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Pharmacology - Exam 2 > Migraine Therapy > Flashcards

Flashcards in Migraine Therapy Deck (21)
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1

What is thought to be the cause of migraine with aura?

Cortical spreading depression

2

What is thought to be the cause of migraine pain?

Activation of the trigeminovascular system

3

What is the latest target in migraine drug development?

CGRP release from trigeminal ganglion neurons

4

How can migraine pain be stopped?

Constricting blood vessels
Addressing seratonin levels
Targeting CGRP release

5

What are 3 subtypes of serotonin receptors that are therapeutic targets for migraine?

5-HT1B (substantia nigra, globus pallidus, basal ganglia)
5-HT1Da,b (Brain, Sumatriptan is partially selective agonist here)
5-HT1F (cortex, hippocampus)

6

Is prophylactic migraine therapy more effective in classic or common migraine?

Classic

7

How do prophylactic migraine therapies work?

Elevate CSD threshold and suppress CSD

8

What are the primary drugs used for migraine prophylaxis?

Beta-blockers (propranolol, timolol)
Anticonvulsants (valproate, topiramate)

9

What are contraindications of beta blockers?

Asthma
Depression
Heart failure
Calcium channel blockers

10

What is the mechanism of valproate in migraine therapy?

Increases GABA-mediated neurotransmission
> suppresses inflammation and nociceptive transmission
Modulates 5-HT > suppresses rostral brain stem modulator
CSD likely suppressed by reduced glutamaergic activity

11

What is the mechanism of topiramate in migraine therapy?

Blocks sodium and calcium channels
Inhibits glutamate receptors
Enhances GABA activity
Inhibits activation of TNC

12

How many migraine days per month are needed before using BoTox for chronic migraine?

15+

13

What is the mechanism of onabotulinum toxin?

Cleaves snares in release of CGRP from peripheral trigeminal sensory nerve terminals which :
1. mitigates development of peripheral sensitization
2. central sensitization

14

What drugs are good for treatment of acute migraine?

Mild to Moderate
- NSAIDs (naproxen), acetaminophen
- Caffeine
- Metoclopramide (anti-emetic, typically used as adjuvant)

Severe
- Ergots (ergotamine, dihydroergotamine)
- Triptans (sumatriptan)

15

What is the mechanism of ergots (ergotamine, DHE)?

Cerebral vasoconstriction
Non-selective 5-HT agonist at trigeminal nerves

16

How does DHE differ from ergotamine?

DHE has :
Fewer adverse effects
Weaker vasoconstriction
Parenteral administration (and nasal) for faster results

17

What drug interactions are there with ergots?

Triptans
Beta blockers
Nicotine

18

What is the mechanism of triptans (sumatriptan)?

Selective agonists at 5-HT1 receptors

19

What drugs should be avoided with triptans in order to reduce likelihood of catecholamine crisis?

MAOIs

20

Sumatriptan is a derivative of what?

Serotonin

21

Are ergots or triptans more effective later in the course of a migraine?

Triptans