Drug Indication Flashcards
Verapamil
Arrhythmia, angina, hypertension
Amlodipine
Hypertension, Angina & Coronary Artery Disease
Losartan
Hypertension & HF (where there are side effects with ACEi)
Ramipril
Hypertension, HF, prevention of HF progression post-myocardial infarction (MI)
Nimodipine
Patients with no neurological deficits after subarachnoid hemorrhage to reduce the onset of new neurological deficits due to vasospasm/ischaemia
Diltiazem
Atrial arrhythmia, hypertension, paroxysmal supraventricular tachycardia, and chronic stable angina
Indapamide
Hypertension (more useful than CCBs with oedema), occasionally HF when in combination with a loop diuretic
Spironolactone
Resistant hypertension,
Bisoprolol
Hypertension and HF
- Prevention of MI/stroke in hypertension
- Prevent chest pain caused by angina
- protecting the ventricles from high atrial rates by slowing AV conduction in A fib or atrial flutter (typically 300A:150V, BB can convert to 75V -> 4:1)
- blocking Reentrant Arrhythmias at AV node
- Sinus Tachy
- Also less commonly migraine, tremor and anxiolytic
Tamsulosin
Benign prostatic hyperplasia
Doxazosin
Hypertension
Spironolactone
Hypertension, HF, hyperaldosteronism, adrenal hyperplasia, and nephrotic syndrome
Furosemide
Acute pulmonary oedema, fluid overload in HF (decreases preload), adjunct in nephrotic syndrome
Amiloride
Often used as an adjunct to loop or thiazide like in HF to limit hyperK+
Sacubitril
Replaces ACEi/ARB in HF if EF <35%
Atorvastatin
Hyperlipidaemia
Reduce CVD risk
Also familial hypercholesterolemia
Primary prevention - 20 mg once daily (if QRISK >10%)
Secondary prevention - 80 mg once daily (if had major cardiovascular event e.g. heart attack/stroke, may be reduced to 20mg if have CKD)
Need a full lipid profile + HDL, non-HDL and TAGs before prescribing. Aim to reduce non-HDL-C by ~>40% at 3 months
Fenofibrate
- Adjunct to diet and other appropriate measures in mixed hyperlipidaemia if statin contraindicated or not tolerated,
- Adjunct to diet and other appropriate measures in severe hypertriglyceridaemia,
- Adjunct to statin in mixed hyperlipidaemia if triglycerides and HDL- cholesterol inadequately controlled in patients at high cardiovascular risk for fenofibrate
Ezetimibe
- Adjunct to statins (as allows reduced dose - useful in CKD)
- or if statins not tolerated for some familial hyperlipidemia pts
2nd most common drug class for cholesterol management
May increase risk of rhabdomyolysis with statins
Alirocumab
Primary hyperlipidaemia
Lidocaine (as Class 1B)
Only acute ventricular tachy (esp. during ischaemia)
Can terminate VT and stop further episodes
Not used in atrial arrhythmias or AV junctional arrhythmias
Tiotropium
Severe asthma and COPD
Flecainide
- Supraventricular arrhythmias (A fib and atrial flutter) - use with caution as slowing conduction and therefore cycle length of flutter can -> 1:1
- Premature ventricular contractions
- Wolff-Parkinson-White Syndrome - slows conduction through accessory pathway
Pro-arrhythmic -> sudden death (esp. chronic use)
Increases ventricular response to supraventricular arrhythmias -> “flecainide flutter”
Don’t use in ischaemic heart disease -> sudden death
Amiodarone
Very wide spectrum - effective for most arrhythmias but many serious side effects that increase with time so not commonly prescribed
Sotalol
Wide spectrum - SVT and VT
but proarrhythmic
Verapamil
Control ventricles during SVT by blocking conduction at AV node
If IV can stop SVT by preventing re-entry through AV node
Alteplase
Acute Myocardial Infarction, Pulmonary Embolism, Acute Ischemic Stroke and Central Venous Catheter Occlusion
Aspirin
Ischaemic heart disease
Post primary percutaneous coronary intervention
Peripheral vascular disease
Acute ischaemic stroke and transient ischaemic attack
NB: Aspirin use should be avoided in children under 16 due to the risk of Reye’s syndrome (except in Kawasaki disease). It is also important to exercise caution during the third trimester and to avoid whilst breast feeding. Furthermore, the effect of aspirin is potentiated by oral hypoglycaemics, warfarin and steroids.
Atypical anti-psychotics e.g.
Clozapine
Risperidone
Olanzapine
Quetiapine
Aripiprazole
Schizophrenia
Mania
Major depression
Clozapine is a very high risk medication. It can cause agranulocytosis and result in severe infections. It can only be started after two other antipsychotics have been trialled. Close life-long monitoring of the full blood count is required during clozapine therapy.
Carbamazepine
Trigeminal neuralgia
Bipolar disorder
Epilepsy partial seizures
Amitriptyline
-Neuropathic pain (smaller doses required)
-Migraine prophylaxis
-Depression: TCAs are now less commonly used for depression due to side effect profile at higher doses and toxicity.
Side effects are due to the anti-cholinergic properties of amitriptyline. These include:
-Dry mouth
-Constipation
-Urinary retention
-Blurred vision
-QT interval prolongation
Vancomycin
Vancomycin is used in serious gram-positive bacterial infections. Oral vancomysin can also be used to treat C. difficile infection.
Tamoxifen
Tamoxifen is indicated in the management of oestrogen-receptor-positive breast cancer in men and pre-menopausal women, and is typically given for 5 years following removal of a tumour to reduce recurrence. It can also be used to reduce the risk of breast cancer in women who are at high risk for the disease.
Tamoxifen can also be prescribed to treat anovulatory infertility.
Dextrose IV fluids
Goes into all compartments
Contains sugar -> hyperglycaemia risk if rate of flow is too fast (can’t produce enough insulin to keep up)
Reduces osmolarity
Saline IV fluids
Extracellular compartment (intravascular and interstitial)
No change in osmolality (NaCl)
Hartmanns IV fluids
Remains in ECF
No change in osmolality
NaCL + Ca, K, Lactate
Normally need:
25-30ml per kilo per day of water
1mmol per kilo per day of K Na Cl
Fondaparinux
An anticoagulant used to prevent venous thromboembolism, to treat deep vein thrombosis, and to improve survival following myocardial infarction
