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18 Cards in this Set

  • Front
  • Back
cause of migraine pain
abnormal activation of trigeminal sensory nerve endings located in meninges and its vasculature
stretch and inflammmatory mediators
stretch caused by VSM relaxation and edema within the vessel wall
serotonin causes VSM in meninges to
constrict
these drugs are sturctureally related to serotonin
triptans
serotonin effect on 5-HT1B/D receptors
activation reduces release of inflammatory peptides from nerve endings,
reduce activation of nociceptive fibers by stretch autocoids
NSAIDS affect on migraine
reduce sensitizing effects of PG on nerve endings
MOA of triptan
constriction of vessels with 1B/1D receptors located on cerebral conductance vessels and meningeal av shunts
activates 1B/1D receptors on rigeminal sensory nerve ending reducing release of inflammatory mediators and reucing excitability
activates 1F receptors in trigeminal nucleus causing reduced synaptic transmission between nociceptive afferents and 2nd order neurons
by constricting blood vessels triptans might precipitate
cardiac problems
angina
triptan A,D,M,E
orally active,, can be given sc or intranasally for faster action
80% hepatic elemination 20% renal
2 hr T/2
side effect of triptans
coronary vasospasm
printzmetal angina
triptan use is incompatible with use of which drugs
SSRI MAOIs
less selective serotonin agonist, partial agonist, used for migrain
ergotamine
side effects of ergotamine
peripheral vasoconstriction
uterine contraction
emesis vomiting
use of ergotamine is contrindicated in
pregnancy, patients with peripheral vascular disease, htn, ischemic HD, renal or hepatic disease
combination analgesics
sedative + analgesic + caffeine
(butalbital a barbiturate, aspirin or acetominophen)
sedative + NSAID + codeine
sedative + analgesic + sympathomimetic amine
agents used for prophylais of migraine attacks
beta adrenergic antagonist propnolol, timolol
amitriptyline/nortryptyline
valproate
Ca channel antagonists (verapamil)
methysergide (semi synthetic ergot derivitive)
treatment of mild migrain
identify and avoid triggering factors
mild analgesics
antiemetics
moderate migraine treatment
tyriptan preferred to ergotamine, or combo analgesic if coronary disease present
severe migraine treatment
sumatriptan
antiemetic
prophylactic meds