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Year 2 neuro exam 2 > Pharm HA and migraines Kinder > Flashcards

Pharm HA and migraines Kinder Flashcards

1
Q

What drugs are used for Acute Migraine Therapies

A 
serotonin agonists "triptans"
ergot alkaloids
analgesics
combinations analgesics
NSAIDs
antiemetics
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2
Q

what drug classes are used for prophylactic migraine therapies

A

beta antagonists
CaCh blockers
antidepressants
anticonvulsants

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3
Q

what are the ergot alkaloids

A

dihydroergotamine DHE

ergotamine +/- caffeine

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4
Q

What are the combination analgesics

A

aspirin, acetaminophen, caffeine (excedrin)

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5
Q

what antiemetics are used for migraines

A

metoclopramide

prochlorperazine

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6
Q

what beta antagonists are used for migrain

A

metoprolol and propanolol

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7
Q

what Ca Ch blocker in migraines

A

verapamil

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8
Q

what antidepressants used in migrain

A

amitriptyline

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9
Q

what antivconvulsant for migraine

A

topiramate (topomax)

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10
Q

what can cause secondary HA

A

infeciton, cerebral HA, brain mass lesion

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11
Q

unilateral HA with crescendo pattern that is pulsatiing and aggravated by physical activity
+ nausea, vomiting and photophobia

A

migraine

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12
Q

bilateral HA with pressure or tightness that waxes and wanes

- nausea vomiting

A

tension HA

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13
Q

unilateral pain around eye that is quick onset deep and excruciating
ipsi lacrimation and redness, rhinorrhea, sweating

A

cluster

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14
Q

aura involves what

A

nausea, vomiting, visual scotomas, hemianopsia and speech abnormalities

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15
Q

pathophys migraine

A

CN V involvement

release calcitonin gene related peptide CGRP which vasodilates and cause dural plasma extravasation causing inflammation

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16
Q

triggers of migraines

A

food, alcohol, caffeine or withdrawal, chocolate, monoNa glutamate, aspartame
flivkering lights, high altitude, strong smells, tobacco, weather
excess or not enough sleep, fatigue, menstruation, skipped meals, strenuous acitivity

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17
Q

most common type primary HA disorder

A

tension type

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18
Q

main stay Tx for preventative of tension type HA

A

amitriptyline

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19
Q

90% serotonin is found where

A

enterochromaffin cells in GI

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20
Q

where is serotonin in blood

A

in platelets

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21
Q

what inactivates serotonin

A

MAO

monoamine oxidase

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22
Q

what is used to detect serotonin secreting tumor

A

5-IAA which is byproduct of inactivated serotonin

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23
Q

CNS serotonin effects

A

vomiting reflex

pain/itch stimulation

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24
Q

CV serotonin effects

A

contraction vascular smooth m
causes dilation in heart and venoconstriction
promotes platelet aggregation

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25
Q

GI serotonin effects

A

increase tone and perstalsis 5-HT2

motility enhancing 5-HT4

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26
Q

skel mm serotonin effects

A

contraction when MAO inhibitors given with serotonin agonists

27
Q

What are the serotonin agonists

A

triptans

5-HT1D/1B

28
Q

triptans used for what HA

A

migraine

29
Q

MOA sumatriptan

A

activates R on presynaptic CN V endings inhbiiting vasodilatory peptides and stimulates vasoconstriction

30
Q

PK sumatriptatn

A

MAO

shorter duration

31
Q

routes of sumatriptan administration

A

oral, nasal, subcut, rectal

32
Q

adverse effects sumatriptan

A

altered sensations like tingling and warmth, dizziness, muscle weakness, fatigue, flushing, drowsiness, nausea, sweating and neck pain

33
Q

sumatriptan CI

A

those taking MAO inhibitors
coronary a disease, angina, IHD, uncontrolled HTN
do not use after ergotamine derivative!

34
Q

MOA ergotamine

A

constriction peripheral and cranial blood vessels
may also affect presynaptic CN V inhibiting vasodilatory peptides
agonist at 5-HT1D/1B

35
Q

PK ergotamine

A

variable from GI

increase absorption with caffeine

36
Q

use of ergotamine

A

migraine

reserved for those with prolonged attack

37
Q

what can occur if exceed max dose of ergotamine

A

too much vasoconstriction
gangrene
bowel infarction

38
Q

adverse effects ergotamine

A

GI :diarrhea, nausea, vomiting through GI serotonin R and medullary vomiting center, paresthesias, drowsiness

39
Q

CI ergotamine

A

obstructive vascular disease, collagen diseases, uncontrolled HTN, hepatic or renal dysfunction, pregnancy

40
Q

MOA analgesics and NSAID in HA

A

prevent PG synthesis decreasing inflammation

41
Q

MOA metoclopramide

A

block D2 like R in chemoR trigger zone and solitary tract nucleus

42
Q

use of antiemetics

A

Tx nausea vomiting part of migraine

43
Q

adverse effects antiemetics

A

drowsiness, dizziness, extrapyramidal Sx not frequent

44
Q

MOA propranolol

A

modulate adrenergic or serotonergic NT in cortical and subcortical pathways raising threshold for migraines

45
Q

use of beta blockers

A

migraine prophylaxis

46
Q

adverse effects beta blockers

A

drowsiness, fatigue, sleep disturbances, vivid dreams, memory disturbance, depression

47
Q

caution with beta blockers in

A 
CHF
Peripheral vascular disease
AV conduction
asthma
depression
DM
48
Q

MOA verapamil

A

inhibits Ca entry from voltage sensitive areas of vasc sm mm

produce vasc sm mm relaxation and vasodilation

49
Q

use verapamil

A

migriane prophylaxis

shows beneficial in prophylaxis for cluster HA

50
Q

type of antidepressan amitriptyline and MOA

A

tricyclic
down regulation 5HT2 R
increased NE in synapse
enhanced opioid R actions

51
Q

therapeutic use amitripyline

A

migraine prophylaxis

52
Q

adverse to tricyclic antidepressants

A

sedation- take at night

53
Q

MOA topiramate

A

enhance GABA mediated inhibition

modulate excitatory NT glutamate and inhibit Na and Ca Channels

54
Q

use of topiramate

A

migraine especially in those with comorbid seizures, anxiety or bipolar disorder

55
Q

adverse effects topiramate

A

paresthesias, fatigue, anorexia, diarrhea, weight loss, taste perversion

56
Q

first line for mild to mod migraines

A

NSAIDs

57
Q

if poor response to NSAID, next step

A

combination product

58
Q

first line for mild to severe migraine attacks

A

triptans

59
Q

if unresponseive to triptan

A

use IV antiemetic and ergot alkaloid

60
Q

when do use daily prophylaxis fo HA

A

migrain recuts with significatn disability
attacks >2 a week
Sx therapies ineffective
patients prefer prophylaxis

61
Q

Tx for mild to moderate tension HA

A

simple analgesics +/- caffeine and NSAIDs

62
Q

prevention tension HA

A

tricyclic antidepressant

63
Q

abortive Tx for cluster HA

A

oxygen, triptan, ergot alkaloid

64
Q

prophylaxis cluster HA

A

verapamil, lithium, prednisone, topiramate

Year 2 neuro exam 2 (23 decks)

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