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
tx N/V with migraine
antiemetic
26
MOA beta-agonists in migraine
raise migraine threshold
27
verapamil
CCB
28
MOA CCB in migraine
inhibit Ca entry | -relax vasc smooth m and vasodilation
29
amitriptyline
tyicyclic antidepressant
30
MOA amitriptyline in migraine
down regulate 5HT2 receptors
31
migraine prophylaxis
beta-adrnergic antagonist also - amitriptyline
32
first line mild to moderate migraines
NSAID/simple analgesic poor response - combo - caffeine, aspirin continued bad response - to triptan
33
preventative therapy for migraine
taken daily if: - migraine recur with disability - attacks frequent (>2 / week) - symptomatic therapies severe ADRs - patient prefers it
34
HA recur predictable pattern
menstrual migraine NSAID or triptan at time of vulnerability
35
preventative migraine tx if healthy or comorbid HTN
beta-blocker
36
preventative migraine tx if depressed or insomniac
tricyclic antidepressant
37
preventative migraine tx if seizure disorder
anticonvulsants
38
topiramate
anticonvulsant
39
valproate
anticonvulsant
40
migraine anticonvulsant MOA
enhance GABA inhibition inhibit Na and Ca ion channel activity
41
prevention of tension headaches
anticonvuslants
42
prevention of cluster HAs
verapamil, lithium, prednisone, topiramate, frovatriptan
43
abortive therapy for cluster HA
O2, triptan, ergot alkaloid
44
abortive therapy for tension HA
analgesic with or without caffeine | and NSAIDs