Indications, Examples and MOA Flashcards
What is activated charcoal used for?
Poisoning and overdose
What is N-acetylcysteine indicated for?
Contrast Nephropathy
Overdose - especially paracetamol
Poisoning
Respiratory Secretions
How is N-acetylcysteine administered?
IV infusion
How is activated charcoal administered?
PO
What is the mechanism of action of activated charcoal?
It adsorbs to toxins in the GI tract, resulting in the reduction of absorption of poisons systemically
When is adenosine indicated?
Treating supraventricular tachycardia
How is adenosine administered?
By rapid IV injection (bolus).
Wat is the mechanism of action of adenosine?
it interrupts AV node and resets it to sinus rhythm - causes brief asystole and bradycardia then returns to normal (as it is metabolised quickly)
What are the contraindications for adenosine?
AF, FLUTTER, asthma, COPD, HF, long QT syndrome
When is adrenaline indicated?
Anaphylaxis
Cardiac Arrest
Mucosal Bleeding - for non-variceal upper GI bleeds
Ventricular fibrillation/tachycardia
What is the mechanism of action for adrenaline in stopping mucosal bleeds?
It causes vasoconstriction by binding to alpha receptors, limiting blood flow to the bleeding artery
What is the mechanism of action for adrenaline in anaphylaxis?
It causes vasoconstriction by stimulating alpha-adrenergic receptors, counteracting the widespread vasodilation and vascular permeability seen in anaphylaxis. This reduces the loss of intravascular fluid and the subsequent hypotension.
What are aldosterone antagonists indicated for?
Ascites
Heart failure
Hyperaldosteronism
What are some examples of aldosterone antagonists?
Spironolactone
Epleronone
What is the mechanism of action of aldosterone antagonists?
They block the action of aldosterone, which increases sodium excretion and potassium retention by the principal cells of the kidney. Water follows sodium to be excreted, resulting in a diuretic effect.
What are alginates / antacids indicated for?
Dyspepsia and GORD
What is nefopam indicated for?
Moderate pain
What are some examples of antacids/alginates?
Gaviscon, Peptac
What is the mechanism of antacids?
They inhibit pepsin (which digests proteins) and neutralise hydrochloric acid, increasing stomach pH
What is the mechanism of action of alginates?
They react with the gastric acid to form a layer on top of the stomach contents, forming a mechanical barrier that prevents reflex into the oesophagus
What is allopurinol indicated for?
Chemotherapy (tumour lysis syndrome)
Prophylaxis of recurrent gout (hyperuricaemia) - if they have more than 2 attack a year or tophi
What is the mechanism of action of allopurinol?
It inhibits the xanthine oxidase enzyme, preventing hypoxanthine conversion to uric acid and crystal formation
What are the indications for alpha blockers?
Benign Prostatic Hyperplasia
Hypertension (not first line)
What are some examples of alpha blockers?
Doxazocin
Tamsulosin
What is the mechanism of action of alpha blockers in BPH?
They relax smooth muscle and tone in the inner urethral sphincter in the bladder neck to aid voiding, with rapidimprovement in symptoms
What is the mechanism of action of alpha blockers in hypertension
Prevent adrenaline binding to alpha 1 receptors in arterial walls, leading to vasodilation
What are aminoglycosides indicated for?
Endocarditis
Pyelonephritis
Sepsis (incl intra-abdominal)
What are some examples of aminoglycosides?
Gentamicin, amikacin, streptomycin
What is the mechanism of action of aminoglycosides?
Inhibit peptide synthesis
What are aminosalycilates indicated for?
Rheumatoid Arthritis
Ulcerative Colitis (maintaining remission in mild cases)
What are some examples of aminosalycilates
Mesalazine
Sulfasalazine
What is amiodarone indicated for?
Atrial Fibrillation/Flutter
Cardiac Arrest
Supraventricular tachycardia
Ventricular fibrillation/tachycardia
What is the mechanism of action of amiodarone?
It blocks potassium currents that cause repolarization of the heart muscle during the third phase of the cardiac action potential. As a result amiodarone increases the duration of the action potential as well as the effective refractory period for cardiac cells (myocytes)
What are ACE inhibitors indicated for?
Acute coronary syndrome
Chronic kidney disease
Diabetic nephropathy
Heart failure
Hypertension (1st line in people <55 who are not of Afro-Caribbean ethnicity)
Ischaemic heart disease
What are some examples of ACE inhibitors?
Ramipril
Lisinopril
Perindopril
What is the mechanism of action of ramipril/ACE inhibitors?
It is a competitive inhibitor of ACE. This prevents ACE from generating angiotensin 2 from angiotensin 1, which prevents vasoconstriction and reduces aldosterone secretion
What are angiotensin receptor blockers indicated for?
Chronic Kidney Disease
Diabetic nephropathy
Heart failure
Hypertension
Ischaemic heart disease
What are some examples of ARBs?
Candesartan
Losartan
Irbesartan
What is the mechanism of action of ARBs?
They prevent angiotensin 2 from binding to AT receptor 1, leading to a reduction in aldosterone release and an increase in vasodilation
What are SSRIs indicated for?
Anxiety
Depression
OCD
(Antidepressants)
What are some examples of SSRIs?
Fluoxetine
Citalopram
Sertraline
What are tricyclic antidepressants indicated for?
Depression
Neuropathic Pain
What are some examples of tricyclic antidepressants?
Amitriptyline
Lofepramine
What are venlafaxine and mirtazapine indicated for? (Velafaxine is a SNRI and mirtazapine is its own thing)
Anxiety incl. Generalised anxiety disorder
Depression
What are dopamine D2 receptor antagonists indicated for?
They’re antiemetics - N&V
What are some examples of dopamine D2 receptor antagonists? (antiemetics)
Metoclopramide
Domperidone
What are histamine H1 receptor antagonists indicated for?
Nausea and Vomiting
What are some examples of histamine H1 receptor antagonists? (antiemetics)
Cyclizine
Cinnarizine
Promethazine
What are phenothiazines indicated for?
Agitation, psychomotor
Nausea and Vomiting
What are some examples of phenothiazines? (antiemetics but can also be first gen antipsychotics)
Prochlorperazine
Chlorpromazine
What are serotonin 5-HT3-receptor antagonists indicated for?
Chemotherapy
Nausea and Vomiting
Panic disorders
What are some examples of serotonin 5-HT3-receptor antagonists (antiemetics)
Ondansetron
Granisetron
What are some examples of antifungals?
Miconazole
Fluconazole
Clotrimazole
Nystatin
What are antihistamines (H1-receptor antagonists) indicated for?
Allergy
Hay fever (seasonal rhinitis)
Pruritus
Urticaria
What are some examples of H1 receptor antagonists used for treating allergies??
Chlorphenamine
Cetirizine
Loratadine
What is the mechanism of action of H1 receptor antagonists? (antihistamines)
They competitively inhibit histamine binding to H1 receptors, preventing the vasodilator effect of histamine to prevent oedema
What are antimotility drugs indicated for?
Diarrhoea
What are some examples of antimotility drugs?
Loperamide
Codeine phosphate
What is the mechanism of action of anti-muscarinic bronchodilators?
They block acetylcholine from acting on muscarinic receptors in smooth muscle in the airways, leading to bronchodilation and improved airflow
What are anti-muscarinic bronchodilators indicated for?
Asthma
COPD
What are some examples of anti-muscarinic bronchodilators?
Ipratropium bromide
Tiotropium
What are antimuscarinics indicated for in a cardiovascular/GI/resp context?
Bradycardia
Irritable Bowel Syndrome
Respiratory secretions
What are some examples of antimuscarinics used for the cardiovascular and GI systems?
Atropine - reversal of bradycardia following MI/BB use etc
Hyoscine butylbromide - IBS, acute GI smooth muscle spasm (buscopan)
Glycopyrronium bromide - for bradycardia, severe dribbling, hyperhidrosis etc
What are antimuscarinics indicated for in a genitourinary context?
Urinary incontinence
What are some examples of antimuscarinics used for the genitourinary systems and what are their indications?
Oxybutynin
Tolterodine
Solifenacin
For frequency, urgency and incontinence
What is the mechanism of action of antimuscarinics used for urinary incontinence?
They inhibit the parasympathetic transmission that drives detrusor contraction by inhibiting ACh release and binding to muscarinic receptors at post synaptic neurons
What are first-gen typical antipsychotics used for?
Agitation, psychomotor
Bipolar Disorder
Nausea and Vomiting
Schizophrenia
What are some examples of first-gen typical antipsychotics?
Haloperidol
Chlorpromazine (also an antiemetic)
Prochlorperazine (also an antiemetic)
What are second-gen atypical antipsychotics used for?
Agitation, psychomotor symptoms
Bipolar Disorder
Schizophrenia
What are some examples of second-gen atypical antipsychotics?
Quetiapine
Olanzapine
Risperidone
Clozapine
What is aspirin indicated for?
Acute Coronary Syndrome
Atrial Fibrillation/Flutter
Fever
Ischaemic heart Disease
Pain
Peripheral arterial disease
Stroke
High dose for Kawasaki’s
What is the mechanism of action of aspirin?
COX 1/2 inhibitor - reduces prostaglandin synthesis including thromboxane, which reduces platelet aggregation and also acts as an antipyretic, anti-inflammatory, analgesic
What are benzodiazepines indicated for?
Alcohol Withdrawl
Anxiety
Status Epilepticus
Insomnia
Poisoning
Sedation
What are some examples of benzodiazepines?
Diazepam (rectal, status epilepticus in community)
Midazolam (buccal, status epilepticus in community)
Temazepam
Lorazepam (status epilepticus in hospital)
Chlordiazepoxide (anxiety and alcohol withdrawal)
What are B2 agonists indicated for?
Asthma
COPD
Hyperkalaemia
What are some examples of B2 agonists?
Salbutamol
Sameterol
Terbutaline
What is the mechanism of action of B2 agonists in respiratory diseases?
Binds to and agonises B2 receptors in the bronchial SM ⇒ relaxation of SM ⇒ bronchodilation ⇒ improved obstruction
What are beta blockers indicated for?
Acute Coronary Syndrome
Angina
Atrial Fibrillation/Flutter
Heart Failure
Hypertension
Ischaemic heart Disease
Supraventricular tachycardia
Anxiety
What are some examples of beta blockers?
Bisoprolol
Atenolol
Propranolol
Metoprolol
What is the mechanism of action of beta blockers?
They prevent adrenaline binding to beta 1 receptors on the heart ⇒ reduce contractility, slow the HR and reduce CO
What are bisphosphonates indicated for?
Bone Metastases
Hypercalcaemia of malignancy
Osteoporosis
What are some examples of bisphosphonates?
Alendronic acid (alendronate)
Zolendronic acid
Risedronate
Disodium Pamidronate
What is the mechanism of action of bisphosphonates?
Inhibit osteoclasts to prevent resorption of bone
What are calcium and vitamin D indicated for?
Chronic Kidney Disease
Hypocalcaemia
Osteoporosis
Vitamin D Deficiency
Myeloma / bony mets
What are some examples of calcium and vitamin D supplements?
Adcal-D3
Colecalciferol
Calcium Carbonate
Calcium Gluconate
Alfacalcidol
What are calcium channel blockers indicated for?
Angina
Atrial Fibrillation/Flutter
Hypertension
Supraventricular tachycardia
Reynaud’s (nifedipine)
What are some examples of CCBs?
Amlodipine
Verapamil
Nifedipine
Diltiazem
What is the mechanism of action of CCBs?
They block L type Ca2+ channels on the heart to slow contraction and reduce CO
What is carbamazepine indicated for?
Bipolar Disorder
Epilepsy, focal
Trigeminal neuralgia
What are cephalosporins and carbapenems indicated for?
Infection (complex)
Meningitis
Pneumonia
Sepsis
Urinary tract Infection
What are some examples of cephalosporins and carbapenems?
Cefalexin
Ceftriaxone
Cefotaxime
Meropenem
What is clopidogrel indicated for?
Acute Coronary Syndrome
Atrial Fibrillation/Flutter
Ischaemic heart Disease
Peripheral arterial disease
Stroke
What is the mechanism of action of clopidogrel?
Anti-platelet (PTY12 inhibitor): platelets release ADP and bind to PTY12 receptors ⇒ amplifies platelet response ⇒ inhibiting these receptors prevents amplification of platelet response ⇒ reduced risk off occlusion