RA and Migraine Treatment Flashcards
What are the stages of Rheumatoid Arthritis?
- ) Initiation (Nonspecific inflammation
- ) Amplification (T-Cell activation)
- ) Chroic Inflammation with Tissue Injury
What type of T Cells are involved in RA?
Memory T cells are activated in response to peptides presented by APCs
What are the major treatments for RA?
NSAIDs
Glucocorticoids
Disease modifying anti-rheumatic drugs (DMARDs)
What is the first line therapy for RA?
NSAIDS. Do not alter progression
What role do glucocorticoids play in RA Treatment?
Decrease inflammation. Do not alter progression
What is the role of DMARDS?
Dec inflammation, improve symptoms, slow bone damage.
What are the drawbacks of DMARDS?
Slow onset. (6w-6m)
Can be more toxic
What are the 2 main groups of DMARDS?
Synthetic and Biologic.
What is the MOA of Methotrexate?
Inhibits AICAR transformylase
Cytotoxic to proliferating lymphocytesLymphocytes.
Waht is the 1st line DMARDS treatment?
Methotrexate
What is the MOA of Cyclosporine?
Inhibits IL 1/2
What is the MOA of Cyclophosphamide?
Cytostatic Cross link DNA to prevent cell replication
What is the MOA of Azathioprene?
Interferes with NA metabolism and inhibits cell proliferation of B and T cells.
What is the MOA of Leflunomide?
Inhibits RN synthesis and causes Cell Cycle arrest.
Symptomatic and retards damage
What are the Drugs included in Biologic DMARDS?
Etanercept Infliximab Adalimumab Rituximab Abatacept Anakinra
What are the ANTI TNF agents?
Etanercept
Infliximab
Adalimumab
What are the B Cel Depleting agents?
Rituximab
What are the T Cell Costimulation inhibitors?
Abatacept
What are the IL-1 Inhibiting agents?
Anakinra
Who is most commonly afflicted with Migraines
3x more women than men
What primary disorders of the brain cause migraines?
Dural vasculature
Trigeminal Sensory System
What causes Neurovascular Headaches?
Dilation of BVs
Pain and further nerve activation
Cortical Spreading Depression
Sensitization of Trigeminal Pain Pathway.
What are the phases of a migraine?
Premonitory Phase Aura Headache Phase Resolution Postdrome
What are the non Pharm approaches to treatment for Migraines?
Avoid Triggers
Regular Sleep, Meals, exercise
What are the Pharmacologic approaches to Migraine Treatment?
Preventive Therapy
Tx of Acute Attack
-Non-specific
-Specific to migraines**
What drugs can be used for Migraine Prevention?
B Blockers(Propanolol, Metoprolol)(Tx of choice) Amitriptyline Divalproex Topiramate Flunarizine
What are the non-specific Tx for acute Migrine Attacks?
Aspirin(900mg)
Naproxen, Ibuprofin(NSAIDS)
Acetaminophen
poorly effective.
What are the opiate Tx for Migraines?
Meperidine
Butorphanol
Oxycodone
Hydromorphone
What are the anti-emetic Tx for Migraines?
Metoclopramide
Chlorpromazine
Prochloperazine
What are the Migraine-Specific Tx that are Ergot Derivatives?
Ergotamine
Dihydroergotamine
What is the MOA of Ergot Derivatives?
Vasoconstriction due to stim of alpha-ad and Serotonin receptors
What are the Pros of using Ergot Derivatives?
Effective, low cost, high experience.
What are the Adverse Effects of EDs?
GI disturbances. Diarrhea, N/V
Disadvantages of EDs?
Complex Pharmacology and kinetcs
Potent and sustained vasoconstrictor effects
What are the Drugs included in the Triptans?
Sumatriptan, -triptan
What is the MOA of Triptans?
Selective Serotonin Receptor agonists
Advantages of Triptans over Ergots?
- selective pharmacology
- consistent pharmacokinetics
- estabilished safety and efficacy
- moderate SA
Disadvantages of Tiptans?
High Cost. Cant use with CVD
Which Anti-Malarial Drugs are used as a DMARD?
Chloroquine and Hydroxychloroquine
What is the MOA of Etanercept?
Anti TNF agent(Cytokine receptor fusion protein)
What is the MOA of Infliximib?
Anti TNF agent (Anti TNF Chimeric monoclonal Ab)
