Flashcards in EXAM #4: RA AD ANTI-MIGRAINE Deck (33):
What two inflammatory cytokines are primarily implicated in the pathogenesis of RA?
What are the first line drugs to treat RA?
*Note that these drugs are only treating the symptoms
What is a DMARD?
Disease Modifying Anti-Rheumatic Drug
*These drugs are able to slow the progression of RA and treat symptoms
How long does it take DMARDs to produce an effect?
6 weeks to 6 months i.e. very slow onset
What is the first line DMARD treatment for RA?
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*
What are the other synthetic DMARDs?
What is the MOA of Leflunomide?
Inhibits ribonucleotide synthesis and causes cell cycle arrest
What was the first RA agent approved for treatment of both the symptoms and pathogenesis of RA?
What is the MOA of the anti-malarial compounds in treating RA?
What are the Biologic DMARDs?
List the anti-TNF agents.
What is the MOA of Etanercept?
Cytokine receptor fusion protein
What is the MOA of Infliximab?
anti-TNF monoclonal antibody
What drug is the anti-IL-1 DMARD?
What are the non-pharmacological approaches to treating migraines?
1) Avoid triggers
2) Regular sleep, meals, and exercise
List the drugs that used to PREVENT migraines.
4) Valproic acid
What are the treatments of choice for the prevention of migraines?
What class of drug is Amitriptyline?
What are the non-specific drugs use to treat acute migraine attacks?
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
Why are opioids not recommended for acute migraine attacks?
- Risk of adverse effects
- Risk of transformation
What are the adverse effects associated with opiates as anti-migraine agents?
- Rebound headache
- Impaired cognitive function
List the anti-emetics commonly used as adjuncts to treat migraines.
What is the MOA of Metoclopramide?
What are the migraine specific drug therapies?
1) Ergot derivatives
What are the ergot derivatives used to treat migraines?
What is the MOA of the ergot derivatives?
Alpha-adrenergic and 5-HT receptor agonists that cause VASOCONSTRICTION
What are the disadvantages associated with the Ergot Derivatives?
- Complex pharmacology
- Complex pharmacokinetics
What is the prototype Triptan?
What is the MOA of the Triptans?
Selevtive 5-HT1D and 1B receptor agonists
What are the disadvantages of the Triptans?
- High cost
- Restrictions in presence of CV disease
*5-HT1B agonism can mimic angina