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NPS Modules > Core drug list for MD > Flashcards

Core drug list for MD Flashcards

1
Q

Indications for Midazolam

A

Conscious sedation
Induction of anaesthesia
sedation during ventilation
Premedication

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2
Q

Mode of action of Midazolam

A

Potentiates the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, anterograde amnesic muscle relaxant and antiepileptic effects.

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3
Q

Common (>1%) adverse effects of midazolam

A

Hypotension
hiccup
cough

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4
Q

Mode of action of local anaesthetics

A

Reversibly interrupt impulse conduction in peripheral nerves and stabilise excitable cell membranes by blocking sodium channels, thus inhibiting depolarisation.

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5
Q

Main actions of aspirin (4)

A

Analgesic, antipyretic, anti-inflammatory and antiplatelet actions.

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6
Q

Mode of action of aspirin

A

Non selective NSAID.
Prevents synthesis of prostaglandins by non-competitively inhibiting both forms of cyclo-oxygenase (COX), COX-1 and COX-2

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7
Q

Indications of codeine

A

mild-to-moderate pain
cough suppression
diarrhoea

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8
Q

What are the four main actions of opioid analgesics?

A

Analgesia
Respiratory depression
Sedation
Constipation

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9
Q

How do opioid analgesics reduce transmission of the pain impulse

A

act pre- and post-synaptically in the spinal cord, and modulate the descending inhibitory pathways from the brain.

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10
Q

In which part of the brain do opioid analgesics act to cause cough suppression?

A

Medulla

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11
Q

What are the indications for Morphine?

A

Moderate-to-severe pain

Opioid adjunct during general anaesthesia

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12
Q

For which respiratory conditions may it be acceptable to use morphine?

A

Acute pulmonary oedema (adjunct)

Relief of severe dyspnoea

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13
Q

What are the withdrawal symptoms of opioid analgesics?

A 
Nausea
vomiting
diarrhoea
sweating 
anxiety
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14
Q

What is the mode of action of Tramadol?

A

Binds to the mu opioid receptors and also inhibits reuptake of noradrenaline and serotonin.

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15
Q

Why should Pethidine be avoided?

A

Serotonergic properties
Neurotoxic metabolite (norpethidine)
Association with drug-seeking behaviour

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16
Q

What are the clinical features of serotonin syndrome?

A

Cognitive: Confusion, agitation, hypomania, hyperactivity, restlessness
Autonomic: hyperthermia, sweating, tachycardia, hypertension, mydriasis, flushing, shivering
Neuromuscular: Clonus, hyperreflexia, hypertonia, ataxia, tremor

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17
Q

Which opioid analgesics are implicated in severe serotonin syndrome?

A

Tramadol and pethidine.

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18
Q

To which class of antibiotics does gentamicin belong?

A

Aminoglycosides

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19
Q

What is the mode of action of aminoglycosides?

A

Inhibit protein synthesis by irreversibly binding to the 30S ribosomal subunit causing cell membrane damage.

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20
Q

Are aminoglycosides bacteriostatic or bactericidal?

A

Bactericidal.

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21
Q

What are the indications for Gentamicin?

A

Empirical treatment for

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22
Q

What are the common (>1%) adverse effects of gentamicin?

A

Ototoxicity

Nephrotoxicity

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23
Q

What is the mode of action of cephalosporins?

A

Interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins.

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24
Q

Are cephalosporins bactericidal or bacterostatic?

A

Bactericidal

25
Q

Are cephalosporins often the drug of first choice?

A

no.

26
Q

What are the names of four macrolides?

A

Azithromycin
Clarithromycin
erythromycin
roxithromycin

27
Q

What is the mechanism of Macrolide antibiotics?

A

Bind reversibly to the 50S subunit of bacterial ribosimes. Prevent protein synthesis.

28
Q

What is the mechanism of action of the Penicillins?

A

Interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins, eventually leading to cell lysis and death.

29
Q

Are the penicillins bactericidal or static?

A

Bactericidal.

30
Q

What are the indications for amoxycillin?

A

Exacerbation of chronic bronchitis, community-acquired pneumonia
Acute bacterial otitis media, sinusitis
Gonococcal infection
Acute cholecystitis, peritonitis,eradication of H. pylori.

31
Q

What is the function of clavulanic acid?

A

Inhibits beta-lactamase, which extends spectrum of activity of amoxycillin.

32
Q

What are the indications for Flucloxacillin?

A 
Staphylococcal skin infections 
Pneumonia
Septicaemia
Osteromyelitis
Surgical prophylaxis
Empirical Treatment for endocarditis

(AMH 2021)

33
Q

What is the spectrum of amoxycillin with clavulanic acid?

A

Broad.

Does not cover:

  • MRSA
  • coag neg staph
  • pseudomonas
  • beta-lactamase producing organisms (ESCHAPPM)
  • atypicals
34
Q

What is the spectrum of activity of Flucloxacillin?

A

Narrow.

Skin bugs

Staph Aureus, Streptococcus. Some Coag negative staph.

Notably not enterococcus

35
Q

What is the mode of action of the quinolones

A

Inhibit bacterial DNA synthesis by blocking DNA gyrase and topoisomerase IV.

36
Q

What are the indications for use of the quinolones?

A

Reserved for proven or suspected infections where alternative agents are ineffective or contraindicated, e.g. complicated UTIs, bone or joint infections, epididymo-orchitis, prostatitis.

37
Q

What is an example of a quinolone?

A

Ciprofloxacin
Moxifloxacin
levofloxacin

38
Q

What is the mechanism of action of the Tetracyclines?

A

Inhibit bacterial protein synthesis by reversibly binding to 30S subunit of the ribosome.

39
Q

Why are tetracyclines contraindicated in children

A

Because they discolour teeth and cause enamel dysplasia, which increases the risk of dental caries.

40
Q

What are the indications for Doxycycline?

A

Acne
Rosacea

CAP
Exacerbation of chronic bronchitis
Infections caused by M. pneumonia
acute bacterial sinusitis

PID
Sexually acquired epididymo-orchitis
Prostatitis

Prophylaxis for malaria
Malaria treatment
Q fever

41
Q

What is the mode of action of trimethoprim?

A

Bacteriostatic. Competitively inhibits bacterial folate production essential for bacterial growth.

42
Q

What are the indications for Trimethoprim?

A

Empirical treatment for uncomplicated lower UTIs
Epidymo-orchitis (urinary tract source)
Prostatitis (acute or chronic)

Mild-to-moderate PJP, with dapsone (second line)

43
Q

What is the mechanism of action of the Azole antifungals?

A

Fungistatic. Impair the synthesis of ergosterol in fungal cell membranes, leading to their breakdown. Cell leakage and death occur by lytic activity of the host defence system.

44
Q

What is the name of one Azole antifungal?

A

Fluconazole
Clotrimazole
Ketoconazole
Voriconazole

45
Q

What are the indications for Fluconazole?

A

Cryptococcosis: consolidation and suppression after induction treatment of meningitis or disseminated disease; treatment of mild pulmonary disease

Oral candidiasis

Vulvovaginal candidiasis - 2nd line where topical therapy has failed.

Tinea - if resistant to topical therapy.

Onychomycosis (if alternatives have failed or are not tolerated)

Histoplasmosis

Primary and secondary prevention of candidal infection in immunocompromised people

46
Q

To which class of drugs does Acyclovir belong?

A

Guanine analogue

47
Q

What is the mechanism of action of the Guanine analogues?

A

Following phosphorylation by viral and cellular enzymes, guanine analogues inhibit viral DNA polymerase and DNA synthesis

48
Q

What are the indications for Aciclovir?

A

Treatment and prevention of herpes simplex infections (e.g. cold sores)

  • Chicken pox
  • Shingles
  • eye herpes
49
Q

What is the mechanism of action of Frusemide?

A

Inhibit reabsorption of sodium and chloride in the ascending limb of the loop of Henle. This site accounts for retention of approximately 20% of filtered sodium.

50
Q

What are the indications for Frusemide?

A

Oedema associated with heart failure, hepatic cirrhosis, renal impairment and nephrotic syndrome.
Also accepted as treatment for severe hypercalcaemia (with adequate rehydration)

51
Q

To which class of drugs does Frusemide belong?

A

Loop diuretics

52
Q

What is the mode of action of glyceryl trinitrate?

A

Provide exogenous source of nitric oxide (which mediates vasodilator effects). Predominantly venodilators; reduce venous return and preload to the heart, reducing myocardial oxygen requirement.

53
Q

Indications for glyceryl trinitrate

A

Prevention and treatment of stable angina
Heart failure associated with acute MI (infusion)

Accepted
Unstable angina (infusion)
Acute pulmonary oedema (infusion)

54
Q

What is the mechanism of action of thiazide diuretics?

A

Inhibit reabsorption of sodium and chloride in the proximal (diluting) segment of the distal convoluted tubule, increasing the delivery of sodium to the collecting tubules, and producing a corresponding increase in potassium excretion.

55
Q

What is the mechanism of action of thiazides when used in low doses to treat hypertension?

A

Lower BP mostly by a vasodilator effect.

56
Q

What are the indications for thiazides?

A

Hypertension
Oedema associated with heart failure or hepatic cirrhosis.
Nephrogenic diabetes insipidus.

Accepted
Prevention of renal calculi associated with hypercalciuria

57
Q

What is the mechanism of action of ACE-inhibitors?

A

Block conversion of angiotensin I to angiotensin II and also inhibit the breakdown of bradykinin. Reduce the effects of angiotensin II-induced vasoconstriction, sodium retention and aldosterone release.

58
Q

What are the indications for ACE-inhibitors

A

Hypertension
HFrEF
Post MI

Diabetic nephropathy
Prevention of progressive renal failure in patients with persistent proteinuria (>1 g daily)

NPS Modules (15 decks)

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