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Neuro-Psych Exam II > Headache Drugs > Flashcards

Headache Drugs Flashcards

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1
Q

How is kallidin formed? Bradykinin?

A

LMW kinogen –> kallidin via tissue kallikrein

HMW kinogen –> bradykinin via plasma kallikrein

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2
Q

How is kallidin converted to bradykinin?

A

Aminopeptidase

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3
Q

How is bradykinin formation linked to the clotting cascade?

A
  • XIIa increases the formation of plasma kallikrein
  • plasma kallikrein induces conversion of XII –> XIIa

positive feedback loop

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4
Q

By what (2) enzymes are kinins metabolized?

A

Kininase 1 (carboxypeptidase M/N) converts to active metabolites

Kininase 2 (ACE) converts to inactive metabolites

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5
Q

The prefix “des-arg” denotes?

A

An active kinin metabolite

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6
Q

Effect of ACEi on bradykinin?

A

INCREASES Bradykinin by preventing metabolism to inactive compounds via kininase 2 (ACE).

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7
Q

Differences between B1/2 kinin receptors:

+ (2) commonalities

A

Both are G protein coupled
Both cause ^NO/PG/EDHF

B1: binds active metabolites; present only in damaged tissue

B2: binds native kinins; always expressed

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8
Q

In what three ways do bradykinins induce pain? (3)

A
  1. ^ CGRP = Trigeminal vasodilation (migraine***)
  2. ^ neurokinins
  3. ^ substance P
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9
Q

How do bradykinins effect

1) microcirculation
2) pulmonary system
3) blood pressure

A

Microcirculation increased permeability = edema
Bronchospasm
Vasodilation = hypotension

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10
Q

Bradykinins increase prostaglandins.
What are two very common drugs that DECREASE prostaglandins?
What are their MOAs?

A

NSAIDs: inhibit COX (AA –> PG)

Corticosteroids: increase lipocortin (inhibits PL –> AA)

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11
Q

Kinins:
Classification
+ 3 general effects

A

Autocoids

Inflammation, pain, vasodilation

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12
Q

Serotonin is stored in platelets.
Why can serotonin be stored without appreciable metabolism?
In what (2) ways does serotonin mediate platelets’ effects?

A
  • Serotonin is metabolized by MAO-A; platelets selectively express MAO-B
  • Promotes vasoconstriction + aggregation
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13
Q

Effects of serotonin on CV and GI systems:

What GI system cells release serotonin?

A

^^ activity in both systems (increased HR; increased motility)
*enterochromaffin cells express serotonin in GI tract

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14
Q

2 Common symptoms assc with serotonin secreting carcinomas:

A

Diarrhea, abdominal cramping b/c serotonin causes increased GI motility

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15
Q

Urinary metabolite of serotonin?

When is it elevated?

A

5-hydroxyindolacetic acid (5HIAA)

Increased during active migraine episode

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16
Q

Effects of 5HT1b and 5HT1d receptors?
What drug class selectively targets these serotonin receptors?
For what are they most commonly used?

A

1d: vasoconstriction of cranial vessels (undoes vasoDilation)
1b: decreased Trigeminal nociception

Triptans select 5HT1b/d; used in acute migraine rescue

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17
Q

What does the pneumonic POUND stand for?

A 
P-pulsatile 
O- 4-72 hOurs 
U- unilateral 
N- nauseating 
D- debilitating
18
Q

4 stages seen in migraine attack?

What does the first stage involve?

A

Prodrome (GI/mood changes)
Aura
Attack
Postdrome

19
Q

Propranolol/ Atenolol

1) MOA
2) Use in HA treatment
3) Contraindication

A

B1 AND 2 blockers
Migraine Px

Asthma (B2 = bronchodilator)

20
Q

Amitriptylline/ Nortryptilline

1) MOA
2) Use in HA treatment
3) Common ADR
4) Contraindication

A

1) TCAs ( ^NE, 5HT)
2 )Migraine Px especially in patients that w/ frequent HA or trouble sleeping
3) anti-muscarinic fx (dry mouth, constipation, etc)
4) never use in patient with risk of suicide

21
Q

Levitiracetam drug class?

A

Anti-epileptic

22
Q

Valproic Acid, Levitiracetam, Gabapentin, Topirimate

1) Drug Class
2) MOA
3) Use in HA treatment
4) Which is a pregnancy X drug?

A

1) Anticonvulsants
2) ^ GABA
3) Migraine Px esp in cases of comorbid anxiety/epilepsy
4) never use valproic acid in pregnancy. Strong teratogen.

23
Q

Verapamil

1) MOA
2) 3 uses

A

Ca Channel Blocker

HTN; migraine Px; cluster Px

24
Q

Cyproheptadine

1) MOA
2) Uses (2)
3) Common ADR

A

1) histamine, serotonin and Ach antagonist
2) Migraine Px and Seasonal allergies
3) sleepiness

25
Q

How is ketorolac (NSAID) used in the treatment of migraines?

A

IV administration

Usually in the ER for rescue from severe migraine

26
Q

What two drugs treat migraine in children?

A

OTC acetaminophen and ibuprofen

27
Q

When shouldn’t NSAIDs be used for migraine rescue? Why?

A

During third trimester of pregnancy

Cause premature closure of the ductus arteriosus + bleeding risk

28
Q

Ergotamine/dihydroergotamine

1) MOA
2) Use
3) Three ADR/ contraindications

A

1) non specific serotonin agonist
2) Migraine rescue
3) causes nausea, vasoconstriction, and is pregnancy X

29
Q

How is ergotamine administered?
Dihydroergotamine?
With what drugs should these never be combined?

A

Ergotamine = sublingual
Dihydroergotamine = SC/IM/IV, nasal spray
Never administer with triptans or SSRI

30
Q

In what way are triptans better for migraine rescue than ergots?

A

Less nausea and vasoconstriction

31
Q

Triptans should not be combined with what drugs?

A

SSRIs; ergots –> 5HT STORM!

32
Q 
Rank the t1/2 of: 
Naratriptan 
Sumatriptan 
Zolmitriptan
Frovatripran
A

Sumstriptan + others = short

Frovatriptan = FROever (longest)

33
Q

Which triptan drug has the highest affinity for the serotonin receptor and is most $$$?

A

Frovatriptan, also has longest t1/2

34
Q

Rizatriptan:

1) ROA
2) metabolism

A

1) sublingual

2) Rapid onset, t1/2= 2hrs

35
Q

Which of the triptans should be carefully monitored in renal patients (2)? Why?

A

Naratriptan
Zolmitriptan

*50% drug excreted unchanged via renal system

36
Q

How are Nara and zolmitriptan metabolized?

A

P450, but 50% renally excreted unchanged

37
Q

Two rescue treatments for cluster HA:

A

O2&raquo_space;»>

Triptans

38
Q

3 Px treatments for Cluster HA:

A

Prednisone
Verapamil
Lithium

39
Q

Tension HA treatment
2 rescue
2 Px

A

Rescue: NSAIDs and acetaminophen
Px: TCA/ Gabapentin

40
Q

Acetazolamide and Topirimate may both be used to treat what condition?
What is their mechanism of action?

A

Treat IIH

Both inhibit carbonic anhydrase and CSF production

41
Q

When do we need to avoid SSRIs/ Ergots?

A

When giving triptans

Neuro-Psych Exam II (11 decks)

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