pharmacology Flashcards
What are the phases of a migraine headache
Aura phase=decrease in blood flow occipital lobe
Headache phase=inflammation of meninges CN V, release of CGRP, vasodilation & inflammation.
How do -triptans like sumatriptan work? When should they be used?
They work as autoreceptor agonists on 5-HT neurons and have the same effect as serotonin would in a negative feedback cycle. This binding suppresses the release of GCRP leading to vasoconstriction; also inhibit nociceptive neurotransmitters.
They are a first line therapy for migraine attacks
What are the pharmacokinetics of -triptans? Adverse effects? Contraindications?
ADME: rapid onset of action-many ways to take it
Side effects:tightness, dizziness, paresthesia (careful about prescribing drugs thinking these are symptoms of something else;cascade effect?)
Contraindications: peripheral vascular disease or uncontrolled bp…..
Ergot alkaloids have what poisoning effects? Which do we need to know? What’s the mechanism of action?
hallucination, vasospasm, spontaneous abortion
Dihydroergotamine DHE, and Ergotamine
Mech-multiple receptors;not specific
When would you take ergotamine? DHE? What are some pharmacokinetic points of interest among these medications?
Ergotamine-Migrane pain, at the beginning of an attack
DHE-headache that wont go away
metabolites are similar to parent compound which increases the effective time of action.
What are some contraindications for Ergot alkaloids?
24hrs since administration of triptan
lots of vascular related diseases and conditions
Beta blockers are used in what context for migrane cephalgia? What drug interactions should you be concerned about?
First line drug for prevention
example-Propranolol (avoid with aura)
Calcium blocker interactions can be severe: heart failure, hypotension
What’s the ANS drug rule to remember?
These drugs, even if they target B1 receptors, don’t alway bind a single receptor type.
What is not an indication for migraine prevention?
A) Frequency is >2/month
B) Duration longer than 24hrs
C) Use of abortive medications more than twice a week
D) facial parethesia
What’s one example of an abortive migraine medication?
D- unrelated
Preventative medications often end in -olol like propranolol
Ex-abortive migraine med-Ergotamine
Which antidepressant is used to treat migraine cephalgia? When is it’s use indicated and what are some adverse effects?
prochlorperazine
Treat symptoms associated with migrane-NVP
Adverse effects- restlessness (can be fixed with diphenhydramine/benadryl)
Better than sumatriptan for pain
How do you treat medication overuse headaches? MOH?
Education and detoxification
A patient comes into your office presenting with some bizarre skin nodules. She tells you that she recently spent some time logging in the pacific northwest; specifically for eucalyptus trees. She also has a unique genetic disorder that decreases her renal function, but she’s optimistic about her chances of a transplant some day. She’s just grateful she doesn’t need to take a lot of medications. You decide to start her on a drug treatment to cure her of these unsightly nodules. What should you treat her with?
A) Deoxycholate B) Itraconazole C) Micafungin D) Penicillin G E) Flucytosine
B) Itraconazole-this has a lot of drug interaction which isn’t a problem in this case
A & E are both contraindicated when renal problems are present
C) Micafungin is best for candida and aspergillus, she has a cryptococcs gadttii infection
D) This is for bacteria not a yeast/fungi
