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Drug indications Flashcards

1
Q

Antacid, e.g. Gaviscon (2)

A
  1. GORD - symptomatic relief within 20mins

2. Dyspepsia - short-term relief of indigestion

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2
Q

H2 receptor antagonist, e.g. Ranitidine (3)

A
  1. Peptic ulcer (gastric or duodenal)
  2. GORD - symptomatic relief
  3. Dyspepsia (indigestion) - symptomatic relief
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3
Q

PPIs, e.g. Omeprazole (4)

A
  1. Peptic ulcers - prevention & treatment
  2. GORD - symptomatic relief
  3. Dyspepsia - symptomatic relief
  4. Eradication of H. pylori (in addition to antibiotics)
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4
Q

Anti-diarrhoeal, e.g. Loperamide (1)

A
  1. Diarrhoea - symptomatic (does not treat underlying cause)
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5
Q

Laxatives, e.g. Senna (2)

A
  1. Constipation

2. Faecal impaction - as suppositories

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6
Q

Aminosalicylates, e.g. Mesalazine (2)

A
  1. Ulcerative colitis - first-line treatment

2. DMARD for RA (Sulfasalazine)

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7
Q

Anti-emetics, e.g. Metoclopramide (1)

A
  1. Nausea & vomiting - prophylaxis & treatment (particularly in the context of reduced gut motility)
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8
Q

Loop diuretics, e.g. Furosemide (3)

A
  1. Acute pulmonary oedema - relieve breathlessness
  2. Chronic heart failure - symptomatic relief of fluid overload
  3. Odematous states, e.g. due to renal disease - symptomatic relief of fluid overload
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9
Q

Thiazide diuretics, e.g. Bendroflumethiazide (1)

A
  1. 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
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10
Q

Potassium-sparing diuretics, e.g. Spironolactone (4)

A
  1. Hyperkalaemia arising from loop or thiazide diuretic therapy
  2. Oedema & ascites in liver cirrhosis
  3. Nephrotic syndrome
  4. Primary hyperaldosteronism (Conn’s syndrome)
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11
Q

Beta blockers, e.g. Atenolol (5)

A
  1. Ischaemic heart disease - first-line for angina & ACS
  2. Chronic heart failure - first-line with ACE inhibitor
  3. Atrial fibrillation - first-line to reduce ventricular rate & maintain sinus rhythm
  4. SVT - first-line to restore sinus rhythm
  5. Hypertension - used when other medications are insufficient or inappropriate
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12
Q

Calcium channel blockers, e.g. Amlodipine (vascular selective) (2)

A
  1. Hypertension - first- or second-line treatment

2. Stable angina - symptom control

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13
Q

Calcium channel blockers, e.g. Verapamil (cardiac selective) (1)

A
  1. Supraventricular arrhythmias - control cardiac rate in people with AF, atrial flutter & spuraventricular tachycardia
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14
Q

ACE inhibitors, e.g. Ramipril (4)

A
  1. Hypertension - first- or second-line treatment
  2. Chronic heart failure - first-line treatment with beta-blocker
  3. Ischaemic heart disease
  4. Diabetic nephropathy & CKD with proteinuria - to reduce proteinuria & the progression of nephropathy
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15
Q

Angiotensin-1 receptor blockers, e.g. Losartan (4)

A

Same as ACE inhibitors:

  1. Hypertension
  2. Chronic heart failure
  3. Ischaemic heart disease
  4. Diabetic nephropathy & CKD with proteinuria
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16
Q

Short-acting nitrates, e.g. GTN spray (1)

A
  1. Acute angina & ACS chest pain
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17
Q

Long-acting nitrates, e.g. ISMN (2)

A
  1. Prophylaxis of angina

2. Pulmonary oedema - in combination with furosemide & oxygen

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18
Q

Cardiac glycosides, e.g. Digoxin (2)

A
  1. AF & atrial flutter - reduces ventricular rate

2. Severe heart failure - third-line treatment in patients already taking ACEi, beta blocker & ARB

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19
Q

Anti-dysarrhythmics, e.g. Amiodarone (1)

A
  1. Tachyarrhythmias - AF, atrial flutter, SVT, ventricular tachycardia, refractory ventricular fibrillation - generally used when other drugs or cardioversion are ineffective or inappropriate
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20
Q

Antiplatelets, e.g. Aspirin (4)

A
  1. ACS & acute ischaemic stroke - prevents or limits arterial thrombosis
  2. Long-term secondary prevention of thrombotic arterial events - in patients with CV, cerebrovascular or peripheral arterial disease
  3. Atrial fibrillation - to reduce risk of intracardiac thrombus & embolic stroke if warfarin or novel oral anticoagulants are contraindicated
  4. Mild-to-moderate pain & fever - NSAIDs are usually preferred
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21
Q

Antiplatelets, e.g. Clopidogrel (4)

A

Generally prescribed with aspirin:

  1. ACS & acute ischaemic stroke - prevents or limits arterial thrombosis
  2. Prevention of thrombotic arterial events - in patients with CV, cerebrovascular or peripheral arterial disease
  3. Atrial fibrillation - to reduce risk of intracardiac thrombus & embolic stroke if warfarin or novel oral anticoagulants are contraindicated
  4. Coronary artery stents - to prevent occlusion
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22
Q

Heparins, e.g. Enoxaparin (LMWH) (2)

A
  1. VTE - prophylaxis & initial treatment of DVT or PE
  2. ACS - LMWH is part of first-line therapy to improve revascularisation & prevent intracoronary thrombus progression
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23
Q

Oral anticoagulants, e.g. Warfarin (3)

A
  1. VTE - to prevent clot extension & recurrence
  2. AF - to prevent embolic complications, e.g. stroke
  3. Heart valve replacement - to prevent embolic complications, e.g. stroke (short-term for tissue valve & lifelong for mechanical valve)
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24
Q

Novel anticoagulants, e.g. Rivaroxaban (4)

A
  1. VTE prophylaxis - following knee (2wks) or hip (5wks) replacement
  2. VTE treatment
  3. Prophylaxis of systemic embolism in non-valvular AF, e.f. stroke
  4. ACS with elevated cardiac biomarkers - prophylaxis of atherothrombotic events following ACS (in combination with aspirin or clopidogrel)
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25
Q

Statins, e.g. Simvastatin (3)

A
  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
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26
Q

Short-acting B2 agonists, e.g. Salbutamol (3)

A
  1. Asthma - short-acting to relieve breathlessness
  2. COPD - short-acting to relieve breathlessness
  3. Hyperkalaemia - nebulised salbutamol alongside insulin, glucose & calcium gluconate
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27
Q

Long-acting B2 agonists, e.g. Salmeterol (2)

A
  1. Asthma - step 3 treatment for chronic asthma in combination with inhaled corticosteroids
  2. COPD - second-line therapy
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28
Q

Short-acting Anticholinergics, e.g. Ipratropium (2)

A
  1. COPD - relieve breathlessness

2. Asthma - relieve breathlessness in acute exacerbations

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29
Q

Long-acting Anticholinergics, e.g. Tiotropium (2)

A
  1. COPD - prevention of breathlessness & exacerbations

2. Asthma - step 4 treatment in chronic asthma with long-acting B2 agonist + high-dose inhaled corticosteroids

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30
Q

Oxygen

A
  1. Hypoxaemia resulting fmor disease - increases tissue oxygen delivery
  2. Pneumothorax - accelerates reabsorption of pleural gas
  3. CO poisoning - reduces half-life of carboxyhaemoglobin
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31
Q

What type of oxygen mask are patients in Type 2 respiratory failure given?

A

Venturi mask (28%)

32
Q

What type of oxygen mask should be given to critically ill patients or those with SpO2<85%?

A

Reservoir (non-breathing) mask with high oxygen concentration (60-80%) given at 15L/min

33
Q

What concentration(ish) & rate(ish) of oxygen is given via nasal cannulae?

A

Variable oxygen concentration (24-50%) at a rate of 2-6L/min

34
Q

Tricyclic antidepressants, e.g. Amitriptyline (2)

A
  1. Neuropathic pain (not actually licensed)

2. Moderate-to-severe depression - second-line when SSRIs are ineffective

35
Q

SSRIs, e.g. Citalopram (4)

A
  1. Mild depression - if psychological treatment fails
  2. Moderate-to-severe depression - first-line treatment
  3. Panic disorder
  4. OCD
36
Q

Benzodiazepines, e.g. Diazepam (5)

A
  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
Q

What 4 severe infections is Tazocin used to treat?

A
  1. Lower respiratory tract infection
  2. Urinary tract infection
  3. Intra-abdominal sepsis
  4. Skin & soft tissue infection
38
Q

What penicillin is reserved for severe infections where there is a broad spectrum of potential pathogens, antibiotic resistance is likely or patients are immunocompromised?

A

Tazocin (antipseudomonal penicillin)

39
Q

What is tonsillitis treated with?

A

Benzylpenicillin or Penicillin V

40
Q

When are IV cephalosporins & carbapenems used?

A
  1. Severe complicated infections due to their broad spectrum of activity
  2. Antibiotic-resistant organisms
41
Q

Trimethoprim

A

First-line for uncomplicated UTIs

42
Q

The 3 main antibiotics used to treat UTIs

A

Trimethoprim, Nitrofurantoin, Amoxicillin

43
Q

Co-trimoxazole (trimethoprim + sulfamethoxazole)

A

Treatment & prevention of pneumocystis pneumonia in people with immunosuppression

44
Q

Nitrofurantoin

A

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
Q

Doxycycline

A
  1. Acne vulgaris
  2. Lower RTI - infective COPD exacerbations, pneumonia, atypical pneumonia
  3. Chlamydia
  4. Malaria, Typhoid, Anthrax, Lyme disease
46
Q

Is gentamicin active against Gram-positive or Gram-negative bacteria?

A

Gram-negative

47
Q

Gentamicin is used in severe infections such as…

A
  1. Severe sepsis
  2. Pyelonephritis & complicated UTIs
  3. Biliary & intra-abdominal sepsis
  4. Endocarditis
48
Q

When the causative organism is unknown, Gentamicin (Gram-negative) should be combined with 2 antibiotics

A

Penicillin + Metronidazole

49
Q

When penicillin is contraindicated due to allergy, what antibiotic is used to treat respiratory tract infections?

A

Macrolides - Clarithromycin or Erythromycin

50
Q

When penicillin is contraindicated due to allergy, what antibiotic is used to treat skin & soft tissue infections?

A

Macrolides - Clarithromycin or Erythromycin

51
Q

Eradication of H. pylori is achieved using a combination of 3 or 4 drugs

A

PPI + amoxicillin + clarithromycin + (metronidazole)

52
Q

Empirical treatment of pneumonia

A

Amoxicillin or Co-amoxiclav - because broad spectrum so covers Gram-positive and Gram-negative

53
Q

What penicillin is broad spectrum, covering both Gram-positive and Gram-negative bacteria?

A

Amoxicillin

54
Q

What organism most commonly causes UTIs?

A

E coli

55
Q

Empirical treatment of UTI

A

Amoxicillin or Co-amoxiclav - because broad spectrum so covers Gram-positive and Gram-negative

56
Q

Hospital-acquired infection or intra-abdominal sepsis may be caused by Gram-negative, anaerobic or antibiotic-resistant bacteria, so is treated using…

A

Co-amoxiclav

57
Q

Flucloxacillin (3)

A
  1. Skin & soft tissue infections
  2. Osteomyelitis & septic artritis
  3. Endocarditis
58
Q

Why are quinolines, e.g. Ciprofloxacin, reserved as second- or third-line treatment? (2)

A
  1. Potential for rapid emergence of resistance

2. Association with C. diff

59
Q

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)
A

Metronidazole

60
Q

Trichomonal vaginal infection is treated with?

A

Metronidazole - as it’s a protozoal infection

61
Q

When infection is severe or penicillins are contraindicated, Gram-positive infections such as endocarditis are treated with?

A

Vancomycin

62
Q

First-line and second-line treatment of C. diff infection…

A
  1. Metronidazole

2. Vencomycin

63
Q

NSAIDs, e.g. Ibuprofen (2)

A
  1. Mild-to-moderate pain

2. Inflammatory pain

64
Q

Strong opioids, e.g. Morphine (4)

A
  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
Q

Weak opioids, e.g. Codeine (1)

A
  1. Mild-to-moderate pain when paracetamol is insufficient
66
Q

Xanthine oxidase inhibitors, e.g. Allopurinol (3)

A
  1. Gout - PREVENTS attacks
  2. Renal stones - prevents uric acid & calcium oxalate renal stones
  3. During chemotherapy - prevents hyperuricaemia & tumour lysis syndrome
67
Q

Paracetamol (2)

A
  1. Acute & chronic pain - first-line on WHO pain ladder

2. Fever - antipyretic

68
Q

Treatment choice in early & late PD

A

Early: DA agonists - Ropinrole, Pramipexol
Late: Levodopa + DA agonists as an add-on

69
Q

Phenytoin

A
  1. Status epilepticus when benzodiazepines are ineffective

2. Reduce frequency of generalised or focal seizures (but other drugs are preferred)

70
Q

Sodium valproate

A
  1. First-choice for the control of generalised or absence seizures
  2. Acute treatment & prophylaxis of manic episodes of bipolar
71
Q

Carbamazepine

A
  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
Q

Generalised seizures, e.g. Tonic-clonic (grand-mal)

A
  1. Sodium valproate

2. Phenytoin

73
Q

Absence seizures (petit-mal)

A
  1. Sodium valproate
74
Q

Focal seizures

A
  1. Carbamazepine

2. Phenytoin

75
Q

Bipolar prophylaxis and acute treatment

A
  1. Sodium valproate

2. Carbamazepine

76
Q

Status epilepticus - if first-aid intervention doesn’t stop the seizure within 5 mins

A
  1. Benzodiazepines - IM midazolam, IV lorazepam, or IV diazepam
  2. Phenytoin
77
Q

Newer anticonvulsants (2)

A

Lamotigrine

Levetiracetam (Keppra)

Drugs (6 decks)

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