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8 Cards in this Set

  • Front
  • Back
Migraine
Trigimenial sensory nerves in meninges activated by stretch and inflammatory mediators.
Inflammation is sterile and initiated by neuropeptides and sustained by autocoids.
Sumatriptan
Mechanism: 5-HT agonist, activates 1B/1D receptors -> vessel constriction, reduced inflammatory mediators

Clinical Use: anti-migraine, cluster headache

Side Effects: coronary vasospasm, little other effect on peripheral vasculature

Druge Interaction: cannot use with SSRIs or MAOIs ("serotonin syndrome")
Ergotamine
Dihydroergotamine
Mechanism: partial agonist of 5-HT, DA, alhpa-1; vasoconstriction, may cause dependence

Clinical Use: second line drug (Triptans preferred) for migraine

Side Effects: ergotism (vascular stasis, thrombosis, gangrene), peripheral vessel constriction, uterine contractions, emesis
NSAIDs
mild migraine pain
Butalbital
Barbiturate (butalbital) + NSAIDs (or acetaminophen) + caffeine

Used only if Triptans do not work
Propranolol
Timolol
Mechanism: beta-antagonists

Clinical Use: First line drugs for migraine prophylaxis

Side Effects: HDL, somnolence, depression
Amitryptiline
Nortryptyline
Mechanism: TCAs

Clinical Use: Second line migraine prophylaxis

Side Effects: anticholinergic, sedation and weight gain
Methysergide
Mechanism: 5-HT antagonist, may have metabolite with 5-HT and alpha-1 AGONIST properties

Clinical Use: Third line for migrain prophylaxis

Side Effects: Inflammatory fibrosis of lung, need 1-2 month drug holiday every 6 months