Ios 8 Exam 2

Front 1

Behavioral Therapy for Migraine

Back 1

Avoid Triggers, biofeed back, stress reduction, application of ice, sleep and relaxation

Front 2

Medications for prophylactic migraine

Back 2

Beta Blockers,Calcium channel blockers, antidepressants, antiepiletic, NSAIDs, cyprohyepatidne, methysergide,

Front 3

Acute Exacerbation/ Relapse MS Tx

Back 3

Steroids: Immunonmodulatory- reduces t lymphocytes
block gamma IFN, reduce IgG synthesis inhibit PGE2
Methylprednisolone, Dexamethasone, prednisone
or PLasma exchange

Front 4

Relapse Remiiting MS Tx

Back 4

Interferon beta -1b
interferon beta -1a
glatiramer acetate

Front 5

interferon beta 1 b

Back 5

betaseron-produced in E coli
SC injection,

Front 6

interferon beta 1-b/a MOA

Back 6

immunomodulating activity, altering the immune response against he mylein sheath. decreases cell migration into CNS, Peripheral and BB

Front 7

interferon beta 1 a

Back 7

Avonex, Rebif
mammalian cell line, identical to human interferon
Ave: IM q week Rebif: SC 3x a week.

Front 8

glatirmaer acetate

Back 8

copxaone,
immunomdulating activity, blocks the binding of MHC class II products to myeline bacis protein, synthetic poplypetptide. SC daily

Front 9

therapies used to treat worsening or progressive MS

Back 9

Mitoxantrone
Natalizumab
Rituxumab: non FDA
Mycophenolate: non fda

Front 10

natalizumab

Back 10

for pts w inadequate response or intolerance to other MS therapies. Partial humanized mAb against VLA-1 works in BBB. IV infusion q 4 weeks. can cause PML

Front 11

mitoxantrone

Back 11

reduces relapse rate, disability progression and MRI activity. IV q 3 months. can cause secondary leukemia

Front 12

Rituximab

Back 12

chimeric murine/human mAb CD 20 IV at baseline

Front 13

visual loss: MS Tx

Back 13

IV methylprednisone

Front 14

weakness: MS Tx

Back 14

PT, OT, Dalfampridine: K channel blocker

Front 15

Spacticity: MS tx

Back 15

Baclofen, tizanidine, Dantrolene

Front 16

bladder dysfunction: MS tx

Back 16

DDVAP, cholinergic agents, prazosin, oxybutin, tolterodine, fesoteradine, darfinencin, solfenacine, trosopium

Front 17

Urinary tract infection: MS tx

Back 17

bactrim, keflex

Front 18

Fatigue: MS tx

Back 18

amantadine, methylphenidate, fluoxetine, modafinil, dexedrine

Front 19

Goals of MS medication therapy

Back 19

shorten recovery time from exacerbations, decrease the nmber/severity of relapses, Prevent development of secondary progressive disease, stop the firther progression of progressive MS, provide symptomatic modalities, improve quality of life.

Front 20

primary headache

Back 20

no 2nd cause
Migraine w Auroa
Migraine w/o Aurora
Cluster
Tension headache

Front 21

2nd headache

Back 21

due to secondary cause,
trauma, headache

Front 22

medidcation over use headache

Back 22

rebound headache due to:
analgesics, ergotamines, caffeine and triptans
withdrawal symptoms on d/c, toxic effects from med. escelating use leads to escelating headache

Front 23

migraine w/o aura

Back 23

at least 5 HA with: last 4-72 hrs
Has 2 of: Unilateral location, pulsating, inhibits ADLs, aggravated by routine physical activity
During HA: n/v and/or photophbia

Front 24

migraine w aura

Back 24

2 attacks with three of:
at least 1 fully reverisable
at least one aura symtom developing over 4 mins or two in sucession
no aura symptom ? 60 mins
migrain headache follows aura within 60 mins. may begin with or before aura

Front 25

migraine triggers

Back 25

sleep: too little or too much
dehydration, stress, emotional letdown, missing meals, meds, EtOH, weather changes, smoking, strong perfumes, foods with preservatives

Front 26

fortification spectra

Back 26

objects appear surrounded by luminous angles

Front 27

photopsia

Back 27

shimmering, sparkling, flashing light

Front 28

scotomata

Back 28

hazy or lost vision

Front 29

formication

Back 29

burning, prickling sensations without external stimuli

Front 30

cluster headache

Back 30

usually male, onset 27-30 years
duration 15min-3hours
excruciating, unilateral, n/v rare, awakens from sleep with headache, cannot remain still and usually paces

Front 31

tension headache

Back 31

attacks 15days/month, pain does not prohibit activity, dual like, bilateral, no n/v, photo/phonophobia

Front 32

migraine generator

Back 32

brain stem

Front 33

migraine patho

Back 33

reticular activating systme-> stimulates brain stem nuclei(vagas) -> stimulates NO and plasma protein release from meningeal blood vessels

Front 34

Plasma protein + NO=

Back 34

irritation of trigeminal nerve

Front 35

Stimulation of peripheral trigeminal nerve

Back 35

calcitonin gene related peptide-vaso dilator
sub P
Neurokinin A
Plasma protein extravastation and inflammation
neurogeic inflammation

Front 36

potent vasodilators

Back 36

NO
Calcitonin Gene related peptide
Sub P
Neurokinin A

Front 37

Central Brain stem trigeminal nuclei

Back 37

central pain transmission through thalamus

Front 38

goals of migraine therapy

Back 38

Acute/abortive: reduce intensity and duration,no effect on aura must take at at onset of pain
Preventitive: to reduce occurance,
overall: pain free, reduce or prevent disability, improve QOL, educate

Front 39

FDA approved for prevention of migraine

Back 39

Valproate
tiromate

Front 40

FDA approved Beta Blocker

Back 40

Propanolol
Timolol-Adult- not commonly used

Front 41

Beta blocker for migraine pro

Back 41

MOA: unknown
Reduce HR, reduce BP, may require several months of tx, sexual dysfunction

Front 42

Calcium Channel Blocker for migraine pro

Back 42

no FDA approved
MOA: interaction with CNS neurotransmission, unknown
may require 3 weeks-2 months
SE: constipation

Front 43

antidepressants for migraine pro

Back 43

TCAs-not fda labeled
MOA: inhibition og 5-HT2
SE: sleepy, increase falls, anticholinergic effects
Amitripyline can cause weight gain

Front 44

AEDs for migraine pro

Back 44

Topiramiate-taste aversion, tired, parasethisia-FDA labeled
Valproate-FDA labeled

Front 45

cyproheptadine

Back 45

serotonin and histamine antagoinst
MOA: unknown
SE: sedation, anticholinergices, weight gain!

Front 46

methylsergide

Back 46

ergotamine
serotonin receptor antagonist
SE: fibrosis- endocardial, pulm, retroperitoneal
compound only

Front 47

importance of dose delivery form

Back 47

gut motility slows down during migraine

Front 48

triptans recommended uses

Back 48

acute
moderate to severe pain
cluster headache-sumatriptan
menstral migraine

Front 49

triptans MOA

Back 49

neuronal inhibition blockks depolarization of sensory affeents at the trigemninal nerve. Thus blocking vasoctive peptide release of neurovascular inflammation of the meningeal and dural vasculature
vasoconstriction of meningeal, dural and cerebral arteries
does not affect regional cerevral blood flow,

Front 50

sumatriptan

Back 50

hits more seratonin receptors besides b/d, (f)
duration of action: short, can repeat dose
SC injection works the fastest
half life: 2
metab: MOA-A

Front 51

sumatriptan/naproxen

Back 51

naprosin: inhibits PG synthesis
approved for acute tx

Front 52

Zolmitriptan

Back 52

can repeat,
Short acting
Nasal, melt tablet-gastric abs, tablet
Met: CYP and MAO
Bio: higher than imitrex

Front 53

Naratriptan

Back 53

repeat time is 4 hours
long duration of action
higher Bioavailbility

Front 54

rizatriptan

Back 54

repeat at 2 hours
short duration of action
MLT-melt tablet, gastric, mint
met: MAO
pts taking propanolol: reduced dose

Front 55

almotriptan

Back 55

repeat at 2 hours
short duration of action
higher bioavailbility
Met: CYP 2D6 and 3A4, MAO,
better tolerated

Front 56

frovatriptan

Back 56

longest duration acting
can repeat at 2
long half life: 26 hours!
Menstral migraines-scheduled or stressful event
Met: renal cyp1A2
BCP can increase Cmax and AUC-decrease dose

Front 57

eletriptan

Back 57

repeat at 2 hours
duration: short 4hours
Bio is increased with fatty meal
Met: CYP 3A4-do not use within 72 hours of inhibitor
propanolol increases AUC-decrease dose
don't use in hepatic impairment

Front 58

ADRs for triptans

Back 58

chest pain
flushing, dizzy
paresthesia
drowsiness
nausea
neck pain
MI, vasospasms

Front 59

CI for triptans

Back 59

Coronary artery disease, hypercholesterolemia, hepatic disease, prinzmal angina, hemiplegic or complicated migraine, breastfeeding/pregnancy
MAO-I use, within 24 hours of other vasoconstricotrs
SSRI use

Front 60

isometheptene

Back 60

contains APAP
weird dosing schedule

Front 61

Antiemetics for migrine

Back 61

mild to moderate pain adjunct
chlorpromazine, metoclopramide-role in preg
prochlorpreazine: 1st line in ED - role in preg

Front 62

corticosteriods in migarin

Back 62

rescue therapy in status migrainus-abortive
pain due to tumor

Front 63

analgesics in migraine

Back 63

cause rebound but can be used in abortive or rebound, limit to 3x a week

Front 64

IV depakon in migraine

Back 64

moderate to severe headache - as rescue therapy! works great when can't use another vasoconstrictor

Front 65

Narcotics for migraine

Back 65

abortive therapy
mereridine
Butorphanol-NS
Butalbital+/- APAP- addictive!

Front 66

ergot deritvates recommened use

Back 66

moderate to severe, menstral migraine, cluster headahce, intractable migrain, chronic daily headaches

Front 67

ergotamines MOA

Back 67

high affinity for 1b/1d/1f adn 2,
affinity for alpha, beta and D2
vasoconstricotr
reuptake inhibition of NE
reduction of vasogenic/neurogenic inflammation

Front 68

dihydroergotamine mesylate

Back 68

IV or IM, NS, for status migraine
SE: nasal irritation, fatigue, diarrhea, dizziness, dry mouth, n/v, taste perversion
Category X
Drug interactions: vasoconstricotrs, abx

Front 69

Neuropathology of MS

Back 69

Demylination: reversible
Axonal loss: irreversible
immune mediated damage: disability

Front 70

immunopathology of MS

Back 70

T cells activated in periphery-> adhesion molecules-> activate MMP->
Release of cytokines, upregulation of immune response, BBB opens more
damage to myelin and axons via antibodies, complement protein, free radicals and cytokines. Variable path between pts

Front 71

pseudo exacerbations

Back 71

temperature-heat
infections: UTIs
stress: emotional, physical

Front 72

3 components of pain

Back 72

sensory, emotional and cognative

Front 73

nociceptive pain

Back 73

stimulation of somatic and visceral peripheral nociceptors by stimuli that damage tissue, post op, sports injury

Front 74

neuropathic pain

Back 74

pain resulting from injury to or dysfunction of the peripheral/central NS. No useful biological function. postherpetic, phantom limb, peripheral neuropathy

Front 75

Mixed pain

Back 75

neuropathic + nociceptive
complex regional pain syndrome
failed low back pain surgery

Front 76

transduction

Back 76

conversion of stimuli into electrical action potential by nociceptors

Front 77

transmission

Back 77

movement of electrical stimulus info into and through the spinal cord: A fibers, C fibers

Front 78

modulation

Back 78

modulation of nerve impulse by SC and higher CNS areas, calc excit vs inhib, if it should go higher into CNS

Front 79

what receptors inhibit pain transmission

Back 79

opioid: Mu, Kappa, gamma
GABA: A and B
Alpha 2
blocked Na and Ca ion channels
opening of ion channels
neuropeptide Y

Front 80

perception

Back 80

summation of steps 1-3
transduction, transmission and modulation

Front 81

peripheral sensitization

Back 81

decreased thershold, increased intensity and prolonged firing, ectopic discharges, abnormal accumulation of Na channels

Front 82

tramadol

Back 82

25 mg/day increase 50-100mg q 3-7 days, max 400 mg/day - can be divided
trial: 4 weeks
Consider: childern>16, adults <75 (max 300/day) renal: max 200/day, cirrohosis: 50 mg q12
DI: CBZ, SSRI, MAO-I
evidence: OA, Neuropathic, diabetic neuropathy

Front 83

TCAs for pain

Back 83

10-25 mg q HS, increase 10-25mg q 3-7 days, max 75-150 mg as tolerated
trial: 6 weeks
SE: Anticholinergic: Am worst
DI: Cimitidine, antiHTN, SSRI, class I antiarryhthmics
Benefit: neuropathic pain

Front 84

duloxetine

Back 84

SNRI,60 mg qD-120mg qD
not for renal or hepatic insufficiency
SE: anorexia, ataxia, HTN
DI: 2D6, 1A2
evidence for: postherpatic, diabetic neuropathy, fibromyalgia

Front 85

venlafaxine

Back 85

SNRI, IR: 25 mg BID increase 50-75 mg q 7, XR: 37.5 mg increase 37.5-75 mg q 14. max150-225/day
DI: antiHTN, 2D6, 3A4
benefit: diabetic, polyneuropathy

Front 86

gabapentin

Back 86

modulation of N type Ca channels
100 mg-300 mg qHS
adjust for renal,
trial: 3-8 weeks for titration, 1-2 for max
benefit: neuropathic

Front 87

pregamblin

Back 87

schedule V
start 150 in divided doses
evidence: diabetic, postherptic, fibromyalgia

Front 88

lidocaine 5% patch

Back 88

Na channel modulator
max 3 patchs/day for 12 hours. 12 on 12 off
trial 2 weeks
evidence: neuropathic

Front 89

capcasin

Back 89

cream
trial 4 weeks
evidence: diabetic, postherpatic, limited use when alone

Front 90

Buproprion

Back 90

2nd line
MOA: seratonin, NE and Dopamine
evidence: neuropathic

Front 91

milnacipran

Back 91

2nd line
Seratonin, NE reuptake inhib
trial 3 weeks
reduce renal
DI: CYP450
evidence: fibromyalgia

Front 92

Carbamezapine

Back 92

2nd line pain
Na modulation
ADR: leukopenia, aplastic anemia
DI: tramadol, fluoxetine, war, BC
benefit; trigeminal, diabetic, postherpatic

Front 93

lamotragine

Back 93

2nd line pain
SE: SJS,
DI: CBZ, pheny, val, APAP
evidence: trigeminal, diabetic, CPSP, spinal cord injury, HIV neuropathy

Front 94

oxcabazepine

Back 94

2nd line pain
SE: hypoNa
DI: BCP, felodipine,
evidence: trigmeinal, diabetic, refractory

Front 95

mexilitine

Back 95

2nd line pain
Na channel modulation
benefit: diabetic, peripheral

Front 96

hyperesthesia

Back 96

increased sensitivity to stimulus

Front 97

parasethesia

Back 97

abnormal or unplesant sensation

Front 98

dysthesia

Back 98

painful stimulation, burning

Front 99

allodynia

Back 99

pain with non-noxious stimuli - light touch

Front 100

hyperalgesia

Back 100

exagerated pain in response to noxious stimuli

Front 101

hyperapthia

Back 101

hyperalgesia that persist after stimulus removed

Front 102

deafferenation

Back 102

pain in region of sensory loss

Front 103

5 main functions of endogenous opioid system

Back 103

analgesia, modulate anxiety and stress, regulation of hormonal function, thermo regulation, and homeostasis

Front 104

opioid peptide families

Back 104

proenkephalin
prodynorphin
proopiomelancortin-B endorphins

Front 105

sensory vs affective perception

Back 105

sensory: nociceptor-> assending pathway
affective: psychological

Front 106

raising thereshold vs increacing pain tolerance

Back 106

threshold: release of enkephalins in dorsal horn, or release of opiods from leukocyte that inhbit sub P
tolerance: psych associated

Front 107

Central affects of opiods

Back 107

neuronal activity, analgesia, mood, resp depression, mood change, sedation

Front 108

peripheral effects of opioids

Back 108

histamine release, GI effects, bradycardia, decrease BP due to decrease pain

Front 109

therapeutic uses for opioids

Back 109

analgesics
preioperative sed
anti-diarrheal
cough suppresion
replacement therapy for addiction
overdose, opiate induced resp depression

Front 110

Morphine

Back 110

Use: analgesia, pre op, MI, Pulm edema
Epidural: tx of abdominal surgery
CI: Hypersens, acute broncho asthma, pulm disease, head injury, compromised renal function

Front 111

Codine

Back 111

use: analgesia mild to mod, anti-tussive (low dose)
little euphoria

Front 112

Fentanyl

Back 112

perioperative
potent - perpidine
adjunvant to surgery
CI: preg, bradycardia, hypotension

Front 113

levorphenol

Back 113

morphine, more potent
pre -op, post op with thiophental

Front 114

merperidine

Back 114

phenylperpidine
use: pulm and cancer pt
little anti-tussive
SE: tachy, blurred vision and dry mouth
not for renal or liver failure due to metabloite-> convulsions and hallucinations
not for seizure pts

Front 115

methadone

Back 115

morphine agoinst, mod to severe pain
replacement therapy
tolerance and phycisal dependence is slow
TCA and benzo increase accumulation

Front 116

pentazocine

Back 116

partial agonist, premed for surgery
CI: MI, epilepsy, head trauma, psychosis
less constipation and n/v
need more nalaxone if OD

Front 117

Naloxone

Back 117

pure antagonist
reversal of opioid OD
half life is 1 hour, need repeated doses
met: glucuronidation
decrease bioavailib with oral

Front 118

Dextramethoraphan

Back 118

less potent than codien
used for cough supression
acts on cough center in medulla