University:
University of North Carolina at Chapel Hill
Course:
NURS 312 | Pharmacology
Academic year:

2020
Views:

293

Pages:

1
Author:

do3ran7ut

1.2 – “Pounding at the Sumo Festival”: Triptans & migraine migrainess • Classic migraine consists of aura of variable duration ± n/v visual scotomas, speech abnormalities, followed by severe, throbbing unilateral headache that lasts for a few hours up to a few days (throbbing bell). Common migraine is similar but sans aura. Pathology is unknown. Pain is d/t activation of trigeminal nerve afferents that innervate intracranial arteries, particularly in the meninges (three gems on protective meningeal hat). Trigeminal afferents release vasoactive peptides (e.g. CGRP, substance P, neurokinin A) onto meningeal vessels → vasodilation & protein extravasation → neurogenic inflammation (dilated sleeves). Mechanical stretch by perivascular edema may be the immediate cause of neurogenic pain. • NSAIDs can be used for migraine as well. Combined with triptan seems to be more effective than either alone. Triptans • Sumatriptan and others (sumo wrestlers) • Acute treatment for migraines. o Triptans + inhaled oxygen are acute treatment for cluster headache (lantern cluster) • Combat neurogenic pain, but MOA is not entirely understood. Act as selective agonists for 5HT-1B & 5HT-1D receptors in trigeminal nerves, meningeal vessels & brainstem (smiley face headband; b & d shaped fingers). o Activates receptors directly on meningeal & cerebral → vasoconstriction, and may reduce pressure/stretch sensitive pain receptors (red constricting headband) o Acts on 5HT-1B & 5HT-1D on the trigeminal nerve, preventing release of vasoactive peptides promoting vasoconstriction (taking out ref in 5 gem hat) o Causes 5HT receptors in brain stem, inhibiting pain pathways • Adverse effects o Mostly mild. Include tingling, dizziness, muscle weakness. o Chest discomfort or pain, likely d/t vasospasm. Contraindicated in CAD (tiny coronary crown), known trigger of Prinzmetal angina (tiny anvils) Long term m migraine igraine proph prophylaxis ylaxis (long term fans) • Calcium channel blockers (Calci-yum ice cream), although questionable efficacy • Triptans • β blockers (ref with bugle) • Valproic acid can be used (festival pro sign) • Topiramate (toupee) • Tricyclic antidepressants, e.g. amitriptyline (tricycle)