Ic3/24 Tx Of Allergies

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propranolol

Back 1

migraine - preventive therapy
beta-adrenergic receptor antagonist
beta1 and beta2 antagonist
treatment of choice
adverse effects: reduced energy, tiredness, postural sx, contraindicated in patients with asthma

Front 2

metoprolol

Back 2

migraine - preventive therapy
beta-adrenergic receptor antagonist
treatment of choice

Front 3

amitriptyline

Back 3

migraine - preventive therapy
antidepressant
adverse effects: drowsiness

Front 4

divalproex (valproate)

Back 4

migraine - preventive therapy
anticonvulsant
side effects: drowsiness, weight gain, tremor, hair loss, hematological and liver abnormalities, teratogenicity

Front 5

topiramate

Back 5

migraine - preventive therapy
anticonvulsant
side effects: drowsiness, weight gain, tremor, hair loss, hematological and liver abnorms, teratogenicity

Front 6

flunarizine

Back 6

migraine - preventive therapy
ca channel blockers
side effects: tiredness, weight gain, depression, parkinsonism

Front 7

verapamil

Back 7

migraine - preventive therapy
Ca channel blocker
side effects: constipation, leg swelling, atrioventricular conduction disturbances

Front 8

methysergide

Back 8

withdrawn!! preventive therapy for migraine
serotonin antagonist
side effects: drowsiness, leg cramps, hair loss, retroorbital fibrosis

Front 9

fluoxetine

Back 9

migraine - preventive therapy
SSRI
adverse effects: anxiety, insomnia

Front 10

NSAIDs

Back 10

migraine - acute attacks
aspirin, acetaminophen, naproxen, ibuprofen
tx immediately as HA is recognized
appropriate dose
coadminister antiemetic drug or drug that increases gastric motility --> facilitates absorption of primary drug, avoid overuse - limit to 2-3 days

Front 11

ergot derivatives

Back 11

for migraine - acute attacks
ergotamine, dihydroergotamine and derivatives; combination: ergotamine tartrate + caffeine
mechanism:
vasoconstriction due to stimulatino of alpha-adrenergic and 5-HT receptors, cerebral vessels are very sensitive to vasoconstriction
cerebral vasoconstriction has been attributed to partial agonist effects on neuronal or vascular 5-HT1D receptors
advantages - low cost, effective, high experience
disadvantages: complex pharma, variable absorption, extensive metabolism, potent and sustained vasoconstrictor effects - contraindicated in patients with CAD

Front 12

the triptans

Back 12

migraine - acute attacks
almotriptan, eletritptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan
mech: selective 5-HT1D and 5-HT1B receptor agonists
distinct advantages over ergot derivatives: selective pharmacology, simple/consistent pharmacokinetics, est efficacy and safety, moderate adverse effects
disadvantages: higher cost, restrictions on use in presence of CV disease
mechanism: inhibits effects of activated nociceptive trigeminal afferents, selective agonist --> cranial vasoconstriction, peripheral neuronal inhibition, inhibition of neurotransmission - second order trigeminocervical complex
safety - safe!! 5-HT1B - constrict coronary arteries (mimicking angina), MI - rare, contraindications - ischemic heart disease, hypertension, cerebrovascular disease
tolerability: medically uninportant but clinically irritating adverse effects; frequent - tingling, sensation of warmth in head, neck, chest, limbs; less frequent: dizziness, flushing, neck pain, and stiffness

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opiates

Back 13

migraine - acute attacks
meperidine, butorphanol, oxycodone, hydromorphone
provide effective relief for severe migraine
risk of dependence and addiction
adverse effects: rebound HAs, dizziness, nausea, vomiting, impaired cognitive function
no advantage over migraine-specific therapy

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antiemetics

Back 14

migraine - acute attakcs
metoclopramide, chlorpromazine, prochlorperazine
adjunctive therapy to combat nausea and vomiting due to migraine and/or ergot alkaloid tx
centrally acting dopamine receptor antagonists (D2) - (metoclopramine - also a weak 5-HT3 receptor antagonist) may also have a direct beneficial effect

Front 15

epinephrine

Back 15

tx allergic reactions
potent vasoconstrictor (alpha)
cardiac stimulant (beta1)
vasodilator in skeletal muscle (beta2)
treats:
anaphylactic shock and related type I hypersensitivity affecting respiratory and CV system
reverses bronchospasm, mucous membrane congestion, angioedema, severe hypotension
parenteral administration - IM (preferred), sc (blood flow in skin is unpredictable during hypotension), sometimes IV infusion

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corticosteroids

Back 16

tx allergic reactions
prevent late-phase reactions

Front 17

methylxanthine drugs (aminophyline)

Back 17

tx allergic reactions
adjunctive therapy to reduce bronchospasm

Front 18

histamine (H1 receptor blockers) diphenhydramine

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tx allergic rxns
block symptoms of anaphylaxis

Front 19

histamine (H2) receptor blockers (cimetidine)

Back 19

tx allergic reactions
tx refractory hypotension