Drugs Flashcards
1
Q
P450 Enzyme inhibitors
A
Sodium valproate Ketoconazole Isoniazid Amiodarone Chloramphenicol Erythromycin Quinidine Grapefruit juice
2
Q
Ketoconazole
A
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
3
Q
Cyclizine
A
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
4
Q
Ondansetron
A
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.
5
Q
Metoclopramide hydrochloride
A
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.
6
Q
Antiemetics
A
Metoclopramide Cyclizine Ondansetron Prochlorperazine (typical antipsychotic) Domperidone Hyoscine hydrobromide Metoclopramide hydrochloride Trifluoperazine (typical antipsychotic) Haloperidol (typical antipsychotic)
7
Q
Terlipressin acetate
A
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
8
Q
Diltiazem hydrochloride
A
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.
9
Q
Beta blockers / β-Adrenergic Antagonists
A
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
10
Q
Ipratropium bromide
A
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.
11
Q
Bleomycin
A
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
12
Q
Treatment of lymphoma (4 drugs)
A
Dacarbazine, vinblastine, bleomycin, and doxorubicin
13
Q
Non-nucleoside reverse transcription inhibitors (NNRTI)
A
HIV antiviral drugs
Nevirapine, Efavirenz, Rilpivirine
S/E stephen johnson syndrome, hepatitis
Efavirenz, Nevirapine.
HIV infection in combination with other antiretroviral drugs
14
Q
Integrase strand transfer inhibitors (InSTIs)
A
HIV antiviral drugs
Dolutegravir, Raltegravir, elvitegravir
S/E GI upset, insomnia
15
Q
Dolutegravir
A
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)
16
Q
Amoxicillin
A
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
17
Q
Penicillin based antibiotics
A
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.
18
Q
Flucloxacillin
A
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.
19
Q
Co-amoxiclav
A
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,
20
Q
The 4 Cs
A
clindamycin, cephalosporins, co-amoxiclav and ciprofloxacin
21
Q
Cephalosporins
A
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
22
Q
Glycopeptides
A
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
23
Q
Aminoglycosides
A
Inhibition of Protein Synthesis.
Treat serous gram -ve infection.
e.g. gentamicin (toxic)
24
Q
Families of antibiotics
A
- Penicillins and cephalosporins (B-lactams)
- Glycopeptides
- Aminoglycosides
- Macrolides
- Tetracyclines
- Oxazolidinones
- Cyclic lipopeptide
- Fluoroquinolones
25
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
26
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.
27
Oxazolidinones
Inhibition of protein synthesis.
Gram +ve infections.
e.g. linezolid
28
Cyclic lipopeptide
Inhibition of protein synthesis.
Gram +ve infections. Good against MRSA and other serious infections.
e.g. daptomycin
29
Quinolones and fluoroquinolones
Inhibition of DNA synthesis and replication.
Best against gram -ves inc. pseudomonas.
e.g. ciprofloxacin, levofloxacin, nitrofurantoin
30
Inhibition of purine synthesis
Trimethoprim
31
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.
32
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.
33
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.
34
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
35
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.
36
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.
37
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.
38
Sulphamethoxazole
Inhibitor of purine synthesis.
Used in a combined form in the drug: co-trimoxazole.
39
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.
40
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
41
Nitrofurantoin
Quinolone antibiotic.
Good in UTI and against e.coli.
Can cause pulmonary fibrosis.
42
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.
43
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.
44
Clindamycin
An synthetic antibiotic developed from lindamycin (a natural antibiotic).
Affective against gram positive cocci inc. MRSA and anerobes.
Can cause c.diff infection.
45
Daptomycin
A naturally-occurring lipopeptide antibiotic that kills susceptible gram positive bacteria.
Dont use in pneumonia as it binds surfactant.
46
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
47
Ertapenem
Broad spec. carbapenem antibiotic used in bad aerobic gram negative infections (not pseudomonas) and some staphs (not MRSA).
48
Imipenem
Very broad spec antibiotic against gram +ve and -ve organisms.
Avoid in pregnancy/lactation.
S/E fits, eosinophilia, neutropenia.
49
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.
50
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).
51
Minocycline
A tetracycline antibiotic but with a wider spec. and more S/E (hepatitis, pneumonitis)
52
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.
53
Tobramycin
Aminoglycoside antibiotic useful in serious gram-negative infections.
Better against pseudomonas (CF) than gentamicin, similar toxicity.
54
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.
55
Oxcarbazepine
Anticonvulsive
56
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.
57
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
58
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
59
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
60
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
61
Acrivastine
Antihistamine (2nd gen) used to treat hay fever, conjunctivitis, eczema, stings/bites and urticaria.
62
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.
63
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.
64
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.
65
Alogliptin
Diabetic drug in the DPP-4 inhibitor class (gliptin). Increases production of insulin.
S/E causes less weight gain and hypos than others.
66
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
67
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.
68
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.
69
Atorvastatin
Statin. Used to lower cholesterol and prevent MI/stroke.
70
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
71
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.
72
Benzoyl peroxide
Antiseptic.
Acne vulgaris.
S/E: skin reactions, facial swelling.
73
Betahistine
Histamine analogue.
Symptom control in Meniere's disease (tinnitus and vertigo).
74
Bisacodyl
Laxative.
Dulcolax - brand name.
75
Bumetanide
Loop diuretic. Treats heart failure, hypertension and oedema.
76
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
77
Candesartan
Angiotensin receptor blocker (ARB).
Used to treat hypertension and heart failure especially if ACEI causes cough.
78
Carbocisteine
Mucolytic.
Makes phlegm less thick and sticky -- easier to cough up.
COPD and CF.
79
Cefalexin
Cephalosporin antibiotic. Brand name: Keflex.
Treats pneumonias, skin infections, UTIs.
80
Cetirizine
Second generation antihistamine (non-drowsy)
Symptomatic relief of allergy such as hay fever, chronic idiopathic urticaria, atopic dermatitis.
81
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
82
Cinnarizine
1st generation (drowsy) antihistamine and diphenylmethyl piperazine calcium channel blocker.
Used for travel sickness and symptoms of meniere's disease.
Trade name: stugeron.
83
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
84
Clobetasol
Topical (strong) corticosteroid.
Clobetasol propionate is used for eczema, psoriasis, lichen planus, lupus.
85
Clobetasone
Topical (mild) corticosteroid.
Can be bought over the counter to treat eczema, psoriasis, insect bites, nappy rash etc.
86
Clonazepam
Benzodiazepine used to treat epilepsy, involuntary muscle spasms, panic disorder and sometimes restless legs syndrome.
87
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
88
Co-codamol
Analgesic (paracetamol and codeine).
89
Co-codaprin
Analgesic (aspirin and codeine).
90
Co-dydramol
Analgesic (paracetamol and dihydrocodeine).
91
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,
92
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
93
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.
94
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.
95
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
96
Diclofenac
NSAID.
Used to treat RA, OA, gout, pain, ankylosing spondylitis, migraine.
! ulcers !
97
Dihydrocodeine
Opioid analgesic used to treat moderate to severe pain.
98
Diltriazem
Calcium Channel Blocker (non-dihydropyridine).
Used to treat hypertension, angina and raynaud's.
Brand names: Adizem, Slozem, Tildiem
99
Diphenhydramine
1st generation antihistamine.
Used to treat: insomnia, hay fever, eczema, hives, cough and cold symptoms.
Avoid alcohol.
Brand names: Histergan, Nytol and Sleepeaze.
100
Dipyridamole
Antiplatelet (nucleoside transport and PDE 3 inhibitor).
Prophylaxis of thromboembolism in Ischaemic stroke or TIA not associated with AF.
And prosthetic heart valves.
101
Docusate
Docusate sodium - laxative.
Treatment of constipation or clearance in abdo x-ray.
102
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.
103
Dobepezil
Dementia medication.
Brands: Aricept, Aricept Evess
104
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)
105
Doxazosin
Alpha-blocker.
Used to treat hypertension (vasodilator) and benign prostatic enlargement.
S/E: Vertigo, oedemia,
106
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
107
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.
108
Empagliflozin
Sodium-glucose co-transporter 2 (SGLT2) inhibitors. (Gliflozins)
Brand name: Jardiance
109
Enalapril
Ace Inhibitor (rarely used due to short half life so BD)
Treats heart failure and hypertension.
110
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
111
Esomeprazole
Proton pump inhibitor (PPI).
Used for gastro-oesophageal reflux disease (GORD) and stomach ulcers.
112
Ezetimibe
Cholesterol absorption inhibitor. Statin.
113
Felidipine
Calcium channel blocker (dihydropyridine). Treats hypertension and angina.
114
Ferrous fumarate
Iron supplement used to treat iron-deficiency anaemia.
115
Ferrous sulfate
Iron supplement used to treat iron-deficiency anaemia.
116
Fexofenadine
Second generation antihistamine used to treat the symptoms of allergies (hay fever, conunctivitis, eczema, urticaria, reactions to insect bites and stings).
117
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.
118
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.
119
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
120
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
121
Fusidic acid
Fusidane antibiotic derived from the fungus Fusidium coccineum.
Topical ointment used to treat cellulitis, impetigo. Eye drops to treat conjunctivitis.
122
Fybogel
Laxative. AKA ispaghula husk.
It comes as plain or fruit-flavoured granules that you mix with water to make a high-fibre drink.
123
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.
124
Gavascon
Antacid to treat acid reflux and indigestion.
125
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.
126
Glimepiride
Sulphonylurea.
Trade name: Amaryl
127
Glyceryl trinitrate (GTN)
Nitrate - used to treat angina.
Brand names: Rectogesic, Minitran
128
Heparinoid
Glycosaminoglycans which are derivatives of heparin.
Used to treat bruises, varicose veins, phlebitis, piles.
129
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.
130
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.
131
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
132
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
133
NSAIDs
Ibuprofen, diclofenac, mefenamic, naproxen
COX inhibitors - reduces prostaglandin production.
S/E exacerbate plaque psoriasis.
134
Mefenamic
NSAID
135
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.
136
Irbesartan
ARB used to treat hypertension and prevent strokes, heart attacks and kidney problems.
137
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
138
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.
139
Retinoids
Isotretinoin, acitretin, alitretinoin
Consultant only - check pregnancy, liver function tests, cholesterol.
Don't give to <12s,
140
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.
141
Alitretinoin
Retinoid used to treat acne.
142
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).
143
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
144
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
145
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
146
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
```
147
Nevirapine
Stevens-Johnson Syndrome
148
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.
149
Lansoprazole
Proton Pump Inhibitor.
Used for indigestion, heartburn, acid reflux and GORD.
150
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
151
Lercanidipine
Calcium channel blocker (dihydropyridine).
152
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.
153
Levetiracetam
Anti-epileptic.
154
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
155
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.
156
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.
157
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.
158
Lisinopril
ACE Inhibitor
159
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.
160
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
161
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).
162
Second generation antihistamines
Loratadine
Cetirizine
Diphenhydramine
Fexofenadine
163
First generation antihistamines.
Promethazine
Acrivastine
Chlorphenamine
164
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
165
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
166
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
167
Lymecycline
Tetracycline antibiotic used mainly for acne.
168
Macrogol
Laxative used to treat constipation or faecal impaction.
Brand names: Movicol, Laxido, CosmoCol, Molaxole or Molative.
169
Laxatives
```
Macrogol
Bisacodyl
Fybogel
Lactulose
Docusate
Senna
```
170
Mebeverine hydrochloride
Antispasmodic it helps with muscle spasms. Treats IBS.
171
Melatonin
Synthetic hormone used to treat short term insomnia in >55s and jet lag. Normally produced by pineal gland.
172
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.
173
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.
174
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.
175
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
176
Morphine
Opiate analgesic - strong.
Brand names: MST, Zomorph, Sevredol, Morphgesic, MXL or Oramorph.
Oral-parenteral potency rate is 1:3.
177
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
178
Diamorphine
Opioid analgesic. AKA heroin 1.5x strength of morphine. Better parenteraly than morphine.
179
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.
180
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
181
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.
182
Oxycodone
Oxycodone hydrochloride.
Opiate (opioid) painkiller used to treat severe pain e.g. cancer pain.
183
Pantoprazole
Proton pump inhibitor
Used for indigestion, heartburn, acid reflux and GORD.
Don't give in pregnancy.
184
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.
185
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
186
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.
187
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.
188
Perindopril
ACEI.
189
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
190
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.
191
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.
192
Thiazolidinedione
AKA glitazone - only one - Pioglitazone (T2DM).
Thiazolidinediones are associated with an increased risk of bladder cancer.
193
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
194
Pravastatin
Statin. Used to lower cholesterol and prevent MI/stroke.
195
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.
196
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.
197
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
198
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.
199
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.
200
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
201
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
202
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
203
Rabeprazole
Proton pump inhibitor, treats GORD and ulcers.
204
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.
205
Ranitidine
Histamine antagonist / H2 blocker.
Treats GORD, dyspepsia, ulcers; Benign gastric ulceration; Duodenal ulceration
S/E: Constipation; diarrhoea; dizziness; fatigue; headache; myalgia; skin reactions
206
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
207
Risedronate
(Risedronate sodium) Bisphosphonate. Treats and prevents osteoporosis and paget's disease of the bone.
208
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,
209
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.
210
Factor Xa inhibitors
Anticoagulants (DOACs)
Apixaban, rivaroxaban.
211
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
212
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.
213
Tramadol
Weak opioid analgesic used to treat moderate to severe pain (acute, chronic or post surgery). IM, PO, IV.
Controlled drug.
214
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
215
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.
216
Valsartan
Angiotensin receptor blocker (ARB).
Treats hypertension, heart failure, MI.
Avoid in pregnancy.
217
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
218
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
219
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
220
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.
221
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.
222
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.
223
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
224
Nitrous oxide
(Entonox) anesthetic and analgesic. N20
Analgesia
Maintenance of anaesthesia in conjunction with other anaesthetic agents
225
Oxygen
Hypoxaemic patients to increase alveolar oxygen tension and decrease the work of breathing. Aim for 94–98% saturation.
226
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.
227
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.
228
Bupivacaine
Local anaesthetic.
Surgical anaesthesia nerve blocks. Epidurals.
S/E: Arrhythmias; dizziness; hypertension; hypotension; nausea; paraesthesia; urinary retention; vomiting
229
Lidocane
Local anaesthetic.
IV regional anaesthesia and nerve block, ointment, ventricular arrhythmias.
230
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
231
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.
232
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.
233
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.
234
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).
235
Epinephrine (adrenaline)
Brand name: Epipen
Cardiopulmonary resuscitation; Acute hypotension; Anaphylaxis; Angioedema
236
Charcoal (activated)
Reduction of absorption of poisons in the gastro-intestinal system.
237
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.
238
Atropine
Antimuscarinic.
Treatment of poisoning by organophosphorus insecticide or nerve agent; Bradycardia; Cycloplegia; Anterior uveitis; pre-medication.
S/E: Dry mouth, headache, constipation, anxiety.
239
Calcium gluconate
Mineral supplement used as an antidote.
Hypocalcaemia; hypocalcaemic tetany; hyperkalaemia, Calcium deficiency.
First-line treatment for magnesium sulphate induced respiratory depression
240
Calcium salts
Calcium gluconate.
Hypocalcaemia; hypocalcaemic tetany; hyperkalaemia, Calcium deficiency.
C/I: Conditions associated with hypercalcaemia (e.g. some forms of malignant disease)
241
Naloxone (hydrochloride)
Competitive opioid receptor antagonist.
Overdosage with opioids; reversal of postoperative respiratory depression.
Cautions: CVD or those receiving cardiotoxic drugs (serious adverse cardiovascular effects reported); maternal physical dependence on opioids (may precipitate withdrawal in newborn); pain; physical dependence on opioids (precipitates withdrawal)
In postoperative use, the dose should be titrated for each patient in order to obtain sufficient respiratory response; however, naloxone antagonises analgesia.
S/E: Arrhythmias; dizziness; headache; hypertension; hypotension; nausea; vomiting
242
Magnesium sulfate
Mineral replacement.
Severe acute asthma; continuing respiratory deterioration in anaphylaxis; prevention and treatment of seizures in pre-eclampsia; hypomagnesaemia; rapid bowel evacuation.
Overdose: nausea, vomiting, flushing, thirst, hypotension, drowsiness, confusion, reflexes absent (due to neuromuscular blockade), respiratory depression, speech slurred, diplopia, muscle weakness, arrhythmias, coma, and cardiac arrest.
Give calcium gluconate for magnesium sulphate induced respiratory depression.
243
Ethosuximide
Anticonvulsive.
Absence seizures,; Atypical absence seizures (adjunct); Myoclonic seizures
S/E: aggression, hiccups, libido increased
244
Methylthioninium chloride
Antidote.
Drug- or chemical-induced methaemoglobinaemia.
245
Penicillamine
DMARD / Antidote
Severe rheumatoid arthritis; Wilson's disease; Autoimmune hepatitis; Cystinuria; heavy metal poisonings.
C/I: Lupus erythematosus
Cautions: Neurological involvement in Wilson's disease
S/E: Proteinuria; thrombocytopenia, nephrotoxicity, Nausea and rash
Patients who are hypersensitive to penicillin may react rarely to penicillamine.
Consider withdrawal if platelet count falls below 120 000/mm 3.
246
Potassium ferric hexacyanoferrate
Antidote.
Cesium or thallium poisoning.
247
Sodium nitrite
Antidote.
Poisoning with cyanides
248
Sodium thiosulfate
Antidote.
Poisoning with cyanides
249
Levamisole
Intestinal anthelminthic
Roundworm infections.
250
Mebendazole
Intestinal anthelminthic.
Threadworm infections; Whipworm infections; Hookworm infections; Roundworm infections
Brand names: Vermox and Ovex.
S/E: Gastrointestinal discomfort
Avoid in pregnancy.
251
Niclosamide
Intestinal anthelminthic
Tapeworm infections
S/E: gastro-intestinal upset, lightheadedness, and pruritus
252
Praziquantel
Intestinal anthelminthic.
Tapeworm infections (Taenia solium, Hymenolepis nana);
Schistosoma worm infections (haematobium, mansoni and japonicum).
253
Pyrantel
Intestinal anthelminthic.
Ascariasis; hookworm; enterobiasis (pinworm infection); trichostrongyliasis, and trichinellosis.
S/E: nausea, headache, dizziness, trouble sleeping, and rash
254
Albendazole
Anthelminthic - antifilarial.
Chronic Strongyloides infection; Hydatid (tapeworm) disease; Hookworm infections
255
Diethylcarbamazine
Anthelminthics - antifilarial
Wuchereria bancrofti infections,
Brugia malayi infections
256
Ivermectin
Anthelminthic / antifilarial
Papulopustular rosacea; Chronic Strongyloides infection; Onchocerciasis; Scabies.
S/E: Skin reactions
257
Ceftriaxone
Cephalosporin antibiotic.
- acute bacterial meningitis
-community acquired pneumonia (severe)
- complicated intraabdominal infections (mild to
moderate)
- complicated intrabdominal infections (severe)
- hospital acquired pneumonia
- Neisseria gonorrhoeae
-pyelonephritis or prostatitis (severe)
258
Pyrazinamide
Antimycobacterial.
Tuberculosis.
C/I: gout
S/E: Appetite decreased; arthralgia; dysuria; flushing; gout aggravated; hepatic disorders; malaise; nausea; peptic ulcer aggravated; photosensitivity reaction; sideroblastic anaemia; skin reactions; splenomegaly; vomiting
259
Rifampicin
Antimycobacterial.
Tuberculosis (treatment and prophylaxis); Brucellosis; Legionnaires; Serious staphylococcal infections; Endocarditis; leprosy; meningococcal meningitis; Haemophilus influenzae type b
S/E: Nausea; thrombocytopenia; vomiting' AKI; influenza-like symptoms
P450 enzyme inducer.
260
Isoniazid
Antimycobacterial.
Tuberculosis (treatment and prophylaxis).
C/I: Drug-induced liver disease
S/E: Hepatic disorders; gynaecomastia; nerve disorders; pancreatitis
P450 enzyme inhibitor
261
Ethambutol
Antimycobacterial.
Tuberculosis.
C/I: Optic neuritis; poor vision
S/E: Hyperuricaemia; nerve disorders; visual impairment
262
Amphotericin
Antifungal / Antileishmaniasis medicine.
Systemic fungal infections; Aspergillosis; Visceral leishmaniasis; Severe invasive candidiasis, cryptococcal meningitis (HIV).
Brand names: Fungizone, AmBisome, Abelcet
S/E: anaemia; appetite decreased; azotaemia; chills; diarrhoea; dyspnoea; electrolyte imbalance; fever; headache; hepatic function abnormal (discontinue); hyposthenuria; hypotension; nausea; nephrocalcinosis; renal impairment; renal tubular acidosis; skin reactions; vomiting
263
Clotrimazole
Antifungal (topical).
Fungal infection in otitis externa; Fungal skin infections (ringworm, athletes foot); vaginal and vulval candidiasis (thrush).
S/E: Oedema; paraesthesia; skin reactions
264
Fluconazole
Antifungal
Candidal balanitis; Vaginal candidiasis; Mucosal candidiasis; Tinea pedis (athletes foot), Tinea corporis (ringworm), tinea cruris (Jock itch), pityriasis versicolor,
Dermal candidiasis
Commonly used to treat thrush.
Brand name: Diflucan
S/E: Diarrhoea; gastrointestinal discomfort; headache; nausea; skin reactions; vomiting.
P450 enzime inhibitor.
C/I in pregnancy as teratogenic.
265
Flucytosine
Antifungal
Systemic yeast and fungal infections, Cryptococcal meningitis.
S/E: Agranulocytosis, hallucination, hepatic disorders
266
Griseofulvin
Antifungal
Tinea pedis, Tinea capitis
C/I: Acute porphyrias ; systemic lupus erythematosus
S/E: diarrhoea; epigastric discomfort; headache; nausea; vomiting
P540 enzyme inducer
267
Itraconazole
Antifungal
Candidiasis (Vulvovaginal, Oral or oesophageal, Systemic); Pityriasis versicolor; Tinea pedis; Tinea manuum; Tinea corporis; Tinea cruris; Onychomycosis (tinea unguium); Aspergillosis; Histoplasmosis; Cryptococcosis
C/I: Acute porphyrias
S/E: Alopecia; constipation; diarrhoea; dyspnoea; gastrointestinal discomfort; headache; heart failure; hepatic disorders; hyperbilirubinaemia; nausea; oedema; pulmonary oedema; skin reactions; vision disorders; vomiting
268
Nystatin
Antifungal
Oral candidiasis
S/E: Abdominal distress; angioedema; diarrhoea; face oedema; nausea; sensitisation; skin reactions; Stevens-Johnson syndrome; vomiting
269
Voriconazole
Antifungal
Invasive aspergillosis; Scedosporium spp., Fusarium spp., or invasive fluconazole-resistant Candida spp
C/I: Acute porphyrias
S/E: Acute kidney injury; agranulocytosis; alopecia; anaemia; anxiety; arrhythmias; asthenia; bone marrow disorders; chest pain; chills; confusion; constipation; depression; diarrhoea; dizziness; drowsiness; dyspnoea; electrolyte imbalance; eye disorders; eye inflammation; fever; gastrointestinal discomfort; haemorrhage; hallucination; headache; hepatic disorders; hypoglycaemia; hypotension; increased risk of infection; insomnia; leucopenia; muscle tone increased; nausea; neutropenia; oedema; oral disorders; pain; pulmonary oedema; respiratory disorders; seizure; sensation abnormal; skin reactions; syncope; tetany; thrombocytopenia; tremor; vision disorders; vomiting
270
Abacavir
Antiretroviral - Nucleoside/Nucleotide reverse transcriptase inhibitors.
HIV infection in combination with other antiretroviral drugs
S/E: Lethargy, arthralgia, flatulence, neutropenia
271
Lamivudine
Antiretrovirals - Nucleoside/Nucleotide reverse transcriptase inhibitors
HIV infection in combination with other antiretroviral drugs; Chronic hepatitis B infection
Brand names: Epivir, Zeffix
S/E: Alopecia; cough; gastrointestinal discomfort; malaise; muscle cramps; myopathy; nasal disorder
272
Tenofovir disoproxil fumarate
Nucleoside/Nucleotide reverse transcriptase inhibitors
HIV infection in combination with other antiretroviral drugs,
Chronic hepatitis B infection
S/E: Abdominal distension, flatulence, neutropenia, anaemia
273
Zidovudine
Antiretroviral - Nucleoside/Nucleotide reverse transcriptase inhibitors
1st HIV antiviral drug (old).
HIV infection in combination with other antiretroviral drugs; Prevention of maternal-fetal HIV transmission
C/I: Abnormally low haemoglobin concentration; abnormally low neutrophil counts
S/E: Leucopenia; malaise, flatulence, neutropenia, anaemia
274
Nucleoside / Nucleotide reverse transcriptase inhibitors (NRTI)
Antiretrovirals treating HIV infection in combination with other antiretroviral drugs (first to be developed).
```
Zidovudine (ZDV or AZT)
Lamivudine (3TC)
Tenofovir disoproxil Fumarate (TDF)
Abacavir (ABC)
Didanosine
entecavir
```
HIV infection in combination with other antiretroviral drugs
S/E: LIPOATROPHY Abdominal pain; anaemia (may require transfusion); appetite decreased; arthralgia; asthenia; diarrhoea; dizziness; fever; flatulence; headache; hepatic disorders; insomnia; myalgia; nausea; neutropenia; skin reactions; vomiting
275
Efavirenz
Antiretrovirals - Non-nucleoside reverse transcriptase inhibitor
HIV infection in combination with other antiretroviral drugs
S/E: Abdominal pain; anxiety; concentration impaired; depression; diarrhoea; dizziness; drowsiness; dyslipidaemia; fatigue; headache; movement disorders; nausea; skin reactions; sleep disorders; vomiting
Neural tube defects in pregnancy.
276
Nevirapine
Antiretrovirals - Non-nucleoside reverse transcriptase inhibitor
HIV infection in combination with other antiretroviral drugs
C/I: Acute porphyrias ; post-exposure prophylaxis
S/E: Abdominal pain; angioedema; diarrhoea; fatigue; fever; headache; hepatic disorders (women more than men); hypersensitivity; hypertransaminasemia; nausea; skin reactions; vomiting
277
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Antiretrovirals treating HIV infection in combination with other antiretroviral drugs
Efavirenz, Nevirapine, Rilpivirine.
278
Protease inhibitors
Antiretrovirals treating HIV infection in combination with other antiretroviral drugs.
Atazanavir; darunavir; ritonavir, saquinavir
S/E: Alopecia; anaemia; angioedema; anxiety; appetite abnormal; arthralgia; asthenia; diabetes mellitus; diarrhoea; dizziness; dry mouth; DYSLIPDAEMIA; dyspnoea; fever; gastrointestinal discomfort; gastrointestinal disorders; headache; hepatic disorders; hypersensitivity; hypertension; malaise; muscle complaints; nausea; neutropenia; oral ulceration; pancreatitis; peripheral neuropathy; seizure; skin reactions; sleep disorders; taste altered; vomiting
279
Darunavir
Antiretroviral - Protease inhibitor.
HIV infection in combination with other antiretroviral drugs
C/I: Acute porphyrias
S/E: Angina pectoris, dry eye, gout; gynaecomastia;
280
Ritonavir
Antiretroviral - Protease inhibitor.
HIV infection in combination with other antiretroviral drugs.
C/I: Acute porphyrias
S/E: Back pain; concentration impaired; confusion; cough; dehydration; feeling hot; flushing; gastrointestinal haemorrhage; gout; hypotension; menorrhagia; myopathy; oedema; oral paraesthesia; oropharyngeal pain; paraesthesia; peripheral coldness; pharyngitis; renal impairment; syncope; thrombocytopenia; urinary frequency increased; vision blurred.
P450 enzyme inhibitor - increase effects of warfrin.
281
Atazanavir
Antiretroviral - Protease inhibitor.
HIV infection in combination with other antiretroviral drugs
C/I: Acute porphyrias
S/E: Dyslipidemia, CKD, gynaecomastia, torsade de pointes.
282
Integrase inhibitors
Antiretrovirals treating HIV infection in combination with other antiretroviral drugs.
Dolutegravir, raltegravir
283
Raltegravir
Antiretroviral - Integrase inhibitor
HIV-1 infection
S/E: Akathisia; appetite abnormal; asthenia; behaviour abnormal; depression; diarrhoea; dizziness; fever; gastrointestinal discomfort; gastrointestinal disorders; headaches; nausea; skin reactions; sleep disorders; vertigo; vomiting
284
Dolutegravir
Antiretroviral - Integrase inhibitor.
HIV infection in combination with other antiretroviral drugs.
S/E: Anxiety; depression; diarrhoea; dizziness; fatigue; flatulence; gastrointestinal discomfort; headache; nausea; skin reactions; sleep disorders; vomiting
285
isoniazid + pyridoxine + sulfamethoxazole +
| trimethoprim
Prevention of HIV-related opportunistic infections
286
Ribavirin
Antiviral.
Bronchiolitis; chronic hepatitis C; viral haemorrhagic fevers
Trade names: Copegus, Rebetol.
C/I: haemoglobinopathies; severe cardiac disease
S/E: Alopecia; anaemia; anxiety; appetite decreased; arrhythmias; arthralgia; arthritis; asthenia etc
287
Valganciclovir
Antiviral.
Cytomegalovirus retinitis (AIDS associated)
S/E: Anaemia; anxiety; appetite decreased; arthralgia; asthenia etc
288
Entecavir
Antihepatitis medicine - Nucleoside/Nucleotide reverse transcriptase inhibitor.
Chronic hepatitis B
S/E: Diarrhoea; dizziness; drowsiness; dyspepsia; fatigue; headache; insomnia; nausea; vomiting
289
Antihepatitis B medicines
Entecavir, tenofovir disoproxil fumarate (TDF) T
290
Antihepatitis C medicines
Nucleotide polymerase inhibitors - sofosbuvir
Protease inhibitors - simeprevir
Non-nucleoside polymerase (NS5A) inhibitors - dasabuvir
291
Sofosbuvir
Nucleotide polymerase inhibitors.
Chronic hepatitis C infection.
S/E: Alopecia; anaemia; anxiety; appetite decreased; arthralgia; asthenia etc
292
Simeprevir
Protease inhibitor - hepatitis C infection.
293
Dasabuvir
Non-nucleoside polymerase (NS5A) inhibitor
Chronic hepatitis C infection
S/E: Anaemia; asthenia; insomnia; nausea; pruritus
294
Diloxanide
Amoebicide
Prevent relapse of E. histolytica.
295
Artemether and lumefantrine
Antimalarial.
Treatment of acute uncomplicated falciparum malaria; Treatment of chloroquine-resistant non-falciparum malaria.
C/I: FHx long QT; history of arrhythmias, bradycardia, congestive heart failure reduced LVEF
S/E: Abdominal pain; appetite decreased; arthralgia; asthenia; cough; diarrhoea; dizziness; gait abnormal; headache; movement disorders; myalgia; nausea; palpitations; QT interval prolongation; sensation abnormal; skin reactions; sleep disorders; vomiting
296
Artesunate
Antimalarial.
IV in severe malaria (high parasite count). Not licenced but used first line by specialists.
S/E: Loss of appetite;
dizziness; nausea
297
Chloroquine
Antimalarial / DMARD
Prophylaxis of malaria; Treatment of non-falciparum malaria; Active rheumatoid arthritis; Systemic and discoid lupus erythematosus.
Cautions: Acute porphyrias ; diabetes; elderly; G6PD deficiency; long-term therapy; may aggravate myasthenia gravis; may exacerbate psoriasis; neurological disorders, especially epilepsy - avoid for prophylaxis of malaria if history of epilepsy; severe gastro-intestinal disorders
S/E: (rare) cardiomyopathy; hallucination; hepatitis.
Screen for retinopathy in long term use.
298
Mefloquine
Antimalarial. Brand name: Lariam.
Treatment and prophylaxis of malaria.
C/I: Hx psychiatric disorders (inc. depression) or convulsions.
S/E: Anxiety; depression; diarrhoea; dizziness; gastrointestinal discomfort; headache; nausea; skin reactions; vision disorders; vomiting, abnormal dreams, insomnia.
Beware risk of psychosis, suicidal ideation and suicide.
299
Primaquine
Antimalarial.
Adjunct in the treatment of non-falciparum malaria caused by P.vivax or P.ovale infection.
S/E: Arrhythmia; dizziness; gastrointestinal discomfort; haemolytic anaemia (in G6PD deficiency)
300
Hydroxychloroquine Sulfate
Antimalarial / DMARD
Brand name: Plaquenil.
Malaria prophylaxis and treatment; rheumatoid arthritis; systemic and discoid lupus erythematosus;
Cautions: Acute porphyrias; diabetes; elderly; G6PD deficiency; may aggravate myasthenia gravis; may exacerbate psoriasis; neurological disorders; severe gastro-intestinal disorders.
Screen for retinopathy!
S/E: Abdominal pain; appetite decreased; diarrhoea; emotional lability; headache; nausea; skin reactions; vision disorders; vomiting; exacerbate psoriasis.
Hydroxychloroquine is very toxic in overdosage; overdosage is extremely hazardous and difficult to treat. Life-threatening features include arrhythmias and convulsions.
301
Pyrimethamine
Toxoplasmosis in pregnancy (in combination with sulfadiazine and folinic acid).
S/E: Anaemia; diarrhoea; dizziness; headache; leucopenia; nausea; skin reactions; thrombocytopenia; vomiting
302
Sulfadiazine
Sulphonamide antibiotic.
Toxoplasmosis
S/E: Agranulocytosis; aplastic anaemia; appetite decreased; ataxia etc
303
Pentamidine
Antitrypanosomal (parasitic flagellate protozoa).
African trypanosomiasis, leishmaniasis, babesiosis, and to prevent and treat Pneumocystis jirovecii (Pneumocystis carinii) pneumonia (HIV).
S/E: Dizziness; hypoglycaemia (can be severe and sometimes fatal); hypotension (can be severe and sometimes fatal); local reaction; nausea; rash; taste altered.
304
Eflornithine
Antitrypanosomal (parasitic flagellate protozoa).
Therapy for facial hirsutism; African trypanosomiasis (sleeping sickness)
S/E: Alopecia; increased risk of infection; paraesthesia; skin reactions
305
Azathioprine
Immunosuppressant / DMARD. Azathioprine is metabolised to mercaptopurine.
Crohn's disease; ulcerative colitis; Rheumatoid arthritis (w/ no response to DMARDs); systemic lupus erythematosus and other connective tissue disorders; Autoimmune conditions; Suppression of transplant rejection; Severe refractory eczema; myasthenia gravis.
S/E: Bone marrow depression (dose-related); increased risk of infection; leucopenia; pancreatitis; thrombocytopenia.
306
Ciclosporin
Immunosuppressant. Inhibits production and release of lymphokines.
rheumatoid arthritis; acute ulcerative colitis; atopic dermatitis; psoriasis; organ transplantation; Nephrotic syndrome
C/I: malignancy (in non-transplant indications); uncontrolled hypertension (in non-transplant indications); uncontrolled infections (in non-transplant indications)
S/E: Eye inflammation. Everything is increased - fluid, BP, K+, hair, gums, glucose.
MONITOR whole blood ciclosporin concentration
307
Tretinoin
Retinoid. AKA all-trans retinoic acid (ATRA).
Induction of remission in acute promyelocytic leukaemia.
S/E: Abdominal pain; alopecia; anxiety; appetite decreased; arrhythmia; asthma etc
308
Asparaginase
Cytotoxic chemotherapy - an enzyme which acts by breaking down L-asparagine to aspartic acid and ammonia, this disrupts protein synthesis of tumour cells.
Acute lymphoblastic leukaemia
C/I: pancreatitis, coagulopathy.
S/E: Abdominal pain; agitation; anaemia; angioedema; appetite decreased; arthralgia etc
309
Bendamustine
Cytotoxic chemotherapy - alkylating agent
Treatment of chronic lymphocytic leukaemia, non-Hodgkin's lymphoma, multiple myeloma.
C/I: Jaundice; low leucocyte count; low platelet count; major surgery less than 30 days before start of treatment; severe bone marrow suppression
S/E: Alopecia; amenorrhoea; anaemia; angina pectoris; appetite decreased; arrhythmias; etc
310
Bleomycin
Cytotoxic chemotherapy (antitumor antibiotic).
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 etc.
311
Calcium folinate
AKA folinic acid.
Reduces toxicity of methotrexate in cancer treatment.
312
Capecitabine
Cytotoxic chemotherapy (anti metabolite).
Advanced colorectal, gastric and breast cancer.
S/E: Alopecia; anaemia; appetite abnormal; asthenia; chest pain; constipation; cough
313
Carboplatin
Cytotoxic chemotherapy.
Ovarian cancer; Small cell lung cancer, testicular cancer.
S/E: Alopecia; anaemia; asthenia; cardiovascular disorder; constipation; diarrhoea etc.
314
Chlorambucil
Cytotoxic chemotherapy.
Lymphomas and chronic leukaemias.
S/E: Anaemia; bone marrow disorders; diarrhoea; gastrointestinal disorder; leucopenia; nausea; neoplasms; neutropenia; oral ulceration; seizures; thrombocytopenia; vomiting.
315
Cisplatin
Cytotoxic chemotherapy.
Testicular, lung, cervical, bladder, head and neck, and ovarian cancer (alone or in combination).
S/E: Anaemia; arrhythmias; bone marrow failure; electrolyte imbalance; extravasation necrosis; fever; leucopenia; nephrotoxicity (dose-related and potentially cumulative); sepsis; thrombocytopenia
316
Cyclophosphamide
Cytotoxic chemotherapy and immunosuppression.
Rheumatoid arthritis and other connective tissue diseases.
Wide range of malignancies, including some leukaemias, lymphomas, and solid tumours.
S/E: Agranulocytosis; alopecia; anaemia; asthenia; bone marrow disorders; cystitis;\
Can cause pulmonary fibrosis.
317
Cytarabine
Cytotoxic chemotherapy.
Acute myeloblastic leukaemia.
S/E: Alopecia; anaemia; appetite decreased; consciousness impaired; diarrhoea; dysarthria; dysphagia
318
Dacarbazine
Cytotoxic chemotherapy.
Metastatic melanoma; Soft-tissue sarcomas;
Hodgkin's disease (combination therapy).
S/E: Anaemia; appetite decreased; leucopenia; nausea; thrombocytopenia; vomiting
319
Dactinomycin
Cytotoxic chemotherapy.
320
Dasatinib
Cytotoxic chemotherapy.
Chronic myeloid leukaemia, Acute lymphoblastic leukaemia.
S/E: Alopecia; anaemia; appetite abnormal; arrhythmias; arthralgia; asthenia etc.
321
Dunorubicin
Cytotoxic chemotherapy (anthracycline)
Acute myelogenous leukaemia,
Acute lymphocytic leukaemia
C/I: Myocardial insufficiency; recent myocardial infarction; severe arrhythmia
S/E: Abdominal pain; alopecia; amenorrhoea; anaemia; arrhythmias; ascites; atrioventricular block; azoospermia etc
322
Docetaxel
Cytotoxic chemotherapy
323
Doxorubicin
Cytotoxic chemotherapy
```
Acute leukaemias,
Hodgkin's lymphoma,
Non-Hodgkin's lymphoma,
Some solid tumours including breast cancer,
Advanced soft-tissue sarcoma
```
S/E: Alopecia; anaemia; anxiety; appetite decreased; arrhythmias; arthralgia; asthenia etc
324
Etoposide
Cytotoxic chemotherapy
325
Filgrastim
Granulate colony stimulating factor.
Treatment of neutropenia.
S/E: Arthralgia; cutaneous vasculitis; dyspnoea; haemoptysis; headache; hypersensitivity; leucocytosis; pain; spleen abnormalities; thrombocytopenia
326
Fludarabine
Cytotoxic chemotherapy
Chronic lymphocytic leukaemia (CLL).
S/E: Anaemia; appetite decreased; asthenia etc
327
Fluorouracil
Cytotoxic chemotherapy
solid tumours, superficial malignant and pre-malignant skin lesions.
S/E: Alopecia; diarrhoea; mucositis; nausea; neutropenia; skin reactions; stomatitis; thrombocytopenia; vomiting
328
Gemcitabine
Cytotoxic chemotherapy.
329
Hydroxycarbamide
Cytotoxic chemotherapy
Chronic myeloid leukaemia (CML); Polycythaemia vera; Essential thrombocythaemia; Sickle-cell disease.
S/E: Alopecia; anaemia; appetite decreased; asthenia; bone marrow disorders etc
330
Ifosfamide
Cytotoxic chemotherapy
331
Imatinib
Cytotoxic chemotherapy
Chronic myeloid leukaemia; acute lymphoblastic leukaemia etc
S/E: Alopecia; anaemia; appetite abnormal; asthenia; bone marrow disorders;
332
Irinotecan
Cytotoxic chemotherapy
Colorectal cancers.
S/E: Common or very common
Alopecia; anaemia (dose-limiting); appetite decreased; asthenia; cholinergic syndrome; constipation etc.
333
Mercaptopurine
Antimetabolite. Cytotoxic chemotherapy. Purine antagonist.
Crohn's; ulcerative colitis; Acute leukaemias; Chronic myeloid leukaemia.
S/E: Anaemia; appetite decreased; bone marrow depression; diarrhoea; hepatic disorders; hepatotoxicity (more common at high doses); leucopenia; nausea; oral disorders; pancreatitis; thrombocytopenia; vomiting.
Monitor liver function.
334
Mesna
Cytotoxic chemotherapy
335
Nilotinib
Cytotoxic chemotherapy
Philadelphia chromosome-positive chronic myeloid leukaemia.
Alopecia; anaemia; angina pectoris; anxiety; appetite abnormal; arrhythmias; arthralgia; asthenia etc
336
Paclitaxel
Cytotoxic chemotherapy (taxane).
337
Procarbazine
Cytotoxic chemotherapy (monoamine-oxidase inhibitor).
Hodgkin's lymphoma
S/E: Appetite decreased
338
Rituximab
Monoclonal antibody (anti-lymphocyte).
Rheumatoid arthritis, Non-Hodgkin's lymphoma, Chronic lymphocytic leukaemia, granulomatosis with polyangiitis, pemphigus vulgaris.
S/E: Alopecia; anaemia; arthralgia; asthenia; conjunctivitis; constipation; cough etc
339
Tioguanine
Cytotoxic chemotherapy
Acute leukaemia,
Chronic myeloid leukaemia
S/E: Bone marrow failure; gastrointestinal disorders etc.
340
Trastuzumab
Monoclonal antibody.
Breast cancer and stomach cancer.
S/E: Alopecia; anaemia; angioedema; anxiety; appetite decreased; arrhythmias; arthralgia; arthritis; asthenia; asthma; ataxia etc
341
Vinblastine
Cytotoxic chemotherapy.
Hodgkin's lymphoma, non-small cell lung cancer, bladder cancer, brain cancer, melanoma, and testicular cancer.
S/E: Abdominal pain; acute respiratory distress syndrome (ARDS); alopecia (reversible); anaemia; appetite decreased; asthenia etc
342
Vincristine
Cytotoxic chemotherapy.
Variety of cancers including leukaemias, lymphomas, and some solid tumours.
S/E: Abdominal cramps; adrenal disorder; alopecia; anaemia; appetite decreased; azotaemia
343
Vinorelbine
Cytotoxic chemotherapy
Breast cancer, non-small cell lung cancer.
S/E: Alopecia; anaemia; appetite decreased; arthralgia; bone marrow depression
344
Zoledronic acid (zoledronate)
Bisphosphonate
Prevention of skeletal related events in advanced malignancies involving bone; Tumour-induced hypercalcaemia; Paget's disease of bone; Osteoporosis
Cautions: Atypical femoral fractures; cardiac disease (avoid fluid overload); concomitant medicines that affect renal function
S/E: Alopecia; anaemia; arthralgia; asthenia; constipation; diarrhoea; dizziness; dysphagia
Correct disturbances of calcium metabolism (e.g. vitamin D deficiency, hypocalcaemia) before starting. Monitor serum electrolytes, calcium, phosphate and magnesium.
Monitor renal function in patients at risk, such as those with pre-existing renal impairment, those of advanced age, those taking concomitant nephrotoxic drugs or diuretics, or those who are dehydrated.
345
Desmopressin
Vasopressin analogue.
Diabetes insipidus, Primary nocturnal enuresis, Polyuria or polydipsia, Idiopathic nocturnal polyuria, Diabetes insipidus diagnosis (water deprivation test), haemophilia and von Willebrand’s disease, Lumbar-puncture-associated headache.
C/I: Cardiac insufficiency; conditions treated with diuretics; history of hyponatraemia; polydipsia in alcohol dependence; psychogenic polydipsia; syndrome of inappropriate ADH secretion; von Willebrand's Disease Type IIB.
S/E: Hyponatraemia; nausea; Abdominal pain; aggression (in children); hyponatraemic seizure.
346
Nitrates
Isosorbide mononitrate, glyceryl trinitrate (GTN)
nicorandil - ish
C/I: Aortic stenosis; cardiac tamponade; constrictive pericarditis; hypertrophic cardiomyopathy; hypotensive conditions; hypovolaemia; marked anaemia; mitral stenosis; raised intracranial pressure due to cerebral haemorrhage; raised intracranial pressure due to head trauma; toxic pulmonary oedema
S/E: Arrhythmias; asthenia; cerebral ischaemia; dizziness; drowsiness; flushing; headache; hypotension; nausea; vomiting
347
Isosorbide mononitrate
Nitrate.
Prophylaxis of angina, adjunct in congestive heart failure.
Cant take with viagra etc.
348
Anastrozole
Hormone therapy (non-steroidal aromatase inhibitor).
Oestrogen-receptor-positive breast cancer; breast cancer.
S/E: Alopecia; appetite decreased; arthritis; asthenia; bone pain; carpal tunnel syndrome; diarrhoea; drowsiness
349
Bicalutamide
Hormone therapy (anti-androgen)
Prostate cancer.
S/E: Alopecia; anaemia; appetite decreased; asthenia; breast tenderness; chest pain; constipation.
350
Leuprorelin
Hormone therapy (LHRH agonist - leads to inhibition of androgen and oestrogen production).
Prostate cancer, endometriosis, ovarian function.
351
Methylprednisolone
Corticosteroid.
Suppression of inflammatory and allergic disorders; cerebral oedema associated with malignancy.
S/E: Anxiety; behaviour abnormal; cataract subcapsular; cognitive impairment; Cushing's syndrome
352
Tamoxifen
Hormone therapy. Selective oestrogen receptor modulator (SERM).
Pre- and perimenopausal women with oestrogen-receptor-positive breast cancer not previously treated with tamoxifen, Gynaecomastia, Breast cancer.
S/E: Alopecia; anaemia; cataract; cerebral ischaemia; constipation; diarrhoea; dizziness; embolism and thrombosis.
353
Levodopa
Precursor to dopamine. Co-beneldopa and co-careldopa.
Parkinson's disease.
First-line treatment if the motor symptoms are affecting the patient's quality of life.
354
Co-beneldopa
Levodopa - precursor to dopamine.
Parkinson's disease.
S/E: Anxiety; appetite decreased; arrhythmia; depression; diarrhoea; hallucination; movement disorders
355
Co-careldopa
Levodopa - precursor to dopamine.
Parkinson's disease.
S/E: Drowsiness; seizure; sleep disorders
356
Ferrous sulfate
Iron-deficiency anaemia (prophylactic and therapeutic).
S/E: Constipation; diarrhoea; gastrointestinal discomfort; nausea.
357
Phytomenadione
Vitamin K1
Reverses effects of Warfarin. Given in bleeding (INR>5); Reversal of anticoagulation.
S/E: none listed.
358
Protamine sulfate
Reverse heparin-induced anticoagulation.
Unfractionated heparin and low molecular weight heparin.
359
Coagulation factor VIII
Haemophilia A, Von Willebrand’s disease
360
Coagulation factor IX
Haemophilia B
361
Bisoprolol fumate
Beta-blocker
Hypertension; Angina; heart failure.
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; myasthenia gravis; portal hypertension; psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked
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
362
Amiodarone
Antiarrhythmic.
Treatment of paroxysmal supraventricular, nodal and ventricular tachycardias, atrial fibrillation and flutter, ventricular fibrillation, and tachyarrhythmias associated with Wolff-Parkinson-White syndrome; Ventricular fibrillation or pulseless ventricular tachycardia.
C/I: Avoid in severe conduction disturbances; avoid in sinus node disease; iodine sensitivity; sino-atrial heart block; sinus bradycardia; thyroid dysfunction
S/E: Arrhythmias; hepatic disorders; hyperthyroidism; nausea; respiratory disorders; skin reactions.
Corneal opacities.
P450 inhibitor - increases warfrin.
AVOID IN BREASTFEEDING
Can cause pulmonary fibrosis.
363
Hydrochlorothiazide
Thiazide-like diuretic
Used in combination with other drugs to reduce oedema.
S/E: Alkalosis hypochloraemic; constipation; diarrhoea; dizziness; dry mouth; electrolyte imbalance; erectile dysfunction; fatigue; headache; hyperglycaemia; hyperuricaemia; nausea; postural hypotension; skin reactions
364
Thiazide-like diuretics
Hydrochlorothiazide; bendroflumethiazide; Indapamide
Relieve oedema due to chronic heart failure and, in lower doses, to reduce blood pressure.
C/I: Addison’s disease; hypercalcaemia; hyponatraemia; refractory hypokalaemia; symptomatic hyperuricaemia
S/E: Alkalosis hypochloraemic; constipation; diarrhoea; dizziness; dry mouth; electrolyte imbalance; erectile dysfunction; fatigue; headache; hyperglycaemia; hyperuricaemia; nausea; postural hypotension; skin reactions
365
Sodium nitroprusside
Vasodilator
Hypertensive emergencies; acute or chronic heart failure.
C/I: Compensatory hypertension; impaired cerebral circulation; Leber’s optic atrophy; severe vitamin B12 deficiency
S/E: Abdominal pain; anaemia; arrhythmias; chest discomfort; cyanide toxicity; dizziness; flushing; headache; hyperhidrosis; hypothyroidism; hypovolaemia; ileus; intracranial pressure increased; methaemoglobinaemia; muscle twitching; nausea; palpitations; rash; thiocyanate toxicity
366
Loop Diuretics
Furosemide, Bumetanide
C/I: Anuria; comatose and precomatose states associated with liver cirrhosis; renal failure due to nephrotoxic or hepatotoxic drugs; severe hypokalaemia; severe hyponatraemia
S/E: Dizziness; electrolyte imbalance; fatigue; headache; metabolic alkalosis; muscle spasms; nausea
367
Indapamide
Thiazide-like diuretic.
Essential hypertension.
C/I: Addison’s disease; hypercalcaemia; hyponatraemia; refractory hypokalaemia; symptomatic hyperuricaemia
S/E: Alkalosis hypochloraemic; constipation; diarrhoea; dizziness; dry mouth; electrolyte imbalance; erectile dysfunction; fatigue; headache; hyperglycaemia; hyperuricaemia; nausea; postural hypotension; skin reactions; Hypersensitivity
368
Colecalciferol
Vitamin D.
Treatment and prophylaxis.
C/I: Hypercalcaemia; metastatic calcification
S/E: Abdominal pain; headache; hypercalcaemia; hypercalciuria; nausea; skin reactions
369
Spironolactone
Potassium-sparing diuretic - aldosterone receptor antagonist.
Oedema; ascites; nephrotic syndrome; heart failure.
C/I: Addison’s disease; anuria; hyperkalaemia
S/E: Acidosis hyperchloraemic; acute kidney injury; agranulocytosis; alopecia; breast neoplasm benign; breast pain; confusion; dizziness; electrolyte imbalance; gastrointestinal disorder; gynaecomastia etc
370
Potassium-sparing diuretics
Amiloride; Spironolactone; Triamterene; Eplerenone
C/I: Addison’s disease; anuria; hyperkalaemia
S/E: Alopecia; angina pectoris; aplastic anaemia; appetite decreased; arrhythmia; arthralgia; asthenia etc
371
Amiloride
Potassium-sparing diuretic
Oedema; Potassium conservation as an adjunct to thiazide or loop diuretics.
C/I: Addison’s disease; anuria; hyperkalaemia
S/E: Alopecia; angina pectoris; aplastic anaemia; appetite decreased; arrhythmia; arthralgia; asthenia etc
372
Streptokinase
Fibrinolytic
Acute myocardial infarction; Deep-vein thrombosis; Pulmonary embolism; Occlusive peripheral arterial disease
S/E: Arrhythmias; asthenia; diarrhoea; epigastric pain; headache; malaise; pain
373
Fibrinolytic
Streptokinase, alteplase, tenecteplase, urokinase
Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.
C/I: Acute pancreatitis; aneurysm; aortic dissection; bacterial endocarditis; bleeding diatheses; coagulation defects; coma; heavy vaginal bleeding; history of cerebrovascular disease; oesophageal varices; pericarditis; recent gastro-intestinal ulceration; recent haemorrhage; recent surgery; recent trauma; severe hypertension
S/E: Anaphylactic reaction; angina pectoris; cardiac arrest; cardiogenic shock; chills; CNS haemorrhage; ecchymosis; fever; haemorrhage; haemorrhagic stroke; heart failure; hypotension; ischaemia recurrent (when used in myocardial infarction); nausea; pericarditis; pulmonary oedema; vomiting
374
Alteplase
Fibrinolytic.
Acute myocardial infarction; Pulmonary embolism; Acute ischaemic stroke;
C/I: Acute pancreatitis; aneurysm; aortic dissection; bacterial endocarditis; bleeding diatheses; coagulation defects etc
S/E: naphylactic reaction; angina pectoris; cardiac arrest; cardiogenic shock; chills; CNS haemorrhage
375
Miconazole
Antifungal.
Fungal skin infections; Fungal nail infections; Vaginal and vulval candidiasis; Oral candidiasis
S/E: Skin reactions, Angioedema
376
Antifungals
```
Miconazole
Clotrimazole
Voriconazole
Ketoconazole
Amphotericin
Nystatin
Itraconazole
Griseofulvin
Terbinafine
```
377
Terbinafine
Antifungal
Tinea pedis; Tinea corporis; Tinea cruris; Cutaneous candidiasis; Pityriasis versicolor
S/E: Skin reactions
378
Silver sulfadiazine
Topical antibiotic
Prophylaxis and treatment of infection in burn wounds and other wounds.
S/E: Leucopenia; skin reactions
379
Betamethasone
Corticosteroid
Local treatment of inflammation (short-term); Severe inflammatory skin disorders such as eczemas unresponsive to less potent corticosteroids; Psoriasis; Suppression of inflammatory and allergic disorders; Oral ulceration
S/E: Anxiety; behaviour abnormal; cataract subcapsular; cognitive impairment; Cushing's syndrome; electrolyte imbalance etc
380
Coal tar
Psoriasis,
Chronic atopic eczema
C/I: Avoid broken or inflamed skin; avoid eye area; avoid genital area; avoid mucosal areas; avoid rectal area; infection; sore, acute, or pustular psoriasis
S/E: Photosensitivity reaction; skin reactions
381
Salicylic acid
Exfoliant - a derivative of aspirin
Common and plantar warts; acne,
S/E: Skin irritation
382
Benzyl benzoate
Insecticide
Scabies (not given routinely).
Cautions: avoid contact with eyes and mucous membranes; children (not recommended); do not use on broken or secondarily infected skin
S/E: eye irritation; mucosal irritation; skin irritation
383
Permethrin
Insecticide.
Scabies (1st line); Crab lice; Head lice
Cautions: avoid contact with eyes; children aged 2 months–2 years, medical supervision required for dermal cream; children under 6 months, medical supervision required for cream rinse; do not use on broken or secondarily infected skin
Side-effects: scalp irritation; skin reactions
384
Fluorescein
Ophthalmic medicine
Detection of lesions and foreign bodies
385
Tropicamide
Ophthalmic medicine (antimuscarinic)
Funduscopy
S/E: Dizziness; photophobia; skin reactions; tachycardia
386
Barium sulfate
Radiological contrast
387
Iohexol
Radiological contrast
388
Amidotrizoate
Radiological contrast
389
Chlorhexidine
Antiseptic
Cleansing and disinfecting wounds and burns; pre-operative skin disinfection; surgical scrub. Oral hygiene and plaque inhibition; Oral candidiasis; Gingivitis;
390
Ethanol
Antiseptic
391
Povidone iodine
Antiseptic
392
Mannitol
Osmotic diuretic
Cerebral oedema; raised intra-ocular pressure; treatment of cystic fibrosis
C/I: anuria; intracranial bleeding; severe cardiac failure; severe dehydration; severe pulmonary oedema
S/E: Cough; headache; vomiting
393
Mesalazine
Aminosalicylate - 5-aminosalicylic acid (5-ASA)
Treatment of acute attack of mild to moderate ulcerative colitis and maintenance of remission.
C/I: blood clotting abnormalities
S/E: Arthralgia; cough; diarrhoea; dizziness; fever; gastrointestinal discomfort; headache; leucopenia; nausea; skin reactions; vomiting
394
Aminosalicylates
5-aminosalicylic acid (5-ASA)
```
Sulfasalazine
Mesalazine
Pentasa
Mezavant
Olsalazine
```
First line in treatment of irritable bowel disease (IBD).
395
Sulfasalazine
5-aminosalicylic acid (5-ASA) / DMARD
Severe ulcerative colitis; Active Crohn's disease; Active rheumatoid arthritis
Cautions: Acute porphyrias ; G6PD deficiency; history of allergy; history of asthma; maintain adequate fluid intake; risk of haematological toxicity; risk of hepatic toxicity; slow acetylator status
S/E: Arthralgia; cough; diarrhoea; dizziness; fever; gastrointestinal discomfort; headache; leucopenia; nausea; skin reactions; vomiting; Insomnia; stomatitis; taste altered; tinnitus; urine abnormalities
Insomnia; stomatitis; taste altered; tinnitus; urine abnormalities
Stevens-Johnson Syndrome
396
Pramipexole
Dopamine agonist
Parkinson's disease; restless leg syndrome
S/E: Appetite abnormal; behaviour abnormal; confusion; constipation; dizziness; drowsiness; fatigue; hallucination; headache; hypotension; movement disorders; nausea; peripheral oedema; psychiatric disorders; sleep disorders; vision disorders; vomiting; weight changes
397
Ropinirole
Dopamine agonist
Parkinson's disease; restless leg syndrome
Cautions: Elderly; major psychotic disorders; severe cardiovascular disease
Dose adjustment might be necessary if smoking started or stopped during treatment
S/E: Confusion; dizziness; drowsiness; fatigue; gastrointestinal discomfort; hallucination; movement disorders; nausea; nervousness; peripheral oedema; sleep disorders; syncope; vertigo; vomiting
398
Dopamine agonists
Pramipexole; Ropinirole
399
COMT inhibitors
COMT (Catechol-O-Methyl Transferase) inhibitors
e.g. entacapone, tolcapone
COMT is an enzyme involved in the breakdown of dopamine, and hence may be used as an adjunct to levodopa therapy in parkinson's disease.
400
Entacapone
COMT (Catechol-O-Methyl Transferase) inhibitor.
Entacapone prevents the peripheral breakdown of levodopa, by inhibiting catechol-O-methyltransferase, allowing more levodopa to reach the brain.
Adjunct to co-beneldopa or co-careldopa in Parkinson's disease with ‘end-of-dose’ motor fluctuations if another inhibitor of peripheral catechol-O-methyltransferase inappropriate (under expert supervision)
S/E: Abdominal pain; confusion; constipation; diarrhoea; dizziness; dry mouth; fall; fatigue; hallucination; hyperhidrosis; ischaemic heart disease; movement disorders; nausea; sleep disorders; urine discolouration; vomiting
401
Tolcapone
COMT (Catechol-O-Methyl Transferase) inhibitor.
Adjunct to co-beneldopa or co-careldopa in Parkinson's disease with ‘end-of-dose’ motor fluctuations if another inhibitor of peripheral catechol-O-methyltransferase inappropriate (under expert supervision)
Tolcapone prevents the peripheral breakdown of levodopa, by inhibiting catechol-O-methyltransferase, allowing more levodopa to reach the brain.
S/E: Appetite decreased; chest pain; confusion; constipation; diarrhoea; dizziness; drowsiness; dry mouth; gastrointestinal discomfort; hallucination; headache; hyperhidrosis; influenza like illness; movement disorders; nausea; postural hypotension; sleep disorders; syncope; upper respiratory tract infection; urine discolouration; vomiting
402
Amantadine
A weak dopamine agonist with modest antiparkinsonian effects.
Parkinson's disease; Post-herpetic neuralgia (pain after shingles); Fatigue in multiple sclerosis
S/E: Anxiety; appetite decreased; concentration impaired; confusion; constipation; depression; dizziness; dry mouth; hallucination; headache; hyperhidrosis; lethargy; mood altered; movement disorders; myalgia; nausea; palpitations; peripheral oedema; postural hypotension; skin reactions; sleep disorders; speech slurred; vision disorders; vomiting
403
Zinc sulfate
Zinc deficiency or supplementation in zinc-losing conditions; diarrhoea
404
Fludrocortisone
Corticosteroid
Neuropathic postural hypotension; Mineralocorticoid replacement in adrenocortical insufficiency
S/E: Anxiety; behaviour abnormal; cataract subcapsular; cognitive impairment; Cushing's syndrome; electrolyte imbalance; fatigue; fluid retention; gastrointestinal discomfort; headache; healing impaired; hirsutism
405
Testosterone
Androgen.
Low sexual desire in postmenopausal women; Hypogonadism due to testosterone deficiency in men
C/I: Breast cancer in males; history of liver tumours; hypercalcaemia; prostate cancer
S/E: Hot flush; hypertension; polycythaemia; prostate abnormalities; skin reactions; weight increased
406
Ethinylestradiol + levonorgestrel
Menopausal symptoms in women with a uterus
407
Levonorgestrel
Progesterone coil. brandname: Mirena
Implant. brandname: Norplant / Jadelle
Emergency contraception; Contraception; Menorrhagia
C/I: active trophoblastic disease; acute cervicitis; acute malignancies affecting the blood; acute vaginitis; distorted uterine cavity; history of breast cancer; increased risk factors for pelvic infections; infected abortion during the previous three months; not suitable for emergency contraception; pelvic inflammatory disease; postpartum endometritis; unexplained uterine bleeding; unresolved cervical intraepithelial neoplasia; uterine or cervical malignancy
S/E: Gastrointestinal discomfort; headaches; menstrual cycle irregularities; nausea; skin reactions
408
Ulipristal
Progesterone receptor modulator. Brand name: EllaOne
uterine fibroids; Emergency contraception
S/E: Back pain; breast tenderness; dizziness; fatigue; gastrointestinal discomfort; headaches; menstrual cycle irregularities; mood altered; myalgia; nausea; pelvic pain; vomiting
409
Infliximab
Biologic TNF-alpha inhibitor (monoclonal antibody).
Severe active Crohn's disease; Fistulating Crohn's disease; Severe active ulcerative colitis; Rheumatoid arthritis; Ankylosing spondylitis; Psoriatic arthritis; Plaque psoriasis.
C/I: Moderate or severe heart failure; severe infections
Cautions: Demyelinating disorders; dermatomyositis; development of malignancy; hepatitis B virus; history of colon carcinoma; history of dysplasia; history of malignancy; history of prolonged immunosuppressant or PUVA treatment in patients with psoriasis; mild heart failure; predisposition to infection; risk of delayed hypersensitivity reactions if drug-free interval exceeds 16 weeks; exacerbate plaque psoriasis
S/E: Abscess; alopecia; anaemia; arrhythmias; arthralgia; chest pain; chills; constipation; decreased leucocytes; depression; diarrhoea; dizziness; dyspnoea; eye inflammation; fatigue; fever; gastrointestinal discomfort; gastrointestinal disorders; haemorrhage; headache; hepatic disorders; hyperhidrosis; hypertension; hypotension; increased risk of infection; infusion related reaction; insomnia; lymphadenopathy; myalgia; nausea; neutropenia; oedema; pain; palpitations; respiratory disorders; sensation abnormal; sepsis; skin reactions; vasodilation; vertigo
410
Medroxyprogesterone acetate
Progesterone hormonal therapy drug.
Brand name: Depo-Provera (injection).
Dysfunctional uterine bleeding; Secondary amenorrhoea; Mild to moderate endometriosis; Endometrial cancer; breast cancer; contraception; hot flushes.
S/E: Alopecia; breast abnormalities; depression; dizziness; fluid retention; insomnia; menstrual cycle irregularities; nausea; sexual dysfunction; skin reactions; weight changes
411
Etonogestrel
Progesterone subdermal implantation.
Brand name: implanon
Contraception
S/E: Abdominal pain; alopecia; anxiety; appetite increased; breast abnormalities; depressed mood; dizziness; emotional lability; fatigue; flatulence; headaches; hot flush; increased risk of infection; influenza like illness; libido decreased; menstrual cycle irregularities; nausea; ovarian cyst; pain; skin reactions; weight changes
412
Progesterone
Infertility due to inadequate luteal phase; Premenstrual syndrome; Post-natal depression
S/E: headache; menstrual cycle irregularities
413
Glucagon
Insulin-induced hypoglycaemia; Beta-blocker poisoning.
Cautions: glucagonoma; ineffective in chronic hypoglycaemia, starvation, and adrenal insufficiency; insulinoma; when used in the diagnosis of growth hormone secretion, delayed hypoglycaemia may result—deaths reported.
S/E: Nausea
414
Insulin
Diabetes mellitus; Diabetic ketoacidosis.
S/E: Oedema
415
Clomifene citrate
Ovulation inducer.
Anti-oestrogen which induces gonadotrophin release by occupying oestrogen receptors in the hypothalamus, thereby interfering with feedback mechanisms; chorionic gonadotrophin is sometimes used as an adjunct.
Female infertility due to ovulatory dysfunction.
C/I: Abnormal uterine bleeding of undetermined cause; hormone-dependent tumours; ovarian cysts
Cautions: Ectopic pregnancy; incidence of multiple births increased; ovarian hyperstimulation syndrome; polycystic ovary syndrome; uterine fibroids
S/E: Abdominal distension; alopecia; angioedema; anxiety; breast tenderness; cataract; cerebral thrombosis; depression; disorientation; dizziness; fatigue; headache; hot flush etc.
416
Propylthiouracil
Antithyroid agent
Hyperthyroidism
417
Atracurium
Muscle relaxant
Neuromuscular blockade for surgery, intubation and intensive care.
418
Neostigmine
Anticholinesterase. Used to reverse non-depolarizing muscle relaxants. Prolongs the action of acetylcholine by inhibiting the action of the enzyme acetylcholinesterase.
Treatment of myasthenia gravis; Reversal of non-depolarising (competitive) neuromuscular blockade;
Cautions: Arrhythmias; asthma; atropine or other antidote to muscarinic effects may be necessary but not given routinely because it may mask signs of overdosage; bradycardia; epilepsy; hyperthyroidism; hypotension; parkinsonism; peptic ulceration; recent myocardial infarction; vagotonia
C/I: Intestinal obstruction; urinary obstruction.
S/E: Abdominal cramps; diarrhoea; excessive tearing; hypersalivation; nausea; vomiting
419
Suxamethonium
Depolarising neuromuscular blockade (the most rapid onset of action of any of the neuromuscular blocking drugs). Acts by mimicking acetylcholine at the neuromuscular junction but hydrolysis is much slower than for acetylcholine; depolarisation is therefore prolonged, resulting in neuromuscular blockade.
Cautions: Cardiac disease; neuromuscular disease; raised intra-ocular pressure; respiratory disease; severe sepsis.
S/E: Arrhythmias; bradycardia; flushing; muscle contractions involuntary; myoglobinaemia; myoglobinuria; post procedural muscle pain; rash
420
Vecuronium
Non-depolarising neuromuscular blockade
Neuromuscular blockade (intermediate duration) during surgery and intubation.
Cautions: Burns; cardiovascular disease; electrolyte disturbances; fluid disturbances; hypothermia; myasthenia gravis; neuromuscular disorders
S/E: Flushing; hypotension
421
Non-depolarising neuromuscular blockades
Competitive muscle relaxants
Vecuronium, rocuronium, pancuronium
Cautions: Burns; cardiovascular disease; electrolyte disturbances; fluid disturbances; hypothermia; myasthenia gravis; neuromuscular disorders
S/E: Flushing; hypotension
Their action can be reversed with anticholinesterases such as neostigmine.
422
Depolarising neuromuscular blockades
Suxamethonium.
Ideal if fast onset and brief duration of action are required. Unlike the non-depolarising neuromuscular blocking drugs, its action cannot be reversed.
Should be given after anaesthetic induction because paralysis is usually preceded by painful muscle fasciculations.
Faster onset.
423
Anticholinesterases
Pyridostigmine; Neostigmine.
They prolong the action of acetylcholine by inhibiting the action of the enzyme acetylcholinesterase.
424
Eltrombopag
Thrombopoietin receptor agonist that binds to and activates the thrombopoietin (TPO) receptor, thereby increasing platelet production.
Chronic immune (idiopathic) thrombocytopenic purpura in patients refractory to other treatments (such as corticosteroids or immunoglobulins); Treatment of thrombocytopenia associated with chronic hepatitis C infection; Acquired severe aplastic anaemia.
Cautions: Patients of East Asian origin; risk factors for thromboembolism
S/E: Abnormal loss of weight; alopecia; anaemia; anxiety; appetite abnormal; arthralgia; asthenia; cataract; chest discomfort; chills; concentration impaired; confusion; constipation; cough; depression; diarrhoea; dizziness etc etc
Monitoring: Manufacturer advises monitor liver function before treatment, every two weeks when adjusting the dose, and monthly thereafter.
425
Salmeterol
Long acting β2-adrenergic agonist aka LABA.
Reversible airways obstruction, nocturnal asthma and prevention of exercise-induced bronchospasm in patients requiring long-term regular bronchodilator therapy; Chronic asthma only in patients who regularly use an inhaled corticosteroid (not for immediate relief of acute asthma); COPD.
Cautions: Arrhythmias; cardiovascular disease; diabetes; hypertension; hyperthyroidism; hypokalaemia; susceptibility to QT-interval prolongation. High doses of beta2 agonists can be dangerous in some children.
S/E: Arrhythmias; dizziness; headache; hypokalaemia (with high doses); nausea; palpitations; tremor.
Muscle cramps.
Advise patients that salmeterol should not be used for relief of acute attacks, not to exceed prescribed dose.
426
Long acting β2-adrenergic agonists aka LABAs.
salmeterol, formoterol, eformoterol.
Bronchodilators. Used in asthma and COPD when SABA and ICS have failed.
S/E: Arrhythmias; dizziness; headache; hypokalaemia (with high doses); nausea; palpitations; tremor
427
Theophylline
Bronchodilator - Xanthine (methylxanthine). Brand names: Slo-Phyllin, Nuelin SA, Uniphyllin Continus.
Chronic asthma; Reversible airways obstruction; Severe acute asthma. (add on treatment towards end of treatment algorithm).
Cautions: Cardiac arrhythmias or other cardiac disease; elderly; epilepsy; fever; hypertension; peptic ulcer; risk of hypokalaemia; thyroid disorder.
Smoking can increase theophylline clearance and increased doses of theophylline are therefore required; dose adjustments are likely to be necessary if smoking started or stopped during treatment.
S/E: Anxiety; arrhythmias; diarrhoea; dizziness; gastrointestinal discomfort; gastrooesophageal reflux disease; headache; hyperuricaemia; nausea; palpitations; seizure; skin reactions; sleep disorders; tremor; urinary disorders; vomiting.
Theophylline is usually taken in tablet or capsule form, but a different version called aminophylline can be given directly into a vein (intravenously) if your symptoms are severe.
428
Anticholinergics (bronchodilators)
Ipratropium, tiotropium, aclidinium and glycopyrronium.
COPD and acute asthma.
Cautions: Bladder outflow obstruction; paradoxical bronchospasm; prostatic hyperplasia; susceptibility to angle-closure glaucoma
S/E: Arrhythmias; cough; dizziness; dry mouth; headache; nausea;
429
Inhaled Corticosteroids (ICS)
Fluticasone, Budesonide, Beclometasone
S/E: Headache; oral candidiasis; pneumonia (in patients with COPD); taste altered; voice alteration
430
Budesonide
Corticosteroid. Glucocorticoid, which exerts significant local anti-inflammatory effects.
Prophylaxis of mild to moderate asthma; Allergic rhinitis; Nasal polyps; Mild to moderate Crohn's disease.
Cautions (intranasal): 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 (inhaled): Headache; oral candidiasis; pneumonia (in patients with COPD); taste altered; voice alteration
431
Sodium Bicarbonate
Alkalinisation of urine; relief of discomfort in mild urinary-tract infections; severe metabolic acidosis; prophylaxis of cardiovascular complications as a result of tricyclic antidepressants overdose; removal of earwax.
C/I: salt restricted diet
Cautions: avoid prolonged use in urinary conditions; cardiac disease; elderly; patients on sodium-restricted diet; respiratory acidosis
S/E: skin exfoliation; soft tissue necrosis; ulcer
432
Tricyclic Antidepressants (TCAs)
The oldest type of antidepressant - prolong the action of noradrenaline and serotonin in the brain.
amitriptyline (Tryptizol), clomipramine (Anafranil), imipramine (Tofranil), lofepramine (Gamanil) and nortriptyline (Allegron).
S/E: Antimuscarinic
drowsiness, dry mouth; blurred vision; constipation; urinary retention; lengthening of QT interval
Treatment should be stopped if the patient enters a manic phase.
Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.
Overdose: dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur.
Bicarbonates are used to prevent cardiovascular complications as a result of tricyclic antidepressant overdose.
If possible tricyclic and related antidepressants should be withdrawn slowly to reduce risk of withdrawal symptoms.
433
Flumazenil
Reversal of sedative effects of benzodiazepines.
C/I: Life-threatening condition (e.g. raised intracranial pressure, status epilepticus) controlled by benzodiazepines
Cautions: Avoid rapid injection following major surgery; avoid rapid injection in high-risk or anxious patients; dependence (may precipitate withdrawal symptoms); elderly; ensure neuromuscular blockade cleared before giving; head injury (rapid reversal of sedation may cause convulsions); history of panic disorders (risk of recurrence); prolonged therapy for epilepsy (risk of convulsions); short-acting (repeat doses may be necessary— effects may persist for at least 24 hours)
S/E: Anxiety; diplopia; dry mouth; eye disorders; flushing; headache; hiccups; hyperhidrosis; hyperventilation; hypotension; insomnia; nausea; palpitations; paraesthesia; speech disorder; tremor; vertigo; vomiting
434
Amitriptyline
Tricyclic antidepressant. Brand name: Tryptizol.
Abdominal pain or discomfort (in patients who have not responded to laxatives, loperamide, or antispasmodics); Major depressive disorder [not recommended—increased risk of fatality in overdose]; Neuropathic pain; Migraine prophylaxis; Chronic tension-type headache prophylaxis; Emotional lability in multiple sclerosis.
C/I: Arrhythmias; during manic phase of bipolar disorder; heart block; immediate recovery period after myocardial infarction
Cautions: Cardiovascular disease; chronic constipation; diabetes; epilepsy; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); increased intra-ocular pressure; patients with a significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy; susceptibility to angle-closure glaucoma; urinary retention
S/E: Anticholinergic syndrome; drowsiness; QT interval prolongation etc etc.
The risk of side-effects is reduced by titrating slowly to the minimum effective dose (every 2–3 days).
OVERDOSAGE: is associated with a relatively high rate (highest of the TCA) of fatality. Symptoms of overdosage may include dry mouth, coma of varying degree, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur.
- treat with Intravenous sodium bicarbonate.
Bicarbonates are used to prevent cardiovascular complications as a result of tricyclic antidepressant overdose.
435
Clomipramine
Tricyclic Antidepressant. Brand name: Anafranil.
Depressive illness; Phobic and obsessional states; Adjunctive treatment of cataplexy associated with narcolepsy.
C/I: Acute porphyrias ; arrhythmias; during the manic phase of bipolar disorder; heart block; immediate recovery period after myocardial infarction
Cautions: Cardiovascular disease; chronic constipation; diabetes; epilepsy; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); increased intra-ocular pressure; patients with a significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy; susceptibility to angle-closure glaucoma; urinary retention
S/E: Aggression; anxiety; arrhythmias; breast enlargement; concentration impaired; confusion; constipation; delirium; depersonalisation; depression exacerbated; diarrhoea; dizziness; drowsiness; dry mouth; fatigue etc etc Antimuscarinic e.g. dry mouth, urinary frequency
The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. The risk of side-effects is reduced by titrating slowly to the minimum effective dose (every 2–3 days). Consider using a lower starting dose in elderly patients..
436
lofepramine
Tricyclic Antidepressant used to treat depressive disorder.
S/E: Antimuscarinic e.g. drowsiness
dry mouth, blurred vision, constipation, urinary retention, lengthening of QT interval.
lower incidence of toxicity in overdose - Less sedative
437
Imipramine
Tricyclic Antidepressant.
Depressive illness; Nocturnal enuresis.
C/I: Immediate recovery period after myocardial infarction; Acute porphyrias; arrhythmia; during the manic phase of bipolar disorder; heart block
S/E: Anxiety; appetite decreased; arrhythmias; asthenia; cardiac conduction disorders; confusion; delirium; depression; dizziness; drowsiness; epilepsy; hallucination; headache; hepatic disorders; hypotension; mood etc. (antimuscarinic side-effects).
438
Nortriptyline
Tricyclic Antidepressant. Brand name: Allegron.
Depressive illness; Neuropathic pain
C/I: Arrhythmias; during the manic phase of bipolar disorder; heart block; immediate recovery period after myocardial infarction
Cautions: Cardiovascular disease; chronic constipation; diabetes; epilepsy; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); increased intra-ocular pressure; patients with a significant risk of suicide; phaeochromocytoma (risk of arrhythmias); prostatic hypertrophy; susceptibility to angle-closure glaucoma; urinary retention.
S/E: Antimuscarinic
drowsiness, dry mouth; blurred vision; constipation; urinary retention; lengthening of QT interval
439
tranylcypromine
Monoamine oxidase inhibitor (MAOIs)
Depressive illness
C/I: Cerebrovascular disease; not indicated in manic phase; phaeochromocytoma; severe cardiovascular disease; History of hepatic disease; hyperthyroidism
CHEESE REACTION: Consumption of foods high in tyramine (such as cheese) can result in a hypertensive crisis.
S/E: Akathisia; anxiety; appetite increased; arrhythmia; asthenia; behaviour abnormal; blood disorder; confusion; etc
440
phenelzine
Monoamine oxidase inhibitor (MAOIs)
C/I: Cerebrovascular disease; not indicated in manic phase; phaeochromocytoma; severe cardiovascular disease
Avoid tyramine-rich (cheese reaction!) or dopa-rich food or drinks.
S/E: Akathisia; anxiety; appetite increased; arrhythmia; asthenia; behaviour abnormal; blood disorder; confusion; etc
441
Isocarboxazid
Monoamine oxidase inhibitor (MAOIs)
C/I: Cerebrovascular disease; not indicated in manic phase; phaeochromocytoma; severe cardiovascular disease
CHEESE REACTION: Consumption of foods high in tyramine (such as cheese) can result in a hypertensive crisis.
S/E: Akathisia; anxiety; appetite increased; arrhythmia; asthenia; behaviour abnormal; blood disorder; confusion; etc
442
Monoamine oxidase inhibitors (MAOIs)
Inhibit monoamine oxidase, thereby causing an accumulation of amine neurotransmitters. MAOIs are an older type of antidepressant that are rarely used nowadays.
tranylcypromine, phenelzine and isocarboxazid.
C/I: Cerebrovascular disease; not indicated in manic phase; phaeochromocytoma; severe cardiovascular disease
Cautions: Acute porphyrias; avoid in agitated patients; blood disorders; cardiovascular disease; concurrent electroconvulsive therapy; diabetes mellitus; elderly (great caution); epilepsy; severe hypertensive reactions to certain drugs and foods; surgery
Interactions: Potentially life-threatening hypertensive crisis can develop in those taking MAOIs who eat tyramine-rich food (such as mature cheese, salami, pickled herring, Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines) or foods containing dopa (such as broad bean pods). Avoid tyramine-rich or dopa-rich food or drinks with, or for 2 to 3 weeks after stopping, the MAOI. - CHEESE REACTION
S/E: Akathisia; anxiety; appetite increased; arrhythmia; asthenia; behaviour abnormal; blood disorder; confusion; constipation; dizziness; drowsiness; dry mouth; dysuria; hallucination; headache; hyperhidrosis; insomnia; jaundice; nausea; paraesthesia; peripheral neuritis; postural hypotension (more common in elderly); reflexes increased; skin reactions; suicidal tendencies; tremor; vision blurred; vomiting; weight increased.
CHEESE REACTION: Consumption of foods high in tyramine (such as cheese) can result in a hypertensive crisis.
Risk of postural hypotension and hypertensive responses. Discontinue if palpitations or frequent headaches occur.
Pregnancy: Increased risk of neonatal malformations
MONITORING: Monitor blood pressure
WITHDRAWAL: MAOIs are associated with withdrawal symptoms on cessation of therapy. Symptoms include agitation, irritability, ataxia, movement disorders, insomnia, drowsiness, vivid dreams, cognitive impairment, and slowed speech. Withdrawal symptoms occasionally experienced when discontinuing MAOIs include hallucinations and paranoid delusions. If possible MAOIs should be withdrawn slowly.
443
Tetracyclic antidepressant / Noradrenaline and specific serotonergic antidepressants (NASSAs)
mirtazapine (Zispin).
The side effects of NASSAs are similar to those of SSRIs, but they're thought to cause fewer sexual problems. However, they may also cause more drowsiness at first.
444
Mirtazapine
Alpha-2 receptor antagonist. - Tetracyclic antidepressant.
Brandname: Zispin
Major depression.
Cautions: Cardiac disorders; diabetes mellitus; elderly; history of bipolar depression; history of seizures; history of urinary retention; hypotension; psychoses (may aggravate psychotic symptoms); susceptibility to angle-closure glaucoma
S/E: Anxiety; appetite increased; arthralgia; back pain; confusion; constipation; diarrhoea; dizziness; drowsiness; dry mouth; fatigue; headache (on discontinuation); myalgia; nausea; oedema; postural hypotension; sleep disorders; tremor; vomiting; weight increased
The side effects of NASSAs are similar to those of SSRIs, but they're thought to cause fewer sexual problems. However, they may also cause more drowsiness at first.
Often not tolerated by patients as it commonly causes increased appetite and sedation.
Withdrawal: Nausea, vomiting, dizziness, agitation, anxiety, and headache are most common features of withdrawal if treatment stopped abruptly or if dose reduced markedly; dose should be reduced over several weeks.
445
Serotonin-noradrenaline reuptake inhibitors (SNRIs)
SNRIs are similar to SSRIs. They were designed to be a more effective antidepressant than SSRIs. However, the evidence that SNRIs are more effective in treating depression is uncertain. It seems that some people respond better to SSRIs, while others respond better to SNRIs.
Examples of SNRIs include duloxetine (Cymbalta and Yentreve) and venlafaxine (Efexor).
446
Co-trimoxazole
Sulfamethoxazole and trimethoprim - used in combination because of their synergistic activity.
Brand name: Bactrim.
Diabetic foot infection; Hospital-acquired pneumonia; COPD; treatment and prophylaxis of Pneumocystis jirovecii (first line); Acute prostatitis; Toxoplasmosis
Cautions: Asthma; avoid in blood disorders; avoid in infants under 6 weeks because of the risk of kernicterus; elderly; G6PD deficiency; maintain adequate fluid intake; predisposition to folate deficiency; predisposition to hyperkalaemia.
S/E: Diarrhoea; electrolyte imbalance; fungal overgrowth; headache; nausea; skin reactions
Associated with rare but serious side effects. Discontinue immediately if blood disorders (including leucopenia, thrombocytopenia, megaloblastic anaemia, eosinophilia) or rash (including Stevens-Johnson syndrome or toxic epidermal necrolysis) develop.
Teratogenic risk in first trimester (trimethoprim a folate antagonist).
447
Sulfamethoxazole
Importance of the sulfonamides has decreased as a result of increasing bacterial resistance and their replacement by antibacterials which are generally more active and less toxic.
Most commonly used alongside Trimethoprim in co-trimoxazole.
448
Zoledronate
denosumab
449
Denosumab
A human monoclonal antibody that inhibits osteoclast formation, function, and survival, thereby decreasing bone resorption.
Osteoporosis in postmenopausal women and in men at increased risk of fractures; Bone loss associated with hormone ablation in men with prostate cancer at increased risk of fractures; Bone loss associated with long-term systemic glucocorticoid therapy in patients at increased risk of fracture; Prevention of skeletal related events in patients with bone metastases; Giant cell tumour of bone that is unresectable
C/I: Hypocalcaemia; Unhealed lesions from dental or oral surgery
Cautions: Atypical femoral fractures; hypocalcaemia; osteonecrosis of the jaw—consider temporary interruption of treatment if occurs
S/E: Abdominal discomfort; cataract; constipation; hypocalcaemia (including fatal cases); increased risk of infection; pain; sciatica; second primary malignancy; skin reactions; Cellulitis (seek prompt medical attention); hypercalcaemia (on discontinuation)
Correct hypocalcaemia and vitamin D deficiency before starting. Monitor plasma-calcium concentration during therapy.
450
Raloxifene
Selective oestrogen receptor modulator (SERM)
Treatment and prevention of postmenopausal osteoporosis (third line if cannot tolerate bisphosphonates)
Breast cancer [chemoprevention in postmenopausal women at moderate to high risk]
C/I Cholestasis; endometrial cancer; history of venous thromboembolism; undiagnosed uterine bleeding
S/E: Influenza; leg cramps; peripheral oedema; vasodilation
451
Strontium ranelate
Stimulates bone formation and reduces bone resorption.
Severe osteoporosis in men and postmenopausal women at increased risk of fractures [when other treatments are contra-indicated or not tolerated]
C/I: Cerebrovascular disease; current or previous venous thromboembolic event; ischaemic heart disease; peripheral arterial disease; temporary or permanent immobilisation; uncontrolled hypertension
S/E: Angioedema; arthralgia; bronchial hyperreactivity; consciousness impaired; constipation; diarrhoea; dizziness; embolism and thrombosis; gastrointestinal discomfort; gastrointestinal disorders; headache; hepatitis
452
Teriparatide
Recombinant form of parathyroid hormone
Very effective at increasing bone mineral density but role in the management of osteoporosis yet to be clearly defined
453
Acetazolamide
Carbonic anhydrase inhibitor.
Reduction of intra-ocular pressure in glaucoma; glaucoma; epilepsy.
C/I: Adrenocortical insufficiency; hyperchloraemic acidosis; hypokalaemia; hyponatraemia; long-term administration in chronic angle-closure glaucoma
Cautions: Avoid extravasation at injection site (risk of necrosis); diabetes mellitus; elderly; impaired alveolar ventilation (risk of acidosis); long-term use; pulmonary obstruction (risk of acidosis); renal calculi
S/E: Haemorrhage; metabolic acidosis; nephrolithiasis; sensation abnormal
454
Mefenamic acid
NSAID
Pain and inflammation in rheumatoid arthritis and osteoarthritis; Postoperative pain; Mild to moderate pain; Acute pain including dysmenorrhoea, Menorrhagia
C/I: Active GI bleeding; active GI ulceration; following coronary artery bypass graft (CABG) surgery; inflammatory bowel disease; severe heart failure
Cautions: Acute porphyrias ; allergic disorders; cardiac impairment (NSAIDs may impair renal function); cerebrovascular disease; coagulation defects; connective-tissue disorders; dehydration (risk of renal impairment); elderly; epilepsy; heart failure; history of gastro-intestinal disorders; ischaemic heart disease; peripheral arterial disease; risk factors for cardiovascular events; uncontrolled hypertension
S/E: Agranulocytosis; anaemia; angioedema; appetite decreased; asthma; bone marrow disorders; confusion;
455
Latanoprost
Prostaglandin analogue.
Raised intra-ocular pressure in open-angle glaucoma; Ocular hypertension.
Increase uveoscleral outflow.
C/I Active herpes simplex keratitis; history of recurrent herpetic keratitis associated with prostaglandin analogues
Cautions: Angle-closure glaucoma; aphakia; asthma; contact lens wearers; risk factors for iritis; risk factors for uveitis
S/E: Eye discolouration; eye discomfort; eye disorders; eye inflammation; vision disorders
456
Pilocarpine
Parasympathomimetic (miotic). Muscarinic receptor agonist.
Primary angle-closure glaucoma (act by opening the aqueous drainage channels in the trabecular meshwork);
Some secondary glaucomas; Xerostomia following irradiation for head and neck cancer; Dry mouth and dry eyes in Sjögren’s syndrome.
C/I acute iritis; anterior uveitis; conditions where pupillary constriction is undesirable; some forms of secondary glaucoma.
Cautions: a darkly pigmented iris may require a higher concentration of the miotic or more frequent administration and care should be taken to avoid overdosage; asthma; cardiac disease; care in conjunctival damage, corneal damage; epilepsy; gastro-intestinal spasm; hypertension; hyperthyroidism; hypotension; marked vasomotor instability; Parkinson’s disease; retinal detachment has occurred in susceptible individuals and those with retinal disease; urinary-tract obstruction
S/E: Diarrhoea; headache; hyperhidrosis; hypersalivation; nausea; skin reactions; vision disorders; vomiting
457
Acetylcholine chloride
Parasympathomimetic (miotic)
Cataract surgery; Penetrating keratoplasty; Iridectomy; Anterior segment surgery requiring rapid complete miosis.
(act by opening the aqueous drainage channels in the trabecular meshwork)
Cautions: Asthma; gastro-intestinal spasm; heart failure; hyperthyroidism; parkinsonism; peptic ulcer; urinary-tract obstruction
S/E: Bradycardia; corneal decompensation; corneal oedema; dyspnoea; flushing; hyperhidrosis; hypotension
458
Timolol maleate
Beta blocker
Chronic open-angle glaucoma (by reducing aqueous production); Ocular hypertension
Hypertension; Angina; Prophylaxis after myocardial infarction; Migraine prophylaxis;
459
Bevacizumab
Monoclonal antibody - Anti-vascular endothelial growth factor (VEGF)
Metastatic breast, colorectal, kidney, lung, ovarian cancer etc
Cautions: Elective surgery; history of arterial thromboembolism; history of cardiovascular disease; history of hypertension; increased risk of fistulas; increased risk of haemorrhage; increased risk of tumour-associated haemorrhage; intra-abdominal inflammation; uncontrolled hypertension; untreated CNS metastases
S/E: Abscess; anaemia; appetite decreased; arthralgia; asthenia; congestive heart failure; constipation; cough; decreased leucocytes; dehydration; diarrhoea; drowsiness; dysarthria; dysphonia etc etc
Monitor for necrotising fasciitis, blood pressure, congestive heart failure.
Monitor for posterior reversible encephalopathy syndrome (presenting as seizures, headache, altered mental status, visual disturbance or cortical blindness, with or without hypertension).
Consider dental check-up before initiating treatment (risk of osteonecrosis of the jaw).
460
Ergometrine maleate
Ergot alkaloid.
Postpartum haemorrhage caused by uterine atony
C/I: Eclampsia; first stage of labour; induction of labour; second stage of labour; sepsis; severe cardiac disease; severe hypertension; vascular disease
S/E: Abdominal pain; arrhythmias; chest pain; coronary vasospasm; dizziness; dyspnoea; headache; hypertension; myocardial infarction; nausea; palpitations; pulmonary oedema; rash; tinnitus; vasoconstriction; vomiting
461
Misoprostol
Synthetic prostaglandin analogue that has antisecretory and protective properties, promoting healing of gastric and duodenal ulcers. It also acts as a potent uterine stimulant.
Termination of pregnancy (following mifepristone); Induction of labour (Mysodelle)
Cytotec - Benign gastric ulcer; Benign duodenal ulcer; NSAID-induced peptic ulcer
C/I (in induction of labour) Before 36 weeks' gestation; chorioamnionitis; fetal malpresentation; placenta praevia; suspicion or evidence of fetal compromise; unexplained vaginal bleeding after 24 weeks gestation; uterine abnormality; uterine scar
Cautions: cardiovascular disease; risk factors for cardiovascular disease
S/E: Nausea; rash; vomiting
462
Mifepristone
Anti-progestogenic steroid, sensitises the myometrium to prostaglandin-induced contractions and ripens the cervix.
Cervical ripening before mechanical cervical dilatation for termination of pregnancy of up to 84 days gestation; Labour induction in fetal death in utero where prostaglandin or oxytocin inappropriate; Medical termination of intra-uterine pregnancy
C/I: Acute porphyrias ; chronic adrenal failure; suspected ectopic pregnancy; uncontrolled severe asthma
Cautions: Adrenal suppression; anticoagulant therapy; asthma; existing cardiovascular disease; haemorrhagic disorders; history of endocarditis; prosthetic heart valve; risk factors for cardiovascular disease
S/E: Abdominal cramps; diarrhoea; infection; nausea; pelvic inflammatory disease; uterine disorders; vaginal haemorrhage; vomiting
463
Oxytocin
Hormone
Induction of labour for medical reasons; Stimulation of labour in hypotonic uterine inertia; Caesarean section; Treatment and prevention of postpartum haemorrhage; Incomplete, inevitable, or missed miscarriage
C/I: Any condition where spontaneous labour / vaginal delivery inadvisable; avoid intravenous injection during labour; avoid prolonged administration in oxytocin-resistant uterine inertia; avoid rapid intravenous injection; fetal distress; hypertonic uterine contractions; severe cardiovascular disease; severe pre-eclamptic toxaemia
Cautions: Avoid large infusion volumes and restrict fluid intake by mouth; enhancement of labour—presence of borderline cephalopelvic disproportion; history of lower-uterine segment caesarean section; pregnancy-induced cardiac disease/ hypertension; risk factors for disseminated intravascular coagulation; secondary uterine inertia; women over 35 years
S/E: Arrhythmias; headache; nausea; vomiting
Placental abruption and amniotic fluid embolism reported on overdose.
Careful monitoring of fetal heart rate and uterine motility essential for dose titration.
Monitor for disseminated intravascular coagulation after parturition.
464
Nifedipine
Dihydropyridine calcium channel blocker.
Raynaud's syndrome; pre-eclampsia!; Postponement of premature labour; Hiccup in palliative care; Chronic anal fissure; Hypertension; Angina prophylaxis
C/I: acute attacks of angina; cardiogenic shock; significant aortic stenosis; unstable angina; within 1 month of myocardial infarction
Cautions: elderly (risk of syncope and falls); diabetes mellitus; heart failure; ischaemic pain; poor cardiac reserve; severe hypotension.
S/E: Constipation; malaise; oedema; vasodilation
465
Chlorpromazine
First generation / typical (phenothiazine) antipsychotic
Brand name: Largactil
Schizophrenia and other psychoses; Mania; Short-term adjunctive management of severe anxiety; Psychomotor agitation, excitement, and violent or dangerously impulsive behaviour; Intractable hiccup; Nausea and vomiting in palliative care
C/I: CNS depression; comatose states; hypothyroidism; phaeochromocytoma
An ECG may be required, particularly if physical examination identifies cardiovascular risk factors
dose adjustment might be necessary if smoking started or stopped during treatment.
S/E: Anxiety; glucose tolerance impaired; mood altered; muscle tone increased
It is advisable to monitor prolactin concentration at the start of therapy, at 6 months, and then yearly.
466
First generation / typical antipsychotics
Haloperidol
Phenothiazines - chlorpromazine, prochlorperazine (antiemetic), fluphenazine, trifluoperazine (antiemetic)
Cautions: Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes; epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma
S/E: Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension; insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased
MONITORING: It is advisable to monitor prolactin concentration at the start of therapy, at 6 months, and then yearly.
As photosensitisation may occur with higher dosages, patients should avoid direct sunlight.
Drowsiness may affect performance of skilled tasks (e.g. driving or operating machinery), especially at start of treatment; effects of alcohol are enhanced.
There is a high risk of relapse if medication is stopped after 1–2 years. Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse. Patients should be monitored for 2 years after withdrawal of antipsychotic medication for signs and symptoms of relapse.
467
Fluphenazine
First generation antipsychotic.
Maintenance in schizophrenia and other psychoses.
C/I: Children; CNS depression; comatose states; marked cerebral atherosclerosis; phaeochromocytoma
Cautions: Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes; epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma; Hypothyroidism; QT-interval prolongation; when transferring from oral to depot therapy, the dose by mouth should be reduced gradually
An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient.
Dose adjustment might be necessary if smoking started or stopped during treatment
S/E: Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension (dose-related); insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased
It is advisable to monitor prolactin concentration at the start of therapy, at 6 months, and then yearly.
Patients taking antipsychotic drugs not normally associated with symptomatic hyperprolactinaemia should be considered for prolactin monitoring if they show symptoms of hyperprolactinaemia (such as breast enlargement and galactorrhoea).
Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year.
Treatment requires careful monitoring for optimum effect - narrow theraputic window.
468
Risperidone
Second generation antipsychotic. Dopamine D2, 5-HT2A, alpha1-adrenoceptor, and histamine-1 receptor antagonist.
Schizophrenia and other psychoses; Mania; Alzheimer's dementia. Short-term treatment of severe aggression in autism.
Cautions: Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes; epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma.
Avoid in Acute porphyrias; cataract surgery; dehydration; dementia with Lewy bodies; prolactin-dependent tumours
S/E: Anaemia; anxiety; appetite abnormal; asthenia; chest discomfort; conjunctivitis; cough; depression; diarrhoea; dyspnoea; epistaxis; fall; fever; gastrointestinal discomfort; headache etc etc
*Top choice for psychiatrists*
469
Second generation antipsychotics
Risperidone, Quetiapine, Clozapine
Cautions: Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes; epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma
An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient.
S/E: Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension; insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased
Monitoring: monitor prolactin - risk of hyperprolactinemia. Risk of developing diabetes and cardiovascular problems. Narrow therapeutic index.
As photosensitisation may occur with higher dosages, patients should avoid direct sunlight.
470
Clozapine
Second generation antipsychotic. Dopamine D2, 5-HT2A, alpha1-adrenoceptor, and histamine-1 receptor antagonist.
Schizophrenia in patients unresponsive to, or intolerant of, conventional antipsychotic drugs; Psychosis in Parkinson's disease.
Clozapine has been associated with varying degrees of impairment of intestinal peristalsis. Neutropenia and potentially fatal AGRANULOCYTOSIS reported. Fatal myocarditis and cardiomyopathy reported.
C/I: Alcoholic and toxic psychoses; bone-marrow disorders; coma; drug intoxication; history of agranulocytosis; history of circulatory collapse; history of neutropenia; paralytic ileus; severe cardiac disorders; severe CNS depression; uncontrolled epilepsy
Cautions: Age over 60 years; prostatic hypertrophy; susceptibility to angle-closure glaucoma; taper off other antipsychotics before starting.
Dose adjustment might be necessary if smoking started or stopped during treatment.
S/E: Appetite decreased; eosinophilia; fatigue; fever; headache; hypertension; leucocytosis; muscle complaints; nausea; oral disorders; postural hypotension (dose-related); speech impairment; sweating abnormal; syncope; temperature regulation disorders; urinary disorders; vision blurred
Monitoring: leucocyte and differential blood counts, Blood lipids and weight, Fasting blood glucose.
On planned withdrawal reduce dose over 1–2 weeks to avoid risk of rebound psychosis. If abrupt withdrawal necessary observe patient carefully.
*rarer extra pyramidal S/E*
471
Phenothiazines
Typical / first generation antipsychotics.
e.g. Chlorpromazine, Prochlorperazine (antiemetic), fluphenazine, trifluoperazine (antiemetic), Olanzapine
Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning.
472
Quetiapine
Second generation antipsychotic. Dopamine D2, 5-HT2A, alpha1-adrenoceptor, and histamine-1 receptor antagonist.
Schizophrenia; Treatment of mania in bipolar disorder; Treatment of depression in bipolar disorder; Prevention of mania and depression in bipolar disorder; Adjunctive treatment of major depression.
Cautions: Cerebrovascular disease; elderly; patients at risk of aspiration pneumonia; treatment of depression in patients under 25 years (increased risk of suicide)
S/E: Appetite increased; asthenia; dysarthria; dyspepsia; dyspnoea; fever; headache; hyperglycaemia; irritability; palpitations; peripheral oedema; rhinitis; sleep disorders; suicidal behaviour (particularly on initiation); suicidal ideation (particularly on initiation); syncope; vision blurred; withdrawal syndrome.
*no extra pyramidal S/E*
473
Fluphenazine
Typical / first generation antipsychotic (phenothiazine)
Maintenance in schizophrenia and other psychoses.
C/I: Children; CNS depression; comatose states; marked cerebral atherosclerosis; phaeochromocytoma.
Cautions: Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma.
Monitor prolactin concentration at the start of therapy, at 6 months, and then yearly.
474
Promazine
First generation (typical) Antipsychotic.
Short-term adjunctive management of psychomotor agitation; Agitation and restlessness in elderly.
C/I: CNS depression; comatose states; phaeochromocytoma.
475
Zuclopenthixol
First generation (typical) Antipsychotic.
Schizophrenia and other psychoses
C/I: Apathetic states; CNS depression; comatose states; pheochromocytoma; withdrawn states
476
Carbamazepine
Anticonvulsant / antiepileptic / mood stabiliser
Brand names: Tegretol, Carbagen.
Focal and generalised tonic-clonic seizure; Primary generalised tonic-clonic seizures; Trigeminal neuralgia; Prophylaxis of bipolar disorder unresponsive to lithium; Adjunct in acute alcohol withdrawal; Diabetic neuropathy.
C/I: Acute porphyrias ; AV conduction abnormalities (unless paced); history of bone-marrow depression
Cautions: Cardiac disease; history of haematological reactions to other drugs; may exacerbate absence and myoclonic seizures; skin reactions; susceptibility to angle-closure glaucoma
Consider vitamin D supplementation in patients who are immobilised for long periods or who have inadequate sun exposure or dietary intake of calcium.
Should be withdrawn immediately in cases of aggravated liver dysfunction or acute liver disease or leucopenia.
S/E: Dizziness; drowsiness; dry mouth; eosinophilia; fatigue; fluid imbalance; gastrointestinal discomfort; headache; hyponatraemia; leucopenia; movement disorders; nausea; oedema; skin reactions; thrombocytopenia; vision disorders; vomiting; weight increased.
Doses should be adjusted on the basis of plasma-drug concentration monitoring.
P450 system inducer.
477
Lithium carbonate
Antimanic agent.
Treatment and prophylaxis of mania, bipolar disorder, recurrent depression, aggressive or self-harming behaviour.
C/I: Addison’s disease; cardiac disease associated with rhythm disorder; cardiac insufficiency; dehydration; family history of Brugada syndrome; low sodium diets; personal history of Brugada syndrome; untreated hypothyroidism.
Cautions: Avoid abrupt withdrawal; cardiac disease; concurrent ECT; diuretic treatment; elderly; epilepsy; myasthenia gravis; psoriasis; QT interval prolongation; review dose as necessary in diarrhoea; review dose as necessary in intercurrent infection; review dose as necessary in vomiting; surgery
Long-term use of lithium has been associated with thyroid disorders and mild cognitive and memory impairment. Long-term lithium use can result in hyperparathyroidism and resultant hypercalcaemia.
S/E: nausea/vomiting, diarrhoea; fine tremor; nephrotoxicity: polyuria, secondary to nephrogenic; diabetes insipidus; thyroid enlargement, may lead to hypothyroidism; ECG: T wave flattening/inversion
weight gain; idiopathic intracranial hypertension
leucocytosis; hyperparathyroidism and resultant hypercalcaemia.
Pregnancy - teratogenic !
Lithium salts have a narrow therapeutic/toxic ratio and should therefore not be prescribed unless facilities for monitoring serum-lithium concentrations are available - target concentration of 0.8–1 mmol/litre.
MONITORING - after starting lithium levels should be performed weekly and after each dose change until concentrations are stable; once established, lithium blood level should 'normally' be checked every 3 months; after a change in dose, lithium levels should be taken a week later and 12 hours after the last dose; thyroid and renal function should be checked every 6 months.
Withdrawal - titrate down over 4 weeks.
Toxicity - hypothyroidism, renal dysfunction (including polyuria and polydipsia), and benign intracranial hypertension (persistent headache and visual disturbance).
478
Valproic acid (sodium valproate)
Anti-epileptic / mood stabiliser
Treatment of manic episodes associated with bipolar disorder; Migraine prophylaxis; Epilepsy
C/I: Acute porphyrias ; known or suspected mitochondrial disorders (higher rate of acute liver failure and liver-related deaths); personal or family history of severe hepatic dysfunction
Cautions: Systemic lupus erythematosus
Can cause liver failure and pancreatitis.
Highly teratogenic - leads to neurodevelopmental disorders.
P450 enzyme inhibitor - increases effects of warfrin.
479
Anti-epileptics
Carbamazepine, sodium valporate, Lamotrigine, Phenytoin, Levetiracetam.
480
Ascorbic acid
Vitamin C
Prevention and treatment of scurvy.
Ascorbic acid should not be given to patients with cardiac dysfunction.
In patients with normal cardiac function ascorbic acid should be introduced 1 month after starting desferrioxamine.
S/E: Diarrhoea; gastrointestinal disorder; hyperoxaluria; oxalate nephrolithiasis; polyuria
481
Ergocalciferol
Vitamin D2 and calciferol (found in food).
Vitamin D deficiency caused by intestinal malabsorption or chronic liver disease; Hypocalcaemia of hypoparathyroidism to achieve normocalcaemia; prevention and treatment of vitamin D deficiency.
C/I: Hypercalcaemia; metastatic calcification
S/E: Abdominal pain; headache; hypercalcaemia; hypercalciuria; nausea; skin reactions.
Symptoms of overdosage include anorexia, lassitude, nausea and vomiting, diarrhoea, constipation, weight loss, polyuria, sweating, headache, thirst, vertigo, and raised concentrations of calcium and phosphate in plasma and urine.
Monitor plasma-calcium concentration in patients receiving high doses.
482
Iodine
Thyrotoxicosis (pre-operative) can help block radioactive iodine from being absorbed by the thyroid gland.
Not for long-term treatment
S/E: Conjunctivitis; depression; erectile dysfunction; excessive tearing; headache; hypersensitivity; increased risk of infection; influenza like illness; insomnia; rash; salivary gland pain
483
Nicotinamide
Vitamin B3
Inflammatory acne vulgaris
Avoid contact with eyes, mucous membranes; reduce frequency of application if excessive dryness, irritation or peeling.
S/E: Paraesthesia; skin reactions.
484
Pyridoxine
Vitamin B6.
Deficiency states; Isoniazid-induced neuropathy; Idiopathic sideroblastic anaemia; Premenstrual syndrome.
S/E: Peripheral neuritis
485
Retinol
Vitamin A1.
486
Retinoic acids
Tretinoin, Isotretinoin, Adapalene, Alitretinoin.
Treat acne. Specialist.
Teratogenic!
487
Riboflavin
Vitamin B
488
Sodium fluoride
Prophylaxis of dental cavities / caries
489
Thiamine
Vitamin B1
Prevention of Wernicke-Korsakoff syndrome in alcoholics.
IV infusion.
490
Calcium gluconate
Calcium salt.
Calcium deficiency; hypocalcaemic tetany
C/I: Conditions associated with hypercalcaemia; conditions associated with hypercalciuria.
Cautions: History of nephrolithiasis; sarcoidosis
S/E: Arrhythmias
Plasma-calcium and ECG monitoring required for administration by slow intravenous injection.
491
Xylometazoline
Sympathomimetic
Nasal congestion - no longer used often due to risk of rebound congestion on withdrawal.
Cautions: Angle-closure glaucoma; avoid excessive or prolonged use; cardiovascular disease; diabetes mellitus; elderly; hypertension; hyperthyroidism; ischaemic heart disease; prostatic hypertrophy; rebound congestion
S/E: Cardiovascular effects; headache; hypersensitivity; nasal dryness; nausea; paraesthesia; visual impairment.
492
Disease-modifying anti-rheumatic drugs (DMARDs)
chloroquine, azathioprine, hydroxychloroquine, methotrexate, penicillamine, sulfasalazine.
493
Procyclidine (hydrochloride)
Exerts its antiparkinsonian action by reducing the effects of the relative central cholinergic excess that occurs as a result of dopamine deficiency.
Parkinsonism; Extrapyramidal symptoms; Acute dystonia; S/E associated with antipsychotics.
C/I: Gastro-intestinal obstruction
Cautions: Cardiovascular disease; elderly; hypertension; liable to abuse; prostatic hypertrophy; psychotic disorders; pyrexia; those susceptible to angle-closure glaucoma
S/E: Constipation; dry mouth; urinary retention; vision blurred.
494
Flecainide acetate
Class IC antiarrhythmic agent
Supraventricular arrhythmias; Ventricular arrhythmias;
C/I: Abnormal left ventricular function; atrial conduction defects; bundle branch block; distal block ; haemo-dynamically significant valvular heart disease; heart failure; second-degree or greater AV block; sinus node dysfunction etc
Cautions: Atrial fibrillation following heart surgery; elderly; patients with pacemakers
S/E: Arrhythmias; asthenia; dizziness; dyspnoea; fever; oedema; vision disorders.
495
Helicobacter pylori eradication
Triple-therapy regimen that comprises a proton pump inhibitor and 2 antibacterials.
e.g. Amoxicillin + clarithromycin / metronidazole
Clarithromycin and metronidazole if penicillin allergic.
The choice of antibacterials should take into consideration the patient's antibacterial treatment history, as each additional course of clarithromycin, metronidazole, or quinolone increases the risk of resistance.
Tetracycline / a fluoroquinolone if clarithromycin / metronidazole used previously.
496
Prochlorperazine
First generation antipsychotic (phenothiazine) / Antiemetic.
Brand name: Buccastem
Schizophrenia and other psychoses; Mania; Nausea and vomiting; Labyrinthine disorders; Acute migraine.
C/I: Avoid oral route in child under 10 kg; CNS depression; comatose states; phaeochromocytoma
Cautions: Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes; epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma.
S/E: Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension; insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased.
497
Trifluoperazine
Typical / first generation antipsychotic (phenothiazine) and antiemetic
Schizophrenia and other psychoses; Short-term adjunctive management of psychomotor agitation, excitement, and violent or dangerously impulsive behaviour; Severe nausea and vomiting.
C/I: CNS depression; comatose states; phaeochromocytoma
Cautions: Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes; epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma.
S/E: Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension; insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased.
498
Apixaban
Anticoagulant (DOAC) a direct inhibitor of activated factor X (factor Xa).
Prophylaxis and treatment of venous thromboembolism, deep-vein thrombosis and pulmonary embolism.
C/I: Active, clinically significant bleeding; antiphospholipid syndrome (increased risk of recurrent thrombotic events); risk factors for major bleeding
Cautions: Anaesthesia with postoperative indwelling epidural catheter (risk of paralysis—monitor neurological signs and wait 20–30 hours after apixaban dose before removing catheter and do not give next dose until at least 5 hours after catheter removal); prosthetic heart valve (efficacy not established); risk of bleeding
S/E: Anaemia; haemorrhage; nausea; skin reactions
499
Direct oral anticoagulants (DOACs)
Apixaban, rivaroxaban
Inhibit activated factor X (factor Xa).
500
Aliskiren
Renin inhibitors inhibit renin directly; renin converts angiotensinogen to angiotensin Ⅰ.
Essential hypertension either alone or in combination with other antihypertensives.
C/I: Concomitant treatment with an ACE inhibitor or an angiotensin-II receptor antagonist in patients with an eGFR less than 60 mL/minute/1.73 m2; concomitant treatment with an ACE inhibitor or an angiotensin-II receptor antagonist in patients with diabetes mellitus; hereditary angioedema; idiopathic angioedema
Cautions: Combination treatment with an ACE inhibitor; combination treatment with an angiotensin-II receptor antagonist; concomitant use of diuretics (first doses may cause hypotension—initiate with care); history of angioedema; moderate to severe congestive heart failure; patients at risk of renal impairment; salt depletion (first doses may cause hypotension—initiate with care); volume depletion (first doses may cause hypotension—initiate with care)
Avoid apple juice and orange juice as they greatly decrease aliskiren concentrations and plasma renin activity.
S/E: Arthralgia; diarrhoea; dizziness; electrolyte imbalance
501
Tolterodine tartrate
Antimuscarinic.
Urinary frequency; Urinary urgency; Urinary incontinence.
C/I: Angle-closure glaucoma; gastro-intestinal obstruction; intestinal atony; myasthenia gravis (but some antimuscarinics may be used to decrease muscarinic side-effects of anticholinesterases); paralytic ileus; pyloric stenosis; severe ulcerative colitis; significant bladder outflow obstruction; toxic megacolon; urinary retention
Cautions: Acute myocardial infarction; arrhythmias; autonomic neuropathy; cardiac insufficiency and cardiac surgery (due to association with tachycardia); children; conditions characterised by tachycardia; congestive heart failure; coronary artery disease; diarrhoea; elderly (especially if frail); gastro-oesophageal reflux disease; hiatus hernia with reflux oesophagitis; hypertension; hyperthyroidism; individuals susceptible to angle-closure glaucoma; prostatic hyperplasia; pyrexia; ulcerative colitis; History of QT-interval prolongation.
STOPP criteria: to treat extrapyramidal side-effects of antipsychotic medications; with delirium or dementia; narrow-angle glaucoma; or chronic prostatism;
if two or more antimuscarinic drugs prescribed concomitantly
S/E: Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting.
Antimuscarinics can affect the performance of skilled tasks (e.g. driving).
502
Antimuscarinics (systemic)
Tolterodine tartrate
Oxybutynin
Darifenacin
Act by blocking muscarinic receptors on the detrusor muscle, which are stimulated by acetylcholine.
C/I: Angle-closure glaucoma; gastro-intestinal obstruction; intestinal atony; myasthenia gravis (but some antimuscarinics may be used to decrease muscarinic side-effects of anticholinesterases); paralytic ileus; pyloric stenosis; severe ulcerative colitis; significant bladder outflow obstruction; toxic megacolon; urinary retention
Cautions: Acute myocardial infarction; arrhythmias; autonomic neuropathy; cardiac insufficiency and cardiac surgery (due to association with tachycardia); children; conditions characterised by tachycardia; congestive heart failure; coronary artery disease; diarrhoea; elderly (especially if frail); gastro-oesophageal reflux disease; hiatus hernia with reflux oesophagitis; hypertension; hyperthyroidism; individuals susceptible to angle-closure glaucoma; prostatic hyperplasia; pyrexia; ulcerative colitis; History of QT-interval prolongation.
STOPP criteria: to treat extrapyramidal side-effects of antipsychotic medications; with delirium or dementia; narrow-angle glaucoma; or chronic prostatism;
if two or more antimuscarinic drugs prescribed concomitantly
S/E: Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting.
Antimuscarinics can affect the performance of skilled tasks (e.g. driving).
503
Oxybutynin
Antimuscarinic. (Oxybutynin hydrochloride)
Urinary frequency; Urinary urgency; Urinary incontinence; Neurogenic bladder instability; Nocturnal enuresis associated with overactive bladder.
C/I: Angle-closure glaucoma; gastro-intestinal obstruction; intestinal atony; myasthenia gravis; paralytic ileus; pyloric stenosis; severe ulcerative colitis; significant bladder outflow obstruction; toxic megacolon; urinary retention.
Cautions: Acute myocardial infarction (in adults); arrhythmias (may be worsened); autonomic neuropathy; cardiac insufficiency (due to association with tachycardia); cardiac surgery (due to association with tachycardia); children (increased risk of side-effects) (in children); conditions characterised by tachycardia; congestive heart failure (may be worsened); coronary artery disease (may be worsened); diarrhoea; elderly (especially if frail) (in adults); gastro-oesophageal reflux disease; hiatus hernia with reflux oesophagitis; hypertension; hyperthyroidism (due to association with tachycardia); individuals susceptible to angle-closure glaucoma; prostatic hyperplasia (in adults); pyrexia; ulcerative colitis.
STOPP criteria: to treat extrapyramidal side-effects of antipsychotic medications; with delirium or dementia; narrow-angle glaucoma; or chronic prostatism;
if two or more antimuscarinic drugs prescribed concomitantly
S/E: Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting; Diarrhoea
504
Mirabegron
Beta-3 adrenergic agonist
Urinary frequency, urgency, and urge incontinence
C/I: Severe uncontrolled hypertension (systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg)
Cautions: History of QT-interval prolongation; stage 2 hypertension
S/E: Arrhythmias; constipation; diarrhoea; dizziness; headache; increased risk of infection; nausea
an alternative medical treatment for urge incontinence with less of an anticholinergic burden. However, it is worth noting that mirabegron is contraindicated in uncontrolled hypertension. Blood pressure needs to be monitored regularly during treatment. It works as a beta-3 agonist, stimulating the sympathetic nervous system, leading to raised blood pressure. This can lead to a hypertensive crisis and an increased risk of TIA and stroke.
505
Darifenacin
Antimuscarinic.
Urinary frequency; Urinary urgency; Urinary incontinence.
C/I: Angle-closure glaucoma; gastro-intestinal obstruction; intestinal atony; myasthenia gravis (but some antimuscarinics may be used to decrease muscarinic side-effects of anticholinesterases); paralytic ileus; pyloric stenosis; severe ulcerative colitis; significant bladder outflow obstruction; toxic megacolon; urinary retention
Cautions: Acute myocardial infarction; arrhythmias; autonomic neuropathy; cardiac insufficiency and cardiac surgery (due to association with tachycardia); children; conditions characterised by tachycardia; congestive heart failure; coronary artery disease; diarrhoea; elderly (especially if frail); gastro-oesophageal reflux disease; hiatus hernia with reflux oesophagitis; hypertension; hyperthyroidism; individuals susceptible to angle-closure glaucoma; prostatic hyperplasia; pyrexia; ulcerative colitis; History of QT-interval prolongation.
STOPP criteria: to treat extrapyramidal side-effects of antipsychotic medications; with delirium or dementia; narrow-angle glaucoma; or chronic prostatism;
if two or more antimuscarinic drugs prescribed concomitantly
S/E: Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting.
Antimuscarinics can affect the performance of skilled tasks (e.g. driving).
506
Solifenacin
Antimuscarinic !
Urinary frequency,
Urinary urgency,
Urinary incontinence
507
Trospium
Antimuscarinic !
Urinary frequency,
Urinary urgency,
Urinary incontinence
508
Fesoterodine
Antimuscarinic !
Urinary frequency,
Urinary urgency,
Urinary incontinence
509
Botulinum toxin type A
Neurotoxin.
Hand and wrist disability due to upper limb spasticity associated with stroke; Foot and ankle disability due to lower limb spasticity associated with stroke; Blepharospasm; Hemifacial spasm; Spasmodic torticollis; Severe hyperhidrosis of the axillae; Prophylaxis of headaches in chronic migraine; Temporary improvement of moderate to severe upper facial lines in adults under 65 years; Management of bladder dysfunctions;
Chronic sialorrhoea.
C/I: Acute urinary retention; catheterisation difficulties; infection at injection site; presence of bladder calculi; urinary tract infection.
Cautions: Atrophy in target muscle; chronic respiratory disorder; elderly; excessive weakness in target muscle; history of aspiration; history of dysphagia; inflammation in target muscle; neurological disorders; neuromuscular disorders; off-label use (fatal adverse events reported)
S/E: Alopecia; asthenia; autonomic dysreflexia; bladder diverticulum; constipation; dizziness; drowsiness; dry eye; dry mouth; dysphagia; ecchymosis; eye discomfort; eye disorders; eye inflammation; fall; fever; gait abnormal etc
510
Botulinum toxin type B
Neurotoxin.
Spasmodic torticollis (cervical dystonia)
C/I: Neuromuscular disorders; neuromuscular junctional disorders
Cautions: History of dysphagia or aspiration; off-label use (risk of toxin spread); tolerance may occur.
S/E: Dry mouth; dysphagia; dysphonia; headache; influenza like illness; muscle weakness; neck pain; taste altered; vision disorders
511
Chlordiazepoxide (hydrochloride)
Benzodiazepine.
Treatment of alcohol withdrawal; Short-term use in anxiety;
Brand name: Librium
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
512
Buprenorphine
Opioid-receptor partial agonist (it has opioid agonist and antagonist properties).
Moderate to severe pain; Premedication; Intra-operative analgesia; Adjunct in the treatment of opioid dependence.
C/I: Acute respiratory depression; comatose patients; head injury (opioid analgesics interfere with pupillary responses vital for neurological assessment); raised intracranial pressure (opioid analgesics interfere with pupillary responses vital for neurological assessment); risk of paralytic ileus
Cautions: adrenocortical insufficiency; asthma; convulsive disorders; debilitated patients; diseases of the biliary tract; elderly; hypotension; hypothyroidism; impaired respiratory function; inflammatory bowel disorders; myasthenia gravis; obstructive bowel disorders; prostatic hypertrophy; shock; urethral stenosis.
Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence.
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.
Monitor liver function; when used in opioid dependence baseline liver function test is recommended before commencing therapy, and regular liver function tests should be performed throughout treatment.
Avoid abrupt withdrawal after long-term treatment; they should be withdrawn gradually to avoid abstinence symptoms.
513
Suboxone
Buprenorphine and naloxone.
Adjunct in the treatment of opioid dependence (dose expressed as buprenorphine).
514
Anticholinesterase inhibitors
Donepezil; Rivastigmine; Galantamine.
Mild to moderate dementia in Alzheimer's disease.
515
Donepezil (hydrochloride)
Anticholinesterase inhibitor.
Mild to moderate dementia in Alzheimer's disease
Cautions: asthma; chronic obstructive pulmonary disease; sick sinus syndrome; supraventricular conduction abnormalities; susceptibility to peptic ulcers.
S/E: Aggression; agitation; appetite decreased; common cold; diarrhoea; dizziness; fatigue; gastrointestinal disorders; hallucination; headache; injury; muscle cramps; nausea; pain; skin reactions; sleep disorders; syncope; urinary incontinence; vomiting.
516
Rivastigmine
Anticholinesterase inhibitor.
Mild to moderate dementia in Alzheimer's disease
Cautions: bladder outflow obstruction; conduction abnormalities; duodenal ulcers; gastric ulcers; history of asthma; history of chronic obstructive pulmonary disease; history of seizures; risk of fatal overdose with patch administration errors; sick sinus syndrome; susceptibility to ulcers
STOPP criteria: in patients with a known history of persistent bradycardia (heart rate less than 60 beats per minute); heart block; recurrent unexplained syncope or concurrent treatment with drugs that reduce heart rate (risk of cardiac conduction failure, syncope and injury).
S/E: Anxiety; appetite decreased; arrhythmias; asthenia; dehydration; depression; diarrhoea; dizziness; drowsiness; fall; gastrointestinal discomfort; headache; hyperhidrosis; hypersalivation; hypertension; movement disorders; nausea; skin reactions; syncope; tremor; urinary incontinence; urinary tract infection; vomiting; weight decreased
517
Galantamine
Anticholinesterase inhibitor.
Mild to moderately severe dementia in Alzheimer's disease.
Cautions: avoid in gastro-intestinal obstruction; avoid in urinary outflow obstruction; avoid whilst recovering from bladder surgery; avoid whilst recovering from gastro-intestinal surgery; cardiac disease; chronic obstructive pulmonary disease; congestive heart failure; electrolyte disturbances; history of seizures; history of severe asthma; pulmonary infection; sick sinus syndrome; supraventricular conduction abnormalities; susceptibility to peptic ulcers; unstable angina.
S/E: appetite decreased; arrhythmias; asthenia; depression; diarrhoea; dizziness; drowsiness; fall; gastrointestinal discomfort; hallucinations; headache; hypertension; malaise; muscle spasms; nausea; skin reactions; syncope; tremor; vomiting; weight decreased
518
Methylphenidate (hydrochloride)
Sympathomimetic (stimulant). Brand name: Ritalin.
Attention deficit hyperactivity disorder; Narcolepsy.
C/I: anorexia nervosa; arrhythmias; cardiomyopathy; cardiovascular disease; cerebrovascular disorders; heart failure; hyperthyroidism; mania; phaeochromocytoma; psychosis; severe depression; severe hypertension; structural cardiac abnormalities; suicidal tendencies; uncontrolled bipolar disorder; vasculitis
Cautions: agitation; alcohol dependence; anxiety; drug dependence; epilepsy (discontinue if increased seizure frequency); family history of Tourette syndrome; susceptibility to angle-closure glaucoma; tics
S/E: alopecia; anxiety; appetite decreased; arrhythmias; arthralgia; behaviour abnormal; cough; depression; diarrhoea; dizziness; drowsiness; dry mouth; fever; gastrointestinal discomfort; growth retardation (in children); headaches; hypertension; laryngeal pain; mood altered; movement disorders; nasopharyngitis; nausea; palpitations; sleep disorders; vomiting; weight decreased.
519
Phencyclidine
Angel Dust. Hallucinogenic drug of abuse.
520
Dextroamphetamine (sulphate)
Stimulant.
Narcolepsy; Refractory attention deficit hyperactivity disorder.
C/I: advanced arteriosclerosis; anorexia; arrhythmias (life-threatening); cardiomyopathies; cardiovascular disease; cerebrovascular disorders; heart failure; history of alcohol abuse; history of drug abuse; hyperexcitability; hyperthyroidism; moderate hypertension; psychiatric disorders; psychosis; severe hypertension; structural cardiac abnormalities; suicidal tendencies
Cautions: history of epilepsy (discontinue if seizures occur); mild hypertension; susceptibility to angle-closure glaucoma; tics; Tourette syndrome.
S/E: Abdominal pain; anxiety; appetite decreased; arrhythmias; arthralgia; behaviour abnormal; depression; dry mouth; headache; mood altered; movement disorders; muscle cramps; nausea; palpitations; poor weight gain; sleep disorders; vertigo; vomiting; weight decreased.
521
Mood stabilizers
```
lithium
carbamazepine (Tegretol)
lamotrigine (Lamictal)
valproate (Depakote, Epilim)
asenapine (Sycrest)
```
bipolar disorder (manic depression)
mania and hypomania
sometimes recurrent severe depression
522
Asenapine
Mood stabiliser (antipsychotic)
Manic episodes associated with bipolar disorder.
Cautions: blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease (may be exacerbated) (in adults); photosensitisation (may occur with higher dosages); prostatic hypertrophy (in adults); severe respiratory disease; susceptibility to angle-closure glaucoma.
S/E: agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension (dose-related); insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased.
523
Sumatriptan
Triptan.
Treatment of acute migraine; Treatment of acute cluster headache.
C/I: coronary vasospasm; ischaemic heart disease; mild uncontrolled hypertension; moderate and severe hypertension; peripheral vascular disease; previous cerebrovascular accident; previous myocardial infarction; previous transient ischaemic attack; Prinzmetal's angina.
Cautions: conditions which predispose to coronary artery disease; elderly; history of seizures; mild, controlled hypertension; risk factors for seizures.
S/E: Asthenia; dizziness; drowsiness; dyspnoea; feeling abnormal; flushing; myalgia; nausea; pain; sensation abnormal; skin reactions; temperature sensation altered; vomiting.
524
Adenosine
Organic compound.
Rapid reversion to sinus rhythm of paroxysmal supraventricular tachycardias; used to aid to diagnosis of broad or narrow complex supraventricular tachycardias;
aid to diagnosis of broad or narrow complex; used in conjunction with radionuclide myocardial perfusion imaging in patients who cannot exercise adequately or for whom exercise is inappropriate.
C/I: asthma; chronic obstructive lung disease; decompensated heart failure; long QT syndrome; second- or third-degree AV block and sick sinus syndrome (unless pacemaker fitted); severe hypotension
Cautions: atrial fibrillation; atrial fibrillation with accessory pathway (conduction down anomalous pathway may increase); atrial flutter; atrial flutter with accessory pathway (conduction down anomalous pathway may increase); autonomic dysfunction; bundle branch block; first-degree AV block; heart transplant; left main coronary artery stenosis; left to right shunt; pericardial effusion; pericarditis; QT-interval prolongation; recent myocardial infarction; severe heart failure; stenotic carotid artery disease with cerebrovascular insufficiency; stenotic valvular heart disease; uncorrected hypovolaemia.
S/E: abdominal discomfort; arrhythmias; atrioventricular block; chest discomfort; chest pain (discontinue); dizziness; dry mouth; dyspnoea; flushing; headache; hypotension (discontinue if severe); pain; paraesthesia; throat discomfort.
Monitor ECG and have resuscitation facilities available..
525
Dobutamine
A cardiac stimulant which acts on beta1 receptors in cardiac muscle, and increases contractility.
Inotropic support in infarction, cardiac surgery, cardiomyopathies, septic shock, cardiogenic shock, and during positive end expiratory pressure ventilation
C/I: phaeochromocytoma
Cautions: acute heart failure; acute myocardial infarction; arrhythmias; correct hypercapnia before starting and during treatment; correct hypovolaemia before starting and during treatment; correct hypoxia before starting and during treatment; correct metabolic acidosis before starting and during treatment; diabetes mellitus; elderly; extravasation may cause tissue necrosis; extreme caution or avoid in marked obstruction of cardiac ejection (such as idiopathic hypertrophic subaortic stenosis); hyperthyroidism; ischaemic heart disease; occlusive vascular disease; severe hypotension; susceptibility to angle-closure glaucoma; tachycardia; tolerance may develop with continuous infusions longer than 72 hours.
S/E: Arrhythmias; bronchospasm; chest pain; dyspnoea; eosinophilia; fever; headache; inflammation localised; ischaemic heart disease; nausea; palpitations; platelet aggregation inhibition (on prolonged administration); skin reactions; urinary urgency; vasoconstriction.
526
Sodium alginate with potassium bicarbonate
Management of mild symptoms of dyspepsia and gastro-oesophageal reflux disease.
527
Olanzapine
Second generation (atypical) antipsychotic. Phenothiazine. Dopamine D1, D2, D4, 5-HT2, histamine- 1-, and muscarinic-receptor antagonist.
Schizophrenia; combination therapy for mania; Preventing recurrence in bipolar disorder; Monotherapy for mania; Control of agitation and disturbed behaviour in schizophrenia or mania.
C/I: acute myocardial infarction; bradycardia; recent heart surgery; severe hypotension; sick sinus syndrome; unstable angina.
Cautions: blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes; epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma.
An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient.
S/E: Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension (dose-related); insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased.
528
Aripiprazole
Third generation antipsychotic drug. Dopamine D2 partial agonist with weak 5-HT1a partial agonism and 5-HT2A receptor antagonism.
Schizophrenia; Treatment and recurrence prevention of mania.
C/I: CNS depression; comatose state; phaeochromocytoma
Cautions: blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes; epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma.
S/E: Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension; insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased.
Monitor: prolactin concentration at the start of therapy, at 6 months, and then yearly. Patients taking antipsychotic drugs not normally associated with symptomatic hyperprolactinaemia should be considered for prolactin monitoring if they show symptoms of hyperprolactinaemia (such as breast enlargement and galactorrhoea).
Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year.
529
Aripiprazole
Third generation antipsychotic drug. Dopamine D2 partial agonist with weak 5-HT1a partial agonism and 5-HT2A receptor antagonism.
Schizophrenia; Treatment of acute mania in bipolar.
C/I: CNS depression; comatose state; phaeochromocytoma
Cautions: blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes; epilepsy; history of jaundice; myasthenia gravis; Parkinson’s disease; photosensitisation; prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma.
S/E: Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; galactorrhoea; gynaecomastia; hyperprolactinaemia; hypotension; insomnia; leucopenia; movement disorders; neutropenia; parkinsonism; QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased.
Monitor: prolactin concentration at the start of therapy, at 6 months, and then yearly. Patients taking antipsychotic drugs not normally associated with symptomatic hyperprolactinaemia should be considered for prolactin monitoring if they show symptoms of hyperprolactinaemia (such as breast enlargement and galactorrhoea).
Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year.
530
Cyproheptadine (hydochloride)
First-generation antihistamine.
Symptomatic relief of allergy such as hay fever, urticaria,
Pruritus;
Cautions: epilepsy; prostatic hypertrophy; pyloroduodenal obstruction; susceptibility to angle-closure glaucoma; urinary retention.
S/E: Aggression; agranulocytosis; anxiety; appetite abnormal; arrhythmias; bronchial secretion viscosity increased; chest tightness; chills; confusion; constipation; coordination abnormal; diarrhoea; dizziness; drowsiness; dry mouth etc
531
Phenobarbital
Barbiturate.
All forms of epilepsy except typical absence seizures; Status epilepticus.
Cautions: avoid in acute porphyrias; children; debilitated; elderly; history of alcohol abuse; history of drug abuse; respiratory depression (avoid if severe)
Consider vitamin D supplementation in patients who are immobilised for long periods or who have inadequate sun exposure or dietary intake of calcium.
S/E: Agranulocytosis; anticonvulsant hypersensitivity syndrome; behaviour abnormal; bone disorders; bone fracture; cognitive impairment; confusion; depression; drowsiness; folate deficiency; hepatic disorders; memory loss; movement disorders; nystagmus; respiratory depression; skin reactions.
Inducer of the P450 system so warfarin is metabolised quicker, therefore decreasing INR. Avoid in hepatic imparement.
Avoid abrupt withdrawal (dependence with prolonged use).
532
Phenobarbital / Phenobarbitone
Barbiturate.
All forms of epilepsy except typical absence seizures; Status epilepticus.
Cautions: avoid in acute porphyrias; children; debilitated; elderly; history of alcohol abuse; history of drug abuse; respiratory depression (avoid if severe)
Consider vitamin D supplementation in patients who are immobilised for long periods or who have inadequate sun exposure or dietary intake of calcium.
S/E: Agranulocytosis; anticonvulsant hypersensitivity syndrome; behaviour abnormal; bone disorders; bone fracture; cognitive impairment; confusion; depression; drowsiness; folate deficiency; hepatic disorders; memory loss; movement disorders; nystagmus; respiratory depression; skin reactions.
Inducer of the P450 system so warfarin is metabolised quicker, therefore decreasing INR. Avoid in hepatic imparement.
Avoid abrupt withdrawal (dependence with prolonged use).
533
Barbiturates
Phenobarbital
Primidone
Thiopental sodium
Consider vitamin D supplementation in patients who are immobilised for long periods or who have inadequate sun exposure or dietary intake of calcium.
Avoid abrupt withdrawal (dependence with prolonged use).
534
Primidone
Barbiturate.
All forms of epilepsy except typical absence seizures; Essential tremor.
Cautions: avoid in acute porphyrias; children; debilitated; elderly (in adults); history of alcohol abuse; history of drug abuse; respiratory depression (avoid if severe)
Consider vitamin D supplementation in patients who are immobilised for long periods or who have inadequate sun exposure or dietary intake of calcium.
S/E: Apathy; ataxia; drowsiness; nausea; nystagmus; visual impairment.
535
Thiopental sodium
Barbiturate.
Status epilepticus (only if other measures fail); Induction of anaesthesia; reduction of raised intracranial pressure if ventilation controlled.
C/I: acute porphyrias ; myotonic dystrophy
Cautions: acute circulatory failure (shock); avoid intra-arterial injection; cardiovascular disease; elderly; fixed cardiac output; hypovolaemia; reconstituted solution is highly alkaline.
S/E: arrhythmia; myocardial contractility decreased.
536
St John's Wort
Herbal medicine.
Some evidance for use in depression.
P450 inducer.
537
Cimetidine
H2-receptor antagonist.
Benign duodenal ulceration; Benign gastric ulceration; NSAID-associated ulceration; Reflux oesophagitis; Prophylaxis of stress ulceration; Gastric acid reduction in obstetrics; Gastric acid reduction during surgical procedures; Short-bowel syndrome; to reduce degradation of pancreatic enzyme supplements.
Cautions: signs and symptoms of gastric cancer (in adults)
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
P450 inhibitor - increases warfrin.
538
Ivabradine
Antianginal drug.
Treatment of angina in patients in normal sinus rhythm; Mild to severe chronic heart failure;
C/I: acute myocardial infarction; cardiogenic shock; congenital QT syndrome; do not initiate for angina if heart rate below 70 beats per minute; do not initiate for chronic heart failure if heart rate below 75 beats per minute; immediately after cerebrovascular accident; patients dependent on pacemaker; second- and third-degree heart block; severe hypotension; sick-sinus syndrome; sino-atrial block; unstable angina; unstable or acute heart failure
Cautions: atrial fibrillation or other arrhythmias (treatment ineffective); elderly; in angina, consider stopping if there is no or limited symptom improvement after 3 months; intraventricular conduction defects; mild to moderate hypotension (avoid if severe); retinitis pigmentosa.
S/E: Arrhythmias; atrioventricular block; dizziness; headache; hypertension; vision disorders.
Monitor regularly for atrial fibrillation and bradycardia.
539
Nimodipine
Dihydropyridine calcium-channel blocker.
Prevention of ischaemic neurological defects following aneurysmal subarachnoid haemorrhage.
Contra-indications: unstable angina; within 1 month of myocardial infarction.
Cautions: elderly.
S/E: Abdominal pain; dizziness; drowsiness; flushing; headache; nausea; palpitations; peripheral oedema; skin reactions; tachycardia; vomiting.
540
Ivabradine
Non CCB; non BB rate limiting drug. A class of anti-anginal drug which works by reducing the heart rate. It acts on the If ('funny') ion current which is highly expressed in the sinoatrial node, reducing cardiac pacemaker activity.
Treatment of angina in patients in normal sinus rhythm; Mild to severe chronic heart failure;
C/I: acute myocardial infarction; cardiogenic shock; congenital QT syndrome; do not initiate for angina if heart rate below 70 beats per minute; do not initiate for chronic heart failure if heart rate below 75 beats per minute; immediately after cerebrovascular accident; patients dependent on pacemaker; second- and third-degree heart block; severe hypotension; sick-sinus syndrome; sino-atrial block; unstable angina; unstable or acute heart failure
Cautions: atrial fibrillation or other arrhythmias (treatment ineffective); elderly; in angina, consider stopping if there is no or limited symptom improvement after 3 months; intraventricular conduction defects; mild to moderate hypotension (avoid if severe); retinitis pigmentosa.
S/E: Arrhythmias; atrioventricular block; dizziness; headache; hypertension; visual disturbances including phosphenes and green luminescence.
Monitor regularly for atrial fibrillation and bradycardia.
541
Verapamil
Calcium channel blocker (non-dihydropyridine).
Treatment of supraventricular arrhythmias; Paroxysmal tachyarrhythmias; Angina; Hypertension; Prophylaxis of cluster headache; Hypertension.
C/I: acute porphyrias; atrial flutter or fibrillation associated with accessory conducting pathways (e.g. Wolff-Parkinson-White-syndrome); bradycardia; cardiogenic shock; heart failure (with reduced ejection fraction); history of significantly impaired left ventricular function (even if controlled by therapy); hypotension; second- and third-degree AV block; sick sinus syndrome; sino-atrial block
S/E: hypotension.
In overdose, verapamil has a profound cardiac depressant effect causing hypotension and arrhythmias, including complete heart block and asystole.
542
Non-dihydropyridine CCB.
Verapamil and diltiazem
C/I: w/ beta blockers due to bradycadia use dihydropyridine CCB instead.
543
Verapamil
Calcium channel blocker (non-dihydropyridine).
Treatment of supraventricular arrhythmias; Paroxysmal tachyarrhythmias; Angina; Hypertension; Prophylaxis of cluster headache; Hypertension.
C/I: acute porphyrias; atrial flutter or fibrillation associated with accessory conducting pathways (e.g. Wolff-Parkinson-White-syndrome); bradycardia; cardiogenic shock; heart failure (with reduced ejection fraction); history of significantly impaired left ventricular function (even if controlled by therapy); hypotension; second- and third-degree AV block; sick sinus syndrome; sino-atrial block
S/E: hypotension.
In overdose, verapamil has a profound cardiac depressant effect causing hypotension and arrhythmias, including complete heart block and asystole.
Not to be used alongside a beta blocker due to the risk of heart block in combined use.
544
Brimonidine
Alpha2-adrenoceptor agonist (Sympathomimetic)
Raised intra-ocular pressure in open-angle glaucoma in patients for whom beta-blockers are inappropriate,
Ocular hypertension in patients for whom beta-blockers are inappropriate; Adjunctive therapy when intra-ocular pressure is inadequately controlled by other antiglaucoma therapy.
Reduces aqueous production and increases outflow.
Avoid if taking MAOI or tricyclic antidepressants.
Adverse effects include hyperaemia.
545
Dorzolamide
Carbonic anhydrase inhibitor.
Glaucoma - Reduces aqueous production.
Systemic absorption may cause sulphonamide-like reactions
546
Tazocin
Piperacillin with tazobactam - penicillin antibiotic.
Hospital-acquired pneumonia; Septicaemia; Complicated infections involving the urinary-tract; Complicated infections involving the skin; Complicated infections involving the soft-tissues; Acute exacerbation of chronic obstructive pulmonary disease; Acute exacerbation of bronchiectasis; diabetic foot infection; Leg ulcer infection; Infections in neutropenic patients.
Cautions: history of allergy; High doses may lead to hypernatraemia (owing to sodium content of preparations)
S/E: Diarrhoea; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting; Anaemia; candida infection; constipation; gastrointestinal discomfort; headache; insomnia.
547
Pabrinex (trade name)
Vitamin B Substances with ascorbic acid.
Severe depletion or malabsorption of vitamins B and C postoperatively, after haemodialysis, following narcosis or electroconvulsive therapy; Treatment of suspected or established Wernicke's encephalopathy; Prophylaxis of Wernicke's encephalopathy.
548
Azithromycin
Macrolide antibiotic.
Prevention of secondary case of invasive group A streptococcal infection in patients who are allergic to penicillin; Respiratory-tract infections, otitis media, skin and soft-tissue infections; Uncomplicated genital chlamydial infections; Non-gonococcal urethritis; Uncomplicated gonorrhoea; Lyme disease; typhoid; Community-acquired pneumonia; Whooping cough if onset <21 days.
Cautions: electrolyte disturbances (predisposition to QT interval prolongation); 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
549
Azithromycin
Macrolide antibiotic.
Prevention of secondary case of invasive group A streptococcal infection in patients who are allergic to penicillin; Respiratory-tract infections, otitis media, skin and soft-tissue infections; Uncomplicated genital chlamydial infections; Non-gonococcal urethritis; Uncomplicated gonorrhoea; Lyme disease; typhoid; Community-acquired pneumonia; Whooping cough if onset <21 days.
Cautions: electrolyte disturbances (predisposition to QT interval prolongation); 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.
550
Azithromycin
Macrolide antibiotic.
Prevention of secondary case of invasive group A streptococcal infection in patients who are allergic to penicillin; Respiratory-tract infections, otitis media, skin and soft-tissue infections; Uncomplicated genital CHLAMYDIA infections; Non-gonococcal urethritis; Uncomplicated gonorrhoea; Lyme disease; typhoid; Community-acquired pneumonia; Whooping cough if onset <21 days.
Cautions: electrolyte disturbances (predisposition to QT interval prolongation); 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.
551
Piperacillin with tazobactam
Penicillin.
Hospital-acquired pneumonia; Septicaemia; Complicated infections involving the urinary-tract; Complicated infections involving the skin; Complicated infections involving the soft-tissues; Acute exacerbation of chronic obstructive pulmonary disease; Acute exacerbation of bronchiectasis; Moderate diabetic foot infection; Severe diabetic foot infection; Leg ulcer infection.
High doses may lead to hypernatraemia.
S/E: Diarrhoea; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting.
552
Ofloxacin
Quinolone.
Local treatment of infections; Urinary-tract infections; Prostatitis; Lower respiratory-tract infections; Skin and soft-tissue infections; Uncomplicated genital chlamydial infection; Uncomplicated gonorrhoea; Non-gonococcal urethritis; PELVIC INFLAMMATORY DISEASE;
The CSM has warned that 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.
Small increased risk of aortic aneurysm and dissection.
553
Ofloxacin
Quinolone.
Local treatment of infections; Urinary-tract infections; Prostatitis; Lower respiratory-tract infections; Skin and soft-tissue infections; Uncomplicated genital chlamydial infection; Uncomplicated gonorrhoea; Non-gonococcal urethritis; PELVIC INFLAMMATORY DISEASE;
The CSM has warned that 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.
Small increased risk of aortic aneurysm and dissection.
Disabling, long-lasting or potentially irreversible adverse reactions affecting musculoskeletal and nervous systems have been reported very rarely.
Cautions: can prolong the QT interval; conditions that predispose to seizures; diabetes (may affect blood glucose); 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 (risk of exacerbation); 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.
554
Ketorolac (trometamol)
NSAID
Short-term management of moderate to severe acute postoperative pain only; Prophylaxis and reduction of inflammation and associated symptoms following ocular surgery.
Contra-indications:
active or history of gastro-intestinal bleeding/ulceration; coagulation disorders; complete or partial syndrome of nasal polyps; confirmed or suspected cerebrovascular bleeding; dehydration; following operations with high risk of haemorrhage or incomplete haemostasis; haemorrhagic diatheses; history of gastro-intestinal bleeding /perforation related to previous NSAID therapy; hypovolaemia; severe heart failure.
Cautions:
allergic disorders; cardiac impairment (NSAIDs may impair renal function); cerebrovascular disease; connective-tissue disorders; elderly (risk of serious side-effects and fatalities); heart failure; history of gastro-intestinal disorders (e.g. ulcerative colitis, Crohn’s disease); ischaemic heart disease; peripheral arterial disease; risk factors for cardiovascular events; uncontrolled hypertension.
S/E: Headache; hypersensitivity; paraesthesia
555
Tamsulosin (hydrochloride)
Alpha1-selective adrenoceptor blocker
Benign prostatic hyperplasia; renal stone expulsive therapy.
Contra-indications: History of micturition syncope; history of postural hypotension
Cautions: Care with initial dose (postural hypotension); cataract surgery (risk of intra-operative floppy iris syndrome); concomitant antihypertensives (reduced dosage and specialist supervision may be required); elderly.
S/E: Dizziness; sexual dysfunction
556
Alfuzosin (hydrochloride)
Alpha1-selective adrenoceptor blocker
Benign prostatic hyperplasia; renal stone expulsive therapy.
Contra-indications: Avoid if history of micturition syncope; avoid if history of postural hypotension
Cautions: Acute heart failure; cerebrovascular disease; concomitant antihypertensives (reduced dosage and specialist supervision may be required); discontinue if angina worsens; elderly; history of QT-interval prolongation; patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome)
S/E: Asthenia; diarrhoea; dizziness; dry mouth; headache; malaise; nausea; postural hypotension; vertigo; vomiting.
557
Memantine (hydrochloride)
Anti-dementia medicine - glutamate receptor antagonist.
Alzheimer's disease; Oscillopsia in multiple sclerosis;
Cautions: epilepsy; history of convulsions; risk factors for epilepsy.
S/E: Balance impaired; constipation; dizziness; drowsiness; dyspnoea; headache; hypersensitivity; hypertension.
558
Leflunomide
Disease-modifying antirheumatic drug (DMARD).
Moderate-to-severe active rheumatoid arthritis; Active psoriatic arthritis
Contra-indications: serious infection; severe hypoproteinaemia; severe immunodeficiency
Cautions: anaemia; history of tuberculosis; impaired bone-marrow function; leucopenia; thrombocytopenia.
S/E: Abdominal pain; accelerated hair loss; appetite decreased; asthenia; diarrhoea; dizziness; gastrointestinal disorders; headache; leucopenia; nausea; oral disorders; paraesthesia; peripheral neuropathy; skin reactions; tendon disorders; vomiting; weight decreased.
Effective contraception essential during treatment and for at least 2 years after treatment in women and at least 3 months after treatment in men!
Monitor full blood count (including differential white cell count and platelet count) before treatment and every 2 weeks for 6 months then every 8 weeks.
Treatment cessation - washout procedure:
The active metabolite persists for a long period; to aid drug elimination in case of serious adverse effect, or before starting another disease-modifying antirheumatic drug, or before conception, stop treatment and give either colestyramine or charcoal, activated.
559
Mycophenolate (mofetil)
Immunosuppressant.
Prophylaxis of acute rejection in transplantation; SLE.
Cautions: active serious gastro-intestinal disease; children; delayed graft function; elderly; increased susceptibility to skin cancer; risk of hypogammaglobulinaemia or bronchiectasis when used in combination with other immunosuppressants.
S/E: Acidosis; alopecia; anaemia; appetite decreased; arthralgia; asthenia; bone marrow disorders; chills; constipation; cough; depression; diarrhoea; drowsiness; dyslipidaemia; dyspnoea; electrolyte imbalance; fever etc etc.
560
Artenimol with piperaquine phosphate
Brand name: Eurartesim.
Treatment of uncomplicated falciparum malaria.
Contra-indications: acute myocardial infarction; bradycardia; congenital long QT syndrome; electrolyte disturbances; family history of sudden death; heart failure with reduced left ventricular ejection fraction; history of symptomatic arrhythmias; left ventricular hypertrophy; risk factors for QT interval prolongation; severe hypertension.
S/E: anaemia; arrhythmias (in adults); asthenia; conjunctivitis (in children); eosinophilia; fever; headache (uncommon in children); leucocytosis (in children); leucopenia (in children); neutropenia (in children); QT interval prolongation; thrombocytopenia .
Consider obtaining ECG in all patients before third dose and 4–6 hours after third dose. If QT C interval more than 500 milliseconds, discontinue treatment and monitor ECG for a further 24–48 hours.
561
Clomiphene (citrate)
Anti-oestrogen which induces gonadotrophin release by occupying oestrogen receptors in the hypothalamus, thereby interfering with feedback mechanisms; chorionic gonadotrophin is sometimes used as an adjunct.
Female infertility due to ovulatory dysfunction.
Contra-indications: abnormal uterine bleeding of undetermined cause; hormone-dependent tumours; ovarian cysts.
Cautions: ectopic pregnancy; incidence of multiple births increased (consider ultrasound monitoring); ovarian hyperstimulation syndrome; polycystic ovary syndrome (cysts may enlarge during treatment, also risk of exaggerated response to usual doses); uterine fibroids.
S/E: Abdominal distension; alopecia; angioedema; anxiety; breast tenderness; cataract; cerebral thrombosis; depression; disorientation; dizziness; fatigue; headache; hot flush; hypertriglyceridaemia; insomnia; jaundice etc
Manufacturer advises clomifene should not normally be used for longer than 6 cycles (possible increased risk of ovarian cancer).
Exclude pregnancy before treatment.
562
Hydrallazine (hydrochloride)
Antihypertensive.
Moderate to severe hypertension (adjunct); Heart failure; Hypertensive emergencies (including during PREGNANCY),
Hypertension with renal complications.
Contra-indications: acute porphyrias ; cor pulmonale; dissecting aortic aneurysm; high output heart failure; idiopathic systemic lupus erythematosus; myocardial insufficiency due to mechanical obstruction; severe tachycardia
Cautions: cerebrovascular disease; coronary artery disease (may provoke angina, avoid after myocardial infarction until stabilised); occasionally blood pressure reduction too rapid even with low parenteral doses.
S/E: Angina pectoris; diarrhoea; dizziness; flushing; gastrointestinal disorders; headache; hypotension; joint disorders; lupus-like syndrome; myalgia; nasal congestion; nausea; palpitations; tachycardia; vomiting.
563
Triamcinolone
steroid
564
fluocinonide
steroid
565
calcipotriol
Topical vitamin D
Plaque psoriasis; Scalp psoriasis.
Contra-indications: calcium metabolism disorders
Cautions: avoid excessive exposure to sunlight and sunlamps; avoid use on face; erythrodermic exfoliative psoriasis (enhanced risk of hypercalcaemia); generalised pustular psoriasis.
S/E: skin reactions
566
Apremilast
Inhibits the activity of phosphodiesterase type-4 (PDE4) which results in suppression of pro-inflammatory mediator synthesis and promotes anti-inflammatory mediators.
Active psoriatic arthritis (in combination with disease-modifying antirheumatic drugs or alone).
S/E: Appetite decreased; back pain; cough; depression; diarrhoea; fatigue; gastrointestinal discomfort; gastrointestinal disorders; headaches; increased risk of infection; insomnia; nausea; vomiting
567
Fondaparinux (sodium)
Anticoagulant - synthetic pentasaccharide that inhibits activated factor X. Works in a similar way to low-molecular weight heparin. Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa.
Prophylaxis of venous thromboembolism; Treatment of superficial-vein thrombosis; Treatment of ST-segment elevation, unstable angina and non-ST-segment elevation myocardial infarction.
Contra-indications: active bleeding; bacterial endocarditis.
Cautions: active gastro-intestinal ulcer disease; bleeding disorders; brain surgery; elderly patients; low body-weight; ophthalmic surgery; recent intracranial haemorrhage; risk of catheter thrombus during percutaneous coronary intervention; spinal or epidural anaesthesia; spinal.
S/E: Anaemia; haemorrhage
568
Sildenafil
Phosphodiesterase type V (PDE5) inhibitor.
Brand name: Viagra
Pulmonary arterial hypertension; Erectile dysfunction; Digital ulcers [associated with systemic sclerosis].
Contraindications
patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)
```
Side-effects
visual disturbances e.g. blue discolouration, non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache
```
The blue pill, Viagra (sildenafil), causes blue discolouration of vision.
Avoiding alpha-blockers for 4 hours after sildenafil.
569
Orlistat
Lipase inhibitor, reduces the absorption of dietary fat.
Adjunct in obesity (in conjunction with a mildly hypocaloric diet in individuals with a body mass index (BMI) of 30 kg/m2 or more or in individuals with a BMI of 28 kg/m2 or more in the presence of other risk factors such as type 2 diabetes, hypertension, or hypercholesterolaemia).
C/I: cholestasis; chronic malabsorption syndrome.
Cautions: chronic kidney disease; may impair absorption of fat-soluble vitamins; volume depletion.
Orlistat might affect the absorption of concurrently administered drugs—consider separating administration. Particular care should be taken with antiepileptics, antiretrovirals, and drugs that have a narrow therapeutic index.
S/E: Abdominal pain (may be minimised by reduced fat intake); anxiety; diarrhoea; gastrointestinal disorders.
570
Phenoxybenzamine
Non-selective, irreversible alpha blocker.
Hypertension in phaeochromocytoma.
C/I: during recovery period after myocardial infarction (usually 3–4 weeks); history of cerebrovascular accident
Cautions: avoid in Acute porphyrias; carcinogenic in animals; cerebrovascular disease; congestive heart failure; elderly; severe ischaemic heart disease.
S/E: Abdominal distress; dizziness; ejaculation failure; fatigue; miosis; nasal congestion; postural hypotension; reflex tachycardia.
571
Triptans
almotriptan, naratriptan, sumatriptan, zolmitriptan
Tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches.
Common side effects of triptans include:
```
warm sensations
tightness
tingling
flushing
feelings of heaviness in the face, limbs or chest
```
572
combined oral contraceptive (COC) pill
if patients have migraine with aura then the COC is absolutely contraindicated due to an increased risk of stroke (relative risk 8.72)
573
DOPAMINE HYDROCHLORIDE
Dopamine is a cardiac stimulant which acts on beta1 receptors in cardiac muscle, and increases contractility with little effect on rate.
Cardiogenic shock in infarction or cardiac surgery.
Contra-indications
Phaeochromocytoma; tachyarrhythmia
Cautions
Correct hypovolaemia; hypertension (may raise blood pressure); hyperthyroidism; low dose in shock due to acute myocardial infarction
574
Palivizumab
A monoclonal antibody that targets the respiratory syncytial virus. A monthly injection is given as prevention against bronchiolitis caused by RSV. It is given to high risk babies, such as ex-premature and those with congenital heart disease.
575
Aminophylline
Bronchodilator. Theophylline with ethylenediamine in 2:1 ratio.
Severe acute asthma.
576
Tiotropium bromide
Long acting bronchodilator. long acting muscarinic antagonist (LAMA)
Maintenance treatment of chronic obstructive pulmonary disease. Asthma.
577
Pizotifen
Prevention of migraine
578
Flunarazine
calcium channel blocker
Migrane
579
Tacrolimus
an immunosuppressive drug. It is used after allogeneic organ transplant to lower the risk of organ rejection, and also as a topical medication in the treatment of T-cell-mediated diseases such as eczema and psoriasis
Causes tremor
580
Clonidine Cyclosporine
agonist of alpha-2 adrenergic receptors and imidazoline receptors.
Hypertension;Prevention of recurrent migraine,
Prevention of vascular headache,
Menopausal symptoms, particularly flushing and vasomotor conditions, particularly where there are contraindications to using HRT.
Contra-indications
Severe bradyarrhythmia secondary to second- or third-degree AV block or sick sinus syndrome
Cautions
Cerebrovascular disease; constipation; heart failure; history of depression; mild to moderate bradyarrhythmia; polyneuropathy; Raynaud’s syndrome or other occlusive peripheral vascular disease
Side-effects
Common or very common
Constipation; depression; dizziness; dry mouth; fatigue; headache; nausea; postural hypotension; salivary gland pain; sedation; sexual dysfunction; sleep disorders; vomiting.
Sudden withdrawal can result in rapid increases in blood pressure and agitation.
581
Letrozole
Hormone-dependent breast cancer
Contra-indications
Not indicated for premenopausal women
Cautions
Susceptibility to osteoporosis
Common or very common
Alopecia; appetite abnormal; arthralgia; asthenia; bone fracture; bone pain; constipation; depression; diarrhoea; dizziness; gastrointestinal discomfort; headache; hot flush; hypercholesterolaemia; hyperhidrosis; hypertension; malaise; myalgia; nausea; oedema; osteoporosis; skin reactions; vaginal haemorrhage; vomiting; weight changes
582
Co-cyprindiol
combined oral contraceptive pill
Moderate to severe acne in females of child-bearing age refractory to topical therapy or oral antibacterials,
Moderately severe hirsutism
Contra-indications
Acute porphyrias ; current breast cancer; heart disease associated with pulmonary hypertension or risk of embolus; history of stroke (including transient ischaemic attack); ischaemic heart disease; known thrombogenic mutations; medical treatment for varicose veins; migraine with aura; positive antiphospholipid antibodies; presence or history of liver tumours; previous or current venous or arterial thrombosis; severe or multiple risk factors for arterial or venous thromboembolism; systemic lupus erythematosus with antiphospholipid antibodies
Cautions
Cardiac disease; cervical cancer; cholestasis with previous use of combined oral contraception—seek specialist advice before use; gallbladder disease—seek specialist advice before use; gene mutations associated with breast cancer (e.g. BRCA 1)—seek specialist advice before use; history of breast cancer—seek specialist advice before use; history of cholestasis during pregnancy; history of depression; hyperprolactinaemia—seek specialist advice before use; inflammatory bowel disease including Crohn's disease; migraine; personal or family history of hypertriglyceridaemia (increased risk of pancreatitis); risk factors for arterial thromboembolism; risk factors for venous thromboembolism; sickle-cell disease; systemic lupus erythematosus; undiagnosed breast mass—seek specialist advice before use; undiagnosed vaginal bleeding
583
adapalene
retinoid
Mild to moderate acne vulgaris
Cautions
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 (including sunlight, solariums); avoid in severe acne involving large areas; caution in sensitive areas such as the neck
Conception and contraception
Females of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective).
584
azelaic acid
Acne vulgaris
lymecycline
585
dinoprostone
prostaglandin E2.
Induction of labour
Contra-indications
Active cardiac disease; active pulmonary disease; avoid extra-amniotic route in cervicitis or vaginitis; fetal distress; fetal malpresentation; grand multiparas; history of caesarean section; history of difficult or traumatic delivery; history of major uterine surgery; major cephalopelvic disproportion; multiple pregnancy; placenta praevia or unexplained vaginal bleeding during pregnancy; ruptured membranes; untreated pelvic infection
Cautions
Effect of oxytocin enhanced; history of asthma; history of epilepsy; history of glaucoma and raised intra-ocular pressure; hypertension; risk factors for disseminated intravascular coagulation; uterine rupture; uterine scarring
586
Imiquimod cream
Immune modulator
Actinic keratosis; Warts; Superficial basal cell carcinoma; vulvuar cancer
Cautions
Autoimmune disease; avoid broken skin; avoid contact with eyes; avoid contact with lips; avoid contact with nostrils; avoid open wounds; immunosuppressed patients; not suitable for internal genital warts; uncircumcised males (risk of phimosis or stricture of foreskin)
Side-effects
Common or very common
Appetite decreased; arthralgia; asthenia; headaches; increased risk of infection; lymphadenopathy; myalgia; nausea; pain
587
Cabergoline
A dopamine receptor agonist which inhibits prolactin production causing suppression of lactation. Medication of choice in suppressing lactation when breastfeeding cessation is indicated.
588
Tolvaptan
ADH receptor blockers. (SIADH) They are very powerful and can cause a rapid increase in sodium. Therefore they are usually initiated by a specialist endocrinologist and require close monitoring, for example 6 hourly sodium levels.
589
Linaclotide
a specialist laxative for patients with IBS not responding to first line laxatives
590
Doxapram
Respiratory stimulant.
Postoperative respiratory depression; Acute respiratory failure
Contra-indications
Cerebral oedema; cerebrovascular accident; coronary artery disease; epilepsy and other convulsive disorders; hyperthyroidism; physical obstruction of respiratory tract; severe hypertension; status asthmaticus
Cautions
Give with beta2 agonist in bronchoconstriction; give with oxygen in severe irreversible airways obstruction or severely decreased lung compliance (because of increased work load of breathing); hypertension; impaired cardiac reserve; phaeochromocytoma
591
Pirfenidone
antifibrotic and anti-inflammatory. slows down the progression of idiopathic pulmonary fibrosis by exerting both antifibrotic and anti-inflammatory properties.
592
Nintedanib
a monoclonal antibody targeting tyrosine kinase.
Treatment of idiopathic pulmonary fibrosis.
Cautions
History or risk factors for QT prolongation; impaired wound healing; increased risk of bleeding; patients at high risk of cardiovascular disease; previous abdominal surgery; recent history of hollow organ perforation; theoretical increased risk of gastrointestinal perforation; theoretical increased risk of venous thromboembolism
Side-effects
Common or very common
Abdominal pain; abscess; appetite decreased; dehydration; diarrhoea; electrolyte imbalance; haemorrhage; hyperbilirubinaemia; hypertension; mucositis; nausea; neutropenia; peripheral neuropathy; sepsis; skin reactions; stomatitis; thrombocytopenia; venous thromboembolism; vomiting; weight decreased
593
epoprostenol
Prostaglandin and a potent vasodilator. It is also a powerful inhibitor of platelet aggregation.
Inhibition of platelet aggregation during renal dialysis when heparins are unsuitable or contra-indicated,
Treatment of primary pulmonary hypertension resistant to other treatments, usually with oral anti-coagulation (initiated by a specialist)
Contra-indications
Severe left ventricular dysfunction
Cautions
Avoid abrupt withdrawal when used for primary pulmonary hypertension (risk of rebound pulmonary hypertension); extreme caution in coronary artery disease; haemorrhagic diathesis; pulmonary veno-occlusive disease; reconstituted solution highly alkaline—avoid extravasation (irritant to tissues); risk of pulmonary oedema (dose titration for pulmonary hypertension should be in hospital)
Side-effects
Common or very common
Abdominal pain; anxiety; arrhythmias; arthralgia; chest discomfort; diarrhoea; flushing; haemorrhage; headache; intracranial haemorrhage; nausea; pain; rash; sepsis; vomiting
594
Macitentan
Endothelin receptor antagonist.
Pulmonary arterial hypertension
Contra-indications
Severe anaemia
Cautions
Patients over 75 years; pulmonary veno-occlusive disease
Side-effects
Common or very common
Anaemia; headache; increased risk of infection; nasal congestion
595
Oseltamivir
treatment in someone presenting with suspected influenza that is at risk of complications of influenza:
596
Zanamivir
treatment in someone presenting with suspected influenza that is at risk of complications of influenza:
597
Cyclosporin
Prevents transplant rejection
Side-effects
Eye inflammation
