- inhibit neuronal impulse in ascending RAS,

depress motor output, carebral and cerebellar

function
– Treatment for insomnia
Neural pathways of Pain
 Opiod receptors
• Sites that respond naturally to endorphins
and enkephalins.
• Found in CNS, periphery and GI tract
• Endorphins and Enkephalins - modulate
pain
• Edorphins are released during stress and
block sensation of pain.
• Three main functions:
– relief of moderate to severe pain
– adjuncts to general anesthesia
– relief of pain during labor and delivery
 Anti-migraine drugs
Migraine
– severe throbbing headache on one side of the head.
– affects GI and CNS function, mood and personality
changes
– Cause: arterial dilation, release of bradykinins,
serotonin
– Classification:
• Common Migraine
– occur with aura, severe unilateral pulsating pain with N/V
and sensitivity to light and sound; aggravated by physical
activity
• Classic Migraine
– preceded by an aura 30 minutes before the pain begins
 Anti-migraine drugs
1. Ergot Derivatives
– cause constriction of cranial blood vessel and
decrease pulsation of cranial arteries
– Dihydroergotamine (Migranal) - nasal spray
– Ergotamine (Ergomar) - sublingual
• (Cafergot) - combined with caffeine for faster
absorption in the GI
• Prevents and aborts migraine
– Action:
• Blocks alpha-adrenergic and serotonin receptor
sites in the brain to cause constriction of cranial
vessel
• Contraindication/Caution:
– allergy
– Coronary Artery Disease, HTN
– Impaired liver function
– Malnutrition
– Pregnancy/Lactation
• Ergotism (Vomiting, diarrhea, seizures) in infants
• Adverse Effect
– CNS: numbness, tingling sensation, muscle pain
– CV: pulselessness, weakness, chest pain, arrythmia,
MI
– GI: N/V, diarrhea
– Drug dependency (prolonged use)
2. Triptans
– cause cranial vascular constriction
– Binds to selective serotonin receptor sites to
cause vasoconstriction of cranial vessels to
relieve S/Sx of migraine
– Used for acute migraine not for prevention
– Sumatriptan (Imitrex) - oral, SC,nasal spray
– Almotriptan(Axert) - has fewer side effects and
has longer half life that prevents rebound
headache
– Eletriptan, Frovatriptan, Naratriptan
• Contraindications/ Caution
– Allergy, Active CAD
– Elderly, Lactating
– Renal/Hepatic dysfunction
• Adverse Effect
– CNS: numbness, tingling, burning sensation,
feelings of coldness, dizziness, weakness,
myalgia, vertigo
– GI: dysphagia, abdominal discomfort
– CV: Chest tightness, BP alteration
 Anesthesia
• May cause complete or partial loss of
sensation
• Classification:
– General
• Affects CNS
• Loss of pain sensation and consciousness
– Local
• loss of pain sensation and feeling in a designated
area of the body