Migraines and RA

Question 1

Stages of rheumatoid arthritis

Answer 1

initiation - inflammation

amplification - T cell activation

final stage - chronic inflammation with TISSUE INJURY

Question 2

Major chemokines (3)

Answer 2

IL-1
IL-6
TNF-alpha

Question 3

Methotrexate MOA

Answer 3

inhibits AICAR transformylase - increases adenosine and INHIBITS T-CELL ACTIVATION

first line DMARD for Ra tx

Question 4

Leflunomide MOA

Answer 4

INHIBITS RIBONUCLEOTIDE SYNTHESIS - causes cell cycle arrest

first line agent for BOTH SYMPTOMATIC MANAGEMENT AND RETARDATION OF STRUCTURAL DAMAGE

Question 5

Two anti-malarial agents used for RA

Answer 5

chloroquine

hydroxychloroquine

Question 6

Etanercept MOA

Answer 6

cytokine receptor fusion protein

Question 7

Infliximab MOA

Answer 7

TNF-alpha antibody

Question 8

Anakinra MOA

Answer 8

binds IL-1 as a decoy

Question 9

Migraine - headache has to have 2 of what 4 characteristics

Answer 9

unilateral location
pulsating quality
moderate to severe pain intensity
aggravation by or causing avoidance of routine physical activity

nausea/vomiting
photophobia/phonophobia

Question 10

Migraines more common in

Answer 10

WOMEN 3 fold increase in incidence

Question 11

Migraine pathophysiology

Answer 11

dural vasculature - vasodilation

trigeminal nerve sensory sytem

Question 12

Phases of Migraine

Answer 12

Prodrome
Aura
Headache
Resolution
Postdrome

Question 13

Preventive Therapy of Migraine Drugs (6)

Answer 13

Propanolol
Metoprolol
Amitriptyline
Divalproex
Topiramate

Flunarizine

Question 14

Non-specific pain therapy of acute migrain

Co-administered with?

Avoid?

Answer 14

aspirin
naproxen/ibuprofen
acetaminophen

anti-emetic

OVERUSE - can transform migraine into severe, chronic disorder

Question 15

Anti-emetics (3) for migraines

Answer 15

Metoclopramide
Chlorpromazine
Prochlorperazine

Question 16

Migraine Specific Therapy - Ergot Derivs (2)

MOA

Answer 16

Ergotamine
Dihydroergotamine

Vasoconstriction - d/t stimulation of alpha-1 and 5-HT

Question 17

Disadvantages of Ergot derivatives 3

Answer 17

Complex pharmacology
Complex pharmacokinetics
Potent and sustained vasoconstrictor effect - increased risk of vascular effects

Question 18

Triptans for migraine specific therapy (1)

MOA

Answer 18

SUMATRIPTAN

inhibit activation of TRIGEMINAL AFFERENT NOCIRECEPTORS

Selective 5-HT(1D)/5-HT(1B) - CRANIAL/DURAL VASOCONSTRICTION

Question 19

Triptans advantage of ergot

Answer 19

MORE SELECTIVE

ESTABLISHED EFFICACY AND SAFETY

simple and consistent pharmacokinetics

Question 20

Disadvantages of sumatriptan

Answer 20

higher cost

restrictions in presence of cardiovascular disease

Question 21

Cyclosporine MOA

Answer 21

inhibits IL1 and IL 2 receptor production

Question 22

Cyclophosphamide MOA

Answer 22

DNA cross-linking to prevent cell replication

Question 23

Azathioprine MOA

Answer 23

interferes with nucleic acid metabolism and synthesis

inhibits cell proliferation

Question 24

Gold Compounds (2)

MOA

Answer 24

aurothioglucose
auranofin

alter morphology and function of MACROPHAGES

Question 25

Rituximab MOA

Answer 25

B cell depleting

Question 26

Abatacept MOA

Answer 26

Inhibits T cell costimulation