Drugs Flashcards
1
Q
GHB
A
Gamma-hydroxy-butyrate
2
Q
Omeprazole
A
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
3
Q
Lansoprazole
A
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
4
Q
Ramipril
A
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
5
Q
Lisinopril
A
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
6
Q
Enalapril
A
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
7
Q
Candesartan
A
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
8
Q
Irbesartan
A
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
9
Q
Losartan
A
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
10
Q
Amlodipine
A
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
11
Q
Verapamil
A
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
12
Q
Diltiazem
A
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
13
Q
Nifedipine
A
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
14
Q
Bumetanide
A
Loop diuretics Inhibits resorption in LoH Mainly used for HTN with CKD Hypokalaemia may lead to hypotension Cause or exacerbate gout
15
Q
Furosemide
A
Loop diuretics Inhibits resorption in LoH Mainly used for HTN with CKD Hypokalaemia may lead to hypotension Cause or exacerbate gout
16
Q
Isosorbide mononitrate
A
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
17
Q
Glyceryl trinitrate
A
Nitrates
Used sublingually for angina attacks
18
Q
Alfuzosin
A
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
19
Q
Doxazosin
A
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
20
Q
Tamsulosin
A
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
21
Q
Atenolol
A
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
22
Q
Bisoprolol
A
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
23
Q
Metoprolol
A
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
24
Q
Ipratropium bromide
A
Anti-muscarinic bronchodilators
25
Tiotropium
Anti-muscarinic bronchodilators
26
Betamethasone
Inhaled corticosteroid
Can be used topically for mild drug hypersensitivity reaction or drug eruption rash
SEs: risk of idiopathic intracranial HTN
27
Seretide
Fluticasone + Salmeterol
28
Salbutamol
Beta 2 agonist
| Bronchodilator
29
Quetiapine
Atypical (2nd generation) antipsychotic
30
Olanzapine
Atypical (2nd generation) antipsychotic
31
Chlordiazepoxide
Benzodiazepine
32
Diazepam
Benzodiazepine
| Used for anxiety disorders
33
Lorazepam
Benzodiazepine
| Used for anxiety disorders
34
Midazolam
Benzodiazepine
| Used for anxiety disorders
35
Temazepam
Benzodiazepine
36
Domperidone
D2 antagonist
| Anti-emetic
37
Metoclopramide
```
D2 antagonist (central dopamine antagonist)
Used for gastrointestinal causes of nausea/vomiting
```
38
Co-careldopa
Levodopa/carbidopa
39
Co-beneldopa
Levodopa
40
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
41
Ibuprofen
NSAID
MoA: inhibit cyclooxygenase to reduce prostaglandin and thromboxane A2 production
SEs: urticaria, tinnitus
42
Codeine
Weak/moderate opioid
| SEs: urticaria
43
Dihydrocodeine
Weak/moderate opioid
| SEs: urticaria
44
Fentanyl
Opioid
| SEs: urticaria
45
Morphine
Opioid
| SEs: urticaria
46
Oxycodone
Opioid
| SEs: urticaria
47
Citalopram
SSRIs
Used for IBS if pt resistant to TCAs
cytochrome P450 inhibitor = raised INR = bleeding risk
IBS dose: 20-40mg PO OD
48
Fluoxetine
SSRIs
| cytochrome P450 inhibitor = raised INR = bleeding risk
49
Amitriptyline
Tricyclic antidepressant
Used for IBS if laxatives, loperamide or antispasmodics have not helped
IBS dose: 10-25mg PO OD at bedtime
50
Dosulepin
Tricyclic antidepressant
51
Gelofusine
Colloid
52
Volplex
Colloid
53
Cephalexin/cefalexin
1st gen Cephalosporin
54
Cefuroxime
2nd gen Cephalosporin
55
Ceftriaxone
3rd gen Cephalosporin
| 1st line for gonorrhoea (IM)
56
Clarithromycin
Macrolides
| Can interact with statins to cause statin-induced myopathy
57
Erythromycin
Macrolide antibiotic
| Can interact with statins to cause statin-induced myopathy
58
Amphotericin
Anti-fungal
59
Fluconazole
Anti-fungal
| Interacts with warfarin hence close INR monitoring required
60
Nystatin
Anti-fungal
61
Amoxicillin
Penicillin
| SEs: urticaria
62
Co-amoxiclav
Penicillin
Used for human and animal bites if the skin has been broken and blood is drawn
SEs: urticaria
63
Flucloxacillin
Penicillin
1st line tx for Erysipelas (500-1000mg QDS PO 5-7d) and most skin infections, 1st line for otitis externa
SEs: urticaria
64
Penicillin G
Penicillin
Benzylpenicillin - used IM as 1st line tx for syphilis
SEs: urticaria
65
Penicillin V
Penicillin
Phenoxymethylpenicillin
SEs: urticaria
66
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
```
67
Artesunate
Anti-protozoal
68
Chloroquine
Anti-protozoal
| Anti-malarial drug
69
Quinine sulphate
Anti-protozoal
| Used for treatment of malaria
70
Dexamethasone
Corticosteroids
Mild anti-emetic effects hence may be given preoperatively to surgical patients
SEs: risk of idiopathic intracranial HTN
71
Hydrocortisone
Corticosteroids
| SEs: risk of idiopathic intracranial HTN
72
Prednisolone
Topical corticosteroid
1st line treatment for ITP (high dose required)
SEs: risk of idiopathic intracranial HTN
73
Mesalazine
Aminosalicylates
| SEs: steven-johnson syndrome
74
Loperamide hydrochloride
Anti-motility drug used for acute diarrhoea
| Dose: 4mg initially, 2mg after each loose stool (max 16mg/day) for 5days
75
Ranitidine
Histamine (H2) receptor antagonists
| Used if PPI poorly tolerated for dyspepsia
76
Macrogol
Osmotic laxatives
77
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
```
78
Senna
Stimulant laxative
79
Docusate sodium
Stimulant laxative
80
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
81
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
82
Atropine sulfate
Antimuscarinic/anticholinergic
Used for IBS as an antispasmodic
GI spasm dose: 0.6-1.2mg OD at night
Also used for bradycardia
83
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)
84
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)
85
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
86
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
87
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
```
88
Bendroflumethiazide
Thiazide-like diuretic
| SEs: hypercalcaemia & hypocalciuria
89
Indapamide
Thiazide diuretic
Used for HTN treatment
SEs: hypercalcaemia & hypocalciuria
90
Alteplase
Fibrinolytics
91
Simvastatin
Statin
Used for angina
May cause statin-induced myopathy, higher risk if pt on macrolide
Not safe in pregnancy
92
Atorvastatin
Statin
Used for angina
1st line for secondary prevention of CVD = 80mg (high dose)
Not safe in pregnancy
93
Pravastatin
Statin
Used for angina
Not safe in pregnancy
94
Warfarin
```
Vitamin K antagonist
Not safe in pregnancy
Warfarin interacts with fluconazole
Careful monitoring of INR is required
Preferred anticoagulant for mitral stenosis
```
95
Salmeterol
Beta 2 agonist
96
Beclometasone
Inhaled corticosteroid
| SEs: risk of idiopathic intracranial HTN
97
Fluticasone
Inhaled corticosteroid
| SEs: risk of idiopathic intracranial HTN
98
Budesonide
Inhaled corticosteroid
| SEs: risk of idiopathic intracranial HTN
99
Cyclizine
H1 receptor antagonist
100
Cetirizine
H1 receptor antagonist
101
Loratadine
H1 receptor antagonist
| Antihistamine
102
Fexofenadine
H1 receptor antagonist
103
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)
104
Montelukast
Leukotriene receptor antagonist
105
Carbocysteine
Mucolytics
106
Donepezil
Acetylcholinesterase inhibitor
107
Venlafaxine
Selective serotonin-norepinephrine reuptake inhibitor
| Used for major depression, panic disorder, generalised anxiety disorder, and social anxiety
108
Mirtazapine
Antidepressant
109
Citalopram
SSRI
cytochrome P450 inhibitor = raised INR = bleeding risk
Used for depressive disorders, panic disorders, social phobia, and OCD
110
Sertraline
SSRI
cytochrome P450 inhibitor = raised INR = bleeding risk
SEs: steven-johnson syndrome
111
Metoclopramide
D2 antagonist
| Anti-emetic
112
Domperidone
D2 antagonist anti-emetic
113
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
114
Haloperidol
1st generation anti-psychotic
Dopamine receptor antagonist
Used for raised ICP causes of nausea
115
Risperidone
Atypical (2nd generation) anti-psychotic
116
Tramadol
Weak/moderate opioids
| SEs: urticaria
117
Sumatriptan
5HT1 receptor agonist
| Used for acute management of cluster headaches and migraines with high flow oxygen
118
Zopiclone
Z-drug hence used for insomnia in short term
| SEs: dry mouth, bitter taste, skin reactions
119
Clotrimazole
Antifungal
120
Ketoconazole
Antifungal
121
Aciclovir
Antiviral
Used for Herpes Zoster (shingles) tx: 800mg 5x/day PO 7d
Also used for herpes simplex virus
122
Piperacillin sodium/tazobactam sodium
Anti-pseudomonal penicillin
| SEs: urticaria
123
Amoxicillin
Broad spectrum penicillin
| SEs: urticaria
124
Co-amoxiclav
Broad spectrum penicillin
| SEs: urticaria
125
Flucloxacillin
Penicillinase-resistant penicillins
| SEs: urticaria
126
Ciprofloxacin
Quinolone
cytochrome P450 inhibitor = raised INR = bleeding risk
Not safe in pregnancy/breastfeeding or for G6PD pt
127
Moxifloxacin
Quinolone
| Not safe in pregnancy
128
Metformin
Biguanide
Use contraindicated if eGFR < 30
SEs: constipation, diarrhoea, vomiting, nausea
129
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
130
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
131
Linagliptin
Dipeptidyl peptidase-4 inhibitors (DPP4) = indirectly reduces insulin secretion
T2DM
5mg PO OD
132
Ethinylestradiol with levonorgestrel AKA combined ethinylestradiol
Oestrogen
133
Desogestrel
Progestogen
134
Oestradiol
Oestrogen
135
Gliclazide
Sulphonylureas
Safe to use with low eGFR but, lower dose required
Not safe in pregnancy
136
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
137
Finasteride
5-alpha reductase inhibitor
| Use: benign prostatic hyperplasia
138
Doxazosin
Alpha-adrenoceptor blocker
| Used for hypertension
139
Tamsulosin
Alpha-adrenoceptor blocker causing smooth muscle in the prostate to relax which improves urinary flow
Used for benign prostatic hyperplasia
140
Solifenacin
Anti-muscarinic (genitourinary use)
141
Tolterodine
Anti-muscarinic (genitourinary use)
142
Oxybutynin
Anti-muscarinic (genitourinary use)
| Used for urinary urge, frequency, incontinence in overactive bladder
143
Sildenafil
Phosphodiesterase (type 5) inhibitor
| SEs: blue-tinted vision (cyanopsia)
144
Azathioprine
Anti-proliferative immunosuppressant
| Used in chronic ITP for pregnant women, used for myasthenia gravis
145
Tamoxifen
Breast cancer tx
146
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
147
Naproxen
NSAID
MoA: inhibit cyclooxygenase to reduce prostaglandin and thromboxane A2 production
SEs: urticaria, tinnitius
148
Hypromellose
Ocular lubricants (artificial tears)
149
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
```
150
Latanoprost
Prostaglandin analogue
151
Ferrous sulphate/fumarate
Iron supplements
200mg PO BD/TDS for 3months for IDA
SEs: diarrhoea, constipation, nausea, dark stool, abdominal discomfort
152
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
153
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
154
Adrenaline
(epinephrine)
155
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
156
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
157
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
158
Alginates
Blood
159
Adenosine
Blood
160
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
161
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
162
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
163
Nicotine
Used for smoking cessation
164
Methadone
Used for substance dependence
165
Gabapentin
Analgesic
| Used for neuropathic pain e.g. diabetic neuropathy, allodynia, hyperalgesia
166
Pregabalin
Analgesic
| Used for anxiety disorders
167
Lamotrigine
Anti-epileptic agent
2nd line tx for generalised and partial seizures
MoA: sodium channel blocker
SEs: steven-johnson syndrome
168
Levetiracetam
Anti-epileptic
| SEs: hyponatraemia, anxiety, insomnia, mood changes, confusion, hallucinations, impaired concentration
169
Paracetamol
Analgesic
170
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
171
Chloramphenicol
Anti-septic agent
172
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
173
Nitrofurantoin
Antibiotic commonly used for uncomplicated UTIs
Standard course for uncomplicated UTIs = 3d (women)
Course of complicated UTIs = 7d (pregnant women & men)
174
Trimethoprim
Antibiotic
Used for UTI treatment in non-pregnant women and men
Not safe in pregnancy due teratogenic effects
175
Vancomycin
Antibiotic
176
Insulin
Promotes uptake of glucose from bloodstream into cells
177
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
178
Calcium
Important for bones
179
Vitamin D
Important for bones
180
Folic acid
Vitamin
181
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
182
Vitamin B12
Important
183
Vitamine B6
Important
184
Hypromellose
Ocular lubricant (artificial tears)
185
Emollients
Moisturisers
186
N-acetylcysteine
Used for paracetamol overdose
187
Activated charcoal
Used for overdoses of recreational drugs
188
Naloxone
Used to reverse effects of opioid overdose
189
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
190
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
191
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)
192
Isoflurane
Liquid under RTP hence requires a vaporizer
Long duration
Most potent of the fluranes
193
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)
194
Propofol
Fast acting
Very potent
Obtunds airway reflexes
195
Ketamine
Induction agent
Painkiller
Protects airway reflexes and less apnoeic effect
Used in paediatrics and out of hospital settings e.g. battlefield
196
Thiopentone
Induction agent
Used for rapid sequence induction due to fast onset and 1 arm-brain circulation
Reduced use due to adverse effects
197
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
198
Sugamadex
Reversal agent/antidote used for vecuronium and rocuronium
199
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)
200
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
201
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
202
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
203
Ispaghula
Laxative
Used for constipation
May be given to IBS sufferer
204
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
205
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
```
206
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
207
Paroxetine
SSRI
Used for IBS if pt resistant to TCAs
IBS dose: 20-40mg PO OD
cytochrome P450 inhibitor = raised INR = bleeding risk
208
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
```
209
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
210
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
211
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)
212
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
213
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
214
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
215
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
216
Anti-D immunoglobulin
Can be used to increase platelet function in ITP but associated with many risks, hence no longer commonly used in UK
217
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
218
Mycophenolate mofetil
May be used in ITP if chronic or persistent
| Immunosuppressive agent that boosts platelet count
219
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
220
Cephalosporins
```
Beta lactam antibiotics
1st gen: cefalexin, cefazolin
2nd gen: cefuroxime, ceftoxitin
3rd gen: ceftriaxone, ceftazidime
4th gen: cefpirome, cefepime
5th gen: ceftaroline, ceftolozane
```
221
Monobactam
Aztreonam
222
Carbapenems
Meropenem
Imipenem
Ertapenem
223
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
```
224
Tinnitus is a side effect of which medications?
NSAIDs e.g. Naproxen, aspirin
Aminoglycosides
Loop diuretics
225
Sulphonamides
Antibiotics
Avoid in pregnancy
SEs: risk of idiopathic intracranial HTN
226
Phenytoin
Anti-epileptic tx
cytochrome P450 inducer hence INR may be reduced
SEs: steven-johnson syndrome
Not safe in pregnancy
227
Sevelamer
Non-calcium based phosphate binder
| Used for hyperphosphataemia in patients with CKD mineral bone disease
228
Calcium acetate
Calcium-based phosphate binder
Used for hyperphosphataemia
SE: hypercalcaemia
229
Calcium carbonate
Calcium-based phosphate binder
Used for hyperphosphataemia
SE: hypercalcaemia
230
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
231
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
232
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
233
Valaciclovir
Antiviral
Used for Herpes zoster (shingles) tx: 1g TDS PO 7d
SEs: N&V, photosensitivity, Microangiopathic haemolytic anaemia
234
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
235
Antibiotics effective against inducible chromosomal cephalosporinase
Carbapenems
Temocillin
Aminoglycosides
Ciprofloxacin
236
Antibiotics effective against pseudomonas
```
Ciprofloxacin
Gentamicin
Meropenem
Piperacillin-Tazobactam
Amikacin
Levofloxacin
```
237
Antibiotics effective against MRSA
```
Doxycycline
Vancomycin
Teicoplanin
Rifampicin
Trimethoprim
Sodium fusidate
```
238
Praziquantel
Tx for tapeworm (Taenia solium) and schistosomiasis
| SEs: N&V, abdo cramping
239
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
240
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
241
Imidazole derivatives
E.g. ketoconazole
Antifungal agents
SEs: steven-johnson syndrome
242
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
243
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
244
Magnesium sulphate
Given IV for acute severe or life-threatening asthma attacks
245
Nicorandil
Potassium channel activator which has a vasodilatory effect on the coronary arteries
Used for angina
Side-effects include headache, flushing
and anal ulceration
246
Prochlorperazine
Dopamine receptor antagonist
Antiemetic agent used for vestibular problems
Used for psychotic delusions
247
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
248
Terbutaline
Short-acting beta 2 agonist (bronchodilator)
| Used in asthma
249
Aminophylline
Used IV for asthma attacks after senior consultant involvement
250
Dobutamine
Beta 1 agonist
Increases contractility and HR (inotrope)
Used for BP drop intra-operatively
251
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
252
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
253
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
254
Pyridostigmine
Long-acting acetylcholinesterase inhibitor
Reduces the breakdown of acetylcholine in the neuromuscular junction
Use: myasthenia gravis
255
Cyclophosphamide
Alkylating agent
| Use: immunosuppressive action for myasthenia gravis
256
Flecanide
Class Ic anti-arrhythmic
| Use: supraventricular and ventricular tachycardias
257
Propylthiouracil
Anti-thyroid drug
Not used as first line due to small risk of liver damage
Used if carbimazole cannot be tolerated
258
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
259
Ticagrelor
P2Y12 receptor antagonist, antiplatelet
| Used in STEMI mx with aspirin, unfractionated heparin, and PCI
260
Prasugrel
P2Y12 receptor antagonist, antiplatelet
| May be used in STEMI mx with aspirin, unfractionated heparin, and PCI
261
Tissue plasminogen activator
AKA tPA
| May be used as thrombolysis in STEMI mx if PCI unavailable
262
Tenecteplase
May be used as thrombolysis in STEMI mx (instead of PCI) as easier to administer than alteplase
263
Flumazenil
GABA receptor antagonist
| Used to reverse the effects of a lorazepam overdose
264
Baclofen
GABA receptor agonist
265
Alpha receptor agonists
Phenylephrine/oxymetazoline = decongestants
| Topical brimonidine = glaucoma tx
266
Ropinirole
Dopamine receptor agonist used for Parkinson's disease
267
Bromocriptine
Dopamine receptor agonist
| Used for prolactinoma treatment and galactorrhoea (excessive milk production), may be used for acromegaly
268
Pilocarpine
Muscarinic agonist
| Used for glaucoma
269
Rifampicin
cytochrome P450 inducer hence INR may be reduced
Effective against MRSA
SE: orange tears and urine
270
Pyridoxine
Vitamin B6 supplement
| Used for sideroblastic anaemia
271
Roaccutane
Used for severe acne
| Can cause depressive symptoms
272
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
273
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
274
Clozapine
Antipsychotic used for schizophrenia and psychosis in Parkinson's disease
D1, D2, 5HT2A, alpha 1 and muscarinic receptor antagonist
SE: neutropenia
275
Ocreotide
Somatostatin analogue which blocks growth hormone
| Used for acromegaly tx
276
Pegvisomant
Growth hormone antagonist
| Used for acromegaly tx
277
Bromocriptine
Dopamine agonist used to suppress growth hormone
| Used for acromegaly tx
278
Exenatide
GLP-1 receptor agonist = inhibits glucagon secretion
T2DM drug
safe for use in pts at risk of hypoglycaemia as monotherapy
279
Pioglitazone
Used for T2DM as 15-30mg PO OD
glitazone class
Monitor LFTs
safe for use in pts at risk of hypoglycaemia as monotherapy
280
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
281
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
282
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
283
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
284
Raloxifene
Selective oestrogen receptor modulators
Used for osteoporosis mx
SEs: leg cramps, VTE
285
levofloxacin
Quinolone
| Not safe in pregnancy/breastfeeding or for G6PD pt
286
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
287
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
288
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
289
Tocilizumab
IL-6 receptor antagonist
| biological agent used in rheumatoid arthritis (fourth line agent)
290
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
291
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
292
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
293
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
294
Ursodeoxycholic acid
Used for primary biliary cirrhosis and breaks down gallstones
