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migraines
clinical neuro 3
| Question | Answer |
|---|---|
| receptors affected by chlorpromazine & prochlorperazine | DA, Ach, adrenergic, histaminergic |
| adverse effects of DA antagonists | poikilothermic, blurred vision, constipation, agranulocytosis, phototoxicity, EPS |
| 1 dose of sumatriptan = | aspirin + metoclopramide |
| NSAIDS most effective when | taken early on in an attack |
| benefit of nasal spray 5HT1 agonists | faster and more effective relief |
| 5HT1 agonists + DA antagonists used for | severe acute attacks |
| amidrine = | acetaminophen + dichloralphenazone + isometheptene |
| potent vasoconstrictor | isometheptene |
| analgesic, anti-pyretic, and sedative drug | dichloralphenazone |
| propanolol use | prophylactic drug for migraines |
| pizotifen use | prophylactic drug for migraines |
| MOA of pizotifen | 5HT1, 2A, & 2C antagonist, with some anti-histamine/cholinergic effects |
| side effect of pizotifen | weight gain, drowsiness, anti-muscarinic effect |
| 3 major components of theory of cortical spreading depression | correlates to visual field distrubances, mediated by release of pro-inflam neuropeptides, involves activating of trigeminal afferents from dural vasculature |
| 3 major arguments for serotonin theory | anti-migraine agents are 5HT agonists/antagonists, increased risk of attack during resperpine/fenfluramine therapy |
| triptans & ergot alkaloids are.. 5HT agonists | |
| MOA of triptans | vasoconstriction & 5HT-1 mediated inhibition of CGRP |
| not effective in migraines w/aura until after the headache has already begun | triptans |
| contraindications of triptans | CV disease and cerebrovascular disease |
| receptors acted on by triptans | 5HT 1B & 1D |
| receptors acted on by ergot alkaloids | 5HT1 |
| contraindications of egot alkaloids | pregnancy, PAD, CAD, HTN, impaired renal/hepatic function |
| MOA of meteoclopramide | 5HT4 agonist, D2 antagonist, 5HT3 antagonist |
| helps w/nausea/vomitting in migraines | metoclopramide |
| adverse effects of metoclopramide | galactorrhea, constipation, EPS, tardive dyskinesia |
| contraindications for metclopramide | pheochromocytoma, PD |
| DA antagonists used to treat migraines chlorpromazine & prochlorperazine | |
| receptors affected by chlorpromazine & prochlorperazine | DA, Ach, adrenergic, histaminergic |
| adverse effects of DA antagonists | poikilothermic, blurred vision, constipation, agranulocytosis, phototoxicity, EPS |
| 1 dose of sumatriptan = | aspirin + metoclopramide |
| NSAIDS most effective when | taken early on in an attack |
| benefit of nasal spray 5HT1 agonists | faster and more effective relief |
| 5HT1 agonists + DA antagonists used for | severe acute attacks |
| amidrine = | acetaminophen + dichloralphenazone + isometheptene |
| potent vasoconstrictor | isometheptene |
| analgesic, anti-pyretic, and sedative drug | dichloralphenazone |
| propanolol use | prophylactic drug for migraines |
| pizotifen use | prophylactic drug for migraines |
| MOA of pizotifen | 5HT1, 2A, & 2C antagonist, with some anti-histamine/cholinergic effects |
| side effect of pizotifen | weight gain, drowsiness, anti-muscarinic effect |
| extremely potent vasodilator neuropeptide | calcitonin gene related peptide |
| most effecacious triptans | rizatriptan,eletriptan; sumatriptan, zolmitriptan |
| least efficacious triptans | naratriptan, frovatriptan |
| bromocriptine | ergot alkaloid |
| LSD | ergot alkaloid |
| methysergide | ergot alkaloid |
| agonists at 5HT and a1 receptors | ergot alkaloids |
| side effects of ergot alkaloids | leg weakness, muscle pain, numbness/tingling, GI issues, nausea |
| post partum hemorrhage | ergot alkaloids |
| metoclopramide | DA antagonists |
| clinical uses of chlorpromazine & prochlorpromazine | antiemetic, schizophrenia, tourette syn, huntington disease, dementia |
| butorphanol | narcotic |
| meperidine | narcotic |
| MOA of butorphanol | partial agonist @u, full agonist @k |
| administration of butorphanol | intranasal spray |
| administration of meperidine | IV |
| concern for addiction liability | oxycodone, hydrocodone, etc |
| zolmitriptan | 5HT1 agonist |
| dihydroergotamine | 5HT1 agonist |
| sumatriptan | 5HT1 agonist |
| acetaminophen + dichloralphenazone + isometheptene = | amidrine |
| MOA of amitriptyline, dothiepin, & nortriptyline | 5HT & NE reuptake inhibitors, block Na+ channels, |
| clinical uses of tricyclics | migraine prophylaxis, pain syn, chronic fatigue syn |
| may precipitate mania in bipolar pts | tricyclic antidepressants |
| clinical uses of valproic acid | generalized seizures, absence seizures, migraine prophylaxis |
| MOA of valproid acid | prolongs inactive state of Na+ channels, inhibits Ca++ channels, increases GABA |
| MOA ofgabapentin | inhibits ca++ channels |
| may be associated with withdrawl sx | gabapentin |
| MOA of methysergide | 5HT2 & 5HT1A antagonist |
| retroperitoneal fibrosis | methysergide |
| clinical uses of methysergide | migraine prophylaxis, severe refractory migraines, cluster headaches |
| migraine prophylaxis drugs | propranolol, pizotifen, tricyclic Ads, valproic acid, gabapentin, methysergide |
| drugs for acute migraines | triptans, ergot alkaloids, DA antagonists, narcotics, combination |
Created by:
drhermy