Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

29 Cards in this Set

  • Front
  • Back
What is the neurovascular theory of Migrain HA?
It is a two part theory.
1. the Trigeminal sensory nerve
2. Vascular components contribute to the HA
Explain the Neurovascualr theory of a Migraine HA?
1. Abnormal activation of trigeminal sensory nerve endings loacted within the meninges and their vasculature.
**During Migraine=Nocireceptor endings activated by stretch and inflammatory mediators.
Stretch= VSM relaxation causing dilitation and inc. flow and/or edema of the vessel wall.
Inflammatory= neuropeptides released from non-myelinated trigeminal snsory fibers; sustained by autocoids released by vessel wall.
What is the rationale for use of seroternergic agonists and NSAIDS for migraine from Vascular component?
-intracranial vessels have 5HT1D receptors = vasoconstriction
-activate vascular receptor = ↓ extravasation = ↓ vessel wall stretch = ↓ inflammatory transmitters = ↓ C fiber activation
What is the rationale for use of seroternerfic agonists and NSAIDS fro migraine from Neurologic component?
5-HT1B/D Receptors also in the nerve endings of the cranial sensory afferents; activation reduces teh release of inflammatory peprtides from the nerve endings and reduces the activation of the nociceptive fibers by stretch and autacoids. NSAIDS= reduce sensitizing effects of PGI on the nerve ednings and give analgesia to area.
What is Sumatriptan?
first generation of Triptans
Seretonin agonist that is structurally related to 5-HT.
What are the properties of Sumatriptan?
*Orally active, SQ, intra-nasal (fastest)
*Elim: 80% hepatic, 20% renal
*half: 2 hrs, no accumulation of active metabolites
***BBB penetration low for sumatripitan, higher for second generation triptans
What is the mechanism of Sumatriptan?
1. Anti-migraine mechanism:
*Activates 1B/1D recept. in cerebral conducatance vessels and meningeal AV shunts; constriction
*Activates inhibitory presyn. receptors (1d/1b) on trigeminal sensory nerve endings
*Activ. 1F Rec. in trigeminal nucleus (central mech) reduced synaptic transmission btwn trig. noci. afferents and second-order neurons
2. Other clinical impt. effects
*Coronary circulation can be adversley effected
What is the therapeutic use of Sumatriptan?
1. Migraine and Cluster HA
*70-80% respond
*Maintained p several uses
*Can come back in 24 hrs, prob. short half
What are the SE of Sumatriptan?
*Major: coronary vasospasm, avoid CAD or Printzmetal angina
**Major drug interaction: Not use with SSRIs or MAOIs
What is ergotamine?
ergot alkaloid related to LSD
What is Dihydroergotamine?
ergot alkaloid related to LSD
What are the properties of ergotamine and dihydroergotamine?
- partial agonist activity of multiple receptors (serotonergic, dopaminergic, and alpha-adrenergic)
*very low, erratic oral bioavail
**Ergotamine is SL, nasal, IM
**Dihydroergotamine is intranasal or IV,IM, SQ
What are the SE of ergotamine and dihydroergotamine?
peripheral vasoconstriction/capillary endothelium damage= ergotism,
Stimulate uterine contractions, can cause vomiting, dependence (stop=severe HA)
What is the mechanism of Ergotamine and dihydroergotamine?
Use in migraine b/c activation of 5HT 1B/D receptors but less selective than tripatns
What are the therapeutic uses of ergotamine and dihydroergotamine?
1.Abort migraine attacks and in cluster HA
**Not used anymore because of triptans
What patients are ergotamine and dihydroergotamine counterindicated in?
pregnancy, PVD, HTN, ischemic HD, renal or hepatic dz
How are NSAIDs used in migraine treatment?
NSAIDs or acetaminophen effecteve for tx of mild migraine pain and can add codeine to boost efficacy.
What antiemetic is used in Migraine headacges?
Metoclopramide; most commonly used when there is N/V as major Sx. Combo analgesics contain muscarinic blockers that alleviate nausea.
How is butalbital used in migraine HAs?
It is used as a sedative + NSAID + caffeine; also instead of caffeine, use codeine; Not used much in US because of dependence
What agents are used as prophylaxis of Migraine HAs?
1. B-adrenergic antagonists: propranolog and timidol
2. TCA: amitriptyline and nortryptyline
3. valproate
4. calcium channel antagonists
5. methysergide
Which B-adrenergic antagonists are used for migraine prophylaxis?
FDA approved are propranolol and timolol
60-80% effective;
Firt line agents; no sure why work
What is the first line agent for migrain prophylaxis?
B-adrenergic antagonists: propanolol and timolol
What TCAs are used for migraine prophylaxis?
Amitriptyline and nortyptyline;
2nd line agents at low doses
What is Methysergide?
semi-synthetic ergot derivative;
non-specific 5-HT antagonist; esp. 5-HT2 (peripheral vasocontraction, platelet aggreg and CNS depol)
***Action may be secondary to metabolite with sertonergic and a1-agonist properties
What are the therapeutic uses of Methysergide?
2. 3rd line agent, b/c of serious inflammatory fibrosis of the lung, heart and peritoneal acvity
**Use with drug holiday q 6 mos.
What patients is Methysergide counterindicated in?
PVD, HTN, angina, not use B-blockers
What drugs do you use with Mild Migraines?
*i.e. no major impairments, throbbing HA occnl
**Mild analgesics; antiemetics PRN
What drugs do you use with a moderate migraine?
*i.e. mod-sev HA; some impair fucn; nausea common
Use: Triptan perferable to ergotamine, or possibly, "combination analgesics" if cornary disease present
What drugs do you use with a severe migraine?
*More than 3 sev HA/month; sign functional impair; Mark N/V

Use: Sumatriptan (or ergot alkaloid), Antiemetics
***Prophylactic meds-give for 6 mos. then reassess