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Pharmacology II - EXAM 2 > Indications / First-Line / Contraindications > Flashcards

Indications / First-Line / Contraindications Flashcards

1
Q

What is indicated for mild to moderate HA treatment?

A

Acetaminophen

NSAIDs

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2
Q

What class of medications is considered first-line for headache treatment?

A

Triptans

Erogotamines

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3
Q

Triptans are specifically first line for treatment of migraines with and without what?

A

Aura

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4
Q

What are contraindications to Triptan use?

A

Basilar Migraine
Ischemic Events
Unctonrlled HTN
Liver Disease

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5
Q

What are TWO indications for DHE use?

A

Acute migraine with or without aura

Cluster Headaches

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6
Q

T/F: Ergotamines can be used as both abortive and prophylaxis in vascular headache treatment

A

True

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7
Q

Should ergotamines be used in patients with Renal Failure, Hepatice Failure, or Vascular disease?

A

No

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8
Q

Are ergotamines safe in pregnancy or breast feeding?

A

No

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9
Q

What is considered second line for headache treatment?

A

Butorhpanol

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10
Q

What is considered third line for headache treatment?

A

Fiorinal (Butalbital, aspirin, caffeine)

Fioricet (Butalbital, acetaminophen, caffeine)

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11
Q

Fiorinal and Fioricet are indicated to treat which type of headache?

A

Tension-type headache

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12
Q

Which for medications have the highest level of evidence for migraine treatment (considered Class A)?

A

NSAIDs
Triptans
Opiates
Nasal DHE

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13
Q

If at home treatment or typical remedies for headache fail…….

What medications can be given?

A
  1. IV DHE + Metoclopramide
  2. IV/IM Lorazepam (Ativan)
  3. IV Divalproex
  4. IM Ketorolac
  5. Steroids
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14
Q

What is the “typical” first line headache remedy in the ED?

A

IV Metoclopramide

SubQ Sumatriptan

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15
Q

What is the “typical” second line headache remedy in the ED?

What should be avoided?

A

IV APAP, ASA, Diclofenac, or Ketorolac

Avoid:

Diphenhydramie
Hydromorphone
Lidocaine
Morphine
Octreotide
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16
Q

What can be used to treat migraines in pediatric patients?

A

NSAIDs
Sumatriptan (Nasal, SubQ)
Oral Zolmitriptan or Rizatriptan

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17
Q

What medications are considered for migraine prophylaxis?

A

Divalproex Sodium
Topiramate
Propanolol, Metoprolol, Timolol (Oral)

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18
Q

What medication is used for prophylaxis of menstrual migraines?

A

Frovatriptan

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19
Q

What is the most commonly used natural treatment for migraine prophylaxis?

How is this dosed?

A

Butterbur

  1. 75 mg daily for 2-6 months until headaches diminish
  2. Then 3-6 months after headaches diminish
  3. Gradual taper to discontinuation following that
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20
Q

What is first-line for relapsing-remitting MS attacks?

A

Interferon Beta
Dimethyl Fumarate
Glatiramer Acetate

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21
Q

Which MS drug is indicated for……

Reducing neurologic disability
Reducing relapse frequency
RRMS and progressive MS

AND….

Hormone-refractory prostate CA
Acute nonlymphocytic Leukemia in adults

A

Mitoxantrone

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22
Q

What is first line for acute MS attacks?

A

Glucocorticoids

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23
Q

What is first-line for Secondary Progressive or Progressive Relapsing MS?

A

Interferon beta
Natalizumab
Mitroxantrone

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24
Q

Is Glatiramer Acetate an immunomodulator or immunosuppressant?

A

Immunomodulator

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25
Q

Is Mitoxantrone an immunomodulator or immunosuppressant?

A

Immunosuppressant

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26
Q

What MS medication is indicated to reduce exacerbation and delay disability, but is NOT considered first line?

This is used in combination with what medication?

What other disease is this used to treat?

A

Natalizumab

Used in combo with Interferon Beta

this is also used to treat Crohn’s disease

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27
Q

What MS medication is indicated to reduce exacerbation and delay disability in relapsing MS, but is associated with first-dose bradycardia?

A

Fingolimod

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28
Q

What MS medication is indicated for relapsing MS, but has major side effects such as hepatotoxicity, teratogencitiy, and bone marrow suppression?

A

Teriflunomide

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29
Q

What medication is indicated to improve walking in MS patients?

In what conditions is this contraindicated?

A

Dalfampridine

Contraindications:

Renal Impairment
Seizures

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30
Q

What muscle relaxant is sometimes used in MS patients which is also FIRST LINE for Malignant Hyperthermia?

A

Dantrolene

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31
Q

Which medication is first-line for treating the pseudobulbar effect of MS?

A

Nuedexta (Dextromethorphan/Quinidine)

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32
Q

What is considered first line in Parkinson’s treatment?

A

Levodopa + Carbidopa

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33
Q

What are contraindications to Levodopa use?

A

MAOIs
Malignant Melanoma
Narrow Angle Glaucoma

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34
Q

What medications can be used in combination with Levodopa and Carbidopa to “smooth out” the “on-iff” effects?

A

Dopamine Receptor Agonists

In lower doses of carbidopa and levodopa

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35
Q

Which non-ergot dopamine receptors can also be used to treat restless leg syndrome?

A

Pramipexole

Ropinirole

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36
Q

Which non-ergot DRA is given as a SubQ injection to provided temporary relief from “off periods” of akinesia?

A

Apomorphine

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37
Q

Which ABx is also a MAOI?

A

Linezolid

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38
Q

Which MAO-B inhibitor is indicated for early Parkinson’s Treatment in adjunct with Levodopa?

A

Rasagiline

39
Q

T/F: COMT Inhibitors are monotherapy

A

False

they are used in adjunct with Levodopa

40
Q

Should COMT inhibitors be used with MAOIs

A

Not really but can be OK with MAOI-Bs

41
Q

What medications compose Stalevo?

A

Levodopa
Carbidopa
Entacapone

42
Q

Which class of medications is useful in Parkinson’s patients taking neuroleptics and can be useful in improving rigidity and tremor?

A

Anticholinergics

Trihexyphenidyl
Benztropine

43
Q

What medication is indicated to reduce hallucination and delusion in PD pyschosis?

A

Pimavanserin

44
Q

What newly approved medication is indicated for”off” episodes in patients taking Levodopa/Carbidopa?

A

Safinamide

45
Q

What liver condition would contraindicate giving a PD patient Safinamide?

A

Cirrhosis

46
Q

What is considered first-line for ALZ treatment and for dementia with Lewy Bodies?

A

Cholinesterase Inhibitors

Donepezil
Rivastigmine
Galantamine

47
Q

What medication is approved for moderate-to-severe ALZ treatment that can be used as monotherapy or with a cholinesterase inhibitor?

A

Memantidine

48
Q

What antidepressants can be used to treat ALZ?

A

Citalopram
Escitalopram
Trazodone

49
Q

What is indicated for Myasethnia Gravis Treatment?

A 
Pyridostigmine
Neostigmine (Faster Acting)
50
Q

What are contraindications to Pyridostigmine use?

A

Urinary/Bowel Obstruction

Asthma/COPD

51
Q

What medication is approved for ALS treatment?

What is the newest approved medication for this and commonly only used in Japan?

A

Riluzole

Edaravone

52
Q

What medication is indicated to treat Chorea?

What are TWO contraindications to this medication?

A

Tetrabenazine

Contraindications:

Liver Disease
MAOIs

53
Q

What should be considered first-line for mild pain treatment in pediatrics?

A

Ibuprofen/Acetaminophen

54
Q

What should be considered first-line for moderate-to-severe pain in pediatrics?

A

Opiates

55
Q

What are THREE indications for acetaminophen?

A
  1. Analgesic (Minor aches/pain)
  2. Antipyretic
  3. Kine/Hip OA (First-Line per ACR although meta-analysis proved this was least effective)
56
Q

What medications is considered the antidote for acetaminophen OD?

A

N-Acetylcysteine

57
Q

Which pain reliever should be recommended to marathon runners?

Why?

A

Acetaminophen

Because it is not renally eliminated

58
Q

What are THREE uses for NSAIDs?

A
  1. Acute/Chronic Pain
  2. Cancer Pain
  3. Anti-Inflammatory
59
Q

What are FOUR medications used to lower GI risks with NSAID use?

A
  1. Naproxen/Esomeprazole
  2. Ibuprofen/Famotidine
  3. ASA/Omeprazole
  4. Mistoprostol
60
Q

What is the maximum dose of ASA?

A

4 grams per day

61
Q

How is ASA overdose treated?

A

Sodium Bicarbonate

62
Q

Which NSAID is first line for gout flares?

A

Indomethacin

63
Q

Other than gout, what are two additional indications of Indomethacin?

A

PDA Closure

Premature Labor

64
Q

Which NSAIDs are indicated for relief of OA and RA symptoms?

A

Meloxicam
Piroxicam
Celecoxib

65
Q

Which NSAID is indicated for prevention of familial adenomatous polyposis

A

Celecoxib

66
Q

What are uses for short-acting opioids?

A

Acute Pain
Incident Pain
Breakthrough Pain
Physical Therapy

67
Q

What are uses for long acting pain?

A

Chronic Pain

Moderate-to-severe Pain

68
Q

What is the most commonly used opioid?

A

Hydrocodone (Norco)

69
Q

Which opioid is often used in a transdermal patch?

When does this reach a steady state?

A

Fentanyl

Reaches steady state in 3-6 days (don’t cut patch b/c dose dumping)

70
Q

What class of medication should be avoided with Meperidine (Demerol)?

Why?

A

MAOIs because of increased risk for respiratory depression

71
Q

Can Propoxyphene be used in the elderly?

A

No, it should be avoided

72
Q

What medication is used for immediate opioid reversible?

A

Naloxone (Narcan)

73
Q

What medication is indicated for opioid and EtOH addiction?

Can this be given to patients currently on opioids?

A

Naltrexone (Vivitrol)

No

74
Q

What medication is as effective as morphine for labor pain?

A

Tramadol

75
Q

What medication classes should be avoided with tramadol due to an increased risk of seizures?

A

SSRIs
TCAs
Opioid
MAOIs

76
Q

What opioid is specifically approved for diabetic neuropathy?

Why should this be avoided with EtOH?

A

Tapentadol (Nucynta)

Can be fatal if taken with EtOh

77
Q

What THREE medications are indicated for treatment of opioid addiction?

A

Methadone
Buprenorphine
Naltrexone

78
Q

Should you start chronic pain management with opioids are the highest of lowest doses?

A

Lowest doses

79
Q

Should benzodiazepines be used in treatment of chronic pain with opioids?

A

No, avoid these

80
Q

What medications are indicated for treatment of fibromyalgia?

A

Milincipran
Pregabalin
Duloxetine

81
Q

Is Milincipran approved to treat fibromyalgia in adults or children?

A

Adult

82
Q

What is cyclobenzaprine (Flexeril) indicated for?

A

In adjunction with rest or physical therapy for relief of muscle spasms associated with acute, painful musculoskeletal conditions

83
Q

Is Cyclobanzaprine (Flexeril) useful in treating spasticity associated with cerebral or spinal cord diseases?

A

No

84
Q

Should cyclobenzaprine (Flexeril) be used in patients with urinary retention or who are at risk for acute angle closure glaucoma?

A

No

85
Q

Should Carisoprodol (Soma) be used as monotherapy or in adjunct with rest and PT?

Does this medication have a known abuse potential?

A

Adjunct

Yes, High abuse potiental

86
Q

Should Metaxalone (Skelaxin) be used as monotherapy or in adjunct with rest and PT?

A

Adjunct

87
Q

What medications is indicated for treatment of muscle spams due to MS, spinal cord injuries, or trigeminal neuroaglia?

A

Baclofen

Chlorzoxazone

88
Q

Is the a potential for Baclofen to treat Opioid, Cocaine, or EtOH addiction?

A

Yes

89
Q

What medication was shown to improve pain and functionality in knee OA?

A

Glucosamine Sulfate

90
Q

When would intraspinal (Intrathecal or Epidural) pain medication delivery be indicated?

What medication is only indicated for intrathecal administration?

A

Severe chronic pain that has been inadequately controlled

Zinconotide

91
Q

What other pain medication can be given intrathecally?

A

Baclofen

There is also a pump, but one dose should be administered prior to determine patient’s response

92
Q

T/F: Capsaicin is indicated for post-herpetic neuralgia

A

True

93
Q

What method of pain medication administration uses ion currents to deliver charged drugs through the skin?

A

Iontophoresis

Pharmacology II - EXAM 2 (5 decks)

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