RA and Migraine Treatment

Question 1

What are the stages of Rheumatoid Arthritis?

Answer 1

1. ) Initiation (Nonspecific inflammation
2. ) Amplification (T-Cell activation)
3. ) Chroic Inflammation with Tissue Injury

Question 2

What type of T Cells are involved in RA?

Answer 2

Memory T cells are activated in response to peptides presented by APCs

Question 3

What are the major treatments for RA?

Answer 3

NSAIDs
Glucocorticoids
Disease modifying anti-rheumatic drugs (DMARDs)

Question 4

What is the first line therapy for RA?

Answer 4

NSAIDS. Do not alter progression

Question 5

What role do glucocorticoids play in RA Treatment?

Answer 5

Decrease inflammation. Do not alter progression

Question 6

What is the role of DMARDS?

Answer 6

Dec inflammation, improve symptoms, slow bone damage.

Question 7

What are the drawbacks of DMARDS?

Answer 7

Slow onset. (6w-6m)

Can be more toxic

Question 8

What are the 2 main groups of DMARDS?

Answer 8

Synthetic and Biologic.

Question 9

What is the MOA of Methotrexate?

Answer 9

Inhibits AICAR transformylase

Cytotoxic to proliferating lymphocytesLymphocytes.

Question 10

Waht is the 1st line DMARDS treatment?

Answer 10

Methotrexate

Question 11

What is the MOA of Cyclosporine?

Answer 11

Inhibits IL 1/2

Question 12

What is the MOA of Cyclophosphamide?

Answer 12

Cytostatic Cross link DNA to prevent cell replication

Question 13

What is the MOA of Azathioprene?

Answer 13

Interferes with NA metabolism and inhibits cell proliferation of B and T cells.

Question 14

What is the MOA of Leflunomide?

Answer 14

Inhibits RN synthesis and causes Cell Cycle arrest.

Symptomatic and retards damage

Question 15

What are the Drugs included in Biologic DMARDS?

Answer 15

Etanercept
Infliximab
Adalimumab
Rituximab
Abatacept
Anakinra

Question 16

What are the ANTI TNF agents?

Answer 16

Etanercept
Infliximab
Adalimumab

Question 17

What are the B Cel Depleting agents?

Answer 17

Rituximab

Question 18

What are the T Cell Costimulation inhibitors?

Answer 18

Abatacept

Question 19

What are the IL-1 Inhibiting agents?

Answer 19

Anakinra

Question 20

Who is most commonly afflicted with Migraines

Answer 20

3x more women than men

Question 21

What primary disorders of the brain cause migraines?

Answer 21

Dural vasculature

Trigeminal Sensory System

Question 22

What causes Neurovascular Headaches?

Answer 22

Dilation of BVs
Pain and further nerve activation
Cortical Spreading Depression
Sensitization of Trigeminal Pain Pathway.

Question 23

What are the phases of a migraine?

Answer 23

Premonitory Phase
Aura
Headache Phase
Resolution
Postdrome

Question 24

What are the non Pharm approaches to treatment for Migraines?

Answer 24

Avoid Triggers

Regular Sleep, Meals, exercise

Question 25

What are the Pharmacologic approaches to Migraine Treatment?

Answer 25

Preventive Therapy Tx of Acute Attack -Non-specific -Specific to migraines**

Question 26

What drugs can be used for Migraine Prevention?

Answer 26

``` B Blockers(Propanolol, Metoprolol)(Tx of choice) Amitriptyline Divalproex Topiramate Flunarizine ```

Question 27

What are the non-specific Tx for acute Migrine Attacks?

Answer 27

Aspirin(900mg) Naproxen, Ibuprofin(NSAIDS) Acetaminophen poorly effective.

Question 28

What are the opiate Tx for Migraines?

Answer 28

Meperidine Butorphanol Oxycodone Hydromorphone

Question 29

What are the anti-emetic Tx for Migraines?

Answer 29

Metoclopramide Chlorpromazine Prochloperazine

Question 30

What are the Migraine-Specific Tx that are Ergot Derivatives?

Answer 30

Ergotamine | Dihydroergotamine

Question 31

What is the MOA of Ergot Derivatives?

Answer 31

Vasoconstriction due to stim of alpha-ad and Serotonin receptors

Question 32

What are the Pros of using Ergot Derivatives?

Answer 32

Effective, low cost, high experience.

Question 33

What are the Adverse Effects of EDs?

Answer 33

GI disturbances. Diarrhea, N/V

Question 34

Disadvantages of EDs?

Answer 34

Complex Pharmacology and kinetcs | Potent and sustained vasoconstrictor effects

Question 35

What are the Drugs included in the Triptans?

Answer 35

Sumatriptan, -triptan

Question 36

What is the MOA of Triptans?

Answer 36

Selective Serotonin Receptor agonists

Question 37

Advantages of Triptans over Ergots?

Answer 37

- selective pharmacology - consistent pharmacokinetics - estabilished safety and efficacy - moderate SA

Question 38

Disadvantages of Tiptans?

Answer 38

High Cost. Cant use with CVD

Question 39

Which Anti-Malarial Drugs are used as a DMARD?

Answer 39

Chloroquine and Hydroxychloroquine

Question 40

What is the MOA of Etanercept?

Answer 40

Anti TNF agent(Cytokine receptor fusion protein)

Question 41

What is the MOA of Infliximib?

Answer 41

Anti TNF agent (Anti TNF Chimeric monoclonal Ab)