[PHARMA] ANTIMIGRAINE DRUGS

Question 1

progression of a migraine attack

Answer 1

prodorma–>aura—>headache unilateraly with nausea+vomiting+photophobia

Question 2

prodorma

Answer 2

irritability
fatigue
muscle aches

Question 3

aura

Answer 3

visual disturbances
scotoma

Question 4

migraines are triggered by

Answer 4

stress
hormonal changes
weather changes
disturbed sleep
alcohol

Question 5

pathophysiology of migraines

Answer 5

release of CGRP from trigeminal nerve endings into perivascular space—>VD of dural BV–>stretch of pain endings

Question 6

CGRP

Answer 6

proinflammatory VD neuropeptide

Question 7

mild analgesics used in acute migraine attack

Answer 7

NSAIDs, acetaminophen

Question 8

specific antimigraine therapy of acute migraine attack

Answer 8

Triptans

Question 9

mechanism of action

Answer 9

activate 5HT1B/1D on presynaptic trigeminal endings to inhibit release of VD neuropeptides–>VC of dural BV—>prevent stretch of nerve endings

Question 10

sumatriptan ROI

Answer 10

oral
SC
nasal spray

Question 11

adverse effects of sumatriptan

Answer 11

injection site reaction
unpleasant taste
chest pressure
paresthesia, warmth, weakness, drowsiness, malaise

Question 12

CI of sumatriptan

Answer 12

uncontrolled HTN
ischemic stroke
IHD
pregnancy
w/ SSRIs or after 24h of ergots

Question 13

1st dose of sumatriptan should be cautiously given in case of

Answer 13

diabetics
hypertensives
men over 40yo
postmenopausals

Question 14

ergotamine tartrate ROI

Answer 14

sublingual
oral
rectal

Question 15

DOC in prolonged or frequent headaches

Answer 15

ergotamine tartrate

Question 16

dihydroergotamine ROI

Answer 16

IV
IM
SC
intranasal

Question 17

adverse effects of ergots

Answer 17

NVD
chest pressure
vasospasms—>gangrene

Question 18

CI of ergots

Answer 18

pregnancy
peripheral vascular disease
valvular heart disease

Question 19

antiemetics

Answer 19

metoclopramide parenteral & oral

Question 20

oral metoclopramide use

Answer 20

added to ergotamine to increase its absorption

Question 21

parenteral metoclopramide use

Answer 21

monotherapy in emergency

Question 22

if parenteral metoclopramide is ineffective, add

Answer 22

IV dihydroergotamine

Question 23

resistant cases require usage of

Answer 23

BZDs, opioids

Question 24

antimigraine therapy shouldnt exceed

Answer 24

10 days/month

Question 25

antimigraine therapy exceeding 10 days can lead to

Answer 25

medication overuse headache

Question 26

prophylactic antimigraine drugs

Answer 26

propanolol
amitripytline (antidepressants)
valproate & topiramate (anticonvulsants)
CCB