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18 Cards in this Set
- Front
- Back
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cause of migraine pain
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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 |
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serotonin causes VSM in meninges to
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constrict
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these drugs are sturctureally related to serotonin
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triptans
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serotonin effect on 5-HT1B/D receptors
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activation reduces release of inflammatory peptides from nerve endings,
reduce activation of nociceptive fibers by stretch autocoids |
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NSAIDS affect on migraine
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reduce sensitizing effects of PG on nerve endings
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MOA of triptan
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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 |
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by constricting blood vessels triptans might precipitate
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cardiac problems
angina |
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triptan A,D,M,E
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orally active,, can be given sc or intranasally for faster action
80% hepatic elemination 20% renal 2 hr T/2 |
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side effect of triptans
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coronary vasospasm
printzmetal angina |
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triptan use is incompatible with use of which drugs
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SSRI MAOIs
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less selective serotonin agonist, partial agonist, used for migrain
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ergotamine
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side effects of ergotamine
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peripheral vasoconstriction
uterine contraction emesis vomiting |
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use of ergotamine is contrindicated in
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pregnancy, patients with peripheral vascular disease, htn, ischemic HD, renal or hepatic disease
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combination analgesics
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sedative + analgesic + caffeine
(butalbital a barbiturate, aspirin or acetominophen) sedative + NSAID + codeine sedative + analgesic + sympathomimetic amine |
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agents used for prophylais of migraine attacks
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beta adrenergic antagonist propnolol, timolol
amitriptyline/nortryptyline valproate Ca channel antagonists (verapamil) methysergide (semi synthetic ergot derivitive) |
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treatment of mild migrain
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identify and avoid triggering factors
mild analgesics antiemetics |
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moderate migraine treatment
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tyriptan preferred to ergotamine, or combo analgesic if coronary disease present
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severe migraine treatment
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sumatriptan
antiemetic prophylactic meds |
