Drugs for Pain Opiods and Headaches-pharm

Migraine headache i migraine overview of treatment

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Unformatted text preview: harmacological management of migraines---1) stop the headache and 2) prevent the migraine from occurring (prophylaxis)***. Migraine Headache I Migraine • Characteristics – – – – – – – Throbbing head pain of moderate to severe intensity Nausea and vomiting Sensitivity to light and sound Highly debilitating Hormonal component Family history typical Two primary forms • Migraine with aura – Preceded by visual symptoms – Ex: flashing light in the side of the eye Ex: • Migraine without aura – More common than with aura Migraine Headache I Migraine • Pathophysiology – Neurovascular disorder that involves dilation Neurovascular and inflammation of intracranial blood vessels and – Vasodilation leads to pain – Neurons of the trigeminal vascular system • May be reduction in blood flow with resulting cortical depression. Followed by vasodilatation which causes inflammation and decrease in serotonin. Migraine Headache I Migraine • Overview of treatment – Aborting an ongoing attack • Nonspecific analgesics Nonspecific – Aspirin-like drugs and opioid analgesics • Migraine-specific drugs – Ergot alkaloids, serotonin1B/1D receptor agonists (triptans) – Preventing attacks from occurring • Beta blockers, tricyclic antidepressants, antiepileptic Beta drugs drugs Migraine Headache II: Abortive Therapy Abortive • Objective: to eliminate headache pain and Objective: suppress associated nausea/vomiting suppress • Earliest treatment possible- within 1-2 hours Earliest of migraine • Route of administration – Oral not effective due to GI distress – Injection, inhalation, rectal suppository may be Injection, more effective more Selection of Drugs Selection • Mild-moderate headache – Aspirin-like drugs • Aspirin, acetaminophen, ibuprofen, and other Aspirin, aspirin-like analgesics aspirin-like • Moderate-severe Moderate-severe – Migraine-specific drug- especially with a Migraine-specific history history – Opioid analgesics • Antiemetics (suppresses the nausea) Ergot Alkaloids Ergot Ergotamine – Mechanism of antimigraine action • Exact mechanism unknown – Therapeutic uses • Drug of choice to stop an ongoing migraine Drug ongoing • Should not be used daily- only with a migraine Should – Pharmacokinetics • Oral, sublingual, rectal, or inhalation – Adverse effects • N/V, weakness in the legs, myalgia, numbness and tingling in N/V, fingers or toes, angina-like pain, tachycardia or bradycardia fingers – Physical dependence • Risk of regular daily use – Contraindications • Hepatic or renal impairment Ergot Alkaloids Ergot Dihydroergotamine (DHE) – Therapeutic uses • Drug of choice for terminating migraine and cluster Drug headaches headaches – Pharmacologic effects • Similar to ergotamine – Pharmacokinetics • Only parenteral or nasal spray administration – not Only oral oral – Contraindications • Patients with CAD, PVD, sepsis, pregnancy, hepatic Patients or renal impairment or Serotonin1B/1D Receptor Agonists Serotonin Sumatriptan (Imitrex) – Mechanism of action • Binds to receptors on intracranial blood vessels and Binds causes vasoconstriction (acts like caffeine) causes • Diminishes perivascular inflammation – Therapeutic use • Aborting an ongoing migraine attack to relieve Aborting headache and associated symptoms headache – Pharmacokinetics • Oral or intranasal administration • 2.5 hour half life dosing 2.5 Serotonin1B/1D...
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