Schedule I drugs are those with a high potential for abuse and have no accepted medical use.

It is illegal to buy, sell, or possess thise drugs!

Ex: Heroin, Mescaline, PCP, LSD, Ecstasy

Schedule II drugs are drugs that have accepted medical uses (with severe restrictions) and have a high potential for abuse.

Ex: Amphetamine (Adderall), Methamphetamine, morphine, oxycodone, Methylphenidate (Ritalin), Nabilone (THC)

Cocaine stimulates the cardiovascular system, producing increased heart rate and blood pressure (recall NE increase!) 
Also remember that NE has vasoconstrictive properties through its actions on alpha-1 receptors.  This can cause ischemic necrosis.  When people snort cocaine, the vasoconstrictive effects cause death of nasal tissue leading to a perforated nasal septum!  It can also cause vasospasms that lead to MI.

Cocaine eliminates fatigue and hunger

Cocaine may induce schizophrenic behavior (DA) and leads to a state of euphoria (DA reward system) and rapid speech.

Remember, withdrawal symptoms are opposite to the symptoms of the drug.  Because cocaine is normally stimulatory and euphoria producing, withdrawal will include sleepiness, dysphoria, depression, and bradycardia.

For severe withdrawal symptoms, the drug Modafinil may be useful.  It is also used in narcoleptics because it prolongs wakefulness... this will help with the fatigue experienced during cocaine withdrawal.

Amphetamines are used in the pharmacological agents Adderall and Ritalin.  These are used for ADHD prescriptions.

As CNS stimulants, amphetamines also find use in narcolepsy treatment (but remember: modafinil can also be used)

Acute amphetamine intoxication produces tachycardia, hypertension, confusion, tremors, and euphoria.  Stroke or seizure may occur.

Remember, amphetamines are stimulatory (like cocaine) and displace NTs (DA, NE, 5-HT) into the synapse.

MAOIs should not be used with amphetamines, as this could precipitate a hypertensive crisis.

Adrenergic neuron blockers (antihypertensives) will be counteracted.  So don't give amphetamines to controlled hypertensives on these medications.

Hypertensives in general should not use amphetamine, as this will only raise their blood pressure even more.

Methylphenidate is an amphetamine derivative.  It is most commonnly known as Ritalin and is prescribed in cases of ADHD. 

It is often abused by students as a neuroenhancer.

Theophylline is a methyl-xanthine.  It is used in cases of respiratory distress, and in cases where opioids have depressed respiration.  (Methyl-xanthines increase the sensitivity of the respiratory center of the medulla to CO2)

Methyl-xanthines (caffeine, theophylline) work by blocking the adenosine receptor 

Caffeine and theophylline are methyl-xanthines, and therefore work by blocking the adenosine receptor.

This causes increased cortical arousal, awareness, restlessness.  It increases heart rate.  It also causes diuresis.

A man jumped from a second story building, breaking his ankle, and continued to run down the street, yelling at passersby and breaking car windows.  Later, in the hospital, he states that he had an "out-of-body" experience.

What drug was he likely on?

PCP (phencyclidine aka phencyclohexylpiperidine) is a schedule 1 psychotomimetic drug.  It produces vivid dreams, out of body experiences, aggressive behavior, and a lack of pain!

It causes both vertical and horizontal nystagmus (a pathognomonic/characteristic sign)

Cannabinoids are schedule II drugs and are prescribed for the treatment of nausea related to chemotherapy...cannabinoid receptors (CB-1) are found in the vomiting center..., glaucoma, spasticity, and anorexia. 

The therapeutic drugs are Dronabinol and Nabilone

Anabolic steroids are androgenic-steroids.  Androgens suppress gonadotropin production in a classical negative feedback system.  This decreases testosterone levels, causing a reduction in sperm production and decreased fertility.

Eventually, this leads to small testicles

Gynecomastia results when the androgens (steroids) are converted to estrogen.

Large doses can be hepatotoxic

Roid Rage is a behavioral change that results in aggresion in susceptible individuals.

Heroin

oxycodone

morphine

methadone

meperidine

These are all opioids (pain relievers) that are regularly abused.

GHB is gamma-hydroxybutyrate.  It is a CNS depressant that is believed to have an inhibitory role in the dopaminergic pathways of the brain.

It is a treatment for narcolepsy... recall: can also use modafinil and amphetamines. 

It is also a treatment for cateplexy

GHB, gamma-hydroxybutyrate, causes intoxication that mimics alcohol intoxication.  It produces euphoria and an increased sexual desire.  Because it causes amnesia, it is also used as a date-rape drug, and is rivaling Rohypnol in this regard.

What are signs of opioid overdose?

What do you treat it with?

Pinpoint pupils, loss of consciousness, decreased respiration leading to cyanosis.  (everything DOWN)

Give IV naloxone (Narcan) to treat opioid overdose toxicity.  Give it by IV and slowly to avoid precipitating withdrawal symptoms.  for long half-life opioids like methadone, serial dosing of naltrexone (another opioid antagonist) may be necessary

Detoxification of opioid abusers involves giving gradually decreasing doses of the opioid agonist methadone.

Additionally, you could use clonidine to decrease withdrawal rebound NE release by its actions at a-2 receptors, or a clonidine-naltrexone combination.  In this last option, clonidine acts to prevent the withdrawal that naltrexone would normally precipitate.  Eventually, clonidine is decreased and naltrexone increased.

Naltrexone or Buprenorphine are used for opioid maintenance therapy.  Buprenorphine is a partial agonist with a very high affinity for the receptors, thus inhibiting the opiates from binding, even if the patient does try to use them again.

Naltrexone is a long-lived antagonist and also reduces cravings.

Norepinephrine

opiate action at presynaptic receptors causes decreased NE release.  This upregulates postsynaptic NE receptors.  When opiates are withdrawn, the increased post-synaptic NE receptor density results in an supersensitivity to the effects of NE.  This manifests as an 'adrenergic storm'.  This is why clonidine, which decreases NE release, is useful in opiate withdrawal!

Cocaine overdose can cause cardiac arrhythmias, tachycardia, hypertension, and seizures.

Treat the symptoms with beta and alpha blockers.  Nitroglycerine is useful in cocaine-induced cardiac ischemia. (this is secondary to the vasospastic influence of cocaine on the coronary arteries)

Barbiturates are CNS depressants.  You would see sedation, reduced BP, cardiac and respiratory depression, and coma.

Don't give CNS stimulants to try to fix it, this strangely increases the mortality from barbiturate overdose.  Instead, use a gastric lavage and activated charcoal.  Hemodialysis if necessary.

Overdose = Naloxone (Narcan)

Withdrawal = Methadone, clonidine, or clonidine&naltrexone

Maintenance = Naltrexone or Buprenorphine