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Pharmacology II - EXAM 3 > Indications / First-Line / Contraindications > Flashcards

Indications / First-Line / Contraindications Flashcards

1
Q

What medication is indicated for prophylaxis and treatment of acute gout flares?

A

Colchicine

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2
Q

Other than gout, what is another indication for Colchicine use?

A

Familial Mediterranean Fever

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3
Q

Colchicine is used off window to treat what cardiac condition?

A

Recurrent Pericarditis

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4
Q

What is Allopurinol indicated for?

A
  1. Primary and Secondary Gout Treatment (Chronically)
  2. Tumor Lysis Syndrome Prevention
  3. Hyperuricemia with recurrent calcium oxalate stones
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5
Q

What is the starting dose for allopurinol?

How can this be tapered?

A

100 mg PO once daily

“Start low and go slow”

Increase by 100 mg daily every WEEK until uric acid levels are <6 mg/dL

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6
Q

What medication is indicated for hyperuricemia treatment associated with gout?

A

Probenecid (Benemid)

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7
Q

What is the NEWEST gout medication?

Is this indicated for acute or chronic gout?

A

Febuxostat

Chronic Gout

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8
Q

What medication is indicated for chronic refractory gout?

A

Pegloticase

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9
Q

What medication is indicated specifically for hyperuricemia due to tumor lysis syndrome?

A

Rasburicase

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10
Q

Lesinurad is indicated for adjunct use with ______ to reach target uric acid levels

A

XOIs

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11
Q

What is first-line for urate limiting treatment in gout?

A

Allopurinol or Febuxostat

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12
Q

What gene should you screen patients for prior to starting allopurinol?

A

HLA-B*5801

Especially in Koreans with Stage 3 CKD, Han Chinese, or of Thai Descent

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13
Q

Other than rheumatic flares…..

What are systemic corticosteroids indicated for?

A

Short Term for inadequately controlled asthma

Long term prevention of severe persistent asthma

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14
Q

Which DMARD is first line for RA?

What are two additional indications for methotrexate use?

A

Methotrexate

Psoriasis
Cancers

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15
Q

Should Methotrexate be used in pregnancy?

A

No, it has teratogenic effects

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16
Q

How long should men wait after discontinuation until trying to get pregnant?

A

3 months

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17
Q

Should a previous alcoholic with liver damage who developed RA be started on Methotrexate?

A

No

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18
Q

Which DMARD is indicated to reduce symptoms and inhibit structural damage of joint with XR evidence of joint space narrowing?

A

Leflunomide

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19
Q

Can Leflunomide be used in pregnancy?

A

No

NEED a baseline pregnancy test

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20
Q

Other than malarial treatment and prophylaxis…..

What is Hydroxychloroquine indicated for?

A

RA

SLE

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21
Q

Should Hydroxychloroquine be used long term in children?

A

No

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22
Q

What eye changes would contraindicated Hydroxychloroquine use?

A

Retinal Changes

Visual Field Changes

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23
Q

Which DMARD is indicated for UC?

A

Sulfasalazine

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24
Q

Other than UC…..

What is Sulfasalazine used for?

A

RA
Juvenile RA
Ankylosing Spondylitis
Psoriatic Arthritis

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25
Q

Which tetracycline is used in RA treatment?

Does this have a fast or slow onset?

A

Minocycline

S-L-O-O-O-O-W Onset (2-3 months to start working)

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26
Q

Should Minocycline be used in pregnancy?

A

No, it should be avoided in the 2nd-3rd trimesters due to risk for permanently stained teeth

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27
Q

When would Anti-TNFs be indicated to treat RA?

A

Inadequate response to DMARDs

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28
Q

Can Anti-TNFs be used in combination with DMARDs?

A

Yes

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29
Q

What inflammatory conditions are Anti-TNFs indicated for?

A 
RA
Psoriatic Arthritis
Juvenile Arthritis
Chron's
Anklosing Spondylitis
Psoriasis
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30
Q

Are non-TNFs (like Abatacept) first or second-line for RA

A

Second Line

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31
Q

Can non-TNFs be used with other biologics?

A

No, worsen infections and flare COPD

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32
Q

Is Rituximab first or second-line for RA treatment?

A

Second-Line

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33
Q

What is Rituximab indicated for?

A

Non-Hodgkins Lymphoma
Chronic Lymphocytic Leukemia
Wegner’s Granulomatosis
Miscorscopic Polyangitis

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34
Q

What is Ustekinumab indicated for?

A

Psoriasis

Psoriatic Arthrits

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35
Q

In patients older than 65, should vitamin D and calcium supplementation be monotherapy or adjuvant?

A

Adjuvant therapy in patients 65 and older

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36
Q

Which bisphosphonates are indicated for treatment AND prevention of osteoporosis?

A

Alendronate (Fosamax)
Risedronate
Ibandronate
Zoledronic Acid

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37
Q

Which bisphosphonate is ONLY indicated for treatment of osteoporosis?

Can this be used in men?

A

Calcitonin

Not used in men

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38
Q

Which bisphosphonate is also indicated for use in Paget’s Disease?

A

Alendronate (Fosamax)

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39
Q

Which Bisphosphonate is also indicated for…

Hypercalcemia due to malignancy
Multiple Myeloma with metastasis to the bones

A

Zoledronic Acid (Zometa)

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40
Q

Can estrogen + medroxyprogesterone reduce the risk of fracture in osteoporosis?

Is this a first line management option?

A

Yes

This is NOT a first line management option

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41
Q

What is Raloxifene indicated for in osteoporosis?

A

Decrease incidence of vertebral fractures

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42
Q

What medication is indicated for…….

Reduce fracture risk in post-menopausal females with osteoporosis

Reduced fracture risk in males with primary and hypogonadal osteoporosis?

A

Teriparatide (Forteo)

43
Q

Should patients with a history of radiation, bone mets, or skeletal malignancies be given N 1-43 PTH (Teriparatide)?

A

No, increased risk of osteosarcoma

44
Q

What is Denosumab indicated for?

A

Treatment of post-menopausal women with osteoporosis and an increased fracture risk

45
Q

What additional indications does Denosumab carry?

A

Unresectable Giant Cell Tumors of the Bone

Increase bone mass in non-metastatic prostate cancer

46
Q

Should Denosumab be used in pregnancy?

A

No, it is associated with fetal loss and deformity

47
Q

When would Calcitonin be used?

A

Women, >5 post-menopausal who are unable to take estrogen

48
Q

What are the FOUR first-line medications for osteoporos?

A

Aldenronate
Risedronate
Zoledronic Acid
Denosumab

49
Q

Ibandronate is _________ (first/second) line for osteoporos

A

Second line

50
Q

T/F: Raloxifene is a third line osteoporosis

A

True

But it is considered second-line in some circles

51
Q

What is LAST LINE for osteoporosis treatment?

A

Calcitonin

52
Q

Should osteoporosis medications be used in combination?

A

Guidelines say no

53
Q

How long should patients take a bisphosphonate?

A

for 5 years….

then you can take the patient off the medication (as a break) and monitor DEXA and bone density…..can restart if needed

54
Q

Stimulants for ADHD are contraindicated for use with what class of medications?

55
Q

What is considered first line for ADHD mangement in pediatrics?

Second-line?

Third-Line?

A

First: Behavioral Therapy +/- Stimulants

Second: Atomoxetine

Third: Alpha-Agonists, Antidepressants

56
Q

What is considered first line for ADHD management in pre-school age children?

A

Behavioral Therapy

57
Q

What is first line management for ADHD in adult?

Second-Line?

A

First: Stimulants

Second: Antidepressants

58
Q

Which class of medications is first line for short-term (4 weeks) treatment of insomnia?

A

BDZ Receptor Agonists

Zolipidem (Ambien)
Eszopiclone (Lunesta)
Zaleplon (Sonata)

59
Q

Zolpidem (Ambien) is used for sleep ______ and _________

A

Sleep onset and maintenance

60
Q

Eszopliclone (Lunesta) is used to manage sleep _______

61
Q

Zaleplon can be taken if you wake up in the middle of the night and you still have __ hours left to sleep

62
Q

Melatonin Supplementation is a good treatment for what condition associated with travelling?

63
Q

What is Ramelteon (Rozerem) indicated for?

Should this be taken with food?

A

Sleep Latency

No, take this on an empty stomach

64
Q

What is FIRST-LINE treatment for non-24 sleep-wake disorder?

A

Tasimelteon (Hetlioz)

65
Q

Should this be used in pregnancy?

66
Q

What is a contraindication for Suvorexant use?

A

Narcolepsy

67
Q

Doxepin (Silenor) is an antidepressant indicated for insomnia…..

With what TWO conditions is this contraindicated in?

Can this be used with MAOIs?

A

Urinary Retention
Glaucoma

No, this should be avoided with MAOIs

68
Q

Is melatonin currently indicated by the American Academy of Sleep Medicine for insomnia use?

69
Q

What is considered FIRST-Line for chronic insomnia treatment?

A

Behavioral Therapy

+

Eszopiclone, zolpidem, suvorexant

70
Q

What are indications for Fluoxetine (Prozac)?

A

MDD
OCD
PD
Bulimia

71
Q

What are indications for Paroxetine (Paxil) use?

A

MDD
OCD
SAD
GAD

72
Q

What are indications for Sertaline (Zoloft) use?

A 
MDD
OCD
PD
PTSD
PMDD
SAD
73
Q

Sertraline (Zoloft) has the most benefit in patients with depression and _________ disease

A

Cardiovascular Disease

74
Q

What are indications for Escitalopram (Lexapro) use?

75
Q

What is the indication for Citalopram (Celexa) use?

A

Depression

76
Q

Is Vortioxetine indicated for generalized anxiety disorder?

A

No, it is indicated for major depressive disorder

77
Q

Other than depresive disorders…..

What is Venlafaxine (Effexor) Indicated for?

A

PTSD
Neuropathic Pain
Hot Flashes

78
Q

What are Desvenlafaxine (Pristiq), Levomilnacipran (Fetzima), and Mirtazapine (remeron) indicated for?

A

Major Depressive Disorder

79
Q

T/F: Duloxetine (Cymbalta) is NOT indicated for Fibromyalgia

A

False

It is indicated for that condition

80
Q

Other than major depressive disorder…..

What is an indication for bupropion (Wellbutrin) use?

A

Smoking Cessation

81
Q

What are general indications for TCA uses?

A 
Depression
Anxiety 
Bipolar disorder
OCD
Neuropathic pain
Migraine prophylaxis
82
Q

What are trazodone and vilazodone indicated for?

A

Depression

83
Q

When would MAOIs be indicated for use in depression?

A

Last Line

Reserved for patients who have failed other anti-depressants

84
Q

Should MAOIs be used in combination with Bupropion?

A

No, this is contraindicated

85
Q

Can MAOIs be used to treat depression in patients with HTN?

A

No, this is contraindicated

86
Q

Can MAOIs be used in combination with one another to treat depression?

A

No, this is contraindicated

87
Q

What FOUR medications/classes are considered FIRST LINE for depression treatment?

A

SSRIs
SNRIs
Bupropion
Mirtazapine (Remeron)

88
Q

Withdrawal from what medications can result in anxiety?

A

Benzodiazepines

89
Q

T/F: Albuterol can result in anxiety

90
Q

What medications are considered FIRST LINE for Generalized Anxiety Disorder?

Second?

Third?

A

First: Venlafaxine, duloxetine, paroxetine, escitalopram

Second: Buspirone (Buspar)

Third: BZDs

91
Q

What medications are considered FIRST LINE for OCD treatment?

A

SSRIs:

Fluvoxamine (Luvox)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)
Sertraline (Zoloft)
Vortioxetine (Brintellix)
92
Q

What medications are considered FIRST line of SAD?

A

SSRIs or Venlafexine (Effexor)

93
Q

What medications are considered FIRST LINE for PTSD

A

Fluoxetine (Luvox)
Seertraline (Zoloft)
Venlafaxine (Effexor)

94
Q

What are general indications for anti-pyschotic use?

A 
Schizophrenia
Bipolar disorder
Acute psychosis (mania)
Major depression with psychotic features
Severe behavioral problems
Tourette syndrome (Haloperidol)
95
Q

Valbenazine is the first drug to treat what?

A

Tardive Dyskniesia

96
Q

T/F: Clozapine is also used in smoking cessation

97
Q

After starting anti-psychotics, what should you see in the first 7 days?

2-3 weeks?

A

7 Days: Decrease in symptoms, normal sleeping/eating patterns

2 -3 Weeks: Return to socialization, self-care (REACH AND MAINTAIN TARGET DOSE)

98
Q

What is Iloperidone (Fanapt) indicated for?

A

Schizophrenia in adult

99
Q

What is Paliperidone indicated for?

A

Schizophrenia

Schizoaffective Disorder

100
Q

Which medication is indicated for acute treatment of manic or mixed episodes associated with bipolar I disorder in adults ?

This can be used as monotherapy or adjuvant with what TWO medications?

A

Asenapine (Saphris)

Adjuvant with Lithium or Valproate

101
Q

Brexpiprazole is indicated for treatment of what as monotherapy?

A

Schizophrenia

102
Q

What is Lithium considered FIRST LINE for?

A
  1. Manic Episodes in Bipolar Disorder

2. Maintenance treatment for Bipolar Disorder

103
Q

What would contraindicate Lithium use?

A 
Renal Disease (Dehydration, Sodium Depletion, Diuretics) 
Cardiovascular History
104
Q

Should Lithium be used in pregnacy?

A

No, it is teratogenic

Pharmacology II - EXAM 3 (5 decks)

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