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Microbial Pharmacology > RA and Migraine Treatment > Flashcards

RA and Migraine Treatment Flashcards

1
Q

What are the stages of Rheumatoid Arthritis?

A
  1. ) Initiation (Nonspecific inflammation
  2. ) Amplification (T-Cell activation)
  3. ) Chroic Inflammation with Tissue Injury
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2
Q

What type of T Cells are involved in RA?

A

Memory T cells are activated in response to peptides presented by APCs

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3
Q

What are the major treatments for RA?

A

NSAIDs
Glucocorticoids
Disease modifying anti-rheumatic drugs (DMARDs)

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4
Q

What is the first line therapy for RA?

A

NSAIDS. Do not alter progression

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5
Q

What role do glucocorticoids play in RA Treatment?

A

Decrease inflammation. Do not alter progression

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6
Q

What is the role of DMARDS?

A

Dec inflammation, improve symptoms, slow bone damage.

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7
Q

What are the drawbacks of DMARDS?

A

Slow onset. (6w-6m)

Can be more toxic

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8
Q

What are the 2 main groups of DMARDS?

A

Synthetic and Biologic.

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9
Q

What is the MOA of Methotrexate?

A

Inhibits AICAR transformylase

Cytotoxic to proliferating lymphocytesLymphocytes.

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10
Q

Waht is the 1st line DMARDS treatment?

A

Methotrexate

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11
Q

What is the MOA of Cyclosporine?

A

Inhibits IL 1/2

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12
Q

What is the MOA of Cyclophosphamide?

A

Cytostatic Cross link DNA to prevent cell replication

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13
Q

What is the MOA of Azathioprene?

A

Interferes with NA metabolism and inhibits cell proliferation of B and T cells.

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14
Q

What is the MOA of Leflunomide?

A

Inhibits RN synthesis and causes Cell Cycle arrest.

Symptomatic and retards damage

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15
Q

What are the Drugs included in Biologic DMARDS?

A 
Etanercept
Infliximab
Adalimumab
Rituximab
Abatacept
Anakinra
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16
Q

What are the ANTI TNF agents?

A

Etanercept
Infliximab
Adalimumab

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17
Q

What are the B Cel Depleting agents?

A

Rituximab

18
Q

What are the T Cell Costimulation inhibitors?

A

Abatacept

19
Q

What are the IL-1 Inhibiting agents?

A

Anakinra

20
Q

Who is most commonly afflicted with Migraines

A

3x more women than men

21
Q

What primary disorders of the brain cause migraines?

A

Dural vasculature

Trigeminal Sensory System

22
Q

What causes Neurovascular Headaches?

A

Dilation of BVs
Pain and further nerve activation
Cortical Spreading Depression
Sensitization of Trigeminal Pain Pathway.

23
Q

What are the phases of a migraine?

A 
Premonitory Phase
Aura
Headache Phase
Resolution
Postdrome
24
Q

What are the non Pharm approaches to treatment for Migraines?

A

Avoid Triggers

Regular Sleep, Meals, exercise

25
Q

What are the Pharmacologic approaches to Migraine Treatment?

A

Preventive Therapy
Tx of Acute Attack
-Non-specific
-Specific to migraines**

26
Q

What drugs can be used for Migraine Prevention?

A 
B Blockers(Propanolol, Metoprolol)(Tx of choice)
Amitriptyline
Divalproex
Topiramate
Flunarizine
27
Q

What are the non-specific Tx for acute Migrine Attacks?

A

Aspirin(900mg)
Naproxen, Ibuprofin(NSAIDS)
Acetaminophen
poorly effective.

28
Q

What are the opiate Tx for Migraines?

A

Meperidine
Butorphanol
Oxycodone
Hydromorphone

29
Q

What are the anti-emetic Tx for Migraines?

A

Metoclopramide
Chlorpromazine
Prochloperazine

30
Q

What are the Migraine-Specific Tx that are Ergot Derivatives?

A

Ergotamine

Dihydroergotamine

31
Q

What is the MOA of Ergot Derivatives?

A

Vasoconstriction due to stim of alpha-ad and Serotonin receptors

32
Q

What are the Pros of using Ergot Derivatives?

A

Effective, low cost, high experience.

33
Q

What are the Adverse Effects of EDs?

A

GI disturbances. Diarrhea, N/V

34
Q

Disadvantages of EDs?

A

Complex Pharmacology and kinetcs

Potent and sustained vasoconstrictor effects

35
Q

What are the Drugs included in the Triptans?

A

Sumatriptan, -triptan

36
Q

What is the MOA of Triptans?

A

Selective Serotonin Receptor agonists

37
Q

Advantages of Triptans over Ergots?

A
  • selective pharmacology
  • consistent pharmacokinetics
  • estabilished safety and efficacy
  • moderate SA
38
Q

Disadvantages of Tiptans?

A

High Cost. Cant use with CVD

39
Q

Which Anti-Malarial Drugs are used as a DMARD?

A

Chloroquine and Hydroxychloroquine

40
Q

What is the MOA of Etanercept?

A

Anti TNF agent(Cytokine receptor fusion protein)

41
Q

What is the MOA of Infliximib?

A

Anti TNF agent (Anti TNF Chimeric monoclonal Ab)

Microbial Pharmacology (13 decks)

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