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Psychopharm > Drug Indications/Contraindications > Flashcards

Drug Indications/Contraindications Flashcards

1
Q

Main Indications of Typical antipsychotics

A

Psychotic disorders:

  • scz
  • schizoaffective d/o
  • brief psychotic d/o (less than 1 mo)
  • substance or med induced psychosis

Mood d/o w/ psychotic features

  • major depression w/ psychotic features
  • acute mania, depressed, mixed manic states of bipolar d/o
  • Tourette’s d/o
  • Huntington’s d/o
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2
Q

Indications for all atypical antipsychotics

A

Psychotic d/o

  • scz
  • schizoaffective
  • brief psychotic d/o
  • med or substance induced psychosis

Mood d/o w/ psychotic features

  • major depression w/ psychotic features
  • acute mania, depressed, mixed manic states of bipoar
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3
Q

Which drug is reserved for treatment refractory schizophrenia?

A

Clozapine (Clozaril)

-last-resort, used only after 2 failed antipsychotic regimens

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4
Q

Which drug can be used in schizophrenia when tardive dyskinesia is present?

A

Clozapine (Clozaril)

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5
Q

Which antipsychotics must be avoided in pts w/ diabetes?

A

Clozapine and Olanzapine

-highest risk of metabolic problems as side effects

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6
Q

Which antipsychotics must be avoided in pts w/ hyperlipidemia?

A

Clozapine and Olanzapine

-highest risk of metabolic problems as side effects

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7
Q

Which antipsychotics are contraindicated in granulocytopenia?

A

Low white count? Can’t use clozapine

-b/c serious AE of clozapine = agranulocytosis

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8
Q

Which antipsychotics are used for bipolar maintenance?

A

Bipolar maintenance: atypicals

  • olanzapine (Zyprexa)
  • aripiprazole (Abilify)

Bipolar maintenance = prophylaxis of recurrent mania

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9
Q

Which antipsychotics are used for bipolar depression?

A

Bipolar depression: atypicals

  • quetiapine (seroquel)
  • lurasidone (Latuda)
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10
Q

Which antipsychotics are used for acute mania?

A

Atypicals (w/ the exception of clozapine) have recently won indications for acute mania

Acute mania: tons of the atypicals
-Risperidone, olanzapine, quetiapine, aripiprazole

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11
Q

Which antipsychotics are used as adjunctive therapy for unipolar depression?

A

Antipsychotics for unipolar depression: atypicals

  • quetiapine (Seroquel)
  • aripiprazol (Abilify)
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12
Q

Indications of clozapine

A

Clozapine = atypical antipsychotic

  • typical antipsychotic indications (psychotic d/o and mood d/o w/ psychotic features)
  • treatment-refractory scz
  • scz w/ TD
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13
Q

Indications of risperidone

A

Risperidone (Risperdal) = atypical antipsychotic

  • typical antipsychotic indications
  • acute mania
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14
Q

Indications of olanzapine

A

Olanzapine = atypical antipsychotic

  • typical antipsychotic indications
  • acute mania
  • bipolar maintenance
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15
Q

Indications for Quetiapine

A

Quetiapine (Seroquel) = atypical antipsychotic

  • typical antipsychotic indications
  • acute mania
  • bipolar depression
  • adjunctive tx for unipolar depression
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16
Q

Indications for ziprasidone

A

Ziprasidone (Geodon) = atypical antipsychotic

  • typical antipsychotic indications
  • acute mania
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17
Q

Indications for aripiprazole

A

Aripiprazole (Abilify) = atypical antipsychotic

  • typical antipsychotic indications
  • acute mania
  • bipolar maintenance
  • adjunctive tx for unipolar depression
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18
Q

Indication for amitriptyline

A

Amitriptyline (Elavil) = tertiary amine (more side effects) TCA

Wide use for pain, headache, and insomnia

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19
Q

Which TCA is indicated for OCD?

A

Clomipramine (Anafranil)
-highly serotonergic

All TCAs antagonize 5HT and NE presynaptic reuptake pumps, but Clomipramine is specifically highly serotonergic

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20
Q

Indications for Doxepin

A

Doxepin = tertiary amine TCA

Used for pain, insomnia, and anxiety

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21
Q

Which of the TCAs is best to use in the elderly?

A

Nortriptyline (Pamelor) = secondary amine TCA

-safest in elderly b/c least anticholinergic effects (least orthostasis)

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22
Q

What are two contraindications of TCAs?

A

Cardiac conduction delays
Arrhythmias

-b/c serious adverse effect of cardiotoxicity: TCAs slow cardiac conduction

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23
Q

Main indications of TCAs

A 
MDD
Bipolar depression
Dysthmia
Panic d/o
Generalized social phobia
Generalized anxiety d/o
OCD (clomipramine)
Pain d/o such as migraines, neuralgias(amitriptyline, doxepin)
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24
Q

Antidepressant indicated for enuresis

A

Enuresis = involuntary urination (ex: wetting the bed)

Use imipramine (tertiary amine TCA)- good for panic and enuresis

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25
Q

Efficacy btwn drugs in the same class

(a) TCAs
(b) SSRIs

A

Drugs in the same class

(a) TCAs have variable efficacy for several mood and anxiety d/o, but similar side effect profiles => prescribe by the therapeutic effect
(b) SSRIs have the same efficacy, but different side effect profiles => prescribe based on the side effect profile

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26
Q

Which antidepressant has proven efficacy in bulimia?

A

Fluoxetine (Prozac)

-SSRI

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27
Q

Which SSRI is the most sedating?

A

Paroxetine (Paxil)

-more sedating than both fluoxetine and sertraline

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28
Q

Which SSRI is indicated for OCD?

A

Can technically use them all, but fluvoxamine (Luvox) shown to be very efficacious in OCD

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29
Q

Contraindication of SSRIs

A

Co-administration of MAOIs (b/c of serotonin syndrome)

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30
Q

Indications for SSRIs

A
  • MDD
  • PMDD (premenstrual dysphoric d/o)
  • PTSD
  • Bulimia (especially fluoxetine)
  • Panic d/o
  • Social phobia
  • OCD
31
Q

Contraindications of SNRIs

A

Co-administration w/ MAOIs (serotonin syndrome)

32
Q

Indications for SNRIs

A
  • MDD
  • GAD (generalized anxiety d/o)
  • Panic d/o
  • Generalized social phobia
33
Q

Compare and contrast indications of SSRIs and SNRIs

A

Both:
-MDD, Panic d/o, Social phobia

SSRI only:
-PMDD, PTSD, Bulimia, OCD

34
Q

Indications for MAOIs

A

-MAOIB inhibition (ex: selegiline) for Parkinsons

MAOIs:

  • panic d/o w/ agoraphobia
  • social phobia
  • atypical depression
  • PTSD
  • borderline personality d/o
  • management of bipolar depression
35
Q

Contraindications of MAOIs

A

Other antidepressants: TCAs, SSRIs, other MAOIs, SNRIs => serotonin crisis

-Ephedrine (bronchodilator in asthma drugs), albuterol => hypertensive crisis

36
Q

Contraindications of Mirtazapine

A

Mirtazapine (Remeron) = NaSSA

Contraindication = co-administration w/ MAOIs

37
Q

Contraindications of trazodone

A

Coadministration w/ MAOIs

trazodone = SARI

38
Q

Contraindications of nefazodone

A

Coadministration w/ MAOIs

nefazodone = SARI

39
Q

Contraindications of bupropion

A

(Bupropion = NDRI)

Contraindications:

  • Coadministration w/ MAOIs
  • Anorexia and bulimia
  • Seizure d/o
40
Q

Indications for mirtazapine

A

(Mirtazapine = NaSSA)

Indication = MDD

41
Q

Indications for trazodone

A

(Trazodone = SARI)

Indications = MDD, dysthymia

42
Q

Indications for nefazodone

A

(Nefazodone = SARI)

Indications = MDD, dysthmia

43
Q

Indications for bupropion

A

(bubropion = NDRI)

Indications:

  • MDD
  • dysthymia
  • bipolar depression
  • ADHD
  • smoking cessation
44
Q

Indications for vilazodone

45
Q

Indications for Vortioxetine

46
Q

Indications for Alprazolam

A

Alprazolam = Valium

  • benzo
  • very effective for panic, but high addictive potential

Indications

  • GAD
  • situational anxiety, phobias
  • panic d/o
  • epilepsy
  • muscle spasms
  • akathisia
  • alcohol withdrawal
  • agitation
  • anxiety associated w/ other psychiatric d/o
47
Q

Indications for all benzos

A
  • GAD
  • situational anxiety/phobias
  • panic d/o
  • epilepsy
  • muscle spasms
  • akathisia (agitation, restlessness)
  • alcohol withdrawal
  • agitation
  • anxiety associated w/ other psychiatric d/o
48
Q

Contraindication for all benzos

A

Substance dependence

49
Q

Which anxiolytic is contraindicated w/ asthma?

A

Propranolol

-b/c beta blocker => bronchoconstriction

50
Q

Indication for propranolol in psychiatry

A

Beta blocker used for performance anxiety

51
Q

Which anxiolytic is indicated for adjunctive use in MDD?

A

Buspirone = nonbenzo anxiolytic

-5HT1A agonist

52
Q

Indications for buspirone

A
  • GAD

- adjunctive use in MDD

53
Q

Indications of hydroxyzine

A

Hydroxyzine = sedative antihistamine (nonbenzo anxiolytic)

-situational anxiety

54
Q

Which anxiolytic is effective as a short-term sleep aid?

A

Temazepam = Restoril

-short half life (least potent of short t1/2) benzo

55
Q

Which benzo is used for alcohol detoxification

A

Chlordiazepoxide (Librium)

56
Q

Which long half-life benzo has a fast onset?

A

Diazepam (Valium)

-fast onset but w/ active metabolite

57
Q

Indications of flumazenil

A

Flumazenil = Benzodiazepine antagonist

-used to counteract benzo OD

58
Q

Name drugs indicated for insomnia

A
  • Zolpidem (Ambien)
  • Zaleplon (Sonata): short acting => can dose in middle of the night
  • Eszopiclone (Lunesta): suggested to not yield tolerance
  • Diphenhydramine (Benadryl)
  • Ramelteon
59
Q

Indications for lithium

A
  • Bipolar I, especially euphoric mania
  • Bipolar II
  • Bipolar maintenance
  • Intermittent Explosive D/o
  • Adjunct to antidepressants
60
Q

Contraindications for lithium

A

1- pregnancy (Ebstein’s anomaly and abnormality of the great vessels)

2- Caution w: thiazide, diuretics, ACEi, NSAIDs which increase Li levels

61
Q

Indications for carbamazepine

A
  • Bipolar I, espeically mixed mania and rapid cycling
  • Bipolar II
  • epilepsy and neuralgias
  • alcohol withdrawal
62
Q

Contraindications for carbamazepine

A

Pregnancy

Can cause craniofacial abnormalities (cleft lip and palate), neural tube defects, and learning d/o

63
Q

Indications for valproic acid

A
  • Bipolar I, especially mixed mania and rapid cycling
  • Bipolar II
  • Epilepsy and neuralgias
  • alcohol withdrawal
64
Q

Contraindications for valproic acid

A

1- pregnancy: can cause neural tube defects (to a greater degree than carbamazepine)

2- child bearing aged women- can cause polycystic ovaries

65
Q

Indications for lamotrigine

A
  • bipolar maintenance
  • bipolar depression
  • epilepsy and neuralgia
66
Q

Contraindications for lamotrigine

A

-caution when administered w/ valproic acid (due to boosted blood levels)

67
Q

Contraindication for gabapentin

A

-caution in renal disease (b/c excreted renally)

68
Q

Indications for gabapentin

A
  • bipolar I, adjunctive tx
  • epilepsy and neuralgias
  • ineffective as monotherapy for mania
  • also off-label use in GAD and social anxiety
69
Q

Indications for CNS stimulants

A
  • ADD

- narcolepsy

70
Q

Contraindications for CNS stimulants

A
  • coadministration w/ MAOIs

- narrow angle glaucoma

71
Q

Indications for Atomoxetine

A

Atomoxetine (Strattera)

Indication = ADD

72
Q

Contraindications for atomoxetine

A
  • coadministration w/ MAOIs

- narrow angle glaucoma

73
Q

Indications for modafinil

A

Modafinil = novel CNS stimulant (not adrenergic, mechanism of action unclear)

  • narcolepsy
  • ADD
  • primary and secondary hypersomnia

Psychopharm (10 decks)

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