Drugs Flashcards
GHB
Gamma-hydroxy-butyrate
Omeprazole
PPI
MoA: irreversible blockade of H+/K+ ATPase on gastric parietal cell
cytochrome P450 inhibitor = raised INR = bleeding risk
SEs: hyponatraemia (via SIADH), hypomagnesaemia, increased risk of osteoporosis and fractures (due to calcium & magnesium malabsorption), increased risk of C. difficile infection, microscopic colitis
Lansoprazole
PPI
MoA: irreversible blockade of H+/K+ ATPase on gastric parietal cell
SEs: hyponatraemia, hypomagnesaemia, increased risk of osteoporosis and fractures (due to calcium & magnesium malabsorption), increased risk of C. difficile infection, microscopic colitis
Ramipril
ACEi
Check serum creatinine and potassium levels pre-treatment, after 7 days and 1 month, and whenever dose increased to exclude renal artery stenosis and monitor potassium levels
SEs: dry cough (due to effects on bradykinin), angioedema (hypersensitivity reaction hence stop ACEi), hyperkalaemia, 1st dose hypotension (seen if pt taking diuretic)
Contraindicated in pregnancy/breastfeeding (risk of renal failure, foetal abnormalities e.g. cranial/cardiac defects, or oligohydramnios), renovascular disease, aortic stenosis (may cause hypotension)
Stopped prior to surgery
Lisinopril
ACEi
Check serum Creatinine and potassium levels pre-treatment, after 7 days and 1 month, and whenever dose increased to exclude renal artery stenosis and monitor potassium levels
SEs: dry cough (due to effects on bradykinin), angioedema (hypersensitivity reaction hence stop ACEi), hyperkalaemia, 1st dose hypotension (seen if pt taking diuretic)
Contraindicated in pregnancy/breastfeeding (risk of renal failure, foetal abnormalities e.g. cranial/cardiac defects, or oligohydramnios), renovascular disease, aortic stenosis (may cause hypotension)
Stopped prior to surgery
Enalapril
ACEi
Check serum Creatinine and potassium levels pre-treatment, after 7 days and 1 month, and whenever dose increased to exclude renal artery stenosis and monitor potassium levels
SEs: dry cough (due to effects on bradykinin), angioedema (hypersensitivity reaction hence stop ACEi), hyperkalaemia, 1st dose hypotension (seen if pt taking diuretic)
Contraindicated in pregnancy/breastfeeding (risk of renal failure, foetal abnormalities e.g. cranial/cardiac defects, or oligohydramnios), renovascular disease, aortic stenosis (may cause hypotension)
Stopped prior to surgery
Candesartan
Angiotensin-II receptor blockers
Blocks AT1 receptor (subtype of the angiotensin II receptor)
Check serum Creatinine and potassium levels pre-treatment, after 7 days and 1 month, and whenever dose increased to exclude renal artery stenosis and monitor potassium levels
Irbesartan
Angiotensin-II receptor blockers
Blocks AT1 receptor (subtype of the angiotensin II receptor)
Check serum Creatinine and potassium levels pre-treatment, after 7 days and 1 month, and whenever dose increased to exclude renal artery stenosis and monitor potassium levels
Losartan
Angiotensin-II receptor blockers
Blocks AT1 receptor (subtype of the angiotensin II receptor)
Check serum creatinine and potassium levels pre-treatment, after 7 days and 1 month, and whenever dose increased to exclude renal artery stenosis and monitor potassium levels
SEs: diarrhoea, abdominal pain, dizziness
Amlodipine
Dihydropyridine calcium channel blocker
Reduce calcium ion flow to vascular smooth muscle cells to vasodilate, reducing BP, and reducing the force and rate of the heart beat to prevent angina
SEs: ankle oedema, headache, constipation, diarrhoea, flushing
Verapamil
Non-dihydropyridine calcium channel blocker
Reduce calcium ion flow to vascular smooth muscle cells to vasodilate, reducing BP, and reducing the force and rate of the heart beat to prevent angina
Used for cluster headache prophylaxis (poss. due to vasodilatory effect on cerebral arteries)
SEs: Heart failure, constipation, hypotension, bradycardia, flushing
Avoid if pt is on a beta blocker (risk of complete heart block), or if pt is known to have heart failure
Diltiazem
Calcium channel blocker
Reduce calcium ion flow to vascular smooth muscle cells to vasodilate, reducing BP, and reducing the force and rate of the heart beat to prevent angina
SEs: Hypotension, bradycardia, heart failure, ankle swelling
Nifedipine
Dihydropyridine calcium channel blocker
Reduce calcium ion flow to vascular smooth muscle cells to vasodilate, reducing BP, and reducing the force and rate of the heart beat to prevent angina
SEs: flushing, headache, ankle swelling
Bumetanide
Loop diuretics Inhibits resorption in LoH Mainly used for HTN with CKD Hypokalaemia may lead to hypotension Cause or exacerbate gout
Furosemide
Loop diuretics Inhibits resorption in LoH Mainly used for HTN with CKD Hypokalaemia may lead to hypotension Cause or exacerbate gout
Isosorbide mononitrate
Nitrates
Used to relieve angina
Tolerance may develop with standard release ISMN requiring a change in dose regime hence asymmetric dosing interval should be used
Glyceryl trinitrate
Nitrates
Used sublingually for angina attacks
Alfuzosin
Alpha adrenergic receptor antagonist
Causes vasodilation by inhibiting alpha-related vasoconstriction
Does not elevate glucose but increased insulin sensitivity may lower lipids
May cause postural hypotension in elderly
Doxazosin
Alpha adrenergic receptor antagonist
Causes vasodilation by inhibiting alpha-related vasoconstriction
Does not elevate glucose but increased insulin sensitivity may lower lipids
May cause postural hypotension in elderly
Tamsulosin
Alpha adrenergic receptor antagonist
Causes vasodilation by inhibiting alpha-related vasoconstriction
Does not elevate glucose but increased insulin sensitivity may lower lipids
May cause postural hypotension in elderly
Atenolol
Beta blockers
Used for stable angina tx (can be used in HF pt)
Avoid in HTN due to increased T2DM risk
Avoid in asthmatics
SEs: erectile dysfunction, bronchospasm, sleep disturbances, cold peripheries, fatigue
Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events
May cause depressive symptoms
Bisoprolol
Beta blockers
Can be used as rate control in AF
Avoid in asthmatics and HF pts
SEs: erectile dysfunction, bronchospasm, sleep disturbances, cold peripheries, fatigue
Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events
May cause depressive symptoms
Metoprolol
Beta blockers
Can be used as rate control in AF
Avoid in asthmatics and HF pts
SEs: erectile dysfunction, bronchospasm, sleep disturbances, cold peripheries, fatigue
Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events
May cause depressive symptoms
Ipratropium bromide
Anti-muscarinic bronchodilators
Tiotropium
Anti-muscarinic bronchodilators
Betamethasone
Inhaled corticosteroid
Can be used topically for mild drug hypersensitivity reaction or drug eruption rash
SEs: risk of idiopathic intracranial HTN
Seretide
Fluticasone + Salmeterol
Salbutamol
Beta 2 agonist
Bronchodilator
Quetiapine
Atypical (2nd generation) antipsychotic
Olanzapine
Atypical (2nd generation) antipsychotic
Chlordiazepoxide
Benzodiazepine
Diazepam
Benzodiazepine
Used for anxiety disorders
Lorazepam
Benzodiazepine
Used for anxiety disorders
Midazolam
Benzodiazepine
Used for anxiety disorders
Temazepam
Benzodiazepine
Domperidone
D2 antagonist
Anti-emetic
Metoclopramide
D2 antagonist (central dopamine antagonist) Used for gastrointestinal causes of nausea/vomiting
Co-careldopa
Levodopa/carbidopa
Co-beneldopa
Levodopa
Diclofenac
NSAID
MoA: inhibit cyclooxygenase to reduce prostaglandin and thromboxane A2 production
SEs: urticaria, tinnitus
do not use with any form of cardiovascular disease e.g. IHD, PAD, cerebrovascular disease, HF
Ibuprofen
NSAID
MoA: inhibit cyclooxygenase to reduce prostaglandin and thromboxane A2 production
SEs: urticaria, tinnitus
Codeine
Weak/moderate opioid
SEs: urticaria
Dihydrocodeine
Weak/moderate opioid
SEs: urticaria
Fentanyl
Opioid
SEs: urticaria
Morphine
Opioid
SEs: urticaria
Oxycodone
Opioid
SEs: urticaria
Citalopram
SSRIs
Used for IBS if pt resistant to TCAs
cytochrome P450 inhibitor = raised INR = bleeding risk
IBS dose: 20-40mg PO OD
Fluoxetine
SSRIs
cytochrome P450 inhibitor = raised INR = bleeding risk
Amitriptyline
Tricyclic antidepressant
Used for IBS if laxatives, loperamide or antispasmodics have not helped
IBS dose: 10-25mg PO OD at bedtime
Dosulepin
Tricyclic antidepressant
Gelofusine
Colloid
Volplex
Colloid
Cephalexin/cefalexin
1st gen Cephalosporin
Cefuroxime
2nd gen Cephalosporin
Ceftriaxone
3rd gen Cephalosporin
1st line for gonorrhoea (IM)
Clarithromycin
Macrolides
Can interact with statins to cause statin-induced myopathy
Erythromycin
Macrolide antibiotic
Can interact with statins to cause statin-induced myopathy
Amphotericin
Anti-fungal
Fluconazole
Anti-fungal
Interacts with warfarin hence close INR monitoring required
Nystatin
Anti-fungal
Amoxicillin
Penicillin
SEs: urticaria
Co-amoxiclav
Penicillin
Used for human and animal bites if the skin has been broken and blood is drawn
SEs: urticaria
Flucloxacillin
Penicillin
1st line tx for Erysipelas (500-1000mg QDS PO 5-7d) and most skin infections, 1st line for otitis externa
SEs: urticaria
Penicillin G
Penicillin
Benzylpenicillin - used IM as 1st line tx for syphilis
SEs: urticaria
Penicillin V
Penicillin
Phenoxymethylpenicillin
SEs: urticaria
Doxycycline
Tetracycline antibiotic V. cheap drug Avoid in pregnancy Can be used in malaria tx and prophylaxis Used as alternative drug for syphilis tx SEs: idiopathic intracranial HTN
Artesunate
Anti-protozoal
Chloroquine
Anti-protozoal
Anti-malarial drug
Quinine sulphate
Anti-protozoal
Used for treatment of malaria
Dexamethasone
Corticosteroids
Mild anti-emetic effects hence may be given preoperatively to surgical patients
SEs: risk of idiopathic intracranial HTN
Hydrocortisone
Corticosteroids
SEs: risk of idiopathic intracranial HTN
Prednisolone
Topical corticosteroid
1st line treatment for ITP (high dose required)
SEs: risk of idiopathic intracranial HTN
Mesalazine
Aminosalicylates
SEs: steven-johnson syndrome
Loperamide hydrochloride
Anti-motility drug used for acute diarrhoea
Dose: 4mg initially, 2mg after each loose stool (max 16mg/day) for 5days
Ranitidine
Histamine (H2) receptor antagonists
Used if PPI poorly tolerated for dyspepsia
Macrogol
Osmotic laxatives
Lactulose
Osmotic laxative Used for constipation May be given to IBS sufferer Synthetic disaccharide with a sweet taste which can increase bloating in some patients 10-20 g (15-30 mL) PO OD
Senna
Stimulant laxative
Docusate sodium
Stimulant laxative
Spironolactone
Aldosterone antagonist
K+ sparing diuretic, used in Conn’s
Not licensed for HTN use but starting dose is 12.5mg (1/2 tablet)
SEs: hyperkalaemia, gynaecomastia
Perindopril
ACEi
Check serum Creatinine and potassium levels pre-treatment, after 7 days and 1 month, and whenever dose increased to exclude renal artery stenosis and monitor potassium levels
SEs: dry cough (due to effects on bradykinin), angioedema (hypersensitivity reaction hence stop ACEi), hyperkalaemia, 1st dose hypotension (seen if pt taking diuretic)
Contraindicated in pregnancy/breastfeeding (risk of renal failure, foetal abnormalities e.g. cranial/cardiac defects, or oligohydramnios), renovascular disease, aortic stenosis (may cause hypotension)
Stopped prior to surgery
Atropine sulfate
Antimuscarinic/anticholinergic
Used for IBS as an antispasmodic
GI spasm dose: 0.6-1.2mg OD at night
Also used for bradycardia
Hyoscine butylbromide
Antimuscarinic/anticholinergic
Used for IBS as an antispasmodic to relieve symptomatic GI smooth muscle spasm
Dose: 10mg PO TDS (up to 20mg QDS)
Clopidogrel
Antiplatelet, P2Y12 receptor antagonist
75mg given lifelong post-TIA/Stroke (after initial 2 weeks of aspirin)
Used to reduce cardiovascular risk e.g. in peripheral arterial disease (along with a statin)
Lercanidipine
Dihydropyridine calcium channel blocker
Reduce calcium ion flow to vascular smooth muscle cells to vasodilate, reducing BP, and reducing the force and rate of the heart beat to prevent angina
SEs: ankle oedema and headache
Digoxin
Cardiac glycoside
Use: rate control in atrial fibrillation, symptom improvement in HF (due to positive inotropic effect)
MoA: reduces conduction through AVN, increases force of contraction (by inhibiting Na+/K+ ATPase pump in cardiac muscle and vagus stimulation)
Narrow therapeutic index but regular monitoring not required, except in suspected toxicity (8-12hrs after last dose)
SEs: toxicity causes xanthopsia(yellow/green-tinted vision), arrhythmias, low K+/Mg+
Tx of severe digoxin toxicity = digibind
Toxicity more likely with hypokalaemia
Direct Oral Anticoagulants (DOACs) Rivaroxaban
Reversible factor Xa inhibitors Dabigatran Edoxaban Apixaban Rivaroxaban Prevents conversion of prothrombin to thrombin and prolongs clotting time to prevent thrombus formation
Bendroflumethiazide
Thiazide-like diuretic
SEs: hypercalcaemia & hypocalciuria
Indapamide
Thiazide diuretic
Used for HTN treatment
SEs: hypercalcaemia & hypocalciuria
Alteplase
Fibrinolytics
Simvastatin
Statin
Used for angina
May cause statin-induced myopathy, higher risk if pt on macrolide
Not safe in pregnancy
Atorvastatin
Statin
Used for angina
1st line for secondary prevention of CVD = 80mg (high dose)
Not safe in pregnancy
Pravastatin
Statin
Used for angina
Not safe in pregnancy
Warfarin
Vitamin K antagonist Not safe in pregnancy Warfarin interacts with fluconazole Careful monitoring of INR is required Preferred anticoagulant for mitral stenosis
Salmeterol
Beta 2 agonist
Beclometasone
Inhaled corticosteroid
SEs: risk of idiopathic intracranial HTN
Fluticasone
Inhaled corticosteroid
SEs: risk of idiopathic intracranial HTN
Budesonide
Inhaled corticosteroid
SEs: risk of idiopathic intracranial HTN
Cyclizine
H1 receptor antagonist
Cetirizine
H1 receptor antagonist
Loratadine
H1 receptor antagonist
Antihistamine
Fexofenadine
H1 receptor antagonist
Chlorphenamine
H1 receptor antagonist
Symptomatic relief of allergy such as hay fever (allergic rhinitis), urticaria, food allergy, drug reactions
4mg every 4-6hrs PO (max. 24mg)
OR 10mg IV/IM for emergency relief (max. 4x)
Montelukast
Leukotriene receptor antagonist
Carbocysteine
Mucolytics
Donepezil
Acetylcholinesterase inhibitor
Venlafaxine
Selective serotonin-norepinephrine reuptake inhibitor
Used for major depression, panic disorder, generalised anxiety disorder, and social anxiety
Mirtazapine
Antidepressant
Citalopram
SSRI
cytochrome P450 inhibitor = raised INR = bleeding risk
Used for depressive disorders, panic disorders, social phobia, and OCD
Sertraline
SSRI
cytochrome P450 inhibitor = raised INR = bleeding risk
SEs: steven-johnson syndrome
Metoclopramide
D2 antagonist
Anti-emetic
Domperidone
D2 antagonist anti-emetic
Ondansetron
5HT3 antagonist that acts on the chemoreceptor trigger zone area of the medulla oblongata
May be given post-operatively to patients for anti-emetic effects
Used for chemotherapy-induced nausea/vomiting
SEs: constipation and prolonged QT interval
Haloperidol
1st generation anti-psychotic
Dopamine receptor antagonist
Used for raised ICP causes of nausea
Risperidone
Atypical (2nd generation) anti-psychotic
Tramadol
Weak/moderate opioids
SEs: urticaria
Sumatriptan
5HT1 receptor agonist
Used for acute management of cluster headaches and migraines with high flow oxygen
Zopiclone
Z-drug hence used for insomnia in short term
SEs: dry mouth, bitter taste, skin reactions
Clotrimazole
Antifungal
Ketoconazole
Antifungal
Aciclovir
Antiviral
Used for Herpes Zoster (shingles) tx: 800mg 5x/day PO 7d
Also used for herpes simplex virus
Piperacillin sodium/tazobactam sodium
Anti-pseudomonal penicillin
SEs: urticaria
Amoxicillin
Broad spectrum penicillin
SEs: urticaria
Co-amoxiclav
Broad spectrum penicillin
SEs: urticaria
Flucloxacillin
Penicillinase-resistant penicillins
SEs: urticaria
Ciprofloxacin
Quinolone
cytochrome P450 inhibitor = raised INR = bleeding risk
Not safe in pregnancy/breastfeeding or for G6PD pt
Moxifloxacin
Quinolone
Not safe in pregnancy
Metformin
Biguanide
Use contraindicated if eGFR < 30
SEs: constipation, diarrhoea, vomiting, nausea
Bisphosphonates
Prevents bone resorption hence used for osteoporosis mx
E.g., alendronate 10mg PO OD, risedronate 5mg PO OD, IV zoledronic acid
Important to check renal function before prescribing,
SEs: oesophageal ulceration (commonest side effect), jaw osteonecrosis (aka avascular necrosis), atypical femoral fracture
Sitagliptin
Dipeptidyl peptidase-4 inhibitors (DPP4) = indirectly reduces insulin secretion
T2DM
100mg PO OD
safe for use in pts at risk of hypoglycaemia as monotherapy
Linagliptin
Dipeptidyl peptidase-4 inhibitors (DPP4) = indirectly reduces insulin secretion
T2DM
5mg PO OD
Ethinylestradiol with levonorgestrel AKA combined ethinylestradiol
Oestrogen
Desogestrel
Progestogen
Oestradiol
Oestrogen
Gliclazide
Sulphonylureas
Safe to use with low eGFR but, lower dose required
Not safe in pregnancy
Levothyroxine
Thyroid hormone replacement used in hypothyroidism (e.g., Hashimoto’s thyroiditis)
Starting dose: 50-100mcg od (25mcg OD for elderly or IHD pt)
If pt pregnant, increase dose by 50%
SEs: hyperthyroidism (over treatment), reduced bone mineral density, worsening of angina, atrial fibrillation
Finasteride
5-alpha reductase inhibitor
Use: benign prostatic hyperplasia
Doxazosin
Alpha-adrenoceptor blocker
Used for hypertension
Tamsulosin
Alpha-adrenoceptor blocker causing smooth muscle in the prostate to relax which improves urinary flow
Used for benign prostatic hyperplasia
Solifenacin
Anti-muscarinic (genitourinary use)
Tolterodine
Anti-muscarinic (genitourinary use)
Oxybutynin
Anti-muscarinic (genitourinary use)
Used for urinary urge, frequency, incontinence in overactive bladder
Sildenafil
Phosphodiesterase (type 5) inhibitor
SEs: blue-tinted vision (cyanopsia)
Azathioprine
Anti-proliferative immunosuppressant
Used in chronic ITP for pregnant women, used for myasthenia gravis
Tamoxifen
Breast cancer tx
Allopurinol
Xanthine oxidase inhibitor which reduces uric acid levels
Gout and hyperuricaemia prophylaxis = 100mg PO OD
cytochrome P450 inhibitor = raised INR = bleeding risk
Do not start use during acute attacks, but if already pt is already on allopurinol, it can be continued during acute attacks
Naproxen
NSAID
MoA: inhibit cyclooxygenase to reduce prostaglandin and thromboxane A2 production
SEs: urticaria, tinnitius
Hypromellose
Ocular lubricants (artificial tears)
Lidocaine/lignocaine
Local anaesthetic Reversible sodium channel blocker Strengths: 0.5%, 1%, 2% Administered subcutaneously Takes effect within 5-10 minutes Duration: 30-120 minutes Maximum adult dose: 3mg/kg Side effects: anaphylaxis, convulsions, paraesthesia or anxiety If IV injection, can cause life threatening cardiac arrhythmias and cardiovascular instability
Latanoprost
Prostaglandin analogue
Ferrous sulphate/fumarate
Iron supplements
200mg PO BD/TDS for 3months for IDA
SEs: diarrhoea, constipation, nausea, dark stool, abdominal discomfort
Doxorubicin hydrochloride
Chemotherapy agent used for Non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, breast cancer, and many other cancers
Aka anthracycline chemotherapeutic agents as extracted from Streptomyces bacterium
Metaramine
Potent sympathomimetic amine used to increase systolic and diastolic blood pressure
Indication: prevent or reverse acute hypotensive state with spinal anaesthesia
Action: alpha-1 adrenergic receptor agonist, mild beta receptor agonist
Adrenaline
(epinephrine)
Propanolol
Beta blocker
Avoid in asthmatics and HF pts
SEs: erectile dysfunction, bronchospasm, sleep disturbances, cold peripheries, fatigue
Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events
Used for sympathetic nervous system overactivity e.g. generalised anxiety disorder and hyperthyroidism (symptom management)
May be used as migraine prophylaxis
May cause depressive symptoms
Felodipine
Calcium channel blocker
Dihydropyridine calcium channel blocker
Reduce calcium ion flow to vascular smooth muscle cells to vasodilate, reducing BP, and reducing the force and rate of the heart beat to prevent angina
SEs: Flushing, headache, ankle swelling
Amiodarone
Anti-arrhythmic
Blocks potassium rectifier channels in heart responsible for repolarisation of heart
300mg IV given during shockable rhythm defibrillation
cytochrome P450 inhibitor = raised INR = bleeding risk
SEs: risk of idiopathic intracranial HTN, thyroid dysfunction (hypo/hyper), long QT, pulmonary fibrosis, peripheral neuropathy, bradycardia
Alginates
Blood
Adenosine
Blood
Aspirin
Acetylsalicylic acid
Inhibits cyclooxgenase (COX) 1 & 2 enzymes to reduce prostaglandin and thromboxane A2 production
Provides pain relief, reduces fever and inflammation
Used for angina
Following ischaemic stroke/TIA, 300mg aspirin is given for 2 weeks then clopidogrel is used. If clopidogrel is contraindicated, aspirin and modified-release dipyridamole are used instead for secondary prevention of TIA/ischaemic stroke
SEs: urticaria (histamine production stimulated due to inhibition of PG and thromboxane A2 production) steven-johnson syndrome
Unfractionated heparin
Activates antithrombin III which forms a complex to inhibit thrombin (factor IIa), factor IXa, Xa, XIa, XIIa
Administered intravenously
Used if high risk of bleeding e.g. perioperatively as can be terminated rapidly (short action)
regular monitoring of APTT required
SEs: bleeding, heparin-induced thrombocytopaenia, osteoporosis, hyperkalaemia
Carbamazepine
Anti-epileptic
Chemically similar to the tricyclic antidepressant drugs
MoA: binds to sodium channels increasing their refractory period
1st line tx for partial seizures
Also used for bipolar disorder and trigeminal neuralgia
Ineffective in absence seizures
cytochrome P450 inducer hence INR may be reduced
SEs: steven-johnson syndrome, cytochrome P450 inducer, dizziness, drowsiness, ataxia, headaches, hyponatraemia secondary to SIADH, leucopenia (myelosuppression and agranulocytosis), visual disturbances (diplopia)
May exhibit autoinduction causing return of seizures 3-4weeks after treatment initiation
Not safe in pregnancy
Nicotine
Used for smoking cessation
Methadone
Used for substance dependence
Gabapentin
Analgesic
Used for neuropathic pain e.g. diabetic neuropathy, allodynia, hyperalgesia
Pregabalin
Analgesic
Used for anxiety disorders
Lamotrigine
Anti-epileptic agent
2nd line tx for generalised and partial seizures
MoA: sodium channel blocker
SEs: steven-johnson syndrome
Levetiracetam
Anti-epileptic
SEs: hyponatraemia, anxiety, insomnia, mood changes, confusion, hallucinations, impaired concentration
Paracetamol
Analgesic
Sodium valproate
Anti-epilpetic
Not safe in pregnancy
cytochrome P450 inhibitor = raised INR = bleeding risk
SEs: suicidal behaviour, behavioural changes, impaired concentration, hallucination, agitation, hyponatraemia
Chloramphenicol
Anti-septic agent
Metronidazole
Antibiotic and anti-protozal activity
Forms reactive cytotoxic metabolites in bacteria
1st line tx for giardiasis - 250mg PO TDS for 5-7d
Also used for amoebic dysentery and bacterial vaginosis
SEs: disulfiram-like reaction with alcohol
Nitrofurantoin
Antibiotic commonly used for uncomplicated UTIs
Standard course for uncomplicated UTIs = 3d (women)
Course of complicated UTIs = 7d (pregnant women & men)
Trimethoprim
Antibiotic
Used for UTI treatment in non-pregnant women and men
Not safe in pregnancy due teratogenic effects
Vancomycin
Antibiotic
Insulin
Promotes uptake of glucose from bloodstream into cells
Methotrexate
Dihydrofolate reductase inhibitor
Conventional DMARD
Used of immunological disorders e.g. rheumatoid arthritis (First line agent)
Used for immunosuppressive action in myasthenia gravis
SEs: mouth ulcers, liver toxicity, bone marrow suppression, pulmonary fibrosis
Not safe in pregnancy
Calcium
Important for bones
Vitamin D
Important for bones
Folic acid
Vitamin
Thiamine hydrochloride
AKA Vitamin B1
Vitamin supplement used in alcohol dependence patient to prevent Wernicke’s encephalopathy
Essential for aerobic metabolism, cell growth, transmission of nerve impulses and acetylcholine synthesis
Vitamin B12
Important
Vitamine B6
Important
Hypromellose
Ocular lubricant (artificial tears)
Emollients
Moisturisers
N-acetylcysteine
Used for paracetamol overdose
Activated charcoal
Used for overdoses of recreational drugs
Naloxone
Used to reverse effects of opioid overdose
Duloxetine
Serotonin/norepinephrine reuptake inhibitor
Used for urinary incontinence associated with stress
Pts typically do not respond to reduction in caffeine intake and pelvic floor exercises before duloxetine is tried
SEs: nausea, dizziness, headache, insomnia, dry mouth
Also acts as an antidepressant hence used for nerve pain in fibromyalgia tx with a starting dose of 60mg PO OD
Volatile anaesthetic agents
Isoflurane
Sevoflurane
Desflurane
Methoxyflurane (nephrotoxicity, used for patient controlled analgesia short term)
Nitrous oxide (gas under RTP)
Halothane (no longer used in US, can cause hepatotoxicity, medium duration)
Enflurane (proconvulsive, medium duration)
Effects: respiratory depression, decreased arterial blood pressure, decreased cerebral metabolic demand, increased cerebral blood flow, decreased RR, myocardial depression
SEs: nausea and vomiting, malignant hypothermia, postoperative shivering
Sevoflurane
Liquid under RTP hence requires a vaporizer
Medium duration hence takes a little longer for pt to come round compared to desflurane
May cause malignant hyperthermia
Commonly used due to rapid onset and recovery
AEs: interacts with soda lime → nephrotoxic breakdown products (known as compounds A–E)
Isoflurane
Liquid under RTP hence requires a vaporizer
Long duration
Most potent of the fluranes
Desflurane
Inhaled anaesthetic (induction agent)
Liquid under RTP hence requires a vaporizer
Pungent odour and may irritate airways
Short duration
AEs: sympatho-adrenergic reaction (↑ BP & HR)
Propofol
Fast acting
Very potent
Obtunds airway reflexes
Ketamine
Induction agent
Painkiller
Protects airway reflexes and less apnoeic effect
Used in paediatrics and out of hospital settings e.g. battlefield
Thiopentone
Induction agent
Used for rapid sequence induction due to fast onset and 1 arm-brain circulation
Reduced use due to adverse effects
Suxamethonium
Fast acting, depolarising nicotinic receptor agonist (muscle relaxant)
Binds to nicotinic acetylcholine receptors at the NMJ to depolarise motor end plate causing flaccid paralysis of skeletal muscles
Short acting effects as plasma cholinesterases break down suxamethonium in 5-10mins
Sugamadex
Reversal agent/antidote used for vecuronium and rocuronium
Non-depolarising muscle relaxants
Consider to be competitive (nicotinic acetylcholine receptor antagonists)
Used for longer procedures
Atracurium
Rocuronium
Vecuronium
Cisatracurium - fewer SEs than atracurium; Hofman elimination (temp. and pH dependent degradation)
Atracurium reversal
Requires:
Anti- acetylcholinesterase agent e.g. neostigmine or pyridostigmine
AND
Anticholinergic agent e.g. atropine or glycopyrrolate to prevent muscarinic effects of the anticholinesterase
Emergency anaesthetic drugs
Ephedrine (alpha 1/2 and beta 1 agonist) to ↑BP and ↑HR
Metaraminol (alpha 1 agonist) to ↑BP
Used for BP or HR drops intra-operatively
Atracurium
Non-depolarising muscle relaxant
Metabolized mostly by Hofmann elimination
May stimulate histamine release (causing hypotension and bradycardia), and laudanosine (CNS stimulant provoking seizures) during degradation
Reversal of effects achieved by anticholinesterase agents such as neostigmine or pyridostigmine
Ispaghula
Laxative
Used for constipation
May be given to IBS sufferer
Linaclotide
14 amino acid peptide
Binds and activates guanylate cyclase C receptor on luminal surface of enterocyte
Used for any type of IBS to reduce pain and increase intestinal secretion and transit
Side effects of antimuscarinics e.g. atropine sulfate, hyoscine butylbromide
Constipation Dizziness Drowsiness Dry mouth Dyspepsia Flushing Headache Nausea Palpitations Skin reactions Tachycardia Urinary disorders Vision disorders; Vomiting
Mebeverine hydrochloride
Direct-acting intestinal smooth muscle relaxants
Relieves abdominal pain or spasm in IBS
Dose: 135mg PO TDS 20mins before meals (up to 150mg)
SEs: angioedema, face oedema, skin reaction
Paroxetine
SSRI
Used for IBS if pt resistant to TCAs
IBS dose: 20-40mg PO OD
cytochrome P450 inhibitor = raised INR = bleeding risk
SSRI side effects
Anxiety Arrhythmias & palpitations Concentration impairment Confusion & memory loss Dizziness or drowsiness Haemorrhage Menstrual cycle irregularities Nausea (dose-related) & vomiting QT interval prolongation
Calcineurin inhibitors
Class of 3 drugs: cyclosporine, tacrolimus, and pimecrolimus
Inhibit phosphatase calcineurin through different mechanisms to block T cell proliferation
May be used for minimal change disease or focal segmental glomerulosclerosis
Used as immunosuppression therapy for allograft transplantation
Cyclosporine has the worst side effects including serious infections, lymphoma, nephrotoxicity and hepatotoxicity
Rituximab
Monoclonal antibodies that bind to CD20 surface antigen on B lymphocytes to cause cell lysis and induce cell death by apoptosis
Thought to reduce B cell activity leading to platelet autoantibody, and upregulate regulatory T cells in ITP
Used for ITP (2nd line), CLL, non-Hodgkin’s lymphoma, RA (4th line), sarcoidosis
SEs: night sweats and thrombocytopenia
Avoid in pregnancy
Penicillamine
Aids the elimination of copper ions in Wilson’s disease (hepatolenticular degeneration)
1.5-2g daily in divided doses initially, maintenance dose of 0.75-1g daily (administered orally)
Carvedilol
Beta blocker
Avoid in asthmatics and HF pts
SEs: erectile dysfunction, bronchospasm, sleep disturbances, cold peripheries, fatigue
Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events
May cause depressive symptoms
Esmolol
Beta blocker
Avoid in asthmatics and HF pts
SEs: erectile dysfunction, bronchospasm, sleep disturbances, cold peripheries, fatigue
Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events
May cause depressive symptoms
Nebivolol
Beta blocker
Avoid in asthmatics and HF pts
SEs: erectile dysfunction, bronchospasm, sleep disturbances, cold peripheries, fatigue
Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events
May cause depressive symptoms
IV immunoglobulin
Used to rapidly increase platelet function and count in ITP if pt is actively bleeding or if an urgent invasive procedure is required
Anti-D immunoglobulin
Can be used to increase platelet function in ITP but associated with many risks, hence no longer commonly used in UK
Fostamatinib
Spleen tyrosine kinase inhibitor used for ITP
Blocks IgG antibody receptor signalling in WBCs to stop immune destruction of platelets
Avoid in pregnancy; only used in adults
Mycophenolate mofetil
May be used in ITP if chronic or persistent
Immunosuppressive agent that boosts platelet count
Thrombopoeitin receptor agonist (2nd gen)
E.g. romiplostim and eltrombopag
Used for chronic ITP
Require indefinite administration to prevent platelet count returning to basal levels
Avoid in pregnancy
Cephalosporins
Beta lactam antibiotics 1st gen: cefalexin, cefazolin 2nd gen: cefuroxime, ceftoxitin 3rd gen: ceftriaxone, ceftazidime 4th gen: cefpirome, cefepime 5th gen: ceftaroline, ceftolozane
Monobactam
Aztreonam
Carbapenems
Meropenem
Imipenem
Ertapenem
Aminoglycosides
Gentamicin Kanamycin Neomycin Tobramycin Streptomycin Amikacin MoA: bind to a protein in the 30S ribosomal subunit of the bacterium to cause misreading of mRNA codons resulting in defective protein synthesis; BACTERICIDAL Not safe in pregnancy
Tinnitus is a side effect of which medications?
NSAIDs e.g. Naproxen, aspirin
Aminoglycosides
Loop diuretics
Sulphonamides
Antibiotics
Avoid in pregnancy
SEs: risk of idiopathic intracranial HTN
Phenytoin
Anti-epileptic tx
cytochrome P450 inducer hence INR may be reduced
SEs: steven-johnson syndrome
Not safe in pregnancy
Sevelamer
Non-calcium based phosphate binder
Used for hyperphosphataemia in patients with CKD mineral bone disease
Calcium acetate
Calcium-based phosphate binder
Used for hyperphosphataemia
SE: hypercalcaemia
Calcium carbonate
Calcium-based phosphate binder
Used for hyperphosphataemia
SE: hypercalcaemia
Dialysis
Initiation for CKD-MBD determined by impact of symptoms of uraemia on daily living, uncontrollable fluid overload, or eGFR of 5-7ml/min/1.73m2
Tranexamic acid
Antifibrinolytic that reversibly binds to lysine receptor sites on plasminogen or plasmin to prevent plasmin from breaking down fibrin
Used for menorrhagia
Within the first 3hours of major bleeding trauma, a 1g IV bolus of tranexamic acid can be given followed by a 1g slow infusion over 8hrs
Disulfiram
Used to cause sensitivity to alcohol in alcohol dependent patients
Inhibits acetaldehyde dehydrogenase
Alcohol consumption results in headache, palpitations, head and neck flushing, N&V, sweating
Valaciclovir
Antiviral
Used for Herpes zoster (shingles) tx: 1g TDS PO 7d
SEs: N&V, photosensitivity, Microangiopathic haemolytic anaemia
Antibiotics effective against carbapenemases
Colistin - SEs: nephro & neurotoxicity
Tigecycline - low serum levels hence, not effective in sepsis
Fosfomycin - high IV dose required typically poorly tolerated
Antibiotics effective against inducible chromosomal cephalosporinase
Carbapenems
Temocillin
Aminoglycosides
Ciprofloxacin
Antibiotics effective against pseudomonas
Ciprofloxacin Gentamicin Meropenem Piperacillin-Tazobactam Amikacin Levofloxacin
Antibiotics effective against MRSA
Doxycycline Vancomycin Teicoplanin Rifampicin Trimethoprim Sodium fusidate
Praziquantel
Tx for tapeworm (Taenia solium) and schistosomiasis
SEs: N&V, abdo cramping
Ciclosporin(e)
Calcineurin inhibitor
Used for RA, Crohn’s, focal glomerulosclerosis, minimal change disease, psoriasis, myasthenia gravis
SEs: risk of idiopathic intracranial HTN, serious infections, lymphoma, nephrotoxicity and hepatotoxicity
Labetalol
Beta blocker with arteriolar vasodilating action hence reduces peripheral resistance
Given IV in management of type B aortic dissection to reduce BP
SEs: bronchospasm, sleep disturbances, cold peripheries, fatigue
Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events
May cause depressive symptoms
Imidazole derivatives
E.g. ketoconazole
Antifungal agents
SEs: steven-johnson syndrome
Varenicline
Selective nicotine receptor partial agonist
Used for smoking cessation - start 1 week before cessation and gradually increase dose
SEs: appetite change, dry mouth, taste disturbance, dizziness, drowsiness, headache, abnormal dreams, depression, suicidal thoughts, sleep disorders, panic, dysarthria
Bupropion
Noradrenaline–dopamine reuptake inhibitor and a nicotinic receptor antagonist
Used for smoking cessation - higher quit rate seen (30%)
SEs: seizures (1:1000), insomnia, headache, Steven Johnson syndrome
Magnesium sulphate
Given IV for acute severe or life-threatening asthma attacks
Nicorandil
Potassium channel activator which has a vasodilatory effect on the coronary arteries
Used for angina
Side-effects include headache, flushing
and anal ulceration
Prochlorperazine
Dopamine receptor antagonist
Antiemetic agent used for vestibular problems
Used for psychotic delusions
Orlistat
Lipase inhibitor hence reduces dietary fat absorption
Used for weight loss in overweight or obese patients
SEs: oily faecal incontinence, anorectal haemorrhage, cholelithiasis, diverticulitis, hepatitis
Terbutaline
Short-acting beta 2 agonist (bronchodilator)
Used in asthma
Aminophylline
Used IV for asthma attacks after senior consultant involvement
Dobutamine
Beta 1 agonist
Increases contractility and HR (inotrope)
Used for BP drop intra-operatively
Interferon alpha
Cytokine produced by leucocytes, binds to type 1 receptors, and cause anti-viral effects
Interferon typically released by the body in response to viral infections and neoplasia
Use: tx for hepatitis B & D, Kaposi’s sarcoma, metastatic renal cell cancer, hairy cell leukaemia
SEs: flu-like symptoms, depression
Interferon beta
Cytokine produced by fibroblasts, binds to type 1 receptors, and cause anti-viral effects
Interferon typically released by the body in response to viral infections and neoplasia
Reduces frequency of relapsing-remitting MS
Interferon gamma
Cytokine produced by natural killer cells and T helper cells, binds to type 2 receptors to cause immunomodulatory effects (macrophage activation)
Use: chronic granulomatous disease, osteopetrosis
Interferon typically released by the body in response to viral infections and neoplasia
Pyridostigmine
Long-acting acetylcholinesterase inhibitor
Reduces the breakdown of acetylcholine in the neuromuscular junction
Use: myasthenia gravis
Cyclophosphamide
Alkylating agent
Use: immunosuppressive action for myasthenia gravis
Flecanide
Class Ic anti-arrhythmic
Use: supraventricular and ventricular tachycardias
Propylthiouracil
Anti-thyroid drug
Not used as first line due to small risk of liver damage
Used if carbimazole cannot be tolerated
Carbimazole
Anti-thyroid drug
1st line tx for hyperthyroidism (e.g. Graves’ disease)
SEs: neutropenia (agranulocytosis) hence pt must present to hospital if fever, sore throat, mouth ulcers are seen
Ticagrelor
P2Y12 receptor antagonist, antiplatelet
Used in STEMI mx with aspirin, unfractionated heparin, and PCI
Prasugrel
P2Y12 receptor antagonist, antiplatelet
May be used in STEMI mx with aspirin, unfractionated heparin, and PCI
Tissue plasminogen activator
AKA tPA
May be used as thrombolysis in STEMI mx if PCI unavailable
Tenecteplase
May be used as thrombolysis in STEMI mx (instead of PCI) as easier to administer than alteplase
Flumazenil
GABA receptor antagonist
Used to reverse the effects of a lorazepam overdose
Baclofen
GABA receptor agonist
Alpha receptor agonists
Phenylephrine/oxymetazoline = decongestants
Topical brimonidine = glaucoma tx
Ropinirole
Dopamine receptor agonist used for Parkinson’s disease
Bromocriptine
Dopamine receptor agonist
Used for prolactinoma treatment and galactorrhoea (excessive milk production), may be used for acromegaly
Pilocarpine
Muscarinic agonist
Used for glaucoma
Rifampicin
cytochrome P450 inducer hence INR may be reduced
Effective against MRSA
SE: orange tears and urine
Pyridoxine
Vitamin B6 supplement
Used for sideroblastic anaemia
Roaccutane
Used for severe acne
Can cause depressive symptoms
Erythropoietin
haematopoietic growth factor secreted by the kidney in response to cellular hypoxia that stimulates the production of erythrocytes
Used to treat anaemia associated with CKD and cytotoxic therapy
Poor response to therapy if pt has iron deficiency anaemia
SEs: accelerated hypertension potentially leading to encephalopathy and seizures (blood pressure increases in 25% of patients), bone aches, flu-like symptoms, skin rashes, urticaria, pure red cell aplasia (due to antibodies against erythropoietin), raised PCV increases risk of thrombosis (e.g. Fistula), iron deficiency 2nd to increased erythropoiesis
Low molecular weight heparin
Activates antithrombin III to form a complex that inhibits factor Xa
Administered subcutaneously
E.g., dalteparin/enoxaparin/tinzaparin sodium
Long action compared to UH; monitoring not routinely required but can monitor anti-factor Xa if indicated
Used in venous thromboembolism tx and prophylaxis, acute coronary syndrome (and MI tx)
SEs: bleeding, hyperkalaemia, lower risk of HIT and osteoporosis than UH
Clozapine
Antipsychotic used for schizophrenia and psychosis in Parkinson’s disease
D1, D2, 5HT2A, alpha 1 and muscarinic receptor antagonist
SE: neutropenia
Ocreotide
Somatostatin analogue which blocks growth hormone
Used for acromegaly tx
Pegvisomant
Growth hormone antagonist
Used for acromegaly tx
Bromocriptine
Dopamine agonist used to suppress growth hormone
Used for acromegaly tx
Exenatide
GLP-1 receptor agonist = inhibits glucagon secretion
T2DM drug
safe for use in pts at risk of hypoglycaemia as monotherapy
Pioglitazone
Used for T2DM as 15-30mg PO OD
glitazone class
Monitor LFTs
safe for use in pts at risk of hypoglycaemia as monotherapy
Danaparoid sodium
Heparinoid
Typically used for DVT prophylaxis in pt undergoing general or orthopaedic surgery
Can be used for pt who have developed heparin-induced thrombocytopaenia
Fondaparinux
Synthetic pentasaccharide that inhibits factor Xa (synthetic heparin)
Used for STEMI, NSTEMI, DVT, PE tx
Prophylaxis in major orthopaedic surgery of the hip or leg, or abdominal surgery
Denosumab
Monoclonal antibodies against RANK ligand which reduce osteoclastic activity
Used in osteoporosis mx
If stopped, rebound increase in bone turnover may be seen hence, must start bisphosphonate
SEs: soft tissue infections in heavily immunocompromised pt, jaw osteonecrosis
Teriparatide
Recombinant PTH which promotes bone formation
SC injection OD for 2yrs for secondary prevention of osteoporosis if T < -3.5
Half-life of 6hrs causes sig. bone density increase
Long term use associated with osteosarcoma hence <2yrs
Contraindications: hyperparathyroidism, bone cancer, previous radiotherapy, renal impairment
SEs: increase bone turnover therefore bisphosphonates when stopping
Raloxifene
Selective oestrogen receptor modulators
Used for osteoporosis mx
SEs: leg cramps, VTE
levofloxacin
Quinolone
Not safe in pregnancy/breastfeeding or for G6PD pt
Leflunomide
Conventional DMARD
Disrupts pyrimidine production (needed for RNA/DNA)
Used for RA (one of 1st line agents)
SEs: mouth ulcers, raised BP, liver toxicity, bone marrow suppression, peripheral neuropathy
Not safe in pregnancy
Sulfasalazine
conventional DMARD
First line agent in rheumatoid arthritis
Safe in pregnancy if taken with folic acid supplements
SEs: reduced sperm count, bone marrow suppression
TNF inhibitors
Adalimumab, infliximab, etanercept
3rd line for RA, type of biological DMARD
MoA: inhibit TNF-mediated inflammation
SEs: ↑ risk of severe infection/sepsis, TB/HepB reactivation risk
Tocilizumab
IL-6 receptor antagonist
biological agent used in rheumatoid arthritis (fourth line agent)
Hydroxychloroquine
Anti-malarial agent
Immunosuppressive action by disrupting Toll-like receptor antigen presentation
Used in mild/palindromic RA
Safe in pregnancy
SEs: reduced visual acuity (macular toxicity), nightmares
Colchicine
Used as 2nd line agent for acute attacks of gout
Dose: 1.2mg PO then 0.6mg 1hr later (max. 1.8mg)
Can be used in renal impairment if eGFR > 10 mL/minute/1.73 m2
SEs: dose-related diarrhoea therefore reduced dose slightly if reported
Naftidrofuryl oxalate
5HT2 receptor antagonist results in peripheral vasodilation
Used for intermittent claudication in peripheral arterial disease if pt shows no improvement with lifestyle management & refuses surgery
Stop if no improvement after 3-6mo
Cholestyramine
Bile acid sequestrant hence, binds to bile acids to prevent reabsorption
Used for pruritus associated with partial biliary obstruction and primary biliary cirrhosis & primary CHD prevention in men with primary hyperlipidaemia (35-39yo)
SE: vitamin ADEK deficiency, hypoprothrombinaemia, night blindness
Ursodeoxycholic acid
Used for primary biliary cirrhosis and breaks down gallstones
