00:00
N-Methyl-D-aspartate receptor antagonist, MD and nMDA receptor antagonist can reduce
central sensitization due to increased nMDA which is a central nervous system
neurotransmitter. So ketamine is a general anesthetic which we have mentioned but in small
doses it's an effective analgesic. It's also currently become drug of abuse and it has become
street drug and the name on the street is special cake. Ketamine is also occasionally used for
labor analgesia and analgesia prior to surgery but only in very small doses. When used as an
anesthetic or with analgesic in higher doses, it can produce the recovery phenomena that I
mentioned in a previous lecture. Other side effects include nausea and vomiting, increased
heart rate and blood pressure, and occasionally agitation and hallucinations. Carrying on
more drugs alpha-2 agonist, the classic of this is clonidine. These are receptor drugs that work
on the alpha-2 receptor which is a central nervous system receptor. They can be given either
orally or they can be given along with spinal anesthesia in a dilute concentration. They
produce sedation and can produce severe postural hypotension. So in other words, when you
stand up your blood pressure drops and that can lead to fainting or even loss of consciousness
and seizure so that's not a good thing. They produce a very dry mouth and patients complain about that.
01:44
The newer drug Dexmedetomidine is an IV
formulation that can be used for ICU
sedation, procedural sedation
and to decrease the use of opioids and
generally anesthesia.
01:53
For migraine headache, there have been great problems finding substances that are useful and one of the
agents of drugs that has been found to be useful in some people with migraine are the
5 hydroxytryptamine 1 agonist and the classic drug in this group is sumatriptan, but there's a
series of drugs. They are used for treatment of migraine headaches. They can be self-administered
by syringe, preloaded syringe. They can be even taken as tablets or you can actually use a
nasal spray, which is quite quick because it's rapidly absorbed by the nasal mucosa and you're
right near the brain when you administer it so it can actually be quite effective. They cause
vasoconstriction, tightening of blood vessels, and reduction of inflammation of the cranial
arteries. So the arteries that come on the outer surface of the skull primarily some of them
perforate the skull and these are the arteries that become dilated and throbbing in migraine
headache. This vasoconstriction can increase the risk in vascular bed such as a cardiac bed
where if you get vasoconstriction you can get cardiac ischemia and myocardial infarction and
it can also increase the possibility of stroke if it causes intracranial vessels also to constrict.