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35 Cards in this Set
- Front
- Back
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How is serotonin made?
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tryptophan ->(tryptophan hydroxylase)-> serotonin
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Where is serotonin found?
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CNS
platelets GI tract |
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Where is the largest pool of serotonin?
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enterochromaffin cells of GI tract- function unknown
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What do carcinoid tumors of enterochromaffin cells cause?
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large amounts of secreted 5-HT --> stimulate intestinal sm mm, diarrhea, abdominal pain
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How do you diagnose carcinoid tumor of enterochromaffin cells?
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5HT metabolites and
5-hydroxyindoleacetic acid in urine |
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How can you treat carcinoid tumor of enterochromaffin cells?
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surgery,
or with 5HT and H1 antagonist = cyproheptadine |
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What is the type of most serotonin receptors?
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G protein linked seven transmembrane
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What is the exceptional serotonin receptor?
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5HT3- a ligand gated ion channel which increases Na and K permeability
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drug for migraines
acts on 5HT10 and 5HT1F |
sumatriptan
(so'-ma-trip-tan_ |
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hallucinogen drug
acts on 5HT2 |
LSD
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anti-emetic drug
acts on 5HT3 |
ondansetron
(on-dan'-se-tron) |
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drug improves gastric motility
acts on 5HT3/D2 |
metoclopramide
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drug used for schizophrenia
acts on 5HT2a2c/5HT6/5HT7 |
clozapine
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drug used for migraine prophylaxis
acts on 5HT1/2a/2c |
methysergide
(meth-i-ser'-jide) |
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What is the most common but least understood neurological syndrome
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migraine
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How do you diagnose migraine?
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clinical hx alone
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Describe the theory of migraine etiology
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trigger -> release 5HT -> activates 5HT2 receptor on endothelial cells in cerebral vasculature -> release NO -> release of CGRP and substance P -> plasma extravasation, pain and hyperalgesia
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Which neurons are involved with registering migraine pain
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sensory neurons of trigeminal ganglia --> through brain stem --> to thalamus and cortex
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Name three potential migraine triggers?
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red wine
chocolate irregular sleep patterns |
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Name three specific anti-migraine drugs that arrest the migrainous process directly and are nonanalgesic
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ergot alkaloids
ergotamine dihydroergotamine triptans sumatriptan |
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How does sumatriptan (imitrex) work?
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5HT1d agonist -> activates inhibitory 5HT1d receptors on sensory neurons -> prevents nociceptive impulses
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Why is sumatriptan not a good idea in patients with angina or ischemic heart disease
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constricts coronary vessels
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Why is sumatriptan contraindicated for pt's on MAOIs
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MAO is necessary for its breakdown, may cause a build up
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Name three triptans recently FDA approved
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zolmitriptan
naratriptan rizitriptan |
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What was responsible for St. Anthony's fire in the Middle Ages
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ergotism from contaminated grain (hallucinations, convulsions, ischemia)
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With what receptors do ergo alkaloids react?
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alpha-adrenoreceptors
DA receptors serotonin receptors |
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What are the major adverse effects of the ergo alkaloids?
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diarrhea
nausea vomitting |
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Name three contraindications for ergo alkaloids
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pregnancy
coronary heart disease impaired hepatic function |
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Why are the ergo alkaloids often administered with caffeine and metoclopramide?
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to aid absorption
to inhibit nausea |
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Name four other ergot alkaloid drugs
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bromocriptine
LSD ergonovine methysergide |
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When is prophylactic treatment of migraine recommended?
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When there are 3 or more per month
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prophylactic migraine beta blocker
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propranolol
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prophylactic migraine ergot alkaloid
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methysergide
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prophylactic migraine antidepressant
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amitriptyline (tricyclic)
phenelzine (MAO) |
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prophylactic migraine calcium channel blocker
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verapamil
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