NR-566 Advanced Pharmacology for Care of the Family

Final Exam Study Set Review

Preventive treatment for migraines

- indicated for patients who have frequent attacks (three or more a month),

attacks that are especially severe, or attacks that do not respond adequately to

abortive agents.

Preferred drugs for migraine prophylaxis

- propranolol, divalproex, and amitriptyline. All three are effective and well

tolerated, and with all three, the benefits take 4 to 6 weeks to develop.

First-line drugs for migraine prevention.

- β blockers; propranolol is used most often

Divalproex (Depakote) Migraine Indication

- Migraine Prophylaxis; reduces the incidence of attacks by 50% or more in 30%

to 50% of patients.

Divalproex (Depakote) Black Box Warning

- Potentially fatal pancreatitis and hepatitis can occur. In addition, divalproex

can cause neural tube defects in the developing fetus, and hence is

contraindicated during pregnancy.

Topiramate (Topamax) Migraine Indication

- Benefits take several weeks to develop and appear equal to those of β

blockers, tricyclic antidepressants, or divalproex. Very expensive

Amitriptyline (Elavil)

- Tricyclic Antidepressants; Alternative for use as Migraine Prophylaxis

Erenumab: a calcitonin gene-related peptide receptor antagonist.

- Prophylaxis of Migraines; antibody binds to, and antagonizes the function of,

the CGRP receptors, and is thought to play an important role in the

development of migraine headache,

Injections of botulinum toxin A (Botox)

- approved for the prevention of headaches in adults with chronic migraine

(defined as having 15 or more headache days per month), but not for patients

with less frequent headaches.

Botulinum Black Box Warning

- can spread from the site of injection and produce muscle weakness, difficulty

with respiration, and swallowing difficulties that can be life threatening.

Memantine

- first-in-class (NMDA) N-Methyl-D-Aspartate Receptor Antagonist; indicated

only for moderate or severe AD.

Memantine MOA

- modulates the effects of glutamate (the major excitatory transmitter in the

central nervous system) at NMDA receptors, which are believed to play a

critical role in learning and memory