Rheumatoid arthritis and migraine Flashcards
what are the stages of RA?
initiation
amplification
chronic inflammation with tissue injury
what characterizes the amplification stage of RA?
T cell activation
what are the first line drugs for RA?
NSAIDs
what are the other drug types for RA?
glucocorticoids
disease-modifying anti-rheumatic drugs (DMARDS)
do NSAIDs alter the progression of RA?
no
do DMARDs alter the progression of RA?
yes - slow progression
what are the two types of DMARDs?
synthetic
biologic
what are the synthetic DMARDs?
antimetabolite / antifolate polypeptide abx cytostatic / cytotoxic antimalarial gold compounds
what is the first line DMARD agent for RA? which class is it in?
methotrexate
antimetabolite
what class of drug is leflunomide? what is the MOA?
synthetic DMARD
inhibits ribonucleotide synthesis cell cycle arrest
chloroquine and hydroxychloroquine are what type of drug?
synthetic DMARDs
what are the general MOAs of the biologic DMARDs?
ab-ag interactions
cytokine receptor interactions
cell signaling proteins, inhibitors, ligands
what are the anti-TNF biologic DMARDs?
etanercept
infliximab
what is the IL-1 inhibitor DMARD?
anakinra
what is the MOA of anakinra?
IL-1 receptor inhibitor
what is the MOA of etanercept and infliximab?
anti-TNF
what is the treatment of choice for PREVENTION of migraines?
metoprolol (b1)
what are the prevention agents for migraines?
propanalol (b1 and b2) metoprolol (b1) amitryptyline divalproex (valproate) topiramate
which migraine drug class has adverse effects that include drowsiness, tremor, hair loss, blood and liver abnormalities, and teratogenicity?
anticonvulsants
which migraine drug class has adverse effects that include postaural symptoms and is contraindicated in patients with asthma?
beta blockers
when are NSAIDs used in migraines?
non specific pain therapy in acute migraine attacks
which drugs carry a risk of transforming migraines into a more severe, chronic form?
NSAIDs
opiates
what are the antiemetic drugs used for acute migraine attacks?
metoclopramide
chlorpromazine
prochlorperazine
what are the ergot derivative agents? what is the MOA?
ergotamine
dihydroergotamine
vasoconstriction via alpha receptors and 5-HT receptors
what is the triptan drug? what is the MOA?
sumatriptan
selective 5-HT1d and 5-HT1b receptor agonists
what are the contraindications of the triptan drugs?
restricted for presence of CV disease
what is the best treatment for migraines?
sleep
the triptan drugs relieve what migraine symptoms?
pain
nausea
photophobia
