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Year 2 neuro exam 2 > Pharm HA and migraines Kinder > Flashcards

Pharm HA and migraines Kinder Flashcards

1
Q

What drugs are used for Acute Migraine Therapies

A 
serotonin agonists "triptans"
ergot alkaloids
analgesics
combinations analgesics
NSAIDs
antiemetics
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2
Q

what drug classes are used for prophylactic migraine therapies

A

beta antagonists
CaCh blockers
antidepressants
anticonvulsants

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3
Q

what are the ergot alkaloids

A

dihydroergotamine DHE

ergotamine +/- caffeine

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4
Q

What are the combination analgesics

A

aspirin, acetaminophen, caffeine (excedrin)

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5
Q

what antiemetics are used for migraines

A

metoclopramide

prochlorperazine

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6
Q

what beta antagonists are used for migrain

A

metoprolol and propanolol

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7
Q

what Ca Ch blocker in migraines

A

verapamil

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8
Q

what antidepressants used in migrain

A

amitriptyline

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9
Q

what antivconvulsant for migraine

A

topiramate (topomax)

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10
Q

what can cause secondary HA

A

infeciton, cerebral HA, brain mass lesion

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11
Q

unilateral HA with crescendo pattern that is pulsatiing and aggravated by physical activity
+ nausea, vomiting and photophobia

A

migraine

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12
Q

bilateral HA with pressure or tightness that waxes and wanes

- nausea vomiting

A

tension HA

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13
Q

unilateral pain around eye that is quick onset deep and excruciating
ipsi lacrimation and redness, rhinorrhea, sweating

A

cluster

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14
Q

aura involves what

A

nausea, vomiting, visual scotomas, hemianopsia and speech abnormalities

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15
Q

pathophys migraine

A

CN V involvement

release calcitonin gene related peptide CGRP which vasodilates and cause dural plasma extravasation causing inflammation

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16
Q

triggers of migraines

A

food, alcohol, caffeine or withdrawal, chocolate, monoNa glutamate, aspartame
flivkering lights, high altitude, strong smells, tobacco, weather
excess or not enough sleep, fatigue, menstruation, skipped meals, strenuous acitivity

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17
Q

most common type primary HA disorder

A

tension type

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18
Q

main stay Tx for preventative of tension type HA

A

amitriptyline

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19
Q

90% serotonin is found where

A

enterochromaffin cells in GI

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20
Q

where is serotonin in blood

A

in platelets

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21
Q

what inactivates serotonin

A

MAO

monoamine oxidase

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22
Q

what is used to detect serotonin secreting tumor

A

5-IAA which is byproduct of inactivated serotonin

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23
Q

CNS serotonin effects

A

vomiting reflex

pain/itch stimulation

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24
Q

CV serotonin effects

A

contraction vascular smooth m
causes dilation in heart and venoconstriction
promotes platelet aggregation

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25
GI serotonin effects
increase tone and perstalsis 5-HT2 | motility enhancing 5-HT4
26
skel mm serotonin effects
contraction when MAO inhibitors given with serotonin agonists
27
What are the serotonin agonists
triptans | 5-HT1D/1B
28
triptans used for what HA
migraine
29
MOA sumatriptan
activates R on presynaptic CN V endings inhbiiting vasodilatory peptides and stimulates vasoconstriction
30
PK sumatriptatn
MAO | shorter duration
31
routes of sumatriptan administration
oral, nasal, subcut, rectal
32
adverse effects sumatriptan
altered sensations like tingling and warmth, dizziness, muscle weakness, fatigue, flushing, drowsiness, nausea, sweating and neck pain
33
sumatriptan CI
those taking MAO inhibitors coronary a disease, angina, IHD, uncontrolled HTN do not use after ergotamine derivative!
34
MOA ergotamine
constriction peripheral and cranial blood vessels may also affect presynaptic CN V inhibiting vasodilatory peptides agonist at 5-HT1D/1B
35
PK ergotamine
variable from GI | increase absorption with caffeine
36
use of ergotamine
migraine | reserved for those with prolonged attack
37
what can occur if exceed max dose of ergotamine
too much vasoconstriction gangrene bowel infarction
38
adverse effects ergotamine
GI :diarrhea, nausea, vomiting through GI serotonin R and medullary vomiting center, paresthesias, drowsiness
39
CI ergotamine
obstructive vascular disease, collagen diseases, uncontrolled HTN, hepatic or renal dysfunction, pregnancy
40
MOA analgesics and NSAID in HA
prevent PG synthesis decreasing inflammation
41
MOA metoclopramide
block D2 like R in chemoR trigger zone and solitary tract nucleus
42
use of antiemetics
Tx nausea vomiting part of migraine
43
adverse effects antiemetics
drowsiness, dizziness, extrapyramidal Sx not frequent
44
MOA propranolol
modulate adrenergic or serotonergic NT in cortical and subcortical pathways raising threshold for migraines
45
use of beta blockers
migraine prophylaxis
46
adverse effects beta blockers
drowsiness, fatigue, sleep disturbances, vivid dreams, memory disturbance, depression
47
caution with beta blockers in
``` CHF Peripheral vascular disease AV conduction asthma depression DM ```
48
MOA verapamil
inhibits Ca entry from voltage sensitive areas of vasc sm mm | produce vasc sm mm relaxation and vasodilation
49
use verapamil
migriane prophylaxis | shows beneficial in prophylaxis for cluster HA
50
type of antidepressan amitriptyline and MOA
tricyclic down regulation 5HT2 R increased NE in synapse enhanced opioid R actions
51
therapeutic use amitripyline
migraine prophylaxis
52
adverse to tricyclic antidepressants
sedation- take at night
53
MOA topiramate
enhance GABA mediated inhibition | modulate excitatory NT glutamate and inhibit Na and Ca Channels
54
use of topiramate
migraine especially in those with comorbid seizures, anxiety or bipolar disorder
55
adverse effects topiramate
paresthesias, fatigue, anorexia, diarrhea, weight loss, taste perversion
56
first line for mild to mod migraines
NSAIDs
57
if poor response to NSAID, next step
combination product
58
first line for mild to severe migraine attacks
triptans
59
if unresponseive to triptan
use IV antiemetic and ergot alkaloid
60
when do use daily prophylaxis fo HA
migrain recuts with significatn disability attacks >2 a week Sx therapies ineffective patients prefer prophylaxis
61
Tx for mild to moderate tension HA
simple analgesics +/- caffeine and NSAIDs
62
prevention tension HA
tricyclic antidepressant
63
abortive Tx for cluster HA
oxygen, triptan, ergot alkaloid
64
prophylaxis cluster HA
verapamil, lithium, prednisone, topiramate

Year 2 neuro exam 2 (23 decks)

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