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Pharmacology 200 > 2-migraine > Flashcards

2-migraine Flashcards

1
Q

what drives aura

A

cortical spreading depression

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2
Q

what is cortical spreading depression

A

wave of depolarization followed by desensitization (depression) that propagates across the cortex

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3
Q

what are familial hemiplegic migraines

A

migraines that include weakness in half of the body

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4
Q

what is the inheritence of familial hemiplegic migraines

A

autosomal dominance

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5
Q

what are the mutated genes associated with familial hemiplegic migraines

A

P/Q type Ca channel
NaK ATPase
Na channel subunit
(maintain hyperexcitability of neuron)

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6
Q

what are the reasons that familial hemiplegic migraines happen

A

lowered threshold for cortical spreading depression

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7
Q

what is the trigeminal nerve special for

A

the largest cranial nerve

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8
Q

what does the trigeminal system do

A

sense pain in face and head, including vasculature and dura matter

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9
Q

what are the three branches of the trigeminal system

A

ophthalmic, maxillary, mandibular

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10
Q

where is pain in the head detected and by who

A

in the dura mater and blood vessels, ophthalmic branch

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11
Q

what does 5HT do to blood vessels

A

vasoconstriction

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12
Q

what are the 5HT levels of migraineurs between attacks

A

low

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13
Q

what happens to 5HT during attacks

A

released

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14
Q

where is CGRP located

A

in trigeminal peripheral afferents

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15
Q

what does CGRP release cause

A

vasodilation (in response to pain)

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16
Q

what are the CGRP levels in migraineurs

A

high

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17
Q

what does prophylatic treatment mean

A

preventative, taken daily

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18
Q

what are some pharmacological prophylatic interventions for migraine

A

beta blockers (decrease bp), anticonvulsants(block pain transmission), antidepressants(increase serotonin)

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19
Q

why can caffeine be good for migraine

A

it leads to vasocontriction

20
Q

where does caffeine bind to

A

caffeine is an adenosine receptor antagonist

21
Q

how else does caffeine help headaches (because vaso-)

A

increases absorption of some analgesics

-constriction

22
Q

what receptors do ergotamines bind to and what does it cause

A

5HT-1b 5HT-1d
inhibit neurogenic inflammation
but low specificity, more side effects

23
Q

what do ergotamines do to coronary vessels

A

vasoconstrict

24
Q

what are bad things that can happen to people with coronary artery disease taking ergotamines

A

can change blood flow and anginal pain

also bad for other vessel and heart diseases

25
Q

what is the absorption and distribution of ergotamines

A

large first pass metabolism, low bioavailability

26
Q

what is the half life and metabolism of ergotamines

A

in liver by poorly defined enzymes, 2 hour half life

27
Q

how is ergotamines excreted

A

in bile

28
Q

where do triptans bind

A

5-HTb/d agonists

29
Q

what are the mechanisms of triptans

A

vasoconstriction and inhibition of trigeminal nerve

30
Q

why are triptans better than ergotamines

A

avoids the side effects (Cardiac!)

31
Q

what is sumatriptan bioavailability and half life

A

14% oral
96% subcutaneously

2 hours

32
Q

how is sumatriptan metabolized

A

by monoamine oxidase in liver into indoleacetic acid

33
Q

how is sumatriptan excreted

A

urine

34
Q

how do CGRP antagonists work

A

antibodies or to receptor

block inflammation, vasodilation and pain

35
Q

what is olcegepant and its story

A

good at treating migraine, poor bioavailability

abandoned phase 2 trials

36
Q

what is the half life and metabolism of ergotamines

A

in liver by poorly defined enzymes, 2 hour half life

37
Q

how is ergotamines excreted

A

in bile

38
Q

where do triptans bind

A

5-HTb/d agonists

39
Q

what are the mechanisms of triptans

A

vasoconstriction and inhibition of trigeminal nerve

40
Q

why are triptans better than ergotamines

A

avoids the side effects (Cardiac!)

41
Q

what is sumatriptan bioavailability and half life

A

14% oral
96% subcutaneously

2 hours

42
Q

how is sumatriptan metabolized

A

by monoamine oxidase in liver into indoleacetic acid

43
Q

how is sumatriptan excreted

A

urine

44
Q

how do CGRP antagonists work

A

antibodies or to receptor

block inflammation, vasodilation and pain

45
Q

what is telcagepant and its story

A

good at treating migraine, but daily it was bad for liver (aminotranferase elevated)
abandoned phase 3 trials

46
Q

what is rimegepant and its story

A

very effective migraine treatment, less effect on liver

Pharmacology 200 (29 decks)

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