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neuro2 > migraine headache treatment > Flashcards

migraine headache treatment Flashcards

1
Q

NSAID moa in migraines

A

COX inhibition reduces the production of PGs, thereby reducing the production of inflammatory signals that would trigger MAPK upregulation and the increased neuronal production of CGRP and substance P for release from nerve endings

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2
Q

triptans moa in headaches

A

produce selective carotid vasoconstriction via 5-HT1B receptors and presynaptic inhibition of the trigeminovascular inflammatory responses implicated in migraines via 5-HT1D/1F receptors

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3
Q

NSAID adverse effects

A

gastric irritation with chronic use,
additive nephrotoxicity, especially in elderly - leads to fluid retention, HTN, edema, and rarely CHF
potentiation of migraine-associated nausea

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4
Q

NSAID drug interactions

A

attenuate diuretics, beta-blockers, ACE inhibitors, vasodilators, central alpha-2 agonists, peripheral alpha-1 antagonists and ARBs

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5
Q

longest acting NSAIDs

A

vabumetone

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6
Q

shortest acting NSAIDs

A

ibuprofen and fenoprofen

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7
Q

butalbital moa

A

sedative-hypnotic effects via thalamic GABA enhancement; used in combination with aspirin or acetaminophen and caffeine

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8
Q

butalbital adverse effects

A

drowsiness, sedation, diminished cerebral function; strongly linked to analgesic overuse syndrome; CNS/respiratory depression

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9
Q

butalbital contraindications

A

porphyria, ethanol, and sedatives

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10
Q

caffeine adverse effects

A

cerebral vasoconstriction and potential CV interactions

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11
Q

triptans (drugs)

A

almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan

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12
Q

triptan moa

A

specific agonism of 1B and 1D serotonin receptors in the CNS - selective intracranial/extracranial vasoconstriction, inhibition of trigeminal nerve activation by vasoactive peptides, inhibition of trigeminal cervical complex activation (decrease release of substance P and CGRP)

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13
Q

triptans with fastest onset of action

A

sumatriptan (nasal spray and SC) and zolmitriptan (nasal spray)

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14
Q

triptans with longest half lives and longest onsets

A

frovatriptan and naratriptan

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15
Q

triptan side effects

A

CNS - dizziness, drowsiness, fatigue
CV - heaviness/tightness of chest
coronary and peripheral vasospasm - contraindicated in heart disease, uncontrolled HTN or ischemic bowel disease
use with SSRIs or SNRIs may precipitate serotonin syndrome

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16
Q

triptans that interact with MAOIs

A

rizatriptan, sumatriptan, and zolmatriptan

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17
Q

triptans that increase serum propranolol levels

A

eletriptan, rizatriptan, zolmatriptan

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18
Q

triptans that are cyp 3A4 inhibitors

A

eletriptan

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19
Q

ergotism

A

caused by excessive intake of ergots; results in mental disorientation, convulsions, muscle cramps, and dry gangrene of extremities

20
Q

ergot alkaloid moa

A

agonist effects on multiple receptors: central 5-HT, peripheral alpha vasoconstriction + decreased amine reuptake; causes contraction of smooth muscle fibers in moderate doses

21
Q

ergot drugs

A

dihydroergotamine and ergotamine

22
Q

ergot interactions

A

triptans - vasoconstriction

23
Q

ergot contraindications

A

vasospastic predisposing conditions, peripheral vascular or CAD, sepsis, MI, uncontrolled HTN; pregnancy and breast feeding

24
Q

migraines in pregnancy treatment

A

acetaminophen is 1st line; opoids if persistence into later trimesters

25
Q

1st line for menstrual migraines

A

NSAIDs

if without aura - COCs may be useful

26
Q

allodynia producing migraines

A

IM ketorolac

27
Q

metoclopromide moa

A

D2 blockade centrally; pro-kinetic by increasing ACh effects

used for antiemesis

28
Q

chlorperazine and prochlorperazine moa

A

D2 blockade centrally; cholinergic and alpha-adrenergic blockade
used for antiemesis

29
Q

promethazine moa

A

cholinergic blockade; H1 and weak D2 blockade

used for antiemesis

30
Q

promethazine adverse effects

A

glaucoma, urinary retention, BPH, drowsiness, parkinson-like symptoms

31
Q

chlorpromazine and prochlorperazine adverse effects

A

dyskinesia, hypotension, glaucoma, urinary retention, and BPH

32
Q

metoclopramide adverse effects

A

increased prolactin levels –> gynecomastia

33
Q

amitriptyline moa

A

decreased reuptake of NE and serotonin and strong anticholinergic action

34
Q

amitriptyline adverse effects

A

aggressiveness, increased weight, dry mouth, sedation

35
Q

divalproex and valproic acid moa

A

Na channel blocker; increased GABA activity

36
Q

divalproex and valproic acid adverse effects

A

hepatotoxicity, sedation, nausea, weight gain, highly protein bound; category X

37
Q

propranolol and timolol moa

A

beta-blockers - decreased arterial dilation and NE-induced lipolysis

38
Q

propranolol and timolol adverse effects

A

fatigue, exercise intolerance, problems with asthma, diabetes, AV block

39
Q

topiramate moa

A

blocks Na and glutamate, increasing GABA activity

40
Q

topiramate AEs

A

paresthesias, fatigue, nausea, narrow therapeutic range

41
Q

low risk of analgesic overuse syndrome

A

long-acting NSAIDs, tramadol, dihydroergotamine

42
Q

high risk of analgesic overuse syndrome

A

aspirin/acetominophen/caffeine, butalbital-containing combinations, opoids

43
Q

migraine prophylaxis in children

A

propranolol

44
Q

bad news in G6PD deficiency

A

acetaminophen

45
Q

triptan with worse AEs

A

SC sumatriptan

neuro2 (9 decks)

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