ADHD

Stimulant Meds -

• RITALIN,CONCERTA (methylphenidate), INC dopamine in brain
• ADDERALL,DEXEDRINE,DEXTROSTAT (amphetamine, dextroamphetamine) - BLOCK reuptake of dopamine and norepinephrine

NON-STIMULANT MEDS:

• STRATTERA (atomexetine) - INC brain Norepi

OFF LABEL MEDS:

• Antidepressants- affect reuptake of serotonin, norepi, and dopamine
• HTN Meds - Alpha2 agonists stimulate norepi release

Alzheimers Disease

Ach Inhibs: DOC

• Tacrine-Cognex: no brain selective, compliance issues
• Donepezil-Aricept: VERY LONG HALF LIFE!!
• Rivastigmine-Exelon: very short half life
• Galantamine-Reminyl: Available generic
• USE: mild-mod severe AD
• MOA: inhibits activity of cholinesterase enzymes(stops binding), DEC metabolism of Ach (more Ach available for binding to muscarinic and nicotinic receptors), improved memory and cognition
• ADR: HA, Tremor, dizzy, Insomnia, anxiety, hallucinations, Mult GI side effects
• DI: drugs w/ anticholinergic properties, antihistamines, tricyclic antidepressants
• CI: glaucoma, seizures, CV conditions, pulmonary disease

NMDA antagonist

• N-Methyl-D-Aspartate receptor antag
• Memantine-Namenda
• USE: Mod-Severe AD, used in combo w/ Ach inhib
• MOA: uncompetitive antag of NMDA glutamate receptors-prevent cell loss and neurotixicity
• ADR: less than ach inhibs; dizzy, HA fatigue, hallucinations, confusion, insomnia, constipation, diarrhea/fecal incontinence
• DI: other NMDA antag, L-DOPA(parkinsons), tubular secretion meds(HCTZ,triamterene), CAI, Sodium Bicarbonate
• CI: epilepsy, renal impairment, UTI

Cushings Syndrome

• Used when surgery and radiation ineffective
• Limited Efficacy
• Ketoconazole-Nizoral: Antifungal, suppresses glucocorticoid synthesis
• Mitotane-Lysodren:only if surgery not possible, suppresses adrenal cortex
• Metyrapone-Metopirone: suppresses glucocorticoid synthesis

Epilepsy

Antiepileptics: 1st line of Tx

Hyperthyroidism

Beta blockers: tx symptoms but NOT underlying cause

• Propranolo-Inderal
• Atenolol-Tenormin
• Metoprolol-Lopressor

Anti-Thyroid Drugs: remission rate: 40-70% w/i 1-2 yrs

Radioactive Iodine: 80% CURE rate, thyroid replacement needed so ptnt doesnt ge thypothyroidism

Insomnia

• Barbituates
• Benzodiazepines - Non selectively bind to GABA-alpha (1-6)/ induces light sleep, dec REM sleep (BAD)/ EX: Temazepam, Flunitrazepam, Triazolam, Flurazepam, Midazolam, Nitrazepam, Quazepam
• Non-Benzodiazepines - Some bind selectively to GABA-alpha1/ Get to sleep quicker/ EX: ambien (better than benz), Sonata (highly selective for alpha 1), Imovane (same as benz), Lunesta (same as benz)
• Antidepressants - remeron-mirtazipine
• Antihistamines

Migraines

• OTC NSAIDS
• TRIPTANS-Axert, ralpex, frova, amerge, maxalt, IMITREX, zomig/ MOA-contric blood vessels in BRAIN and releive swelling
• ERGOTS-DHE 45, Ergomar+caffeine-Ergotamine/ MOA-constrict blood vessels in body (less side effects)
• TRICYCLIC ANTIDEPRESSANTS-amitriptyline, pamelor/ MOA-affect level of serotonin in brain (more dec sede effects)

Narcolepsy

• General Sleepiness Tx: Modafinil-Provigil, Methylphenidate HCl-Ritalin, Methylphetamine HCl-Desoxyn, Dextroamphetamine sulfate-dexedrine
• Abnormal REM sleep Tx-anticataplectic: Fluoxetine-Prozac, Venlafaxine-EffexsorSR, Protriptyline-triptil, Sodium oxybate-xyrem

Obsessive-Compulsive Disorder

• SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI): Fluoxetine-Prozac, Sertraline-Zoloft, Paroxetine-Paxil
• TRICYLIC ANTIDEPRESSANTS (TCA): Desipramine-norpramine, Clomipramine-anafranil
• SEROTONIN/NOREPINEPHRINE REUPTAKE INHIB (SNRI): Venlafaxine-effexor, duloxetine-cymbalta

Osteoporosis

BISPHOSPHATES: poorly absorbed, many side effects

     Alendronate-Fosamax: inhib OSTEOCLAST bone destruction

     Risedronate

     Ibandronate-Boniva

     Zoledronic Acid-Reclast

MIXED ESTROGEN AGONIST/ANTAGONIST:

     Raloxifene

     Calcitonin

     Teriparatide: injectable PTH, Regulates calcium levels, stim bone formation, #1 risk is osteosarcoma, DONT give w/ bisphosphates

TESTOSTERONE PRODUCTS: men w/ low T levels

Panic Attacks

• Selective Serotonin Reuptake Inhib (SSRI) - Prozac, Zoloft, Paxil
• Benzodiazepines - Xanax, Valium, Ativan, Klonopin
• MAOI
• TCA
• SNRI- Dulozetine and venlafaxine

Parkinsons Disease

Schizophrenia

• Antipsychotic meds
• 2nd gen have fewer side effects than 1st generation, they also have more effect at treating negative symptoms and cognitive impairment associated w disease
• MOA: block dopamine receptors and dopamine pathway
• Clozapine-most efficacious drug, blocks dopamine, serotonin, and acetylcholine receptors
• 1st Gen Drugs: Thorazine, Prolixin, Haldol, Navane, Stelazine
• 2nd Gen Drugs: Clozapine, Risperidone, Olanzapine, Zisprasidone, Quetiapine