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Robbins Pathology Neuro (Chpter 28,29) > Migraine > Flashcards

Migraine Flashcards

1
Q

What are the delivery options for sumatriptan

A

Injectable, nasal spray, oral tablet

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2
Q

Which form of the migraine is treated with administration of ergot alkaloids

A

Severe or refractory migraines

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3
Q

What is the theory behind the cause of a migraine

A

1) Electrical activity causes hydrogen/potassium through the nerve cells
2) Release of neuropeptides and inflammatory mediators
3) Dilation of cranial blood vessel sensitizes nerves to pain
4) Sensitization spreads to the brain

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4
Q

What are the anticonvulsives that can be given to prevent a migraine attacks

A
  • Topirimate

- Valproate

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5
Q

Which chronic conditions are contraindicated for triptan use

A
  • Vasospastic heart conditions
  • Uncontrolled hypertension

*Because Triptans cause vasoconstriction of coronary and renal vessels

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6
Q

What are the pros and cons of taking oral forms of Triptans

A

Pro: easy to take
Con: ineffective if vomiting

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7
Q

What are the delivery options for zolmitriptan

A

-Oral disintegrating tablets, nasal spray, and tables

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8
Q

How effective are propranolol or timolol for the prevention of migraines

A

60-80% effective

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9
Q

What is the mechanism of action for Triptans

A

Selective 5HT-1B/1D agonist

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10
Q

What is the mechanism of action for dihydroergotamine poisoning

A

Non-selectively binds to serotonin receptors, and at high amounts, binds to adrenergic and dopamine receptors.

*Especially alpha 1 receptors on smooth muscle causing vasoconstriction

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11
Q

What is the result of neurokinin A release

A

Increased Dural vessel permeability

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12
Q

What is the pathophysiology of migraines

A

Neural event that results in dilation of blood vessels that result in pain and nerve aggregation

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13
Q

What is the mechanism of actio for dihydroergotamine (DHE)

A

Binds to serotonin receptors non-selectively

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14
Q

What are the clinical presentations of patients overdosing on ergot alkaloids

A
  • Cerebral and coronary ischemia
  • Headaches, nausea, vomiting
  • angina
  • gangrene
  • MI
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15
Q

Which treatments for migraines are contraindicated for pregnant mothers

A
  • Ergot alkaloids (DHE)
  • Triptans
  • Valproic acid
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16
Q

Which triptan should be administered for long duration of migraine pain relief

A

Frovatriptan

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17
Q

Where is substance P and neurokinin A released from

A

Trigeminal C fibers

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18
Q

Serotonin binds to which receptor on vasculature and what is the result

A

Binds to 5HT-1B and causes vasoconstriction

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19
Q

Where is calcitonin gene released peptide (CGRP) released from

A

Trigeminal alpha delta fibers

20
Q

Which triptan drugs specifically are contraindicated with use of MAO inhibitors

A
  • Sumatriptan
  • Rizatriptan
  • Zolmitriptan
21
Q

Serotonin binds to which receptor in synapses and what is the response.

A

Binds to 5HT-1D and causes reduction in pain

22
Q

What are the pros and cons of the nasal spray form of Triptans

A

Pros: effective if vomiting or nausea
Cons: Few formulated as nasal spray

23
Q

What is the frequency of administration for preventative agents of migraines

A

Daily

24
Q

What are the side effects of beta blockers for migraines and where is it contraindicated

A
  • Fatigue, CNS depression, and bronchoconstriction

* Contraindicated in asthma patients

25
Q

Which treatment for migraines in pregnant females allowed in first and second trimesters only

A
  • Aspirin

- Ibuprofen

26
Q

What is the result of Calcitonin-gene related peptide (CGRP) release

A

Increases the Dural vessel vasodilation

27
Q

What is the mechanism of action of Triptans with regards to how it affects migranes

A
  • 5HT-1B: vasoconstriction of vessels
  • 5HT-1D Presynaptic: inhibits CGRP release
  • 5HT-1D: inhibits passage of signal to the higher brain centers
28
Q

What are the two beta blockers that can be given for prevention of migraine attacks

A
  • Propranolol

- Timolol

29
Q

Which class of drugs will make administering Triptans contraindicated

A
  • MAO inhibitors

- Selective serotonin reuptake inhibators (SSRIs)

30
Q

Central neurons express which subset of serotonin receptors

A

1B/1D

31
Q

What are the two tricyclics antidepressants that can be given for prevention of migraine attacks

A
  • Amitriptylene

- Imipramine

32
Q

What might be a side affect of using organic nitrates to treat coronary artery disease

A

Can provoke a migraine via the release of NO, which causes the release of CGRP and subsequent migraine pain

33
Q

What is the result of substance P release

A

Increased Dural vessel permeability

34
Q

What is the process of Cortical spreading depression (CSD)

A

1) CSD leads to vasoconstriction
2) Vasoconstriction leads to discharge of hydrogen, potassium, nitric oxide
3) These cause vasodilation and migraine pain

35
Q

Which treatment for migraines is acceptable for pregnancies in all trimesters

A

Acetaminophen and codeine

36
Q

Which condition are patients on Triptans and SSRIs at risk for

A

Serotonin Syndrome

37
Q

When is verapamil commonly used

A

Calcium channel blocker commonly used for migraine prevention, and is usually the first choice

38
Q

Cranial vessels/vasculature express which subset of serotonin receptors

A

1B

39
Q

What is the prototype triptan

A

Sumatriptan

40
Q

Peripheral nerves express which subset of serotonin receptors

A

1D

41
Q

What calcium channel blocker can be given for prevention of migraine attacks

A

Verapamil

42
Q

What is the relationship between CGRP and nitric oxide

A

They interact together, sometimes causing a postive feedback loop on the release of each other

43
Q

What is the criteria to receive preventative therapy for migraines

A
  • More than 2 per month with disability
  • disability lasting more than 3 days a month
  • Rescue medication used more than 2 times per week
44
Q

When is valproate used and when is it contraindicated

A

Used in those who fail to respond to triptan but contraindicated in pregnant women

45
Q

What is a popular combination for migraine treatment that involves Triptans

A

Triptans and an analgesic, such as acetaminophen, ibuprofen, or naproxen

Robbins Pathology Neuro (Chpter 28,29) (5 decks)

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