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27 Cards in this Set
- Front
- Back
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MOA of migraine drugs****** |
vasodition********* |
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what HA catefory does migraines fall in? |
category IV |
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what are the 4 phases of a migraine |
prodome: euphoria, depression, irritability, food craving, constipation, neck stiffness, increased yawning aura: visual, sensory, verbal, motor disturbances headache: robbing of pulsing postdrome: spontaneous throbbing stops,draines, exhausted, mild elation or eruphoria |
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what are the triptans? |
Almotriptan (Axert) Eletriptan (Relpax) Frovatriptan (Frova) Naratriptan (Amerge) Rizatriptan (Maxalt, Maxalt-MLT) Sumatriptan (Imitrex) Zolmitriptan (Zomig, Zomig ZMT) |
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what is the onset of most triptans? what has the fastest onset? |
1-2.5h fastest = Sumatriptan SQ 0.2h (12m) |
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what is max daily dose sumatriptan? |
200mg/day |
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are triptans used for tx or prophylaxis? |
tx! ASAP |
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drug rxns for triptans? |
MAOI and ergot alkaloids |
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dose for triptan |
SUMAtriptan 50mg T at migraine onset and repeat 2h if insufficient response |
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how to ergot derivatives work? |
6,8-dimethylergoline is POTENT vasoconstrictor (its used in postpartum bleeding and abortions) also has alpha adrenergic effect |
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what are the ergot derivatives that work for migraine |
Dihydroergotomaine (D.H.E.-45, Migranal) Ergotamine (Ergomar) Ergotamine/caffeine (Cafegot) |
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max does for ergot derivatives |
6mg for each attack 10mg in a week's time |
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dosage forms for ergot derivatives |
SL, nasal spray, SQ NOT oral |
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SE of ergot derivatives |
n/v leg weakness ergotism-like effect: numbness, tingling in fingers and toes cardiovascular: bradycardia, ECG changes, HTN, ischemia |
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contraindications to ergot derivatives |
pregnancy CAD impaired renal func sepsis peripheral vascular disease HTN impaired hepatic function within 24h of taking triptan
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dose for SL ergot derivatives |
Ergomar Sublingual 2mg T under the tongue at first sign of HA and repeat 30m intervals if necessary up to a total 6mg in a 24h period |
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dose for IV ergot derivatives |
D.H.E. 45 1mg IC and repeat dose after 1h to total of 2mg |
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what is Rascan Protocol |
use with D.H.E. 45 combo with metacholpormide to reduce n/v can be use q8h for 2-3d |
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what is the Fioricet |
combo of Butalbital, APAP, & caffeine depresses CNS caffeine vasocon used for tension or muscle contraction HA |
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what is Midrin (Nodular) |
combo of APAP, isometheptene, dichloralphenazone vasocon and sedative/analgesic |
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when to prevent migraines |
interferes with daily routine contraindications frequent attacks uncommon migraine types cost pt preference |
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rules of prevention of migraines |
-start low and go slow -trial period 2-3mo -discontinue overused drugs that may be causing rebound |
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what can you use as prophylaxis |
BB- propranolol, timolol TCA- amitriptyline antiseizure- topiramate, valproate neuromuscular blockade- onabotulinumtoxin |
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dose for prophylaxis |
Propranolol XL 80mg qd |
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what are OTC meds for migraine |
ibuprofen APAP ASA Naproxen |
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MOA of triptans |
o Mediates release of neuropeptides
o Inhibits 5HT1d-serotonin release
§ Prevents meningeal vasodilation
§ Stops the cascade (5ht1Dà5ht1B)
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what dosage forms do the triptans come in? |
all oral except sumatriptan which is oral, nasal, and SQ |
