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NPS Modules > Core drug list for MD > Flashcards

Core drug list for MD Flashcards

1
Q

Indications for Midazolam

A

Conscious sedation
Induction of anaesthesia
sedation during ventilation
Premedication

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2
Q

Mode of action of Midazolam

A

Potentiates the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, anterograde amnesic muscle relaxant and antiepileptic effects.

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3
Q

Common (>1%) adverse effects of midazolam

A

Hypotension
hiccup
cough

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4
Q

Mode of action of local anaesthetics

A

Reversibly interrupt impulse conduction in peripheral nerves and stabilise excitable cell membranes by blocking sodium channels, thus inhibiting depolarisation.

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5
Q

Main actions of aspirin (4)

A

Analgesic, antipyretic, anti-inflammatory and antiplatelet actions.

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6
Q

Mode of action of aspirin

A

Non selective NSAID.
Prevents synthesis of prostaglandins by non-competitively inhibiting both forms of cyclo-oxygenase (COX), COX-1 and COX-2

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7
Q

Indications of codeine

A

mild-to-moderate pain
cough suppression
diarrhoea

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8
Q

What are the four main actions of opioid analgesics?

A

Analgesia
Respiratory depression
Sedation
Constipation

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9
Q

How do opioid analgesics reduce transmission of the pain impulse

A

act pre- and post-synaptically in the spinal cord, and modulate the descending inhibitory pathways from the brain.

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10
Q

In which part of the brain do opioid analgesics act to cause cough suppression?

A

Medulla

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11
Q

What are the indications for Morphine?

A

Moderate-to-severe pain

Opioid adjunct during general anaesthesia

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12
Q

For which respiratory conditions may it be acceptable to use morphine?

A

Acute pulmonary oedema (adjunct)

Relief of severe dyspnoea

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13
Q

What are the withdrawal symptoms of opioid analgesics?

A 
Nausea
vomiting
diarrhoea
sweating 
anxiety
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14
Q

What is the mode of action of Tramadol?

A

Binds to the mu opioid receptors and also inhibits reuptake of noradrenaline and serotonin.

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15
Q

Why should Pethidine be avoided?

A

Serotonergic properties
Neurotoxic metabolite (norpethidine)
Association with drug-seeking behaviour

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16
Q

What are the clinical features of serotonin syndrome?

A

Cognitive: Confusion, agitation, hypomania, hyperactivity, restlessness
Autonomic: hyperthermia, sweating, tachycardia, hypertension, mydriasis, flushing, shivering
Neuromuscular: Clonus, hyperreflexia, hypertonia, ataxia, tremor

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17
Q

Which opioid analgesics are implicated in severe serotonin syndrome?

A

Tramadol and pethidine.

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18
Q

To which class of antibiotics does gentamicin belong?

A

Aminoglycosides

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19
Q

What is the mode of action of aminoglycosides?

A

Inhibit protein synthesis by irreversibly binding to the 30S ribosomal subunit causing cell membrane damage.

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20
Q

Are aminoglycosides bacteriostatic or bactericidal?

A

Bactericidal.

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21
Q

What are the indications for Gentamicin?

A

Empirical treatment for

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22
Q

What are the common (>1%) adverse effects of gentamicin?

A

Ototoxicity

Nephrotoxicity

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23
Q

What is the mode of action of cephalosporins?

A

Interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins.

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24
Q

Are cephalosporins bactericidal or bacterostatic?

A

Bactericidal

25
Are cephalosporins often the drug of first choice?
no.
26
What are the names of four macrolides?
Azithromycin Clarithromycin erythromycin roxithromycin
27
What is the mechanism of Macrolide antibiotics?
Bind reversibly to the 50S subunit of bacterial ribosimes. Prevent protein synthesis.
28
What is the mechanism of action of the Penicillins?
Interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins, eventually leading to cell lysis and death.
29
Are the penicillins bactericidal or static?
Bactericidal.
30
What are the indications for amoxycillin?
Exacerbation of chronic bronchitis, community-acquired pneumonia Acute bacterial otitis media, sinusitis Gonococcal infection Acute cholecystitis, peritonitis,eradication of H. pylori.
31
What is the function of clavulanic acid?
Inhibits beta-lactamase, which extends spectrum of activity of amoxycillin.
32
What are the indications for Flucloxacillin?
``` Staphylococcal skin infections Pneumonia Septicaemia Osteromyelitis Surgical prophylaxis Empirical Treatment for endocarditis ``` (AMH 2021)
33
What is the spectrum of amoxycillin with clavulanic acid?
Broad. Does not cover: - MRSA - coag neg staph - pseudomonas - beta-lactamase producing organisms (ESCHAPPM) - atypicals
34
What is the spectrum of activity of Flucloxacillin?
Narrow. Skin bugs Staph Aureus, Streptococcus. Some Coag negative staph. Notably not enterococcus
35
What is the mode of action of the quinolones
Inhibit bacterial DNA synthesis by blocking DNA gyrase and topoisomerase IV.
36
What are the indications for use of the quinolones?
Reserved for proven or suspected infections where alternative agents are ineffective or contraindicated, e.g. complicated UTIs, bone or joint infections, epididymo-orchitis, prostatitis.
37
What is an example of a quinolone?
Ciprofloxacin Moxifloxacin levofloxacin
38
What is the mechanism of action of the Tetracyclines?
Inhibit bacterial protein synthesis by reversibly binding to 30S subunit of the ribosome.
39
Why are tetracyclines contraindicated in children
Because they discolour teeth and cause enamel dysplasia, which increases the risk of dental caries.
40
What are the indications for Doxycycline?
Acne Rosacea CAP Exacerbation of chronic bronchitis Infections caused by M. pneumonia acute bacterial sinusitis PID Sexually acquired epididymo-orchitis Prostatitis Prophylaxis for malaria Malaria treatment Q fever
41
What is the mode of action of trimethoprim?
Bacteriostatic. Competitively inhibits bacterial folate production essential for bacterial growth.
42
What are the indications for Trimethoprim?
Empirical treatment for uncomplicated lower UTIs Epidymo-orchitis (urinary tract source) Prostatitis (acute or chronic) Mild-to-moderate PJP, with dapsone (second line)
43
What is the mechanism of action of the Azole antifungals?
Fungistatic. Impair the synthesis of ergosterol in fungal cell membranes, leading to their breakdown. Cell leakage and death occur by lytic activity of the host defence system.
44
What is the name of one Azole antifungal?
Fluconazole Clotrimazole Ketoconazole Voriconazole
45
What are the indications for Fluconazole?
Cryptococcosis: consolidation and suppression after induction treatment of meningitis or disseminated disease; treatment of mild pulmonary disease Oral candidiasis Vulvovaginal candidiasis - 2nd line where topical therapy has failed. Tinea - if resistant to topical therapy. Onychomycosis (if alternatives have failed or are not tolerated) Histoplasmosis Primary and secondary prevention of candidal infection in immunocompromised people
46
To which class of drugs does Acyclovir belong?
Guanine analogue
47
What is the mechanism of action of the Guanine analogues?
Following phosphorylation by viral and cellular enzymes, guanine analogues inhibit viral DNA polymerase and DNA synthesis
48
What are the indications for Aciclovir?
Treatment and prevention of herpes simplex infections (e.g. cold sores) - Chicken pox - Shingles - eye herpes
49
What is the mechanism of action of Frusemide?
Inhibit reabsorption of sodium and chloride in the ascending limb of the loop of Henle. This site accounts for retention of approximately 20% of filtered sodium.
50
What are the indications for Frusemide?
Oedema associated with heart failure, hepatic cirrhosis, renal impairment and nephrotic syndrome. Also accepted as treatment for severe hypercalcaemia (with adequate rehydration)
51
To which class of drugs does Frusemide belong?
Loop diuretics
52
What is the mode of action of glyceryl trinitrate?
Provide exogenous source of nitric oxide (which mediates vasodilator effects). Predominantly venodilators; reduce venous return and preload to the heart, reducing myocardial oxygen requirement.
53
Indications for glyceryl trinitrate
Prevention and treatment of stable angina Heart failure associated with acute MI (infusion) Accepted Unstable angina (infusion) Acute pulmonary oedema (infusion)
54
What is the mechanism of action of thiazide diuretics?
Inhibit reabsorption of sodium and chloride in the proximal (diluting) segment of the distal convoluted tubule, increasing the delivery of sodium to the collecting tubules, and producing a corresponding increase in potassium excretion.
55
What is the mechanism of action of thiazides when used in low doses to treat hypertension?
Lower BP mostly by a vasodilator effect.
56
What are the indications for thiazides?
Hypertension Oedema associated with heart failure or hepatic cirrhosis. Nephrogenic diabetes insipidus. Accepted Prevention of renal calculi associated with hypercalciuria
57
What is the mechanism of action of ACE-inhibitors?
Block conversion of angiotensin I to angiotensin II and also inhibit the breakdown of bradykinin. Reduce the effects of angiotensin II-induced vasoconstriction, sodium retention and aldosterone release.
58
What are the indications for ACE-inhibitors
Hypertension HFrEF Post MI Diabetic nephropathy Prevention of progressive renal failure in patients with persistent proteinuria (>1 g daily)

NPS Modules (15 decks)

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