Drug Indication

Question 1

Verapamil

Answer 1

Arrhythmia, angina, hypertension

Question 2

Amlodipine

Answer 2

Hypertension, Angina & Coronary Artery Disease

Question 3

Losartan

Answer 3

Hypertension & HF (where there are side effects with ACEi)

Question 4

Ramipril

Answer 4

Hypertension, HF, prevention of HF progression post-myocardial infarction (MI)

Question 5

Nimodipine

Answer 5

Patients with no neurological deficits after subarachnoid hemorrhage to reduce the onset of new neurological deficits due to vasospasm/ischaemia

Question 6

Diltiazem

Answer 6

Atrial arrhythmia, hypertension, paroxysmal supraventricular tachycardia, and chronic stable angina

Question 7

Indapamide

Answer 7

Hypertension (more useful than CCBs with oedema), occasionally HF when in combination with a loop diuretic

Question 8

Spironolactone

Answer 8

Resistant hypertension,

Question 9

Bisoprolol

Answer 9

Hypertension and HF

• Prevention of MI/stroke in hypertension
• Prevent chest pain caused by angina
• protecting the ventricles from high atrial rates by slowing AV conduction in A fib or atrial flutter (typically 300A:150V, BB can convert to 75V -> 4:1)
• blocking Reentrant Arrhythmias at AV node
• Sinus Tachy
• Also less commonly migraine, tremor and anxiolytic

Question 10

Tamsulosin

Answer 10

Benign prostatic hyperplasia

Question 11

Doxazosin

Answer 11

Hypertension

Question 12

Spironolactone

Answer 12

Hypertension, HF, hyperaldosteronism, adrenal hyperplasia, and nephrotic syndrome

Question 13

Furosemide

Answer 13

Acute pulmonary oedema, fluid overload in HF (decreases preload), adjunct in nephrotic syndrome

Question 14

Amiloride

Answer 14

Often used as an adjunct to loop or thiazide like in HF to limit hyperK+

Question 15

Sacubitril

Answer 15

Replaces ACEi/ARB in HF if EF <35%

Question 16

Atorvastatin

Answer 16

Hyperlipidaemia

Reduce CVD risk
Also familial hypercholesterolemia

Primary prevention - 20 mg once daily (if QRISK >10%)
Secondary prevention - 80 mg once daily (if had major cardiovascular event e.g. heart attack/stroke, may be reduced to 20mg if have CKD)

Need a full lipid profile + HDL, non-HDL and TAGs before prescribing. Aim to reduce non-HDL-C by ~>40% at 3 months

Question 17

Fenofibrate

Answer 17

• Adjunct to diet and other appropriate measures in mixed hyperlipidaemia if statin contraindicated or not tolerated,
• Adjunct to diet and other appropriate measures in severe hypertriglyceridaemia,
• Adjunct to statin in mixed hyperlipidaemia if triglycerides and HDL- cholesterol inadequately controlled in patients at high cardiovascular risk for fenofibrate

Question 18

Ezetimibe

Answer 18

• Adjunct to statins (as allows reduced dose - useful in CKD)
• or if statins not tolerated for some familial hyperlipidemia pts

2nd most common drug class for cholesterol management

May increase risk of rhabdomyolysis with statins

Question 19

Alirocumab

Answer 19

Primary hyperlipidaemia

Question 20

Lidocaine (as Class 1B)

Answer 20

Only acute ventricular tachy (esp. during ischaemia)
Can terminate VT and stop further episodes

Not used in atrial arrhythmias or AV junctional arrhythmias

Question 21

Tiotropium

Answer 21

Severe asthma and COPD

Question 22

Flecainide

Answer 22

• Supraventricular arrhythmias (A fib and atrial flutter) - use with caution as slowing conduction and therefore cycle length of flutter can -> 1:1
• Premature ventricular contractions
• Wolff-Parkinson-White Syndrome - slows conduction through accessory pathway

Pro-arrhythmic -> sudden death (esp. chronic use)
Increases ventricular response to supraventricular arrhythmias -> “flecainide flutter”
Don’t use in ischaemic heart disease -> sudden death

Question 23

Amiodarone

Answer 23

Very wide spectrum - effective for most arrhythmias but many serious side effects that increase with time so not commonly prescribed

Question 24

Sotalol

Answer 24

Wide spectrum - SVT and VT
but proarrhythmic

Question 25

Verapamil

Answer 25

Control ventricles during SVT by blocking conduction at AV node If IV can stop SVT by preventing re-entry through AV node

Question 26

Alteplase

Answer 26

Acute Myocardial Infarction, Pulmonary Embolism, Acute Ischemic Stroke and Central Venous Catheter Occlusion

Question 27

Aspirin

Answer 27

Ischaemic heart disease Post primary percutaneous coronary intervention Peripheral vascular disease Acute ischaemic stroke and transient ischaemic attack NB: Aspirin use should be avoided in children under 16 due to the risk of Reye's syndrome (except in Kawasaki disease). It is also important to exercise caution during the third trimester and to avoid whilst breast feeding. Furthermore, the effect of aspirin is potentiated by oral hypoglycaemics, warfarin and steroids.

Question 28

Atypical anti-psychotics e.g. Clozapine Risperidone Olanzapine Quetiapine Aripiprazole

Answer 28

Schizophrenia Mania Major depression Clozapine is a very high risk medication. It can cause agranulocytosis and result in severe infections. It can only be started after two other antipsychotics have been trialled. Close life-long monitoring of the full blood count is required during clozapine therapy.

Question 29

Carbamazepine

Answer 29

Trigeminal neuralgia Bipolar disorder Epilepsy partial seizures

Question 30

Amitriptyline

Answer 30

-Neuropathic pain (smaller doses required) -Migraine prophylaxis -Depression: TCAs are now less commonly used for depression due to side effect profile at higher doses and toxicity. Side effects are due to the anti-cholinergic properties of amitriptyline. These include: -Dry mouth -Constipation -Urinary retention -Blurred vision -QT interval prolongation

Question 31

Vancomycin

Answer 31

Vancomycin is used in serious gram-positive bacterial infections. Oral vancomysin can also be used to treat C. difficile infection.

Question 32

Tamoxifen

Answer 32

Tamoxifen is indicated in the management of oestrogen-receptor-positive breast cancer in men and pre-menopausal women, and is typically given for 5 years following removal of a tumour to reduce recurrence. It can also be used to reduce the risk of breast cancer in women who are at high risk for the disease. Tamoxifen can also be prescribed to treat anovulatory infertility.

Question 33

Dextrose IV fluids

Answer 33

Goes into all compartments Contains sugar -> hyperglycaemia risk if rate of flow is too fast (can't produce enough insulin to keep up) Reduces osmolarity

Question 34

Saline IV fluids

Answer 34

Extracellular compartment (intravascular and interstitial) No change in osmolality (NaCl)

Question 35

Hartmanns IV fluids

Answer 35

Remains in ECF No change in osmolality NaCL + Ca, K, Lactate Normally need: 25-30ml per kilo per day of water 1mmol per kilo per day of K Na Cl

Question 36

Fondaparinux

Answer 36

An anticoagulant used to prevent venous thromboembolism, to treat deep vein thrombosis, and to improve survival following myocardial infarction