EXAM #4: RA AD ANTI-MIGRAINE Flashcards Preview

Pharmacology > EXAM #4: RA AD ANTI-MIGRAINE > Flashcards

Flashcards in EXAM #4: RA AD ANTI-MIGRAINE Deck (33):
1

What two inflammatory cytokines are primarily implicated in the pathogenesis of RA?

- TNF-a
- IL-1

2

What are the first line drugs to treat RA?

NSAIDs

*Note that these drugs are only treating the symptoms

3

What is a DMARD?

Disease Modifying Anti-Rheumatic Drug

*These drugs are able to slow the progression of RA and treat symptoms

4

How long does it take DMARDs to produce an effect?

6 weeks to 6 months i.e. very slow onset

5

What is the first line DMARD treatment for RA?

Methotrexate

6

What is the MOA of Methotrexate?

- Inhibits AICAR transformylase
- Increases extracellular adenosine
- Inhibits T-cell activation
- Cytotoxic to lymphocytes

*Note that the mechanism of MTX is different for RA and cancer*

7

What are the other synthetic DMARDs?

Leflunomide
Chloroquine
Hydroxychloroquine

8

What is the MOA of Leflunomide?

Inhibits ribonucleotide synthesis and causes cell cycle arrest

9

What was the first RA agent approved for treatment of both the symptoms and pathogenesis of RA?

Lefluomide

10

What is the MOA of the anti-malarial compounds in treating RA?

Unknown

11

What are the Biologic DMARDs?

Etanercept
Infliximab
Anakinra

12

List the anti-TNF agents.

Etanercept
Infliximab

13

What is the MOA of Etanercept?

Cytokine receptor fusion protein

14

What is the MOA of Infliximab?

anti-TNF monoclonal antibody

15

What drug is the anti-IL-1 DMARD?

Anakinra

16

What are the non-pharmacological approaches to treating migraines?

1) Avoid triggers
2) Regular sleep, meals, and exercise

17

List the drugs that used to PREVENT migraines.

1) Propranolol
2) Metoprolol
3) Amitriptyline
4) Valproic acid
5) Topiramate

18

What are the treatments of choice for the prevention of migraines?

Beta-blockers:
- Propranolol
- Metoprolol

19

What class of drug is Amitriptyline?

TCA

20

What are the non-specific drugs use to treat acute migraine attacks?

NSAIDs
Opiods
Anti-emetics

21

Why should on avoid the overuse of non-specific agents to treat migraines?

Overuse can lead to "transformation" of the migraine into a more severe chronic disorder

22

Why are opioids not recommended for acute migraine attacks?

- Dependence
- Tolerance
- Risk of adverse effects
- Risk of transformation

23

What are the adverse effects associated with opiates as anti-migraine agents?

- Rebound headache
- Dizziness
- Nausea
- Vomiting
- Impaired cognitive function

24

List the anti-emetics commonly used as adjuncts to treat migraines.

Metoclopramide
Cholpromazine
Prochlorperazine

25

What is the MOA of Metoclopramide?

5-HT3 antagonist

26

What are the migraine specific drug therapies?

1) Ergot derivatives
2) Triptans

27

What are the ergot derivatives used to treat migraines?

- Ergotamine
- Dihydroergotamine

28

What is the MOA of the ergot derivatives?

Alpha-adrenergic and 5-HT receptor agonists that cause VASOCONSTRICTION

*5-HT1D specifically

29

What are the disadvantages associated with the Ergot Derivatives?

- Complex pharmacology
- Complex pharmacokinetics

30

What is the prototype Triptan?

Sumatriptan

31

What is the MOA of the Triptans?

Selevtive 5-HT1D and 1B receptor agonists

32

What are the disadvantages of the Triptans?

- High cost
- Restrictions in presence of CV disease

*5-HT1B agonism can mimic angina

33

What ultimately resolves many migraines?

Sleep

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