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Sweatman Migraines Flashcards

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1
Q

tx of tension headaches

A

OTC NSAIDS an rarely require a doctors visit

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2
Q

tx of cluster headaches

A

nasal or subQ triptans or ergots + burst taper steroid like prednisone

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3
Q

rare form of headache, 25-50 yo male smoker,

A

cluster headaches

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4
Q

vasodilation causing pain and autonomic symptoms, trigeminovascular and superior hypothalmic activation, acitvation of CN VII

A

cluster headaches

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5
Q

tx of mild to moderate or menstrual migraine

A

non-narcotic NSAIDS

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6
Q

moderate to severe migraine tx.

A

short acting triptans

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7
Q

route of admin for triptans

A

oral or faster acting nasal

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8
Q

fasted route of admin for triptans

A

S.C. sumatriptan most effective and fastest onset

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9
Q

efficacy of oral triptans

A

all are equally effective

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10
Q

longer acting triptans but have slower onset

A

naratriptan, frovatriptan

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11
Q

prophyllaxis of migraine

A 
topiramate
valproate
propranolol
timolol
metoprolol
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12
Q

who is a candidate for prophylaxis therapy for migraines

A
  1. those with frequent attacks

2. those who are using anti-migraine therapy too frequent which has paradoxically made their symptoms worse

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13
Q

the aura of migraine is caused by?

A

spreading depression wave in the primary visual cortex (17) in the brain

*spreading depression also causes central sensitization

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14
Q

5HT1 agonists aid in migraine tx by three mechs

A
  1. inhibit sensory nerve discharge from periphery to CNS
  2. inhibit release of CGRP in periphery therfore abating neuroinflammation
  3. inihibit NO from dilating extracerebral blood vessels thus hindering sensory nerve discharge
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15
Q

triptan MOA

A

5HT receptor antagonist that inihibits CGRP release

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16
Q

5HTD and 5HTF receptors are found

A

presynaptically and triptan activation increases Ca entry…this inhibits CGRP release

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17
Q

5HT1B receptors are found

A

in blood vessels, agonism causes vasoconstriction

*local inflammatory mediators of the migrain had caused dilation-thus these throbbing

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18
Q

NSAIDS late in pregnancy can cause

A
  1. PDA

2. prolong labor and delivery

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19
Q

NSAIDS for migraine with longest durability of action and most convenient dosing schedule

A

once daily-nabumetone
naproxen-twice daily
ketoprofen 3 times daily
4 times-ibuprofen, fenoprofen, ketoprofen

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20
Q

NSAID COMBOS

A

acetaminophin, butalbital, caffeine

aspirin, butalbital, caffeine

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21
Q

barbirutrate used to tx. migrain in combo with other drugs

A

butalbital

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22
Q

moq for butalbital

A

sedatie hypnotic, effects via gaba enhancement

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23
Q

strongly linked to analgesic overuse syndrome

A

butalbital

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24
Q

barbiturates are ______ inducers and ____

A

cyp

cns respiratory depressants

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25
contraindications for butalbital
porphyria, ethanol, sedative
26
caffeine withdrawl can cayse
CVS complications headache
27
triptans are specific agonists one which receptors
5HT b and d agonists
28
where are the 5htB receptors
on the blood vessel that is dilated in a migraine
29
where are the 5HTD receptors located
pre-synaptically
30
MOA for triptans
inhibits trigeminal nerve activation by vasoactive peptides inhibit cervical complex activation bring about selective intracranial/ extracerebral vasconstriction
31
triptan drugs avaiulable in a nasal spray
sumatriptan zolmitriptan *faster onset than oral
32
one triptan that can be given S.C. and is the most effective tx for migrain
sumatriptan-rapid onset if given S.C.
33
triptans with long duration of action but slower onset
naratriptan (6 hours) frovatriptan (25hrs)
34
triptans side effects/contraindications
contra in Heart Disease, uncontrolled HTN, ischemic bowel dz may cause chest tightness drowsiness, CNA effects, dizziness after resolution of the pain
35
sideeffects of triptans worst with
SC sumatriptan
36
drug interactions with triptans
MAOs-cyp 3a4 SSRI-serotonin syndrome ergots-also cause vasoconstriction
37
found in moldy grains and used to cause convulsions with dry gangrene
ergot alkaloids--> vasoconstrictor,
38
ergot alkaloid for migraine tx
dihydroergotamine | ergotamine
39
MOA for ergot alkaloids
central serotonin and peripheral vasoconstrictor (alpha) also decrease amine reuptake
40
ergot amines contraindicated in
peripheral vascular disease | CAD, sepsis, M,. uncontroleld HTN,
41
hepatic metabolism with renal eliminiation
erghot amines
42
triptan affected by concurrent cyp3a4 inhibitor
eletriptan
43
triptans when given with propranolol cause increase in blood levels of the triptan
elitriptan,. rizatriptan, zolmitriptan
44
MAO inhibtos inhibit the breakdown of these triptans
rizatriptan, sumatriptan, zolmitriptan
45
do ergots work better or worse than triptans
worse bro
46
pt.s unresponsive to triptans can get
ergots
47
contraindicated in lactation
ergots
48
tetratogens
ergots
49
ergots and beta blockers or dopamine
potentiate vasoconstrcition
50
ergots and strong CYP3a4 inhibitor
increased ergot perisistence thus increase vasoconstriciton
51
triptaps plus ergots
24 hour rule???
52
migrains in pregnancy
worse in 1st trimester-when fetus most suceptible acetaminophen only agent used
53
when to begin tx of menstrual migraine
2-3 days before period and continue until period is done
54
severe menstrual migraines of when taking OCP's how shoudl NSAIDS be used
begin on the 9th day of the cycle and take them through the second day of the next cyle
55
OCP's and migraine with aura
these patients should only get Combine OCP's 2 x risk for aura migraine and 2 x risk of OCP these are multuiplicative rather than additive risk *use cuation with pure estrogen OC's
56
triptans ineffective in tx of which migraine symptom
allodynia
57
narcotis for migraine
hydrocodone oxycodone codeine
58
alternative analgesic for migraine
IM ketorolac
59
narcotis for migraine should be given as
last resort
60
vomit center in the brain is where
retucular formation in the medulla
61
antiemetics for migraine tx
metoclopramide prochlorperazine promethazine chloprmazine
62
ade of metoclopramide
inc prolactin levels | gynecomastia
63
ade of prochloperazine and chlopromazine
dyskinesia hypotension urinary retention BPH
64
ade for promethazine
glaucoma, urinary retention, BPH, drowsiness, Parkinson like symptoms
65
works via cholinergic blockade
promthazine
66
works via D2 blockade centrally
metoclopramide prochloperazine chlopromazine
67
sum up the overall cause of migraine headaches
peripheral neurogenic inflammation from emotional of environmental triggers (exact trigger often unknown)
68
major drug classes available for prophyllaxis of migraine headaches
antiepileptic drugs antidepressants beta blockers calcium channel blockers
69
1st line prophyllactics for migraine
amitriptyline valproic acid propranolol topiramate
70
Amitriptyline MOA and adverse effects
decreases reuptake of NE and serotonin, strong anticholinergic activity --> aggressiveness, weight gain, dry mouth and sedation
71
MOA for valproic acid and adverse effects
Na channel blocker, increases GABA activity category X, hepatotoxicity, weight gain, highly protein bound
72
drug with which perturbation of protein bound fraction can cause massive swings in free drug availabilit and increase adverse effects
valproic acid
73
MOA for propranolol and adverse effects
decrease arterial dilation, decrease NE induced lipolysis fatigue, exercise intolerance, asthma, diabetes, AV block
74
moa for topiramate and adverse effects
block NA and glutamate, increase GABA activity parasthesias, fatigue, nausea, narrow therapeutic range
75
prophylactic not FDA approves for migraine
amitriptyline
76
only drug for migraine prophylaxis in children
propranolol
77
analgesic overuse syndrome is essence is caused by
cellular adaptation in the already aberrant signalling pathway
78
four areas of cellular adaptation that cause analgesic overuse syndrome
Trigeminovascular syndrome Reduced 5HT levels cellular adaptation free radical damage to PAG
79
high risk for analgesic overuse syndrome
Apirin/acetaminiphen/caffeine combos butalbital combos opioids short acting NSAIDS>>> Long acting
80
bull shit home remedies for migraines that fucking witch doctors use
coQ10 and riboflavin butterbur and feverfew *but not in pregnancy

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