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Central Nervous System Pathology > Treatment of HAs > Flashcards

Treatment of HAs Flashcards

1
Q 
Used in prophylaxis of migraines
Take 3 weeks to be effective
Mechanism is unclear
Reduced energy, tiredness
contraindicated in pts with asthma
A

Beta blockers
Propranolol and Atenolol
propane and antenna lol’ing

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2
Q

Prophylaxis of migraines
mechanism unclear
Inhibit serotonin reuptake
cause weight gain and tiredness

A

TCAs
amitriptyline and nortriptyline
“ami and nora tripped and fell on their heads”

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3
Q

Px of migraines

MOA unclear, increase GABA signaling

A

Anticonvulsants

Valproic acid, topiramate, gabapentin, Levetriracetam

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4
Q

Contraindicated in pregnancy due to teratogenicity

causes drowsiness, nausea, ataxia, alopecia, tremor, and liver toxicity

A

Valproic acid

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5
Q

calcium channel blocker
antihypertensive, Px of migraines
MOA unclear
negative inotropic effects and hypotension

A

Verapamil

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6
Q

Px of migraines
histamine antagonist
Ach and serotonin antagonist
used for seasonal allergy and pruritus

A

Cyproheptadine

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7
Q

mild to moderate migraine abortion
nonspecific pain reduction agents
(4 examples)

A

NSAIDs, Ibuprofen, naproxen, acetaminophen, ketorolac

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8
Q

mild to moderate migraine abortion

combined with caffeine to increase efficacy

A

acetaminophen, aspirin, ibuprofen, naproxen

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9
Q

moderate migraine abortion
nonspecific pain reduction agent
given IV or PO for max 5 days

A

ketorolac

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10
Q

which two nonspecific agents are given to children and pregnant women to stop migraines?
which nonspecific agent should be avoided during the last trimester of pregnancy?

A

acetaminophen and ibuprofen

NSAIDs because they close ductus arteriosus and increase bleeding

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11
Q

Migraine abortive therapy
agonist at 5-ht1 receptors
partial agonist and antagonist at serotonergic, dopaminergic, and adrenergic receptors
very widespread side effects, causing nausea and vasoconstriction

A

ergot alkaloids

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12
Q

which ergot is given sublingual?

A

ergotamine

ergot, it’s mine. i’m hiding it under my tongue.

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13
Q

which ergot is given sc, im, iv, or nasal spray?

A

dihydroergotamine

this ergot is also mine, but i can take it in a variety of ways.

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14
Q

contraindications for ergotamine and dihydroergotamine

A

pregnancy X (fetal stress, miscarriage, vasoconstriction)
peripheral vascular disease
ischemic heart disease
within 24 hours of triptans

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15
Q

migraine abortive therapy
causes less vasoconstriction and nausea than ergots
selective MOA: 5-HT1 receptor agonism

A

triptans

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16
Q

Triptan effects:
vascular
neurogenic
central

A
  • vasoconstriction of cranial blood vessels
  • reduction of trigeminal sensory nerve activation and inhibition of vasoactive neuropeptide release
  • inhibition of NT release from trigeminal nerves in the brainstem and upper cervical spine
17
Q

short onset triptan

sq, PO, or nasal spray

A

sumatriptan

sumo tripped and fell on your head

18
Q

greater bioavailability than sumatriptan
lipophilic and greater CNS distribution
P450 metabolism
lower dose in renal dysfunction

A

noratriptan and zolmitriptan

Nora’s ohms. Imagine nora tripping and getting upset, so she sits down to meditate. Unfortunately, as she’s sitting she realizes that he kidneys really hurt, but her brain is highly active.

19
Q

longest acting triptan
highest affinity for 5-HT1B receptors
slower onset

A

Frovatriptan

frova the triptan, likes the 5HT1B, he was really slow as the people know just the same as you and me

20
Q

quick dissolving sublingual tablet
faster onset, less nausea than sumatriptan
MAO metabolism

A

Rizatriptan

rizatriptan rapidly rises to your brain

21
Q

Triptan side effects:
CNS
peripheral
MSK

A

HA recurrence, drowsiness
tingling, paresthesias, dizziness
neck stiffness

22
Q

drug interactions of triptans

A

SSRIs: causes serotonin syndrome due to inhibition of serotonin reuptake and simultaneous 5HT1B agonism (restlessness, hallucinations, diarrhea)
within 24 hours of ergots

23
Q

Abortive therapy for cluster HAs

A

oxygen

triptans

24
Q

Gold standard Px for cluster HAs

A

high dose prednisone

verapamil

25
Q

Acute Tx for tension HAs

A

nonspecific anti-inflammatory drugs: acetaminophen and NSAIDs

26
Q

Px for tension HAs

A

TCAs

Gabapentin

27
Q

Lifestyle changes for treating IIH

A

weight loss
removal of drugs like tetracycline, oral contraceptives
reducing vitamin A hypervitaminosis

28
Q

acute Tx of IIH
what class?
side effects?

A

CA inhibitors to reduce CSF production
acetazolamide and topiramate
nausea, fatigue, tingling in extremities, weight loss, loss of concentration

29
Q

What are the three drug classes used in Px of migraines?

Order them from most to least commonly used

A
  • beta blockers
  • TCAs
  • anticonvulsants
30
Q

Name the two drug classes used for abortive therapy of migraines.

A
  • ergot alkaloids

- Triptans

Central Nervous System Pathology (5 decks)

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