Indications Flashcards
Adrenaline
1) Cardiac Arrest
2) Anaphylaxis
3) Induce local vasoconstriction e.g with local anaesthetic
Corticosteroids (systemic)
Hydrocortisone, prednisolone, dexamethasone
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
Thiazide like Diuretics
1️⃣First line hypertension in those who would normally have CCBs but cannot (e.g. heart failure, oedema)
2️⃣Add on for HTN
Statins
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
Clopidogrel
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 ❌
Antihistamine
1️⃣Allergies e.g. hayfever
2️⃣Anaphylaxis
3️⃣Relief of pruritis and urticaria
4️⃣Anti-emetic (see elsewhere)
Beta-blockers
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
5-a reductase inhibitors
Finasteride
Benign prostatic enlargement (2nd-line)
Alpha blockers
Doxazosin, tamsulosin, alfuzosin
1) Benign Prostatic Enlargement
2) Resistant HTN as add on tmt
Acetylcholinesterase inhibitors
Donepezil, Rivastigmine
1) Mild to mod Alzheimer’s
2) Mild to mod dementia in Parkinson’s (rivastigmine)
Acetylcysteine
1) Paracetamol poisoning antidote
2) Help prevent contrast nephropathy
3) Reduce viscosity of respiratory secretions in hospital
Activated charcoal
1) Reduce absorption of poisons in the gut
2) Increase elimination of poisons
Adenosine
1) Diagnosis and treatment of supraventricular tachycardia
Aldosterone antagonists
spironolactone, eplerenone
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)
Alginates and antacids
Gaviscon, Peptac
1) GORD
2) Dyspepsia - short term relief of indigestion
Allopurinol
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
Aminoglycosides
gentamicin, amikacin, neomycin
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)
Aminosalicylates
mesalazine, sulfasalazine
1) Ulcerative colitis (mesalazine + corticosteroids)
2) Rheumatoid arthritis (sulfasalazine = DMARD)
Amiodarone
Tachyarrhythmias - generally used when other options are ineffective or inappropriate
ACE-i
ramipril, lisinopril, perindopril
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
Angiotensin Receptor Blockers
losartan, candesartan, irbesartan
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
Antidepressants - SSRIs
citalopram, sertraline, fluoxetine, escitalopram
1) Depression (moderate to severe)
2) Panic disorder
3) Obsessive compulsive disorder
Antidepressants - Tricyclics
amitriptyline, lofepramine
1) 2nd line treatment for moderate to severe depression
2) Neuropathic pain (unlicensed)
Antidepressants - Venlafaxine and Mirtazapine
1) Major depression where SSRIs are not tolerated
2) Generalised Anxiety Disorder (venlafaxine)
Antiemetics - dopamine D2-receptor antagonists
metoclopramide, domperidone
Nausea and vomiting - particularly in the context of reduced gut motility
Antiemetics - histamine H1-receptor antagonists
cyclizine, cinnarizine, promethazine
Nausea and vomiting - particularly in the context of motion sickness or vertigo
Antiemetics - serotonin 5-HT3-receptor antagonists
ondansetron, granisetron
Nausea and vomiting - particularly in the context of general anaesthesia and chemotherapy
Antifungal drugs
nystatin, clotrimazole, fluconazole
1) Local fungal infections - topical application
2) Systemic treatment of disseminated or invasive infection (specialist treatment required)
Antihistamines (H1-receptor antagonists)
cetirizine, loratidine, fexofenadine, chlorphenamine
1) Allergies - particularly hayfever
2) Aid relief of pruritus and urticaria
3) Adjunct in anaphylaxis after other life-saving measures/adrenaline
Antimotility drugs
loperamide, codeine phosphate
1) Treatment for diarrhoea, usually in the context of IBS or viral gastroenteritis
Antimuscarinics, bronchodilators
ipratropium, tiotropium, glycopyrronium, aclidinium
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
Antimuscarinics, cardiovascular and GI uses
atropine, hyoscine butylbromide, glycopyrronium
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
Antimuscarinics, GU uses
oxybutynin, tolterodine, solifenacin
1) Reduce urinary frequency, urgency, and urge incontinence in overactive bladder if bladder training ineffective
Antipsychotics, first generation (typical)
haloperidol, chlorpromazine, prochlorperazine
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
Antipsychotics, second generation (atypical)
quetiapine, olanzapine, risperidone, clozapine
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
Antiviral drugs
aciclovir
1) Acute episodes of herpesvirus infections
2) Suppression of recurrent herpes simplex attacks (>6/yr)
Antiplatelet drugs, ADP-receptor antagonists
clopidogrel, ticagrelor, prasugrel
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
Antiplatelet drugs, aspirin
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
Azathioprine
1) Maintenance of Crohn’s and UC remission
2) DMA in RA and autoimmune conditions
3) Prevent organ rejection in transplant recipients
β-blockers
bisoprolol, atenolol, propanolol, metoprolol, carvedilol
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
β2-agonists
salbutamol, terbutaline, salmeterol, formoterol, indacaterol
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)
Benzodiazepines
diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam
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
Bisphosphonates
alendronic acid, disodium pamidronate, zoledronic acid
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
Calcium and Vitamin D
calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol
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
Calcium channel blockers
amlodipine, nifedipine, diltiazem, verapamil
1) Hypertension
2) Stable angine
3) DiVer used to control cardiac rate in people with supraventricular arrhythmias, including SVT, A-fib and atrial flutter
Carbamazepine
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)
Cephalosporins and carbapenems
cefalexin, cefotaxime, meropenem, ertapenem
1) Oral - 2nd and 3rd line for urinary and respiratory tract infections
2) Parenteral - very severe or complicated or caused by antibiotic-resistant organisms
Chloramphenicol
1) Bacterial conjunctivitis using eye drops
2) Otitis externa using ear drops
Corticosteroids (glucocorticoids), inhaled
beclometasone, budesonide, fluticasone
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
Corticosteroids (glucocorticoids), topical
hydrocortisone, betamethasone
1) Inflammatory skin conditions e.g. eczema where emollients alone are ineffective
Digoxin
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
Dipeptydylpeptidase-4 inhibitors
sitagliptin, linagliptin, saxagliptin
T2DM in combo with metformin (unless metformin is contraindicated or not tolerated)
Direct oral anticoagulants
apixaban, dabigatran, edoxaban, rivaroxaban
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)
Diuretics, loop
furosemide, bumetanide
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)
Diuretics, thiazide and thiazide-like
bendroflumethiazide, indapamide, chlortalidone
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
Dopaminergic drugs for Parkinson’s disease
levodopa (as co-careldopa, co-beneldopa), ropinirole, pramipexol
1) Early Parkinson’s disease
2) Later Parkinson’s disease
3) secondary Parkinsonism but treating the underlying cause generally takes precedence
Emollients
aqueous cream, liquid paraffin
Dry/scaling skin disorders, specifically eczema and psoriasis
Fibrinolytic drugs
alteplase, streptokinase
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
Gabapentin and pregabalin
1) Both drugs as add on for focal epilepsies (not absence or myoclonic seizures)
2) Neuropathic pain
3) Generalised anxiety disorder
H2-receptor antagonists
ranitidine
1) Peptic ulcer disease (although PPIs usually preferred)
2) GORD and dyspepsia for relief of symptoms
