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35 Cards in this Set

  • Front
  • Back
How is serotonin made?
tryptophan ->(tryptophan hydroxylase)-> serotonin
Where is serotonin found?
CNS
platelets
GI tract
Where is the largest pool of serotonin?
enterochromaffin cells of GI tract- function unknown
What do carcinoid tumors of enterochromaffin cells cause?
large amounts of secreted 5-HT --> stimulate intestinal sm mm, diarrhea, abdominal pain
How do you diagnose carcinoid tumor of enterochromaffin cells?
5HT metabolites and
5-hydroxyindoleacetic acid in urine
How can you treat carcinoid tumor of enterochromaffin cells?
surgery,
or with 5HT and H1 antagonist = cyproheptadine
What is the type of most serotonin receptors?
G protein linked seven transmembrane
What is the exceptional serotonin receptor?
5HT3- a ligand gated ion channel which increases Na and K permeability
drug for migraines
acts on 5HT10 and 5HT1F
sumatriptan
(so'-ma-trip-tan_
hallucinogen drug
acts on 5HT2
LSD
anti-emetic drug
acts on 5HT3
ondansetron
(on-dan'-se-tron)
drug improves gastric motility
acts on 5HT3/D2
metoclopramide
drug used for schizophrenia
acts on 5HT2a2c/5HT6/5HT7
clozapine
drug used for migraine prophylaxis
acts on 5HT1/2a/2c
methysergide
(meth-i-ser'-jide)
What is the most common but least understood neurological syndrome
migraine
How do you diagnose migraine?
clinical hx alone
Describe the theory of migraine etiology
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
Which neurons are involved with registering migraine pain
sensory neurons of trigeminal ganglia --> through brain stem --> to thalamus and cortex
Name three potential migraine triggers?
red wine
chocolate
irregular sleep patterns
Name three specific anti-migraine drugs that arrest the migrainous process directly and are nonanalgesic
ergot alkaloids
ergotamine
dihydroergotamine
triptans
sumatriptan
How does sumatriptan (imitrex) work?
5HT1d agonist -> activates inhibitory 5HT1d receptors on sensory neurons -> prevents nociceptive impulses
Why is sumatriptan not a good idea in patients with angina or ischemic heart disease
constricts coronary vessels
Why is sumatriptan contraindicated for pt's on MAOIs
MAO is necessary for its breakdown, may cause a build up
Name three triptans recently FDA approved
zolmitriptan
naratriptan
rizitriptan
What was responsible for St. Anthony's fire in the Middle Ages
ergotism from contaminated grain (hallucinations, convulsions, ischemia)
With what receptors do ergo alkaloids react?
alpha-adrenoreceptors
DA receptors
serotonin receptors
What are the major adverse effects of the ergo alkaloids?
diarrhea
nausea
vomitting
Name three contraindications for ergo alkaloids
pregnancy
coronary heart disease
impaired hepatic function
Why are the ergo alkaloids often administered with caffeine and metoclopramide?
to aid absorption
to inhibit nausea
Name four other ergot alkaloid drugs
bromocriptine
LSD
ergonovine
methysergide
When is prophylactic treatment of migraine recommended?
When there are 3 or more per month
prophylactic migraine beta blocker
propranolol
prophylactic migraine ergot alkaloid
methysergide
prophylactic migraine antidepressant
amitriptyline (tricyclic)
phenelzine (MAO)
prophylactic migraine calcium channel blocker
verapamil