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BNF > GI System > Flashcards

GI System Flashcards

1
Q

Mebeverine

A

Antispasmodic
IBS
200mg BD

Symptomatic relief: max. single dose is 135 mg, max. daily dose is 405 mg;

For uses other than symptomatic relief of irritable bowel syndrome: max. single dose is 100 mg and max. daily dose is 300 mg.

Suspension not for children under 10, Tablet/MR capsule not for use in children.

Avoid in pregnancy
Side effects: mild, rarely causes problem, allergy (itchy rash, swelling), angiodema/face oedema

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2
Q

Peppermint Oil

A

Relief of abdominal colic and distension, particularly in IBS

1–2 capsules 3 times a day for up to 3 months if necessary, capsule to be swallowed whole with water; Manufacturer advises capsules should not be broken or chewed because peppermint oil may irritate mouth or oesophagus. (Colpermin, Mintec)

> Do not take indigestion remedies 2 hours before or after you take this medicine
Take 30 to 60 minutes before food
Swallow this medicine whole. Do not chew or crush

Caution: Sensitivity to Menthol

Side Effects: Heartburn, indigestion

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3
Q

Mesalazine

A

Aminosalicylate

Treatment of mild to moderate ulcerative colitis, acute attack

> 2.4g in divided doses (Asacol MR 400)
2.4g-4.8g in divided doses (Asacol MR 800)
2.4g-4.8g OD or divided doses (Octasa)
4g OD or divided doses (Pentasa tablets: Manufacturer advises tablets may be halved, quartered, or dispersed in water, but should not be chewed.
Pentasa granules: Manufacturer advises granules should be placed on tongue and washed down with water or orange juice without chewing
In Children: Expert sources advise contents of one sachet should be weighed and divided immediately before use; discard any remaining granules.)

Hepatic/Renal Impairment: caution in mild to moderate, avoid in severe

MR tablet: Take with or just after food, or a meal, Swallow this medicine whole. Do not chew or crush

GR tablet: Do not take indigestion remedies 2 hours before or after you take this medicine, Swallow this medicine whole. Do not chew or crush

MR granules: Swallow this medicine whole. Do not chew or crush

Hepatic/Renal impairment: caution in mild to moderate, avoid in severe
>Renal function should be monitored before starting, at 3 months, and annually during treatment

Breast feeding: diarrhoea in breast-fed infant

Contra-indicated: blood clotting abnormalities

Stick to same brand

Side Effects: gastrointestinal symptoms, aches and pains, blood disorder: unexplained bleeding, bruising, red or purple discolourations of the skin (purpura), sore throat, a high temperature (fever), or if you feel generally unwell (malaise).

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4
Q

Sulfasalazine

A

Treatment of acute and mild to moderate and severe ulcerative colitis I Active Crohn’s disease

1-2g QDS until remission occurs

Maintenance
500mg QDS

Doses in children upon body weight

> Tablet: This medicine may colour your urine. This is harmless
GR Tablet: Do not take indigestion remedies 2 hours before or after you take this medicine, This medicine may colour your urine. This is harmless, Swallow this medicine whole. Do not chew or crush

Caution: G6PD deficiency, asthma, hepatic toxicity

Monitoring: full blood count, renal/liver function

Hepatic: caution
Renal: caution in mild to moderate, avoid in severe

Drink plenty of water

Side Effects: nausea, loss of appetite, diarrhoea, abdominal pain, headache, rash, dizzy, Gives body fluids (such as tears and urine) a yellow/orange colour. This is harmless. >More severe: Trouble sleeping (insomnia). Altered Taste. Bleeding disorder. Allergy, Jaundice.

***HAS BEEN CONFUSED WITH SULFADIAZINE, CARE TO BE TAKEN WHEN DISPENSED

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5
Q

Beclometasone dipropionate

A

Corticosteroid

Adjunct to aminosalicylates in acute mild to moderate ulcerative colitis

5mg daily max duration of treatment of 4 weeks, dose to be taken in the morning

Hepatic: Avoid in severe

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6
Q

Budesonide

A

Glucocorticoid, anti-inflammatory effects

Mild to moderate Crohn’s disease affecting the ileum or ascending colon

9mg OD for 8 weeks, to be taken in the morning, reduce dose gradually over two weeks following treatment (Budenofalk)

Side Effects: muscle twitching, oedema, oral disorder, diarrhoea, GI disorders

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7
Q

Teduglutide

A

Amino Acid and Derivative

glucagon-like peptide-2 (GLP-2), preserves mucosal integrity by promoting growth and repair of the intestine

Short Bowel Syndrome

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8
Q

Macrogol 3350

A

Osmotic Laxative
(Laxido, Movical)

Onset 24-48hrs

Bowel cleansing

Moviprep: 1L for 2 doses

Plenvu: 500mL for 2 doses

1st dose on evening before procedure, 2nd dose on morning of procedure

Chronic Constipation
Child 12-17: FS 1-3 satchets, HS 2-6
Adult: FS 1-3 satchets, HS 2-6

full strength: 13.125g, half strength/paediatric 6.563g

Caution: CVD impairment, 2 FS or 4HS in any one hour

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9
Q

Isphaghula Husk

A

Bulk-Forming Laxative
(increases faecal mass which stimulates peristalsis)

Constipation
up to 11 yrs: 2.5-5mL BD, dose to be given as a half or whole level spoonful in water, preferably after meals, morning and evening

12-Adult: 1 satchet BD

1 satchet equal to 2 level 5mL spoonful

To be taken with at least 150mL

Contra: faecal impaction, intestinal obstruction, reduced gut motility

Adequate fluid intake

Fybogel

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10
Q

Lactulose

A

Osmotic Laxative

Constipation

Adult: 15mL BD

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11
Q

Docusate Sodium

A

Softening Laxative

Oral onset: 1-2 days, Rectal within 20 min

Chronic Constipation

Oral:
up to 11 yrs: 12.5-25 mg TDS (oral solution)
12-Adult: 500mg in divided doses

Rectum: 120mg for 1 dose

Contra: abdominal obstruction
Caution: excess use of stimulant can cause diarrhoea and hypokalaemia

Dioctyl

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12
Q

Liquid Parrafin

A

Softening Laxative

Constipation
10-30mL daily at night

Side effect: anal irritation, contact dermatitis, rectal discharge of drug, granuloma (cluster of white blood cells)

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13
Q

Bisacodyl

A

Stimulant Laxative
Acts in 10-12hrs, suppository in 20-60min

Constipation
4-17yrs: 5-20mg ON
Adult: 5-10mg, increased to 20mg ON

Rectum:
2-17yrs: 5-10mg OM
Adult: 10mg OM

may be used for constipation but higher dose not licensed in children

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14
Q

Co-danthramer

A

Stimulant Laxative

Constipation in Palliative Care (standard stregnth capsule)

6-11yrs: 1 capsule ON, oral suspension 2.5-5mL ON
12-Adult: 1-2capsules OD, oral suspension 5-10mL ON

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15
Q

Glycerol

A

Stimulant Laxative

1-11months: 1g as required
Children1-11yrs: 2g suppository as required
12-Adult 4g suppository as required

Moisten suppository before insertion

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16
Q

Senna

A

Stimulant Laxactive

Constipation
6-17 yrs: 7.5-30mg OD
Adult: 7.5-15mg ON (max. 30mg) start dose low then gradual increase

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17
Q

Naloxegol

A

Opiod Receptor Antagonist
(Moventig)
decreases the constipating effects of opioids without altering central analgesic effects

25mg OM

concurrent use of CYP3A4 inhibitors

SE: abdominal pain, diarrhoea, flatulence, headache, vomitting, nausea

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18
Q

Loperamide HCl

A

Antidiarrohoeals

Initially 4mg, followed by 2mg for up to 5 days, dose to be taken after each stool (max 16mg)

not licensed in children under 8

***REPORTS OF SERIOUS CARDIAC ADVERSE REACTIONS (QT PROLONGATION, CARDIAC ARREST, TORSADES DE POINTES) WITH HIGH DOSES WITH ABUSE/MISUSE, NALOXONE ANTIDOTE

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19
Q

ALGINIC ACID

A

Alginate Antacid

Management of GORD
Gaviscon Infant
uptown 4.5kg: 1 dose as req
4.5+: 2 doses as req

contra: intestinal obstruction, preterm neonates, excess water loss

renal impairment: avoid antacids with large amounts of sodium in patients with fluid retention

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20
Q

Sodium Alginate with Potassium Bicarbonate

A

Alginate Antiacid

Acidex/Gaviscon Advance
Management of mild symptoms of dyspepsia and GORD

up to 11: under medical advice only
12-Adult: 5-10ML after meal/bedtime

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21
Q

Co-magaldrox

A

Aluminium and Magnesium

Maalox/Mucogel
Dyspepsia: 10-20mL taken 20-60 min after eating/bedtime or when required

renal impairment: effervescent preparations of analgesics contain citrates which increases aluminium absorption=risk of aluminium toxicity

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22
Q

Simeticone

A

Antifoaming Drugs

Infacol
Colic/Wind Pains
1month-1yr: 0.5-1mL with/after each feed

Windeze

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23
Q

Bismuth Subsalicylate

A

Antacid

Helicobacter Pylori eradication

525mg QDS for 7 days

children under 16 at risk of Reyes syndrome

SE: black stools, black tongue/saliva

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24
Q

Famotidine

A

H2-Receptor Antagonist

Treatment of Benign gastric and duodenal ulceration
40mgON 4-8 week

Maintenance treatment of duodenal ulceration 20mgON

Reflux Oesophagits
20-40mg BD 6-12 weeks

SE: constipation, diarrhoea, dizzy, fatigue, headache

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25
Q

Cimetidine

Nizatidine

Ranitidine

A

H2 Receptor Antagonist

Benign duodenal ulceratoin/benign gastric ulceration/NSAID associated ulceration
C:400mg BD
N: 300mg ON
R: 75, 150, 300 OD/BD

Hepatic: increase risk of confusion, reduce does
Renal: reduce to 200mg QDS if eGFR 30-50mL/min/1.73m2

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26
Q

Misoprostol

A

Prostaglandins and Analogues

Cytotec
Benign duodenal ulceratoin/benign gastric ulceration/NSAID induced peptic ulcer

400mcg BD

Prophylaxis
200mcg 2-4times daily

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27
Q

Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole

A

Proton Pump Inhibitor

***Very low risk of subacute cutaneous lupus: lesions in sun-exposed areas can occur from weeks/months/years after exposure of drug

can increase the risk of fractures when used in high doses for over a year in elderly, risk of osteoporosis

may mask symptoms of gastric cancer

increased risk of C. difficile

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28
Q

Sodium Alginate with Calcium Carbonate and Sodium Bicarbonate

A

Alginate Antacid

Acidex/Gaviscon/Peptac/Rennie

GORD
6-11: 5-10mL after meal/bedtime
12-Adult: 10-20mL after meal/bedtime

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29
Q

H. Pylori Triple Therapy

A

comprises a PPI and 2 antibacterials for 7 days

1st: a proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole

PENICILIN ALLERGY: A proton pump inhibitor, plus clarithromycin, and metronidazole.

2nd: A proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (whichever not used in first line)

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30
Q

Dicycloverine Hal

A

Antimuscarinic

Symptomatic relief of GI disorders characterised by smooth muscle spasm

Adult: 10-20mg TDS

Contra: child under 6 months

SE: decreased appetite, thirst, fatigue

Avoid in breastfeeding mothers, apnoea reported in infants (muscle/soft tissue in throat relax and causes total blockage of airways)

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31
Q

Hyoscine Butylbromide

A

Antimuscarinic

Symptomatic relief of gastro-intestinal or genito-urinary disorders characterised by smooth muscle spasm

IBS

***Buscopan injection: serious risk of tachycardia, hypotension, and anaphylaxis in patients with underlying cardiac disease

Buscopan

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32
Q

Alverine Citrate

A

Antispasmodics

Symptomatic relief of gastro-intestinal disorders characterised by smooth muscle spasm

12-17: 60-120mg 1-3 times
Adult: 60-120mg 1-3 times

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33
Q

Cholic Acid

Ursodeoxycholic Acid

A

Bile Acids

Inborn errors of primary bile acid synthesis (initiated by specialist)

Dissolution of gallstones

Avoid in chronic liver disease

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34
Q

Orlistat

A

Lipase Inhibitor, Peripherally Acting Antiobesity Products

120mg TDS

Alli (without prescription, no more than 6 months): 60mg TDS

blocks enzyme that digests fat, undigested fat is not absorbed and therefore eliminated through stool
reduce your fat intake to 30%
goal is a 5% (or more) weight loss within three months of starting orlistat, should not continue if not lost

SE: flatulence, oily stools, loose/increased stools, oily spotting, urgency to use restroom

use other methods of contraceptive as you may have severe diaherroa

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35
Q

Benzyl benzoate with bismuth oxide, bismuth subgallate, hydrocortisone acetate, Peru balsam and zinc oxide

A

Corticosteroid

Haemorrhoids/Pruritus ani

by rectum using ointment
apply twice daily for no longer than 7 days applied morning and night, additional dose applied after bowel movement

Anusol HC

***corticosteroids: rare risk of central chorioretinopathy with local as well as systemic administration

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36
Q

cinchocaine with hydrocortisone

A

corticosteroid

haemorrhoids

proctosedyl ointment/uniroid-hc ointment

apply twice daily (externally or by rectum) and after a bowel movement, no more than 7 days

suppositories
insert 1 at night, morning, and after a bowel movement

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37
Q

cinchocaine with prednisolone

A

corticosteroid

sheriproct ointment
apply BD for 5-7 days, 3-4 times on the first day, then once daily for a few days after symptoms have cleared

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38
Q

Pancreatin

A

pancreatin enzyme

compensate for reduced/absent endocrine secretion, assist digestion of starch, fat and protein

Creon
1-2 capsules with meal or mixed with acidic/soft food

SE: constipation, nausea, vomitting, abdominal distension

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39
Q

Digoxin

A

Cardiac Glycoside

Maintenance for atrial fibrillation
125-250mcg OD

Heart failure
62.5-125mcg OD (reduce for elderly)

Caution: hypercalcaemia, hyperkalaemia, hypermagneseamia

SE: diarrhoea, dizziness, nausea, vomitting, vision disorder (blurry)

Monitor concentration in renal impairment

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40
Q

Tranexamic Acid

A

Antifibrinolytics, Antihaemorrhagics

Local fibrinolysis

Menorrhagia
1g TDS for up to 4 days, initiated when menstruation has started

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41
Q

Emicizumab

A

Haemostatic, Antimhaemorrhagics

monoclonal antibody

Prophylaxis of haemorrhage in haemophilia A

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42
Q

Dried prothrombin complex

A

coagulation proteins, blood and related products

Treatment and peri-operative prophylaxis of haemorrhage in patients with congenital deficiency of factors II, VII, IX, or X if purified specific coagulation factors not available,
Treatment and peri-operative prophylaxis of haemorrhage in patients with acquired deficiency of factors II, VII, IX, or X (e.g. during warfarin treatment)

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43
Q

Factor VIIa (recombinant)

Factor VIII fraction, dried

Factor IX fraction, dried

Factor XIII fraction, dried

Fibrinogen, dried

A

coagulation proteins

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44
Q

Andexanet alfa

A

antidote and chelator

recombinant form of human factor Xa

Reversal of apixaban or rivaroxaban in life-threatening or uncontrolled bleeding

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45
Q

Idarucizumab

A

monoclonal antibody

rapid reversal of dabigatrarin for emergency procedures

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46
Q

Aspirin

A

anti platelet

CVD (secondary prevention)

75mg OD

Management of unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI)/suspected transient ischaemic attack

300mg

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47
Q

Clopidogrel

A

antiplatelet

Transient ischaemic attack for patients with aspirin hypersensitivity, or those intolerant of aspirin despite the addition of a proton pump inhibitor,
Acute ischaemic stroke for patients with aspirin hypersensitivity, or those intolerant of aspirin despite the addition of a proton pump inhibitor, Prevention of atherothrombotic events in peripheral arterial disease or within 35 days of myocardial infarction, or within 6 months of ischaemic stroke

75mg OD

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48
Q

Dipyridamole

A

anti platelet

Secondary prevention of ischaemic stroke (not associated with atrial fibrillation) and transient ischaemic attacks (used alone or with aspirin),
Adjunct to oral anticoagulation for prophylaxis of thromboembolism associated with prosthetic heart valves

200mg BD

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49
Q

Apixaban

A

Factor XA Inhibitor, Antithrombotic drug

direct inhibitor of factor XA

Prophylaxis of recurrent deep-vein thrombosis,
Prophylaxis of recurrent pulmonary embolism

2.5 mg twice daily, following completion of 6 months anticoagulant treatment.

Prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation and at least one risk factor (such as previous stroke or transient ischaemic attack, symptomatic heart failure, diabetes mellitus, hypertension, or age 75 years and over)

5 mg twice daily, alternatively 2.5 mg twice daily, reduced dose used in patients with at least two of the following characteristics: age 80 years and over, body-weight 60 kg or less, or serum creatinine 133 micromol/litre and over.

***direct-acting oral coagulants (DOACS): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome

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50
Q

Edoxaban

A

factor XA inhibitor, antithrombolytic

direct and reversible inhibitor of factor XA

up to 60kg: 30mg OD
61+: 60mg OD

(max dose 30 mg with cico sporin, dronedarone, erythromycin, or ketoconazole

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51
Q

Rivaroxaban

A

antithrombolytic, factor XA inhibitor

Prophylaxis of venous thromboembolism following knee/hip replacement surgery

10mg OD

Treatment of deep-vein thrombosis,
Treatment of pulmonary embolism

Initially 15mg BD to be taken with food, for duration of treatment, consult product literature.

Prophylaxis of stroke and systemic embolism in patients with non-valvular atrial fibrillation and with at least one of the following risk factors: congestive heart failure, hypertension, previous stroke or transient ischaemic attack, age ≥ 75 years, or diabetes mellitus

20mg OD

**(Xarelto) 15mg and 20mg should be taken with food

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52
Q

Dalteparin sodium

Enoxaparin sodium

Heparin

Tinzaparin sodium

A

heparins, antithrombitic drugs

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53
Q

Dabigatran etexilate

A

thrombin inhibitor, direct

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54
Q

Warfarin

A

Vitamin K antagonists

Prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation,
Prophylaxis after insertion of prosthetic heart valve,
Prophylaxis and treatment of venous thrombosis and pulmonary embolism,
Transient ischaemic attacks

***direct acting antivirals to treat chronic hepatitis C: risk of interaction with vitamin K antagonist, INR should be monitored

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55
Q

Carvedilol (a,b)

Labetalol (a,b)

Nadolol (ns)

Propranolol (ns)

Atenolol (s)

Bisoprolol

Metoprolol

A

Beta-adrenoceptor blocker

hypertension

P: 80mg BD

A: 25-50mg

B: 5-10mg OD (max 20)
Adjunct HF, 1.25 (1), 2.5 (1), 3.75 (10, 5 (4), 7.5 (4), 10
**atenolol can be confused with amlodipine

***propranolol can be confused with prednisolone

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56
Q

Amlodipine

Diltiazem

Felodipine

Lercaidipine

Nifedipine

Verapamil

A

Calcium channel blockers

A: 5-10mg

F: 5mg OD, Elderly: 2.5 OD
Prophylaxis/treatment of angina, Hypertension

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57
Q

Bendroflumethizide

Co-amilozide

Indapamide

A

Thiazides and related diuretics

B: Hypertension: 2.5mg, Oedema 5-10mg

CA: 2.5/25, 5/50
contra: hyperkalaemia

I: 2.5mg IR/1.5MR

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58
Q

Enalapril maleate

Lisinopril

Perindopril

Ramipril

A

Angiotensin-converting Enzyme inhibitor

Caution: afro-caribbean, diabetic, agranulocytosis

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59
Q

Candesartan

Irbesartan

Losartan

Valsartan

A

Angiotensin II Receptor Antagonists

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60
Q

Aliskiren

A

Renin Inhibitor

Essential hypertension either alone or in combination with other antihypertensives
150mg OD

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61
Q

Hydralazine HCl

Minoxidil

A

Vasodilator

Moderate to Severe Hypertension, Heart Failure

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62
Q

Midodrine HCl

A

Vasoconstrictor, Sympathomimetics

Pro-drug

Severe orthostatic hypotension due to autonomic dysfunction when corrective factors have been ruled out and other forms of treatment are inadequate

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63
Q

Eplerenone

Spirnolactone

Amiloride HCl

A

Diuretic>Potassium-Sparring Diuretic>Aldosterone Antagonist

Adjunct in stable patients with left ventricular ejection fraction ≤40% with evidence of heart failure, following myocardial infarction (start therapy within 3–14 days of event),
Adjunct in chronic mild heart failure with left ventricular ejection fraction ≤30%

Initially 25 mg daily, then increased to 50 mg daily, increased within 4 weeks of initial treatment.

Contra: hyperkalaemia

***causes potassium retention, potassium supplement not to be given

thiazide: relieve oedema due to HF to reduce blood pressure
loop: in pulmonary oedema due to left ventricular failure/chronic heart failure

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64
Q

Sacubitril with valsartan

A

Angiotensin II Receptor Antagonist

Entresto

Symptomatic chronic heart failure with reduced ejection fraction (in patients not currently taking an ACE inhibitor or angiotensin II receptor antagonist, or stabilised on low doses of either of these agents)

Initially 24/26 mg twice daily for 3–4 weeks, increased if tolerated to 49/51 mg twice daily for 3–4 weeks, then increased if tolerated to 97/103 mg twice daily.

Symptomatic chronic heart failure with reduced ejection fraction (in patients currently stabilised on an ACE inhibitor or angiotensin II receptor antagonist)

Initially 49/51 mg twice daily for 2–4 weeks, increased if tolerated to 97/103 mg twice daily, consider a starting dose of 24/26 mg if systolic blood pressure less than 110 mmHg.

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65
Q

Colesevelam HCl

Coletyramine

A

Bile Acid Sequestrants

Primary hypercholesteroleamia as an adjust to dietary measures

Caution: interference with absorption of fat-soluble vitamins (A, D, K, folic acid)

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66
Q

Ezetimibe

A

Cholesterol Absorption Inhibitor, Lipid modifying drugs

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67
Q

Bezafibrate

Fenofibrate

A

Fibrates, Lipid Modifying drugs

contra: GB disease, photosensitivity

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68
Q

Atorvastatin

Pravastatin

Rosuvastatin

Simvastatin

A

Statins, Lipid Modifying drugs

S: ON

No grapefruit juice. avoid getting pregnant

SE: unusual cramps/pains (sign of muscle inflammation)

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69
Q

Ranolazine

A

Piperazine derivatine

As adjunctive therapy in the treatment of stable angina in patients inadequately controlled or intolerant of first-line antianginal therapies

Initially 375 mg twice daily for 2–4 weeks, then increased to 500 mg twice daily, then adjusted according to response to 750 mg twice daily; reduced if not tolerated to 375–500 mg twice daily.

Caution: Body-weight less than 60 kg; elderly; moderate to severe congestive heart failure; QT interval prolongation

Common: Asthenia (abnormal weakness); constipation; headache; vomiting

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70
Q

Ticagrelor

A

Antiplatelet drug, antithrombotic

Prevention of atherothrombotic events in patients with acute coronary syndrome [in combination with aspirin]

Contra: Active bleeding; history of intracranial haemorrhage

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71
Q

Alteplase

Streptokinase

A

Fibronolytics (breaks up thrombi)

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72
Q

Glyceryl trinitrate

Isosorbide dinitrate/mononitrate

A

Nitrates (role in angina)

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73
Q

Adrenoline/epinephrine

A

Cardiopulmonary Resuscitation/acute anaphylaxis

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74
Q

Bumetanide

Furosemide

Co-amilofruse

A

Loop Diuretics

B: 1mg
F:20-40mg
CA: 2.5/20, 10/80

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75
Q

Mannitol

A

Osmotic Diuretic

IV

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76
Q

Pentoxifylline (Trental)

A

Peripheral Vasodilator

Peripheral vascular disease, venous leg ulcer

400mg 2-3 times

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77
Q

Ipratroprium bromide

Glycopyrronium bromide

Tiotropium (Braltus)

Tiotropium with olodaterol (Spiolto Respimat) 2 puffs OD

Umeclidinium (Incruse Ellipta) 55mcg OD

Umeclidinium (Anoro Ellipta) 1 inhalation OD

A

Antimuscarinic

COPD

Caution: QT prolongation
SE: risk of infection, insomnia, pain

***Braltus: risk of inhalation of capsule if placed in the mouthpiece of the inhaler (store capsule in screw-top bottle)

***pressurised metered dose inhalers: risk of airway obstruction from aspiration of loose objects

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78
Q

Formotertol fumerate (Easyhaler), 12 hr duration

Indacaterol

Salmeterol

A

BEta2 adrenoreceptor agonist, selective, long-acting

***added only if standard-dose corticosteroids fail to control asthma, not use in deteriorating asthma, used in low dose, not for exercise-relief, reviewed clinically

Caution: high dose dangerous in children

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79
Q

Salbutamol (3-5hr duration) (Salamol, Ventolin Accuhaler, Airomir Autohaler)

Terbutaline sulfate (Bricanyl)

A

BEta2 adrenoreceptor agonist, selective, short-acting

S: muscle cramps
T: hypotension, muscle spasm

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80
Q

Beclometasone dipropionate (Clenil modulite, Qvar (fine particles, twice a potent as clenil)

Beclometasone with formoterol (Fostair nexthaler, Fostair)

Becloemtasone with formoterol and glypyrronium (Trimbow)

Budesonide with formoterol (Duoresp spiromax, Symbicort turbohaler)

Fluticasone with formoterol (Flutiform)

Fluticasone with salmertol (Sereflo, Seretide 250 Evohaler, Seretide 500 Accuhaler)

Fluticasone with umeclidinium and vilanterol (Trelegy Ellipta)

Fluticasone with vilanterol (Relver Ellipta 184/22, 92/22)

A

Corticosteroid

SE: oral candidiasis

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81
Q

Montelukast

A

Leukotriene Receptor Antagonist

6 months-5yrs: 4mg in the evening
6-14: 5mg ON
15-adult: 10mg ON

***reminder of the risk of neuropsychiatric reactions (speech impairment, OCD)

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82
Q

Aminophylline (Phyllocontin continus)

Theophylline (Uniphyllin Continus)

Nebuliser solutions (hypertonic sodium chloride solutions)

A

Xanthanes

SE: arrythimias, diarrhoea, dizziness, GORD, tremor

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83
Q

Acrivastine (Benadryl)

Cetirizine HCl

Fexofenadine (Allevia)

Levocetirizine HCl (isomer of cetirizine)

Loratidine (Clarityn)

A

Antihistamine, non-sedating

A: (12-adult) 8mg TDS

C: 2-5: 2.5mg BD
6-11: 5mg BD
12-adult: 10mg OD

seasonal allergy
F: 6-11: 30mg BD
12-Adult: 120mg OD
chronic allergy
12-adult: 180 mg OD

L: 5mg OD

Lora:
child ups 11 under 31kg: 6mg OD
10mg OD

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84
Q

Chlorphenamine maleate (Puritan)

Hydroxyzine HCl

Promethazine Hal (Phenergan)

A

Antihistamine, sedating

C: ***children under 6 should not be given OTC cough and cold with chlorphenamine

H: ***risk of QT-interval prolongation and torsade de pointes (contraindicated in patients with risk factors, avoid use in elderly)

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85
Q

Carbocisteine

A

Reduction of sputum viscosity (helpful in COPD)

capsule: two 375 mg capsules three times a day, reduced when symptoms improve to one 375 mg capsule four times daily

liquid: 15 ml (750 mg) three times a day, reduced when symptoms improve to 10 ml (500 mg) three times a day.

satchet: one sachet three times a day, reduced when symptoms improve to one sachet twice a day.

CHILD DOSE
2-5 years is: 1.25-2.5 ml (62.5-125 mg) four times daily.
5-12 years is: 5 ml (250 mg) three times daily.

**be aware of double strength for children

SE: GI bleed, skin reaction

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86
Q

Dornase alfa

Ivacaftor

Lumacaftor with ivacaftor

Mannitol

A

Cystic Fibrosis (main sign pulmonary disease)

should be offered mucolytic

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87
Q

Pholcodine (Day nurse)

A

Cough Suppressant, Cough and cold preparation

***increased risk of the very rare event of a severe allergic reaction (anaphylaxis) to muscle relaxants (neuromuscular blocking agents) that are used during general anaesthesia in surgery

use with caution in hepatic/renal impairment

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88
Q

Donepezil HCl (reversible acetylcholinesterase inhibitor)

Galantamine

Rivastigmine (4.6 or 9.5 patches)

Memantine (Dopaminergic, NMDA receptor antagonist)

A

Centrally Acting Anticholinesterases

Mild to Moderate dementia in Alzheimer’s disease

5mg ON

SE: aggression, agitation, decrease appetite

transdermal less likely to cause SE
DGR as mono therapies

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89
Q

Carbamazepine (Tegretol)/Oxcarbazepine

Ethosuximide

Ganapentin/Pregabalin

Lamotrigine

Levetiracetam and Brivaracetam

Phenobarbital/Primidone (Barbiturate)

Phenytoin (interacts with folic)

Refinamide

Valproate

Clobazam (Benzo, all epilepsy)

A

Antiepileptics

C: 1st line for generalised tonic-clonic seizures

E: 1st line in absence seizures

G/P: focal seizures

L: 1st line for focal seizures

LB: mono therapy in focal seizures

PP: tonic-clonic and focal but may be sedative

P: avoid in absence/myoconic, use in tonic-clonic and focal

R: seizures in Lennox-Gastaut syndrome

V: generalised epilepsy, tonic-clonic seizures

C: adjunctive therapy

***gabapentin: risk of severe respiratory depression, abuse and dependence

***phenytoin: risk of death and severe harm in IV

***pregabalin: risk of abuse and dependence

**valproate: contraindicate in women and girls of childbearing age unless pregnancy prevention program are met

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90
Q

Lorazepam, Midozolam, Alprazolam, Diazepam

Buspirone (seretonin receptor agonist)

A

Benzodiazepines

status epilepticus, anxiety, panic attacks

***Midazolam: mis-selection of high-strength during conscious sedation

***risk of potential fatal respiratory depression

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91
Q

Atomoxetine

Methyphenidate (Concerta, Delmosart, Equasym, Medikinet)

A

Centrally Acting Symptathomimetics, CNS Stimulants

ADHD

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92
Q

Dexamfetamine

Lisdexamfetamine mesilate (Elvanse)

A

Amfetamines

ADHD

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93
Q

Guanfacine (Intiniv)

A

Alpha2 adrenoceptor agonist

ADHD

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94
Q

Valproic Acid (Antiepiletic)

Lithium (Priadel)

A

Manic episodes in bipolar disorder

Lithium salts, antiphychotics

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95
Q

Isocarboxazid

Phenelzine

Trancylcypromine

A

Monoamine-oxidase inhibitor (MOAI), less used than tricyclic/SSRIs

food restrictions, tyramine

Drepressive illness

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96
Q

Citalopram

Escitalopram

Fluoxetine

Paroxetine

Sertraline

Duloxetine (and noradrenaline)

Venlafaxine (vencarm)

Trozodone HCl

A

SSRI

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97
Q

Mirtazapine

A

Tetracyclic antidepressant

Major depression

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98
Q

Amitriptyline HCl

Dosulepin HCl

Doxepin

Nortriptyline

Vortioxetine

A

Tricyclic antidepressant

Depressive Illness

99
Q

Chlorpromazine HCl

Flupentixol

Haloperidol

Prochlorperazine

Sulpiride

Zuclophenthixol acetate

A

first generation, antipsychotic

schizophrenia

***haloperidol/Zuclophenthixol: preparation for acute apisode not to be confused with depot preparation for maintenance

***Zuclophenthixol acetate confused with Zuclophenthixol decanoate

100
Q

Amisulpiride

Aripriprazole

clozapine

Olanzapine

Quetiapine

Risperidone

A

second generation, antipsychotic

schizophrenia

***aripripazole: preparation for acute apisode not to be confused with depot preparation for maintenance

***clozapine: fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus (varying degrees of impairment of intestinal peristalsis)

***risperidone confused with ropinirole

101
Q

Procyclidine HCl (antimusc)

Trihexyphenidyl HCl (antimusc)

Co-beneldopa (dopamine)

co-careldopa

Ropinirole

Rasagiline (MOAIb inhibitor)

A

Parkinson’s disease

neurogenative condition, death of dopinergic cells of substantial nigra

present with motor symptoms: hypokinesia (folded arms/legs), bradykinesia (slowness of movement), rest tremor, non-motor: dementia, depression

incurable progressive condition, treatment to control symptoms and improve quality of life

co-careldopa/benserazide: motor symptoms decrease quality of life

levodopa, ropinirole, rasagiline: motor symptoms do not affect quality of life

treatment with levodopa is associated with impulse control disorder: gambling, binge eating, hyper sexuality

102
Q

Cyclizine

Domperidone (Motilium)

Metoclopramide HCl

Aprepitant (neurokinin receptor antagonist)

Ondansetron (seretonin receptor antagonist)

Cinnarizine (sedating antihistamine)

Hyoscine hydrobromide (Kwells, Scopoderm) motion sickness, antimusc

A

antiemetic and antonauseants, antihistamine

50mg TDS

Dom: dopamine receptor antagonist, lack of efficacy in children

met:risk of neurological effects (extrapyramidal disorders (repetitive involuntary movements) and tardive dyskinesia (sudden irregular movements that are not controlled)

ondans: increased risk of oral clefts if used in first 12 weeks

103
Q

Betahistine dihydrochloride

A

Menieres Disease

104
Q

Paracetamol (acetaminophen)

Nefopam HCl (centrally acting)

A

non-opioid anageisc

105
Q

Buprenorphine

Co-codamol

Codeine

Diamorphine

Dihydrocodeine

Fentanyl

Morphine

Oxycodone

Tapentadol

Tramadol HCl

A

Opioids

***benzos/opiods: risk of respiratory depression

**codeine: restricted use in children for morphine toxicity and coughs and colds

fentanyl: life threatening and fatal opiod exposure in children

106
Q

Pizotifen

Almotriptan/Eletriptan/Frovatriptan/Rizartriptan/Sumatriptan/Zolmitriptan

A

sedating antihistamine

“triptans”

headache, prophylaxis of migraine

107
Q

Capsaicin

A

Plant alkaloids analgesics

neuropathic pain

apply 3-4 times daily

108
Q

Flurazepam/Loprazolam/Nitrazepam/Temazepam

Melatonin/Zolpidem/Zopiclone (non-bonzo hynotic)

A

sleep disorders

insomnia

benzo/z-drugs avoided in elderly

109
Q

Sodium Oxybate

Pitolisant

A

Narcolepsy

110
Q

Acamprosate calcium

A

GABA analogues

maintenance of abstinence in alcohol-dependent patients

333mg GR tablet

111
Q

Bupropion HCl (zyban)

A

Nicotine dependence

to aid smoking cessation in combination with motivational support in nicotine-dependent patients

112
Q

Methadone

A

Opiod dependence

113
Q

Amikacin (used in gentamicin-resistant gram positive)

Gentamicin (broad spectrum, antibacterial of choice)

Tobramycin

Neomycin sulfate

Streptomycin (mycobacterium tuberculosis)

A

Aminoglycosides

against some Gram-positive and many Gram-negative organisms

AGT: Pseudomonas aeruginosa

114
Q

Etrapenem

Imippenem with cilastatin

Meropenem

A

carbapenems: beta-lactam antibacterials, broad spectrum, many gram-positive and gram-negative organisms, and anaerobes

115
Q

Cefalexin

A

Cephalosporins (attach to penicillin binding proteins to interrupt cell biosyntheses leading to cell death)

hospital-acquired pneumonia, lower UTI

116
Q

Vancomycin

A

glyopeptide antibacterial

C. difficile
125mg every 6 hrs for 10 days

117
Q

Clindamycin

A

Lincosamides

MRSA

118
Q

Azithromycin

Claritbromycin

Erythromycin

A

Macrolides

caution: QT prolongation

119
Q

Metronidazole

A

nitromidazole derivatives

anaerobic infections, H. pylori, Crohn’s disease

120
Q

Phenoxymethylpenicillin (Penicillin V)

Amoxicillin (broad spectrum)

Co-amoxiclav (broad with beta lactamase inhibitor)

Pivmecillinam HCl (mecillinam-type)

Flucloxacillin (penicillinase resistant)

A

Penicillins

P: oral infection, otits media, acute sore throat
500mg QDS

A: sinitus, oral infection, community-acquired pneumonia, COPD, dental abcess
500mg TDS

Co-amoxiclav: 250/125, 500/125

Piv: uncomplicated cystitis, UTI

Flu: 500mg QDS

***flu: cholestatic jaundice and hepatitis can occur after 2 months after treatment

121
Q

Ciprofloxacin

Levofloxacin

Moxifloxacin

Ofloxacin

A

Quinolones

***may induce convulsions, tendon damage, risk of aortic aneurysm

Caution: QT prolongation

122
Q

Co-trimoxazole

Sulfadiazine (prevention of rheumatic fever occurrence)

A

Sulfonamides

***drug choice in prophylaxis and treatment of pneumonia

123
Q

Doxycycline

Lymecycline

Minocycline

Tigecycline

A

Tetracyclines

chlamydia, UTI, bronchietasis, COPD, acne

D: 200mg then 100mg OD

L: 408mg BD

124
Q

Chloramphenicol

Fosfomycin

Fucidic Acid

Trimethoprim

A

antibacterial, other

C: typhoid fever, lifethretening infections

F: uti

FA: skin infection

125
Q

Dapsone

Rifampicin

Clofazimine

Isoniazis

A

Antimycobacterials

Leprosy

rif: contra in jasduce
caution: discolours soft lenses

126
Q

Methenamine hippurate

Nitrofurantoin

A

Antibacterials

UTI

Meth: 1g BD

127
Q

Amphotericin

A

Antifungal, pollen anti fungal

fungal infection

**error dose in fungi zone administration

128
Q

Fluconazole

Itraconazole

A

triazole antifungal

thrush
F: 150mg OD

I: 200mg BD

129
Q

Atovaquone

Ivermectin

Mebendazole

A

Antoprotozoal

Pneumonia
750mg BD

130
Q

Ivermectin

Mebendazole

A

Anthelmintics

I: scabies
M: threadworm

131
Q

Atovaquone with proguanil HCl

Chloroquine

Mefloquine

A

Antimalarials

A: 1 tablet OD started 1-2 days before travel and continued for 1 week after leaving

C: 310mg once weekly started 1 week before travel and continued for 4 week after leaving

M: 250mg once weekly started 2-3 weeks before travel and continued for 4 week after leaving

132
Q

Entecavir

Telbivudine

Adefovir dipivoxil (nucleotide analogues)

Ribavirin (nucleoside)

A

Nucleoside Analogues

Hepatitis B

Hep C

133
Q

Peginterferon alfa

Elbasvir with grazovir

A

Interferones, immunostimulants

Hepatitis C

HCV inhibitor, antiviral

***risk of interaction with vitamin K antagonist and changed in INR

134
Q

Inosine pranobex

Aciclovir/Famciclovir/Valaciclovir

A

Inosine Complex, antiviral

nucleoside analogues, antiviral

HPV

135
Q

Cidofovir

Ganciclovir

A

Cytomegalovirus Infections

nucleoside analogues

136
Q

Enfuvirtide

Dolutegravir

Elvitegravir, Raltegravir

A

HIV infection

HIV-fusion inhibitor

HIV-integrase inhibitor

**increase risk of neural tube defects, not prescribed in pregnant seeking woman

137
Q

Oseltammivir

Zanamivir

A

Antiviral, Influenza, Neuraminidase inhibitor

138
Q

Desmopressin (Desmomelt)

A

Vasopressin and Analogues, Pituitary and hypothalamic hormones and analogues

Diabetes insipidus, treament

Primary nocturnal enuresis
120 micrograms once daily, increased if necessary to 240 micrograms once daily, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least 1 week.

Contra: hyponatraemia (elderly at risk, renal impairment)

139
Q

Betamethasone

Deflazacort

Dexamethasone*

Hydrocortisone*

Methylprednisolone*

Prednisolone*

Triamcinolone acetonide*

A

Corticosteroid

Suppression of inflammatory and allergic disorders, congenital adrenal hyperplasia

***M: do not use in patients with cow milk allergy, Solu-Medrone contains lactose

Prednisolone: COPD, croup, asthma, myasthenia gravis

*local inflammation of joints and soft tissue

140
Q

Ketoconazole

A

Enzyme Inhibitor

Cushing’s syndrome

**oral ketoconaole suspended for fungal treatments, risk of hepatotoxicity

141
Q

Metformin HCl (Glucophage SR, Sukkarto SR)

A

Biguanides, Blood glucose lowering drugs

T2DM, PCOS

IR: Initially 500 mg once daily for at least 1 week, dose to be taken with breakfast, then 500 mg twice daily for at least 1 week, dose to be taken with breakfast and evening meal, then 500 mg 3 times a day, dose to be taken with breakfast, lunch and evening meal; maximum 2 g per day.

MR: Initially 500 mg once daily, then increased if necessary up to 2 g once daily, dose increased gradually, every 10–15 days, dose to be taken with evening meal, alternatively increased to 1 g twice daily, dose to be taken with meals, alternative dose only to be used if control not achieved with once daily dose regimen. If control still not achieved then change to standard release tablets.

SE: nausea, vomitting, diarrhoea, lack of appetite, abdominal pain, unusual taste

Lactic acidosis

Diabetic ketoacidosos

***reduces B12 levels

142
Q

Linagliptin (Trajenta)

Sitagliptin (Januvia)

Vildagliptin with metformin (Eucreas, 50/850, 50/1)

A

Dipeptidylpeptidase-4 inhibitors (Gliptins)

T2DM
L: 5mgOD
S: 100mg OD
V: 1 tab BD

SE: cough, nose/throat symptoms, rash

if persistent, severe tummy ache (can indicate inflamed pancreatitis), speak with GP

143
Q

Dulalgutide (Trulicity)

Liraglutide (Victoza, Saxenda)

Semaglutide (Ozempic)

A

Glucagon-like peptide-1 receptor agonists

T2DM (if metformin inappropriate)
0.75mg OW s/c

in combination
1.5mg OW s/c

Lira: Initially 0.6 mg once daily for at least 1 week, then increased to 1.2 mg once daily for at least 1 week, then increased if necessary to 1.8 mg once daily.

Sema: Initially 0.25 mg once weekly for 4 weeks, then increased to 0.5 mg once weekly for at least 4 weeks, then increased if necessary to 1 mg once weekly.

***reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced/discontinued

**insulin/sulfonylurea needs to be reduced when used concomitantly

144
Q

Canagliflozin (Invokana 100mg, 300mg)

Dapagliflozin (Forxiga)

Dapafliflozin with metformin (Xigduo 5/850, 5/1)

Empagliflozin (Jardiance 10, 25)

Empagliflozin with metformin (Synjardy 12.5/850, 5/850, 5/1)

A

sodium glucose co-transportor 2 inhibitors

T2DM
100 mg once daily; increased if tolerated to 300 mg once daily if required, dose to be taken preferably before breakfast.

Dapag: T2DM 10mg OD, T1DM 5mg OD

Empag: T2DM 10mg OD, increased to 25mg OD

Empag w/met: 5/850–5/1000 mg twice daily, based on patient’s current metformin dose, increased if necessary to 12.5/850–12.5/1000 mg twice daily

not recommended in adults 85+

***risk of ketoacidosis, lower-limb mutations (preventative foot care), Fournier’s gangrene (necrotising fasciitis of the genitalia/perineum)

145
Q

Glicazide

Glimepiride

A

Sulfonylureas

T2DM
IR: Initially 40–80 mg daily, adjusted according to response, increased if necessary up to 160 mg once daily, dose to be taken with breakfast, doses higher than 160 mg to be given in divided doses; maximum 320 mg per day.

MR: Initially 30 mg daily, dose to be taken with breakfast, adjust dose according to response every 4 weeks (after 2 weeks if no decrease in blood glucose); maximum 120 mg per day.

Glimi: Initially 1 mg daily, adjusted according to response, then increased in steps of 1 mg every 1–2 weeks, increased to 4 mg daily, dose to be taken shortly before or with first main meal, the daily dose may be increased further, in exceptional circumstances; maximum 6 mg per day.

caution: can cause weight gain, elderly, G6PD

146
Q

Pioglitazone

A

Thiazolidinediones

T2DM
Initially 15–30 mg once daily, adjusted according to response to 45 mg once daily, review treatment after 3–6 months and regularly thereafter. In elderly patients, initiate with lowest possible dose and increase gradually.

***CVD safety, heart failure incidence, risk of bladder cancer

147
Q

Insulin

Insulin aspart (Fiasco, Novorapid)

Insulin lispro (Humalog, Humalog Kwikpen)

A

Insulin

**unit/international units should NOT be abbreviated, insulin NOT be withdrawn from pen/pen refill, can lead to fatal overdose

SE: oedema
overdose: hypoglycaemia

148
Q

Biphasic isophane insulin (Humulin M3, Humulin M3 Kwikpen)

Isophane insulin (Humulin I, Humulin I Kwikpen, Insulatard)

A

Intermediate acting insulin

149
Q

Biphasic insulin aspart (Novomix 30 flexpen/penfill)

Biphasic insulin lispro (Humalog Mix25/Mix 50)

A

Intermediate acting combined with rapid-acting insulin

150
Q

Insulin deluded (Tresiba)

Insulin determir (Levemir)

Insulin glargine (Tuojeo, Abasaglar, Lantus, Semglee)

A

Long-Acting

151
Q

15-20g of fast-acting carbohydrate (40% gel: glucogel, dextrogel)

3-4 teaspoons of sugar in water

4-7 glucose tablets

150-200mL fruit juice

A

Hypoglycaemia treatment

low blood sugar
able to swallow

152
Q

Alendronic Acid

Ibandronic Acid

A

Bisphosphates

Osteoporosis
A: 10mg OD, 70mg OW

SE: GI disorder, joint swelling, vertigo

***atypical femoral fractures, osteonecrosis of the jaw/external auditory canal

1st line in postmenopausal women, in men: alendrotnic acid or risedronate

treatment duration: benefit from biphosphnate period, review after 5 yrs in alendrotnic/risdronate/ibandronic, 3 yrs in zoledronic

153
Q

Denusumab (Prolia, Xgeva)

A

Monoclonal Antibody, drugs affecting bone structure and mineralisation

Osteoporosis in postmenopausal women and in men at increased risk of fractions (Prolia)

Prevention of skeletal related events in patients with bone metastases (Xgeva)

154
Q

Goserelin (Zoladex 3.6, Zoladex LA 10.8))

Leuprorelin acetate (Prostap 3 DCS)

A

Gonadotrophin-releasing hormones, pituitary and hypothalamic hormones/analogues

Endometriosis

Advanced prostate cancer

155
Q

Estradiol (Elleste, Estraderm, Estradot, Evorel, Oestrogel, Sandrena)

Ethinylestradio;

A

Female sex hormone responsive conditions

Oestrogens (HRT)

Menopausal women
osteoporosis prophylaxis

***increased risk of breast cancer

SE: headache, nausea, skin reaction

156
Q

Oestrogen combined with medroxyprogesterone (Premique)

Estradiol with dydrogesterone (Femoston, Femoston Conti)

Estradiol with levonorgestrel (Femseven conti/sequi patch)

Estradiol with norethisterone (Elleste duet, Evorel conti/sequi, kliofem, kliovance)

A

Oestrogen combined with medroxyprogesterone

Menopausal symptoms in women with a uterus: 1 tablet OD

157
Q

Norethisterone

Progesterone (Utrogestan)

A

Progestogens

N: endometriosis, dysfunctional uterine bleeding, dysmenorrhoea, contraception

progestognenic opposition of oestrogen HRT
200mg OD on days 15-26 of each 28-day oestrogen HRT cycle, alternatively 100mg OD on days 1-25 of each 28-day oestrogen HRT cycle

158
Q

Testosterone (Testim, Testogel, Tostran)

A

Androgens (male sex hormones)

SE: hypertrigluceridaemia, hot flush, hypertension, increase weight, prostate abnormalities

Testim/Testogel 50mg/5g: Apply 50 mg once daily, subsequent application adjusted according to response; maximum 100 mg per day.

Testim (Testogel): one tube (satchet) of 5 g contains 50 mg testosterone.

Testogel 16.2mg/g: Apply 40.5 mg once daily; increased in steps of 20.25 mg, adjusted according to response; maximum 81 mg per day.
**monitor prostate in men over 45

one pump actuation delivers 1.25 g of gel containing 20.25 mg of testosterone.

159
Q

Carbimazole

Propylthiouracil (thiouracil)

A

Sulfur-containing imidazole, antithyroid drugs

Hyperthyroidism15–40 mg daily continue until the patient becomes euthyroid, usually after 4 to 8 weeks, higher doses should be prescribed under specialist supervision only, then reduced to 5–15 mg daily, reduce dose gradually, therapy usually given for 12 to 18 months.

***neutropenia, agranulocytosis, risk of congenital malformations, risk of acute pancreatitis

contra: blood disorders, pregnancy

160
Q

Levothyroxine sodium

Liothyronine sodium

A

Thyroid hormones

Hypothyroidism

contra: thyrotoxicosis

161
Q

Darifenacin

Fesoterodine fumarate

Flavoxate HCl

Oxybutynin HCl

Propiverine HCl

Solifenacin succinate

Tolterodine tartrate

Trospium HCl

Mirabegron (beta3 adrenoreceptor, 25, 50)

A

antimuscarinics, Urinary

urinary frequency, urgency, incontinenence

D: 7.5mg OD increased to 15mg after 2 weeks

Fe: 4mg OD, increased to 8mg OD (4mg MAX with concurrent CYP3A4 inhibitors)

Fl: 200mg TDS

O: (IR)5mg 2-3 times, upto 4 times
(MR): 5mg OD, 20mg max

avoid in hepatic/renal impairment

caution: QT prolongation

162
Q

Alfuzosin HCl

Doxazosin

Tamsulosin (400mcg MR)

A

alpha adrenoreceptor

urinary retention

benign prostatic hyperplasia

D: hypertension

163
Q

Dutaseride

Finsasteride

A

5alpha-reductase inhibitor

F: androgenic alopecia in men, 1mg

164
Q

Cirtic acid with potassium citrate

Sodium citrate

A

Alkalising drug, urinary

Lidocaine HCl gel for urethral pain/catherter discomfort

Alkalisation of urine with potassium citrate, cystitis discomfort

165
Q

Pentosan polysulfate sodium

A

Heparinoids

bladder pain syndrome
100mg TDS

166
Q

Dienogest with estradiol valerate (Qlaira)

Estradiol with nomegestrol

Ethinylestradiol with desogestrel (Gedarel, Mercilon)

Ethinylestradiol with drospirenone (Lucette, Yasmin)

Ethinylestradiol with etanogestrel (Nuvaring)

Ethinylestradiol with gestodene (Millinette)

Ethinylestradiol with levonorgestrel (Microgynon 30, Rigevidon)

Ethinylestradiol with norgestimate (Cilique)

A

Combined hormonal contraceptive

167
Q

Ulipristal acetate

A

Progesterone receptor modulator, emergency

U: 30mg within 5 days

***risk of liver injury

168
Q

Desogestrel (desogestrel, Cerazette)

Levonorgestrel (Levonelle, Mirena (IUD)

A

progestogen-only contraception

L: emergency, 1.5 mg within 3 days

***uterine perforation

169
Q

Etonogestral (implant)

Medroxyprogesterone acetate (Depo)

A

progestogen-only parenteral contraception

**neurovascular injury and implant migration

170
Q

Nonoxinol (gel)

A

spermicidal contraception

171
Q

avanafil

sildenafil (Viagra)

tadalafil (longer-acting)

vardenafil

alprostadil (prostaglandin and analogue, caverjet)

dapoxetine (SSRI, premature ejaculation)

A

phosphodiesterase type-5 inhibitor

erectile dysfunction

172
Q

Mifepristone

misoprostol

A

termination of pregnancy

progesterone receptor modulators

misoprostol dose to be given after mifepristone

173
Q

Clindamycin (Dalacin 2%)

A

Lincosamide, antibacterial

bacterial vaginosis

174
Q

Clotrimazole (Canesten1%, 2%, 10%)

A

Imidazole anti fungal

superficial sites (1%/2%) cream 2-3 times a day

thrush (10%)
cream, inserted, 5g in 1 dose

pessary 200mg for three nights

recurrent thrush
500mg every week for 6 months

175
Q

Azathioprine

A

antimetabolites, immunosuppressant

Crohn’s disease, rheumatoid arthritis, autoimmune conditions, myasthenia gravis

176
Q

Ciclosporin

Tacrolimus (Adoport, Prograf)

A

calcineurin inhibitors and related drugs, immunosuppressants

ulcerative colitis, rheumatoid arthritis, organ transplantation

T: prophylaxis or transplant rejection

**Cic/Tac: must be prescribed by brand

177
Q

Mycophenolate mofetil

A

purine synthesis inhibitor, immunosuppressant

prophylaxis of rejection in transplantation

*does not indicate increased risk of malformations/miscarriage where father was taking medicine

178
Q

Fampridine

interferon beta, peginterferon beta-1a (interferon)

A

cholinergic receptor stimulating drugs

F: improvement of walking disability in multiple sclerosis

I: relapsing, remitting MS

179
Q

Alemtuzumab

Natalizumab

Ocrelizumab

A

anti-lymphocyte monoclonal antibodies

treatment of adults with relapsing-remitting MS with active disease by clinical or imaging features

***monitoring requirements due to CVD and immune-mediated reactions

180
Q

Atezolizumab (Lung)

Avelumab (me static merkel cell carcinoma)

Bevacizumab (mestatic breast cancer)

Daratumumab (multiple myeloma)

Durvalumab (lung)

Rituximab (non-hodgkins)

Mitoxantrone (breast cancer)

Fluorouracil (GI/breast)

Mercaptopurine (leukaemia)

methotrexate (crohns)

Bleomycin (non Hodgkins, mestatic germ cell, squamous cell)

cisplatin (platinums) (testicular, cervical, bladder, head and neck, ovarian)

Paclitaxel (taxanes) (ovarian)

vinblastine, vincristine (vinca alkaloid)

Thalidomide

A

monoclonal antibodies, malignant disease

***Beva: risk of osteonecrosis of jaw

***Dara: risk of hep B virus reactivation

181
Q

Darbepoetin Alfa

Epoetin alfa

Epoetin beta

Epoetin zeta

A

Epoetins

Symptomatic anaemia associated with renal failure in patients on dialysis

**Stevens-Johnson syndrome, toxic epidermal necrolysis, severe skin reactions

**erythropoietins-haemoglobin concentration overcorrection in patients with CKD increase CVD event and cancer patients increased thrombosis

***tumor progression and survival in patients with cancer

182
Q

Ferric carboxymatlose

Iron dextran

Iron isomaltoside 1000

Iron sucrose

Ferric maltolate

Ferrous fumarate

Ferrous sulfate

Sodium feredetate (Sytron)

A

Iron, injectable

iron-deficiency anaemia

**hypersensitivity reactions with IV iron

Iron, oral

FM: 30mg BD
FF: 210mg 1-2 times a day (prophylactic), 2-3times a day (therapeutic)

FS: 200mg OD (pro), 200mg 2-3 times (thera)

183
Q

Folic acid

A

Folate

5mg OD (in pregnant women), OW prevention of methotrexate side effects in rheumatic disease taken on different day to met

184
Q

Cyanocobalamin

Hydroxocobalamin (IM, 1mg/ml)

A

Vitamin B Group

vitamin B12 deficiency of dietary origin
50-150mcg OD to be taken between meals

185
Q

Filgrastim

Lenograstim

Lipegfilgrastim

A

Granulocyte-colony stimulating factors, immunostimulant

reduction in duration of neutropenia and incidence of febrile neutropenia in cytotoxic chemotherapy

186
Q

Sodium bicarbonate

A

Bicarbonate

Alkinisation of urine, severe metabolic acidosis

187
Q

Potassium chloride with….

A

Potassium

electrolyte imbalance

188
Q

sodium chloride

A

sodium chloride

prophylaxis of sodium deficiency, renal salt wasting, management of diabetic ketoacidosis

189
Q

Disodium hydrogen citrate with glucose, potassium chloride and sodium chloride (Dioralyte)

Potassium chloride with rice powder, sodium chloride and sodium citrate (Dioralyte Relief)

A

oral rehydration salts

fluid and electrolyte loss in diarrhoea

190
Q

calcium carbonate (Adcal, Calciche, Rennie)

calcium carbonate with calcium lactate gluconate (Sandocal)

calcium chloride
calcium glutinate

A

calcium

calcium deficiency

hypocalcaemia

191
Q

Sevelamer

A

Phosphate binder

hyperphosphataemia in patients on harm-dialysis, CKD

192
Q

Mercaptamine

A

Cystinosis

nephropathic cystinosis

193
Q

Ascorbic Acid

A

Vitamin C

prevention/treatment of scurvy

194
Q

Thiamine (B1)

Pyridoxine HCl (B6)

Vitamin B complex

A

Vitamin B group

195
Q

Alfacalcidol

Cholecalciferol (D3, Sterol, Fultium, SunVit)

Ergocalciferol (D2)

Colecalciferol with calcium carbonate (Adcal, Accrete, Calcichew)

A

Vitamin D and analogues

rickets, vitamin D prevention

***contra: hypercalcaemia

196
Q

Glucosamine

A

chondroprotective drugs

symptomatic relief of mild to moderate osteoarthritis of the knew

197
Q

hydroxychloroquine sulfate

leflunomide

penicillamine

sodium aurothiomalate

A

disease modifying antirheumatic drugs

active rheumatic arthritis

198
Q

Anakinra

Sarilumab

Secukinumab

Tocilizumab

Ustekinumab

Baricitinib
Tofacitinib
Upadacitinb

Abatacept

Etanercept
Infliximab

A

interleukin inhibitor, immunosuppressant

RA

JAK inhibitors

T-Cell Activation

Tumour necrosis factor alpha inhibitors

199
Q

Colchicine

Allopurinol

Febuxostat

A

Plant alkaloids

acute gout
500mcg 2-4 times

Xanthane Oxidase inhibitors
prophylaxis of gout

treatment of chronic hyperuricaemia in gout

200
Q

Neostigmine

Pyridostigmine bromide

A

antocholinesterase

Myasthenia gravis

201
Q

Amifampridine

A

cholinergic receptor stimulating drugs

Lambert-Eaton myasthenic syndrome

202
Q

Baclofen

Methocarbamol

Tizanidine

A

centrally acting muscle relaxant

B: pain of muscle spasm in palliative care, hiccup due to gastric distension, chronic severe spasticity

M: short-term symptomatic relief of muscle spasm

T: spasticity associated with MS or spinal cord injury

203
Q

Aceclofenac/Celecoxib

Ibuprofen (not for acute gout)

Naproxen (1st choice)

Flurbiprofen (more effective than ibuprofen)

Ketoprofen

Diclofenac sodium (voltarol emugel)

Etodolac

Indometacin (high incidence of side effects)

Mefenamic acid

Meloxicam

Piroxicam (long furation of action, associated with skin reactions)

Nabumetone

Tolfenamic acid (migraine treatment)

Aspirin

A

NSAIDs

low back pain/sciatica
=>nsaid, weake opiod with paracetamol, but not paracetamol alone for back pain, benzodiazepines
=>consider GI, cardio-renal, hepatic c risks (paracetamol preferrred for elderly)

A/C: pain and inflammation in osteoarthritis, RA, ankylosing spondylitis

E: symptomatic relief osteoarthritis, RA

Men: pain and inflammation in osteoarthritis, menorrhagia/dysmenorrhoea

Mel: short-term relief of pain in osteoarthritis, long-term for RA and ankylosing

A: high doses to treat RA

204
Q

Xylometazoline and antazoline (Otrivine Antistin)

Azelastine HCl (Optilast)

Olopatadine

A

Antihistamines, eye

allergic conjunctivitis

205
Q

Sodium cromoglicate

A

mast-cell stabiliser

allergic conjunctivitis

206
Q

Nepafenac (Nevanac)

A

NSAID, eye drop

prophylaxis and treatment of postoperative pain and inflammation associated with cataract surgery

207
Q

Betamethasone (Betnesol)

Dexamethasone (Dexafree, Eythalm)

Prednisolone (Minims)

A

corticosteroid, eye drops

local treatment of inflammation (short-term)

208
Q

Betamethasone with neomycin (Betnesol-N)

Dexamethasone with framycetin sulfate and gramicidin (Sofradex)

Dexamethasone with hypromellose, neomycin and polymyxin B sulfate (Maxitrol)

Dexamethasone with Tobramycin (Tobradex)

A

corticosteroid combination with anti-infectives

local treatment of inflammation and bacterial infection (short-term)

209
Q

Atropine sulfate

Cyclopentolate HCl

A

antimuscarinic, eye

cyclopegia, anterior uveitis

210
Q

Acetylcysteine (Ilube)

Carbomer (Viscotears, Pailin)

Carmellose sodium (Carmize, Celluvisc)

Hypromellose (Hydromoor)

Sodium hyaluronate (Blink)

Sodiukm hyaluronate with trehalose (Thealoz duo)

A

ocular lubricants, dry eye conditions

A: tear deficiency

C: dry eyes

CS: dry eye condition

H: tear deficiency

S: dry eye condition

211
Q

latanoprost
tafluprost (saflutan)
travoprost
bimatoprost

betaxolol
levobunolol hcl
timolol maleate

brinzolamide
dorzolamide

apraclonidine

pilocarpine

A

ocular hypertension/glaucoma

1st line (topical prostaglandin analogue)

switch to alternative TPA before topical beta blocker switch (2nd line)

carbonic anhydrase inhibitor (3rd line)

sympathomimetic

topical miotic

212
Q

Framycetin sulfate

Gentamicin

Neomycin sulfate

Acetic Acid 2% (EarCalm)

A

Ear
Aminoglycosides

Bacterial infection in otitis externa

213
Q

Ciprofloxacin

A

Ear
Quinolones
acute otitis externa

214
Q

Chloramphenicol

A

Other antibacterial, ear
Bacterial infection in otitis externa

215
Q

clotrimazole

A

Imidazole antifungals, ear

fungal infection in otitis externa

216
Q

Betamethasone

Flumetasone pivalate with clioquinol

Prednisolone

Betamethasone with neomycin

Dexamethasone with framycetin sulfate and gramicidin

Ciprofloxacin with dexamethasone

Ciprofloxacin with fluocinolone

A

corticosteroids, ear

eczematous inflammation in otitis externa

acute otitis media in patients with tympanostomy tubes, acute otitis externa

217
Q

sodium bicarbonate

almond oil

docusate sodium

olive oil

urea hydrogen peroxide

A

Bicarbonate

softening drugs

removal of earwax

218
Q

Ephedrine HCl

Pseudoephedrine HCl

Xylometazoline HCl

A

Nasal congestion

219
Q

Chlorhexidine with neomycin (Naseptin)

Mupirocin (Bactroban)

A

Nasal infection, sinitus ‘common cold’

aminoglycosides

220
Q

Azelastine HCl (Rhinolast)

Ipratropium bromide (Rinatec)

A

nasal inflammation, allergic/nonallergic rhinitis

antihistamine

antimuscarinic

221
Q

Beclometasone dipropionate (Beconase)

Budesonide (Rhinocort)

Fluticasone (Avamys)

Fluticasone with azelastine (Dymista)

Mometasone furoate (Nasonex)

Triamcinolone acetonide (Nasocort)

A

corticosteroids, nose

222
Q
  1. Biotene Oralbalance gel, Xerotin
  2. BioXtra, Glandosane, Saliva Orthana, Saliveze
  3. Saliveze pastilles
A

Artificial saliva products

  1. any condition to dry mouth
  2. dry mouth associated only with radiotherapy or sicca syndrome
  3. salivary stimulant
223
Q

Chlorhexidine (Corsodyl)

Hexetidine (Oraldene)

Hydrogen peroxide (Peroxyl)

Sodium Chloride

A

oral hygiene

gingivitis, oral candidiasis

224
Q

sodium fluoride

A

prophylaxis of dental caries

225
Q

Lidocaine HCl (Anbesol)

A

mouth ulcer

226
Q

benzydamine HCl (Difflam)

A

sore throat

227
Q

Choline salicylate (bonjela)

A

mild oral lesions

228
Q

miconazole (Daktarin oral gel)

Nystatin

A

oropharyngeal fungal infections

oral thrush

229
Q

barrier creams and oitnments (Sudocrem)

emollient bath and shower products, antimicrobial-containing (Dermol 200 shower emollient, Dermol 600 bath emoillient, Dermal wash emulsion, oilatum plus)

emollient bath and shower products, paraffin-containing (Dermalo, doublebase, E45, hydromol, QV bath oil/gentle wash, Zerolatum)

emollient bath and shower products, soya-bean oil-containing (Balneum)

emollient creams and ointments, antimicrobial-containing (Dermol 500)

emollient creams and ointments, colloidal oatmeal-containing (Aveeno)

emollient creams and ointments, paraffin-containing (AproDerm, Epimax, Cetraben, Diprobase, E45, ZeroAQS, Zerobase, Epaderm, 50:50

emollients, urea-containing (Eucerin, Flexitol)

A

barrier preparations, skin

emollients
dry and pruritic skin conditions including eczema and dermatitis

dry skin conditions

dry skin conditions, eczema

eczema, ichthyosis, xeroderma, hyperkeratosis

dry skin of feet/heels

230
Q

metronidazole (Rozex)

clotrimazole (Canesten 1% solution, Canesten 1%/2%/10%)

A

bacterial skin infection

inflammatory papules, pustules and erythema of rosacea

fungal skin infection

231
Q

Ketoconazole (Dandrozol, Nizoral)

A

treatment/prophylaxis of dermatitis and dandruff

232
Q

Amorolfine

A

fungal nail infection

233
Q

Terbinafine (Lamisil)

Griseofulvin

Undecenoic acid with zinc undecenoate (Mycota)

A

tinea pedis (athlete’s foot)

234
Q
  1. benzoic acid with salicylic acid
  2. benzyl benzoate/permethrin
  3. dimeticone/malathion/permethrin
  4. aciclovir (Zovirax)
  5. coal tar (Alphosyl 2 in 1, Neutrogena T/gel)
  6. coal tar with coconut oil and salicylic acid (Capasal)
  7. tacrolimus (Protopic)
A
  1. ringworm
  2. scabies
  3. head lice, crab lice
  4. cold sore
  5. psoriasis, scaly scalp disorder such as psoriasis, eczema, seborrhoeic dermatitis and dandruff
  6. 5+cradle cap
  7. atopic eczema
235
Q
  1. betamethasone (Audavate), fluocinolone acetonide (Synalar), mometasone (Elocon)
  2. Calcipotriol with betamethasone (Dovobet, Enstilar)
  3. Clobetasol propionate (Dermovate, Etrivex)
  4. Clobetasol butyrate (Eumovate)
  5. betamethasone with clotrimazole (Lotriderm)
  6. betamethasone with salicylic acid (Diprosalic)
  7. clobetasone butyrate with nystatin and oxytetracycline (Trimovate)
  8. Hydrocortisone with benzalkonium chloride, dimeticone and nystatin (Timodine), hydrocortisone with clotrimazole (Canesten HC), hydrocortisone with fusidic acid (Fucidin H), hydrocortisone with miconazole (Daktacort)
A
  1. severe inflammatory skin disorder, psoriasis
  2. scalp psoriasis
  3. short-term treatment only of severe resistant inflammatory skin disorder, moderate scalp psoriasis
  4. eczemas and dermatitis of all types, maintenance between courses of more potent corticosteroids
  5. short-term treatment of ringworm infections and candidiasis
  6. severe inflammatory skin disorders such as eczema and unresponsive to less potent corticosteroids, psoriasis
  7. steroid-responsive dermatoses where candidal or bacterial infection is present
  8. Mild inflammatory skin disorder associated with infection
236
Q

Isotretinoin

A

retinoid

severe acne

***PPP

**neuropsychiatric reactions and sexual dysfunction: erectile dysfunction and decreased libido, depression

Caution: Avoid blood donation during treatment and for at least 1 month after treatment

237
Q

Glycopyrronium bromide

aluminium chloride hexahydrate (Driller)

A

hyperhidrosis

238
Q

Levomenthol 0Dermacool, Menthoderm)

Crotamiton (Eurex)

A

pruritis (itchy skin)

239
Q

Clindamycin (Dalacin T)

Co-cyprindiol (Clairette, Dianette, Teragezza)*

Erythromycin with zinc acetate (Zineryt)

Benzoyl peroxide (Acnecide)

Benzoyl peroxide with clindamycin (Duac)

Azelaic acid (Skinoren)

Adapalene (Differin)

Adapalene with benzoyl peroxide (Epiduo)

A

Acne vulgaris

acne in females*

240
Q

Ivermectin

A

rosacea

241
Q

minoxidil (Regaine)

A

androgenetic alopecia

242
Q

Povidone-iodine

Chlorhexidine (Hibiscrub, Hydrex)

Chlorhexidine with cetrimide (Savlon)

A

antiseptic and disinfectant

243
Q

Silver nitrate

Imiquimod (Aldara, genital)

salicylic acid with lactic acid (Salataxc)

A

warts, verrucas

BNF (15 decks)

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