57: RA and Migraine Flashcards
chronic inflammation resulting in pain and destruciton of bone and cartilage
rheumatoid arthritis
initiation(nonspecific inflammation) –> amplification (t-cell activation) –> chronic inflammation with tissue injury
first line drugs RA
NSAIDS
reduce inflamamtion and pian, do not alter progression of RA
trade off of DMARDs for RA
++ reduces inflammation, improve symptoms and slow bone damage (improve prognosis)
- slow onset of action, more toxic
antimetabolite and antifolate synthetic DMARD
methotrexate
inhibits AICAR transformylase to increase extracellualr adenosine and inhibit T-cell activation, cytotoxic to proliferation lymphocytes following antigen exposure
first line DMARD for treatment of RA
methotrexate
synthetic DMARDs
methtotrexate
leflunomide
chloroquine and hydroxychloroquine
MOA leflunomide
inhibits ribonucleotide synthesis and causes cell cycle arrest
double meaning of biologic DMARDs
organic compounds made by living cells that modify biologic responses
Anti-TNF agents
etanercept
inliximab
biologic DMARDs
MOA Anakinra
IL-1 inhibitor
bio DMARD
during headache (unilatral, pulsating, not mild) lasting 4-72 hrs one of the following:
nausea and/or vomiting
photophobia and phonophobia
defined migraine
sex bias toward women
current pathophys ideas migraine
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
treatment of choice prevention migraine
beta blockers
propanolol and metoprolol
proven preventative medications for migraines
propanolol metoprolol amitriptyline divalproex topiramate
antiemetics for the treatment of acute migraine attacks
metoclopramide
chlorpromazine
prochlorperazine
adjunctive therapy to combat nausea and vomiting due to migraine
ergot derivatives for migraine specific therapy
ergotamine
dihydroergotamine
MOA ergot derviatives
vasconstriction due to stimulation of a adrenergic and 5HT receptors
can cause adverse GI side effects and prolonged vasocconstriction
MOA triptans
selective 5HT receptor agonists
inhibit activation of trigemial afferent nociceptors
advantages triptans over ergots for acute migrain
selective pharmacology, moderate adverse side effect, established efficacy and safety
dis: $$ and restrictions on use in presence of cardiovascular disease
what typically resolves most migraines..
sleep
