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Neuro Path (2nd Year) > Head ache pharm > Flashcards

Head ache pharm Flashcards

head ache pharm

1
Q

concept behind migrane prophylaxis

A

raise threshld for initiating cortical spreading depression

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2
Q

triptans work on which NT

A

5-HT/ 1D/B agonists

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3
Q

how do triptans work

A

action at 5-HT 1D recetpor stops release of CGRP which stop vasodilation/ neurogenic inflammation and action at G0HT1B causes vasoconstriction

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4
Q

triptans used for what

A

acute migraine therapy

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5
Q

which drugs are used for head ache prevention

A

beta blockers, anticonvulsants (topiramate and valproic acid), antidepressants (amitriptyline, calcium channel blocking drugs (verapamil for cluster), botulinum toxin

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6
Q

What is cortical spreading depression

A

wave of neuronal depolarization followed by a suppression of neuronal activity and gradual recovery. Blood flow changes follow in its wake

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7
Q

what can trigger KCl

A

electrical, stimulation, trauma

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8
Q

what is relationship b/w CSD and migraine

A

leads to long lasting blood flow inrease in middle meningeal artery which is dependent on trigeminal and parasympathetic activation. In addition plasma protein leakage occurs in the dura. Ie vasodilation could be linked to neurometabolic events that includ transmission of pain

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9
Q

What is relationshiop b/w trigeminal neuron and migraines

A

release substance P, neurokinin A, and CGRP which cause vasodilation and inflammation

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10
Q

What is most effective acute treatment for migraine

A

dihydroergotamine

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11
Q

how does ergotamiand and dihydroergotamine suppress inflammation

A

5-HT1B and 5HT 1D antagonism leads to vasoconstriction

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12
Q

avoid ergotamine and dihydroergotamine in which situation

A

CAD and pregnancy

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13
Q

ergotamine and dihydroergotamine side ffects

A

nausea, vomiting

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14
Q

ergotamine and dihydroergotamine route

A

IV, IM, intranasal

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15
Q

Triptan targets and mechanism

A

5HT1B on blood vessels and 5HT 1D neuron agonists= vasoconstriction and shuts off release of CGRP from trigeminal

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16
Q

triptans side effects

A

chest/neck tightness, flushing, sedation

17
Q

triptan contraindications

A

CAD, stroke

18
Q

how is 5HT1D related to migraines

A

stops rellease of neuropeptides and constricts blood vessels, may

19
Q

5HT1D on neuron or blood vessel

A

neuron

20
Q

5HT1B on neuron or blood vessel

A

vessel

21
Q

sumitriptan itneractions

A

SSRI, SNRI, MAOs, propranol (rizatriptan), cyp450 ( eletriptan, zolmitriptan)

22
Q

whens should beta blockers not be used prophalatically

A

depression, raynaud’s, fibromyalgia, ashtma

23
Q

which anti depressant for prophylactic migraine treatment

A

amitryiptyline

24
Q

what do you have to monitor w/ antidepresants

A

EKG for QTc

25
Q

which drugs have best eveidence for efficacy for chronic migraine

A

topiramate and Botox-A

26
Q

how does Botox work to prevent head aches

A

prevents CGRP, substance P release

27
Q

what drug is used during lacation for prophylaxis

A

sumatriptan

28
Q

first line drug for episodic TTH

A

NSAID

29
Q

what is only proven pharmacolgoic therapy for chronic TTH

A

amitriptyline

30
Q

amitriptyline mechanism

A

Potentiates endogenous opioids…blocks reuptake of serotonin and NE, blocks muscarinic aCh, histamine, and alpha adrnergic, and 5ht recetors.

31
Q

are oral narcotics approprite for cluster headahces

A

no

32
Q

1st line treatment for cluster

A

sumatriptan

33
Q

cluster head ache other drugs

A

intranasal lidocaine, intranasal zolmitriptan, IV dihydroergotamine

34
Q

1st line for cluster prevention

A

verapamil, verapamil + Lithium

35
Q

other prevention for cluster

A

occiptial nerve block, st3eroids

Neuro Path (2nd Year) (6 decks)

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