Agents for Headaches and Migraines - Kinder

Question 1

classic migraine

Answer 1

30%

has aura

Question 2

common migraine

Answer 2

70%

no aura

Question 3

path of migraine

Answer 3

trigem nerve

• CGRP - vasodilator
• also substance P and neurokinin A

dural plasma extravasation - neurogenic inflammation

Question 4

MC primary HA

Answer 4

tension

Question 5

serotonin

Answer 5

5-hydroxytryptamine

Question 6

precursor to serotonin

Answer 6

tryptophan

Question 7

majority of serotonin

Answer 7

90% in GI tract - enterochromaffin cells

also in platelets

Question 8

inactivation of serotonin

Answer 8

monoamine oxidase

Question 9

measure of serotonin synthesis

Answer 9

5-HIAA

24 hour urine - diagnostic test for tumors synthesizing serotonin

Question 10

vomiting reflex

Answer 10

5-HT3 serotonin receptor

Question 11

pain/itching

Answer 11

sensory nerve endings - serotonin

Question 12

contraction of vascular smooth muscle

Answer 12

serotonin to 5-HT2

vasoconstriction - except skeletal and cardiac m

Question 13

GI tone and peristalsis

Answer 13

serotonin 5HT2 receptor

Question 14

prokinetic GI

Answer 14

serotonin 5HT2 receptor

Question 15

5-HT 1D/1B agonist

Answer 15

triptan

tx of migraine

Question 16

sumatriptan MOA

Answer 16

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

inhibit release vasodilating peptide
-stimulate vasoconstriction

Question 17

1st line mild to severe migraine

Answer 17

sumatriptan

Question 18

do not use within 24 hours of ergotamine use

Answer 18

sumatriptan

Question 19

ergotamine MOA

Answer 19

constriction of peripheral and cranial blood vesels

agonist at 5-HT 1D/1B receptors

agonist, partial agonist, antagonist - at various receptors

Question 20

clinical use of ergotamine

Answer 20

reserved for pt with prolonged migraine (>48 hours)

ADRs and uncertain efficacy

Question 21

gangrene and amputation

Answer 21

over-dosage of ergotamine

prolonged vasospasm

Question 22

NSAIDs

Answer 22

inhibit PG synthesis

acetaminophen, asprin, ibuprofen, naproxen

Question 23

metoclopramide

Answer 23

antiemetic

block D2 receptors

Question 24

prochlorperazine

Answer 24

antiemetic

block D2 receptors

Question 25

tx N/V with migraine

Answer 25

antiemetic

Question 26

MOA beta-agonists in migraine

Answer 26

raise migraine threshold

Question 27

verapamil

Answer 27

CCB

Question 28

MOA CCB in migraine

Answer 28

inhibit Ca entry

-relax vasc smooth m and vasodilation

Question 29

amitriptyline

Answer 29

tyicyclic antidepressant

Question 30

MOA amitriptyline in migraine

Answer 30

down regulate 5HT2 receptors

Question 31

migraine prophylaxis

Answer 31

beta-adrnergic antagonist

also - amitriptyline

Question 32

first line mild to moderate migraines

Answer 32

NSAID/simple analgesic

poor response - combo - caffeine, aspirin

continued bad response - to triptan

Question 33

preventative therapy for migraine

Answer 33

taken daily if:

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

Question 34

HA recur predictable pattern

Answer 34

menstrual migraine

NSAID or triptan at time of vulnerability

Question 35

preventative migraine tx if healthy or comorbid HTN

Answer 35

beta-blocker

Question 36

preventative migraine tx if depressed or insomniac

Answer 36

tricyclic antidepressant

Question 37

preventative migraine tx if seizure disorder

Answer 37

anticonvulsants

Question 38

topiramate

Answer 38

anticonvulsant

Question 39

valproate

Answer 39

anticonvulsant

Question 40

migraine anticonvulsant MOA

Answer 40

enhance GABA inhibition

inhibit Na and Ca ion channel activity

Question 41

prevention of tension headaches

Answer 41

anticonvuslants

Question 42

prevention of cluster HAs

Answer 42

verapamil, lithium, prednisone, topiramate, frovatriptan

Question 43

abortive therapy for cluster HA

Answer 43

O2, triptan, ergot alkaloid

Question 44

abortive therapy for tension HA

Answer 44

analgesic with or without caffeine

and NSAIDs