Page 591 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat

Neurology aNd Special SeNSeS ` neurology—PhArmACology Neurology aNd Special SeNSeS ` neurology—PhArmACology SecTioN iii 547

Suvorexant
meChAnism Orexin (hypocretin) receptor antagonist. Suvorexant is an orexin antagonist.
CliniCAl use Insomnia.
AdVerse eFFeCts CNS depression (somnolence), headache,
abnormal sleep-related activities.
Contraindications: narcolepsy, combination
with strong CYP3A4 inhibitors. Not
recommended in patients with liver disease.
Limited physical dependence or abuse
potential.

Ramelteon
meChAnism Melatonin receptor agonist; binds MT1 and Ramelteon is a melatonin receptor agonist.
MT2 in suprachiasmatic nucleus.

CliniCAl use Insomnia.
AdVerse eFFeCts Dizziness, nausea, fatigue, headache. No
dependence (not a controlled substance).

Triptans Sumatriptan
meChAnism 5-HT 1B/1D agonists. Inhibit trigeminal nerve A sumo wrestler trips and falls on his head.
activation, prevent vasoactive peptide release,
induce vasoconstriction.

CliniCAl use Acute migraine, cluster headache attacks.
AdVerse eFFeCts Coronary vasospasm (contraindicated in
patients with CAD or vasospastic angina),
mild paresthesia, serotonin syndrome (in
combination with other 5-HT agonists).

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