Indications Flashcards
Fibrinolytic drugs
(alteplase, streptokinase)
1) Acute ischaemic stroke
2) Acute STEMI
3) Massive PE with haemodynamic instability
Vitamins
(folic acid, thiamine, hydroxocobalamin, phytomenadione)
1) Thiamine (vit B) used in treatment and prevention of Wernicke’s encephalopathy and Korsakoff’s psychosis (severe thiamine deficiency)
2) Folic acid (vit B3) used in megaloblastic anaemia and in first trimester to reduce risk of neural tube defects
3) Hydroxocobalamin (vit B12) used in treatment of megaloblastic anaemia and subacute combined generation of the cord as a result of B12 deficiency
4) Phytomenadione (vit K) recommended for newborn babies to prevent vit K deficiency bleeding, and is used to reduce anticoagulant effect of warfarin
Nitrates
(isosorbide mononitrate, glyceryl trinitrate)
1) Short-acting (GTN) used in treatment of acute angina and chest pain associated with ACS
2) Long-acing (isosorbide) used for prophylaxis of angina where β-blocker and/or CCB insufficient
3) IV used in treatment of pulmonary oedema
Methotrexate
1) As disease-modifying treatment for RA
2) As part of chemotherapy for leukaemia, lymphoma and some solid tumours
3) Severe psoriasis (and psoriatic arthritis) that is resistant to other therapies
Antiemetics - dopamine D2-receptor antagonists
(metoclopramide, domperidone)
1) Prophylaxis and treatment of nausea and vomiting
Particularly in reduced gut motility
Penicillins - penicillinase-resistant
(flucloxacillin)
Staphylococcal infection, usually as part of combination therapy:
1) Skin and soft tissue infections such as cellulitis
2) Osteomyelitis and septic arthritis
3) Other infections including endocarditis
Quinolones
(ciprofloxacin, moxifloxacin, levofloxacin)
Generally reserved as 2nd or 3rd line due to antibiotic resistance
1) UTI (mostly Gram-negative organisms)
2) Severe gastroenteritis (e.g. Shigella, Campylobacter)
3) lower respiratory tract infections (Gram-positive and negative)
5α reductase inhibitors
(finasteride)
Benign prostatic enlargement (2nd line)
Leukotriene receptor antagonists
(montelukast)
1) Adults: add-on therapy for asthma where symptoms not adequately controlled with other meds
2) Children aged 5-12: alternatives to LABAs as an add-on for asthma
3) Children under 5: 1st line prevention for children with asthma who cannot take inhaled corticosteroid
Tetracyclines
(doxycycline, lymecycline)
1) Acne vulgaris
2) Lower respiratory tract infections inc. infective exacerbations of COPD, pneumonia and atypical pneumonia
3) Chlamydia infection including PID
4) Other infections e.g. typhoid, anthrax, malaria and Lyme disease
Calcium and vitamin D
(calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol)
1) Osteoporisis
2) CKD to treat/prevent secondary hyperparathyroidism and renal osteodystrophy
3) Severe hyperkalaemia to prevent life-threatening arrhythmias (calcium gluconate)
4) Symptomatic hypocalcaemia
5) Prevention/treatment of vitamin D deficiency
Vancomycin
1) treatment of Gram-positive infection e.g. endocarditis where infection is severe and penicillins cannot be used
2) Treatment of antibiotic-associated colitis (usually 2nd line where emtronidazole is poorly tolerated)
Antimuscarinics - cardiovascular and GI uses
(atropine, hyoscine butylbromide, glycopyrronium)
1) 1st line for bradycardia
2) 1st line for IBS (particularly hyoscine butylbromide)
3) Reducing copious respiratory secretions in dying patients
β-blockers
(bisoprolol, atenolol, propanolol, metoprolol, carvedilol)
1) Ischaemic heart disease to improve symptoms/prognosis associated with angina and ACS
2) Chronic heart failure to improve prognosis
3) AF to reduce ventricular rate
4) SVT to restore sinus rhythm
5) HTN (if other medications insufficient)
Naloxone
1) Acute treatment of opioid toxicity
Lidocaine
1) First choice local anaesthetic
2) Uncommonly as anti-arrhythmic in VT and VF refractory to electrical cardioversion
Antipsychotics - 2nd generation (atypical)
(quetiapine, olanzapine, risperidone, clozapine)
1) Urgent treatment of severe psychomotor agitation
2) Schizophrenia
3) Bipolar disorder
Chloramphenicol
1) Bacterial conjunctivitis (eye drops)
2) Otitis externa (ear drops)
Gabapentin and pregablin
1) Add-on treatment of focal epilepsies (not recommended in absence or myoclonic seizures)
2) 1st line for neuropathic pain (inc. painful diabetic neuropathy)
3) Generalised anxiety disorder (pregablin)
Angiotensin receptor blockers
(losartan, candesartan, irbesartan)
Generally used when ACE inhibitors not tolerated due to cough
1) HTN - 1st or 2nd line
2) Chronic heart failure 1st line
3) Ischaemic heart disease to reduce risk of further CV events
4) Diabetic nephropathy and CKD with proteinuria
Antiemetics - serotonin 5-HT3-receptor antagonists
(ondansetron, granisetron)
1) Prophylaxis and treatment of nausea and vomiting
Particularly in general anaesthesia and chemotherapy
Antiemetics - histamine H1-receptor antagonists
(cyclizine, cinanrizine, promethazine)
1) Prophylaxis and treatment of nausea and vomiting
Particularly in motion sickness and vertigo
Corticosteroids (glucocorticoids) - systemic
(prednisolone, hydrocortisone, dexamethasone)
1) Allergic or inflammatory disorders e.g. anaphylaxis, asthma
2) Suppression of autoimmune disease e.g. IBD, inflammatory arthritis
3) Some cancers - reduce tumour-associated swelling
4) Hormone replacement in adrenal insufficiency or hypopituitarism
Warfarin
1) VTE treatment and prevention of recurrence
2) To prevent arterial embolism in patients with AF or prosthetic heart valves
Thyroid hormones
(levothyroxine, liothyronine)
1) Primary hypothyroidism
2) Hypothyroidism secondary to hypopituitarism
α-blockers
(doxazosin, tamsulosin, alfuzosin)
1) Benign prostatic enlargement
2) Resistant HTN (as add-on)
Dopaminergic drugs for Parkinson’s disease
(levodopa as co-careldopa/co-beneldopa, ropinirole, premipexol)
1) Early Parkinson’s disease - ropinirole, pramipexol
2) Later Parkinson’s disease - levodopa
3) Levodopa and dopamine agonists may be options for secondary parkinsonism
Sex hormone antagonists for breast cancer
(tamoxifen, anastrozole, letrozole)
1) Early and locally advanced oestrogen-receptor positive (ER-positive) breast cancer as adjuvant treatment to reduce risk of recurrent disease
2) Advanced ER-positive breast cancer
to slow disease progression
Adenosine
1) 1st line diagnostic and therapeutic agent in SVT
Prostaglandin analogue of eye drops
(latanoprost, bimatoprost)
1) 1st line agents to lower intraocular pressure in open-angle glaucoma and ocular hypertension
Dipeptidylpeptidase-4 inhibitors
(sitagliptin, linagliptin, saxagliptin)
T2DM
1) In combination with metformin where blood glucose not adequately controlled on single agent
2) As single agent to control blood glucose where metformin is contraindicated/not tolerated
Lamotrigine
1) Seizure prophylaxis in epilepsy - 1st line in focal, generalised tonic-clonic and absence
2) Bipolar depression (not mania/hypomania)
Penicillins
(benzylpenicilin, phenoxymethylpenicillin)
1) Streptococcal infection inc. tonsillitis, pneumonia, endocarditis, and skin and soft tissue infections
2) Meningococcal infection e.g. meningitis, septicaemia
3) Clostridial infection e.g. gas gangrene (clostridial myonecrosis)
Bisphosphonates
(alendronic acid, disodium pamidronate, zoledronic acid)
1) 1st line for patients at risk of osteoporotic fragility fractures
2) Treatment of severe hypercalcaemia of malignancy (pamidronate and zoledronic acid)
3) Myeloma and bone metastases (pamidronate and zoledronic acid)
4) 1st line treatment for metabolically active Paget’s disease
Aminoglycosides
(gentamicin, amikacin, neomycin)
Systemic (gentamicin, amikacin): treatment of severe infections
1) severe sepsis
2) Pyelonephritis and complicated UTI
3) Biliary and other intra-abdominal sepsis
4) Endocarditis
Topical (neomycin):
5) Bacterial skin, eye or external ear infections
Macrolides
(clarithromycin, erythromycin, azithromycin)
1) Treatment of respiratory, skin and soft tissue infections as alternative to penicillin when contraindicated
2) Severe pneumonia added to penicillin to cover atypical organisms
3) Eradication of H. pylori in combination with PPI and amoxicillin/metronidazole
Calcium channel blockers
(amlodipine, nifedipine, dilitiazem, verapamil)
1) 1st or 2nd line treatment for HTN (amlodipine)
2) Symptom control instable angina
3) Rate control in SVT (dilitiazem and verapimil)
Acetylcholinesterase inhibitors
(donepezil, rivastigmine)
1) Mild to moderate Alzheimer’s
2) Mild to moderate dementia in Parkinson’s (rivastigmine)
Amiodarone
1) Used in a wide range of tachyarrhythmias
AF, SVT, RVF
Metronidazole
1) Antibiotic-associated colitis caused by Gram-positive anaerobe C. dif
2) Oral infections or aspiration pneumonia caused by Gram-negative anaerobes form mouth
3) Surgical and gynaecological infections caused by Gram-negative anaerobes from colon
4) Protozoal infections
Z-drugs
(zopiclone, zolpidem)
1) Short-term treatment of insomnia which is debilitating/distressing
Valproate (valproic acid)
(sodium valproate, valproic acid)
1) Seizure prophylaxis in epilepsy, effective in most seizure types
2) Selected cases of established convulsive status epilepticus
3) Bipolar disorder for acute treatment of manic episodes
Corticosteroids (glucocorticoids) - topical
(hydrocortisone, betamethasone)
1) Inflammatory skin conditions e.g. eczema
To treat disease flares or control chronic disease where emollients alone are ineffective
Direct oral anticoagulants (DOACs)
(apixaban, dabigatran, edoxaban, rivaroxaban)
1) VTE
2) AF - to prevent stroke and systemic embolism in patients with at least one risk factor e.e. previous stroke
Antiviral drugs
(aciclovir)
1) Treatment of acute episodes of herpesvirus infection
2) Suppression of recurrent herpes simplex attacks
Antiplatelet drugs
(aspirin)
1) Treatment of ACS and acute ischaemic stroke
2) Long-term secondary prevention of thrombotic events in patients with CV, cerebrovascular and peripheral arterial disease
Allopurinol
1) Prevent recurrent attacks of gout
2) Prevent uric acid and calcium oxalate renal stones
3) Prevent hyperuricaemia and tumour lysis syndrome associated with chemo
Protein pump inhibitors
(lansoprazole, omeprazole, pantoprazole)
1) Prevention and treatment of peptic ulcer disease including NSAID-associated ulcers
2) Symptomatic relief of dyspepsia and GORD
3) Eradication of H. pylori infection (in combination with antibiotics)
Heparins and fondaparinux
(enoxaparin, dalteparin, fondaparinux, unfractioned heparin)
1) DVT and PE (usually LMWH)
2) ACS to reduce clot progression or maintain revascularisation
Laxatives - stimulant
(senna, bisacodyl, glycerol suppositories, docusate sodium)
1) Constipation
2) Suppositories for faecal impaction
ACE inhibitors
(ramipril, lisinopril, perindopril)
1) HTN - 1st or 2nd line
2) Chronic heart failure 1st line
3) Ischaemic heart disease to reduce risk of further CV events
4) Diabetic nephropathy and CKD with proteinuria
Penicillins - antipseudomonal
(piperacilllin with tazobactam - tazocin)
Reserved for severe infections, particularly where broad spectrum of potential pathogens; antibiotic resistance likely, or immunocompromised patient
1) Lower respiratory tract infections
2) Urinary tract infections
3) Intra-abdominal sepsis
4) Skin and soft tissue infections
Penicillins - broad-spectrum
(amoxicillin, co-amoxiclav)
1) Susceptible infections including CAP, otitis media, sinusitis and UTIs (amoxicillin)
2) Treatment of H. pylori infection - amoxicillin may be given in combination with clarithromycin or metronidazole and PPI
3) Severe, resistant and hospital-acquired infections including respiratory tract infections, GU and abdominal infections, cellulitis and bone and joint infections (co-amoxiclav)
Antiplatelet drugs - ADP-receptor antagonists
(clopidogrel, ticagrelor, prasugrel)
1) Treatment of ACS
2) Prevent occlusion of coronary artery stents
3) Long-term secondary prevention of thrombotic events in patients with CV, cerebrovascular and peripheral arterial disease
Activated charcoal
1) Reduce absorption of certain poisons in the gut
2) Increase elimination of certain poisons
Cephalosporins and carbapenems
(cefalexin, cefotazime, meropenem, ertapenem)
1) 2nd and 3rd line for urinary and respiratory tract infections (oral cephalosporins)
2) Very severe/complicated infections, or those caused by antibiotic-resistant microorganisms (parenteral cephalosporins/carbapenems)
Phosphodiesterase (type 5) inhibitors
(sildenafil)
1) Erectile dysfunction
2) Primary pulmonary hypertension
Loop diuretics
(furosemide, bumetanide)
1) Relief of breathlessness in acute pulmonary oedema
2) Symptomatic relief of fluid overload in chronic heart failure
3) Symptomatic relief of fluid overload in other oedematous states e.g. renal disease, liver failure
Ocular lubricants - artificial tears
(hypromellose, carbomers, liquid and white soft paraffin)
1) 1st line symptomatic treatment of dry eye conditions e.g. keratoconjunctivitis sicca and Sjogren’s syndrome
Antihistamines - H1-receptor antagonists)
(cetirizine, loratadine, fexofenadine, chlorpgenamine)
1) 1st line for allergies, particularly hayfever
2) Aid relief of pruritis and urticaria
3) Adjunctive for anaphylaxis
Trimethoprim
(trimethoprim, co-trimoxazole)
First choice antibiotic for the treatment of:
1) Acute lower UTI
2) Prophylaxis of recurrent UTI
Iron
(ferrous fumarate, ferrous sulfate)
1) Treatment of iron-deficiency anaemia
2) Prophylaxis of iron-deficiency anaemia
Serotonin 5HT1-receptor agonists
(sumatriptan)
1) Acute migraine with or without aura
H2-receptor antagonists
(ranitidine)
1) Peptic ulcer disease - treatment and prevention
2) GORD and dyspepsia (PPIs preferred in severe cases)
Antipsychotics - 1st generation (typical)
(haloperidol, chlorpromazine, prochlorperazine)
1) Urgent treatment of severe psychomotor agitation
2) Schizophrenia
3) Bipolar disorder
4) Nausea and vomiting
Emollients
(aqueous cream, liquid paraffin)
1) Topical treatment for all dry or scaling skin disorders
Metformin
1) T2DM as first choice for control of blood glucose
Used alone or in combination with sulphonylureas, DPP-4 inhibitors, insulin
Carbamazepine
1) Seizure prophylaxis in epilepsy
2) Trigeminal neuralgia (pain control, reduce frequency/severity of attacks)
Antimuscarinics - GU uses
(oxybutynin, tolterodine, solifenacin)
1) 1st line in overactive bladder to reduce frequency, urgency and urge incontinence
Azathioprine
1) Maintenance of remission in Crohn’s and UC
2) Disease-modifying agent in RA and autoimmune conditions
3) Prevention of organ rejection
Antidepressants
(tricyclics; amitriptyline, lofepramine)
1) 2nd line for moderate to severe depression when SSRIs ineffective
2) Neuropathic pain (unlicensed)
Sulphonylureas
(glicazide)
in T2DM:
1) In combination with metformin where blood glucose is not adequately controlled on a single agent
2) As a single agent to control blood glucose when metformin is contraindicated/not tolerated
β2-agonists
(salbutamol, terbutaline, salmeterol, formoterol, indacaterol)
1) Asthma - short acting to relieve breathlessness, long-acting as treatment for chronic asthma
2) COPD - short-acting to relieve breathlessness, long-acting as 2nd line therapy
3) Hyperkalaemia
Oxygen
1) Increase tissue oxygen delivery in acute hypoxaemia
2) Accelerate reabsorption of pleural gas in pneumothorax
3) Reduce carboxyhaemoglobin half-life in carbon monoxide poisoning
Benzodiazepines
(diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam)
1) 1st line management for seizures and status epilepticus
2) 1st line management for alcohol withdrawal
3) Sedation for interventional procedures
4) Short-term treatment of severe, disabling anxiety or insomnia
Paracetamol
1) 1st line analgesic for most forms of acute and chronic pain
2) Antipyretic that can reduce fever and its associated symptoms
Antidepressants
(venfalaxine, mirtazapine)
1) Option for major depression when SSRIs ineffective
Generalised anxiety disorder (venfalaxine)
Acetylcysteine (N-acetylcysteine)
1) Antidote to paracetamol poisoning
2) Prevention of contrast nephropathy
3) Reduce viscosity of respiratory secretions
Nitrofurantoin
1) First choice treatment for acute, uncomplicated lower UTI
2) Prophylaxis of UTI in patient with recurrent infections
Alginates and antacids
(gaviscon, peptac)
1) GORD
2) Dyspepsia
Oestrogens and progestogens
(combined ethinylestradiol products, desogestrel)
1) Hormonal contraception
2) HRT to delay early menopause or to treat distressing menopausal symptoms
Opioids - strong
(morphine, oxycodone)
1) Rapid relief of acute severe pain
2) Relief of chronic pain when paracetamol, NSAIDs and weak/moderate opioids insufficient (rung 3 of pain ladder)
3) Relief of breathlessness in context of end-of-life care
4) Relief of breathlessness/anxiety in acute pulmonary oedema (alongside oxygen furosemide and nitrates)
Insulin
(insulin aspart, insulin glargine, biphasic insulin, soluble insulin)
1) Insulin replacement in T1DM and control of blood glucose in T2DM
2) Diabetic emergencies e.g. DKA and hyperglycaemic hyperosmolar syndrome
3) Alongside glucose to treat hyperkalaemia
Statins
(simvastatin, atorvastatin, pravastatin, rosuvastatin)
1) Primary prevention of CV events (people over 40 with risk factors)
2) Secondary prevention of CV events
3) Primary hyperlipidaemia
Antimotility drugs
(loperamide, codeine phosphate)
1) Symptomatic treatment for diarrhoea (IBS, gastroenteritis)
Laxatives - osmotic
(lactulose, macrogol, phosphate enema)
1) Constipation and faecal impaction
2) Bowel preparation prior to surgery/endoscopy
3) Hepatic encephalopathy
Antifungal drugs
(nystatin, clotrimazole, fluconazole)
1) Local fungal infections (oropharynx, vagina, skin)
2) Systemic treatment of invasive or disseminated fungal infections
Thiazide and thiazide-like diuretics
(bendroflumethiazide, indapamide, chlortalidone)
1) Alternative 1st line for HTN where CCB would otherwise be used, but is either unsuitable (e.e.g oedema) or there are features of heart failure
2) Add-on treatment of HTN
Adrenaline
(epinephrine)
1) Cardiac arrest
2) Anaphylaxis
3) Induce local vasoconstriction e.g. prolong local anaesthetic
Antimuscarinics - bronchodilators
(ipratropium, tiotropoium, glycopyrronium, aclidinium)
1) COPD to relieve breathlessness
2) Asthma to relieve breathlessness
NSAIDs
(naproxen, ibuprofen, etoricoxib)
1) Treatment of mild to moderate pain
2) Regular treatment for pain related to inflammation, particularly MSK e.g. RA, severe OA and gout
Quinine
(quinine sulfate)
1) Treatment and prevention of night-time leg cramps
2) 1st line treatment for Plasmodium falciparum malaria
Corticosteroids (glucocorticoids) - inhaled
(beclometasone, budesonide, fluticasone)
1) Asthma to treat inflammation and control symptoms
2) COPD to control symptoms and prevent exacerbations
Digoxin
1) AF and atrial flutter to reduce ventricular rate (β-blocker or CCB usually more effective)
2) Severe heart failure
Aldosterone antagonists
(spironolactone, eplerenone)
1) Ascites and oedema due to liver cirrhosis
2) Chronic heart failure
3) Primary hyperaldosteronism
Aminosalicylates
(mesalazine, sulfasalazine)
1) Mesalazine is 1st line for mild to moderate UC
2) Sulfasalazine is used in RA
Levetiracetam
1) Seizure prophylaxis in epilepsy - focal, myoclonic and generalised tonic-clonic
2) Established convulsive status epilepticus that has not responded to benzodiazepine
Opioids - weak/moderate
(tramadol, codeine, dihydrocodeine)
1) Mild to moderate pain as 2nd line when simple analgesics insufficient - rung 2 on pain ladder
