Pharm HA and migraines Kinder Flashcards Preview

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Flashcards in Pharm HA and migraines Kinder Deck (64):
1

What drugs are used for Acute Migraine Therapies

serotonin agonists "triptans"
ergot alkaloids
analgesics
combinations analgesics
NSAIDs
antiemetics

2

what drug classes are used for prophylactic migraine therapies

beta antagonists
CaCh blockers
antidepressants
anticonvulsants

3

what are the ergot alkaloids

dihydroergotamine DHE
ergotamine +/- caffeine

4

What are the combination analgesics

aspirin, acetaminophen, caffeine (excedrin)

5

what antiemetics are used for migraines

metoclopramide
prochlorperazine

6

what beta antagonists are used for migrain

metoprolol and propanolol

7

what Ca Ch blocker in migraines

verapamil

8

what antidepressants used in migrain

amitriptyline

9

what antivconvulsant for migraine

topiramate (topomax)

10

what can cause secondary HA

infeciton, cerebral HA, brain mass lesion

11

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

migraine

12

bilateral HA with pressure or tightness that waxes and wanes
- nausea vomiting

tension HA

13

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

cluster

14

aura involves what

nausea, vomiting, visual scotomas, hemianopsia and speech abnormalities

15

pathophys migraine

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

16

triggers of migraines

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

17

most common type primary HA disorder

tension type

18

main stay Tx for preventative of tension type HA

amitriptyline

19

90% serotonin is found where

enterochromaffin cells in GI

20

where is serotonin in blood

in platelets

21

what inactivates serotonin

MAO
monoamine oxidase

22

what is used to detect serotonin secreting tumor

5-IAA which is byproduct of inactivated serotonin

23

CNS serotonin effects

vomiting reflex
pain/itch stimulation

24

CV serotonin effects

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

25

GI serotonin effects

increase tone and perstalsis 5-HT2
motility enhancing 5-HT4

26

skel mm serotonin effects

contraction when MAO inhibitors given with serotonin agonists

27

What are the serotonin agonists

triptans
5-HT1D/1B

28

triptans used for what HA

migraine

29

MOA sumatriptan

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

30

PK sumatriptatn

MAO
shorter duration

31

routes of sumatriptan administration

oral, nasal, subcut, rectal

32

adverse effects sumatriptan

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

33

sumatriptan CI

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

34

MOA ergotamine

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

35

PK ergotamine

variable from GI
increase absorption with caffeine

36

use of ergotamine

migraine
reserved for those with prolonged attack

37

what can occur if exceed max dose of ergotamine

too much vasoconstriction
gangrene
bowel infarction

38

adverse effects ergotamine

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

39

CI ergotamine

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

40

MOA analgesics and NSAID in HA

prevent PG synthesis decreasing inflammation

41

MOA metoclopramide

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

42

use of antiemetics

Tx nausea vomiting part of migraine

43

adverse effects antiemetics

drowsiness, dizziness, extrapyramidal Sx not frequent

44

MOA propranolol

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

45

use of beta blockers

migraine prophylaxis

46

adverse effects beta blockers

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

47

caution with beta blockers in

CHF
Peripheral vascular disease
AV conduction
asthma
depression
DM

48

MOA verapamil

inhibits Ca entry from voltage sensitive areas of vasc sm mm
produce vasc sm mm relaxation and vasodilation

49

use verapamil

migriane prophylaxis
shows beneficial in prophylaxis for cluster HA

50

type of antidepressan amitriptyline and MOA

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

51

therapeutic use amitripyline

migraine prophylaxis

52

adverse to tricyclic antidepressants

sedation- take at night

53

MOA topiramate

enhance GABA mediated inhibition
modulate excitatory NT glutamate and inhibit Na and Ca Channels

54

use of topiramate

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

55

adverse effects topiramate

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

56

first line for mild to mod migraines

NSAIDs

57

if poor response to NSAID, next step

combination product

58

first line for mild to severe migraine attacks

triptans

59

if unresponseive to triptan

use IV antiemetic and ergot alkaloid

60

when do use daily prophylaxis fo HA

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

61

Tx for mild to moderate tension HA

simple analgesics +/- caffeine and NSAIDs

62

prevention tension HA

tricyclic antidepressant

63

abortive Tx for cluster HA

oxygen, triptan, ergot alkaloid

64

prophylaxis cluster HA

verapamil, lithium, prednisone, topiramate