Indications / First-Line / Contraindications Flashcards
(104 cards)
1
Q
What medication is indicated for prophylaxis and treatment of acute gout flares?
A
Colchicine
2
Q
Other than gout, what is another indication for Colchicine use?
A
Familial Mediterranean Fever
3
Q
Colchicine is used off window to treat what cardiac condition?
A
Recurrent Pericarditis
4
Q
What is Allopurinol indicated for?
A
- Primary and Secondary Gout Treatment (Chronically)
- Tumor Lysis Syndrome Prevention
- Hyperuricemia with recurrent calcium oxalate stones
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
6
Q
What medication is indicated for hyperuricemia treatment associated with gout?
A
Probenecid (Benemid)
7
Q
What is the NEWEST gout medication?
Is this indicated for acute or chronic gout?
A
Febuxostat
Chronic Gout
8
Q
What medication is indicated for chronic refractory gout?
A
Pegloticase
9
Q
What medication is indicated specifically for hyperuricemia due to tumor lysis syndrome?
A
Rasburicase
10
Q
Lesinurad is indicated for adjunct use with ______ to reach target uric acid levels
A
XOIs
11
Q
What is first-line for urate limiting treatment in gout?
A
Allopurinol or Febuxostat
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
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
14
Q
Which DMARD is first line for RA?
What are two additional indications for methotrexate use?
A
Methotrexate
Psoriasis
Cancers
15
Q
Should Methotrexate be used in pregnancy?
A
No, it has teratogenic effects
16
Q
How long should men wait after discontinuation until trying to get pregnant?
A
3 months
17
Q
Should a previous alcoholic with liver damage who developed RA be started on Methotrexate?
A
No
18
Q
Which DMARD is indicated to reduce symptoms and inhibit structural damage of joint with XR evidence of joint space narrowing?
A
Leflunomide
19
Q
Can Leflunomide be used in pregnancy?
A
No
NEED a baseline pregnancy test
20
Q
Other than malarial treatment and prophylaxis…..
What is Hydroxychloroquine indicated for?
A
RA
SLE
21
Q
Should Hydroxychloroquine be used long term in children?
A
No
22
Q
What eye changes would contraindicated Hydroxychloroquine use?
A
Retinal Changes
Visual Field Changes
23
Q
Which DMARD is indicated for UC?
A
Sulfasalazine
24
Q
Other than UC…..
What is Sulfasalazine used for?
A
RA
Juvenile RA
Ankylosing Spondylitis
Psoriatic Arthritis
25
Which tetracycline is used in RA treatment?
Does this have a fast or slow onset?
Minocycline
S-L-O-O-O-O-W Onset (2-3 months to start working)
26
Should Minocycline be used in pregnancy?
No, it should be avoided in the 2nd-3rd trimesters due to risk for permanently stained teeth
27
When would Anti-TNFs be indicated to treat RA?
Inadequate response to DMARDs
28
Can Anti-TNFs be used in combination with DMARDs?
Yes
29
What inflammatory conditions are Anti-TNFs indicated for?
```
RA
Psoriatic Arthritis
Juvenile Arthritis
Chron's
Anklosing Spondylitis
Psoriasis
```
30
Are non-TNFs (like Abatacept) first or second-line for RA
Second Line
31
Can non-TNFs be used with other biologics?
No, worsen infections and flare COPD
32
Is Rituximab first or second-line for RA treatment?
Second-Line
33
What is Rituximab indicated for?
Non-Hodgkins Lymphoma
Chronic Lymphocytic Leukemia
Wegner's Granulomatosis
Miscorscopic Polyangitis
34
What is Ustekinumab indicated for?
Psoriasis
| Psoriatic Arthrits
35
In patients older than 65, should vitamin D and calcium supplementation be monotherapy or adjuvant?
Adjuvant therapy in patients 65 and older
36
Which bisphosphonates are indicated for treatment AND prevention of osteoporosis?
Alendronate (Fosamax)
Risedronate
Ibandronate
Zoledronic Acid
37
Which bisphosphonate is ONLY indicated for treatment of osteoporosis?
Can this be used in men?
Calcitonin
Not used in men
38
Which bisphosphonate is also indicated for use in Paget's Disease?
Alendronate (Fosamax)
39
Which Bisphosphonate is also indicated for...
Hypercalcemia due to malignancy
Multiple Myeloma with metastasis to the bones
Zoledronic Acid (Zometa)
40
Can estrogen + medroxyprogesterone reduce the risk of fracture in osteoporosis?
Is this a first line management option?
Yes
This is NOT a first line management option
41
What is Raloxifene indicated for in osteoporosis?
Decrease incidence of vertebral fractures
42
What medication is indicated for.......
Reduce fracture risk in post-menopausal females with osteoporosis
Reduced fracture risk in males with primary and hypogonadal osteoporosis?
Teriparatide (Forteo)
43
Should patients with a history of radiation, bone mets, or skeletal malignancies be given N 1-43 PTH (Teriparatide)?
No, increased risk of osteosarcoma
44
What is Denosumab indicated for?
Treatment of post-menopausal women with osteoporosis and an increased fracture risk
45
What additional indications does Denosumab carry?
Unresectable Giant Cell Tumors of the Bone
Increase bone mass in non-metastatic prostate cancer
46
Should Denosumab be used in pregnancy?
No, it is associated with fetal loss and deformity
47
When would Calcitonin be used?
Women, >5 post-menopausal who are unable to take estrogen
48
What are the FOUR first-line medications for osteoporos?
Aldenronate
Risedronate
Zoledronic Acid
Denosumab
49
Ibandronate is _________ (first/second) line for osteoporos
Second line
50
T/F: Raloxifene is a third line osteoporosis
True
| But it is considered second-line in some circles
51
What is LAST LINE for osteoporosis treatment?
Calcitonin
52
Should osteoporosis medications be used in combination?
Guidelines say no
53
How long should patients take a bisphosphonate?
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
Stimulants for ADHD are contraindicated for use with what class of medications?
MAOIs
55
What is considered first line for ADHD mangement in pediatrics?
Second-line?
Third-Line?
First: Behavioral Therapy +/- Stimulants
Second: Atomoxetine
Third: Alpha-Agonists, Antidepressants
56
What is considered first line for ADHD management in pre-school age children?
Behavioral Therapy
57
What is first line management for ADHD in adult?
Second-Line?
First: Stimulants
Second: Antidepressants
58
Which class of medications is first line for short-term (4 weeks) treatment of insomnia?
BDZ Receptor Agonists
Zolipidem (Ambien)
Eszopiclone (Lunesta)
Zaleplon (Sonata)
59
Zolpidem (Ambien) is used for sleep ______ and _________
Sleep onset and maintenance
60
Eszopliclone (Lunesta) is used to manage sleep _______
Latency
61
Zaleplon can be taken if you wake up in the middle of the night and you still have __ hours left to sleep
4 hours
62
Melatonin Supplementation is a good treatment for what condition associated with travelling?
Jet Lag
63
What is Ramelteon (Rozerem) indicated for?
Should this be taken with food?
Sleep Latency
No, take this on an empty stomach
64
What is FIRST-LINE treatment for non-24 sleep-wake disorder?
Tasimelteon (Hetlioz)
65
Should this be used in pregnancy?
No
66
What is a contraindication for Suvorexant use?
Narcolepsy
67
Doxepin (Silenor) is an antidepressant indicated for insomnia.....
With what TWO conditions is this contraindicated in?
Can this be used with MAOIs?
Urinary Retention
Glaucoma
No, this should be avoided with MAOIs
68
Is melatonin currently indicated by the American Academy of Sleep Medicine for insomnia use?
No
69
What is considered FIRST-Line for chronic insomnia treatment?
Behavioral Therapy
+
Eszopiclone, zolpidem, suvorexant
70
What are indications for Fluoxetine (Prozac)?
MDD
OCD
PD
Bulimia
71
What are indications for Paroxetine (Paxil) use?
MDD
OCD
SAD
GAD
72
What are indications for Sertaline (Zoloft) use?
```
MDD
OCD
PD
PTSD
PMDD
SAD
```
73
Sertraline (Zoloft) has the most benefit in patients with depression and _________ disease
Cardiovascular Disease
74
What are indications for Escitalopram (Lexapro) use?
MDD
| GAD
75
What is the indication for Citalopram (Celexa) use?
Depression
76
Is Vortioxetine indicated for generalized anxiety disorder?
No, it is indicated for major depressive disorder
77
Other than depresive disorders.....
What is Venlafaxine (Effexor) Indicated for?
PTSD
Neuropathic Pain
Hot Flashes
78
What are Desvenlafaxine (Pristiq), Levomilnacipran (Fetzima), and Mirtazapine (remeron) indicated for?
Major Depressive Disorder
79
T/F: Duloxetine (Cymbalta) is NOT indicated for Fibromyalgia
False
It is indicated for that condition
80
Other than major depressive disorder.....
What is an indication for bupropion (Wellbutrin) use?
Smoking Cessation
81
What are general indications for TCA uses?
```
Depression
Anxiety
Bipolar disorder
OCD
Neuropathic pain
Migraine prophylaxis
```
82
What are trazodone and vilazodone indicated for?
Depression
83
When would MAOIs be indicated for use in depression?
Last Line
Reserved for patients who have failed other anti-depressants
84
Should MAOIs be used in combination with Bupropion?
No, this is contraindicated
85
Can MAOIs be used to treat depression in patients with HTN?
No, this is contraindicated
86
Can MAOIs be used in combination with one another to treat depression?
No, this is contraindicated
87
What FOUR medications/classes are considered FIRST LINE for depression treatment?
SSRIs
SNRIs
Bupropion
Mirtazapine (Remeron)
88
Withdrawal from what medications can result in anxiety?
Benzodiazepines
89
T/F: Albuterol can result in anxiety
True
90
What medications are considered FIRST LINE for Generalized Anxiety Disorder?
Second?
Third?
First: Venlafaxine, duloxetine, paroxetine, escitalopram
Second: Buspirone (Buspar)
Third: BZDs
91
What medications are considered FIRST LINE for OCD treatment?
SSRIs:
```
Fluvoxamine (Luvox)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)
Sertraline (Zoloft)
Vortioxetine (Brintellix)
```
92
What medications are considered FIRST line of SAD?
SSRIs or Venlafexine (Effexor)
93
What medications are considered FIRST LINE for PTSD
Fluoxetine (Luvox)
Seertraline (Zoloft)
Venlafaxine (Effexor)
94
What are general indications for anti-pyschotic use?
```
Schizophrenia
Bipolar disorder
Acute psychosis (mania)
Major depression with psychotic features
Severe behavioral problems
Tourette syndrome (Haloperidol)
```
95
Valbenazine is the first drug to treat what?
Tardive Dyskniesia
96
T/F: Clozapine is also used in smoking cessation
True
97
After starting anti-psychotics, what should you see in the first 7 days?
2-3 weeks?
7 Days: Decrease in symptoms, normal sleeping/eating patterns
2 -3 Weeks: Return to socialization, self-care (REACH AND MAINTAIN TARGET DOSE)
98
What is Iloperidone (Fanapt) indicated for?
Schizophrenia in adult
99
What is Paliperidone indicated for?
Schizophrenia
| Schizoaffective Disorder
100
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?
Asenapine (Saphris)
Adjuvant with Lithium or Valproate
101
Brexpiprazole is indicated for treatment of what as monotherapy?
Schizophrenia
102
What is Lithium considered FIRST LINE for?
1. Manic Episodes in Bipolar Disorder
| 2. Maintenance treatment for Bipolar Disorder
103
What would contraindicate Lithium use?
```
Renal Disease (Dehydration, Sodium Depletion, Diuretics)
Cardiovascular History
```
104
Should Lithium be used in pregnacy?
No, it is teratogenic
