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Neuro II Exam 2 > Agents for Headaches and Migraines - Kinder > Flashcards

Agents for Headaches and Migraines - Kinder Flashcards

1
Q

classic migraine

A

30%

has aura

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2
Q

common migraine

A

70%

no aura

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3
Q

path of migraine

A

trigem nerve

  • CGRP - vasodilator
  • also substance P and neurokinin A

dural plasma extravasation - neurogenic inflammation

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4
Q

MC primary HA

A

tension

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5
Q

serotonin

A

5-hydroxytryptamine

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6
Q

precursor to serotonin

A

tryptophan

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7
Q

majority of serotonin

A

90% in GI tract - enterochromaffin cells

also in platelets

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8
Q

inactivation of serotonin

A

monoamine oxidase

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9
Q

measure of serotonin synthesis

A

5-HIAA

24 hour urine - diagnostic test for tumors synthesizing serotonin

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10
Q

vomiting reflex

A

5-HT3 serotonin receptor

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11
Q

pain/itching

A

sensory nerve endings - serotonin

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12
Q

contraction of vascular smooth muscle

A

serotonin to 5-HT2

vasoconstriction - except skeletal and cardiac m

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13
Q

GI tone and peristalsis

A

serotonin 5HT2 receptor

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14
Q

prokinetic GI

A

serotonin 5HT2 receptor

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15
Q

5-HT 1D/1B agonist

A

triptan

tx of migraine

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16
Q

sumatriptan MOA

A

activate 5-HT 1D/1B receptor - presynaptic trigeminal nerve

inhibit release vasodilating peptide
-stimulate vasoconstriction

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17
Q

1st line mild to severe migraine

A

sumatriptan

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18
Q

do not use within 24 hours of ergotamine use

A

sumatriptan

19
Q

ergotamine MOA

A

constriction of peripheral and cranial blood vesels

agonist at 5-HT 1D/1B receptors

agonist, partial agonist, antagonist - at various receptors

20
Q

clinical use of ergotamine

A

reserved for pt with prolonged migraine (>48 hours)

ADRs and uncertain efficacy

21
Q

gangrene and amputation

A

over-dosage of ergotamine

prolonged vasospasm

22
Q

NSAIDs

A

inhibit PG synthesis

acetaminophen, asprin, ibuprofen, naproxen

23
Q

metoclopramide

A

antiemetic

block D2 receptors

24
Q

prochlorperazine

A

antiemetic

block D2 receptors

25
Q

tx N/V with migraine

A

antiemetic

26
Q

MOA beta-agonists in migraine

A

raise migraine threshold

27
Q

verapamil

28
Q

MOA CCB in migraine

A

inhibit Ca entry

-relax vasc smooth m and vasodilation

29
Q

amitriptyline

A

tyicyclic antidepressant

30
Q

MOA amitriptyline in migraine

A

down regulate 5HT2 receptors

31
Q

migraine prophylaxis

A

beta-adrnergic antagonist

also - amitriptyline

32
Q

first line mild to moderate migraines

A

NSAID/simple analgesic

poor response - combo - caffeine, aspirin

continued bad response - to triptan

33
Q

preventative therapy for migraine

A

taken daily if:

  • migraine recur with disability
  • attacks frequent (>2 / week)
  • symptomatic therapies severe ADRs
  • patient prefers it
34
Q

HA recur predictable pattern

A

menstrual migraine

NSAID or triptan at time of vulnerability

35
Q

preventative migraine tx if healthy or comorbid HTN

A

beta-blocker

36
Q

preventative migraine tx if depressed or insomniac

A

tricyclic antidepressant

37
Q

preventative migraine tx if seizure disorder

A

anticonvulsants

38
Q

topiramate

A

anticonvulsant

39
Q

valproate

A

anticonvulsant

40
Q

migraine anticonvulsant MOA

A

enhance GABA inhibition

inhibit Na and Ca ion channel activity

41
Q

prevention of tension headaches

A

anticonvuslants

42
Q

prevention of cluster HAs

A

verapamil, lithium, prednisone, topiramate, frovatriptan

43
Q

abortive therapy for cluster HA

A

O2, triptan, ergot alkaloid

44
Q

abortive therapy for tension HA

A

analgesic with or without caffeine

and NSAIDs

Neuro II Exam 2 (20 decks)

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