1 DRUGS ACTING ON THE NERVOUS SYSTEM

1.1 Anxiolytics and hypnotics

In this chapter, drugs relieving the feeling of anxiety and those that bring about sedation and
hypnosis are discussed. Anxiety can be defined as a state of unpleasant feeling of tension, fear,
nervousness, or a combination of these feeling as a response to environmental stimuli, regardless if
these stimuli are real or imaginary. Sedation is a term used to describe a state in which one losses
awareness and reaction to stimuli from the external environment. Sedation is superior to anxiolytic
effect as the former might cause drowsiness. Hypnosis is a result of extreme sedation which results
in further depression of the CNS depression causing sleep. Further depression of the CNS might cause
anesthesia, coma, and subsequently death. The dose of the agent used plays a key role in causing
these effects. These are shown in the Figure below.

Death

Coma

Anesthetic

Hypnotic

Sedative

Anxiolytic

1.1.1 Anxiolytics, sedatives, and hypnotics

Contraindi
Mechanism of Adverse cations
Chemical class Indication Route
action effects and
cautions
Benzodiazepines used as anxiolytics

1
 Contraindi
Mechanism of Adverse cations
Chemical class Indication Route
action effects and
cautions

Sedation,
Diazepam drowsiness,
depression,
Anxiety; alcohol Acute
lethargy,
withdrawal; narrow-
Alprazolam These agents blurred vision,
muscle relaxant; angle
potentiate the headaches,
Chlordiazepoxide antiepileptic; glaucoma,
actions of gamma- apathy, light-
Clorazepate anti-tetanus; Oral, shock,
aminobutyric acid headedness,
preoperative IV, IM coma, or
Estazolam (GABA) thus and confusion.
anxiolytic, panic acute
Flurazepam reducing neuron Hypotension,
attacks, partial alcoholic
Lorazepam firing arrythmias,
seizures, intoxication
constipation,
Oxazepam insomnia .
dry mouth,
Quazepam nausea, and
Temazepam vomiting.
Triazolam
Barbiturates used as anxiolytics-hypnotics
Drowsiness,
Phenobarbital somnolence,
CNS
Amobarbital lethargy,
depressant
Multiple actions ataxia, vertigo,
Butabarbital s, including
including CNS Sedative– a feeling of a
Mephobarbital alcohol,
depressant that hypnotic; control Oral, “hangover,”
antihistami
Pentobarbital inhibit neuronal of seizures; pre- IV, IM thinking
nes, and
impulse anesthetic abnormalities,
other
conduction paradoxical
tranquilizer
Secobarbital excitement,
s.
anxiety, and
hallucinations.
Other anxiolytic and hypnotic drugs

Buspirone Drowsiness,
Multiple actions somnolence,
CNS
Chloral hydrate including CNS lethargy,
depressant
depressant that ataxia, vertigo,
anxiety s, including
inhibit neuronal a feeling of a
Dexmedetomidine disorders, alcohol,
impulse Oral, “hangover,”
preoperative antihistami
conduction and IV, IM thinking
sedation, nes, and
Diphenhydramine probably abnormalities,
insomnia other
Eszopiclone interfering with paradoxical
tranquilizer
Meprobamate GABA excitement,
s.
neurotransmission anxiety, and
Promethazine hallucinations.
Ramelteon

2
 Contraindi
Mechanism of Adverse cations
Chemical class Indication Route
action effects and
cautions
Zaleplon
Zolpidem

1.2 Antidepressants

Depression can be defined as an affective disorder in which a person experiences a feeling of severe
and prolonged sadness that the condition may not even be traceable to a specific event or stressor.
The biogenic amine theory hypothesized that depression is a result of deficiency of biogenic amines
in certain key areas of the brain. These biogenic amines are: norepinephrine (NE), dopamine, and
serotonin (5HT).

Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

TRICYCLIC ANTIDEPRESSANTS
Sedation, sleep
disturbances,
relief of fatigue,
symptoms of hallucinations,
depression, disorientation,
imipramine
sedative effects visual
Inhibit of these drugs disturbances,
presynaptic may make them difficulty in
reuptake of the more effective concentrating,
neurotransmitters in patients weakness, Recent myocardial
amitriptyline 5HT and NE, whose ataxia, and infarction,
amoxapine which leads to an depression is tremors may preexisting
accumulation of characterized occur. GI cardiovascular
clomipramine
these by anxiety and anticholinergic disorders, urinary
desipramine neurotransmitters sleep effects, such as retention, prostate
doxepin in the synaptic disturbances, dry mouth, hypertrophy, or GI
maprotiline cleft and enuresis in constipation, or genitourinary
nortriptyline increased children older nausea, (GU) surgery.
stimulation of the than 6 years, vomiting,
protriptyline
postsynaptic might be useful anorexia,
receptors. in intractable increased
pain, and salivation,
obsessive– cramps, and
trimipramine compulsive diarrhea.
disorders Resultant GU
effects may
include urinary

3
 Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

retention and
hesitancy, loss
of
libido, and
changes in
sexual
functioning. CV
effects such as
orthostatic
hypotension,
hypertension,
arrhythmias,
myocardial
infarction,
angina,
palpitations,
and stroke may
also pose
problems.
MONOAMINE OXIDASE INHIBITORS
The MAOIs are
associated with
more adverse
phenelzine effects, more of
which are fatal,
Blocking the than most other
breakdown of the antidepressants. Hypertension,
biogenic amines treatment of Dizziness, coronary artery
isocarboxazid NE, dopamine, the signs and excitement, disease, angina,
and 5HT allows symptoms of nervousness, and congestive
these amines to depression in mania, heart failure,
accumulate in the patients who hyperreflexia, ingesting foods
synaptic cleft and cannot tolerate tremors, high in tyramine
in neuronal or do not confusion, while taking an
storage vesicles, respond to insomnia, MAOI poses the
causing increased other, safer agitation, and risk of a severe
tranylcypromine stimulation of the antidepressants blurred vision hypertensive
postsynaptic may occur. crisis.
receptors. Arrhythmias,
palpitations,
angina, and the
potentially fatal
hypertensive
crisis.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS

4
 Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

Depression,
obsessive
The action of compulsive
fluoxetine Headache,
SSRIs blocking the disorders, panic
drowsiness,
reuptake of 5HT attacks,
dizziness, Caution should
increases the bulimia,
insomnia, also be used with
levels of 5HT in premenstrual
citalopram anxiety, tremor, severely
the synaptic cleft dysphoric
agitation, and depressed or
duloxetine and may disorder,
seizures. suicidal patients,
escitalopram contribute to the posttraumatic
Suicidal especially children
fluvoxamine antidepressant stress
ideation and and adolescents.
and other effects disorders,
paroxetine suicide
attributed to social phobias,
attempts.
these drugs. and social
sertraline anxiety
disorders.
OTHER ANTIDEPRESSANTS

bupropion

desvenlafaxine These drugs have Treatment of

mirtazapine varying effects on depression in Similar to other
nefazodone NE, 5HT, and adults, smoking antidepressants
selegiline dopamine. cessation
trazodone
venlafaxine

1.3 Psychotherapeutic Agents

These are agents used to treat various types of mental disorders related to perceptual and behavioral
disorders to help children and adults function in a more acceptable manner while carrying on their
usual daily activities. Schizophrenia is the most common type of psychosis and characterized with
hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Mania, with its
associated bipolar illness (i.e., manic depressive illness), is characterized by periods of extreme
overactivity and excitement. Bipolar disorder involves extremes of depression alternating with
hyperactivity and excitement. Narcolepsy is characterized by daytime sleepiness and sudden periods
of loss of wakefulness.

5
 Important
Pharmacologic/chemical Mechanism of Major adverse cautions and
Indication
class action effects contraindicat
ions
Typical Antipsychotics
Sedation,
weakness,
chlorpromazine tremor,
drowsiness,
extrapyramidal
fluphenazine
side effects
haloperidol (EPS), pseudo
loxapine parkinsonism,
molindone dystonia,
perphenazine akathisia,
tardive
pimozide
Schizophrenia and for dyskinesia, and
prochlorperazine manifestations of potentially
thioridazine other psychotic irreversible central
Block dopamine
thiothixene disorders, including neuroleptic nervous
receptors,
trifluoperazine hyperactivity, malignant system (CNS)
preventing the
combative behavior, syndrome. depression,
Atypical Antipsychotics stimulation of
and severe behavioral Anticholinergic circulatory
the postsynaptic
problems in children effects include collapse,
neurons by
(short-term control); dry mouth, Parkinson
dopamine. They
for the treatment of nasal disease,
also have
bipolar disorder. congestion, coronary
clozapine anticholinergic,
Decrease flushing, disease,
antihistamine,
preoperative constipation, severe
and alpha-
restlessness and urinary hypotension,
adrenergic
apprehension, to treat retention, bone marrow
blocking effects,
intermittent impotence, suppression,
aripiprazole all related to the
porphyria, as an glaucoma, and blood
olanzapine blocking of the
adjunct in the blurred vision, dyscrasias,
dopamine-
paliperidone treatment of tetanus, and cardiac
receptor sites
quetiapine and to control nausea, photophobia. arrhythmias.
vomiting, and Cardiovascular
risperidone
intractable hiccups. (CV) effects,
which are
probably related
to the
dopamine-
blocking effects,
ziprasidone include
hypotension,
orthostatic
hypotension,
cardiac
arrhythmias,

6
 Important
Pharmacologic/chemical Mechanism of Major adverse cautions and
Indication
class action effects contraindicat
ions
congestive heart
failure, and
pulmonary
edema.
ANTIMANIC DRUGS
These very toxic
drugs can cause
severe CNS,
renal, and
lithium
pulmonary
problems that
may lead to
manic-depressive or
death.
bipolar illness
aripiprazole

lamotrigine
olanzapine
quetiapine
ziprasidone
CENTRAL NERVOUS SYSTEM STIMULANTS
Nervousness,
insomnia,
dizziness,
headache,
methylphenidate Increasing the blurred vision,
release of and difficulty
catecholamines with
marked
from presynaptic obstructive sleep accommodation.
anxiety,
neurons, leading disorders (including GI effects such
agitation, or
armodafinil to an increase in sleep apnea), as anorexia,
tension and
atomoxetine stimulation of narcolepsy, and shift nausea, and
severe fatigue
dexmethylphenidate the postsynaptic work sleep disorders weight loss may
or glaucoma,
neurons. to improve occur. CV effects
dextroamphetamine cardiac
Paradoxically, wakefulness, can include
lisdexamfetamine disease,
these drugs calm attention- hypertension,
history of
hyperkinetic deficit/hyperactivity arrhythmias,
seizures,
children and help disorders and angina. Skin
hypertension
them to focus on rashes are a
one activity for a common
modafinil longer period. reaction to some
of these drugs.
Physical and
psychological
dependence

7
 Important
Pharmacologic/chemical Mechanism of Major adverse cautions and
Indication
class action effects contraindicat
ions
may also
develop.

1.4 Antiepileptic agents

Epilepsy is a collection of various syndromes, all of which are characterized by seizures. Seizures can
be classified into generalized or partial seizures. Generalized seizures begin in one area of the brain
and then spread rapidly throughout both hemispheres of the brain. However, partial seizures
involve one area of the brain and does not spread throughout the brain. Status epilepticus is the
most severe form of generalized seizures. In this condition, seizures recur rapidly.

Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

DRUGS FOR TREATING GENERALIZED SEIZURES

Hydantoins
CNS depression
phenytoin and its effects
fosphenytoin on body
function:
depression,
confusion,
Stabilize nerve drowsiness,
membranes lethargy,
throughout the fatigue,
CNS directly by constipation, Pregnancy or
influencing ionic dry mouth, lactation unless
tonic–clonic and
channels in the anorexia, the risk of seizures
psychomotor
cell membrane, cardiac outweighs the
seizures
ethotoin thereby arrhythmias potential risk to
decreasing and changes in the fetus.
excitability and blood pressure,
hyperexcitability urinary
to stimulation. retention, and
loss of libido.
bone marrow
suppression,
gingival
hyperplasia,
and potentially

8
 Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

serious
dermatological
reactions (e.g.,
hirsutism,
Steven–
Johnson
syndrome).
Barbiturates and Barbiturate-Like Drugs

phenobarbital tonic–clonic and

absence seizures;
mephobarbital
sedative/hypnotic
primidone
Benzodiazepines
seizures; panic
diazepam attacks, restless leg
movements during
sleep, hyperkinetic
clonazepam dysarthria
Succinimides

Suppress the Depression,

abnormal drowsiness,
ethosuximide electrical activity fatigue, ataxia,
absence seizures
in the brain that is insomnia,
associated with headache, and
absence seizures. blurred vision.
methsuximide
Drugs That Modulate the Inhibitory Neurotransmitter GABA
Valproic acid is
valproic acid associated with
acetazolamide liver toxicity.
All of these
drugs cause
Increase GABA
CNS effects
activity at
absence seizures related to CNS
inhibitory
suppression—
zonisamide receptors.
weakness,
fatigue,
drowsiness,
dizziness, and
paresthesias.
DRUGS FOR TREATING PARTIAL SEIZURES

9
 Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

CNS depression
that results.
stabilize nerve The following
membranes in conditions may
carbamazepine either of two occur:
ways—directly, drowsiness,
by altering fatigue,
sodium and weakness,
partial seizures,
calcium channels, confusion,
clorazepate trigeminal
or indirectly, by headache, and
felbamate neuralgia, bipolar
increasing the insomnia; GI
disorder
gabapentin activity of GABA, depression,
lamotrigine an inhibitory with nausea,
neurotransmitter, vomiting, and
levetiracetam
and thereby anorexia.
oxcarbazepine decreasing Severe liver
pregabalin excessive activity failure and
tiagabine aplastic
topiramate anemia.

1.5 Anti-parkinsonism agents

Parkinson disease is a progressive, chronic neurological disorder characterized by resting tremors,

bradykinesia, and progressive loss of coordination and function, which results from the degeneration
of dopamine-producing cells in the substantia nigra which is an area in the brain rich in dopamine.
Patients with Parkinson’s disease often lack coordination, have trouble maintaining position or
posture, having resting rhythmic tremors, and might ultimately develop bradykinesia which is a
marked difficulty in performing intentional movements characterized by slowness and sluggishness.
In Parkinson’s disease, as dopaminergic neurons degrade, cholinergic neurons which are excitatory
neurons dominate. The aim of the treatment is to restore balance between these two types of
neurons.

Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

DOPAMINERGIC AGENTS

10
 Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

Anxiety,
nervousness,
A precursor of headache,
dopamine that is malaise, fatigue,
converted to confusion,
levodopa
dopamine by the mental changes,
enzyme dopa blurred vision,
decarboxylase muscle
twitching, and
ataxia.
Glaucoma,
Anorexia,
myocardial
nausea,
infarction,
Parkinson's vomiting,
arrhythmias, and
disease, dysphagia, and
hypertension;
Parkinson-like constipation or
bronchial asthma;
symptoms, diarrhea;
history of peptic
restless leg cardiac
ulcers; urinary
Carbidopa is a dopa syndrome arrhythmias,
tract obstruction;
decarboxylase that hypotension,
and psychiatric
cannot cross the and
disorders.
blood-brain barrier palpitations;
which is bizarre
carbidopa–levodopa breathing
administered with
levodopa to prevent patterns;
conversion of dopa urinary
to dopamine in the retention; and
periphery flushing,
increases the release increased
of dopamine from sweating, and
amantadine hot flashes.
dopaminergic
neurons
apomorphine
bromocriptine
Dopamine receptor
pramipexole
agonists
rasagiline
ropinirole
ANTICHOLINERGIC AGENTS

11
 Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

Dry mouth,
biperiden nausea,
benztropine vomiting,
paralytic ileus,
diphenhydramine
and
constipation
related to
decreased GI GI obstruction,
Parkinson's
secretions and genitourinary (GU)
ACh receptor disease,
motility. obstruction, and
antagonists Parkinson-like
Tachycardia, prostatic
symptoms
trihexyphenidyl palpitations, hypertrophy
and
hypotension.
Urinary
retention,
blurred vision
and
photophobia.
ADJUNCTIVE AGENTS
entacapone Inhibitors of COMT
enzyme that
metabolizes
tolcapone Parkinson's
catecholamines
disease in Extended
including dopamine
combination activity of
Inhibitor of MAO
with other dopamine
enzyme that
drugs
selegiline metabolizes
catecholamines
including dopamine

1.6 General and local anesthetics

These agents are used to produce complete or partial loss of sensation. General anesthetics depress
the CNS and produce loss of pain sensation and consciousness. Local anesthetics produce loss of
sensation and pain in a certain area of the body. During general anesthesia, usually several agents are
administered to produce analgesia which is loss of pain perception, unconsciousness which s loss of
awareness of the surroundings, and amnesia which is inability to remember what happened.

12
 Important
cautions
Pharmacologic/chemical Major adverse
Mechanism of action Indication and
class effects
contraindic
ations
GENERAL ANESTHETIC AGENTS
Barbiturate Anesthetics
Refer to barbiturates,
thiopental no analgesic
properties
methohexital
Nonbarbiturate General Anesthetics
Refer to
benzodiazepines,
midazolam
potent amnesiac
sedative hypnotic
propofol potent sedative,
droperidol potential anti-
etomidate vomiting activity
Analgesic activity,
ketamine
cardiac stimulant
Anesthetic Gases
very potent analgesic;
used
weakest of the gas
nitrous oxide frequently for
anesthetics and the
dental surgery
least toxic,
causes muscle
cyclopropane
relaxation
Ethylene is not
associated
ethylene
with
bronchospasm
Volatile Liquids
Fever, anorexia,
nausea,
vomiting, and
eventually
halothane
hepatitis, which
can progress to
fatal hepatic
necrosis.
desflurane
enflurane
isoflurane
sevoflurane
LOCAL ANESTHETIC AGENTS

13
 Important
cautions
Pharmacologic/chemical Major adverse
Mechanism of action Indication and
class effects
contraindic
ations
lidocaine
benzocaine
chloroprocaine
procaine
tetracaine
bupivacaine
Na+ channel blockers
dibucaine
levobupivacaine
mepivacaine
prilocaine
ropivacaine
pramoxine

1.7 Neuromuscular junction blockers and muscle relaxants

The neuromuscular junction is the point at which a motor neuron communicates with a skeletal
muscle fiber. Agents that block the communication between motor neurons and skeletal muscles
produce paralysis. Paralyzing muscles is desired when during surgical procedures, when putting
patients on mechanical ventilation, and sometimes to facilitate intubation.
Injuries, accidents, and damage to neurons may produce muscle spasms and pain. Many
neurodegenerative diseases are also associated with muscle spasticity.

Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

Neuromuscular Junction
Blockers
Nondepolarizing
Neuromuscular Junction
Blockers
Profound and
pancuronium prolonged
Mechanical
muscle
ventilation;
Nicotinic paralysis is
atracurium surgical
receptor always
cisatracurium procedures; to
antagonists possible,
rocuronium facilitate
depressed
intubation
respiration,
vecuronium
bronchospasm,

14
 Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

and apnea. The

histamine
release
associated
with many of
the
depolarizing
NMJ blockers
can cause
respiratory
obstruction
with wheezing
and
bronchospasm.
Hypotension
and cardiac
arrhythmias
may occur in
patients who
do not adapt to
the drugs
effectively.
Mechanical
ventilation;
Depolarizing
surgical
Neuromuscular Junction
procedures; to
Blocker
facilitate
intubation
succinylcholine
CENTRALLY ACTING
SKELETAL MUSCLE
RELAXANTS
(spasmolytics)
muscle spasticity CNS
associated with depression:
baclofen Work in the neuromuscular drowsiness,
CNS to diseases such as fatigue, cardiac
interfere with multiple sclerosis, weakness, dysfunction, any
carisoprodol the reflexes muscle rigidity, confusion, condition marked
that are and spinal cord headache, and by muscle
chlorzoxazone causing the injuries, insomnia. weakness
cyclobenzaprine muscle spasm. symptoms of Nausea, dry
metaxalone tetanus, leg mouth,
methocarbamol cramps anorexia, and

15
 Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

orphenadrine constipation.
Hypotension
and
arrhythmias
may occur.
Urinary
frequency,
tizanidine enuresis, and
feelings of
urinary
urgency
reportedly
may occur.
DIRECT-ACTING
SKELETAL MUSCLE
RELAXANTS
muscle spasticity
such as spinal
cord injury,
myasthenia
gravis, cerebral
palsy, multiple
sclerosis,
acts within
muscular
skeletal muscle
dystrophy, polio,
fibers,
tetanus,
interfering
quadriplegia, and
dantrolene with the
amyotrophic
release of
lateral sclerosis
calcium from
(ALS); prevention
the muscle
or treatment of
tubules
malignant
hyperthermia—a
state of intense
muscle
contraction and
resulting
hyperpyrexia
bind directly to Improvement of
botulinum toxin type A the receptor appearance in
sites of motor glabellar (frown)
nerve lines associated
botulinum toxin type B terminals and with corrugator
inhibit the or procerus

16
 Important
Pharmacologic/chemical Mechanism of Major adverse
Indication cautions and
class action effects
contraindications

release of muscle activity in

acetylcholine adults

1.8 Opioid analgesics

Opioid receptors are receptor sites that respond to naturally occurring peptides, the endorphins
and the enkephalins. These receptor sites are found in the CNS, on nerves in the periphery, and on
cells in the gastrointestinal (GI) tract. In the brainstem, opioid receptors help to control blood
pressure, pupil diameter, GI secretions, and the chemoreceptor trigger zone (CTZ) that regulates
nausea and vomiting, cough, and respiration. In the spinal cord and thalamus, these receptors help
to integrate and relate incoming information about pain.

Important
cautions
Pharmacologic/chemical Mechanism of Major adverse
Indication and
class action effects
contraindi
cations
Narcotic Agonists
Respiratory
morphine Agonists at specific depression with
codeine opioid receptor sites apnea, cardiac
in the CNS to arrest, and
fentanyl produce analgesia, Relief of moderate shock may
hydrocodone sedation, and a to severe chronic result from
hydromorphone sense of wellbeing. and acute pain; narcotic-
levorphanol They also are used preoperatively induced
meperidine as antitussives (anti- and respiratory
cough) and as postoperatively center
methadone adjuncts to general and during labor; depression.
oxycodone anesthesia to relief of cough; Orthostatic
oxymorphone produce rapid treatment of hypotension is
propoxyphene analgesia, sedation, diarrhea commonly seen
and respiratory with some
remifentanil
depression. narcotics.
sufentanil Indications Gastrointestinal
tramadol effects such as
Narcotic Agonists– nausea,
Antagonists vomiting,
Relief of moderate constipation,
Agonists at some
pentazocine to severe pain, and biliary
opioid receptors and
treatment of spasm may

17
 Important
cautions
Pharmacologic/chemical Mechanism of Major adverse
Indication and
class action effects
contraindi
cations
buprenorphine antagonists at other migraine occur as a result
butorphanol opioiod receptors headaches of CTZ
stimulation and
nalbuphine
negative effects
Narcotic Antagonists on GI motility.
naloxone Reversal of opioid
Antagonists at effects,
naltrexone opioid receptors management of
nalmefene narcotic overdose
ANTIMIGRAINE AGENTS
Ergot Derivatives
Numbness,
ergotamine tingling of
extremities, and
muscle pain; CV
effects such as
pulselessness,
weakness, chest
pain,
arrhythmias,
localized edema
and itching, and
block alpha-
MI may also
adrenergic and
occur. the direct
serotonin receptor
stimulation of
sites in the brain to
the CTZ can
cause a constriction Rapid treatment of
cause GI upset,
of cranial vessels, a acute attacks of
nausea,
decrease in cranial migraines in
vomiting, and
dihydroergotamine artery pulsation, and adults
diarrhea.
a decrease in the
Ergotism, a
hyperperfusion of
syndrome
the basilar artery
associated with
bed
the use of these
drugs, causes
nausea,
vomiting,
severe thirst,
hypoperfusion,
chest pain,
blood pressure
changes,
confusion, drug
dependency.

18
 Important
cautions
Pharmacologic/chemical Mechanism of Major adverse
Indication and
class action effects
contraindi
cations
Triptans
Numbness,
sumatriptan tingling,
almotriptan burning
sensation,
eletriptan
feelings of
frovatriptan coldness or
naratriptan strangeness,
rizatriptan dizziness,
bind to selective weakness,
serotonin receptor myalgia, and
sites to cause vertigo. GI
Treatment of
vasoconstriction of effects such as
acute migraines in
cranial vessels, dysphagia and
adults
relieving the signs abdominal
and symptoms of discomfort may
migraine headache occur. CV
zolmitriptan effects can be
severe and
include blood
pressure
alterations and
tightness or
pressure in the
chest.

19