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DT2 E2 > 3. Headache Tx > Flashcards

3. Headache Tx Flashcards

1
Q

migraine abortive agent for kids?

A

acetaminophen and ibuprofen

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2
Q

wt binds B2 kinin receptor?

A

native bradykinin and kallidin

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3
Q

Triptans:
AE?
Contraindicaitons?

A

Headache reccurence

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

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4
Q

2 Tricyclic antidepressants for headache? side effect?

A

amitriptyline and nortriptyline

weight gain and tiredness due to antimuscarinic properties

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5
Q 
use for ergot alkaloids?
MOA?
sublingual ergot?
nasal spray and injection ergot?
2 Side effects?
4 contraindications?
A

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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6
Q

wt cleaves low molecular weight kininogen?

A

tissue kallikrein cleaves it to kallidin.

then aminopeptidase cleaves to bradykinin

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7
Q

Ketorolac use? route? hw long to use?

A

moderate to severe headaches
IV or oral
max of 5 days

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8
Q

most potent vasodilating peptide in trigemnial system?

A

CGRP (calcitonin gene related peptide)

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9
Q

wt cleaves kinins into active kinin metabolites?

A

carboxypeptidase N and M (kinase I)

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10
Q

botox use for headaches? hw to administer? MOA?

A

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

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11
Q

is B1 or B2 kinin receptor inducable?

A

B1

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12
Q

4 anticonvulsants used to tx headache? wc is tetragenic?

A

Valproic acid (tetragenic)
Topiramate
Gabapentin
Levetricatem

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13
Q

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

A

vasoconstriction of cranial blood vessels

reduced trigeminal sensory activation

inhibit neurotransmitter release from trigeminal in brainstem and cervical spine

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14
Q

2 Beta blockers prophylactic for headache?

MOA?

A

Propanolol Atenolol

MOA not clear - hyperfunctioning sympathetic suspected cause of migraine

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15
Q

2 drugs to tx IIH?

A

Acetazolamide and Topiramate

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16
Q

longest acting triptan?

A

frovatriptan

17
Q

wt binds B1 kinin receptor?

A

bradykinin and kinin active metabolites

18
Q

MOA of triptans? use?

A

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

19
Q 
Serotonin effect on:
Platelets
CV
GI
CNS
A

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

20
Q

2 enzymes that metabolize serotonin?

urinary metabolite?

A

MAO then aldehyde dehydrogenase

5-Hydroxyindoeacetic acid (5-HIAA)

21
Q

3 things released upon stimulaiton of B kinin receptors?

A

PGs
NO
EDHF

22
Q

compare AEs of triptans and ergot alkaloids? why?

A

triptans have less AEs

bc more selective for 5-HT1

23
Q

wt cleaves high molecular weight kininogen?

A

plasma kallikrein

24
Q

enzyme that hydrolyzes bradykinin to inactive products?

A

Angiotensin I-Converting Enzyme (ACE/Kinase II)

25
Q

kinin effect on:
inflammation
respiration
CV

A

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

26
Q

role of coagulation pathway in kinin?

A

factor XIIa converts plasma prekallikrein to plasma kallikrein

27
Q

3 effects of binding B kinin receptor?

A

Vasodilation
Na excretion
Pain (acute)

28
Q

headache abortive drug contraindicated in pregnancy?

A

ergot alkaloid

29
Q

fastest onset triptan?
ROA?
metabolism?

A

Rizatriptan
sublingual
MAO metabolism

30
Q

prototype triptan? routes of administration?

A

sumatriptan

SC, oral or nasal spray

31
Q

migraine abortive agent for pregos?

A

ibuprofen and acetaminophen except 3rd trimester

32
Q

4 stages of migraine? times of each?

A
  1. prodome - GI effects (1-2 days)
  2. Aura (20-60 min prior to attack
  3. Attack (4-72 hrs)
  4. Postdrome
33
Q

MOA of ergot alkaloids and triptans?

A

bind 5-HT1B/D receptor

DT2 E2 (25 decks)

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