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PC 707 Pharmacology > Module 5: Unit C Migraines,Gout, Fibro > Flashcards

Module 5: Unit C Migraines,Gout, Fibro Flashcards

1
Q

What is the difference between acute/abortive versus prophylactic treatment of migraines?

A

Abortive is stopping the headache. Prophylactic is preventing frequency, reducing length and intensity (2+ per week).

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2
Q

Abortive treatments for migraine

A

Triptans – selective serotonin receptor agonists (5-HT1)
Ergot alkaloids (ergotamine & dihydroergotamine (DHE)
Ditan- 5HT1F receptor agonist (CV)
Oral CGRP receptor antagonist
Analgesics (Opioids, NSAIDs, acetaminophen (Tylenol)

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3
Q

Indication for prophylactic migraine medication

A

> 2/month
Attacks last > 24 hours
Cause major disruptions in ADLs with disability of 3 or > days
Abortive therapy fails or is overused
Symptomatic medications are contraindicated or ineffective.
Use of abortive meds > two times/week.
Migraine variants produce profound neurologic effects

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4
Q

Triptans (serotonin 1B/1D receptor agonist) Example

A

Sumatriptan (Imitrex)

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5
Q

Sumatriptan (Imitrex) indication

A

Acute/abortive treatment of migraines

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6
Q

MOA Imitrex

A

Selective activation of 5ht receptors suppresses the release of CGRP

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7
Q

Safety Sumatriptan (Imitrex)

A

Potential for coronary vasospasm

D2D with other triptans, ergots, MAOIs, SSRIs, SNRIs (agonist amplifies and we can give them too much serotonin).

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8
Q

Contraindications for Sumatriptan (Imitrex)

A

Ischemic Disease and MI

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9
Q

Ergot alkaloids Example

A

Dihydroergotamine

Ergotamine

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10
Q

Indication Ergot alkaloids

A

acute treatment of migraines

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11
Q

MOA ergot alkaloids

A

Alters transmission at serotonergic, dopaminergic, and a-adrenergic junctions. Causes constriction of cranial arteries.

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12
Q

Contraindications and D2d for Ergot

A

Pregnancy- can cause uterine contractions and abortion. Cateogry X.
Renal and hepatic impairment.
CAD, PVD, and uncontrolled hypertension.

CYP3A4 inhibitors.
Do not use with triptans.

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13
Q

BBW ergot

A

Potent inhibitors of CYP3A4 can raise levels posing a risk of vasospasm. Cerebral or peripheral ischemia can occur.

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14
Q

Side effect of ergot

A

Can stimulate nausea and vomiting.

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15
Q

Ditan Lasmiditan (Reyvow) indication

A

acute treatment of migraines

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16
Q

Ditan Lasmiditan (Reyvow) MOA

A

Activating the 5 HT1F receptors inhibits the release of neuropeptides and neurotransmitters and inhibits the pain pathway.

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17
Q

Safety with Ditan Lasmiditan (Reyvow)

A

Schedule V controlled substance (C-V) has abuse potential.

CNS depression and driving impairment.

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18
Q

calcitonin gene-related peptide (CGRP) antagonists example

A

Ubrogepant (Ubrelvy)

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19
Q

Indication for Ubrelvy

A

acute treatment of migraines

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20
Q

MOA Ubrelvy

A

calcitonin gene-related peptide (CGRP) antagonists

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21
Q

Side effects with Ubrelvy

A

The most common side effects are Central nervous system: Drowsiness (2% to 3%)

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22
Q

Beta-Blockers examples for prophylaxic migraines

A

Propranolol (Inderal)

Atenolol (Tenormin)

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23
Q

Indication for beta blockers

A

Migraine prophylaxis (angina, HTN, cardiac dysrhythmia, heart failure, symptoms of hyperthyroidism)

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24
Q

Safety with BB

A

Avoid it in patients with severe allergies- because it blocks epinephrine.
Mask symptoms of hypoglycemia.
Can worsen heart failure and asthma.

It can result in bradycardia, reduced cardiac output, precipitation of heart failure, AV block, Bronchoconstriction, and hypoglycemia.

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25
Q

BBW beta-blockers

A

Abrupt discontinuation may exacerbate angina and increase the risk of MI.

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26
Q

Pregnancy and lactations use of BB for headaches

A

Excreted in breastmilk. Not recommended in pregnancy or lactation.

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27
Q

Headaches Preventive- AEDs example

A

Divalproex (Depakote), Topomax

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28
Q

Indication Depakote

A

Seizure disorders, bipolar disorder, and migraine prevention.

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29
Q

MOA depakote

A

May augment inhibitory effects of GABA

30
Q

Side effects and contraindicatinos of depakote

A

Nausea, fatigue, weight gain

Contraindicated in pregnancy.

31
Q

BBW depakote:

A

Potentially fatal pancreatitis and hepatitis. Neural tube defects in developing fetus.

32
Q

Example TCAs

A

Nortriptyline (Elavil)

33
Q

Indication TCAs Nortriptyline (Elavil)

A

Migraine prevention, Depression, Fibromyalgia, neuropathic pain

34
Q

MOA Elavil

A

Block reuptake of NE and 5-HT

35
Q

Side effects TCAs (Elavil)

A 
Orthostatic hypotension
Anticholinergic effects 
Diaphoresis
Sedation
Cardiac toxicity
seizures
36
Q

BBW TCA

A

May increase the risk of suicide.

37
Q

CGRP receptor antagonist example

A

Erenumab (Aimovig)

One a month injection)

38
Q

Indication of Aimovig

A

Prevention of migraine headache

39
Q

MOA Erenumab (Aimovig)- immunomodulator

A

Binds to and antagonizes the function of the CGRP receptor to decrease inflammation.

40
Q

Indication botox

A

Migraine prevention for those with 15+ per month.

41
Q

MOA botox

A

Neurotoxic protein. Prevents the release of acetylcholine at neuromuscular junctions

42
Q

BBW botox

A

It can spread from the injection site and produce muscle weakness, difficulty with respiration and swallowing, and can be life-threatening

43
Q

Indication for Colchicine (Colcrys)

A

Gout prevention and acute treatment

44
Q

MOA Colchicine (Colcrys)

A

anti-inflammatory agent thought to be due to its ability to decrease the infiltration of leukocytes into the joint cavities

45
Q

Safety/D2D/Contracindications for Colchicine (Colcrys)

A

Nausea, vomiting, myelosuppression myopathy

Colchicine can cause rhabdomyolysis, especially if the patient is on a statin.

Do not take with P-GlycoProtein inhibitors (amiorderone, procardia, etc.) or CYP3A4 inhibitors (erythromycin…)

do not use it during pregnancy

46
Q

Xanthine oxidase inhibitors example

A

Allopurinol (Zyloprim)

47
Q

Indication Allopurinol (Zyloprim)

A

Chronic tophaceous gout

48
Q

MOA Allopurinol (Zyloprim)

A

Inhibits XO (required for uric acid formation)

49
Q

Safety/Side effects with Allopurionl (Zyloprim)

A

Rare bone marrow suppression, hepatotoxicity, and hypersensitivity

50
Q

Uricosuric agent example

A

Probenecid (Probalan)

51
Q

indication Probenecid (probalan)

A

gouty arthritis

52
Q

Safety/D2D Probenecid (probalan)

A

may precipitate or worsen any current acute attacks: do not start it until the acute attack has resolved.

Hypersensitivity reactions may occur, and there is a risk of this drug causing renal stones.

Do not take aspirin with Probenecid, as its mechanism of action is reduced if combined.

53
Q

Recombinant uric acid oxidase (IV) example

A

(Pegloticase (Krystexxa)

54
Q

Indication for Pegloticase (Krystexxa)

A

Severe, treatment-refractory, chronic gout.

55
Q

MOA Pegloticase (Krystexxa)

A

Reduces uric acid levels by converting it to allantoin, a water-soluble compound easily excreted by the kidneys.

56
Q

Safety Pegloticase (Krystexxa)

A

Hemolysis and methemoglobinemia have been reported with pegloticase in patients with G6PD deficiency.

57
Q

Fibromyalgia SNRI example

A

Milnacipran (Savella)

Duloxetine (Cymbalta)

58
Q

Indication Milnacipran (Savella)

A

Depression, anxiety, Fibromyalgia

59
Q

MOA Savella

A

Boost serotonin and norepinephrine

60
Q

Fibromyalgia Anticonvulsant example

A

Pregabalin (Lyrica)

61
Q

indication Lyrica

A

Epilepsy, neuropathic pain, Fibromyalgia, general anxiety disorder

62
Q

MOA Lyrica

A

Inhibits release of neurotransmitters

63
Q

Safety/D2D Lyrica

A

Scheduled V
Potential physical dependence
Drug to-drug interactions: alcohol, benzos, CNS depressants

64
Q

What is the difference between acute/abortive treatment of gout and prophylactic treatment of gout?

A

The medications for gout are used to relieve the pain (acute) and then to help lessen the occurrence (prophylactic) of another gouty attack by lowering the uric acid levels.

65
Q

What should we do to a warfarin dose if a patient is on Allopurinol (Zyloprim)?

66
Q

What is the level of evidence for prescribing muscle relaxants to patients with Fibromyalgia?

67
Q

What is the level of evidence for prescribing opioids to patients with Fibromyalgia?

68
Q

List the three FDA-approved drugs for the treatment of Fibromyalgia?

A

Cymbalta, Lyrica, Savella

69
Q

Topiramate (Topamax)

A

Broad spectrum anti seizure used for migraine prevention.

70
Q

Safety with Topomax

A

Paresthesia, fatigue, cognitive dysfunction

Drug-to-drug interactions with phenytoin and carbamazepine.

PC 707 Pharmacology (39 decks)

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