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Untitled Prezi

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by

Manoj Pradeep

on 4 June 2013

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MIGRAINE A pharmacological review What is Migraine? PATHOGENESIS OF MIGRAINE A severe, painful headache.
Origin - Neurological disorder (involving Autonomic nervous system)
Chief complains - Typically the headache is unilateral (affecting one half of the head) and pulsating in nature always associated with nausea and vomiting.
Episodes - Each episode of Migraine may last from 4 hours to 72 hours and the severity varies from person to person. A person may suffer from any number of episodes per month.
Sensory warning signs - such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light (photophobic) and sound (phonophobic). PAIN AURA Mechanism of pain and aura are still not clearly known. Some believe that reason is neuronal mechanism (neuropeptide release) and others feel blood vessels are the key(Vaso dilation).
HIGH LEVELS OF SEROTONIN is believed to be the key factor along with Arterial dilatation. PROVOKING FACTORS EPIDEMIOLOGY WOMEN > MEN & MORE PREVALENT IN AGES OF 16 to 60 CAUSES 1. GENETICS
Studies of twins indicate a 34 to 51% genetic influence of likelihood to develop migraine headaches. This genetic relationship is stronger for migraines with aura than for migraines without aura. A number of specific variants of genes increase the risk by a small to moderate amount.
Single gene disorders that result in migraines are rare. One of these is known as familial hemiplegic migraine, a type of migraine with aura, which is inherited in an autosomal dominant fashion. Four genes have been shown to be involved in familial hemiplegic migraine.Three of these genes are involved in ion transport.The fourth is an axonal protein associated with the exocytosis complex. Another genetic disorder associated with migraine is CADASIL syndrome or cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

2. SOCIO-ENVIRONMENTAL FACTORS. SIGNS AND SYMPTOMS ERGOT ALKALOIDS DIAGNOSIS PHARMACOLOGY Beta Blockers.
Anti-Convulsants.
Anti-Depressants.
Pain relievers.
Triptans.
Ergotamine and caffeine combination drugs
Anti-nausea medications
Opiates
Dexamethasone
Preventive medications
Cardiovascular drugs
Antidepressants
Anti-seizure drugs
Botulinum toxin type A (Botox).
Cyproheptadine Anti-nausea medications:
Frequently prescribed medications are metoclopramide (Reglan) or prochlorperazine (Compro).
Opiates:
Medications containing narcotics, particularly codeine, are sometimes used to treat migraine headache pain when people can't take triptans or ergot
Dexamethasone:
This corticosteroid may be used in conjunction with other medication to improve pain relief. Because of the risk of steroid toxicity, dexamethasone should not be used frequently.
Preventive medications:
Can reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. Symptomatic treatment drugs.
Cyproheptadine:
This antihistamine specifically affects serotonin activity.
Botulinum toxin type A (Botox):
The FDA has approved botulinum toxin type A for treatment of chronic migraine headaches in adults. During this procedure, injections are made in muscles of the forehead and neck. When this is effective, the treatment typically needs to be repeated every 12 weeks. Latest treatment and even a prevention to migraine. OTHER DRUGS BETA BLOCKERS Beta blockers are the drugs most widely used in the treatment of Migraine.
eg, Propranolal, Nadolol, Timolol, Acebutolol, Celiprolol.

MECHANISM OF ACTION :
Blocks B adrenergic receptor and causes Vaso constriction.

EFFECTS :
Bradycardia and hypotension.

TOXICITY :
1. Fatigue
2. Depression
3. Impotency in case of prolonged drug use.
4. Organ dysfunction in case of Over dose.

DURATION OF ACTION :
3 hours to 6 hours.

CONTRAINDICATIONS
Should be avoided in elderly patient coz it may lead to Heart failure due to hypotension and bradycardia
These drugs includes Gabapectins, Valproate and Lamotrigine.

MECHANISM OF ACTION :
Na+ channel blocking Anti-epileptic drugs.

EFFECTS :
Causes Vasoconstriction.

TOXICITY :
1. Angina Pectoris
2. Gangrene

DURATION OF ACTION :
12 hours to 24 hours.


TRIPTANS SSRI - Selective Serotonin Reuptake Inhibitors and SNRI - Selective Norepinephrine Reuptake Inhibitor.

SSRI SNRI

MECHANISM OF ACTION Blocks Serotonin Re-uptake Blocks Nor epinephrine


DRUGS AVAILABLE : Fluoxetine, Sertraline. Duloxetine, Vendafaxine.

01. Sexual Dysfunction. 01. Sedation.
TOXICITY : 02. Serotonin syndrome. 02. Hypertension.
(dangerous, SHOCK)

DURATION OF ACTION : 15 hours to 72 hours 75 to 300 hours.


SSRI and SNRI These drugs includes Ibubrofen, Acetaminophen

MECHANISM OF ACTION :
It elevates the pain threshold so person needs more pain to actually feel the pain.

EFFECTS :
Some times It may be addictive.

TOXICITY :
1. Some times leads to hepatotoxicity due to over dose.
2. Drug dependence.

DURATION OF ACTION :
6 hours to 12 hours.

CONTRAINDICATIONS
Should be avoided during pregnancy and breast feeding.
PAIN RELIEVERS ANTI SEIZURE DRUGS Most Widely used Anti-depressants are Tri-cyclic Anti Depressants (TCA). Most commonly used TCA is Amitriptyline.

MECHANISM OF ACTION :
Causes decreased reuptake of serotonin and Nor epinephrine.

EFFECTS :
Down regulation of signalling of neuropeptides.

TOXICITY :
1. Fatigue
2. Sedation
3. Seizures in case of prolonged drug use.
4. Weight gain..

DURATION OF ACTION :
20 hours to 90 hours

CONTRAINDICATIONS
Should be avoided in pregnancy and during breast feeding.
ANTI- DEPRESSANTS These drugs includes Gabapectins, Valproate and Lamotrigine.

MECHANISM OF ACTION :
Na+ channel blocking Anti-epileptic drugs.

EFFECTS :
Leads to blockage of Neuropeptides transmission and thus stops pain.

TOXICITY :
1. Dizziness
2. Head ache

DURATION OF ACTION :
10 hours to 14 hours.

CONTRAINDICATIONS
Should be avoided during pregnancy and breast feeding.
These drugs includes Sumatriptan, Lizatriptan, Zolmitriptan etc.

MECHANISM OF ACTION :
5HT receptor agonist.

EFFECTS :
Inhibition of Neuropeptides and causes Vasoconstriction.

TOXICITY :
1. Dizziness
2. Sometimes may cause Coronary Vaso constriction.

DURATION OF ACTION :
2 hours to 4 hours

CONTRAINDICATIONS
Should be avoided with heart diseases and hypertension.
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