Drugs Flashcards
P450 Enzyme inhibitors
Sodium valproate Ketoconazole Isoniazid Amiodarone Chloramphenicol Erythromycin Quinidine Grapefruit juice
Ketoconazole
Antifungal medication.
An imidazole derivative which acts as a potent inhibitor of cortisol and aldosterone synthesis by inhibiting the activity of 17α-hydroxylase, 11-hydroxylation steps and at higher doses the cholesterol side-chain cleavage enzyme.
It also inhibits the activity of adrenal C17-20 lyase enzymes resulting in androgen synthesis inhibition, and may have a direct effect on corticotropic tumour cells in patients with Cushing’s disease.
Endogenous Cushing’s syndrome; Tinea pedis; treatment and prophylaxis of seborrhoeic dermatitis and dandruff; Treatment and prophylaxis of pityriasis versicolor; Vaginal and vulva candidiasis.
Risk of hepatotoxicity associated with oral ketoconazole is greater than the benefit in treating fungal infections (doesn’t include Cuishings).
The use of carbonated drinks, such as cola, improves ketoconazole bioavailability.
S/E: Skin reactions. P450 enzyme inhibitor
Avoid in pregnancy / breastfeefing / hepatic imparement.
Monitor ECG before and one week after initiation
Cyclizine
An antiemetic.
Nausea, vomiting, vertigo, motion sickness, labyrinthine disorders, palliative care.
Although not licenced for morning sickness it is considered useful and safe.
Cautions: Epilepsy; glaucoma; prostatic hypertrophy; severe heart failure, mean arterial pressure and pulmonary wedge pressure; susceptibility to angle-closure glaucoma; urinary retention
S/E: Agitation; angle closure glaucoma; depression
Drowsiness may affect performance of skilled tasks; effects of alcohol enhanced
Ondansetron
Antiemetic. Specific 5HT3-receptor antagonist which blocks 5HT3 receptors in the gastro-intestinal tract and in the CNS.
Emetogenic chemotherapy or radiotherapy; postoperative nausea and vomiting.
C/I: long QT syndrome.
S/E: Constipation; feeling hot; headache; sensation abnormal
Small risk of cleft lip and/or cleft palate in babies born to women who used oral ondansetron during the first trimester of pregnancy.
Metoclopramide hydrochloride
Antiemetic.
Brand name: Maxolon
Treats nausea and vomiting associated with: chemo, RT, migraine, post-operatively.
Palliative care - hiccup; nausea and vomiting.
C/I: 3–4 days after GI surgery; epilepsy; GI haemorrhage; GI obstruction; GI perforation; phaeochromocytoma, parkinsons.
S/E: Asthenia; depression; diarrhoea; drowsiness; hypotension; menstrual cycle irregularities; movement disorders; parkinsonism (extrapyramidal SE)
Can induce acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crises.
Safe in pregnancy one of the second line options after pyridoxine / doxylamine.
Antiemetics
Metoclopramide Cyclizine Ondansetron Prochlorperazine (typical antipsychotic) Domperidone Hyoscine hydrobromide Metoclopramide hydrochloride Trifluoperazine (typical antipsychotic) Haloperidol (typical antipsychotic)
Terlipressin acetate
Analogue of vasopressin.
Bleeding from oesophageal varices;
Cautions: Arrhythmia; elderly; electrolyte and fluid disturbances; heart disease; history of QT-interval prolongation; respiratory disease; septic shock; uncontrolled hypertension; vascular disease
S/E: Abdominal cramps; arrhythmias; diarrhoea; headache; hypertension; hypotension; pallor; peripheral ischaemia; vasoconstriction
Diltiazem hydrochloride
Non-dihydropyridine calcium channel blocker.
Prophylaxis and treatment of angina; hypertension; Chronic anal fissure (unlicenced).
C/I : Acute porphyrias ; cardiogenic shock; heart failure; left ventricular failure with pulmonary congestion; second- or third-degree AV block; severe bradycardia; sick sinus syndrome; significant aortic stenosis; Cardiac conduction disorders; constipation; gastrointestinal discomfort; malaise
Overdose: nausea, vomiting, dizziness, agitation, confusion, and coma in severe poisoning
There is some evidence that sudden withdrawal of calcium-channel blockers may be associated with an exacerbation of myocardial ischaemia.
Beta blockers / β-Adrenergic Antagonists
Metoprolol, Atenolol, Propranolol, Sotalol
Hypertension
Timolol, betaxolol - glaucoma (reduces aqueous production)
C/I: Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma (apart from specific use with alpha-blockers); Prinzmetal’s angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure
S/E: Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; peripheral vascular disease; rash (reversible on discontinuation); sleep disorders; syncope; visual impairment; vomiting
Ipratropium bromide
Anticholinergics (inhaled) - bronchodilator.
Reversible airways obstruction (asthma and COPD); Acute bronchospasm; Severe or life-threatening acute asthma; Rhinorrhoea associated with allergic and non-allergic rhinitis.
Cautions: Bladder outflow obstruction; paradoxical bronchospasm; prostatic hyperplasia; susceptibility to angle-closure glaucoma.
S/E: Arrhythmias; cough; dizziness; dry mouth; headache; nausea; Gastrointestinal motility disorder; throat complaints
It is used by inhaler or nebulizer.
Bleomycin
Glycopeptide antibiotic - cancer medication
Squamous cell carcinoma; Metastatic germ cell cancer; Non-Hodgkin’s lymphoma
C/I: Acute pulmonary infection; significantly reduced lung function
S/E: Alopecia; angular stomatitis; appetite decreased; chills; fever; haemorrhage; headache; interstitial pneumonia; leucopenia; malaise; nail discolouration; nail disorder; nausea; pain; pulmonary fibrosis; scleroderma; skin reactions; stomatitis; vomiting; weight decreased
Treatment of lymphoma (4 drugs)
Dacarbazine, vinblastine, bleomycin, and doxorubicin
Non-nucleoside reverse transcription inhibitors (NNRTI)
HIV antiviral drugs
Nevirapine, Efavirenz, Rilpivirine
S/E stephen johnson syndrome, hepatitis
Efavirenz, Nevirapine.
HIV infection in combination with other antiretroviral drugs
Integrase strand transfer inhibitors (InSTIs)
HIV antiviral drugs
Dolutegravir, Raltegravir, elvitegravir
S/E GI upset, insomnia
Dolutegravir
Integrase strand transfer inhibitors (InSTIs).
Preferred HIV Drug recommended by WHO.
S/E: Anxiety; depression; diarrhoea; dizziness; fatigue; flatulence; gastrointestinal discomfort; headache; nausea; skin reactions; sleep disorders; vomiting
Teratogenic (neural tube defects)
Amoxicillin
Penicillin antibiotic.
Broader spec. than penicillin.
Streps, meningococcus, syphilis, gram -ve rods.
Community-acquired pneumonia; Acute exacerbation of bronchiectasis / COPD; Lyme disease; Anthrax; Dental abscess; Listerial meningitis; sinusitis, salmonellosis; Endocarditis; Helicobacter pylori eradication; Acute diverticulitis; Prophylaxis and treatment of urinary-tract infection.
Cautions: allergy; Acute lymphocytic leukaemia; chronic lymphocytic leukaemia; cytomegalovirus infection; glandular fever; maintain adequate hydration with high doses.
S/E: Diarrhoea; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting
Penicillin based antibiotics
B-lactams (Inhibition of cell wall synthesis).Effective mostly againstGram-positivebacteria.
Amoxicillin, flucloxacillin, benzylpenicillin (penicillin)
The penicillins are bactericidal and act by interfering with bacterial cell wall synthesis. They diffuse well into body tissues and fluids, but penetration into the cerebrospinal fluid is poor except when the meninges are inflamed. They are excreted in the urine in therapeutic concentrations.
S/E: Diarrhoea; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting
The most important side-effect of the penicillins is hypersensitivity which causes rashes and anaphylaxis and can be fatal. Allergic reactions to penicillins occur in 1–10% of exposed individuals; anaphylactic reactions occur in fewer than 0.05% of treated patients. Patients with a history of atopic allergy (e.g. asthma, eczema, hay fever) are at a higher risk of anaphylactic reactions to penicillins. Individuals with a history of anaphylaxis, urticaria, or rash immediately after penicillin administration are at risk of immediate hypersensitivity to a penicillin; these individuals should not receive a penicillin.
Individuals with a history of a minor rash (i.e. non-confluent, non-pruritic rash restricted to a small area of the body) or a rash that occurs more than 72 hours after penicillin administration are probably not allergic to penicillin and in these individuals a penicillin should not be withheld unnecessarily for serious infections; the possibility of an allergic reaction should, however, be borne in mind. Other beta-lactam antibiotics (including cephalosporins) can be used in these patients.
Flucloxacillin
Penicillin based antibiotic
Staphylococci (Gram +ve b-lactamase producers)
Infections due to beta-lactamase-producing staphylococci including otitis externa; Adjunct in pneumonia; Adjunct in impetigo; Cellulitis; Erysipelas; Diabetic foot infection; Leg ulcer infection; Endocarditis; Osteomyelitis; Surgical prophylaxis; Prevention of Staphylococcus aureus lung infection in cystic fibrosis.
S/E: Diarrhoea; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting; gastrointestinal disorder
Patients who are allergic to one penicillin will be allergic to all.
Co-amoxiclav
Penicillin based antibiotic.
Amoxicillin + clavulanic acid.
Infections due to beta-lactamase-producing strains (where amoxicillin alone not appropriate), including respiratory tract infections, bone and joint infections, genito-urinary and abdominal infections, and animal bites; diabetic foot infection; Leg ulcer infection; Cellulitis; Erysipelas; Surgical prophylaxis; Community-acquired pneumonia; Hospital-acquired pneumonia; Acute exacerbation of bronchiectasis / COPD; sinusitis; otitis media; Acute pyelonephritis;
Urinary-tract infection.
C/I: History of co-amoxiclav/ penicillin associated jaundice or hepatic dysfunction.
Cautions: Increased risk of erythematous rashes in acute lymphocytic leukaemia, chronic lymphocytic leukaemia, cytomegalovirus infection, glandular fever; maintain adequate hydration with high doses (particularly during parental therapy); Cholestatic jaundice can occur
S/E: C.diff infeciton,
The 4 Cs
clindamycin, cephalosporins, co-amoxiclav and ciprofloxacin
Cephalosporins
B-lactams (Inhibition of cell wall synthesis). Effective mostly againstGram-positivebacteria.
Active against staphs (including b-lactamase producers), streps, pneumococci, E Coli etc.
Used mainly in surgical prophylaxis or for UTI, pneumonia etc if penicillin allergic (10% will also be cephalosporin allergic).
S/E Hypersensitivity, warfarin potentiation, Abdominal pain; diarrhoea; dizziness; eosinophilia; headache; leucopenia; nausea; neutropenia; skin reactions; thrombocytopenia; vomiting; vulvovaginal candidiasis
C. diff infection!
Cefotaxime, cefuroxime, ceftriaxone
Glycopeptides
Inhibition of cell wall synthesis.
Only act on gram +ve organisms (cannot penetrate wall of gram -ve). Not absorbed from the GI tract and are only given parenterally.
e.g. vancomycin (!toxic), teicoplanin
Aminoglycosides
Inhibition of Protein Synthesis.
Treat serous gram -ve infection.
e.g. gentamicin (toxic)
Families of antibiotics
- Penicillins and cephalosporins (B-lactams)
- Glycopeptides
- Aminoglycosides
- Macrolides
- Tetracyclines
- Oxazolidinones
- Cyclic lipopeptide
- Fluoroquinolones
Macrolides
Inhibition of protein synthesis.
Useful alternatives to penicillins in treatment of Gram-positive infections in patients who are penicillin allergic.
e.g. Erythromycin, Clarithromycin
Good against legionella.
S/E: Appetite decreased; diarrhoea; dizziness; gastrointestinal discomfort; gastrointestinal disorders; headache; hearing impairment; insomnia; nausea; pancreatitis; paraesthesia; skin reactions; taste altered; vasodilation; vision disorders; vomiting
Statins must be temporarily held when prescribing a macrolide antibiotic due to the increased risk of rhabdomyolysis when combing the two drugs.
Cautions: electrolyte disturbances; may aggravate myasthenia gravis; predisposition to QT interval prolongation
Tetracyclines
Doxycycline, tetracycline, lymecycline, minocycline, Demeclocycline.
Inhibition of protein synthesis. Gram +ve infections. High levels of resistance in staph aureus, strep. pyrogenes etc
Indications: acne vulgaris; Lyme disease; Chlamydia; Mycoplasma pneumoniae
Cautions: myasthenia gravis (muscle weakness may be increased); systemic lupus erythematosus (may be exacerbated)
S/E: discolouration of teeth: therefore should not be used in children < 12 years of age; photosensitivity; angioedema; black hairy tongue.
Tetracyclines should not be given to women who are pregnant or breastfeeding due to the risk of discolouration of the infant’s teeth.
Oxazolidinones
Inhibition of protein synthesis.
Gram +ve infections.
e.g. linezolid
Cyclic lipopeptide
Inhibition of protein synthesis.
Gram +ve infections. Good against MRSA and other serious infections.
e.g. daptomycin
Quinolones and fluoroquinolones
Inhibition of DNA synthesis and replication.
Best against gram -ves inc. pseudomonas.
e.g. ciprofloxacin, levofloxacin, nitrofurantoin
Inhibition of purine synthesis
Trimethoprim
Vancomycin
Glycopeptide bactericidal antibiotic.
Effective against aerobic and anaerobic Gram-positive bacteria including multi-resistant staphylococci. However, there are reports of Staphylococcus aureus with reduced susceptibility to glycopeptides. There are increasing reports of glycopeptide-resistant enterococci. Penetration into cerebrospinal fluid is poor.
Clostridioides difficile infection; diabetic foot infection; Cellulitis; Erysipelas; Bone infections; Joint infections; Community-acquired pneumonia; Hospital-acquired pneumonia, including ventilator-associated pneumonia; Infective endocarditis; Acute bacterial meningitis,
Bacteraemia; MRSA.
C/I: previous hearing loss
Cautions: systemic absorption may be enhanced in patients with inflammatory disorders of the intestinal mucosa or with Clostridioides difficile-induced pseudomembranous colitis (increased risk of adverse reactions).
S/E: Agranulocytosis; dizziness; drug fever; eosinophilia; hypersensitivity; nausea; nephritis tubulointerstitial; neutropenia; renal failure; severe cutaneous adverse reactions; skin reactions; thrombocytopenia; tinnitus; vasculitis; vertigo
Monitoring: base initial dose on body-weight, subsequent dose adjustments should be based on serum-vancomycin concentrations to achieve targeted therapeutic concentrations. All patients require serum-vancomycin measurement (on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment.
Narrow therapeutic window, toxicity is a common monitor!
IV: MRSA pr other gram +ve organisms
PO: In C. diff severe infection / metronidazole c/i.
S/E: oto and nephrotoxicity.
Get help in renal failure.
Do not overuse as risk of drug resistance.
Teicoplanin
Glycopeptide bactericidal antibiotic good against gram +ve organisms.
Less toxic than Vancomycin
and has the advantage of
single daily dosing.
Not absorbed from the GI tract and are only given parenterally.
Gentamicin
Aminoglycoside antibiotic useful in serious gram-negative infections.
Toxic and requires a careful dosing regime and monitoring of levels (U&Es).
Oto and nephrotoxic. Don’t use in myasthenia gravis, pregnancy.
Erythromycin
Macrolide antibiotic.
Effective against gram-positive organisms. Good alternative if penicillin allergic.
Impetigo; Cellulitis; Erysipelas; Mild diabetic foot infection; Leg ulcer infection; Community-acquired pneumonia; Acute otitis media; Early syphilis; chlamydia; Prevention and treatment of pertussis; Chronic prostatitis; Rosacea; Acne; campylobacter enteritis; Legionella infection.
1st line in atypical pneumonia.
Statins must be temporarily held when prescribing a macrolide antibiotic due to the increased risk of rhabdomyolysis when combing the two drugs.
Cautions: electrolyte disturbances; may aggravate myasthenia gravis; predisposition to QT interval prolongation;
P450 Enzyme inhibitor
S/E: Appetite decreased; diarrhoea; dizziness; gastrointestinal discomfort; gastrointestinal disorders; headache; hearing impairment; insomnia; nausea; pancreatitis; paraesthesia; skin reactions; taste altered; vasodilation; vision disorders; vomiting; Hearing loss
Linezolid
Oxazolidinone antibiotic effective against gram positive organisms (inc. MRSA, VISA, VRE)
Can be given orally. Generally held in reserve for the treatment of serious infections.
May cause pancytopenia if > 2 weeks use. Montior FBC and visual acuitiy.
Daptomycin
Cyclic Lipopeptide effective against gram positive organisms.
Novel agent recently introduced with activity against Gram-positives in general and MRSA in particular. Used in serious infections on specialist advice.
Trimethoprim
Inhibitor of purine synthesis.
Respiratory-tract infections; UTI, Shigellosis, salmonella infection, Acute prostatitis
Treatment of urinary tract (UTI) and chest infections (COPD)
Cautions: Elderly; Acute porphyrias; neonates; predisposition to folate deficiency
Less likely than cephalosporins to cause Clostridium difficile infections.
S/E Diarrhoea; electrolyte imbalance; fungal overgrowth; headache; nausea; skin reactions; vomiting; depressed marrow.
Teratogenic risk in first trimester (folate antagonist).
Manufacturer advises monitor blood counts with long-term use and in those with, or at risk of, folate deficiency.
Sulphamethoxazole
Inhibitor of purine synthesis.
Used in a combined form in the drug: co-trimoxazole.
Ciprofloxacin
Quinolone. Particularly effective against Gram-negative organisms, including Pseudomonas.
Bacterial eye infection; corneal ulcer; acute otitis externa; diabetic foot infection; Fistulating Crohn’s disease; Acute diverticulitis; Respiratory-tract infections; Urinary-tract infections; Acute prostatitis; Gonorrhoea; Surgical prophylaxis; Anthrax; Cystic fibrosis, typhoid, salmonella, campylobacter/
C/I: history of tendon disorders related to quinolone use; cannot be used in children (interference with cartilage growth).
Cautions: can prolong the QT interval; conditions that predispose to seizures; diabetes; exposure to excessive sunlight and UV radiation should be avoided during treatment and for 48 hours after stopping treatment; G6PD deficiency; history of epilepsy; myasthenia gravis; psychiatric disorders.
S/E: Appetite decreased; arthralgia; asthenia; constipation (in adults); diarrhoea; dizziness; dyspnoea; eye discomfort; eye disorders; fever; gastrointestinal discomfort; headache; muscle complaints; nausea; QT interval prolongation; skin reactions; sleep disorders; taste altered; tinnitus; vision disorders; vomiting
Can cause c. diff infection.
Given as prophylaxis for meningitis contacts.
P450 enzime inhibitor.
Levofloxacin
(Fluoro)quinolone particularly effective against Gram-negative organisms, including Pseudomonas.
Eye infections; sinusitis; COPD and bronchiectasis exacerbation; Community-acquired pneumonia; Hospital-acquired pneumonia; UTI; Complicated skin infections; Complicated soft-tissue infections; prostatitis; Helicobacter pylori eradication (in combination).
Quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them.
Tendon damage (including rupture) has been reported rarely in patients receiving quinolones.
Cautions: can prolong the QT interval; conditions that predispose to seizures; diabetes; exposure to excessive sunlight should be avoided; G6PD deficiency; history of epilepsy; myasthenia gravis
S/E: Appetite decreased; arthralgia; asthenia; constipation (in adults); diarrhoea; dizziness; dyspnoea; eye discomfort; eye disorders; fever; gastrointestinal discomfort; headache; muscle complaints; nausea; QT interval prolongation; skin reactions; sleep disorders; taste altered; tinnitus; vision disorders; vomiting
Avoid in pregnancy
Nitrofurantoin
Quinolone antibiotic.
Good in UTI and against e.coli.
Can cause pulmonary fibrosis.
Chloramphenicol
Antibiotic first developed to treat typhoid fever although now most Salmonella typhi is multi-drug-resistant.
Used as an ointment to treat eye infections and sometimes in meningitis.
Avoid in late pregnancy and lactation.
P450 enzyme inhibitor.
Clarithromycin
A macrolide antibiotic.
Useful against staph. aureus, streptococci, mycoplasma, h.pylori, chlamydia, legionella.
Diabetic foot; pneumonia; cellulitis; chest infections; otitis media; whooping cough if onset <21 days.
Cautions: electrolyte disturbances; may aggravate myasthenia gravis; predisposition to QT interval prolongation;
S/E: Appetite decreased; diarrhoea; dizziness; gastrointestinal discomfort; gastrointestinal disorders; headache; hearing impairment; insomnia; nausea; pancreatitis; paraesthesia; skin reactions; taste altered; vasodilation; vision disorders; vomiting
STATINS must be temporarily held when prescribing a macrolide antibiotic due to the increased risk of rhabdomyolysis when combing the two drugs.
Clindamycin
An synthetic antibiotic developed from lindamycin (a natural antibiotic).
Affective against gram positive cocci inc. MRSA and anerobes.
Can cause c.diff infection.
Daptomycin
A naturally-occurring lipopeptide antibiotic that kills susceptible gram positive bacteria.
Dont use in pneumonia as it binds surfactant.
Doxycycline
A tetracycline antibiotic and antimalarial.
Chlamydia, rickettsia and mycoplasma, severe UTI, community/hospital acquired pneumonia, chest infections, cellulitis and erysipelas, acne, rosacea, syphilis, PID, lyme disease, anthrax, travellers diarrhoea, leptosporpsis.
Prophylaxis and treatment of malaria (adjunct to quinine)
Unlike tetracycline it CAN be used in renal failure.
S/E: Angioedema; diarrhoea; headache; Henoch-Schönlein purpura; hypersensitivity; nausea; pericarditis; photosensitivity reaction; skin reactions; systemic lupus erythematosus exacerbated; vomiting
Ertapenem
Broad spec. carbapenem antibiotic used in bad aerobic gram negative infections (not pseudomonas) and some staphs (not MRSA).
Imipenem
Very broad spec antibiotic against gram +ve and -ve organisms.
Avoid in pregnancy/lactation.
S/E fits, eosinophilia, neutropenia.
Meropenem
Very broad spec antibiotic against gram +ve and -ve organisms. Similar to Imipenem but causes less fits.
Aerobic and anaerobic Gram-positive and Gram-negative infections; Hospital-acquired septicaemia; Exacerbations of chronic lower respiratory-tract infection in cystic fibrosis; Meningitis; Endocarditis.
S/E: Abdominal pain; diarrhoea; headache; inflammation; nausea; pain; skin reactions; thrombocytosis; vomiting
Monitor liver function—risk of hepatotoxicity.
Metronidazole
Nitroimidazole antibiotic / Antiamoebic.
Gums and GUM.
Anaerobic infections; diabetic foot infection; Cellulitis; Erysipelas; Helicobacter pylori eradication; Acute diverticulitis; Bacterial vaginosis; Leg ulcers and pressure sore; Pelvic inflammatory disease; Acute oral infections; gingivitis; Surgical prophylaxis; Giardiasis; cellulitis (unlicenced).
1st choice against anaerobes, gardnerella, entamoeba histolytica, giardia lamblia, colostrium difficile (PO).
1st line in C Diff infection.
Cautions: avoid exposure to strong sunlight or UV light (topical); avoid intravaginal preparations in young girls who are not sexually active; not recommended during menstruation; some systemic absorption may occur with vaginal gel. Optic neuritis.
S/E: With intravenous use - dry mouth; myalgia; nausea; oral disorders; taste metallic; vomiting. With topical use - skin reactions. With vaginal use - pelvic discomfort; vulvovaginal candidiasis; vulvovaginal disorders
Disulfiram reaction with alcohol. Interacts with warfarin (inhibits P450 system increases effects of warfarin, increasing INR).
Minocycline
A tetracycline antibiotic but with a wider spec. and more S/E (hepatitis, pneumonitis)
Tetracycline
A tetracycline antibiotic.
Susceptible infections (e.g. chlamydia, rickettsia, mycoplasma); Rosacea; acne; Helicobacter pylori eradication
C/I: children under 12 years (deposition in growing bone and teeth, by binding to calcium, causes staining and occasionally dental hypoplasia)
Cautions: myasthenia gravis (muscle weakness may be increased); systemic lupus erythematosus (may be exacerbated)
S/E: Angioedema; diarrhoea; headache; Henoch-Schönlein purpura; hypersensitivity; nausea; pericarditis; PHOTOSENSITIVITY reaction; skin reactions; systemic lupus erythematosus exacerbated; vomiting.
Tobramycin
Aminoglycoside antibiotic useful in serious gram-negative infections.
Better against pseudomonas (CF) than gentamicin, similar toxicity.
Digoxin
Cardiac glycoside
Atrial fibrillation; atrial flutter; heart failure.
C/I: Constrictive pericarditis; hypertrophic cardiomyopathy; intermittent complete heart block; myocarditis; second degree AV block; supraventricular arrhythmias associated with accessory conducting pathways; ventricular tachycardia or fibrillation
S/E: Arrhythmias; cardiac conduction disorder; cerebral impairment; diarrhoea; dizziness; eosinophilia; nausea; skin reactions; vision disorders; vomiting
Therapeutic monitoring at least 6 hrs post-dose.
Oxcarbazepine
Anticonvulsive
Heparin
Anticoagulant. IV admin.
Activates antithrombin III. Forms a complex that inhibits thrombin, factors Xa, IXa, Xia and XIIa
Pulmonary embolism; deep-vein thrombosis; thromboprophylaxis; haemodialysis
S/E Bleeding, Heparin-induced thrombocytopaenia (HIT)
Osteoporosis
Monitoring: Activated partial thromboplastin time (APTT). Overdose may be reversed by protamine sulphate.
Low molecular weight heparin (LMWH)
Dalteparin, Enoxaparin.
Activates antithrombin III. Forms a complex that inhibits factor Xa.
Routine monitoring not required.
C/I: Acute bacterial endocarditis; after major trauma; epidural anaesthesia with treatment doses; haemophilia or other haemorrhagic disorders; peptic ulcer; recent cerebral haemorrhage; recent surgery to eye; recent surgery to nervous system; spinal anaesthesia with treatment doses; thrombocytopenia.
S/E: Haemorrhage; heparin-induced thrombocytopenia; skin reactions; thrombocytopenia; thrombocytosis
Dalteparin
Low molecular weight heparin (LMWH)
Unstable coronary artery disease; NSTEMI; prophylaxis of deep-vein thrombosis in surgical patients; Treatment of deep-vein thrombosis; Treatment of pulmonary embolism; treatment of venous thromboembolism in pregnancy.
S/E: Haemorrhage; heparin-induced thrombocytopenia; skin reactions; thrombocytopenia; thrombocytosis
Enoxaparin
Low molecular weight heparin (LMWH) - Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa.
Treatment of venous thromboembolism in pregnancy; prophylaxis of deep-vein thrombosis; unstable angina, MI.
S/E: Haemorrhage; heparin-induced thrombocytopenia; skin reactions; thrombocytopenia; thrombocytosis
Aciclovir
Antiviral
Herpes simplex infection (treatment and prophylaxis); Varicella zoster and Herpes zoster (in immunocopromised)
S/E: abdominal pain; diarrhoea; dizziness; fatigue; fever; headache; nausea; photosensitivity reaction; skin reactions; vomiting
Acrivastine
Antihistamine (2nd gen) used to treat hay fever, conjunctivitis, eczema, stings/bites and urticaria.
Adalimumab
Biologic TNF-alpha inhibitor.
Plaque psoriasis; Rheumatoid arthritis; Psoriatic arthritis; Ankylosing spondylitis; Axial spondyloarthritis; Crohn’s disease; Ulcerative colitis; Hidradenitis suppurativa; Uveitis.
C/I: moderate or severe heart failure; severe infections
Cautions: demyelinating disorders; development of malignancy; do not initiate until active infections are controlled; hepatitis B virus—monitor for active infection; history of malignancy; mild heart failure; predisposition to infection; Tuberculosis.
S/E: Agranulocytosis; alopecia; anaemia; anxiety; arrhythmias; arterial occlusion; asthma; broken nails; chest pain; coagulation disorder; connective tissue disorders; cough; dehydration; depression; dyspnoea; electrolyte imbalance; embolism and thrombosis; eye inflammation; fever; flushing; gastrointestinal discomfort etc.
Alendronic acid (alendronate)
Bisphosphonate.
Treatment of postmenopausal osteoporosis (first line); Treatment of osteoporosis in men; Prevention and treatment of corticosteroid-induced osteoporosis in postmenopausal women not receiving hormone replacement therapy.
C/I: Abnormalities of oesophagus; hypocalcaemia; other factors which delay emptying (e.g. stricture or achalasia), CKD.
Cautions: Active gastro-intestinal bleeding; atypical femoral fractures; duodenitis; dysphagia; exclude other causes of osteoporosis; gastritis; history (within 1 year) of ulcers; surgery of the upper gastro-intestinal tract; symptomatic oesophageal disease; ulcers; upper gastro-intestinal disorders
S/E: Gastrointestinal disorders; joint swelling; vertigo
Correct disturbances of calcium and mineral metabolism (e.g. vitamin-D deficiency, hypocalcaemia) before starting treatment. Monitor serum-calcium concentration during treatment.
Allopurinol
Xanthine oxidase inhibitor.
Prophylaxis of gout and of uric acid and calcium oxalate renal stones; Prophylaxis of hyperuricaemia associated with cancer chemotherapy;
Not a treatment for acute gout but continue if attack develops when already receiving allopurinol, and treat attack separately.
Caution: Ensure adequate fluid intake (2–3 litres/day); for hyperuricaemia associated with cancer therapy, allopurinol treatment should be started before cancer therapy.
Administer prophylactic NSAID (not aspirin or salicylates) or colchicine until at least 1 month after hyperuricaemia corrected to avoid precipitating an acute attack.
S/E: Rash (discontinue therapy; if rash mild re-introduce cautiously but discontinue immediately if recurrence). Stephen johnson syndrome.
P450 inhibitor - increases warfrin.
Alogliptin
Diabetic drug in the DPP-4 inhibitor class (gliptin). Increases production of insulin.
S/E causes less weight gain and hypos than others.
Amlodipine
Calcium channel blocker. (dihydropyridine).
Prophylaxis of angina; hypertension
C/I: Cardiogenic shock; significant aortic stenosis; unstable angina
S/E: Asthenia; constipation; diarrhoea; dyspepsia; dyspnoea; gastrointestinal disorders; joint disorders; muscle cramps; oedema; vision disorders
Acetylsalicylic acid
Aspirin. NSAID (COX inhibitor) and antiplatelet - inhibits the production of thromboxane A2
Mild to moderate pain; Pyrexia; Acute migraine; Management of unstable angina and MI; Transient ischaemic attack; Atrial fibrillation; Prevention of pre-eclampsia
C/I: Active peptic ulceration; bleeding disorders; children under 16 years (risk of Reye’s syndrome); haemophilia; previous peptic ulceration (analgesic dose); severe cardiac failure (analgesic dose)
S/E: dyspepsia; haemorrhage; gastric ulcers.
Atenolol
Beta blocker.
Hypertension; angina; arrhythmias; migraine prophylaxis; anxiety; early intervention within 12 hours of myocardial infarction.
C/I: asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma; Prinzmetal’s angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure.
Cautions: diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked.
S/E: Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; peripheral vascular disease; rash (reversible on discontinuation); sleep disorders; syncope; visual impairment; vomiting.
Atorvastatin
Statin. Used to lower cholesterol and prevent MI/stroke.
Beclometasone
Corticosteroid.
Management of oral ulceration; Prophylaxis of asthma (ICS) - brown inhaler; prophylaxis and treatment of allergic and vasomotor rhinitis; Severe inflammatory skin disorders such as eczemas unresponsive to less potent corticosteroids; Psoriasis; Adjunct to aminosalicylates in acute mild to moderate ulcerative colitis
S/E: Anxiety; behaviour abnormal; cataract subcapsular; cognitive impairment; Cushing’s syndrome; electrolyte imbalance; fatigue; fluid retention; gastrointestinal discomfort; headache; healing impaired; hirsutism; hypertension; increased risk of infection; menstrual cycle irregularities; mood altered; nausea; osteoporosis; peptic ulcer; psychotic disorder; skin reactions; sleep disorders; weight increased
Bendroflumethiazide
Thiazide-like diuretic.
Treats hypertension, oedema.
Take <4pm.
Contra-indications
Addison’s disease; hypercalcaemia; hyponatraemia; refractory hypokalaemia; symptomatic hyperuricaemia
Cautions
Diabetes; gout; hyperaldosteronism; malnourishment; nephrotic syndrome; systemic lupus erythematosus
Teratogenic.
Benzoyl peroxide
Antiseptic.
Acne vulgaris.
S/E: skin reactions, facial swelling.
Betahistine
Histamine analogue.
Symptom control in Meniere’s disease (tinnitus and vertigo).
Bisacodyl
Laxative.
Dulcolax - brand name.
Bumetanide
Loop diuretic. Treats heart failure, hypertension and oedema.
Hyoscine butylbromide
Antimuscarinic.
AKA Buscopan.
Symptomatic relief of gastro-intestinal or genito-urinary disorders characterised by smooth muscle spasm; irritable bowel syndrome; excessive respiratory secretions and bowel colic in palliative care.
S/E: Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting.
Avoid in pregnancy
Candesartan
Angiotensin receptor blocker (ARB).
Used to treat hypertension and heart failure especially if ACEI causes cough.
Carbocisteine
Mucolytic.
Makes phlegm less thick and sticky – easier to cough up.
COPD and CF.
Cefalexin
Cephalosporin antibiotic. Brand name: Keflex.
Treats pneumonias, skin infections, UTIs.
Cetirizine
Second generation antihistamine (non-drowsy)
Symptomatic relief of allergy such as hay fever, chronic idiopathic urticaria, atopic dermatitis.
Chlorphenamine
First generation antihistamine (sedating). Trade name: Piriton
Symptomatic relief of allergy such as hay fever, urticaria, food allergy, drug reactions; relief of itch associated with chickenpox
C/I: neonates
Cautions: epilepsy; prostatic hypertrophy (in adults); pyloroduodenal obstruction; susceptibility to angle-closure glaucoma; urinary retention
Not compatible with alcohol.
S/E: concentration impaired; coordination abnormal; dizziness; dry mouth; fatigue; headache; nausea; vision blurred
Cinnarizine
1st generation (drowsy) antihistamine and diphenylmethyl piperazine calcium channel blocker.
Used for travel sickness and symptoms of meniere’s disease.
Trade name: stugeron.
Citalopram
Selective serotonin reuptake inhibitor (SSRI). Brand name: Cipramil.
Depressive illness; Panic disorder
C/I: Poorly controlled epilepsy; SSRIs should not be used if the patient enters a manic phase
Cautions: Cardiac disease; concurrent electroconvulsive therapy; diabetes mellitus; epilepsy (discontinue if convulsions develop); history of bleeding disorders (especially gastro-intestinal bleeding); history of mania; susceptibility to angle-closure glaucoma
S/E: Anxiety; appetite abnormal; arrhythmias; arthralgia; asthenia; concentration impaired; confusion; constipation; tiredness, dry mouth and sweating. etc
Clobetasol
Topical (strong) corticosteroid.
Clobetasol propionate is used for eczema, psoriasis, lichen planus, lupus.
Clobetasone
Topical (mild) corticosteroid.
Can be bought over the counter to treat eczema, psoriasis, insect bites, nappy rash etc.
Clonazepam
Benzodiazepine used to treat epilepsy, involuntary muscle spasms, panic disorder and sometimes restless legs syndrome.
Clopidogrel
Antiplatelet - inhibits ADP binding to its platelet receptor.
Prevention of atherothrombotic and thromboembolic events (post MI, stroke, acute coronary syndrome, AF, PCI)
S/E: Diarrhoea; gastrointestinal discomfort; haemorrhage; skin reactions
Co-codamol
Analgesic (paracetamol and codeine).
Co-codaprin
Analgesic (aspirin and codeine).
Co-dydramol
Analgesic (paracetamol and dihydrocodeine).
Codeine
Milder opiate analgesic (also used to treat diarrhoea and cough). Only if cannot be relieved by paracetamol/ ibuprofen alone.
C/I: children <12, CYP2D6 ultra-rapid metabolisers,
Colchicine
Anti-inflammatory.
Acute gout; Short-term prophylaxis during initial therapy with allopurinol and uricosuric drugs; Prophylaxis of familial Mediterranean fever
C/I: blood disorders
Cautions: Cardiac disease; elderly; gastro-intestinal disease
S/E: Abdominal pain; diarrhoea; nausea; vomiting
Dabigatran
Anticoagulant used as thromboembolism prophylaxis for stroke (AF), heart attack, DVT, PE.
Inhibits formation of fibrin from fibrinogen by inhibiting thrombin . No monitoring requires.
Dapagliflozin
Gliflozin (diabetes medication) used as alternative to metformin in T2DM or alongside insulin in T1DM.
Trade name: Farxiga
S/E: DKA, infections, back pain .
Not recommended in pregnancy.
Diazepam
Benzodiazepine.
Muscle spasm, tetanus, anxiety, insomnia, alcohol withdrawal, panic attacks, premedication, sedation, status epilepticus, febrile convulsions, drug-induced dystonic reactions, palliative care.
S/E: Appetite abnormal; concentration impaired; movement disorders; muscle spasms; palpitations; sensory disorder; vomiting
Diclofenac
NSAID.
Used to treat RA, OA, gout, pain, ankylosing spondylitis, migraine.
! ulcers !
Dihydrocodeine
Opioid analgesic used to treat moderate to severe pain.
Diltriazem
Calcium Channel Blocker (non-dihydropyridine).
Used to treat hypertension, angina and raynaud’s.
Brand names: Adizem, Slozem, Tildiem
Diphenhydramine
1st generation antihistamine.
Used to treat: insomnia, hay fever, eczema, hives, cough and cold symptoms.
Avoid alcohol.
Brand names: Histergan, Nytol and Sleepeaze.
Dipyridamole
Antiplatelet (nucleoside transport and PDE 3 inhibitor).
Prophylaxis of thromboembolism in Ischaemic stroke or TIA not associated with AF.
And prosthetic heart valves.
Docusate
Docusate sodium - laxative.
Treatment of constipation or clearance in abdo x-ray.
Domperidone
Dopamine antagonist and antiemetic.
Relief of nausea and vomiting; Gastro-intestinal pain in palliative care
C/I: Cardiac disease; conditions where cardiac conduction is, or could be, impaired; gastro-intestinal haemorrhage; gastro-intestinal mechanical obstruction; gastro-intestinal mechanical perforation; if increased gastro-intestinal motility harmful; prolactinoma
Cautions: Patients over 60 years—increased risk of ventricular arrhythmia
S/E: Dry mouth; Anxiety; asthenia; breast abnormalities; diarrhoea; drowsiness; headache; lactation disorders; libido loss
Patients and their carers should be told how to recognise signs of arrhythmia and advised to seek medical attention if symptoms such as palpitation or syncope develop.
Safe to use in parkinsons.
Dobepezil
Dementia medication.
Brands: Aricept, Aricept Evess
Dosulepin
Tricyclic antidepressant.
Treats depression, fibromyalgia, migraine prophylaxis.
Rarely prescribed due to side effects (most dangerous): dry mouth, urinary obstruction, dousiness, tachycardia etc. (antimuscarinic side effects)
Doxazosin
Alpha-blocker.
Used to treat hypertension (vasodilator) and benign prostatic enlargement.
S/E: Vertigo, oedemia,
Duloxetine
Serotonin-noradrenaline reuptake inhibitors (SNRIs)
Major depressive disorder; Generalised anxiety disorder; Diabetic neuropathy; Moderate to severe stress urinary incontinence;
Cautions: Bleeding disorders; cardiac disease; elderly; history of mania; history of seizures; hypertension (avoid if uncontrolled); raised intra-ocular pressure; susceptibility to angle-closure glaucoma
S/E: Anxiety; appetite decreased; constipation; diarrhoea; dizziness; drowsiness; dry mouth; fall; fatigue; flushing; gastrointestinal discomfort; gastrointestinal disorders; headache; muscle complaints; nausea; pain; palpitations; paraesthesia; sexual dysfunction; skin reactions; sleep disorders; sweat changes; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning
Edoxaban
DOAC. Direct and reversible inhibitor of activated factor X (factor Xa).
Prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation.
Monitor renal function before treatment.
Empagliflozin
Sodium-glucose co-transporter 2 (SGLT2) inhibitors. (Gliflozins)
Brand name: Jardiance
Enalapril
Ace Inhibitor (rarely used due to short half life so BD)
Treats heart failure and hypertension.
Escitalopram
Selective serotonin reuptake inhibitor (SSRI).
Used to treat depression and is sometimes used for anxiety, obsessive compulsive disorder or panic attacks.
Brand names: Cipralex and Lexapro
Esomeprazole
Proton pump inhibitor (PPI).
Used for gastro-oesophageal reflux disease (GORD) and stomach ulcers.
Ezetimibe
Cholesterol absorption inhibitor. Statin.
Felidipine
Calcium channel blocker (dihydropyridine). Treats hypertension and angina.
Ferrous fumarate
Iron supplement used to treat iron-deficiency anaemia.
Ferrous sulfate
Iron supplement used to treat iron-deficiency anaemia.
Fexofenadine
Second generation antihistamine used to treat the symptoms of allergies (hay fever, conunctivitis, eczema, urticaria, reactions to insect bites and stings).
Fluoxetine
Selective serotonin reuptake inhibitor (SSRI). Brand name: Prozac.
Major depression; Bulimia nervosa; Obsessive-compulsive disorder; Menopausal symptoms
Avoid in postnatal depression due to long hard life.
C/I: Poorly controlled epilepsy; SSRIs should not be used if the patient enters a manic phase
Cautions: Cardiac disease; concurrent electroconvulsive therapy; diabetes mellitus; epilepsy (discontinue if convulsions develop); history of bleeding disorders (especially gastro-intestinal bleeding); history of mania; susceptibility to angle-closure glaucoma
S/E: Anxiety; appetite abnormal; arrhythmias; arthralgia; asthenia; concentration impaired; confusion; constipation; etc
Overdose: Chills; feeling abnormal; postmenopausal haemorrhage; uterine disorder; vasodilation; vision blurred.
P450 enzyme inhibitor.
Fluticasone
Corticosteroid.
INHALED (ICS)
Brand name: Flixotide.
Prophylaxis of asthma - preventative (brown) inhaler.
S/E: Headache; oral candidiasis; pneumonia (in patients with COPD); taste altered; voice alteration
TOPICAL
Brand name: Cutivate.
Severe inflammatory skin disorders such as dermatitis and eczemas unresponsive to less potent corticosteroids; Psoriasis
C/I: Acne; perioral dermatitis; potent corticosteroids in widespread plaque psoriasis; rosacea; untreated bacterial, fungal or viral skin lesions
Cautions: Avoid prolonged use (particularly on the face); dermatoses of infancy, including nappy rash (extreme caution required—treatment should be limited to 5–7 days); infection; keep away from eyes; use potent or very potent topical corticosteroids under specialist supervision.
S/E: Skin reactions; telangiectasia
INTRANASAL
Brand names: Flixonase, Avamys, Nasofan.
Prophylaxis and treatment of allergic rhinitis and perennial rhinitis; Nasal polyps
Cautions: Avoid after nasal surgery (until healing has occurred); avoid in pulmonary tuberculosis; avoid in the presence of untreated nasal infections; patients transferred from systemic corticosteroids may experience exacerbation of some symptoms.
S/E: Altered smell sensation; epistaxis; headache; nasal complaints; taste altered; throat irritation.
MONITORING: The height and weight of children receiving prolonged treatment with corticosteroids should be monitored annually; if growth is slowed, referral to a paediatrician should be considered.
Folic acid
Synthetic folate (vitamin B9).
Folate-deficient megaloblastic anaemia; Prevention of neural tube defects; Prevention of methotrexate side-effects; Prophylaxis of folate deficiency.
S/E: Abdominal distension; appetite decreased; flatulence; nausea; vitamin B12 deficiency exacerbated
Furosemide
Loop diuretic.
Oedema; resistant hypertension
C/I: Anuria; renal failure due to nephrotoxic or hepatotoxic drugs; severe hypokalaemia; severe hyponatraemia
S/E: Agranulocytosis; aplastic anaemia; auditory disorder; diabetes mellitus; eosinophilia; fever; gout etc
Fusidic acid
Fusidane antibiotic derived from the fungus Fusidium coccineum.
Topical ointment used to treat cellulitis, impetigo. Eye drops to treat conjunctivitis.
Fybogel
Laxative. AKA ispaghula husk.
It comes as plain or fruit-flavoured granules that you mix with water to make a high-fibre drink.
Gabapentin
Anti-convulsant.
Used to treat epilepsy, nerve pain, migrane, restless leg syndrome,
Brand name: Neurontin.
S/E: Anxiety, movement disorders, mood changes.
Risk of ARDS if taken with opiods.
Gavascon
Antacid to treat acid reflux and indigestion.
Gliclazide
Sulfonylurea.
Type 2 diabetes mellitus.
Can encourage weight gain; elderly; G6PD deficiency
S/E Abdominal pain; diarrhoea; hypoglycaemia; nausea.
The use of sulfonylureas in pregnancy should generally be avoided because of the risk of neonatal hypo-glycaemia.
Glimepiride
Sulphonylurea.
Trade name: Amaryl
Glyceryl trinitrate (GTN)
Nitrate - used to treat angina.
Brand names: Rectogesic, Minitran
Heparinoid
Glycosaminoglycans which are derivatives of heparin.
Used to treat bruises, varicose veins, phlebitis, piles.
Hydrocortisone
Corticosteroid.
Immunosuppressant or hormone replacement.
Thyrotoxic crisis (thyroid storm);
Acute hypersensitivity reactions such as angioedema and anaphylaxis;
Adrenocortical replacement in Addison’s disease, adrenalectomy, prednisolone, septic shock
Inflammatory bowel disease
Atopy (asthma and eczemas).
S/E: cushings, anxiety, infections.
Chronic steroid use can lead to skin thinning and brittle bones.
Hydroxocobalamin
Synthetic vitamin B12.
Prophylaxis and treatment of macrocytic anaemias associated with vitamin B12 deficiency (pernicious anemia); Poisoning with cyanides.
S/E: Diarrhoea; dizziness; headache; hot flush; nausea; skin reactions; urine discolouration.
Hyoscine hydrobromide
Anticholinergic (antimuscarinic) - Antiemetic.
First line for MOTION SICKNESS, hypersalivation (clozapine) and excessive respiratory secretion in palliative care.
Trade names: Kwells and Joy-Rides
Ibuprofen
NSAID - short acting (COX inhibitor - reduces prostaglandin production.
Pain and inflammation; dysmenorrhoea; Dental pain; Acute migraine; Pyrexia with discomfort; Pain and inflammation in rheumatic disease; Pain relief in musculoskeletal conditions.
Trade names: Nurofen, Advil
C/I: History of gastro-intestinal bleeding or ulceration; severe heart failure; varicella infection
S/E: (uncommon) Gastrointestinal discomfort; hypersensitivity; rash (discontinue); skin reactions
NSAIDs
Ibuprofen, diclofenac, mefenamic, naproxen
COX inhibitors - reduces prostaglandin production.
S/E exacerbate plaque psoriasis.
Mefenamic
NSAID
Naproxen
NSAID (long acting)
Reduces inflammation and pain in joints and muscles. such as rheumatoid arthritis, osteoarthritis and gout.
It’s also used for period pain and muscle and bone disorders, such as back pain and sprains and strains.
Irbesartan
ARB used to treat hypertension and prevent strokes, heart attacks and kidney problems.
Angiotensin Receptor Blockers (ARB) / Angiotensin II receptor antagonist
Irbesartan, candesartan, losartan, olmesartan, valsartan
Often used if ACEI not tolerated.
C/I: eGFR <60
S/E: Abdominal pain; diarrhoea; hyperkalaemia; nausea; renal impairment; vertigo; vomiting
Isotretinoin
Retinoid.
Topical treatment of acne.
Brand name: Roaccutane
C/I: With oral use - hyperlipidaemia; hypervitaminosis A
With topical use - perioral dermatitis; rosacea.
Avoid blood donation during treatment and for at least 1 month after treatment; diabetes; dry eye syndrome; history of depression
With topical use - allow peeling to subside before using a topical retinoid; alternating a preparation that causes peeling with a topical retinoid may give rise to contact dermatitis; avoid accumulation in angles of the nose; avoid contact with eyes, nostrils, mouth and mucous membranes, eczematous, broken or sunburned skin; avoid exposure to UV light; avoid in severe acne involving large areas; avoid use of topical retinoids with abrasive cleaners, comedogenic or astringent cosmetics; caution in sensitive areas such as the neck; personal or familial history of skin cancer
S/E: alopecia; anaemia; arthralgia; back pain; cheilitis; dry eye; eye discomfort; eye inflammation; haemorrhage; headache; increased risk of infection; myalgia; nasal dryness; neutropenia; proteinuria; skin fragility; thrombocytopenia; thrombocytosis
Risk of pancreatitis if triglycerides above 9 mmol/litre.
Discontinue treatment if skin peeling severe or haemorrhagic diarrhoea develops.
Visual disturbances require expert referral and possible withdrawal.
Psychiatric side-effects could require expert referral.
Teratogenic!! Pregnancy prevention programme.
Retinoids
Isotretinoin, acitretin, alitretinoin
Consultant only - check pregnancy, liver function tests, cholesterol.
Don’t give to <12s,
Acitretin
Oral retinoid.
Severe extensive psoriasis resistant to other forms of therapy; palmoplantar pustular psoriasis; severe congenital ichthyosis.
Pregnancy Prevention Programme in women and girls of childbearing potential due to a high risk of serious congenital malformations.
Contra-indications - Hyperlipidaemia
Cautions - avoid excessive exposure to sunlight and unsupervised use of sunlamps; diabetes; do not donate blood during and for 3 years after stopping therapy (teratogenic risk); history of depression (risk of neuropsychiatric reactions); in children use only in exceptional circumstances and monitor growth parameters and bone development (premature epiphyseal closure reported); investigate atypical musculoskeletal symptoms.
S/E: Abdominal pain; arthralgia; brittle nails; conjunctivitis; diarrhoea; dry mouth; gastrointestinal disorder; haemorrhage; hair texture abnormal; headache; increased risk of infection; mucosal abnormalities; myalgia; nausea; oral disorders; peripheral oedema; skin reactions; thirst; vomiting; xerophthalmia.
Alitretinoin
Retinoid used to treat acne.
Labetalol
Beta-blocker.
S/E: dizziness, skin rash, headache, difficulty peeing.
Trade name: Trandate
First line treatment for hypertension in pregnancy. and in hypertensive emergency (>180/120 mmHg).
Beta-blockers
Labetalol, Bisoprolol
Slows down your heart rate and makes it easier for your heart to pump blood around your body.
C/I: Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma; Prinzmetal’s angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure
S/E: Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye; dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; peripheral vascular disease; rash; sleep disorders; syncope; visual impairment; vomiting; exacerbate plaque psoriasis
Lactulose
Laxative.
Used to relieve constipation and in hepatic encephalopathy.
C/I: Galactosaemia; gastro-intestinal obstruction; gastro-intestinal perforation.
S/E: Abdominal pain; diarrhoea; flatulence; nausea; vomiting
Lamotrigine
Anticonvulsive / mood stabiliser.
Focal seizures; tonic-clonic seizures; bipolar disorder (when depression is the predominant feature).
S/E: Aggression; agitation; arthralgia; diarrhoea; dizziness; drowsiness; dry mouth; fatigue; headache; irritability; nausea; pain; rash; sleep disorders; tremor; vomiting.
Cautions: Myoclonic seizures (may be exacerbated); Parkinson’s disease (may be exacerbated)
Stephen-Johnson Syndrome
Drugs that can cause Stevens-Johnson syndrome.
Allopurinol Carbamazepine Lamotrigine Nevirapine The "oxicam" class of anti-inflammatory drugs (including meloxicam and piroxicam) Phenobarbital Phenytoin Sulfamethocazole and other Sulfa antibiotics Sertraline Sulfasalazine
Nevirapine
Stevens-Johnson Syndrome
Sertraline
Selective serotonin reuptake inhibitor (SSRI). Brandname: Lustral.
Depressive illness; Obsessive-compulsive disorder; Panic disorder, Post-traumatic stress disorder, Social anxiety disorder
C/I: Poorly controlled epilepsy; SSRIs should not be used if the patient enters a manic phase
Cautions: Cardiac disease; concurrent electroconvulsive therapy; diabetes mellitus; epilepsy (discontinue if convulsions develop); history of bleeding disorders (especially gastro-intestinal bleeding); history of mania; susceptibility to angle-closure glaucoma
S/E: Chest pain; depression; gastrointestinal disorders; increased risk of infection; neuromuscular dysfunction; vasodilation; Anxiety; appetite abnormal; arrhythmias; arthralgia; asthenia; concentration impaired; confusion; constipation; tiredness, dry mouth and sweating etc.
Inhibitor of P450 system so would increase the effects of warfarin, therefore increasing INR.
Risk of Stevens-Johnson Syndrome.
Lansoprazole
Proton Pump Inhibitor.
Used for indigestion, heartburn, acid reflux and GORD.
Proton Pump Inhibitors
Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, Rabeprazole.
Used for indigestion, heartburn, acid reflux and GORD.
Can increase the risk of fractures; may increase the risk of gastro-intestinal infections (including Clostridioides difficile infection); may mask the symptoms of gastric cancer (in adults); patients at risk of osteoporosis; Risk of subacute cutaneous lupus erythematosus (SCLE).
S/E: Abdominal pain; constipation; diarrhoea; dizziness; dry mouth; gastrointestinal disorders; headache; insomnia; nausea; skin reactions; vomiting
Lercanidipine
Calcium channel blocker (dihydropyridine).
Calcium channel blockers
Types
Names
C/I
S/E
Dihydropyridines: Lercanidipine, amlodipine, felodipine, nifedipine
Non-dihydropyridines: Verapamil hydrochloride, Diltiazem
Calcium-channel blockers interfere with the inward displacement of calcium ions through the slow channels of active cell membranes. They influence the myocardial cells, the cells within the specialised conducting system of the heart, and the cells of vascular smooth muscle. Thus, myocardial contractility may be reduced, the formation and propagation of electrical impulses within the heart may be depressed, and coronary or systemic vascular tone may be diminished.
C/I heart failure, unstable angina, post MI
S/E: Abdominal pain; dizziness; drowsiness; flushing; headache; nausea; palpitations; peripheral oedema; skin reactions; tachycardia; vomiting.
Levetiracetam
Anti-epileptic.
Levothyroxine
Synthetic thyroxine.
Hypothyroidism;
C/I: Thyrotoxicosis
Cautions: Cardiovascular disorders; diabetes insipidus; diabetes mellitus; elderly; hypertension; long-standing hypothyroidism; MI; panhypopituitarism (initiate corticosteroid therapy before starting levothyroxine); predisposition to adrenal insufficiency (initiate corticosteroid therapy before starting levothyroxine)
S/E: Angina pectoris; anxiety; arrhythmias; arthralgia; diarrhoea; dyspnoea; fever; flushing; headache; hyperhidrosis; insomnia; malaise; menstruation irregular; muscle spasms; muscle weakness; oedema; palpitations; skin reactions; thyrotoxic crisis; tremor; vomiting; weight decreased
Lidocaine
Anesthetic.
Infiltration anaesthesia, regional anaesthesia and nerve block, cardiopulmonary resuscitation, ventricular arrhythmia; dental practice; pain relief
C/I: atrioventricular block; severe myocardial depression; sino-atrial disorders
S/E: anxiety; arrhythmias; atrioventricular block; cardiac arrest; circulatory collapse; confusion etc.
Linagliptin
Gliptin. Inhibits dipeptidylpeptidase-4 (DPP-4) AKA gliptin to increase insulin secretion and lower glucagon secretion.
Used to treat T2DM but less favoured that metformin or sulfanayreas.
Gliptins
Inhibit dipeptidylpeptidase-4 (DPP-4) to increase insulin secretion and lower glucagon secretion.
Linagliptin, Alogliptin, Saxagliptin, Sitagliptin.
Used to treat T2DM but less favoured that metformin or sulfonylureas.
Lisinopril
ACE Inhibitor
Angiotensin-converting enzyme inhibitors (ACEI)
Lisinopril, Ramipril, Enalapril (rarely given), Perindopril
S/E: Alopecia; angina pectoris; angioedema; arrhythmias; asthenia; chest pain; constipation; cough; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; electrolyte imbalance; gastrointestinal discomfort; headache; hypotension; myalgia; nausea; palpitations; paraesthesia; renal impairment; rhinitis; skin reactions; sleep disorder; syncope; taste altered; tinnitus; vertigo; vomiting
Should be avoided in pregnancy unless essential
Monitoring: Renal function and electrolytes should be checked before starting.
Loperamide
Opioid-receptor agonist. Brand name: Imodium
Diarrhoea (gastroenteritis, IBS, IBD): short bowel syndrome; faecal incontinence; pain of bowel colic in palliative care.
C/I: Active ulcerative colitis; bacterial enterocolitis; Abdominal distension; conditions where inhibition of peristalsis should be avoided.
S/E: Gastrointestinal disorders; headache; nausea
Loratadine
Second generation (non-drowsy) antihistamine.
Brand name: Clarityn.
Symptomatic relief of allergy such as hay fever, eczema, chronic idiopathic urticaria
S/E: Drowsiness; nervousness (in children).
Second generation antihistamines
Loratadine
Cetirizine
Diphenhydramine
Fexofenadine
First generation antihistamines.
Promethazine
Acrivastine
Chlorphenamine
Lorazepam
Benzodiazepine.
Anxiety, insomnia, premed, panic attacks, status epilepticus, febrile convulsions.
C/I: CNS depression; compromised airway; respiratory depression
S/E: Apnoea; asthenia; coma; disinhibition; extrapyramidal symptoms; hypothermia; memory loss; speech slurred; suicide attempt
Benzodiazepines
Lorazepam - good in depression Clonazepam Diazepam Temazepam Midazolam Chlordiazepoxide (alcohol withdrawal)
Sleeping pills and minor tranquillisers used to treat insomnia and anxiety; Sedation for procedures or premedication; Status epilepticus; Febrile convulsions;
Convulsions caused by poisoning.
C/I: Acute pulmonary insufficiency; marked neuromuscular respiratory weakness; not for use alone to treat chronic psychosis; not for use alone to treat depression (or anxiety associated with depression); obsessional states; phobic states; sleep apnoea syndrome; unstable myasthenia gravis; Chronic psychosis; respiratory depression
Cautions: Avoid prolonged use (and abrupt withdrawal thereafter); debilitated patients (reduce dose); elderly (reduce dose); history of alcohol dependence or abuse; history of drug dependence or abuse; myasthenia gravis; personality disorder (within the fearful group—dependent, avoidant, obsessive-compulsive) may increase risk of dependence; respiratory disease; Muscle weakness; organic brain changes
S/E: Movement disorders; Alertness decreased; anxiety; ataxia; confusion; depression; dizziness; drowsiness; dysarthria; fatigue; gastrointestinal disorder; headache; hypotension; mood altered; muscle weakness; nausea; respiratory depression (particularly with high dose and intravenous use—facilities for its treatment are essential); sleep disorders; suicidal ideation; tremor; vertigo; vision disorders; withdrawal syndrome
Overdose: taken alone can cause drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma.
Antidote: Flumazenil
Losartan
Angiotensin Receptor Blocker (ARB).
Hypertension; Chronic heart failure when ACE inhibitors are unsuitable or contra-indicated; Diabetic nephropathy in type 2 diabetes mellitus; reduction of stroke risk
S/E: Anaemia; hypoglycaemia; postural disorders
Lymecycline
Tetracycline antibiotic used mainly for acne.
Macrogol
Laxative used to treat constipation or faecal impaction.
Brand names: Movicol, Laxido, CosmoCol, Molaxole or Molative.
Laxatives
Macrogol Bisacodyl Fybogel Lactulose Docusate Senna
Mebeverine hydrochloride
Antispasmodic it helps with muscle spasms. Treats IBS.
Melatonin
Synthetic hormone used to treat short term insomnia in >55s and jet lag. Normally produced by pineal gland.
Metformin
First line for treating type 2 diabetes, also used for polycystic ovary syndrome.
Decreases gluconeogenesis and increases peripheral utilisation of glucose.
S/E: Abdominal pain; appetite decreased; diarrhoea; nausea; taste altered; vomiting
NOT associated with weight gain.
Methotrexate
Immunosuppressant and chemotherapy agent.
Used to treat crohn’s, rheumatoid arthritis, psoriasis, psoriatic arthritis and other autoimmune conditions. Taken once a week.
Cancer treatment (chemo).
Monitoring: test LFTs and U&Es before starting, monitor levels.
S/E: diarrhoea, headaches, hair loss, anorexia, photosensitivity. Bone marrow suppression can occur abruptly! Hepatotoxicity,
Teratogenic!
Folic acid sometimes given to reduce S/Es.
Brand names: Jylamvo, Maxtrex, Methofill, Metoject, Nordimet, Zlatal.
Can cause pulmonary fibrosis.
Metoprolol (tartrate)
Beta blocker.
Hypertension; thyrotoxicosis, arrhythmias, prevent MI, strokes, angina, migraines.
C/I: asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma; Prinzmetal’s angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure
Cautions: diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked.
S/E: Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; peripheral vascular disease; rash (reversible on discontinuation); sleep disorders; syncope; visual impairment; vomiting.
Montelukast
Antileukotriene / leukotriene receptor antagonist. Brand name: Singulair
Prophylaxis of asthma; Symptomatic relief of seasonal allergic rhinitis in patients with asthma.
S/E: Diarrhoea; fever; gastrointestinal discomfort; headache; nausea; skin reactions; upper respiratory tract infection; vomiting
Morphine
Opiate analgesic - strong.
Brand names: MST, Zomorph, Sevredol, Morphgesic, MXL or Oramorph.
Oral-parenteral potency rate is 1:3.
Opioid and opiate pain killers
Opiate (derived from opium poppy): morphine > codeine
Opioid (synthetic): fentanyl > diamorphine > methadone > oxycodone > dihydrocodeine > tramadol
S/E: Arrhythmias; confusion; constipation; dizziness; drowsiness; dry mouth; euphoric mood; flushing; hallucination; headache; hyperhidrosis; hypotension (with high doses); miosis; nausea (more common on initiation); palpitations; respiratory depression (with high doses); skin reactions; urinary retention; visual impairment; vomiting (more common on initiation); withdrawal syndrome
Diamorphine
Opioid analgesic. AKA heroin 1.5x strength of morphine. Better parenteraly than morphine.
Nefopam
Analgesic for moderate pain (SNDRI).
Used to treat moderate pain. After an operation or a serious injury, dental pain, joint pain or muscle pain, or pain from cancer.
Step up from paracetamol/naproxen.
Olmesartan
Angiotensin receptor blocker (ARB).
Used to treat hypertension and reduce risk of stroke and MI.
C/I: Biliary obstruction
S/E: Arthritis; bone pain; chest pain; dyspepsia; haematuria; hypertriglyceridaemia; hyperuricaemia; increased risk of infection; influenza like illness; oedema
Omeprazole
Proton pump inhibitor.
Benign gastric ulceration; Duodenal ulceration; Helicobacter pylori eradication; Zollinger–Ellison syndrome; Gastro-oesophageal reflux disease; Severe oesophagitis; Acid reflux disease
Can increase the risk of fractures; may increase the risk of gastro-intestinal infections (including Clostridioides difficile infection); may mask the symptoms of gastric cancer (in adults); patients at risk of osteoporosis
S/E: Abdominal pain; constipation; diarrhoea; dizziness; dry mouth; gastrointestinal disorders; headache; insomnia; nausea; skin reactions; vomiting.
P450 inhibitor - increases warfrin.
Oxycodone
Oxycodone hydrochloride.
Opiate (opioid) painkiller used to treat severe pain e.g. cancer pain.
Pantoprazole
Proton pump inhibitor
Used for indigestion, heartburn, acid reflux and GORD.
Don’t give in pregnancy.
Paracetamol
Analgesic and antipyretic.
Mild to moderate pain; Pyrexia; Acute migraine
Adult dose: 0.5–1 g every 4–6 hours; maximum 4 g per day.
Hepatotoxic in overdose - antidote acetylcysteine.
No C/I or S/E.
Paroxetine
Selective serotonin reuptake inhibitor (SSRI). Brandname: Seroxat.
Major depression, Social anxiety disorder, Post-traumatic stress disorder, Generalised anxiety disorder Obsessive-compulsive disorder Panic disorder Menopausal symptoms
1st line in post natal depression due to low milk/plasma ratio.
C/I: Poorly controlled epilepsy; SSRIs should not be used if the patient enters a manic phase
Cautions: Cardiac disease; concurrent electroconvulsive therapy; diabetes mellitus; epilepsy (discontinue if convulsions develop); history of bleeding disorders (especially gastro-intestinal bleeding); history of mania; susceptibility to angle-closure glaucoma
S/E: Anxiety; appetite abnormal; arrhythmias; arthralgia; asthenia; concentration impaired; confusion; constipation; etc
Selective serotonin reuptake inhibitors (SSRIs)
Fluoxetine (Prozac) Paroxetine (Seroxat) Citalopram (Cipramil) Escitalopram (Cipralex and Lexapro) Sertraline (Lustral)
Treats depression, OCD, panic attacks, anxiety, PTSD.
C/I: Poorly controlled epilepsy; SSRIs should not be used if the patient enters a manic phase
Cautions: Cardiac disease; concurrent electroconvulsive therapy; diabetes mellitus; epilepsy (discontinue if convulsions develop); history of bleeding disorders (especially gastro-intestinal bleeding); history of mania; susceptibility to angle-closure glaucoma
S/E: Anxiety; appetite abnormal; arrhythmias; arthralgia; asthenia; concentration impaired; confusion; constipation; depersonalisation; diarrhoea; dizziness; drowsiness; dry mouth; fever; gastrointestinal discomfort; haemorrhage; headache; hyperhidrosis; malaise; memory loss; menstrual cycle irregularities; myalgia; mydriasis; nausea (dose-related); palpitations; paraesthesia; QT interval prolongation; sexual dysfunction; skin reactions; sleep disorders; taste altered; tinnitus; tremor; urinary disorders; visual impairment; vomiting; weight changes; yawning
Overdose: nausea, vomiting, agitation, tremor, nystagmus, drowsiness, and sinus tachycardia; convulsions may occur.
Serotonin syndrome: marked neuropsychiatric effects, neuromuscular hyperactivity, and autonomic instability; hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop.
Withdrawal: GI disturbances, headache, anxiety, dizziness, paraesthesia, electric shock sensation in the head, neck, and spine, tinnitus, sleep disturbances, fatigue, influenza-like symptoms, and sweating. The dose should be tapered over at least a few weeks to avoid these effects.
Pregnancy: avoid unless the potential benefit outweighs the risk. There is a small increased risk of congenital heart defects when taken during early pregnancy. If used during the third trimester there is a risk of neonatal withdrawal symptoms, and persistent pulmonary hypertension in the newborn has been reported.
Pepto-Bismol
AKA bismuth subsalicylate. A salicylate/ antacid.
Used to treat diarrhea, nausea, heartburn, indigestion, gas, or upset stomach.
Don’t take with aspirin or if pregnant/ breastfeeding.
Perindopril
ACEI.
Phenoxymethylpenicillin
Penicillin antibiotic.
Oral infections; Tonsillitis; Acute sore throat; Otitis media; Prevention of recurrence of rheumatic fever; Prevention of recurrent cellulitis/ erysipela; Acute sinusitis.
Cautions: Hx allergy.
S/E: Diarrhoea; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting
Phenytoin
Anti-epileptic drug.
Indcations: Tonic-clonic seizures , Focal seizures Status epilepticus, Prevention and treatment of seizures during/following neurosurgery or severe head injury.
Monitoring: plasma-phenytoin concentration when started, HLAB* 1502 allele in individuals of Han Chinese or Thai origin.
S/E: skin rashes, Stevens-Johnson syndrome, Bradycardia and hypotension.
P450 inducer.
Pioglitazone
Thiazolidinedione (glitazone) used to treat type 2 diabetes.
Reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration.
Can be taken alone or with metformin and/or a sulfonylurea.
S/E: Bone fracture; increased risk of infection; numbness; visual impairment; weight increased.
C/I: History of heart failure; previous or active bladder cancer; uninvestigated macroscopic haematuria.
Elderly - prescription potentially inappropriate (STOPP criteria) in patients with heart failure.
Avoid in pregnancy.
Thiazolidinediones are associated with an increased risk of bladder cancer.
Thiazolidinedione
AKA glitazone - only one - Pioglitazone (T2DM).
Thiazolidinediones are associated with an increased risk of bladder cancer.
Sulfonylureas
Names, action, cautions, S/Es.
Most commonly Gliclazide.
Amaryl (Glimepiride) Daonil (Gilbenclamide) Diamicron (Gilclazide) Diamicron MR (Gilclazide) Glibenese (Glipizide) Minodiab (Glipizide) Tolbutamide (Tolbutamide)
Insulin secretagogues (increase insulin secretion).
Cautions: Can encourage weight gain; elderly; G6PD deficiency
S/E: Abdominal pain; diarrhoea; hypoglycaemia; nausea
Pravastatin
Statin. Used to lower cholesterol and prevent MI/stroke.
Statins
Pravastatin, Atorvastatin, Ezetimibe, Simvastatin, fluvastatin, rosuvastatin
Used to lower cholesterol and prevent MI/stroke.
Statins inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.
S/E: Asthenia; constipation; diarrhoea; dizziness; flatulence; gastrointestinal discomfort; headache; myalgia; nausea; sleep disorders; thrombocytopenia.
Teratogenic!!
Monitoring: full lipid profile (non-fasting), thyroid-stimulating hormone, and renal function before start.
Statins must be temporarily held when prescribing a MACROLIDE antibiotic due to the increased risk of rhabdomyolysis when combing the two drugs.
Simvastatin
Statin.
Primary hypercholesterolaemia; prophylaxis of CV events in patients with atherosclerotic CV disease or DM.
Cautions: Elderly; high alcohol intake; history of liver disease; hypothyroidism; known genetic polymorphisms; patients at increased risk of muscle toxicity, including myopathy or rhabdomyolysis
Muscle toxicity can occur with all statins,
S/E: Asthenia; constipation; diarrhoea; dizziness; flatulence; gastrointestinal discomfort; headache; myalgia; nausea; sleep disorders; thrombocytopenia.
Statins should be avoided in pregnancy (discontinue 3 months before attempting to conceive).
Monitoring: full lipid profile (non-fasting), thyroid-stimulating hormone, and renal function before start.
Statins must be temporarily held when prescribing a MACROLIDE antibiotic due to the increased risk of rhabdomyolysis when combing the two drugs.
Prednisolone
Corticosteroid.
Acute exacerbation of COPD; croup; asthma; IBD, myasthenia gravis; rheumatoid disease; Polymyalgia rheumatica; Giant cell (temporal) arteritis; Systemic lupus erythematosus
Brand name: Deltastab - intra-articular injection.
S/E: Anxiety; behaviour abnormal; cataract subcapsular; cognitive impairment; Cushing’s syndrome
Corticosteroids
Prednisolone, beclomethasone, clobetasol (topical), clobetasone (topical), fluticasone (brown inhailer), hydrocortisone, dexamethasone, methylprednisolone
C/I: avoid live vaccines in immunosuppression, systempic infection.
S/E: Anxiety; behaviour abnormal; cataract subcapsular; cognitive impairment; Cushing’s syndrome; electrolyte imbalance; fatigue; fluid retention; gastrointestinal discomfort; headache; healing impaired; hirsutism; hypertension; increased risk of infection; menstrual cycle irregularities; mood altered; nausea; osteoporosis; peptic ulcer; psychotic disorder; skin reactions; sleep disorders; weight increased.
Adrenal suppression Infections Chickenpox Measles Psychiatric reactions
Benefit > risk in pregnancy.
Abrupt withdrawal after a prolonged period can lead to acute adrenal insufficiency, hypotension or death.
Promethazine
Antihistamine (1st generation)
Symptomatic relief of allergy such as hay fever and urticaria; Insomnia associated with urticaria and pruritus
By mouth; emergency treatment of anaphylactic reactions; sedation (short-term use); nausea; vomiting; vertigo; labyrinthine disorders; motion sickness
First line treatment for morning sickness.
Brand name: Phenergan
C/I: neonate; should not be given to children under 2 years, except on specialist advice, due to the potential for fatal respiratory depression (in children)
Cautions: epilepsy; prostatic hypertrophy (in adults); pyloroduodenal obstruction; severe coronary artery disease; susceptibility to angle-closure glaucoma; urinary retention.
S/E: Arrhythmia; blood disorder; confusion; dizziness; drowsiness; dry mouth; headache; hypotension; jaundice; movement disorders; palpitations; photosensitivity reaction; urinary retention; vision blurred.
Propranolol
Beta blocker.
Thyrotoxic crisis; Hypertension; Angina; Hypertrophic cardiomyopathy; Anxiety symptom management; Migraine prophylaxis; Arrhythmias; Essential tremor
C/I: Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; severe peripheral arterial disease.
Cautions: Diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked.
S/E: Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; peripheral vascular disease; rash (reversible on discontinuation); sleep disorders; syncope; visual impairment; vomiting
Contraindications for Beta Blockers
Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; pheochromocytoma; Prinzmetal’s angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure
Pseudoephedrine
Decongestant.
Brand name: Sudafed.
Congestion of mucous membranes of upper respiratory tract; stress incontinence
Cautions: Diabetes; heart disease; hypertension; hyperthyroidism; ischaemic heart disease; prostatic hypertrophy; raised intra-ocular pressure; susceptibility to angle-closure glaucoma
S/E: Angle closure glaucoma; anxiety; arrhythmias; circulation impaired; dry mouth; hallucination; headache; hypertension; irritability; nausea; palpitations; psychotic disorder; skin reactions; sleep disorders; tremor; urinary retention; vomiting
Rabeprazole
Proton pump inhibitor, treats GORD and ulcers.
Ramipril
ACE Inhibitor.
Hypertension; Symptomatic heart failure; Prophylaxis after myocardial infarction in patients with clinical evidence of heart failure; Prevention of cardiovascular events in patients with atherosclerotic CVD / DM; Nephropathy
C/I: The combination of an ACE inhibitor with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m2; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus
Cautions: Afro-Caribbean patients (may respond less well to ACE inhibitors); concomitant diuretics; diabetes (may lower blood glucose); first dose hypotension; peripheral vascular disease or generalised atherosclerosis; primary aldosteronism; the risk of agranulocytosis is possibly increased in collagen vascular disease; use with care in those with a history of idiopathic or hereditary angioedema; use with care in patients with hypertrophic cardiomyopathy; use with care in patients with severe or symptomatic aortic stenosis.
S/E: Alopecia; angina pectoris; angioedema (may be delayed; more common in Afro-Caribbean patients); arrhythmias; asthenia; chest pain; constipation; cough; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; electrolyte imbalance; gastrointestinal discomfort; headache; hypotension; myalgia; nausea; palpitations; paraesthesia; renal impairment; rhinitis; skin reactions; sleep disorder; syncope; taste altered; tinnitus; vertigo; vomiting.
ACE inhibitors should be avoided in pregnancy unless essential.
Ranitidine
Histamine antagonist / H2 blocker.
Treats GORD, dyspepsia, ulcers; Benign gastric ulceration; Duodenal ulceration
S/E: Constipation; diarrhoea; dizziness; fatigue; headache; myalgia; skin reactions
H2 blockers / histamine antagonist
ranitidine, cimetidine, famotidine, nizatidine.
One step up from antacids, step down from PPI.
Treats GORD, dyspepsia, ulcers.
H2-receptor antagonists might mask symptoms of gastric cancer; particular care is required in patients presenting with ‘alarm features’ in such cases gastric malignancy should be ruled out before treatment.
S/E: Constipation; diarrhoea; dizziness; fatigue; headache; myalgia; skin reactions
Risedronate
(Risedronate sodium) Bisphosphonate. Treats and prevents osteoporosis and paget’s disease of the bone.
Bisphosphonates
Risedronate, alendronic acid, zoledronic acid.
Bisphosphonates are adsorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution, and therefore reducing the rate of bone turnover.
Treats paget’s disease of the bone, osteoporosis.
C/I: Hypocalcaemia
S/E: Alopecia; anaemia; arthralgia; asthenia; constipation; diarrhoea; dizziness; dysphagia; electrolyte imbalance; eye inflammation; fever; gastritis; gastrointestinal discomfort; headache; influenza like illness; malaise; myalgia; nausea; oesophageal ulcer; oesophagitis (discontinue); pain; peripheral oedema; renal impairment; skin reactions; taste altered; vomiting.
Risk of atypical femoral fractures.
Avoid in pregnancy,
Rivaroxaban
Direct oral anticoagulants (DOACs) a direct inhibitor of activated factor X (factor Xa).
Prophylaxis of venous thromboembolism; treatment and prophylaxis of deep-vein thrombosis and pulmonary embolism; Prophylaxis of stroke and systemic embolism in patients with non-valvular atrial fibrillation; Prophylaxis of atherothrombotic events.
C/I: Active bleeding; antiphospholipid syndrome (increased risk of recurrent thrombotic events); malignant neoplasms at high risk of bleeding; oesophageal varices; recent brain surgery; recent gastro-intestinal ulcer; recent intracranial haemorrhage; recent ophthalmic surgery; recent spine surgery; significant risk of major bleeding; vascular aneurysm
Cautions: Anaesthesia with postoperative indwelling epidural catheter (risk of paralysis—monitor neurological signs and wait at least 18 hours after rivaroxaban dose before removing catheter and do not give next dose until at least 6 hours after catheter removal); bronchiectasis; elderly; prosthetic heart valve (efficacy not established); risk of bleeding; rivaroxaban should not be used as an alternative to unfractionated heparin in pulmonary embolism in patients with haemodynamic instability, or who may receive thrombolysis or pulmonary embolectomy; severe hypertension; vascular retinopathy
S/E: Anaemia; asthenia; constipation; diarrhoea; dizziness; fever; gastrointestinal discomfort; haemorrhage; headache; hypotension; menorrhagia; nausea; oedema; pain in extremity; post procedural anaemia; renal impairment; skin reactions; vomiting; wound complications.
Monitor for signs of bleeding or anaemia.
Factor Xa inhibitors
Anticoagulants (DOACs)
Apixaban, rivaroxaban.
Salbutamol
Short acting β2-adrenergic agonist aka SABA. (bronchodilator).
Used to treat symptoms of asthma and COPD. Blue reliever inhaler.
Can be given IV, nebulised, subcut, oral.
Brand name: Ventolin
Cautions: Arrhythmias; cardiovascular disease; diabetes; hypertension; hyperthyroidism; hypokalaemia; susceptibility to QT-interval prolongation
Sitagliptin
Gliptin. Inhibits dipeptidylpeptidase-4 (DPP-4) increases insulin secretion and lower glucagon secretion to lower blood sugar levels.
Used to treat T2DM but less favoured that metformin or sulfanayreas.
Tramadol
Weak opioid analgesic used to treat moderate to severe pain (acute, chronic or post surgery). IM, PO, IV.
Controlled drug.
Tranexamic acid
Anti-fibrinolytic (aka TXA). Synthetic derivative of lysine. Its primary mode of action is to reversibly bind to lysine receptor sites on plasminogen or plasmin. This prevents plasmin from binding to and degrading fibrin.
Treatment of significant haemorrhage following trauma; epistaxis; menorrhagia; fibrinolysis.
First-line non-hormonal treatment for menorrhagia.
Given as an IV bolus followed by an infusion in cases of major haemorrhage.
S/E: Diarrhoea (reduce dose); nausea; vomiting
Trazodone
Triazolopyridine (Tricyclic) antidepressant. New with less side effects.
Used to treat depression and anxiety. Usually prescribed when other antidepressants haven’t worked or have caused side effects.
Sedative take at night. Toxic in overdose.
Brand name: Molipaxin.
Valsartan
Angiotensin receptor blocker (ARB).
Treats hypertension, heart failure, MI.
Avoid in pregnancy.
Hydralazine
Peripheral vasodilator.
Hypertension (adjunct), heart failure, hypertensive emergencies, hypertension with renal complications.
2nd line for hypertension in pregnancy.
S/E: Angina pectoris; diarrhoea; dizziness; flushing; gastrointestinal disorders; headache; hypotension; joint disorders; lupus-like syndrome; myalgia; nasal congestion; nausea; palpitations; tachycardia; vomiting
Methyldopa
Alpha2 Agonist.
Hypertension - 3rd line in pregnancy after labetalol or nifedipine.
C/I: Acute porphyrias ; depression; paraganglioma; phaeochromocytoma
S/E: Abdominal distension; amenorrhoea; angina pectoris; angioedema; arthralgia; asthenia etc
Venlafaxine
Serotonin-noradrenaline reuptake inhibitors (SNRIs)
Major depression, general/ social anxiety disorder, panic disorder, menopausal symptoms.
Venlafaxine is used for menopausal symptoms, but it is not licensed for this indication.
C/I: Uncontrolled hypertension
Cautions: Conditions associated with high risk of cardiac arrhythmia; diabetes; heart disease (monitor blood pressure); history of bleeding disorders; history of epilepsy; history or family history of mania; susceptibility to angle-closure glaucoma
S/E (fewer than older ones): Anxiety; appetite decreased; arrhythmias; asthenia; chills; confusion; constipation; depersonalisation; diarrhoea; dizziness; dry mouth; dyspnoea; headache; hot flush; hypertension; menstrual cycle irregularities; movement disorders; muscle tone increased; mydriasis; nausea; palpitations; paraesthesia; sedation; sexual dysfunction; skin reactions; sleep disorders; sweat changes; taste altered; tinnitus; tremor; urinary disorders; vision disorders; vomiting; weight changes; yawning
Warfarin
Anticoagulant (vitamin K antagonist).
Prophylaxis of embolisation (in AF, rheumatic HD, after insertion of prosthetic heart valve), prophylaxis and treatment of venous thrombosis and pulmonary embolism, transient ischaemic attacks.
S/E: haemorrhage, alopecia, nausea, vomiting.
Teratogenic!!
Monitoring: baseline prothrombin time, INR daily when starting then up to every 12 weeks.
Vitamin K is antidote.
Daily dose between 3mg and 9mg.
0.5mg - white tablet
1mg - brown tablet
3mg - blue tablet
5mg - pink table
Patients given yellow book to keep record.
Zolpidem
Z-drug (non-benzodiazepine with similar effects).
Insomnia (short term use)
C/I: Acute respiratory depression; marked neuromuscular respiratory weakness; obstructive sleep apnoea; psychotic illness; severe respiratory depression; unstable myasthenia gravis
S/E: Abdominal pain; anterograde amnesia; anxiety; back pain; diarrhoea; dizziness; fatigue; hallucination; headache; increased risk of infection; nausea; sleep disorders; vomiting.
Wait 8 hours after taking until driving/ operating heavy machinery.
Avoid prolonged use (risk of tolerance and withdrawal symptoms).
Don’t give in pregnancy.
Controlled drug.
Zopiclone
Z-drug (non-benzodiazepine with similar effects).
Insomnia (short term use).
C/I: Marked neuromuscular respiratory weakness; respiratory failure; severe sleep apnoea syndrome; unstable myasthenia gravis
Avoid prolonged use (risk of tolerance and withdrawal symptoms).
S/E: Dry mouth; taste bitter.
Avoid in pregnancy (neonatal withdrawal, neonatal hypothermia, hypotonia, and respiratory depression).
Controlled drug.
Isoflurane
Volatile halogenated (general) anesthetic used for Induction of anaesthesia (in oxygen or nitrous oxide-oxygen) or maintenance of anesthesia (in nitrous oxide–oxygen).
!Malignant hyperthermia!
S/E: Agitation; apnoea; arrhythmias; chills; cough; dizziness; headache; hypersalivation; hypertension; hypotension; nausea; respiratory disorders; vomiting
Nitrous oxide
(Entonox) anesthetic and analgesic. N20
Analgesia
Maintenance of anaesthesia in conjunction with other anaesthetic agents
Oxygen
Hypoxaemic patients to increase alveolar oxygen tension and decrease the work of breathing. Aim for 94–98% saturation.
Ketamine
Induction and maintenance of anaesthesia, local anesthetic.
C/I: Acute porphyrias ; eclampsia; head trauma; hypertension; pre-eclampsia; raised intracranial pressure; severe cardiac disease; stroke.
S/E: Anxiety; behaviour abnormal; confusion; diplopia; hallucination; muscle tone increased; nausea; nystagmus; skin reactions; sleep disorders; tonic clonic movements; vomiting.
Driving and skilled tasks - avoid for 24 hours.
Propofol
Anaesthetic.
Induction and maintenance of anaesthesia and sedation.
S/E: Apnoea; arrhythmias; headache; hypotension; localised pain; nausea; vomiting.
Driving and skilled tasks - not for 24 hours.
Bupivacaine
Local anaesthetic.
Surgical anaesthesia nerve blocks. Epidurals.
S/E: Arrhythmias; dizziness; hypertension; hypotension; nausea; paraesthesia; urinary retention; vomiting
Lidocane
Local anaesthetic.
IV regional anaesthesia and nerve block, ointment, ventricular arrhythmias.
Midazolam
Benzodiazepine.
Status epilepticus (buccal in children) febrile convulsions, conscious sedation for procedures, pre-med.
C/I: CNS depression; compromised airway; severe respiratory depression
S/E: vomiting, anxiety, GI upset, respiratory depression
Methadone
Opioid analgesic.
Used for severe pain, treatment of opioid dependence, cough in palliative care.
S/E: Arrhythmias; confusion; constipation; Asthma exacerbated; dry eye; dysuria; hyperprolactinaemia; hypothermia; menstrual cycle irregularities; mood altered; nasal dryness; QT interval prolongation; vertigo
Patients with the following risk factors for QT-interval prolongation should be carefully monitored while taking methadone: heart or liver disease, electrolyte abnormalities, or concomitant treatment with drugs that can prolong QT interval; patients requiring more than 100 mg daily should also be monitored.
Dexamethasone
Corticosteroid.
Suppression of inflammatory and allergic disorders; local treatment of inflammation (short-term); croup; congenital adrenal hyperplasia; overnight dexamethasone suppression test; cerebral oedema.
Palliative care symptom control - pain (nerve compression) nausea and vomiting and anorexia.
S/E: anxiety, cushings, osteoporosis.
Haloperidol
First generation / typical antipsychotic and antiemetic.
Prophylaxis of postoperative nausea and vomiting (when alternatives ineffective or not tolerated); nausea and vomiting in palliative care; schizophrenia and schizoaffective disorder; acute delirium; mania in bipolar; aggression and psychotic symptoms; Tourette’s syndrome.
C/I: CNS depression; long QT syndrome; dementia with Lewy bodies; Parkinson’s disease; recent acute myocardial infarction.
S/E: Depression; eye disorders; headache; hypersalivation; nausea; neuromuscular dysfunction; psychotic disorder; vision disorders; weight decreased.
Anticholinergics
Antimuscarinics: hyoscine butylbromide, hyoscine hydrobromide, antipsychotics (clozapine, quetiapine etc), tricyclic antidepressants, Atropine
Antinicotinics: ganglion blockers e.g. bupropion.
Used to treat a variety of conditions: vertigo, motion sickness, extrapyramidal symptoms (S/E of antipsychotics), GI disorders, GU disorders, insomnia, restrictive respiratory diseases and in palliative care (reduce saliva production).
C/I: Angle-closure glaucoma; gastro-intestinal obstruction; myasthenia gravis; paralytic ileus; pyloric stenosis; severe ulcerative colitis; significant bladder outflow obstruction; toxic megacolon; urinary retention.
S/E: Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting, angioedema; confusion (more common in elderly).
Epinephrine (adrenaline)
Brand name: Epipen
Cardiopulmonary resuscitation; Acute hypotension; Anaphylaxis; Angioedema
Charcoal (activated)
Reduction of absorption of poisons in the gastro-intestinal system.
Acetylcysteine
Paracetamol overdose, Tear deficiency;
Impaired or abnormal mucus production; Reduction of sputum viscosity.
S/E: diarrhoea; fever; GI discomfort; headache; hypotension; nausea; stomatitis; tinnitus; vomiting.
Commonly causes an anaphylactoid reaction (non-IgE mediated mast cell release). Anaphylactoid reactions to IV acetylcysteine are generally treated by stopping the infusion, then restarting at a slower rate.
Atropine
Antimuscarinic.
Treatment of poisoning by organophosphorus insecticide or nerve agent; Bradycardia; Cycloplegia; Anterior uveitis; pre-medication.
S/E: Dry mouth, headache, constipation, anxiety.
