Autocoids and therapy of migraines

Question 1

histamine releasers

Answer 1

Morphine, d-tubocurarine, vancomycin, succinylcholine

Heat, cold, exposure to sunlight & X-rays

Insect bites/ stings, venoms

*** may lead to anaphylaxis, side effects, allergies

Question 2

anaphylactic shock

Answer 2

bronchospasms, angioneurotic edema, and hypotension (due to release, and effects of histamine)

Question 3

drug of choice against anaphylactic shock

Answer 3

epinephrine

Question 4

Histamine release inhibitors

Answer 4

β2 agonist- Albuterol, Epinephrine

Mast cell membrane stabilizers- sodium cromoglycate

***Used in bronchial asthma

Question 5

H1 blockers are used in

Answer 5

allergic conditions

Question 6

H2 blockers are used in

Answer 6

peptic ulcer

Question 7

H1 receptor mediated actions

Answer 7

Smooth muscles: bronchoconstriction

Exocrine glands: ↑ secretion

** Postsynaptic H1 in CNS: maintenance of wakefulness

Question 8

H1 & H2 receptor mediated actions

Answer 8

fall i BP, ↑ cap permeability, headache: due to release of EDRF (NO)**

flush, wheel, flare

Question 9

H2 receptor mediated actions

Answer 9

H2 receptor on gastric parietal cells

Question 10

H3 receptor mediated actions

Answer 10

feedback inhibitors

release of histamine, NE & Ach

Question 11

First generation H1 receptor antagonists

Answer 11

High permeability to BBB

More sedating

antimuscarinic side effects (dry mouth, urinary retention, constipation)

Question 12

Second generation H1 receptor antagonists

Answer 12

selective H1 antagonism

Poor permeability to BBB (non-/less sedating)

Question 13

First generation H1 receptor antagonist examples

Answer 13

Dimenhydrinate Diphenhydramine

HIGHLY SEDATIVE, antimotion sickness, antiemetic, sleep aid

Question 14

Second generation H1 receptor antagonist examples

Answer 14

Fexofenadine
Cetrizine
Loratadine Desloratadine

(NON-SEDATING, more potent, longer acting, no/minimal anticholinergic effects )

Question 15

Vertigo (Meniere’s disease)

Answer 15

cinnarizine

Question 16

COX 1

Answer 16

constitutive

Question 17

COX 2

Answer 17

inducible

Question 18

PGI2 causes

Answer 18

vasodilation and inhibits platelet aggregation

Question 19

TXA2 causes

Answer 19

vasoconstriction and platelet aggregation

Question 20

PGE2 keeps

Answer 20

the ductus arteriosus patent

Question 21

PGE2 in the hypothalamus causes

Answer 21

pyrogen induced fever

Question 22

Medical termination of pregnancy (up to 56 days of pregnancy)

Answer 22

Misoprostol (PGE1 analogue)

Question 23

Induction/ augmentation of labor/mid term abortion/ softening or ripening of cervix

Answer 23

Dinoprostone (PGE2 analogue)

Gemeprost (PGE1 analogue)

Question 24

Post-partum hemorrhage

Answer 24

Carboprost (PGF2α analogue)

Question 25

Peptic ulcer due to NSAIDs use

Answer 25

Misoprostol (PGE1 analogue)

Question 26

Glaucoma

Answer 26

Latanoprost

Question 27

To avoid platelet damage

Answer 27

PGI2 (Epoprostenol)

Question 28

Impotence

Answer 28

sildenafil/ tadalafil

Question 29

aspirin in low dose

Answer 29

used to inhibit platelets in MI patients

Question 30

aspirin in high dose

Answer 30

inhibits TXA2 in platelets (anti-platelet effect)

Question 31

NSAIDs

Answer 31

relieve musculoskeletal inflammatory pain very well (↓ inflammation, ↓ sensitization)

Question 32

useful in bronchial asthma

Answer 32

Zilueton and LTC4 and D4 receptor blockers (Zafirlukast & montelukast)

Question 33

classical migraine

Answer 33

migraine with aura

Question 34

common migraine

Answer 34

migraine without aura

Question 35

The Vascular theory

Answer 35

initial vasoconstriction -> cerebral ischemia -> vasodilation

Question 36

Buspirone

Answer 36

partial agonist of 5-HT1A receptor anti-anxiety drug

Question 37

sumatriptan

Answer 37

selective 5-HT1D/1B agonist antimigraine drug induce vasoconstriction Side effect: • Coronary vasospasm (contraindicated in patients with CAD or Prinzmetal angina)

Question 38

Cisapride and renzapride

Answer 38

selective 5-HT4 agonists prokinetic drugs

Question 39

metoclopramide

Answer 39

5-HT4 agonist, 5-HT3 & D2 antagonist antiemetic

Question 40

Ondansetron

Answer 40

selective 5-HT3 antagonist **** antiemetic in cancer chemotherapy induced nausea & vomiting

Question 41

Clozapine

Answer 41

5-HT2A/2C antagonist antipsychotic

Question 42

SSRIs

Answer 42

fluoxetine antidepressants

Question 43

Ergotamine, Dihydroergotamine

Answer 43

partial agonists at α adrenergic and 5-HT1, and 5HT2 receptors

Question 44

Propranolol

Answer 44

β blockers

Question 45

Amitriptyline

Answer 45

tricyclic antidepressants

Question 46

Flunarizine

Answer 46

Ca2+ channel blockers