Indications

Question 1

Adrenaline

Answer 1

1) Cardiac Arrest
2) Anaphylaxis
3) Induce local vasoconstriction e.g with local anaesthetic

Question 2

Corticosteroids (systemic)

Hydrocortisone, prednisolone, dexamethasone

Answer 2

1️⃣ In allergic or inflammatory disorders e.g. anaphylaxis or asthma

2️⃣ In autoimmune disorders e.g IBD

3️⃣ In the treatment of cancers as chemotherapy or to reduce tumour associated swelling

4️⃣ Hormone replacement in adrenal insufficiency or hypopituitarism

Question 3

Thiazide like Diuretics

Answer 3

1️⃣First line hypertension in those who would normally have CCBs but cannot (e.g. heart failure, oedema)

2️⃣Add on for HTN

Question 4

Statins

Answer 4

1️⃣ Primary prevention of CVD (those over 40 with risk >10% in next 20 yrs)
2️⃣ Secondary prevention of CVD (in those with existing disease alongside lifestyle changes)
3️⃣ Primary hyperlipidaemia

Question 5

Clopidogrel

Answer 5

1️⃣ Treatment of ACS
2️⃣ Prevention on thrombotic arterial events in those with CVD, cerebrovascular disease or peripheral arterial disease
3️⃣ Prevent occlusion of coronary artery stents
4️⃣ Reduce risk of thrombus in atrial fibrillation where warfarin and NOACs are ❌

Question 6

Antihistamine

Answer 6

1️⃣Allergies e.g. hayfever
2️⃣Anaphylaxis
3️⃣Relief of pruritis and urticaria
4️⃣Anti-emetic (see elsewhere)

Question 7

Beta-blockers

Answer 7

1) Ischaemic heart disease - 1st line for angina and ACS
2) Chronic heart failure - 1st line
3) Atrial Fibrillation - 1st line rate control
4) Supraventricular tachycardia - 1st line w/o circulatory compromise
5) Hypertension - not first line

Question 8

5-a reductase inhibitors

Finasteride

Answer 8

Benign prostatic enlargement (2nd-line)

Question 9

Alpha blockers

Doxazosin, tamsulosin, alfuzosin

Answer 9

1) Benign Prostatic Enlargement

2) Resistant HTN as add on tmt

Question 10

Acetylcholinesterase inhibitors

Donepezil, Rivastigmine

Answer 10

1) Mild to mod Alzheimer’s

2) Mild to mod dementia in Parkinson’s (rivastigmine)

Question 11

Acetylcysteine

Answer 11

1) Paracetamol poisoning antidote
2) Help prevent contrast nephropathy
3) Reduce viscosity of respiratory secretions in hospital

Question 12

Activated charcoal

Answer 12

1) Reduce absorption of poisons in the gut

2) Increase elimination of poisons

Question 13

Adenosine

Answer 13

1) Diagnosis and treatment of supraventricular tachycardia

Question 14

Aldosterone antagonists

spironolactone, eplerenone

Answer 14

1) Ascites and oedema due to liver cirrhosis
2) Chronic heart failure (as addition to Ace inhibitor/ARB and beta-blocker)
3) Primary hyperaldosteronism (while awaiting surgery)

Question 15

Alginates and antacids

Gaviscon, Peptac

Answer 15

1) GORD

2) Dyspepsia - short term relief of indigestion

Question 16

Allopurinol

Answer 16

1) To prevent recurrent attacks of gout
2) To prevent uric acide and calcium oxalate renal stones
3) To prevent hyperuricaemia and tumour lysis syndrome associate with chemotherapy

Question 17

Aminoglycosides

gentamicin, amikacin, neomycin

Answer 17

Severe infections (particularly Gram -ve aerobes):
1) Severe sepsis
2) Pyelonephritic & complicated UTI
3) Biliary sepsis
4) Endocarditis
(also 5) topical for skin/eye/ear infections)

Question 18

Aminosalicylates

mesalazine, sulfasalazine

Answer 18

1) Ulcerative colitis (mesalazine + corticosteroids)

2) Rheumatoid arthritis (sulfasalazine = DMARD)

Question 19

Amiodarone

Answer 19

Tachyarrhythmias - generally used when other options are ineffective or inappropriate

Question 20

ACE-i

ramipril, lisinopril, perindopril

Answer 20

1) HTN
2) Chronic Heart Failure - first line treatment
3) Ischaemic Heart Disease - reduce risk of subsequent cardiovascular events
4) Diabetic nephropathy and CKD with proteinuria

Question 21

Angiotensin Receptor Blockers

losartan, candesartan, irbesartan

Answer 21

When ACE-i are not tolerated due to cough

1) HTN
2) Chronic Heart Failure - first line treatment
3) Ischaemic Heart Disease - reduce risk of subsequent cardiovascular events
4) Diabetic nephropathy and CKD with proteinuria

Question 22

Antidepressants - SSRIs

citalopram, sertraline, fluoxetine, escitalopram

Answer 22

1) Depression (moderate to severe)
2) Panic disorder
3) Obsessive compulsive disorder

Question 23

Antidepressants - Tricyclics

amitriptyline, lofepramine

Answer 23

1) 2nd line treatment for moderate to severe depression

2) Neuropathic pain (unlicensed)

Question 24

Antidepressants - Venlafaxine and Mirtazapine

Answer 24

1) Major depression where SSRIs are not tolerated

2) Generalised Anxiety Disorder (venlafaxine)

Question 25

Antiemetics - dopamine D2-receptor antagonists

metoclopramide, domperidone

Answer 25

Nausea and vomiting - particularly in the context of reduced gut motility

Question 26

Antiemetics - histamine H1-receptor antagonists

cyclizine, cinnarizine, promethazine

Answer 26

Nausea and vomiting - particularly in the context of motion sickness or vertigo

Question 27

Antiemetics - serotonin 5-HT3-receptor antagonists

ondansetron, granisetron

Answer 27

Nausea and vomiting - particularly in the context of general anaesthesia and chemotherapy

Question 28

Antifungal drugs

nystatin, clotrimazole, fluconazole

Answer 28

1) Local fungal infections - topical application

2) Systemic treatment of disseminated or invasive infection (specialist treatment required)

Question 29

Antihistamines (H1-receptor antagonists)

cetirizine, loratidine, fexofenadine, chlorphenamine

Answer 29

1) Allergies - particularly hayfever
2) Aid relief of pruritus and urticaria
3) Adjunct in anaphylaxis after other life-saving measures/adrenaline

Question 30

Antimotility drugs

loperamide, codeine phosphate

Answer 30

1) Treatment for diarrhoea, usually in the context of IBS or viral gastroenteritis

Question 31

Antimuscarinics, bronchodilators

ipratropium, tiotropium, glycopyrronium, aclidinium

Answer 31

1) COPD - short acting for relief of SOB, long acting for prevention
2) Asthma - short acting for relief of SOB in acute exacerbations (along with SABA). LAMAs added to high-dose ICS + LABA as maintenance treatment

Question 32

Antimuscarinics, cardiovascular and GI uses

atropine, hyoscine butylbromide, glycopyrronium

Answer 32

1) Atropine to treat symptomatic bradycardia first-line
2) Firstline for IBS where used for antispasmodic effect
3) Reducing copious respiratory secretions in care of dying patient

Question 33

Antimuscarinics, GU uses

oxybutynin, tolterodine, solifenacin

Answer 33

1) Reduce urinary frequency, urgency, and urge incontinence in overactive bladder if bladder training ineffective

Question 34

Antipsychotics, first generation (typical)

haloperidol, chlorpromazine, prochlorperazine

Answer 34

1) Urgent tmt of severe psychomotor agitation that is causing dangerous behaviour or to calm patients to permit assessment
2) Schizophrenia - particularly where metabolic side effect of second gen. atypical antopsychotics are likely to be problematic
3) Bipolar disorder - acute episodes
4) Nausea and vomiting

Question 35

Antipsychotics, second generation (atypical)

quetiapine, olanzapine, risperidone, clozapine

Answer 35

1) Psychomotor agitation
2) Schizophrenia - esp. where EPSE complicated use of first gen or when negative symptoms are prominent
3) Bipolar disorder - acute episodes of mania or hypomania

Question 36

Antiviral drugs

aciclovir

Answer 36

1) Acute episodes of herpesvirus infections

2) Suppression of recurrent herpes simplex attacks (>6/yr)

Question 37

Antiplatelet drugs, ADP-receptor antagonists

clopidogrel, ticagrelor, prasugrel

Answer 37

1) ACS, usually in combo with aspirin to limit arterial thrombosis and reduce subsequent mortality
2) Prevent occlusion of coronary artery stents, in combo with aspirin
3) Long-term secondary prevention of thrombotic arterial events in pts with cardio, cerebro and peripheral vascular disease - in combo with aspirin

Question 38

Antiplatelet drugs, aspirin

Answer 38

1) ACS and acute ischaemic stroke for rapid inhibition of platelet aggregation
2) Long-term secondary prevention of thrombotic arterial events in pts with cardio, cerebro and peripheral vascular disease

Question 39

Azathioprine

Answer 39

1) Maintenance of Crohn’s and UC remission
2) DMA in RA and autoimmune conditions
3) Prevent organ rejection in transplant recipients

Question 40

β-blockers

bisoprolol, atenolol, propanolol, metoprolol, carvedilol

Answer 40

1) Ischaemic heart disease - improve sx associated with angina and ACS
2) Chronic heart failure
3) Atrial fibrillation to reduce ventricular rate and maintain sinus rhythm
4) Supraventricular tachycardia - in patients without circulatory compromise
5) Hypertension algorithm

Question 41

β2-agonists

salbutamol, terbutaline, salmeterol, formoterol, indacaterol

Answer 41

1) Asthma -SABA to relieve breathlessness, LABAs for chronic asthma when ICS not enough
2) COPD - SABA to relieve breathlessness. LABAs are second line therapy to improve sx and reduce exacerbations
3) Hyperkalaemia - nebulised salbutamol may be used to lower serum K+ conventration (along with insulin and glucose add calcium gluconate to stabilise the myocardium)

Question 42

Benzodiazepines

diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam

Answer 42

1) 1st line seizures and status epilepticus
2) 1st line alcohol withdrawal reactions
3) Sedations for interventional procedures is GA unnecessary
4) for SHORT TERM severe anxiety or insomnia

Question 43

Bisphosphonates

alendronic acid, disodium pamidronate, zoledronic acid

Answer 43

1) Patients at risk of osteoporotic fragility fractures (alendronic acid)
2) Tmt of severe hypercalcaemia of malignancy after IV rehydration (pamidronate and zolendronic acid)
3) Patients with myeloma and breast cancer with bone mets to reduce risk of pathological fractures/complications
4) 1st line treatment of metabolically active Paget’s disease to reduce bone turnover and pain

Question 44

Calcium and Vitamin D

calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

Answer 44

1) Osteoporosis (also bisphosphonates)
2) Chronic Kidney Disease to treat and prevent secondary hyperparathyroidism and renal osteodystrophy
3) Calcium is used in severe hyperkalaemia to prevent life threatening arrhythmias. Insulin and glucose also given.
4) Calcium is used in hypocalcaemia that is symptomatic or severe
5) Prevention and treatment of vit D deficiency, including rickets and osteomalacia

Question 45

Calcium channel blockers

amlodipine, nifedipine, diltiazem, verapamil

Answer 45

1) Hypertension
2) Stable angine
3) DiVer used to control cardiac rate in people with supraventricular arrhythmias, including SVT, A-fib and atrial flutter

Question 46

Carbamazepine

Answer 46

1) Epilepsy - seizure prophylaxis of generalised tonic-clonic and focal seizures (NOT myoclonic or absence)
2) Trigeminal neuralgia (control pain and reduce frequency and severity of attacks)

Question 47

Cephalosporins and carbapenems

cefalexin, cefotaxime, meropenem, ertapenem

Answer 47

1) Oral - 2nd and 3rd line for urinary and respiratory tract infections
2) Parenteral - very severe or complicated or caused by antibiotic-resistant organisms

Question 48

Chloramphenicol

Answer 48

1) Bacterial conjunctivitis using eye drops

2) Otitis externa using ear drops

Question 49

Corticosteroids (glucocorticoids), inhaled

beclometasone, budesonide, fluticasone

Answer 49

1) Asthma - to treat airway inflammation and control sx where asthma is not adequately controlled by SABA alone
2) COPD - control sx, prevent exacerbations. Usually prescribed in combo with LABA

Question 50

Corticosteroids (glucocorticoids), topical

hydrocortisone, betamethasone

Answer 50

1) Inflammatory skin conditions e.g. eczema where emollients alone are ineffective

Question 51

Digoxin

Answer 51

1) In atrial fibrillation and atrial flutter, used to reduce ventricular rate (however a beta blocker or non-dihydropyridine CCB is usually more effective)
2) Severe heart failure, used in patients already taking ACE-i, B-blocker and ARB/aldosterone antagonist

Question 52

Dipeptydylpeptidase-4 inhibitors

sitagliptin, linagliptin, saxagliptin

Answer 52

T2DM in combo with metformin (unless metformin is contraindicated or not tolerated)

Question 53

Direct oral anticoagulants

apixaban, dabigatran, edoxaban, rivaroxaban

Answer 53

1) VTE - treatment and prevention of recurrence. Also primary prevention in hip or knee replacement surgery (can also use warfarin or heparin)
2) AF - anticoagulation indicated to prevent stroke and embolism in patients with AF. (can also use warfarin)

Question 54

Diuretics, loop

furosemide, bumetanide

Answer 54

1) Acute pulmonary oedema - relief of breathlessness
2) Fluid overload in Chronic Heart Failure
3) Fluid overload in other oedematous states (e.g. renal disease)

Question 55

Diuretics, thiazide and thiazide-like

bendroflumethiazide, indapamide, chlortalidone

Answer 55

1) Alternative first-line treatment for hypertension where CCB is unsuitable
2) Add-on treatment for hypertension where BP not controlled by CCB plus ACEi/ARB

Question 56

Dopaminergic drugs for Parkinson’s disease

levodopa (as co-careldopa, co-beneldopa), ropinirole, pramipexol

Answer 56

1) Early Parkinson’s disease
2) Later Parkinson’s disease
3) secondary Parkinsonism but treating the underlying cause generally takes precedence

Question 57

Emollients

aqueous cream, liquid paraffin

Answer 57

Dry/scaling skin disorders, specifically eczema and psoriasis

Question 58

Fibrinolytic drugs

alteplase, streptokinase

Answer 58

1) Acute Ischaemic Stroke (give within 4.5h onset of stroke)
2) Acute ST elevation MI (give within 12h of onset with antiplatelets and anticoagulants but mostly PCI now)
3) Massive PE with haemodynamic instability - reduce clot size and pulmonary artery pressures

Question 59

Gabapentin and pregabalin

Answer 59

1) Both drugs as add on for focal epilepsies (not absence or myoclonic seizures)
2) Neuropathic pain
3) Generalised anxiety disorder

Question 60

H2-receptor antagonists

ranitidine

Answer 60

1) Peptic ulcer disease (although PPIs usually preferred)

2) GORD and dyspepsia for relief of symptoms