Drug indications Flashcards
1
Q
Antacid, e.g. Gaviscon (2)
A
- GORD - symptomatic relief within 20mins
2. Dyspepsia - short-term relief of indigestion
2
Q
H2 receptor antagonist, e.g. Ranitidine (3)
A
- Peptic ulcer (gastric or duodenal)
- GORD - symptomatic relief
- Dyspepsia (indigestion) - symptomatic relief
3
Q
PPIs, e.g. Omeprazole (4)
A
- Peptic ulcers - prevention & treatment
- GORD - symptomatic relief
- Dyspepsia - symptomatic relief
- Eradication of H. pylori (in addition to antibiotics)
4
Q
Anti-diarrhoeal, e.g. Loperamide (1)
A
- Diarrhoea - symptomatic (does not treat underlying cause)
5
Q
Laxatives, e.g. Senna (2)
A
- Constipation
2. Faecal impaction - as suppositories
6
Q
Aminosalicylates, e.g. Mesalazine (2)
A
- Ulcerative colitis - first-line treatment
2. DMARD for RA (Sulfasalazine)
7
Q
Anti-emetics, e.g. Metoclopramide (1)
A
- Nausea & vomiting - prophylaxis & treatment (particularly in the context of reduced gut motility)
8
Q
Loop diuretics, e.g. Furosemide (3)
A
- Acute pulmonary oedema - relieve breathlessness
- Chronic heart failure - symptomatic relief of fluid overload
- Odematous states, e.g. due to renal disease - symptomatic relief of fluid overload
9
Q
Thiazide diuretics, e.g. Bendroflumethiazide (1)
A
- Hypertension - if calcium channel blocker is unsuitable due to oedema or if there are other features of heart failure; or as an add-on treatment to CCB + ACEi
10
Q
Potassium-sparing diuretics, e.g. Spironolactone (4)
A
- Hyperkalaemia arising from loop or thiazide diuretic therapy
- Oedema & ascites in liver cirrhosis
- Nephrotic syndrome
- Primary hyperaldosteronism (Conn’s syndrome)
11
Q
Beta blockers, e.g. Atenolol (5)
A
- Ischaemic heart disease - first-line for angina & ACS
- Chronic heart failure - first-line with ACE inhibitor
- Atrial fibrillation - first-line to reduce ventricular rate & maintain sinus rhythm
- SVT - first-line to restore sinus rhythm
- Hypertension - used when other medications are insufficient or inappropriate
12
Q
Calcium channel blockers, e.g. Amlodipine (vascular selective) (2)
A
- Hypertension - first- or second-line treatment
2. Stable angina - symptom control
13
Q
Calcium channel blockers, e.g. Verapamil (cardiac selective) (1)
A
- Supraventricular arrhythmias - control cardiac rate in people with AF, atrial flutter & spuraventricular tachycardia
14
Q
ACE inhibitors, e.g. Ramipril (4)
A
- Hypertension - first- or second-line treatment
- Chronic heart failure - first-line treatment with beta-blocker
- Ischaemic heart disease
- Diabetic nephropathy & CKD with proteinuria - to reduce proteinuria & the progression of nephropathy
15
Q
Angiotensin-1 receptor blockers, e.g. Losartan (4)
A
Same as ACE inhibitors:
- Hypertension
- Chronic heart failure
- Ischaemic heart disease
- Diabetic nephropathy & CKD with proteinuria
16
Q
Short-acting nitrates, e.g. GTN spray (1)
A
- Acute angina & ACS chest pain
17
Q
Long-acting nitrates, e.g. ISMN (2)
A
- Prophylaxis of angina
2. Pulmonary oedema - in combination with furosemide & oxygen
18
Q
Cardiac glycosides, e.g. Digoxin (2)
A
- AF & atrial flutter - reduces ventricular rate
2. Severe heart failure - third-line treatment in patients already taking ACEi, beta blocker & ARB
19
Q
Anti-dysarrhythmics, e.g. Amiodarone (1)
A
- Tachyarrhythmias - AF, atrial flutter, SVT, ventricular tachycardia, refractory ventricular fibrillation - generally used when other drugs or cardioversion are ineffective or inappropriate
20
Q
Antiplatelets, e.g. Aspirin (4)
A
- ACS & acute ischaemic stroke - prevents or limits arterial thrombosis
- Long-term secondary prevention of thrombotic arterial events - in patients with CV, cerebrovascular or peripheral arterial disease
- Atrial fibrillation - to reduce risk of intracardiac thrombus & embolic stroke if warfarin or novel oral anticoagulants are contraindicated
- Mild-to-moderate pain & fever - NSAIDs are usually preferred
21
Q
Antiplatelets, e.g. Clopidogrel (4)
A
Generally prescribed with aspirin:
- ACS & acute ischaemic stroke - prevents or limits arterial thrombosis
- Prevention of thrombotic arterial events - in patients with CV, cerebrovascular or peripheral arterial disease
- Atrial fibrillation - to reduce risk of intracardiac thrombus & embolic stroke if warfarin or novel oral anticoagulants are contraindicated
- Coronary artery stents - to prevent occlusion
22
Q
Heparins, e.g. Enoxaparin (LMWH) (2)
A
- VTE - prophylaxis & initial treatment of DVT or PE
- ACS - LMWH is part of first-line therapy to improve revascularisation & prevent intracoronary thrombus progression
23
Q
Oral anticoagulants, e.g. Warfarin (3)
A
- VTE - to prevent clot extension & recurrence
- AF - to prevent embolic complications, e.g. stroke
- Heart valve replacement - to prevent embolic complications, e.g. stroke (short-term for tissue valve & lifelong for mechanical valve)
24
Q
Novel anticoagulants, e.g. Rivaroxaban (4)
A
- VTE prophylaxis - following knee (2wks) or hip (5wks) replacement
- VTE treatment
- Prophylaxis of systemic embolism in non-valvular AF, e.f. stroke
- ACS with elevated cardiac biomarkers - prophylaxis of atherothrombotic events following ACS (in combination with aspirin or clopidogrel)
25
Statins, e.g. Simvastatin (3)
1. Primary prevention of CV disease in >40yrs with 10yr CV risk >20%
2. Secondary prevention of CV disease - first-line to prevent CV events
3. Primary hyperlipidaemia - first-line
26
Short-acting B2 agonists, e.g. Salbutamol (3)
1. Asthma - short-acting to relieve breathlessness
2. COPD - short-acting to relieve breathlessness
3. Hyperkalaemia - nebulised salbutamol alongside insulin, glucose & calcium gluconate
27
Long-acting B2 agonists, e.g. Salmeterol (2)
1. Asthma - step 3 treatment for chronic asthma in combination with inhaled corticosteroids
2. COPD - second-line therapy
28
Short-acting Anticholinergics, e.g. Ipratropium (2)
1. COPD - relieve breathlessness
| 2. Asthma - relieve breathlessness in acute exacerbations
29
Long-acting Anticholinergics, e.g. Tiotropium (2)
1. COPD - prevention of breathlessness & exacerbations
| 2. Asthma - step 4 treatment in chronic asthma with long-acting B2 agonist + high-dose inhaled corticosteroids
30
Oxygen
1. Hypoxaemia resulting fmor disease - increases tissue oxygen delivery
2. Pneumothorax - accelerates reabsorption of pleural gas
3. CO poisoning - reduces half-life of carboxyhaemoglobin
31
What type of oxygen mask are patients in Type 2 respiratory failure given?
Venturi mask (28%)
32
What type of oxygen mask should be given to critically ill patients or those with SpO2<85%?
Reservoir (non-breathing) mask with high oxygen concentration (60-80%) given at 15L/min
33
What concentration(ish) & rate(ish) of oxygen is given via nasal cannulae?
Variable oxygen concentration (24-50%) at a rate of 2-6L/min
34
Tricyclic antidepressants, e.g. Amitriptyline (2)
1. Neuropathic pain (not actually licensed)
| 2. Moderate-to-severe depression - second-line when SSRIs are ineffective
35
SSRIs, e.g. Citalopram (4)
1. Mild depression - if psychological treatment fails
2. Moderate-to-severe depression - first-line treatment
3. Panic disorder
4. OCD
36
Benzodiazepines, e.g. Diazepam (5)
1. Seizures +; Status epilepticus - first-line
2. Alcohol withdrawal reactions - first-line
3. Sedation for interventional procedures - if general anaesthesia is unnecessary
4. Anxiety - if severe or disabling (short-term 4wks)
5. Insomnia - if severe or disabling (short-term 4wks)
37
What 4 severe infections is Tazocin used to treat?
1. Lower respiratory tract infection
2. Urinary tract infection
3. Intra-abdominal sepsis
4. Skin & soft tissue infection
38
What penicillin is reserved for severe infections where there is a broad spectrum of potential pathogens, antibiotic resistance is likely or patients are immunocompromised?
Tazocin (antipseudomonal penicillin)
39
What is tonsillitis treated with?
Benzylpenicillin or Penicillin V
40
When are IV cephalosporins & carbapenems used?
1. Severe complicated infections due to their broad spectrum of activity
2. Antibiotic-resistant organisms
41
Trimethoprim
First-line for uncomplicated UTIs
42
The 3 main antibiotics used to treat UTIs
Trimethoprim, Nitrofurantoin, Amoxicillin
43
Co-trimoxazole (trimethoprim + sulfamethoxazole)
Treatment & prevention of pneumocystis pneumonia in people with immunosuppression
44
Nitrofurantoin
Uncomplicated UTIs - not suitable for pyelonephritis or complicated UTIs because tissue concentrations are very low (therapeutic concentrations reached in urine due to renal excretion)
45
Doxycycline
1. Acne vulgaris
2. Lower RTI - infective COPD exacerbations, pneumonia, atypical pneumonia
3. Chlamydia
4. Malaria, Typhoid, Anthrax, Lyme disease
46
Is gentamicin active against Gram-positive or Gram-negative bacteria?
Gram-negative
47
Gentamicin is used in severe infections such as...
1. Severe sepsis
2. Pyelonephritis & complicated UTIs
3. Biliary & intra-abdominal sepsis
4. Endocarditis
48
When the causative organism is unknown, Gentamicin (Gram-negative) should be combined with 2 antibiotics
Penicillin + Metronidazole
49
When penicillin is contraindicated due to allergy, what antibiotic is used to treat respiratory tract infections?
Macrolides - Clarithromycin or Erythromycin
50
When penicillin is contraindicated due to allergy, what antibiotic is used to treat skin & soft tissue infections?
Macrolides - Clarithromycin or Erythromycin
51
Eradication of H. pylori is achieved using a combination of 3 or 4 drugs
PPI + amoxicillin + clarithromycin + (metronidazole)
52
Empirical treatment of pneumonia
Amoxicillin or Co-amoxiclav - because broad spectrum so covers Gram-positive and Gram-negative
53
What penicillin is broad spectrum, covering both Gram-positive and Gram-negative bacteria?
Amoxicillin
54
What organism most commonly causes UTIs?
E coli
55
Empirical treatment of UTI
Amoxicillin or Co-amoxiclav - because broad spectrum so covers Gram-positive and Gram-negative
56
Hospital-acquired infection or intra-abdominal sepsis may be caused by Gram-negative, anaerobic or antibiotic-resistant bacteria, so is treated using...
Co-amoxiclav
57
Flucloxacillin (3)
1. Skin & soft tissue infections
2. Osteomyelitis & septic artritis
3. Endocarditis
58
Why are quinolines, e.g. Ciprofloxacin, reserved as second- or third-line treatment? (2)
1. Potential for rapid emergence of resistance
| 2. Association with C. diff
59
Anaerobic infections such as the below are treated with what?
1. Antibiotic-associated colitis caused by C. diff (Gram-positive)
2. Oral infections such as dental abscesses (Gram-negative from the mouth)
3. Surgical & gynae infections (Gram-negative from the colon)
Metronidazole
60
Trichomonal vaginal infection is treated with?
Metronidazole - as it's a protozoal infection
61
When infection is severe or penicillins are contraindicated, Gram-positive infections such as endocarditis are treated with?
Vancomycin
62
First-line and second-line treatment of C. diff infection...
1. Metronidazole
| 2. Vencomycin
63
NSAIDs, e.g. Ibuprofen (2)
1. Mild-to-moderate pain
| 2. Inflammatory pain
64
Strong opioids, e.g. Morphine (4)
1. Rapid relief of acute severe pain
2. Relief of chronic pain when paracetamol & NSAIDs are insufficient
3. Relief of breathlessness in end-of-life care
4. Relief of breathlessness & anxiety in acute pulmonary oedema
65
Weak opioids, e.g. Codeine (1)
1. Mild-to-moderate pain when paracetamol is insufficient
66
Xanthine oxidase inhibitors, e.g. Allopurinol (3)
1. Gout - PREVENTS attacks
2. Renal stones - prevents uric acid & calcium oxalate renal stones
3. During chemotherapy - prevents hyperuricaemia & tumour lysis syndrome
67
Paracetamol (2)
1. Acute & chronic pain - first-line on WHO pain ladder
| 2. Fever - antipyretic
68
Treatment choice in early & late PD
Early: DA agonists - Ropinrole, Pramipexol
Late: Levodopa + DA agonists as an add-on
69
Phenytoin
1. Status epilepticus when benzodiazepines are ineffective
| 2. Reduce frequency of generalised or focal seizures (but other drugs are preferred)
70
Sodium valproate
1. First-choice for the control of generalised or absence seizures
2. Acute treatment & prophylaxis of manic episodes of bipolar
71
Carbamazepine
1. First-line for focal seizures
2. First-choice for trigeminal neuralgia - reduces pain & frequency
3. Option for bipolar prophylaxis if resistant to other medication
72
Generalised seizures, e.g. Tonic-clonic (grand-mal)
1. Sodium valproate
| 2. Phenytoin
73
Absence seizures (petit-mal)
1. Sodium valproate
74
Focal seizures
1. Carbamazepine
| 2. Phenytoin
75
Bipolar prophylaxis and acute treatment
1. Sodium valproate
| 2. Carbamazepine
76
Status epilepticus - if first-aid intervention doesn't stop the seizure within 5 mins
1. Benzodiazepines - IM midazolam, IV lorazepam, or IV diazepam
2. Phenytoin
77
Newer anticonvulsants (2)
Lamotigrine
| Levetiracetam (Keppra)
