Indications / First-Line / Contraindications Flashcards by Zachary Schulz

What is indicated for mild to moderate HA treatment?

Acetaminophen

NSAIDs

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

Triptans

Erogotamines

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

Aura

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What are contraindications to Triptan use?

Basilar Migraine
Ischemic Events
Unctonrlled HTN
Liver Disease

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What are TWO indications for DHE use?

Acute migraine with or without aura

Cluster Headaches

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

True

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

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Are ergotamines safe in pregnancy or breast feeding?

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What is considered second line for headache treatment?

Butorhpanol

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What is considered third line for headache treatment?

Fiorinal (Butalbital, aspirin, caffeine)

Fioricet (Butalbital, acetaminophen, caffeine)

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

Tension-type headache

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

NSAIDs
Triptans
Opiates
Nasal DHE

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

What medications can be given?

IV DHE + Metoclopramide
IV/IM Lorazepam (Ativan)
IV Divalproex
IM Ketorolac
Steroids

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

IV Metoclopramide

SubQ Sumatriptan

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

What should be avoided?

IV APAP, ASA, Diclofenac, or Ketorolac

Avoid:

Diphenhydramie
Hydromorphone
Lidocaine
Morphine
Octreotide

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What can be used to treat migraines in pediatric patients?

NSAIDs
Sumatriptan (Nasal, SubQ)
Oral Zolmitriptan or Rizatriptan

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What medications are considered for migraine prophylaxis?

Divalproex Sodium
Topiramate
Propanolol, Metoprolol, Timolol (Oral)

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What medication is used for prophylaxis of menstrual migraines?

Frovatriptan

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

How is this dosed?

Butterbur

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

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

Interferon Beta
Dimethyl Fumarate
Glatiramer Acetate

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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

Mitoxantrone

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What is first line for acute MS attacks?

Glucocorticoids

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

Interferon beta
Natalizumab
Mitroxantrone

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Is Glatiramer Acetate an immunomodulator or immunosuppressant?

Immunomodulator

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Is Mitoxantrone an immunomodulator or immunosuppressant?

Immunosuppressant

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?

Natalizumab Used in combo with Interferon Beta this is also used to treat Crohn's disease

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

Fingolimod

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

Teriflunomide

What medication is indicated to improve walking in MS patients? In what conditions is this contraindicated?

Dalfampridine Contraindications: Renal Impairment Seizures

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

Dantrolene

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

Nuedexta (Dextromethorphan/Quinidine)

What is considered first line in Parkinson's treatment?

Levodopa + Carbidopa

What are contraindications to Levodopa use?

MAOIs Malignant Melanoma Narrow Angle Glaucoma

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

Dopamine Receptor Agonists | In lower doses of carbidopa and levodopa

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

Pramipexole | Ropinirole

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

Apomorphine

Which ABx is also a MAOI?

Linezolid

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

Rasagiline

T/F: COMT Inhibitors are monotherapy

False they are used in adjunct with Levodopa

Should COMT inhibitors be used with MAOIs

Not really but can be OK with MAOI-Bs

What medications compose Stalevo?

Levodopa Carbidopa Entacapone

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

Anticholinergics Trihexyphenidyl Benztropine

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

Pimavanserin

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

Safinamide

What liver condition would contraindicate giving a PD patient Safinamide?

Cirrhosis

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

Cholinesterase Inhibitors Donepezil Rivastigmine Galantamine

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

Memantidine

What antidepressants can be used to treat ALZ?

Citalopram Escitalopram Trazodone

What is indicated for Myasethnia Gravis Treatment?

``` Pyridostigmine Neostigmine (Faster Acting) ```

What are contraindications to Pyridostigmine use?

Urinary/Bowel Obstruction | Asthma/COPD

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

Riluzole Edaravone

What medication is indicated to treat Chorea? What are TWO contraindications to this medication?

Tetrabenazine Contraindications: Liver Disease MAOIs

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

Ibuprofen/Acetaminophen

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

Opiates

What are THREE indications for acetaminophen?

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

What medications is considered the antidote for acetaminophen OD?

N-Acetylcysteine

Which pain reliever should be recommended to marathon runners? Why?

Acetaminophen Because it is not renally eliminated

What are THREE uses for NSAIDs?

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

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

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

What is the maximum dose of ASA?

4 grams per day

How is ASA overdose treated?

Sodium Bicarbonate

Which NSAID is first line for gout flares?

Indomethacin

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

PDA Closure | Premature Labor

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

Meloxicam Piroxicam Celecoxib

Which NSAID is indicated for prevention of familial adenomatous polyposis

Celecoxib

What are uses for short-acting opioids?

Acute Pain Incident Pain Breakthrough Pain Physical Therapy

What are uses for long acting pain?

Chronic Pain | Moderate-to-severe Pain

What is the most commonly used opioid?

Hydrocodone (Norco)

Which opioid is often used in a transdermal patch? When does this reach a steady state?

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

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

MAOIs because of increased risk for respiratory depression

Can Propoxyphene be used in the elderly?

No, it should be avoided

What medication is used for immediate opioid reversible?

Naloxone (Narcan)

What medication is indicated for opioid and EtOH addiction? Can this be given to patients currently on opioids?

Naltrexone (Vivitrol) No

What medication is as effective as morphine for labor pain?

Tramadol

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

SSRIs TCAs Opioid MAOIs

What opioid is specifically approved for diabetic neuropathy? Why should this be avoided with EtOH?

Tapentadol (Nucynta) Can be fatal if taken with EtOh

What THREE medications are indicated for treatment of opioid addiction?

Methadone Buprenorphine Naltrexone

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

Lowest doses

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

No, avoid these

What medications are indicated for treatment of fibromyalgia?

Milincipran Pregabalin Duloxetine

Is Milincipran approved to treat fibromyalgia in adults or children?

Adult

What is cyclobenzaprine (Flexeril) indicated for?

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

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

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

Should Carisoprodol (Soma) be used as monotherapy or in adjunct with rest and PT? Does this medication have a known abuse potential?

Adjunct Yes, High abuse potiental

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

Adjunct

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

Baclofen | Chlorzoxazone

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

Yes

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

Glucosamine Sulfate

When would intraspinal (Intrathecal or Epidural) pain medication delivery be indicated? What medication is only indicated for intrathecal administration?

Severe chronic pain that has been inadequately controlled Zinconotide

What other pain medication can be given intrathecally?

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

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

True

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

Iontophoresis

Indications / First-Line / Contraindications Flashcards

(93 cards)