Week 2 - Neuro + Headaches Flashcards
(45 cards)
Contraindications and Drug interactions for Triptans
CAD and pregnancy.
Interactions with ergot alkaloids, SSRIs, SNRIs, MAOIs
What are the 3 kinds of Neuroglia found in the central nervous system?
Microglia and Oligodendrocytes, Astrocytes (“tiny little astronaut” in your brain)
What are the 2 kinds of Neuroglia found in the peripheral nervous system ?
Satelite cells, Schwann cells
Afferent vs Efferent neurons do what?
Afferent: Carry impulses from peripheral receptors to CNS
Efferent: Transfer from CNS to gland, organ, muscle
In a neuron, what is the functional difference between Dendrites and axons?
Dendrites carry nerve impulse towards the cell body, Axons carry nerve impulse away from the cell body
Myelin sheath is created by neuroglia. What cells compose the myelin sheath in the central,vs peripheral nervous system?
central: oligodendrocytes
Peripheral: schwann cells.
Describe the three types of neuron: Sensory,
Interneuron,
Motor
Sensory: (afferent)
Carry impulses from peripheral receptors to CNS
Interneuron: (associational)
Only in CNS
Motor: (efferent)
Transfer from CNS to gland, organ, muscle
Three main structural divisions of the brain
Forebrain, midbrain, hindbrain
The forebrain contains the cerebrum, name the cerebrum’s Four Lobes:
Frontal, Parietal, Temporal, Occipital
3 components of the brainstem
Midbrain, Pons, Medulla
What is the RETICULAR FORMATION (or “reticular activating system”):
large collection of diffuse nuclei found throughout the brain. Connects cerebral cortex to brain stem. Controls vital reflexes like CV function and breathing, maintaining wakefulness.
What is the BASAL GANGLIA
group of structures deep within Cerebral hemisphere and brainstem, primarily involved in controlling VOLUNTARY MOVEMENTS, as well as learning, thinking, eye movements and emotion. (a gang where we eat basil, organize, learn, think, move our eyes and get emotional. )
What is the LYMBIC SYSTEM:
group of interconnected structures: amygdala, hypthalamus, hippocampus. emption, arousal, long term memory.
What is the Monroe-Kellie Doctrine?
The relationship between the 3 components of the cranium. The sum of the volumes of brain tissue, blood and CSF is constant. An increase in one component will cause a decrease in one or both of the other two components.
Indicators of Increased ICP
Change in level of consciousness
Headache
Projectile vomiting WITHOUT NAUSEA
Definition of episodic vs chronic headache
Episodic: less than 15 days/month
Chronic: at least 15 days/month, for at least 3 months
Meds for Tension-Type headache prophylaxis: -
- Venlafaxine (effexor, an SNRI)*
Mirtazapine *)
Tricyclic antidepressants (amitriptyline, nortriptyline,
*caution in those under 18)
Migraine is defined as At least 5 attacks of a headache lasting 4-72 hours, with at least 2 of the following 4 characteristics: - Unilateral location
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by or causing avoidance of routine physical activity
PLUS one of what TWO symptoms???
PLUS Nausea and/or vomiting
OR Photophobia and phonophobia
four phases of Migraine headache
- Premonitory phase
- Migraine aura
- Headache phase
Recovery (postdrome) phase
Neurovascular disorder that involves dilation and inflammation of the intracranial blood vessels. What sensory nerve and compounds are most involved?
Trigeminovascular system includes the trigeminal nerve and the projections of this nerve to surrounding intracranial blood vessels.
Also
Serotonin suppresses migraines
Calcitonin gene-related peptide (CGRP) promotes migraine
MOA of Triptans
constricting intracranial blood vessels and reducing inflammation (by suppressing release of inflammatory neuropeptides, including calcitonin gene-related peptide)
C/I of Triptans
- Ischemic heart disease, prior MI, or uncontrolled hypertension. avoid in patients w/risk factors for CAD
- SSRIs, SNRIs (risk of serotonin syndrome)
- MAOIs (toxicity can result)
- DO not give within 24h of another triptan (vasospasm)
- C/I in pregnancy
Triptans available for kids?
Only approved triptan 12-17y is Almotriptan (Axert)
None avail <12y
S/E and C/I of Ergot Alkaloids
SE: n&v
Weakness in the legs, myalgia, numbness and tingling in the fingers and toes, angina-like pain, and tachycardia or bradycardia.
-hepatic or renal impairment
- sepsis (gangrene has resulted)
- CAD, peripheral vascular disease, and uncontrolled HTN
- taking potent inhibitors of CYP3A4 (can raise ergotamine to toxic levels)
- within 24 h of another triptan.
-C/I in pregnancy
