Indications

Question 1

Fibrinolytic drugs

(alteplase, streptokinase)

Answer 1

1) Acute ischaemic stroke

2) Acute STEMI

3) Massive PE with haemodynamic instability

Question 2

Vitamins

(folic acid, thiamine, hydroxocobalamin, phytomenadione)

Answer 2

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

Question 3

Nitrates

(isosorbide mononitrate, glyceryl trinitrate)

Answer 3

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

Question 4

Methotrexate

Answer 4

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

Question 5

Antiemetics - dopamine D2-receptor antagonists

(metoclopramide, domperidone)

Answer 5

1) Prophylaxis and treatment of nausea and vomiting

Particularly in reduced gut motility

Question 6

Penicillins - penicillinase-resistant

(flucloxacillin)

Answer 6

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

Question 7

Quinolones

(ciprofloxacin, moxifloxacin, levofloxacin)

Answer 7

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)

Question 8

5α reductase inhibitors

(finasteride)

Answer 8

Benign prostatic enlargement (2nd line)

Question 9

Leukotriene receptor antagonists

(montelukast)

Answer 9

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

Question 10

Tetracyclines

(doxycycline, lymecycline)

Answer 10

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

Question 11

Calcium and vitamin D

(calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol)

Answer 11

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

Question 12

Vancomycin

Answer 12

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)

Question 13

Antimuscarinics - cardiovascular and GI uses

(atropine, hyoscine butylbromide, glycopyrronium)

Answer 13

1) 1st line for bradycardia

2) 1st line for IBS (particularly hyoscine butylbromide)

3) Reducing copious respiratory secretions in dying patients

Question 14

β-blockers

(bisoprolol, atenolol, propanolol, metoprolol, carvedilol)

Answer 14

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)

Question 15

Naloxone

Answer 15

1) Acute treatment of opioid toxicity

Question 16

Lidocaine

Answer 16

1) First choice local anaesthetic

2) Uncommonly as anti-arrhythmic in VT and VF refractory to electrical cardioversion

Question 17

Antipsychotics - 2nd generation (atypical)

(quetiapine, olanzapine, risperidone, clozapine)

Answer 17

1) Urgent treatment of severe psychomotor agitation

2) Schizophrenia

3) Bipolar disorder

Question 18

Chloramphenicol

Answer 18

1) Bacterial conjunctivitis (eye drops)

2) Otitis externa (ear drops)

Question 19

Gabapentin and pregablin

Answer 19

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)

Question 20

Angiotensin receptor blockers

(losartan, candesartan, irbesartan)

Answer 20

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

Question 21

Antiemetics - serotonin 5-HT3-receptor antagonists

(ondansetron, granisetron)

Answer 21

1) Prophylaxis and treatment of nausea and vomiting

Particularly in general anaesthesia and chemotherapy

Question 22

Antiemetics - histamine H1-receptor antagonists

(cyclizine, cinanrizine, promethazine)

Answer 22

1) Prophylaxis and treatment of nausea and vomiting

Particularly in motion sickness and vertigo

Question 23

Corticosteroids (glucocorticoids) - systemic

(prednisolone, hydrocortisone, dexamethasone)

Answer 23

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

Question 24

Warfarin

Answer 24

1) VTE treatment and prevention of recurrence

2) To prevent arterial embolism in patients with AF or prosthetic heart valves

Question 25

Thyroid hormones (levothyroxine, liothyronine)

Answer 25

1) Primary hypothyroidism 2) Hypothyroidism secondary to hypopituitarism

Question 26

α-blockers (doxazosin, tamsulosin, alfuzosin)

Answer 26

1) Benign prostatic enlargement 2) Resistant HTN (as add-on)

Question 27

Dopaminergic drugs for Parkinson's disease (levodopa as co-careldopa/co-beneldopa, ropinirole, premipexol)

Answer 27

1) Early Parkinson's disease - ropinirole, pramipexol 2) Later Parkinson's disease - levodopa 3) Levodopa and dopamine agonists may be options for secondary parkinsonism

Question 28

Sex hormone antagonists for breast cancer (tamoxifen, anastrozole, letrozole)

Answer 28

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

Question 29

Adenosine

Answer 29

1) 1st line diagnostic and therapeutic agent in SVT

Question 30

Prostaglandin analogue of eye drops (latanoprost, bimatoprost)

Answer 30

1) 1st line agents to lower intraocular pressure in open-angle glaucoma and ocular hypertension

Question 31

Dipeptidylpeptidase-4 inhibitors (sitagliptin, linagliptin, saxagliptin)

Answer 31

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

Question 32

Lamotrigine

Answer 32

1) Seizure prophylaxis in epilepsy - 1st line in focal, generalised tonic-clonic and absence 2) Bipolar depression (not mania/hypomania)

Question 33

Penicillins (benzylpenicilin, phenoxymethylpenicillin)

Answer 33

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)

Question 34

Bisphosphonates (alendronic acid, disodium pamidronate, zoledronic acid)

Answer 34

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

Question 35

Aminoglycosides (gentamicin, amikacin, neomycin)

Answer 35

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

Question 36

Macrolides (clarithromycin, erythromycin, azithromycin)

Answer 36

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

Question 37

Calcium channel blockers (amlodipine, nifedipine, dilitiazem, verapamil)

Answer 37

1) 1st or 2nd line treatment for HTN (amlodipine) 2) Symptom control instable angina 3) Rate control in SVT (dilitiazem and verapimil)

Question 38

Acetylcholinesterase inhibitors (donepezil, rivastigmine)

Answer 38

1) Mild to moderate Alzheimer's 2) Mild to moderate dementia in Parkinson's (rivastigmine)

Question 39

Amiodarone

Answer 39

1) Used in a wide range of tachyarrhythmias AF, SVT, RVF

Question 40

Metronidazole

Answer 40

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

Question 41

Z-drugs (zopiclone, zolpidem)

Answer 41

1) Short-term treatment of insomnia which is debilitating/distressing

Question 42

Valproate (valproic acid) (sodium valproate, valproic acid)

Answer 42

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

Question 43

Corticosteroids (glucocorticoids) - topical (hydrocortisone, betamethasone)

Answer 43

1) Inflammatory skin conditions e.g. eczema To treat disease flares or control chronic disease where emollients alone are ineffective

Question 44

Direct oral anticoagulants (DOACs) (apixaban, dabigatran, edoxaban, rivaroxaban)

Answer 44

1) VTE 2) AF - to prevent stroke and systemic embolism in patients with at least one risk factor e.e. previous stroke

Question 45

Antiviral drugs (aciclovir)

Answer 45

1) Treatment of acute episodes of herpesvirus infection 2) Suppression of recurrent herpes simplex attacks

Question 46

Antiplatelet drugs (aspirin)

Answer 46

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

Question 47

Allopurinol

Answer 47

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

Question 48

Protein pump inhibitors (lansoprazole, omeprazole, pantoprazole)

Answer 48

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)

Question 49

Heparins and fondaparinux (enoxaparin, dalteparin, fondaparinux, unfractioned heparin)

Answer 49

1) DVT and PE (usually LMWH) 2) ACS to reduce clot progression or maintain revascularisation

Question 50

Laxatives - stimulant (senna, bisacodyl, glycerol suppositories, docusate sodium)

Answer 50

1) Constipation 2) Suppositories for faecal impaction

Question 51

ACE inhibitors (ramipril, lisinopril, perindopril)

Answer 51

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

Question 52

Penicillins - antipseudomonal (piperacilllin with tazobactam - tazocin)

Answer 52

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

Question 53

Penicillins - broad-spectrum (amoxicillin, co-amoxiclav)

Answer 53

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)

Question 54

Antiplatelet drugs - ADP-receptor antagonists (clopidogrel, ticagrelor, prasugrel)

Answer 54

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

Question 55

Activated charcoal

Answer 55

1) Reduce absorption of certain poisons in the gut 2) Increase elimination of certain poisons

Question 56

Cephalosporins and carbapenems (cefalexin, cefotazime, meropenem, ertapenem)

Answer 56

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)

Question 57

Phosphodiesterase (type 5) inhibitors (sildenafil)

Answer 57

1) Erectile dysfunction 2) Primary pulmonary hypertension

Question 58

Loop diuretics (furosemide, bumetanide)

Answer 58

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

Question 59

Ocular lubricants - artificial tears (hypromellose, carbomers, liquid and white soft paraffin)

Answer 59

1) 1st line symptomatic treatment of dry eye conditions e.g. keratoconjunctivitis sicca and Sjogren's syndrome

Question 60

Antihistamines - H1-receptor antagonists) (cetirizine, loratadine, fexofenadine, chlorpgenamine)

Answer 60

1) 1st line for allergies, particularly hayfever 2) Aid relief of pruritis and urticaria 3) Adjunctive for anaphylaxis

Question 61

Trimethoprim (trimethoprim, co-trimoxazole)

Answer 61

First choice antibiotic for the treatment of: 1) Acute lower UTI 2) Prophylaxis of recurrent UTI

Question 62

Iron (ferrous fumarate, ferrous sulfate)

Answer 62

1) Treatment of iron-deficiency anaemia 2) Prophylaxis of iron-deficiency anaemia

Question 63

Serotonin 5HT1-receptor agonists (sumatriptan)

Answer 63

1) Acute migraine with or without aura

Question 64

H2-receptor antagonists (ranitidine)

Answer 64

1) Peptic ulcer disease - treatment and prevention 2) GORD and dyspepsia (PPIs preferred in severe cases)

Question 65

Antipsychotics - 1st generation (typical) (haloperidol, chlorpromazine, prochlorperazine)

Answer 65

1) Urgent treatment of severe psychomotor agitation 2) Schizophrenia 3) Bipolar disorder 4) Nausea and vomiting

Question 66

Emollients (aqueous cream, liquid paraffin)

Answer 66

1) Topical treatment for all dry or scaling skin disorders

Question 67

Metformin

Answer 67

1) T2DM as first choice for control of blood glucose Used alone or in combination with sulphonylureas, DPP-4 inhibitors, insulin

Question 68

Carbamazepine

Answer 68

1) Seizure prophylaxis in epilepsy 2) Trigeminal neuralgia (pain control, reduce frequency/severity of attacks)

Question 69

Antimuscarinics - GU uses (oxybutynin, tolterodine, solifenacin)

Answer 69

1) 1st line in overactive bladder to reduce frequency, urgency and urge incontinence

Question 70

Azathioprine

Answer 70

1) Maintenance of remission in Crohn's and UC 2) Disease-modifying agent in RA and autoimmune conditions 3) Prevention of organ rejection

Question 71

Antidepressants (tricyclics; amitriptyline, lofepramine)

Answer 71

1) 2nd line for moderate to severe depression when SSRIs ineffective 2) Neuropathic pain (unlicensed)

Question 72

Sulphonylureas (glicazide)

Answer 72

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

Question 73

β2-agonists (salbutamol, terbutaline, salmeterol, formoterol, indacaterol)

Answer 73

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

Question 74

Oxygen

Answer 74

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

Question 75

Benzodiazepines (diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam)

Answer 75

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

Question 76

Paracetamol

Answer 76

1) 1st line analgesic for most forms of acute and chronic pain 2) Antipyretic that can reduce fever and its associated symptoms

Question 77

Antidepressants (venfalaxine, mirtazapine)

Answer 77

1) Option for major depression when SSRIs ineffective Generalised anxiety disorder (venfalaxine)

Question 78

Acetylcysteine (N-acetylcysteine)

Answer 78

1) Antidote to paracetamol poisoning 2) Prevention of contrast nephropathy 3) Reduce viscosity of respiratory secretions

Question 79

Nitrofurantoin

Answer 79

1) First choice treatment for acute, uncomplicated lower UTI 2) Prophylaxis of UTI in patient with recurrent infections

Question 80

Alginates and antacids (gaviscon, peptac)

Answer 80

1) GORD 2) Dyspepsia

Question 81

Oestrogens and progestogens (combined ethinylestradiol products, desogestrel)

Answer 81

1) Hormonal contraception 2) HRT to delay early menopause or to treat distressing menopausal symptoms

Question 82

Opioids - strong (morphine, oxycodone)

Answer 82

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)

Question 83

Insulin (insulin aspart, insulin glargine, biphasic insulin, soluble insulin)

Answer 83

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

Question 84

Statins (simvastatin, atorvastatin, pravastatin, rosuvastatin)

Answer 84

1) Primary prevention of CV events (people over 40 with risk factors) 2) Secondary prevention of CV events 3) Primary hyperlipidaemia

Question 85

Antimotility drugs (loperamide, codeine phosphate)

Answer 85

1) Symptomatic treatment for diarrhoea (IBS, gastroenteritis)

Question 86

Laxatives - osmotic (lactulose, macrogol, phosphate enema)

Answer 86

1) Constipation and faecal impaction 2) Bowel preparation prior to surgery/endoscopy 3) Hepatic encephalopathy

Question 87

Antifungal drugs (nystatin, clotrimazole, fluconazole)

Answer 87

1) Local fungal infections (oropharynx, vagina, skin) 2) Systemic treatment of invasive or disseminated fungal infections

Question 88

Thiazide and thiazide-like diuretics (bendroflumethiazide, indapamide, chlortalidone)

Answer 88

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

Question 89

Adrenaline (epinephrine)

Answer 89

1) Cardiac arrest 2) Anaphylaxis 3) Induce local vasoconstriction e.g. prolong local anaesthetic

Question 90

Antimuscarinics - bronchodilators (ipratropium, tiotropoium, glycopyrronium, aclidinium)

Answer 90

1) COPD to relieve breathlessness 2) Asthma to relieve breathlessness

Question 91

NSAIDs (naproxen, ibuprofen, etoricoxib)

Answer 91

1) Treatment of mild to moderate pain 2) Regular treatment for pain related to inflammation, particularly MSK e.g. RA, severe OA and gout

Question 92

Quinine (quinine sulfate)

Answer 92

1) Treatment and prevention of night-time leg cramps 2) 1st line treatment for Plasmodium falciparum malaria

Question 93

Corticosteroids (glucocorticoids) - inhaled (beclometasone, budesonide, fluticasone)

Answer 93

1) Asthma to treat inflammation and control symptoms 2) COPD to control symptoms and prevent exacerbations

Question 94

Digoxin

Answer 94

1) AF and atrial flutter to reduce ventricular rate (β-blocker or CCB usually more effective) 2) Severe heart failure

Question 95

Aldosterone antagonists (spironolactone, eplerenone)

Answer 95

1) Ascites and oedema due to liver cirrhosis 2) Chronic heart failure 3) Primary hyperaldosteronism

Question 96

Aminosalicylates (mesalazine, sulfasalazine)

Answer 96

1) Mesalazine is 1st line for mild to moderate UC 2) Sulfasalazine is used in RA

Question 97

Levetiracetam

Answer 97

1) Seizure prophylaxis in epilepsy - focal, myoclonic and generalised tonic-clonic 2) Established convulsive status epilepticus that has not responded to benzodiazepine

Question 98

Opioids - weak/moderate (tramadol, codeine, dihydrocodeine)

Answer 98

1) Mild to moderate pain as 2nd line when simple analgesics insufficient - rung 2 on pain ladder