EXAM #4: RA AD ANTI-MIGRAINE

Question 1

What two inflammatory cytokines are primarily implicated in the pathogenesis of RA?

Answer 1

• TNF-a

- IL-1

Question 2

What are the first line drugs to treat RA?

Answer 2

NSAIDs

*Note that these drugs are only treating the symptoms

Question 3

What is a DMARD?

Answer 3

Disease Modifying Anti-Rheumatic Drug

*These drugs are able to slow the progression of RA and treat symptoms

Question 4

How long does it take DMARDs to produce an effect?

Answer 4

6 weeks to 6 months i.e. very slow onset

Question 5

What is the first line DMARD treatment for RA?

Answer 5

Methotrexate

Question 6

What is the MOA of Methotrexate?

Answer 6

• Inhibits AICAR transformylase
• Increases extracellular adenosine
• Inhibits T-cell activation
• Cytotoxic to lymphocytes

Note that the mechanism of MTX is different for RA and cancer

Question 7

What are the other synthetic DMARDs?

Answer 7

Leflunomide
Chloroquine
Hydroxychloroquine

Question 8

What is the MOA of Leflunomide?

Answer 8

Inhibits ribonucleotide synthesis and causes cell cycle arrest

Question 9

What was the first RA agent approved for treatment of both the symptoms and pathogenesis of RA?

Answer 9

Lefluomide

Question 10

What is the MOA of the anti-malarial compounds in treating RA?

Answer 10

Unknown

Question 11

What are the Biologic DMARDs?

Answer 11

Etanercept
Infliximab
Anakinra

Question 12

List the anti-TNF agents.

Answer 12

Etanercept

Infliximab

Question 13

What is the MOA of Etanercept?

Answer 13

Cytokine receptor fusion protein

Question 14

What is the MOA of Infliximab?

Answer 14

anti-TNF monoclonal antibody

Question 15

What drug is the anti-IL-1 DMARD?

Answer 15

Anakinra

Question 16

What are the non-pharmacological approaches to treating migraines?

Answer 16

1) Avoid triggers

2) Regular sleep, meals, and exercise

Question 17

List the drugs that used to PREVENT migraines.

Answer 17

1) Propranolol
2) Metoprolol
3) Amitriptyline
4) Valproic acid
5) Topiramate

Question 18

What are the treatments of choice for the prevention of migraines?

Answer 18

Beta-blockers:

• Propranolol
• Metoprolol

Question 19

What class of drug is Amitriptyline?

Answer 19

TCA

Question 20

What are the non-specific drugs use to treat acute migraine attacks?

Answer 20

NSAIDs
Opiods
Anti-emetics

Question 21

Why should on avoid the overuse of non-specific agents to treat migraines?

Answer 21

Overuse can lead to “transformation” of the migraine into a more severe chronic disorder

Question 22

Why are opioids not recommended for acute migraine attacks?

Answer 22

• Dependence
• Tolerance
• Risk of adverse effects
• Risk of transformation

Question 23

What are the adverse effects associated with opiates as anti-migraine agents?

Answer 23

• Rebound headache
• Dizziness
• Nausea
• Vomiting
• Impaired cognitive function

Question 24

List the anti-emetics commonly used as adjuncts to treat migraines.

Answer 24

Metoclopramide
Cholpromazine
Prochlorperazine

Question 25

What is the MOA of Metoclopramide?

Answer 25

5-HT3 antagonist

Question 26

What are the migraine specific drug therapies?

Answer 26

1) Ergot derivatives

2) Triptans

Question 27

What are the ergot derivatives used to treat migraines?

Answer 27

• Ergotamine

- Dihydroergotamine

Question 28

What is the MOA of the ergot derivatives?

Answer 28

Alpha-adrenergic and 5-HT receptor agonists that cause VASOCONSTRICTION

*5-HT1D specifically

Question 29

What are the disadvantages associated with the Ergot Derivatives?

Answer 29

• Complex pharmacology

- Complex pharmacokinetics

Question 30

What is the prototype Triptan?

Answer 30

Sumatriptan

Question 31

What is the MOA of the Triptans?

Answer 31

Selevtive 5-HT1D and 1B receptor agonists

Question 32

What are the disadvantages of the Triptans?

Answer 32

• High cost
• Restrictions in presence of CV disease

*5-HT1B agonism can mimic angina

Question 33

What ultimately resolves many migraines?

Answer 33

Sleep