3. Headache Tx Flashcards by Alex Christopher

migraine abortive agent for kids?

acetaminophen and ibuprofen

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wt binds B2 kinin receptor?

native bradykinin and kallidin

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Triptans:
AE?
Contraindicaitons?

Headache reccurence

Ergot alkaloid w/i 24 hrs, vascular disease, ischmic heart disease, SSRIs

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2 Tricyclic antidepressants for headache? side effect?

amitriptyline and nortriptyline

weight gain and tiredness due to antimuscarinic properties

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use for ergot alkaloids?
MOA?
sublingual ergot?
nasal spray and injection ergot?
2 Side effects?
4 contraindications?

moderate to severe migraine abortive agent
5-HT1 agonist
ergotamine - sublingual
dihydroergotamine - nasal/injection
AE: nausea/V & vasoconstriciton
CI: prego, vascular disease, ischemic heart disease, Triptans

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wt cleaves low molecular weight kininogen?

tissue kallikrein cleaves it to kallidin.

then aminopeptidase cleaves to bradykinin

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Ketorolac use? route? hw long to use?

moderate to severe headaches
IV or oral
max of 5 days

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most potent vasodilating peptide in trigemnial system?

CGRP (calcitonin gene related peptide)

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wt cleaves kinins into active kinin metabolites?

carboxypeptidase N and M (kinase I)

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botox use for headaches? hw to administer? MOA?

prophylaxis for migraine
multiple injections in head/neck
Inhibit release of acetylcholine

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is B1 or B2 kinin receptor inducable?

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4 anticonvulsants used to tx headache? wc is tetragenic?

Valproic acid (tetragenic)
Topiramate
Gabapentin
Levetricatem

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anti-migraine effects of triptans at:
vascular level?
neurogenic level?
Central level?

vasoconstriction of cranial blood vessels

reduced trigeminal sensory activation

inhibit neurotransmitter release from trigeminal in brainstem and cervical spine

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2 Beta blockers prophylactic for headache?

MOA?

Propanolol Atenolol

MOA not clear - hyperfunctioning sympathetic suspected cause of migraine

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2 drugs to tx IIH?

Acetazolamide and Topiramate

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longest acting triptan?

frovatriptan

wt binds B1 kinin receptor?

bradykinin and kinin active metabolites

MOA of triptans? use?

5-HT1B/1D agonist. abort migraine pain and induce vasoconstriction

Serotonin effect on:
Platelets
CV
GI
CNS

Platelets - promotes platelet aggregation
CV - casoconstriction
GI - inc motility
CNS - regulate sensory perception and nociception

2 enzymes that metabolize serotonin?

urinary metabolite?

MAO then aldehyde dehydrogenase

5-Hydroxyindoeacetic acid (5-HIAA)

3 things released upon stimulaiton of B kinin receptors?

PGs
NO
EDHF

compare AEs of triptans and ergot alkaloids? why?

triptans have less AEs

bc more selective for 5-HT1

wt cleaves high molecular weight kininogen?

plasma kallikrein

enzyme that hydrolyzes bradykinin to inactive products?

Angiotensin I-Converting Enzyme (ACE/Kinase II)

kinin effect on: inflammation respiration CV

inflammation - inc permeability --> promote respiration - bronchospasms CV - low BP and vasodilate

role of coagulation pathway in kinin?

factor XIIa converts plasma prekallikrein to plasma kallikrein

3 effects of binding B kinin receptor?

Vasodilation Na excretion Pain (acute)

headache abortive drug contraindicated in pregnancy?

ergot alkaloid

fastest onset triptan? ROA? metabolism?

Rizatriptan sublingual MAO metabolism

prototype triptan? routes of administration?

sumatriptan | SC, oral or nasal spray

migraine abortive agent for pregos?

ibuprofen and acetaminophen except 3rd trimester

4 stages of migraine? times of each?

1. prodome - GI effects (1-2 days) 2. Aura (20-60 min prior to attack 3. Attack (4-72 hrs) 4. Postdrome

MOA of ergot alkaloids and triptans?

bind 5-HT1B/D receptor