Migraines, Emesis and Sleep Disorder Drugs

Naratriptan and especially frovatriptan

Selective 5HT1F receptor agonist - works similar to triptans in that it inhibits neurotransmitter and neuropeptide release but does NOT cause vasoconstriction and thus can be used in patients with vascular disease.

Broad spectrum serotonin agonists (meaning it acts on a variety of serotonin receptors) - MOA similar to triptans but not as frequently used given its more severe side effects

Rimegepant and Ubrogepant

1. Monoclonal antibodies targeting CGRP
2. Beta blockers
3. CGRP antagonists (gepants)
4. Antiepileptic drugs
5. Antidepressants
6. Behavioral therapy

Monoclonal Antibody that targets the CGRP RECEPTOR --> thus by binding to the receptor itself, Erenumab prevents CGPR from doing so and thus exerting its effects

Monoclonal Antibodies that target CGPR ITSELF --> thus by blocking the CGPR, the CGPR is stopped in its tracks and can't get to its receptor

Altogepant and Rimegepant

Vomitting center

5-HT3 receptors are present in the vomiting center and when the body detects a stimulus to induce vomiting, serotonin is released which activates the 5-HT3 receptors. By blocking these receptors, the serotonin will be unable to bind to them and thus the emesis signals will be cut short

Dexamethason

Ondansetron, granisetron, dolasetron, palonosetron

FALSE - the delayed emetic response is responsive to antiseptics that block Neurokinin 1 (NK1) Receptors

Neurokinin 1 (NK1) Receptor blockers

Shorting acting benzodiazepines - Zolpidem, Zaleplon, and Escoplicone

While GABA binds to the GABAa receptor, benzodiazepines bind to an allosteric site on the same GABAa receptor and they enhance the effect of allowing more Cl- ions to enter the neuron. This in turn hyper polarizes the neuron, inducing an inhibitory effect - something we want for anxiety or insomnia.

Modafinil

Loss of hypothalamic neurons that produce orexin A and B (hypocretin). Orexins typically act through two GPCR receptors (OX1 and OX2) and they help to mediate the structure of sleep/wake cycles. However, when the neurons that produce them are destroyed, we get a disordered state of sleep such as narcolepsy.

Orexin receptor antagonists that block sedative effects and thus promote wakefulness - used to treat insomnia

TRUE: GBH condenses sleep into its discrete period during the night time, thus helping combat the sleep fragmentation that occurs in patients with narcolepsy as a result of orexin producing neurons

5-HT₁B/1D receptor agonists. They cause cranial vasoconstriction and inhibit trigeminal nerve pain pathways,