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Drug Indications/Contraindications Flashcards

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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
Efficacy btwn drugs in the same class (a) TCAs (b) SSRIs
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
26
Which antidepressant has proven efficacy in bulimia?
Fluoxetine (Prozac) | -SSRI
27
Which SSRI is the most sedating?
Paroxetine (Paxil) | -more sedating than both fluoxetine and sertraline
28
Which SSRI is indicated for OCD?
Can technically use them all, but fluvoxamine (Luvox) shown to be very efficacious in OCD
29
Contraindication of SSRIs
Co-administration of MAOIs (b/c of serotonin syndrome)
30
Indications for SSRIs
- MDD - PMDD (premenstrual dysphoric d/o) - PTSD - Bulimia (especially fluoxetine) - Panic d/o - Social phobia - OCD
31
Contraindications of SNRIs
Co-administration w/ MAOIs (serotonin syndrome)
32
Indications for SNRIs
- MDD - GAD (generalized anxiety d/o) - Panic d/o - Generalized social phobia
33
Compare and contrast indications of SSRIs and SNRIs
Both: -MDD, Panic d/o, Social phobia SSRI only: -PMDD, PTSD, Bulimia, OCD
34
Indications for MAOIs
-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
Contraindications of MAOIs
Other antidepressants: TCAs, SSRIs, other MAOIs, SNRIs => serotonin crisis -Ephedrine (bronchodilator in asthma drugs), albuterol => hypertensive crisis
36
Contraindications of Mirtazapine
Mirtazapine (Remeron) = NaSSA | Contraindication = co-administration w/ MAOIs
37
Contraindications of trazodone
Coadministration w/ MAOIs | trazodone = SARI
38
Contraindications of nefazodone
Coadministration w/ MAOIs | nefazodone = SARI
39
Contraindications of bupropion
(Bupropion = NDRI) Contraindications: - Coadministration w/ MAOIs - Anorexia and bulimia - Seizure d/o
40
Indications for mirtazapine
(Mirtazapine = NaSSA) Indication = MDD
41
Indications for trazodone
(Trazodone = SARI) Indications = MDD, dysthymia
42
Indications for nefazodone
(Nefazodone = SARI) Indications = MDD, dysthmia
43
Indications for bupropion
(bubropion = NDRI) Indications: - MDD - dysthymia - bipolar depression - ADHD - smoking cessation
44
Indications for vilazodone
MDD
45
Indications for Vortioxetine
MDD
46
Indications for Alprazolam
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
Indications for all benzos
- GAD - situational anxiety/phobias - panic d/o - epilepsy - muscle spasms - akathisia (agitation, restlessness) - alcohol withdrawal - agitation - anxiety associated w/ other psychiatric d/o
48
Contraindication for all benzos
Substance dependence
49
Which anxiolytic is contraindicated w/ asthma?
Propranolol | -b/c beta blocker => bronchoconstriction
50
Indication for propranolol in psychiatry
Beta blocker used for performance anxiety
51
Which anxiolytic is indicated for adjunctive use in MDD?
Buspirone = nonbenzo anxiolytic | -5HT1A agonist
52
Indications for buspirone
- GAD | - adjunctive use in MDD
53
Indications of hydroxyzine
Hydroxyzine = sedative antihistamine (nonbenzo anxiolytic) | -situational anxiety
54
Which anxiolytic is effective as a short-term sleep aid?
Temazepam = Restoril | -short half life (least potent of short t1/2) benzo
55
Which benzo is used for alcohol detoxification
Chlordiazepoxide (Librium)
56
Which long half-life benzo has a fast onset?
Diazepam (Valium) | -fast onset but w/ active metabolite
57
Indications of flumazenil
Flumazenil = Benzodiazepine antagonist | -used to counteract benzo OD
58
Name drugs indicated for insomnia
- Zolpidem (Ambien) - Zaleplon (Sonata): short acting => can dose in middle of the night - Eszopiclone (Lunesta): suggested to not yield tolerance - Diphenhydramine (Benadryl) - Ramelteon
59
Indications for lithium
- Bipolar I, especially euphoric mania - Bipolar II - Bipolar maintenance - Intermittent Explosive D/o - Adjunct to antidepressants
60
Contraindications for lithium
1- pregnancy (Ebstein's anomaly and abnormality of the great vessels) 2- Caution w: thiazide, diuretics, ACEi, NSAIDs which increase Li levels
61
Indications for carbamazepine
- Bipolar I, espeically mixed mania and rapid cycling - Bipolar II - epilepsy and neuralgias - alcohol withdrawal
62
Contraindications for carbamazepine
Pregnancy | Can cause craniofacial abnormalities (cleft lip and palate), neural tube defects, and learning d/o
63
Indications for valproic acid
- Bipolar I, especially mixed mania and rapid cycling - Bipolar II - Epilepsy and neuralgias - alcohol withdrawal
64
Contraindications for valproic acid
1- pregnancy: can cause neural tube defects (to a greater degree than carbamazepine) 2- child bearing aged women- can cause polycystic ovaries
65
Indications for lamotrigine
- bipolar maintenance - bipolar depression - epilepsy and neuralgia
66
Contraindications for lamotrigine
-caution when administered w/ valproic acid (due to boosted blood levels)
67
Contraindication for gabapentin
-caution in renal disease (b/c excreted renally)
68
Indications for gabapentin
- bipolar I, adjunctive tx - epilepsy and neuralgias - ineffective as monotherapy for mania - also off-label use in GAD and social anxiety
69
Indications for CNS stimulants
- ADD | - narcolepsy
70
Contraindications for CNS stimulants
- coadministration w/ MAOIs | - narrow angle glaucoma
71
Indications for Atomoxetine
Atomoxetine (Strattera) | Indication = ADD
72
Contraindications for atomoxetine
- coadministration w/ MAOIs | - narrow angle glaucoma
73
Indications for modafinil
Modafinil = novel CNS stimulant (not adrenergic, mechanism of action unclear) - narcolepsy - ADD - primary and secondary hypersomnia

Psychopharm (10 decks)

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