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Neuro > Sweatman Migraines > Flashcards

Sweatman Migraines Flashcards

1
Q

tx of tension headaches

A

OTC NSAIDS an rarely require a doctors visit

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2
Q

tx of cluster headaches

A

nasal or subQ triptans or ergots + burst taper steroid like prednisone

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3
Q

rare form of headache, 25-50 yo male smoker,

A

cluster headaches

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4
Q

vasodilation causing pain and autonomic symptoms, trigeminovascular and superior hypothalmic activation, acitvation of CN VII

A

cluster headaches

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5
Q

tx of mild to moderate or menstrual migraine

A

non-narcotic NSAIDS

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6
Q

moderate to severe migraine tx.

A

short acting triptans

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7
Q

route of admin for triptans

A

oral or faster acting nasal

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8
Q

fasted route of admin for triptans

A

S.C. sumatriptan most effective and fastest onset

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9
Q

efficacy of oral triptans

A

all are equally effective

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10
Q

longer acting triptans but have slower onset

A

naratriptan, frovatriptan

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11
Q

prophyllaxis of migraine

A 
topiramate
valproate
propranolol
timolol
metoprolol
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12
Q

who is a candidate for prophylaxis therapy for migraines

A
  1. those with frequent attacks

2. those who are using anti-migraine therapy too frequent which has paradoxically made their symptoms worse

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13
Q

the aura of migraine is caused by?

A

spreading depression wave in the primary visual cortex (17) in the brain

*spreading depression also causes central sensitization

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14
Q

5HT1 agonists aid in migraine tx by three mechs

A
  1. inhibit sensory nerve discharge from periphery to CNS
  2. inhibit release of CGRP in periphery therfore abating neuroinflammation
  3. inihibit NO from dilating extracerebral blood vessels thus hindering sensory nerve discharge
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15
Q

triptan MOA

A

5HT receptor antagonist that inihibits CGRP release

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16
Q

5HTD and 5HTF receptors are found

A

presynaptically and triptan activation increases Ca entry…this inhibits CGRP release

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17
Q

5HT1B receptors are found

A

in blood vessels, agonism causes vasoconstriction

*local inflammatory mediators of the migrain had caused dilation-thus these throbbing

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18
Q

NSAIDS late in pregnancy can cause

A
  1. PDA

2. prolong labor and delivery

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19
Q

NSAIDS for migraine with longest durability of action and most convenient dosing schedule

A

once daily-nabumetone
naproxen-twice daily
ketoprofen 3 times daily
4 times-ibuprofen, fenoprofen, ketoprofen

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20
Q

NSAID COMBOS

A

acetaminophin, butalbital, caffeine

aspirin, butalbital, caffeine

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21
Q

barbirutrate used to tx. migrain in combo with other drugs

A

butalbital

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22
Q

moq for butalbital

A

sedatie hypnotic, effects via gaba enhancement

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23
Q

strongly linked to analgesic overuse syndrome

A

butalbital

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24
Q

barbiturates are ______ inducers and ____

A

cyp

cns respiratory depressants

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25
Q

contraindications for butalbital

A

porphyria, ethanol, sedative

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26
Q

caffeine withdrawl can cayse

A

CVS complications

headache

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27
Q

triptans are specific agonists one which receptors

A

5HT b and d agonists

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28
Q

where are the 5htB receptors

A

on the blood vessel that is dilated in a migraine

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29
Q

where are the 5HTD receptors located

A

pre-synaptically

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30
Q

MOA for triptans

A

inhibits trigeminal nerve activation by vasoactive peptides

inhibit cervical complex activation

bring about selective intracranial/ extracerebral vasconstriction

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31
Q

triptan drugs avaiulable in a nasal spray

A

sumatriptan
zolmitriptan
*faster onset than oral

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32
Q

one triptan that can be given S.C. and is the most effective tx for migrain

A

sumatriptan-rapid onset if given S.C.

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33
Q

triptans with long duration of action but slower onset

A

naratriptan (6 hours) frovatriptan (25hrs)

34
Q

triptans side effects/contraindications

A

contra in Heart Disease, uncontrolled HTN, ischemic bowel dz

may cause chest tightness

drowsiness, CNA effects, dizziness after resolution of the pain

35
Q

sideeffects of triptans worst with

A

SC sumatriptan

36
Q

drug interactions with triptans

A

MAOs-cyp 3a4
SSRI-serotonin syndrome
ergots-also cause vasoconstriction

37
Q

found in moldy grains and used to cause convulsions with dry gangrene

A

ergot alkaloids–> vasoconstrictor,

38
Q

ergot alkaloid for migraine tx

A

dihydroergotamine

ergotamine

39
Q

MOA for ergot alkaloids

A

central serotonin and peripheral vasoconstrictor (alpha)

also decrease amine reuptake

40
Q

ergot amines contraindicated in

A

peripheral vascular disease

CAD, sepsis, M,. uncontroleld HTN,

41
Q

hepatic metabolism with renal eliminiation

A

erghot amines

42
Q

triptan affected by concurrent cyp3a4 inhibitor

A

eletriptan

43
Q

triptans when given with propranolol cause increase in blood levels of the triptan

A

elitriptan,. rizatriptan, zolmitriptan

44
Q

MAO inhibtos inhibit the breakdown of these triptans

A

rizatriptan, sumatriptan, zolmitriptan

45
Q

do ergots work better or worse than triptans

A

worse bro

46
Q

pt.s unresponsive to triptans can get

A

ergots

47
Q

contraindicated in lactation

A

ergots

48
Q

tetratogens

A

ergots

49
Q

ergots and beta blockers or dopamine

A

potentiate vasoconstrcition

50
Q

ergots and strong CYP3a4 inhibitor

A

increased ergot perisistence thus increase vasoconstriciton

51
Q

triptaps plus ergots

A

24 hour rule???

52
Q

migrains in pregnancy

A

worse in 1st trimester-when fetus most suceptible

acetaminophen only agent used

53
Q

when to begin tx of menstrual migraine

A

2-3 days before period and continue until period is done

54
Q

severe menstrual migraines of when taking OCP’s how shoudl NSAIDS be used

A

begin on the 9th day of the cycle and take them through the second day of the next cyle

55
Q

OCP’s and migraine with aura

A

these patients should only get Combine OCP’s

2 x risk for aura migraine and 2 x risk of OCP
these are multuiplicative rather than additive risk
*use cuation with pure estrogen OC’s

56
Q

triptans ineffective in tx of which migraine symptom

A

allodynia

57
Q

narcotis for migraine

A

hydrocodone
oxycodone
codeine

58
Q

alternative analgesic for migraine

A

IM ketorolac

59
Q

narcotis for migraine should be given as

A

last resort

60
Q

vomit center in the brain is where

A

retucular formation in the medulla

61
Q

antiemetics for migraine tx

A

metoclopramide
prochlorperazine
promethazine
chloprmazine

62
Q

ade of metoclopramide

A

inc prolactin levels

gynecomastia

63
Q

ade of prochloperazine and chlopromazine

A

dyskinesia
hypotension
urinary retention
BPH

64
Q

ade for promethazine

A

glaucoma, urinary retention, BPH, drowsiness, Parkinson like symptoms

65
Q

works via cholinergic blockade

A

promthazine

66
Q

works via D2 blockade centrally

A

metoclopramide
prochloperazine
chlopromazine

67
Q

sum up the overall cause of migraine headaches

A

peripheral neurogenic inflammation from emotional of environmental triggers

(exact trigger often unknown)

68
Q

major drug classes available for prophyllaxis of migraine headaches

A

antiepileptic drugs
antidepressants
beta blockers
calcium channel blockers

69
Q

1st line prophyllactics for migraine

A

amitriptyline
valproic acid
propranolol
topiramate

70
Q

Amitriptyline MOA and adverse effects

A

decreases reuptake of NE and serotonin, strong anticholinergic activity

–> aggressiveness, weight gain, dry mouth and sedation

71
Q

MOA for valproic acid and adverse effects

A

Na channel blocker, increases GABA activity

category X, hepatotoxicity, weight gain, highly protein bound

72
Q

drug with which perturbation of protein bound fraction can cause massive swings in free drug availabilit and increase adverse effects

A

valproic acid

73
Q

MOA for propranolol and adverse effects

A

decrease arterial dilation, decrease NE induced lipolysis

fatigue, exercise intolerance, asthma, diabetes, AV block

74
Q

moa for topiramate and adverse effects

A

block NA and glutamate, increase GABA activity

parasthesias, fatigue, nausea, narrow therapeutic range

75
Q

prophylactic not FDA approves for migraine

A

amitriptyline

76
Q

only drug for migraine prophylaxis in children

A

propranolol

77
Q

analgesic overuse syndrome is essence is caused by

A

cellular adaptation in the already aberrant signalling pathway

78
Q

four areas of cellular adaptation that cause analgesic overuse syndrome

A

Trigeminovascular syndrome
Reduced 5HT levels
cellular adaptation
free radical damage to PAG

79
Q

high risk for analgesic overuse syndrome

A

Apirin/acetaminiphen/caffeine combos
butalbital combos
opioids

short acting NSAIDS»> Long acting

80
Q

bull shit home remedies for migraines that fucking witch doctors use

A

coQ10 and riboflavin

butterbur and feverfew
*but not in pregnancy

Neuro (19 decks)

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