57: RA and Migraine

Question 1

chronic inflammation resulting in pain and destruciton of bone and cartilage

Answer 1

rheumatoid arthritis

initiation(nonspecific inflammation) –> amplification (t-cell activation) –> chronic inflammation with tissue injury

Question 2

first line drugs RA

Answer 2

NSAIDS

reduce inflamamtion and pian, do not alter progression of RA

Question 3

trade off of DMARDs for RA

Answer 3

++ reduces inflammation, improve symptoms and slow bone damage (improve prognosis)

• • slow onset of action, more toxic

Question 4

antimetabolite and antifolate synthetic DMARD

Answer 4

methotrexate

inhibits AICAR transformylase to increase extracellualr adenosine and inhibit T-cell activation, cytotoxic to proliferation lymphocytes following antigen exposure

Question 5

first line DMARD for treatment of RA

Answer 5

methotrexate

Question 6

synthetic DMARDs

Answer 6

methtotrexate
leflunomide
chloroquine and hydroxychloroquine

Question 7

MOA leflunomide

Answer 7

inhibits ribonucleotide synthesis and causes cell cycle arrest

Question 8

double meaning of biologic DMARDs

Answer 8

organic compounds made by living cells that modify biologic responses

Question 9

Anti-TNF agents

Answer 9

etanercept
inliximab

biologic DMARDs

Question 10

MOA Anakinra

Answer 10

IL-1 inhibitor

bio DMARD

Question 11

during headache (unilatral, pulsating, not mild) lasting 4-72 hrs one of the following:

Answer 11

nausea and/or vomiting
photophobia and phonophobia

defined migraine

sex bias toward women

Question 12

current pathophys ideas migraine

Answer 12

1- originates deep within brain
2 - spread to other regions
3 - changes in n. cell acitiy and blood flow result in symptoms such as visual distrubance, numbness or tingling, dizzziness
4. chemicals in brian cause blood vessel dilation and inflammation of surrounding tissue
5 inflammation irritates trigeminal n. resulting in severe or throbbing pain

Question 13

treatment of choice prevention migraine

Answer 13

beta blockers

propanolol and metoprolol

Question 14

proven preventative medications for migraines

Answer 14

propanolol
metoprolol
amitriptyline
divalproex
topiramate

Question 15

antiemetics for the treatment of acute migraine attacks

Answer 15

metoclopramide
chlorpromazine
prochlorperazine

adjunctive therapy to combat nausea and vomiting due to migraine

Question 16

ergot derivatives for migraine specific therapy

Answer 16

ergotamine

dihydroergotamine

Question 17

MOA ergot derviatives

Answer 17

vasconstriction due to stimulation of a adrenergic and 5HT receptors

can cause adverse GI side effects and prolonged vasocconstriction

Question 18

MOA triptans

Answer 18

selective 5HT receptor agonists

inhibit activation of trigemial afferent nociceptors

Question 19

advantages triptans over ergots for acute migrain

Answer 19

selective pharmacology, moderate adverse side effect, established efficacy and safety

dis: $$ and restrictions on use in presence of cardiovascular disease

Question 20

what typically resolves most migraines..

Answer 20

sleep