2023-12-07T05:48:39+03:00[Europe/Moscow] en true <p>c</p>, <p>30-39; decreases slightly w/age </p>, <p>dull, diffuse pain like a band above eyeballs</p>, <p>c</p>, <p>hormonal changes, stress, food chemicals </p>, <p>a,c</p>, <p>premonitory, aura, headache, postdrome</p>, <p>a</p>, <p>b</p>, <p>d</p>, <p>throbbing pain, N/V, sensory sensitivity, visual disturbances</p>, <p>a</p>, <p>alcohol, cigarette smoke, seasonal (spring or fall)</p>, <p>intense/incapacitating pain behind one eye, nasal congestion, eyelid swelling, facial sweating</p>, <p>15min-3hr; multiple times a day over 4-12 weeks</p>, <p>activation/sensitization of trigeminal neurons, the release of vasoactive peptide/local inflammation, sensitization of 2nd order neurons in the brain stem, then 3rd order neurons in the thalamus, nociceptive impulses reach somatosensory for pain perception</p>, <p>naproxen; good CNS penetration </p>, <p>b</p>, <p>metoclopramide </p>, <p>Naproxen + Sumatriptan </p>, <p>selective agonism of 5-HT1B and 5-HT1D receptors found in cerebrum/meningeal blood vessels; causes vasoconstriction</p>, <p>vasoactive peptide release, neurogenic inflammation, pain transmission </p>, <p>c</p>, <p>a</p>, <p>c</p>, <p>incomplete/inconsistent pain relief; high rates of HA recurrence </p>, <p>a</p>, <p>a</p>, <p>a,c</p>, <p>c</p>, <p>c</p>, <p>non-selective 5-HT1 receptor agonist; also agonizes alpha-1 receptors </p>, <p>c</p>, <p>d</p>, <p>does not cause</p>, <p>selective 5-HT1F agonist; inhibits trigeminovascular/CNS pain pathways and neuropeptide release</p>, <p>dopamine; chemoreceptor trigger zone</p>, <p>e</p>, <p>f</p>, <p>gepants </p> flashcards
Pharmacology of Headaches

Pharmacology of Headaches

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  • c

    Which is the most common primary H/A?

    a) migraine

    b) cluster

    c) tension

  • 30-39; decreases slightly w/age

    What is the peak age of Tension-Type HAs?

  • dull, diffuse pain like a band above eyeballs

    What are the symptoms of Tension-Type HAs?

  • c

    Which is triggered by physical/emotional stress?

    a) migraine

    b) cluster

    c) tension

  • hormonal changes, stress, food chemicals

    What are the triggers of Migraines? (3)

  • a,c

    Which affects women more than men?

    a) migraine

    b) cluster

    c) tension

  • premonitory, aura, headache, postdrome

    What are the phases of Migraine symptoms? (4)

  • a

    Which phase is characterized by neck discomfort and brain fog?

    a) premonitory

    b) aura

    c) HA phase

    d) postdrome

  • b

    Which phase is characterized by neurologic disturbances/tingling in face or arm?

    a) premonitory

    b) aura

    c) HA phase

    d) postdrome

  • d

    Which phase is characterized by tiredness & lack of concentration?

    a) premonitory

    b) aura

    c) HA phase

    d) postdrome

  • throbbing pain, N/V, sensory sensitivity, visual disturbances

    What are the HA phase symptoms in Migraines? (4)

  • a

    Which phase involves mood changes?

    a) premonitory

    b) aura

    c) HA phase

    d) postdrome

  • alcohol, cigarette smoke, seasonal (spring or fall)

    What are the triggers for Cluster HAs? (3)

  • intense/incapacitating pain behind one eye, nasal congestion, eyelid swelling, facial sweating

    What are the symptoms of Cluster HAs? (4)

  • 15min-3hr; multiple times a day over 4-12 weeks

    How long do Cluster HAs last?

  • activation/sensitization of trigeminal neurons, the release of vasoactive peptide/local inflammation, sensitization of 2nd order neurons in the brain stem, then 3rd order neurons in the thalamus, nociceptive impulses reach somatosensory for pain perception

    What is the pathophysiological cascade for Migraines? (5)

  • naproxen; good CNS penetration

    Which NSAID is good at treating Migraines? Why?

  • b

    Which can cause rebound analgesic headaches in continuous use?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • metoclopramide

    What can increase the speed of absorption in NSAIDs?

  • Naproxen + Sumatriptan

    Treximet =

  • selective agonism of 5-HT1B and 5-HT1D receptors found in cerebrum/meningeal blood vessels; causes vasoconstriction

    Triptans MOA?

  • vasoactive peptide release, neurogenic inflammation, pain transmission

    Triptans reduce: (3)

  • c

    Which one has the fastest onset when given SC?

    a) frovatriptan

    b) zolmitriptan

    c) sumatriptan

  • a

    Which one has the longest half-life?

    a) frovatriptan

    b) zolmitriptan

    c) sumatriptan

  • c

    Which is the most effective?

    a) frovatriptan

    b) zolmitriptan

    c) sumatriptan

  • incomplete/inconsistent pain relief; high rates of HA recurrence

    What are the limitations of Triptans? (2)

  • a

    Which can cause chest tightness and increased pressure?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • a

    Which can cause serotonin syndrome?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • a,c

    Which are Contraindicated with MAO-I?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • c

    Which has a BW for life-threatening peripheral/cerebral ischemia?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • c

    Which are substrates of CYP3A4?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • non-selective 5-HT1 receptor agonist; also agonizes alpha-1 receptors

    Ergot Alkaloid MOA?

  • c

    Which is contraindicated in pregnancy?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • d

    Which is a Schedule V drug?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • does not cause

    Activation of 5-HT1F receptors __________ vasoconstriction.

  • selective 5-HT1F agonist; inhibits trigeminovascular/CNS pain pathways and neuropeptide release

    Lasmiditan MOA?

  • dopamine; chemoreceptor trigger zone

    Antiemetics block _______ receptors in the _______.

  • e

    Which is effective at relieving migraines and preventing them?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • f

    Which is ONLY effective at preventing migraines?

    a) Triptans

    b) NSAIDs

    c) Ergots

    d) Lasmiditan

    e) CGRP inhibitors

    f) mABs

  • gepants

    What are the CGRP inhibitors?