B - 13. PVD/PAD, Migraine

Question 1

Peripheral vascular disease drug names

Answer 1

Nicergoline
Cinnarizine
Vinpocetine
(Nice Cinnamon Vinnie)

Pentoxifylline
Bencyclane
(Pen-Ben)

Cilostazol
Ca-dobesilate
(CiloCa-do (you need cilantro and avocado to make guacamole 😎)

Question 2

Nicergoline

Answer 2

Ergot derivative

a1 receptor blocker
inhibits platelet aggregation
(enhances dopamine turnover in brain)

indications

• brain circulatory problems
• dementia
• post-stroke

Question 3

Cinnarizine

Answer 3

Inhibits calcium channels and platelet aggregation

Indications
- peripheral circulatory problems, Meniere’s, brain circ. probs, migraine prophylaxis

SE: depression, somnolence

Question 4

Vinpocetine

Answer 4

Increases cerebral perfusion

Indications
- brain circulatory and memory problems

Can cause tachycardia and hypotension

Question 5

Pentoxifylline

Answer 5

A methylxanthine derivative like theophylline

Inhibits platelet aggregation, improves RBC pathological formation

Indications

• atherosclerotic and diabetic circulatory disturbances
• Intermittent claudication
• Sickle cell anemia

SE:
Gi disturbances, tachycardia, angina, flushing, allergy

Question 6

Bencyclane

Answer 6

Calcium channel inhibitor, visceral spasmolytic, vasodialator, antiaggregate

Indications:

• Raynaud
• Brain circulatory problems
• Visceral spasmolytic disorders

SE:
GI, CNS (Seizures), allergy, arrythmia

Contraindications:

• AV block
• MI
• Epilepsy
• Hypersensitivity

Question 7

Cilostazol

Answer 7

PDE3 inhibitor (cAMP increase), antiplatelet and vasodialation

Indications

• claudication
• secondary stroke prevention (potentially, hasn’t been approved officially)

SE: GI, low platelets, leukopenia

Contraindication with heart failure

Question 8

Ca-dobesilate

Answer 8

Vasoprotective

Used for peripheral circulatory disorders

Question 9

Main headache syndromes

Answer 9

Tension headache

• most common
• rarely treated unless very frequent attacks

Cluster headache

• comes in periods like “clusters”, is extremely painful
• more common in men

Migraine

• one sided throbbing headache
• aura symptoms - visual disturbances
• women > men

Question 10

Migraine cause/pathomechanism

Answer 10

Exact cause unclear, suspected sterile inflammation

Inital vasoconstriction by seratonin receptors -> seratonin depletion -> vascular permeability increases -> local edema and hormone release

• (NO, bradykinin, substance-P and CGRP)
• Causes increased pressure and severe pain

Question 11

Treatment of ongoing migraine attack

Answer 11

Seratonin 1B/1D, 1F agonists: causes vasoconstriction

• SUMATRIPTAN
• SE: sudden cardiac death

NSAIDS - high dose DICLOFENAC for MILD migraines

Question 12

Prophylaxis of migraine

Answer 12

Beta blockers
- Propranolol (reduces blood vessel dialation in brain, maintains seratonin levels)

Ca++ blockers
- Verapamil (vasodialation and seratonin interaction)

Epilepsy medication

• carbamazepine (Na+ chn blocker, theorized to affect serotonin system)
• valproate

Antidepressants
- imipramine (very strong seratonin inhibition)

Question 13

Treatment of cluster headache

Answer 13

• 800-1000mg (high dose) of VERAPAMIL (should be enough to block heart and cause collapse due to hypotension, but it doesn’t)
• Galcanezumab - monoclonal AB (blocks CGRP)
• (we give morphine injections against pain in Norway)