1. Depression
   1. MAOI's
   2. Atypical Antidepressants
   3. SSRI's
   4. Tricyclic Antidepressants
      1. Potentiates actions of NE & S By inhibiting reuptake transporter
         1. Topic
2. Alzheimer's Disease
   1. Ach inhibitors
      1. Tacrin
         1. Hepatotoxic
      2. Donepezil
      3. Rivastigmine
   2. N-methyl-D-aspartame Receptor antagonist
      1. Memantine
         1. Overexposure to NMDA leads to cellular degeneration
   3. Depression
      1. SSRI
         1. Citalopram
         2. Escitalopram
         3. Paroxetine
         4. Sertraline
         5. Fluoxetine
   4. Psychosis and Agitation
      1. Antipsychotics
         1. Risperidone
         2. Olanzapine
         3. Quetiapine
3. Parkinson's Disease
   1. Increase Dopamine
      1. Levodopa
         1. MOA: decarboxylated to Dopamine in D neurons In the striatum
            1. Early in Tx: N, V, OhTN, tachy, arrh. Late in Tx: diskinesias, halluc., wild dreams and delusions
            2. Don't take pyridoxine (B6) Increases peripheral break- down of levodopa
         2. Most effective PD agent
   2. Dopamine receptor Agonists
      1. Bromocriptine
         1. May save D neurons from Oxidative stress, ERGOT LIKE Fibrosis (vasoconstrictor)
            1. MOA: agonist at D2 receptors Partial antagonist at D1 receptors
            2. Dyskinesias, OhTN, <3 prob. in pt w/ MI
      2. Pergolide
         1. ERGOT LIKE Fibrosis (vasoconstrictor)
            1. MOA: agonist at both D1 & D2 MORE POTENT THAN BROMOCRIPTINE
      3. Pramipexole
         1. First line, best in pt that HAVE NOT received levodopa,
            1. MOA: NON ERGOT dopamine agonist at D2 & D3 receptors
            2. Daytime sedation, cause Reward seeking compulsive Behavior: drinking, shopping, And gambling.
            3. CIMETIDINE inhibits Renal secretion of PRAMIPEXOLE
      4. Ropinrole
   3. Dopamine release/ Uptake
      1. Amantadine
         1. MOA: alters D release (if at max, no effect) or Uptake.
            1. OhTN, dry mouth, hallucinations
   4. Monoamine Oxidase B Inhibitor
      1. Selegiline
         1. MOA: enhances the effect of levodopa
            1. High doses affect MAOI type A--> Severe HTN
   5. Antimuscarinic Agents
      1. MOA: blockage of cholinergic Transmission to augment D.
         1. Same side Fx as high Dose atropine.
   6. COMT inhibitors
      1. Tolcapone
         1. Useful in on-off phenomenon Long acting.
            1. MOA: inhibits COMT catechol-o-methyl transf.--> dec'd 3-O-methydopa,--> ind'd Uptake of levodopa
            2. Hepatotoxic, Cause blood dyscrasias
      2. Entacapone
         1. MOA: SEE TOLCAPONE
            1. NOT HEPATOTOXIC, does cause blood, dyscrasias
4. Alcohol
   1. Alcohol Abuse
      1. Disulfiram
         1. MOA: inhibits ADH and ALDH so aldehyde accumulates
            1. Face hot and flushed, throbbing headache, hypotension, thirst, sweating Chest pain, copious vomiting.
      2. Naltrexone
         1. MOA: opiate antagonist
      3. Acamprosate Calcium
         1. MOA: not sure, but: Has affinity for GABA A &B
   2. Ethanol
      1. MOA: competes for ADH
         1. Methanol Poisoning
         2. Ethylene glycol Poisoning
         3. Isopropyl alcohol Poisoning
5. Psychomotor Stimulants
   1. Methylxanthines
      1. BENEFITS: increased alertness, loss of fatigue, sustained attention
         1. MOA: --| phophodiesterases, raising cAMP; Antagonizing adenosine A1 and A2 receptors; = enhanced neurotransmission
            1. Nausea/vomiting, >200mg = nervousness, restlessness and tremors
            2. Caffeine
            3. Theophylline
            4. Can cause seizures at high doses.
   2. Amphetamines
      1. Large amounts excreted in urine. (can "ion trap")
         1. MOA: (oral) causes the release Of biogenic amines (NE,S&D) MAY interfere with re-uptake
            1. CNS: restlessness, tenseness, irritability Weakness, insomnia, confusion, delirium Paranoid hallucinations, suicidal or homicidal tendencies. CV: headache, palpitation, cardiac arrhythmias, HTN, circulatory collapse. EXCESSIVE SWEATING
            2. Dextroamphetamine
            3. Methamphetamine
            4. More central, less peripheral effects
      2. Amphetamine Derivatives
         1. Methylphenidate
            1. *SEE AMPHETAMINE
            2. *SEE AMPHETAMINE
            3. Narcolepsy
            4. ADHD
         2. Phentermine
            1. Exogenous Obesity
            2. C/I in pt with history Of CV. problems; HTN crisis with MAOI
   3. Nicotine
      1. Smoking Cessation
         1. BENEFITS: euphoria, Arousal, improved attention, Learning, problem solving and reaction time
            1. MOA: stimulates nicotinic Receptors in the CNS
            2. OBVIOUS
   4. Cocaine
      1. MOA: --| reuptake Of dopamine
   5. Ephedrine
      1. Stay awake preps, Energy boosters and Come asthma preps.
         1. MOA: [oral] α/β adrenergic agonist, also enhances Release of NE
   6. NON-AMPHETAMINE
      1. Modanifil
         1. MOA: UNKNOWN (may weakly block Dopamine uptake)
            1. psychoactive and euphoric Fx seen in CNS stimulants
            2. ADHD
            3. Narcolepsy
   7. OTHERS
      1. Narcolepsy
         1. Sodium Oxybate
            1. Take at bedtime and 2.5-4 hours After falling asleep
            2. MOA: Reduces cataplexy (loss or muscle control/weakness)
            3. Depression, BEDWETTING, Sleep walking and abuse potential.
      2. Weightloss
         1. Sibutramine
            1. MOA: weak inhibitor of the re-uptake Of NE and S, also thought to interact With the receptors causing hunger.
            2. HTN, cardiac Dz, stroke, narrow angle glaucoma, renal or hepatic Dz POSSIBLE CARDIAC VALVE DISORDERS
            3. DRUG INTERACTIONS: MAOI
      3. ADHD
         1. Atomoxetine
            1. MOA: re-uptake Inhibitor of NE and S
            2. Suicidal thoughts and liver DZ
         2. Guanfacine
            1. MOA: agonist at post synaptic α2 adrenergic receptors
            2. Caution with Cardiac problems
6. Sleep disorders
   1. BDZ's
      1. MOA: BZ1 receptor on GABA- Chloride channel receptor Complex --> hyperpolarization
         1. DO NOT TAKE WITH: OSA (obstructive sleep apnea) dec. muscle tone in upper airway worsen Apnea episode DON'T DRINK!
            1. Short Acting (3-8 hours)
            2. Midazolam
            3. Triazolam
            4. Intermediate (10-20 hours)
            5. Temazepam
            6. Estazolam
            7. Long Acting (1-3 days)
            8. Quazepam
            9. Flurazepam
   2. Barbiturates
      1. Weak acid, can induce P450 enzymes, can Also increase ALA, Therefore C/I in pt.s With porphyria
         1. MOA: bind to separate Sight on the GABA Cl channel Receptor complex increasing The duration that the channel is open
            1. Tolerance, high Abuse potential SMALL THERAPEUTIC INDEX
            2. DRUG INTERACTIONS! Decreased serum Warfarin Decreased serum digoxin Decreased serum CCB's
            3. Ultra-short Acting (20 min)
            4. Thiopental
            5. Methohexital
            6. Short Acting (3-8 hours)
            7. Pentobarbital
            8. Secobarbital
            9. Amobarbital
            10. Long Acting (1-2 days)
            11. Phenobarbital
   3. Miscellaneous
      1. Zolpidem
         1. Increases sleep Duration
            1. No effect on different Stages of sleep Minimal rebound insomnia, Little to no tolerance, Great to avoid jet lag.
            2. MOA: binds to a Sub-site of BZ1
            3. Can cause sleepwalking Pt.s binge eat, shop and drive With no memory DO NOT DRINK! (Increases sleepwalking)
      2. Zaplelon
         1. Increases sleep Duration
            1. No effect on different Stages of sleep Minimal rebound insomnia, Little to no tolerance,
            2. MOA: binds to a Sub-site of BZ1
      3. Eszopiclone
         1. Increases sleep Duration
            1. No effect on different Stages of sleep Minimal rebound insomnia, Little to no tolerance, APPROVED FOR LONG TERM.
            2. MOA: binds to a Sub-site of BZ1
      4. Ramelteon
         1. MOA: MT1, MT2 receptor Agonist (no affinity for BZ1 Or BZ2)
            1. DO NOT DRINK!
      5. Choral Hydrate
         1. Sedation for Kids Undergoing procedures
7. Panic Disorder
   1. Symptoms: 1. Palpitations, pounding heart, inc. HR 2. Sweating. 3. Trembling or shaking 4. Sensations of SOB or smothering 5. Feeling dizzy, unsteady, lightheaded or faint 6. Fear of dying
      1. BDZ
         1. Alprazolam
      2. SSRI
         1. Sertraline
         2. Paroxetine
8. Anxiety
   1. Antihistamines
      1. MOA: antagonist at H1 receptors (excitatory)
         1. SEDATION! Do not drink!
            1. Hydroxyzine HCL
            2. Hydroxyzine pamoate
   2. SSRI
      1. MOA: --| reputake Of serotonin at transporter = more in synaptic cleft
         1. [buspirone] + sexual dysfunction AND insomnia, tremors; palpitations, Postural HTN (paroxetine only) Vasodilation; anorexia, NVD; Loss of libido... Wah wah.
            1. DRUG INTERACTIONS! MAOI's (14 day wait) TCA's (inhibits metabolism) TRYPTOPHAN (add. serotonin Fx) WARFARIN (inc. risk of bleeding)
            2. Paroxetine
            3. Sertraline
   3. SNRI
      1. MOA: blocks S & N Reuptake transporters
         1. See SSRI, AND Hypertension With withdrawal.
            1. Venlafaxine
            2. Also treats Depression!
            3. Desvenlafaxine
            4. Duloxetine
   4. Carbamates
      1. Respiratory depression Dangerous withdrawal Geriatric problems
         1. Meprobamate
   5. Azapirones
      1. MOA: 5HT1a receptors --> G proteins --> inc. opening of K+ channels = hyperpolarization = decreased firing
         1. Headache and dizziness BUT! NO impaired motor function NO D.W.T. NO cross tolerance with BDZ NO problems drinking NO muscle relaxation/ Anticonvulsant
            1. Buspirone
   6. Benzodiazepines
      1. MOA: enhances the affinity for GABA receptors to its NT, -> more frequent opening of Cl channels, --| neuronal firing.
         1. Drowsiness and confusion Ataxia at high doses Brain Drain- (Recall and learning) DON'T DRINK! D.W.T.
            1. Short Acting (3-8 hours)
            2. Oxazepam
            3. Choice in Aged and Hepatic Dz BECAUSE: Bypasses oxidation And n-dealkylation
            4. Intermediate (10-20 hours)
            5. Lorazepam
            6. Alprazolam
            7. Long Acting (1-3 days)
            8. Diazepam
            9. Clorazepate
            10. Prodrug
            11. Chlordiazepoxide
      2. BDZ overdose, Anesthesia sedation reversal
         1. BDZ Antagonist
            1. MOA: binds and Completely antagonizes binding and allosteric Effects of BDZs
            2. Flumazenil
      3. Lipid soluble!