Migraines and RA Flashcards
Stages of rheumatoid arthritis
initiation - inflammation
amplification - T cell activation
final stage - chronic inflammation with TISSUE INJURY
Major chemokines (3)
IL-1
IL-6
TNF-alpha
Methotrexate MOA
inhibits AICAR transformylase - increases adenosine and INHIBITS T-CELL ACTIVATION
first line DMARD for Ra tx
Leflunomide MOA
INHIBITS RIBONUCLEOTIDE SYNTHESIS - causes cell cycle arrest
first line agent for BOTH SYMPTOMATIC MANAGEMENT AND RETARDATION OF STRUCTURAL DAMAGE
Two anti-malarial agents used for RA
chloroquine
hydroxychloroquine
Etanercept MOA
cytokine receptor fusion protein
Infliximab MOA
TNF-alpha antibody
Anakinra MOA
binds IL-1 as a decoy
Migraine - headache has to have 2 of what 4 characteristics
unilateral location
pulsating quality
moderate to severe pain intensity
aggravation by or causing avoidance of routine physical activity
nausea/vomiting
photophobia/phonophobia
Migraines more common in
WOMEN 3 fold increase in incidence
Migraine pathophysiology
dural vasculature - vasodilation
trigeminal nerve sensory sytem
Phases of Migraine
Prodrome Aura Headache Resolution Postdrome
Preventive Therapy of Migraine Drugs (6)
Propanolol Metoprolol Amitriptyline Divalproex Topiramate
Flunarizine
Non-specific pain therapy of acute migrain
Co-administered with?
Avoid?
aspirin
naproxen/ibuprofen
acetaminophen
anti-emetic
OVERUSE - can transform migraine into severe, chronic disorder
Anti-emetics (3) for migraines
Metoclopramide
Chlorpromazine
Prochlorperazine
Migraine Specific Therapy - Ergot Derivs (2)
MOA
Ergotamine
Dihydroergotamine
Vasoconstriction - d/t stimulation of alpha-1 and 5-HT
Disadvantages of Ergot derivatives 3
Complex pharmacology
Complex pharmacokinetics
Potent and sustained vasoconstrictor effect - increased risk of vascular effects
Triptans for migraine specific therapy (1)
MOA
SUMATRIPTAN
inhibit activation of TRIGEMINAL AFFERENT NOCIRECEPTORS
Selective 5-HT(1D)/5-HT(1B) - CRANIAL/DURAL VASOCONSTRICTION
Triptans advantage of ergot
MORE SELECTIVE
ESTABLISHED EFFICACY AND SAFETY
simple and consistent pharmacokinetics
Disadvantages of sumatriptan
higher cost
restrictions in presence of cardiovascular disease
Cyclosporine MOA
inhibits IL1 and IL 2 receptor production
Cyclophosphamide MOA
DNA cross-linking to prevent cell replication
Azathioprine MOA
interferes with nucleic acid metabolism and synthesis
inhibits cell proliferation
Gold Compounds (2)
MOA
aurothioglucose
auranofin
alter morphology and function of MACROPHAGES
Rituximab MOA
B cell depleting
Abatacept MOA
Inhibits T cell costimulation
