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Chapter-104 N-Methyl-D-Aspartate Antagonists

BOOK TITLE: Ramamurthy's Decision Making in Pain Management: An Algorithmic Approach

Author
1. B Mitchell
2. Assistant Professor, Department of Anesthesiology UT Health San Antonio, San Antonio, TX, USA
ISBN
9789386261458
DOI
10.5005/jp/books/14128_105
Edition
3/e
Publishing Year
2018
Pages
2
Author Affiliations
1. UT Health San Antonio, San Antonio, TX, USA
Chapter keywords
Chronic pain, N-methyl-Daspartate receptor, NMDAR, nitric oxide, NO, neurotoxicity, peripheral nervous system, ketamine, amantadine

Abstract

The ideal approach to chronic pain is the routine use of multimodal analgesic techniques that act on the central and peripheral nervous systems to improve pain control. Antagonists to the N-methyl-Daspartate receptors (NMDARs) are an example of this targeted approach to pain management, particularly for pain that has been refractory to traditional modalities. NMADRs are ligand-gated ion receptors that become “activated” or open when glutamate and glycine bind to the receptor. The Ca2+ influx is crucial for the induction of the NMDA receptor-dependent long-term potentiation, which is thought to underlie neural plasticity, including the development of central sensitization. The activation of the NMDARs leads a Ca2+ or calmodulin-mediated activation of nitric oxide (NO) synthase, which plays a crucial role in nociception and neurotoxicity.

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