
combination analgesics, opiates, ergotamine and the triptans
botulinum toxin is only relieving for med overuse ha

34
Q

NSAIDs mechanism

A

dec. PG formation–>dec. inflammation in trigeminovascular system–>lessens pain sensitization

35
Q

Dihydroergotamine (D.H.E.45) (IV, IM, SC, nasal) dihydroergotamine mesylate nasal spray (Migranal)

A

Ergot Alkaloid, acts at 5-HT1 receptor

acute tx of mod-severe migraine

  • like Ergotamine, less vasoconstriction
  • dirty drug: acts @ catechoamine, serotonin, dopamine receptors
36
Q

ergotamine contraindications/interactions

A

Do not use in pts with peripheral vascular disease
Do not use with B- blockers

*potentiate vasoconstriction

37
Q

Dihydroergotamine tox

A

GI upset: stim. CRTZ–>N/V

transient bradycardia, leg wkness, vasospasm (less than ergotamine, less vasoconstr, more a-blocking)

38
Q

sumatriptan tox

A

CV: MI, arrhythmia, vasospasm if taken with ergot

“triptan symptoms”: chest/throat tighness, diff breathing, panic, parethesia, feeling of heaviness

39
Q

do not use sumatriptan with..

A

MAO inhibitor (phenelzine, isocarboxazid) w.in 2 week time span

40
Q

evaluate ppx therapy

A
  • stay on for 2-3 mos to see if effective

- continue for 3-6 mos then examine for remission

41
Q

tension ha tx

A

abortive:
self medicate w. OTC analgesics
relaxation techniques

ppx:
amitriptyline
botulinum toxin inj.

42
Q

ha tx for kiddos

A
  1. Ibuprofen, acetominophen
  2. don’t use metoclopramide for antiemetic (extrapyramidal SEs), domperidone may be better
  3. triptans
  4. B-blockers for ppx

Pharm (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions