GI System Flashcards
Mebeverine
Antispasmodic
IBS
200mg BD
Symptomatic relief: max. single dose is 135 mg, max. daily dose is 405 mg;
For uses other than symptomatic relief of irritable bowel syndrome: max. single dose is 100 mg and max. daily dose is 300 mg.
Suspension not for children under 10, Tablet/MR capsule not for use in children.
Avoid in pregnancy
Side effects: mild, rarely causes problem, allergy (itchy rash, swelling), angiodema/face oedema
Peppermint Oil
Relief of abdominal colic and distension, particularly in IBS
1–2 capsules 3 times a day for up to 3 months if necessary, capsule to be swallowed whole with water; Manufacturer advises capsules should not be broken or chewed because peppermint oil may irritate mouth or oesophagus. (Colpermin, Mintec)
> Do not take indigestion remedies 2 hours before or after you take this medicine
Take 30 to 60 minutes before food
Swallow this medicine whole. Do not chew or crush
Caution: Sensitivity to Menthol
Side Effects: Heartburn, indigestion
Mesalazine
Aminosalicylate
Treatment of mild to moderate ulcerative colitis, acute attack
> 2.4g in divided doses (Asacol MR 400)
2.4g-4.8g in divided doses (Asacol MR 800)
2.4g-4.8g OD or divided doses (Octasa)
4g OD or divided doses (Pentasa tablets: Manufacturer advises tablets may be halved, quartered, or dispersed in water, but should not be chewed.
Pentasa granules: Manufacturer advises granules should be placed on tongue and washed down with water or orange juice without chewing
In Children: Expert sources advise contents of one sachet should be weighed and divided immediately before use; discard any remaining granules.)
Hepatic/Renal Impairment: caution in mild to moderate, avoid in severe
MR tablet: Take with or just after food, or a meal, Swallow this medicine whole. Do not chew or crush
GR tablet: Do not take indigestion remedies 2 hours before or after you take this medicine, Swallow this medicine whole. Do not chew or crush
MR granules: Swallow this medicine whole. Do not chew or crush
Hepatic/Renal impairment: caution in mild to moderate, avoid in severe
>Renal function should be monitored before starting, at 3 months, and annually during treatment
Breast feeding: diarrhoea in breast-fed infant
Contra-indicated: blood clotting abnormalities
Stick to same brand
Side Effects: gastrointestinal symptoms, aches and pains, blood disorder: unexplained bleeding, bruising, red or purple discolourations of the skin (purpura), sore throat, a high temperature (fever), or if you feel generally unwell (malaise).
Sulfasalazine
Treatment of acute and mild to moderate and severe ulcerative colitis I Active Crohn’s disease
1-2g QDS until remission occurs
Maintenance
500mg QDS
Doses in children upon body weight
> Tablet: This medicine may colour your urine. This is harmless
GR Tablet: Do not take indigestion remedies 2 hours before or after you take this medicine, This medicine may colour your urine. This is harmless, Swallow this medicine whole. Do not chew or crush
Caution: G6PD deficiency, asthma, hepatic toxicity
Monitoring: full blood count, renal/liver function
Hepatic: caution
Renal: caution in mild to moderate, avoid in severe
Drink plenty of water
Side Effects: nausea, loss of appetite, diarrhoea, abdominal pain, headache, rash, dizzy, Gives body fluids (such as tears and urine) a yellow/orange colour. This is harmless. >More severe: Trouble sleeping (insomnia). Altered Taste. Bleeding disorder. Allergy, Jaundice.
***HAS BEEN CONFUSED WITH SULFADIAZINE, CARE TO BE TAKEN WHEN DISPENSED
Beclometasone dipropionate
Corticosteroid
Adjunct to aminosalicylates in acute mild to moderate ulcerative colitis
5mg daily max duration of treatment of 4 weeks, dose to be taken in the morning
Hepatic: Avoid in severe
Budesonide
Glucocorticoid, anti-inflammatory effects
Mild to moderate Crohn’s disease affecting the ileum or ascending colon
9mg OD for 8 weeks, to be taken in the morning, reduce dose gradually over two weeks following treatment (Budenofalk)
Side Effects: muscle twitching, oedema, oral disorder, diarrhoea, GI disorders
Teduglutide
Amino Acid and Derivative
glucagon-like peptide-2 (GLP-2), preserves mucosal integrity by promoting growth and repair of the intestine
Short Bowel Syndrome
Macrogol 3350
Osmotic Laxative
(Laxido, Movical)
Onset 24-48hrs
Bowel cleansing
Moviprep: 1L for 2 doses
Plenvu: 500mL for 2 doses
1st dose on evening before procedure, 2nd dose on morning of procedure
Chronic Constipation
Child 12-17: FS 1-3 satchets, HS 2-6
Adult: FS 1-3 satchets, HS 2-6
full strength: 13.125g, half strength/paediatric 6.563g
Caution: CVD impairment, 2 FS or 4HS in any one hour
Isphaghula Husk
Bulk-Forming Laxative
(increases faecal mass which stimulates peristalsis)
Constipation
up to 11 yrs: 2.5-5mL BD, dose to be given as a half or whole level spoonful in water, preferably after meals, morning and evening
12-Adult: 1 satchet BD
1 satchet equal to 2 level 5mL spoonful
To be taken with at least 150mL
Contra: faecal impaction, intestinal obstruction, reduced gut motility
Adequate fluid intake
Fybogel
Lactulose
Osmotic Laxative
Constipation
Adult: 15mL BD
Docusate Sodium
Softening Laxative
Oral onset: 1-2 days, Rectal within 20 min
Chronic Constipation
Oral:
up to 11 yrs: 12.5-25 mg TDS (oral solution)
12-Adult: 500mg in divided doses
Rectum: 120mg for 1 dose
Contra: abdominal obstruction
Caution: excess use of stimulant can cause diarrhoea and hypokalaemia
Dioctyl
Liquid Parrafin
Softening Laxative
Constipation
10-30mL daily at night
Side effect: anal irritation, contact dermatitis, rectal discharge of drug, granuloma (cluster of white blood cells)
Bisacodyl
Stimulant Laxative
Acts in 10-12hrs, suppository in 20-60min
Constipation
4-17yrs: 5-20mg ON
Adult: 5-10mg, increased to 20mg ON
Rectum:
2-17yrs: 5-10mg OM
Adult: 10mg OM
may be used for constipation but higher dose not licensed in children
Co-danthramer
Stimulant Laxative
Constipation in Palliative Care (standard stregnth capsule)
6-11yrs: 1 capsule ON, oral suspension 2.5-5mL ON
12-Adult: 1-2capsules OD, oral suspension 5-10mL ON
Glycerol
Stimulant Laxative
1-11months: 1g as required
Children1-11yrs: 2g suppository as required
12-Adult 4g suppository as required
Moisten suppository before insertion
Senna
Stimulant Laxactive
Constipation
6-17 yrs: 7.5-30mg OD
Adult: 7.5-15mg ON (max. 30mg) start dose low then gradual increase
Naloxegol
Opiod Receptor Antagonist
(Moventig)
decreases the constipating effects of opioids without altering central analgesic effects
25mg OM
concurrent use of CYP3A4 inhibitors
SE: abdominal pain, diarrhoea, flatulence, headache, vomitting, nausea
Loperamide HCl
Antidiarrohoeals
Initially 4mg, followed by 2mg for up to 5 days, dose to be taken after each stool (max 16mg)
not licensed in children under 8
***REPORTS OF SERIOUS CARDIAC ADVERSE REACTIONS (QT PROLONGATION, CARDIAC ARREST, TORSADES DE POINTES) WITH HIGH DOSES WITH ABUSE/MISUSE, NALOXONE ANTIDOTE
ALGINIC ACID
Alginate Antacid
Management of GORD
Gaviscon Infant
uptown 4.5kg: 1 dose as req
4.5+: 2 doses as req
contra: intestinal obstruction, preterm neonates, excess water loss
renal impairment: avoid antacids with large amounts of sodium in patients with fluid retention
Sodium Alginate with Potassium Bicarbonate
Alginate Antiacid
Acidex/Gaviscon Advance
Management of mild symptoms of dyspepsia and GORD
up to 11: under medical advice only
12-Adult: 5-10ML after meal/bedtime
Co-magaldrox
Aluminium and Magnesium
Maalox/Mucogel
Dyspepsia: 10-20mL taken 20-60 min after eating/bedtime or when required
renal impairment: effervescent preparations of analgesics contain citrates which increases aluminium absorption=risk of aluminium toxicity
Simeticone
Antifoaming Drugs
Infacol
Colic/Wind Pains
1month-1yr: 0.5-1mL with/after each feed
Windeze
Bismuth Subsalicylate
Antacid
Helicobacter Pylori eradication
525mg QDS for 7 days
children under 16 at risk of Reyes syndrome
SE: black stools, black tongue/saliva
Famotidine
H2-Receptor Antagonist
Treatment of Benign gastric and duodenal ulceration
40mgON 4-8 week
Maintenance treatment of duodenal ulceration 20mgON
Reflux Oesophagits
20-40mg BD 6-12 weeks
SE: constipation, diarrhoea, dizzy, fatigue, headache
Cimetidine
Nizatidine
Ranitidine
H2 Receptor Antagonist
Benign duodenal ulceratoin/benign gastric ulceration/NSAID associated ulceration
C:400mg BD
N: 300mg ON
R: 75, 150, 300 OD/BD
Hepatic: increase risk of confusion, reduce does
Renal: reduce to 200mg QDS if eGFR 30-50mL/min/1.73m2
Misoprostol
Prostaglandins and Analogues
Cytotec
Benign duodenal ulceratoin/benign gastric ulceration/NSAID induced peptic ulcer
400mcg BD
Prophylaxis
200mcg 2-4times daily
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
Proton Pump Inhibitor
***Very low risk of subacute cutaneous lupus: lesions in sun-exposed areas can occur from weeks/months/years after exposure of drug
can increase the risk of fractures when used in high doses for over a year in elderly, risk of osteoporosis
may mask symptoms of gastric cancer
increased risk of C. difficile
Sodium Alginate with Calcium Carbonate and Sodium Bicarbonate
Alginate Antacid
Acidex/Gaviscon/Peptac/Rennie
GORD
6-11: 5-10mL after meal/bedtime
12-Adult: 10-20mL after meal/bedtime
H. Pylori Triple Therapy
comprises a PPI and 2 antibacterials for 7 days
1st: a proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole
PENICILIN ALLERGY: A proton pump inhibitor, plus clarithromycin, and metronidazole.
2nd: A proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (whichever not used in first line)
Dicycloverine Hal
Antimuscarinic
Symptomatic relief of GI disorders characterised by smooth muscle spasm
Adult: 10-20mg TDS
Contra: child under 6 months
SE: decreased appetite, thirst, fatigue
Avoid in breastfeeding mothers, apnoea reported in infants (muscle/soft tissue in throat relax and causes total blockage of airways)
Hyoscine Butylbromide
Antimuscarinic
Symptomatic relief of gastro-intestinal or genito-urinary disorders characterised by smooth muscle spasm
IBS
***Buscopan injection: serious risk of tachycardia, hypotension, and anaphylaxis in patients with underlying cardiac disease
Buscopan
Alverine Citrate
Antispasmodics
Symptomatic relief of gastro-intestinal disorders characterised by smooth muscle spasm
12-17: 60-120mg 1-3 times
Adult: 60-120mg 1-3 times
Cholic Acid
Ursodeoxycholic Acid
Bile Acids
Inborn errors of primary bile acid synthesis (initiated by specialist)
Dissolution of gallstones
Avoid in chronic liver disease
Orlistat
Lipase Inhibitor, Peripherally Acting Antiobesity Products
120mg TDS
Alli (without prescription, no more than 6 months): 60mg TDS
blocks enzyme that digests fat, undigested fat is not absorbed and therefore eliminated through stool
reduce your fat intake to 30%
goal is a 5% (or more) weight loss within three months of starting orlistat, should not continue if not lost
SE: flatulence, oily stools, loose/increased stools, oily spotting, urgency to use restroom
use other methods of contraceptive as you may have severe diaherroa
Benzyl benzoate with bismuth oxide, bismuth subgallate, hydrocortisone acetate, Peru balsam and zinc oxide
Corticosteroid
Haemorrhoids/Pruritus ani
by rectum using ointment
apply twice daily for no longer than 7 days applied morning and night, additional dose applied after bowel movement
Anusol HC
***corticosteroids: rare risk of central chorioretinopathy with local as well as systemic administration
cinchocaine with hydrocortisone
corticosteroid
haemorrhoids
proctosedyl ointment/uniroid-hc ointment
apply twice daily (externally or by rectum) and after a bowel movement, no more than 7 days
suppositories
insert 1 at night, morning, and after a bowel movement
cinchocaine with prednisolone
corticosteroid
sheriproct ointment
apply BD for 5-7 days, 3-4 times on the first day, then once daily for a few days after symptoms have cleared
Pancreatin
pancreatin enzyme
compensate for reduced/absent endocrine secretion, assist digestion of starch, fat and protein
Creon
1-2 capsules with meal or mixed with acidic/soft food
SE: constipation, nausea, vomitting, abdominal distension
Digoxin
Cardiac Glycoside
Maintenance for atrial fibrillation
125-250mcg OD
Heart failure
62.5-125mcg OD (reduce for elderly)
Caution: hypercalcaemia, hyperkalaemia, hypermagneseamia
SE: diarrhoea, dizziness, nausea, vomitting, vision disorder (blurry)
Monitor concentration in renal impairment
Tranexamic Acid
Antifibrinolytics, Antihaemorrhagics
Local fibrinolysis
Menorrhagia
1g TDS for up to 4 days, initiated when menstruation has started
Emicizumab
Haemostatic, Antimhaemorrhagics
monoclonal antibody
Prophylaxis of haemorrhage in haemophilia A
Dried prothrombin complex
coagulation proteins, blood and related products
Treatment and peri-operative prophylaxis of haemorrhage in patients with congenital deficiency of factors II, VII, IX, or X if purified specific coagulation factors not available,
Treatment and peri-operative prophylaxis of haemorrhage in patients with acquired deficiency of factors II, VII, IX, or X (e.g. during warfarin treatment)
Factor VIIa (recombinant)
Factor VIII fraction, dried
Factor IX fraction, dried
Factor XIII fraction, dried
Fibrinogen, dried
coagulation proteins
Andexanet alfa
antidote and chelator
recombinant form of human factor Xa
Reversal of apixaban or rivaroxaban in life-threatening or uncontrolled bleeding
Idarucizumab
monoclonal antibody
rapid reversal of dabigatrarin for emergency procedures
Aspirin
anti platelet
CVD (secondary prevention)
75mg OD
Management of unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI)/suspected transient ischaemic attack
300mg
Clopidogrel
antiplatelet
Transient ischaemic attack for patients with aspirin hypersensitivity, or those intolerant of aspirin despite the addition of a proton pump inhibitor,
Acute ischaemic stroke for patients with aspirin hypersensitivity, or those intolerant of aspirin despite the addition of a proton pump inhibitor, Prevention of atherothrombotic events in peripheral arterial disease or within 35 days of myocardial infarction, or within 6 months of ischaemic stroke
75mg OD
Dipyridamole
anti platelet
Secondary prevention of ischaemic stroke (not associated with atrial fibrillation) and transient ischaemic attacks (used alone or with aspirin),
Adjunct to oral anticoagulation for prophylaxis of thromboembolism associated with prosthetic heart valves
200mg BD
Apixaban
Factor XA Inhibitor, Antithrombotic drug
direct inhibitor of factor XA
Prophylaxis of recurrent deep-vein thrombosis,
Prophylaxis of recurrent pulmonary embolism
2.5 mg twice daily, following completion of 6 months anticoagulant treatment.
Prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation and at least one risk factor (such as previous stroke or transient ischaemic attack, symptomatic heart failure, diabetes mellitus, hypertension, or age 75 years and over)
5 mg twice daily, alternatively 2.5 mg twice daily, reduced dose used in patients with at least two of the following characteristics: age 80 years and over, body-weight 60 kg or less, or serum creatinine 133 micromol/litre and over.
***direct-acting oral coagulants (DOACS): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
Edoxaban
factor XA inhibitor, antithrombolytic
direct and reversible inhibitor of factor XA
up to 60kg: 30mg OD
61+: 60mg OD
(max dose 30 mg with cico sporin, dronedarone, erythromycin, or ketoconazole
Rivaroxaban
antithrombolytic, factor XA inhibitor
Prophylaxis of venous thromboembolism following knee/hip replacement surgery
10mg OD
Treatment of deep-vein thrombosis,
Treatment of pulmonary embolism
Initially 15mg BD to be taken with food, for duration of treatment, consult product literature.
Prophylaxis of stroke and systemic embolism in patients with non-valvular atrial fibrillation and with at least one of the following risk factors: congestive heart failure, hypertension, previous stroke or transient ischaemic attack, age ≥ 75 years, or diabetes mellitus
20mg OD
**(Xarelto) 15mg and 20mg should be taken with food
Dalteparin sodium
Enoxaparin sodium
Heparin
Tinzaparin sodium
heparins, antithrombitic drugs
Dabigatran etexilate
thrombin inhibitor, direct
Warfarin
Vitamin K antagonists
Prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation,
Prophylaxis after insertion of prosthetic heart valve,
Prophylaxis and treatment of venous thrombosis and pulmonary embolism,
Transient ischaemic attacks
***direct acting antivirals to treat chronic hepatitis C: risk of interaction with vitamin K antagonist, INR should be monitored
Carvedilol (a,b)
Labetalol (a,b)
Nadolol (ns)
Propranolol (ns)
Atenolol (s)
Bisoprolol
Metoprolol
Beta-adrenoceptor blocker
hypertension
P: 80mg BD
A: 25-50mg
B: 5-10mg OD (max 20)
Adjunct HF, 1.25 (1), 2.5 (1), 3.75 (10, 5 (4), 7.5 (4), 10
**atenolol can be confused with amlodipine
***propranolol can be confused with prednisolone
Amlodipine
Diltiazem
Felodipine
Lercaidipine
Nifedipine
Verapamil
Calcium channel blockers
A: 5-10mg
F: 5mg OD, Elderly: 2.5 OD
Prophylaxis/treatment of angina, Hypertension
Bendroflumethizide
Co-amilozide
Indapamide
Thiazides and related diuretics
B: Hypertension: 2.5mg, Oedema 5-10mg
CA: 2.5/25, 5/50
contra: hyperkalaemia
I: 2.5mg IR/1.5MR
Enalapril maleate
Lisinopril
Perindopril
Ramipril
Angiotensin-converting Enzyme inhibitor
Caution: afro-caribbean, diabetic, agranulocytosis
Candesartan
Irbesartan
Losartan
Valsartan
Angiotensin II Receptor Antagonists
Aliskiren
Renin Inhibitor
Essential hypertension either alone or in combination with other antihypertensives
150mg OD
Hydralazine HCl
Minoxidil
Vasodilator
Moderate to Severe Hypertension, Heart Failure
Midodrine HCl
Vasoconstrictor, Sympathomimetics
Pro-drug
Severe orthostatic hypotension due to autonomic dysfunction when corrective factors have been ruled out and other forms of treatment are inadequate
Eplerenone
Spirnolactone
Amiloride HCl
Diuretic>Potassium-Sparring Diuretic>Aldosterone Antagonist
Adjunct in stable patients with left ventricular ejection fraction ≤40% with evidence of heart failure, following myocardial infarction (start therapy within 3–14 days of event),
Adjunct in chronic mild heart failure with left ventricular ejection fraction ≤30%
Initially 25 mg daily, then increased to 50 mg daily, increased within 4 weeks of initial treatment.
Contra: hyperkalaemia
***causes potassium retention, potassium supplement not to be given
thiazide: relieve oedema due to HF to reduce blood pressure
loop: in pulmonary oedema due to left ventricular failure/chronic heart failure
Sacubitril with valsartan
Angiotensin II Receptor Antagonist
Entresto
Symptomatic chronic heart failure with reduced ejection fraction (in patients not currently taking an ACE inhibitor or angiotensin II receptor antagonist, or stabilised on low doses of either of these agents)
Initially 24/26 mg twice daily for 3–4 weeks, increased if tolerated to 49/51 mg twice daily for 3–4 weeks, then increased if tolerated to 97/103 mg twice daily.
Symptomatic chronic heart failure with reduced ejection fraction (in patients currently stabilised on an ACE inhibitor or angiotensin II receptor antagonist)
Initially 49/51 mg twice daily for 2–4 weeks, increased if tolerated to 97/103 mg twice daily, consider a starting dose of 24/26 mg if systolic blood pressure less than 110 mmHg.
Colesevelam HCl
Coletyramine
Bile Acid Sequestrants
Primary hypercholesteroleamia as an adjust to dietary measures
Caution: interference with absorption of fat-soluble vitamins (A, D, K, folic acid)
Ezetimibe
Cholesterol Absorption Inhibitor, Lipid modifying drugs
Bezafibrate
Fenofibrate
Fibrates, Lipid Modifying drugs
contra: GB disease, photosensitivity
Atorvastatin
Pravastatin
Rosuvastatin
Simvastatin
Statins, Lipid Modifying drugs
S: ON
No grapefruit juice. avoid getting pregnant
SE: unusual cramps/pains (sign of muscle inflammation)
Ranolazine
Piperazine derivatine
As adjunctive therapy in the treatment of stable angina in patients inadequately controlled or intolerant of first-line antianginal therapies
Initially 375 mg twice daily for 2–4 weeks, then increased to 500 mg twice daily, then adjusted according to response to 750 mg twice daily; reduced if not tolerated to 375–500 mg twice daily.
Caution: Body-weight less than 60 kg; elderly; moderate to severe congestive heart failure; QT interval prolongation
Common: Asthenia (abnormal weakness); constipation; headache; vomiting
Ticagrelor
Antiplatelet drug, antithrombotic
Prevention of atherothrombotic events in patients with acute coronary syndrome [in combination with aspirin]
Contra: Active bleeding; history of intracranial haemorrhage
Alteplase
Streptokinase
Fibronolytics (breaks up thrombi)
Glyceryl trinitrate
Isosorbide dinitrate/mononitrate
Nitrates (role in angina)
Adrenoline/epinephrine
Cardiopulmonary Resuscitation/acute anaphylaxis
Bumetanide
Furosemide
Co-amilofruse
Loop Diuretics
B: 1mg
F:20-40mg
CA: 2.5/20, 10/80
Mannitol
Osmotic Diuretic
IV
Pentoxifylline (Trental)
Peripheral Vasodilator
Peripheral vascular disease, venous leg ulcer
400mg 2-3 times
Ipratroprium bromide
Glycopyrronium bromide
Tiotropium (Braltus)
Tiotropium with olodaterol (Spiolto Respimat) 2 puffs OD
Umeclidinium (Incruse Ellipta) 55mcg OD
Umeclidinium (Anoro Ellipta) 1 inhalation OD
Antimuscarinic
COPD
Caution: QT prolongation
SE: risk of infection, insomnia, pain
***Braltus: risk of inhalation of capsule if placed in the mouthpiece of the inhaler (store capsule in screw-top bottle)
***pressurised metered dose inhalers: risk of airway obstruction from aspiration of loose objects
Formotertol fumerate (Easyhaler), 12 hr duration
Indacaterol
Salmeterol
BEta2 adrenoreceptor agonist, selective, long-acting
***added only if standard-dose corticosteroids fail to control asthma, not use in deteriorating asthma, used in low dose, not for exercise-relief, reviewed clinically
Caution: high dose dangerous in children
Salbutamol (3-5hr duration) (Salamol, Ventolin Accuhaler, Airomir Autohaler)
Terbutaline sulfate (Bricanyl)
BEta2 adrenoreceptor agonist, selective, short-acting
S: muscle cramps
T: hypotension, muscle spasm
Beclometasone dipropionate (Clenil modulite, Qvar (fine particles, twice a potent as clenil)
Beclometasone with formoterol (Fostair nexthaler, Fostair)
Becloemtasone with formoterol and glypyrronium (Trimbow)
Budesonide with formoterol (Duoresp spiromax, Symbicort turbohaler)
Fluticasone with formoterol (Flutiform)
Fluticasone with salmertol (Sereflo, Seretide 250 Evohaler, Seretide 500 Accuhaler)
Fluticasone with umeclidinium and vilanterol (Trelegy Ellipta)
Fluticasone with vilanterol (Relver Ellipta 184/22, 92/22)
Corticosteroid
SE: oral candidiasis
Montelukast
Leukotriene Receptor Antagonist
6 months-5yrs: 4mg in the evening
6-14: 5mg ON
15-adult: 10mg ON
***reminder of the risk of neuropsychiatric reactions (speech impairment, OCD)
Aminophylline (Phyllocontin continus)
Theophylline (Uniphyllin Continus)
Nebuliser solutions (hypertonic sodium chloride solutions)
Xanthanes
SE: arrythimias, diarrhoea, dizziness, GORD, tremor
Acrivastine (Benadryl)
Cetirizine HCl
Fexofenadine (Allevia)
Levocetirizine HCl (isomer of cetirizine)
Loratidine (Clarityn)
Antihistamine, non-sedating
A: (12-adult) 8mg TDS
C: 2-5: 2.5mg BD
6-11: 5mg BD
12-adult: 10mg OD
seasonal allergy
F: 6-11: 30mg BD
12-Adult: 120mg OD
chronic allergy
12-adult: 180 mg OD
L: 5mg OD
Lora:
child ups 11 under 31kg: 6mg OD
10mg OD
Chlorphenamine maleate (Puritan)
Hydroxyzine HCl
Promethazine Hal (Phenergan)
Antihistamine, sedating
C: ***children under 6 should not be given OTC cough and cold with chlorphenamine
H: ***risk of QT-interval prolongation and torsade de pointes (contraindicated in patients with risk factors, avoid use in elderly)
Carbocisteine
Reduction of sputum viscosity (helpful in COPD)
capsule: two 375 mg capsules three times a day, reduced when symptoms improve to one 375 mg capsule four times daily
liquid: 15 ml (750 mg) three times a day, reduced when symptoms improve to 10 ml (500 mg) three times a day.
satchet: one sachet three times a day, reduced when symptoms improve to one sachet twice a day.
CHILD DOSE
2-5 years is: 1.25-2.5 ml (62.5-125 mg) four times daily.
5-12 years is: 5 ml (250 mg) three times daily.
**be aware of double strength for children
SE: GI bleed, skin reaction
Dornase alfa
Ivacaftor
Lumacaftor with ivacaftor
Mannitol
Cystic Fibrosis (main sign pulmonary disease)
should be offered mucolytic
Pholcodine (Day nurse)
Cough Suppressant, Cough and cold preparation
***increased risk of the very rare event of a severe allergic reaction (anaphylaxis) to muscle relaxants (neuromuscular blocking agents) that are used during general anaesthesia in surgery
use with caution in hepatic/renal impairment
Donepezil HCl (reversible acetylcholinesterase inhibitor)
Galantamine
Rivastigmine (4.6 or 9.5 patches)
Memantine (Dopaminergic, NMDA receptor antagonist)
Centrally Acting Anticholinesterases
Mild to Moderate dementia in Alzheimer’s disease
5mg ON
SE: aggression, agitation, decrease appetite
transdermal less likely to cause SE
DGR as mono therapies
Carbamazepine (Tegretol)/Oxcarbazepine
Ethosuximide
Ganapentin/Pregabalin
Lamotrigine
Levetiracetam and Brivaracetam
Phenobarbital/Primidone (Barbiturate)
Phenytoin (interacts with folic)
Refinamide
Valproate
Clobazam (Benzo, all epilepsy)
Antiepileptics
C: 1st line for generalised tonic-clonic seizures
E: 1st line in absence seizures
G/P: focal seizures
L: 1st line for focal seizures
LB: mono therapy in focal seizures
PP: tonic-clonic and focal but may be sedative
P: avoid in absence/myoconic, use in tonic-clonic and focal
R: seizures in Lennox-Gastaut syndrome
V: generalised epilepsy, tonic-clonic seizures
C: adjunctive therapy
***gabapentin: risk of severe respiratory depression, abuse and dependence
***phenytoin: risk of death and severe harm in IV
***pregabalin: risk of abuse and dependence
**valproate: contraindicate in women and girls of childbearing age unless pregnancy prevention program are met
Lorazepam, Midozolam, Alprazolam, Diazepam
Buspirone (seretonin receptor agonist)
Benzodiazepines
status epilepticus, anxiety, panic attacks
***Midazolam: mis-selection of high-strength during conscious sedation
***risk of potential fatal respiratory depression
Atomoxetine
Methyphenidate (Concerta, Delmosart, Equasym, Medikinet)
Centrally Acting Symptathomimetics, CNS Stimulants
ADHD
Dexamfetamine
Lisdexamfetamine mesilate (Elvanse)
Amfetamines
ADHD
Guanfacine (Intiniv)
Alpha2 adrenoceptor agonist
ADHD
Valproic Acid (Antiepiletic)
Lithium (Priadel)
Manic episodes in bipolar disorder
Lithium salts, antiphychotics
Isocarboxazid
Phenelzine
Trancylcypromine
Monoamine-oxidase inhibitor (MOAI), less used than tricyclic/SSRIs
food restrictions, tyramine
Drepressive illness
Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Duloxetine (and noradrenaline)
Venlafaxine (vencarm)
Trozodone HCl
SSRI
Mirtazapine
Tetracyclic antidepressant
Major depression
Amitriptyline HCl
Dosulepin HCl
Doxepin
Nortriptyline
Vortioxetine
Tricyclic antidepressant
Depressive Illness
Chlorpromazine HCl
Flupentixol
Haloperidol
Prochlorperazine
Sulpiride
Zuclophenthixol acetate
first generation, antipsychotic
schizophrenia
***haloperidol/Zuclophenthixol: preparation for acute apisode not to be confused with depot preparation for maintenance
***Zuclophenthixol acetate confused with Zuclophenthixol decanoate
Amisulpiride
Aripriprazole
clozapine
Olanzapine
Quetiapine
Risperidone
second generation, antipsychotic
schizophrenia
***aripripazole: preparation for acute apisode not to be confused with depot preparation for maintenance
***clozapine: fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus (varying degrees of impairment of intestinal peristalsis)
***risperidone confused with ropinirole
Procyclidine HCl (antimusc)
Trihexyphenidyl HCl (antimusc)
Co-beneldopa (dopamine)
co-careldopa
Ropinirole
Rasagiline (MOAIb inhibitor)
Parkinson’s disease
neurogenative condition, death of dopinergic cells of substantial nigra
present with motor symptoms: hypokinesia (folded arms/legs), bradykinesia (slowness of movement), rest tremor, non-motor: dementia, depression
incurable progressive condition, treatment to control symptoms and improve quality of life
co-careldopa/benserazide: motor symptoms decrease quality of life
levodopa, ropinirole, rasagiline: motor symptoms do not affect quality of life
treatment with levodopa is associated with impulse control disorder: gambling, binge eating, hyper sexuality
Cyclizine
Domperidone (Motilium)
Metoclopramide HCl
Aprepitant (neurokinin receptor antagonist)
Ondansetron (seretonin receptor antagonist)
Cinnarizine (sedating antihistamine)
Hyoscine hydrobromide (Kwells, Scopoderm) motion sickness, antimusc
antiemetic and antonauseants, antihistamine
50mg TDS
Dom: dopamine receptor antagonist, lack of efficacy in children
met:risk of neurological effects (extrapyramidal disorders (repetitive involuntary movements) and tardive dyskinesia (sudden irregular movements that are not controlled)
ondans: increased risk of oral clefts if used in first 12 weeks
Betahistine dihydrochloride
Menieres Disease
Paracetamol (acetaminophen)
Nefopam HCl (centrally acting)
non-opioid anageisc
Buprenorphine
Co-codamol
Codeine
Diamorphine
Dihydrocodeine
Fentanyl
Morphine
Oxycodone
Tapentadol
Tramadol HCl
Opioids
***benzos/opiods: risk of respiratory depression
**codeine: restricted use in children for morphine toxicity and coughs and colds
fentanyl: life threatening and fatal opiod exposure in children
Pizotifen
Almotriptan/Eletriptan/Frovatriptan/Rizartriptan/Sumatriptan/Zolmitriptan
sedating antihistamine
“triptans”
headache, prophylaxis of migraine
Capsaicin
Plant alkaloids analgesics
neuropathic pain
apply 3-4 times daily
Flurazepam/Loprazolam/Nitrazepam/Temazepam
Melatonin/Zolpidem/Zopiclone (non-bonzo hynotic)
sleep disorders
insomnia
benzo/z-drugs avoided in elderly
Sodium Oxybate
Pitolisant
Narcolepsy
Acamprosate calcium
GABA analogues
maintenance of abstinence in alcohol-dependent patients
333mg GR tablet
Bupropion HCl (zyban)
Nicotine dependence
to aid smoking cessation in combination with motivational support in nicotine-dependent patients
Methadone
Opiod dependence
Amikacin (used in gentamicin-resistant gram positive)
Gentamicin (broad spectrum, antibacterial of choice)
Tobramycin
Neomycin sulfate
Streptomycin (mycobacterium tuberculosis)
Aminoglycosides
against some Gram-positive and many Gram-negative organisms
AGT: Pseudomonas aeruginosa
Etrapenem
Imippenem with cilastatin
Meropenem
carbapenems: beta-lactam antibacterials, broad spectrum, many gram-positive and gram-negative organisms, and anaerobes
Cefalexin
Cephalosporins (attach to penicillin binding proteins to interrupt cell biosyntheses leading to cell death)
hospital-acquired pneumonia, lower UTI
Vancomycin
glyopeptide antibacterial
C. difficile
125mg every 6 hrs for 10 days
Clindamycin
Lincosamides
MRSA
Azithromycin
Claritbromycin
Erythromycin
Macrolides
caution: QT prolongation
Metronidazole
nitromidazole derivatives
anaerobic infections, H. pylori, Crohn’s disease
Phenoxymethylpenicillin (Penicillin V)
Amoxicillin (broad spectrum)
Co-amoxiclav (broad with beta lactamase inhibitor)
Pivmecillinam HCl (mecillinam-type)
Flucloxacillin (penicillinase resistant)
Penicillins
P: oral infection, otits media, acute sore throat
500mg QDS
A: sinitus, oral infection, community-acquired pneumonia, COPD, dental abcess
500mg TDS
Co-amoxiclav: 250/125, 500/125
Piv: uncomplicated cystitis, UTI
Flu: 500mg QDS
***flu: cholestatic jaundice and hepatitis can occur after 2 months after treatment
Ciprofloxacin
Levofloxacin
Moxifloxacin
Ofloxacin
Quinolones
***may induce convulsions, tendon damage, risk of aortic aneurysm
Caution: QT prolongation
Co-trimoxazole
Sulfadiazine (prevention of rheumatic fever occurrence)
Sulfonamides
***drug choice in prophylaxis and treatment of pneumonia
Doxycycline
Lymecycline
Minocycline
Tigecycline
Tetracyclines
chlamydia, UTI, bronchietasis, COPD, acne
D: 200mg then 100mg OD
L: 408mg BD
Chloramphenicol
Fosfomycin
Fucidic Acid
Trimethoprim
antibacterial, other
C: typhoid fever, lifethretening infections
F: uti
FA: skin infection
Dapsone
Rifampicin
Clofazimine
Isoniazis
Antimycobacterials
Leprosy
rif: contra in jasduce
caution: discolours soft lenses
Methenamine hippurate
Nitrofurantoin
Antibacterials
UTI
Meth: 1g BD
Amphotericin
Antifungal, pollen anti fungal
fungal infection
**error dose in fungi zone administration
Fluconazole
Itraconazole
triazole antifungal
thrush
F: 150mg OD
I: 200mg BD
Atovaquone
Ivermectin
Mebendazole
Antoprotozoal
Pneumonia
750mg BD
Ivermectin
Mebendazole
Anthelmintics
I: scabies
M: threadworm
Atovaquone with proguanil HCl
Chloroquine
Mefloquine
Antimalarials
A: 1 tablet OD started 1-2 days before travel and continued for 1 week after leaving
C: 310mg once weekly started 1 week before travel and continued for 4 week after leaving
M: 250mg once weekly started 2-3 weeks before travel and continued for 4 week after leaving
Entecavir
Telbivudine
Adefovir dipivoxil (nucleotide analogues)
Ribavirin (nucleoside)
Nucleoside Analogues
Hepatitis B
Hep C
Peginterferon alfa
Elbasvir with grazovir
Interferones, immunostimulants
Hepatitis C
HCV inhibitor, antiviral
***risk of interaction with vitamin K antagonist and changed in INR
Inosine pranobex
Aciclovir/Famciclovir/Valaciclovir
Inosine Complex, antiviral
nucleoside analogues, antiviral
HPV
Cidofovir
Ganciclovir
Cytomegalovirus Infections
nucleoside analogues
Enfuvirtide
Dolutegravir
Elvitegravir, Raltegravir
HIV infection
HIV-fusion inhibitor
HIV-integrase inhibitor
**increase risk of neural tube defects, not prescribed in pregnant seeking woman
Oseltammivir
Zanamivir
Antiviral, Influenza, Neuraminidase inhibitor
Desmopressin (Desmomelt)
Vasopressin and Analogues, Pituitary and hypothalamic hormones and analogues
Diabetes insipidus, treament
Primary nocturnal enuresis
120 micrograms once daily, increased if necessary to 240 micrograms once daily, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least 1 week.
Contra: hyponatraemia (elderly at risk, renal impairment)
Betamethasone
Deflazacort
Dexamethasone*
Hydrocortisone*
Methylprednisolone*
Prednisolone*
Triamcinolone acetonide*
Corticosteroid
Suppression of inflammatory and allergic disorders, congenital adrenal hyperplasia
***M: do not use in patients with cow milk allergy, Solu-Medrone contains lactose
Prednisolone: COPD, croup, asthma, myasthenia gravis
*local inflammation of joints and soft tissue
Ketoconazole
Enzyme Inhibitor
Cushing’s syndrome
**oral ketoconaole suspended for fungal treatments, risk of hepatotoxicity
Metformin HCl (Glucophage SR, Sukkarto SR)
Biguanides, Blood glucose lowering drugs
T2DM, PCOS
IR: Initially 500 mg once daily for at least 1 week, dose to be taken with breakfast, then 500 mg twice daily for at least 1 week, dose to be taken with breakfast and evening meal, then 500 mg 3 times a day, dose to be taken with breakfast, lunch and evening meal; maximum 2 g per day.
MR: Initially 500 mg once daily, then increased if necessary up to 2 g once daily, dose increased gradually, every 10–15 days, dose to be taken with evening meal, alternatively increased to 1 g twice daily, dose to be taken with meals, alternative dose only to be used if control not achieved with once daily dose regimen. If control still not achieved then change to standard release tablets.
SE: nausea, vomitting, diarrhoea, lack of appetite, abdominal pain, unusual taste
Lactic acidosis
Diabetic ketoacidosos
***reduces B12 levels
Linagliptin (Trajenta)
Sitagliptin (Januvia)
Vildagliptin with metformin (Eucreas, 50/850, 50/1)
Dipeptidylpeptidase-4 inhibitors (Gliptins)
T2DM
L: 5mgOD
S: 100mg OD
V: 1 tab BD
SE: cough, nose/throat symptoms, rash
if persistent, severe tummy ache (can indicate inflamed pancreatitis), speak with GP
Dulalgutide (Trulicity)
Liraglutide (Victoza, Saxenda)
Semaglutide (Ozempic)
Glucagon-like peptide-1 receptor agonists
T2DM (if metformin inappropriate)
0.75mg OW s/c
in combination
1.5mg OW s/c
Lira: Initially 0.6 mg once daily for at least 1 week, then increased to 1.2 mg once daily for at least 1 week, then increased if necessary to 1.8 mg once daily.
Sema: Initially 0.25 mg once weekly for 4 weeks, then increased to 0.5 mg once weekly for at least 4 weeks, then increased if necessary to 1 mg once weekly.
***reports of diabetic ketoacidosis when concomitant insulin was rapidly reduced/discontinued
**insulin/sulfonylurea needs to be reduced when used concomitantly
Canagliflozin (Invokana 100mg, 300mg)
Dapagliflozin (Forxiga)
Dapafliflozin with metformin (Xigduo 5/850, 5/1)
Empagliflozin (Jardiance 10, 25)
Empagliflozin with metformin (Synjardy 12.5/850, 5/850, 5/1)
sodium glucose co-transportor 2 inhibitors
T2DM
100 mg once daily; increased if tolerated to 300 mg once daily if required, dose to be taken preferably before breakfast.
Dapag: T2DM 10mg OD, T1DM 5mg OD
Empag: T2DM 10mg OD, increased to 25mg OD
Empag w/met: 5/850–5/1000 mg twice daily, based on patient’s current metformin dose, increased if necessary to 12.5/850–12.5/1000 mg twice daily
not recommended in adults 85+
***risk of ketoacidosis, lower-limb mutations (preventative foot care), Fournier’s gangrene (necrotising fasciitis of the genitalia/perineum)
Glicazide
Glimepiride
Sulfonylureas
T2DM
IR: Initially 40–80 mg daily, adjusted according to response, increased if necessary up to 160 mg once daily, dose to be taken with breakfast, doses higher than 160 mg to be given in divided doses; maximum 320 mg per day.
MR: Initially 30 mg daily, dose to be taken with breakfast, adjust dose according to response every 4 weeks (after 2 weeks if no decrease in blood glucose); maximum 120 mg per day.
Glimi: Initially 1 mg daily, adjusted according to response, then increased in steps of 1 mg every 1–2 weeks, increased to 4 mg daily, dose to be taken shortly before or with first main meal, the daily dose may be increased further, in exceptional circumstances; maximum 6 mg per day.
caution: can cause weight gain, elderly, G6PD
Pioglitazone
Thiazolidinediones
T2DM
Initially 15–30 mg once daily, adjusted according to response to 45 mg once daily, review treatment after 3–6 months and regularly thereafter. In elderly patients, initiate with lowest possible dose and increase gradually.
***CVD safety, heart failure incidence, risk of bladder cancer
Insulin
Insulin aspart (Fiasco, Novorapid)
Insulin lispro (Humalog, Humalog Kwikpen)
Insulin
**unit/international units should NOT be abbreviated, insulin NOT be withdrawn from pen/pen refill, can lead to fatal overdose
SE: oedema
overdose: hypoglycaemia
Biphasic isophane insulin (Humulin M3, Humulin M3 Kwikpen)
Isophane insulin (Humulin I, Humulin I Kwikpen, Insulatard)
Intermediate acting insulin
Biphasic insulin aspart (Novomix 30 flexpen/penfill)
Biphasic insulin lispro (Humalog Mix25/Mix 50)
Intermediate acting combined with rapid-acting insulin
Insulin deluded (Tresiba)
Insulin determir (Levemir)
Insulin glargine (Tuojeo, Abasaglar, Lantus, Semglee)
Long-Acting
15-20g of fast-acting carbohydrate (40% gel: glucogel, dextrogel)
3-4 teaspoons of sugar in water
4-7 glucose tablets
150-200mL fruit juice
Hypoglycaemia treatment
low blood sugar
able to swallow
Alendronic Acid
Ibandronic Acid
Bisphosphates
Osteoporosis
A: 10mg OD, 70mg OW
SE: GI disorder, joint swelling, vertigo
***atypical femoral fractures, osteonecrosis of the jaw/external auditory canal
1st line in postmenopausal women, in men: alendrotnic acid or risedronate
treatment duration: benefit from biphosphnate period, review after 5 yrs in alendrotnic/risdronate/ibandronic, 3 yrs in zoledronic
Denusumab (Prolia, Xgeva)
Monoclonal Antibody, drugs affecting bone structure and mineralisation
Osteoporosis in postmenopausal women and in men at increased risk of fractions (Prolia)
Prevention of skeletal related events in patients with bone metastases (Xgeva)
Goserelin (Zoladex 3.6, Zoladex LA 10.8))
Leuprorelin acetate (Prostap 3 DCS)
Gonadotrophin-releasing hormones, pituitary and hypothalamic hormones/analogues
Endometriosis
Advanced prostate cancer
Estradiol (Elleste, Estraderm, Estradot, Evorel, Oestrogel, Sandrena)
Ethinylestradio;
Female sex hormone responsive conditions
Oestrogens (HRT)
Menopausal women
osteoporosis prophylaxis
***increased risk of breast cancer
SE: headache, nausea, skin reaction
Oestrogen combined with medroxyprogesterone (Premique)
Estradiol with dydrogesterone (Femoston, Femoston Conti)
Estradiol with levonorgestrel (Femseven conti/sequi patch)
Estradiol with norethisterone (Elleste duet, Evorel conti/sequi, kliofem, kliovance)
Oestrogen combined with medroxyprogesterone
Menopausal symptoms in women with a uterus: 1 tablet OD
Norethisterone
Progesterone (Utrogestan)
Progestogens
N: endometriosis, dysfunctional uterine bleeding, dysmenorrhoea, contraception
progestognenic opposition of oestrogen HRT
200mg OD on days 15-26 of each 28-day oestrogen HRT cycle, alternatively 100mg OD on days 1-25 of each 28-day oestrogen HRT cycle
Testosterone (Testim, Testogel, Tostran)
Androgens (male sex hormones)
SE: hypertrigluceridaemia, hot flush, hypertension, increase weight, prostate abnormalities
Testim/Testogel 50mg/5g: Apply 50 mg once daily, subsequent application adjusted according to response; maximum 100 mg per day.
Testim (Testogel): one tube (satchet) of 5 g contains 50 mg testosterone.
Testogel 16.2mg/g: Apply 40.5 mg once daily; increased in steps of 20.25 mg, adjusted according to response; maximum 81 mg per day.
**monitor prostate in men over 45
one pump actuation delivers 1.25 g of gel containing 20.25 mg of testosterone.
Carbimazole
Propylthiouracil (thiouracil)
Sulfur-containing imidazole, antithyroid drugs
Hyperthyroidism15–40 mg daily continue until the patient becomes euthyroid, usually after 4 to 8 weeks, higher doses should be prescribed under specialist supervision only, then reduced to 5–15 mg daily, reduce dose gradually, therapy usually given for 12 to 18 months.
***neutropenia, agranulocytosis, risk of congenital malformations, risk of acute pancreatitis
contra: blood disorders, pregnancy
Levothyroxine sodium
Liothyronine sodium
Thyroid hormones
Hypothyroidism
contra: thyrotoxicosis
Darifenacin
Fesoterodine fumarate
Flavoxate HCl
Oxybutynin HCl
Propiverine HCl
Solifenacin succinate
Tolterodine tartrate
Trospium HCl
Mirabegron (beta3 adrenoreceptor, 25, 50)
antimuscarinics, Urinary
urinary frequency, urgency, incontinenence
D: 7.5mg OD increased to 15mg after 2 weeks
Fe: 4mg OD, increased to 8mg OD (4mg MAX with concurrent CYP3A4 inhibitors)
Fl: 200mg TDS
O: (IR)5mg 2-3 times, upto 4 times
(MR): 5mg OD, 20mg max
avoid in hepatic/renal impairment
caution: QT prolongation
Alfuzosin HCl
Doxazosin
Tamsulosin (400mcg MR)
alpha adrenoreceptor
urinary retention
benign prostatic hyperplasia
D: hypertension
Dutaseride
Finsasteride
5alpha-reductase inhibitor
F: androgenic alopecia in men, 1mg
Cirtic acid with potassium citrate
Sodium citrate
Alkalising drug, urinary
Lidocaine HCl gel for urethral pain/catherter discomfort
Alkalisation of urine with potassium citrate, cystitis discomfort
Pentosan polysulfate sodium
Heparinoids
bladder pain syndrome
100mg TDS
Dienogest with estradiol valerate (Qlaira)
Estradiol with nomegestrol
Ethinylestradiol with desogestrel (Gedarel, Mercilon)
Ethinylestradiol with drospirenone (Lucette, Yasmin)
Ethinylestradiol with etanogestrel (Nuvaring)
Ethinylestradiol with gestodene (Millinette)
Ethinylestradiol with levonorgestrel (Microgynon 30, Rigevidon)
Ethinylestradiol with norgestimate (Cilique)
Combined hormonal contraceptive
Ulipristal acetate
Progesterone receptor modulator, emergency
U: 30mg within 5 days
***risk of liver injury
Desogestrel (desogestrel, Cerazette)
Levonorgestrel (Levonelle, Mirena (IUD)
progestogen-only contraception
L: emergency, 1.5 mg within 3 days
***uterine perforation
Etonogestral (implant)
Medroxyprogesterone acetate (Depo)
progestogen-only parenteral contraception
**neurovascular injury and implant migration
Nonoxinol (gel)
spermicidal contraception
avanafil
sildenafil (Viagra)
tadalafil (longer-acting)
vardenafil
alprostadil (prostaglandin and analogue, caverjet)
dapoxetine (SSRI, premature ejaculation)
phosphodiesterase type-5 inhibitor
erectile dysfunction
Mifepristone
misoprostol
termination of pregnancy
progesterone receptor modulators
misoprostol dose to be given after mifepristone
Clindamycin (Dalacin 2%)
Lincosamide, antibacterial
bacterial vaginosis
Clotrimazole (Canesten1%, 2%, 10%)
Imidazole anti fungal
superficial sites (1%/2%) cream 2-3 times a day
thrush (10%)
cream, inserted, 5g in 1 dose
pessary 200mg for three nights
recurrent thrush
500mg every week for 6 months
Azathioprine
antimetabolites, immunosuppressant
Crohn’s disease, rheumatoid arthritis, autoimmune conditions, myasthenia gravis
Ciclosporin
Tacrolimus (Adoport, Prograf)
calcineurin inhibitors and related drugs, immunosuppressants
ulcerative colitis, rheumatoid arthritis, organ transplantation
T: prophylaxis or transplant rejection
**Cic/Tac: must be prescribed by brand
Mycophenolate mofetil
purine synthesis inhibitor, immunosuppressant
prophylaxis of rejection in transplantation
*does not indicate increased risk of malformations/miscarriage where father was taking medicine
Fampridine
interferon beta, peginterferon beta-1a (interferon)
cholinergic receptor stimulating drugs
F: improvement of walking disability in multiple sclerosis
I: relapsing, remitting MS
Alemtuzumab
Natalizumab
Ocrelizumab
anti-lymphocyte monoclonal antibodies
treatment of adults with relapsing-remitting MS with active disease by clinical or imaging features
***monitoring requirements due to CVD and immune-mediated reactions
Atezolizumab (Lung)
Avelumab (me static merkel cell carcinoma)
Bevacizumab (mestatic breast cancer)
Daratumumab (multiple myeloma)
Durvalumab (lung)
Rituximab (non-hodgkins)
Mitoxantrone (breast cancer)
Fluorouracil (GI/breast)
Mercaptopurine (leukaemia)
methotrexate (crohns)
Bleomycin (non Hodgkins, mestatic germ cell, squamous cell)
cisplatin (platinums) (testicular, cervical, bladder, head and neck, ovarian)
Paclitaxel (taxanes) (ovarian)
vinblastine, vincristine (vinca alkaloid)
Thalidomide
monoclonal antibodies, malignant disease
***Beva: risk of osteonecrosis of jaw
***Dara: risk of hep B virus reactivation
Darbepoetin Alfa
Epoetin alfa
Epoetin beta
Epoetin zeta
Epoetins
Symptomatic anaemia associated with renal failure in patients on dialysis
**Stevens-Johnson syndrome, toxic epidermal necrolysis, severe skin reactions
**erythropoietins-haemoglobin concentration overcorrection in patients with CKD increase CVD event and cancer patients increased thrombosis
***tumor progression and survival in patients with cancer
Ferric carboxymatlose
Iron dextran
Iron isomaltoside 1000
Iron sucrose
Ferric maltolate
Ferrous fumarate
Ferrous sulfate
Sodium feredetate (Sytron)
Iron, injectable
iron-deficiency anaemia
**hypersensitivity reactions with IV iron
Iron, oral
FM: 30mg BD
FF: 210mg 1-2 times a day (prophylactic), 2-3times a day (therapeutic)
FS: 200mg OD (pro), 200mg 2-3 times (thera)
Folic acid
Folate
5mg OD (in pregnant women), OW prevention of methotrexate side effects in rheumatic disease taken on different day to met
Cyanocobalamin
Hydroxocobalamin (IM, 1mg/ml)
Vitamin B Group
vitamin B12 deficiency of dietary origin
50-150mcg OD to be taken between meals
Filgrastim
Lenograstim
Lipegfilgrastim
Granulocyte-colony stimulating factors, immunostimulant
reduction in duration of neutropenia and incidence of febrile neutropenia in cytotoxic chemotherapy
Sodium bicarbonate
Bicarbonate
Alkinisation of urine, severe metabolic acidosis
Potassium chloride with….
Potassium
electrolyte imbalance
sodium chloride
sodium chloride
prophylaxis of sodium deficiency, renal salt wasting, management of diabetic ketoacidosis
Disodium hydrogen citrate with glucose, potassium chloride and sodium chloride (Dioralyte)
Potassium chloride with rice powder, sodium chloride and sodium citrate (Dioralyte Relief)
oral rehydration salts
fluid and electrolyte loss in diarrhoea
calcium carbonate (Adcal, Calciche, Rennie)
calcium carbonate with calcium lactate gluconate (Sandocal)
calcium chloride
calcium glutinate
calcium
calcium deficiency
hypocalcaemia
Sevelamer
Phosphate binder
hyperphosphataemia in patients on harm-dialysis, CKD
Mercaptamine
Cystinosis
nephropathic cystinosis
Ascorbic Acid
Vitamin C
prevention/treatment of scurvy
Thiamine (B1)
Pyridoxine HCl (B6)
Vitamin B complex
Vitamin B group
Alfacalcidol
Cholecalciferol (D3, Sterol, Fultium, SunVit)
Ergocalciferol (D2)
Colecalciferol with calcium carbonate (Adcal, Accrete, Calcichew)
Vitamin D and analogues
rickets, vitamin D prevention
***contra: hypercalcaemia
Glucosamine
chondroprotective drugs
symptomatic relief of mild to moderate osteoarthritis of the knew
hydroxychloroquine sulfate
leflunomide
penicillamine
sodium aurothiomalate
disease modifying antirheumatic drugs
active rheumatic arthritis
Anakinra
Sarilumab
Secukinumab
Tocilizumab
Ustekinumab
Baricitinib
Tofacitinib
Upadacitinb
Abatacept
Etanercept
Infliximab
interleukin inhibitor, immunosuppressant
RA
JAK inhibitors
T-Cell Activation
Tumour necrosis factor alpha inhibitors
Colchicine
Allopurinol
Febuxostat
Plant alkaloids
acute gout
500mcg 2-4 times
Xanthane Oxidase inhibitors
prophylaxis of gout
treatment of chronic hyperuricaemia in gout
Neostigmine
Pyridostigmine bromide
antocholinesterase
Myasthenia gravis
Amifampridine
cholinergic receptor stimulating drugs
Lambert-Eaton myasthenic syndrome
Baclofen
Methocarbamol
Tizanidine
centrally acting muscle relaxant
B: pain of muscle spasm in palliative care, hiccup due to gastric distension, chronic severe spasticity
M: short-term symptomatic relief of muscle spasm
T: spasticity associated with MS or spinal cord injury
Aceclofenac/Celecoxib
Ibuprofen (not for acute gout)
Naproxen (1st choice)
Flurbiprofen (more effective than ibuprofen)
Ketoprofen
Diclofenac sodium (voltarol emugel)
Etodolac
Indometacin (high incidence of side effects)
Mefenamic acid
Meloxicam
Piroxicam (long furation of action, associated with skin reactions)
Nabumetone
Tolfenamic acid (migraine treatment)
Aspirin
NSAIDs
low back pain/sciatica
=>nsaid, weake opiod with paracetamol, but not paracetamol alone for back pain, benzodiazepines
=>consider GI, cardio-renal, hepatic c risks (paracetamol preferrred for elderly)
A/C: pain and inflammation in osteoarthritis, RA, ankylosing spondylitis
E: symptomatic relief osteoarthritis, RA
Men: pain and inflammation in osteoarthritis, menorrhagia/dysmenorrhoea
Mel: short-term relief of pain in osteoarthritis, long-term for RA and ankylosing
A: high doses to treat RA
Xylometazoline and antazoline (Otrivine Antistin)
Azelastine HCl (Optilast)
Olopatadine
Antihistamines, eye
allergic conjunctivitis
Sodium cromoglicate
mast-cell stabiliser
allergic conjunctivitis
Nepafenac (Nevanac)
NSAID, eye drop
prophylaxis and treatment of postoperative pain and inflammation associated with cataract surgery
Betamethasone (Betnesol)
Dexamethasone (Dexafree, Eythalm)
Prednisolone (Minims)
corticosteroid, eye drops
local treatment of inflammation (short-term)
Betamethasone with neomycin (Betnesol-N)
Dexamethasone with framycetin sulfate and gramicidin (Sofradex)
Dexamethasone with hypromellose, neomycin and polymyxin B sulfate (Maxitrol)
Dexamethasone with Tobramycin (Tobradex)
corticosteroid combination with anti-infectives
local treatment of inflammation and bacterial infection (short-term)
Atropine sulfate
Cyclopentolate HCl
antimuscarinic, eye
cyclopegia, anterior uveitis
Acetylcysteine (Ilube)
Carbomer (Viscotears, Pailin)
Carmellose sodium (Carmize, Celluvisc)
Hypromellose (Hydromoor)
Sodium hyaluronate (Blink)
Sodiukm hyaluronate with trehalose (Thealoz duo)
ocular lubricants, dry eye conditions
A: tear deficiency
C: dry eyes
CS: dry eye condition
H: tear deficiency
S: dry eye condition
latanoprost
tafluprost (saflutan)
travoprost
bimatoprost
betaxolol
levobunolol hcl
timolol maleate
brinzolamide
dorzolamide
apraclonidine
pilocarpine
ocular hypertension/glaucoma
1st line (topical prostaglandin analogue)
switch to alternative TPA before topical beta blocker switch (2nd line)
carbonic anhydrase inhibitor (3rd line)
sympathomimetic
topical miotic
Framycetin sulfate
Gentamicin
Neomycin sulfate
Acetic Acid 2% (EarCalm)
Ear
Aminoglycosides
Bacterial infection in otitis externa
Ciprofloxacin
Ear
Quinolones
acute otitis externa
Chloramphenicol
Other antibacterial, ear
Bacterial infection in otitis externa
clotrimazole
Imidazole antifungals, ear
fungal infection in otitis externa
Betamethasone
Flumetasone pivalate with clioquinol
Prednisolone
Betamethasone with neomycin
Dexamethasone with framycetin sulfate and gramicidin
Ciprofloxacin with dexamethasone
Ciprofloxacin with fluocinolone
corticosteroids, ear
eczematous inflammation in otitis externa
acute otitis media in patients with tympanostomy tubes, acute otitis externa
sodium bicarbonate
almond oil
docusate sodium
olive oil
urea hydrogen peroxide
Bicarbonate
softening drugs
removal of earwax
Ephedrine HCl
Pseudoephedrine HCl
Xylometazoline HCl
Nasal congestion
Chlorhexidine with neomycin (Naseptin)
Mupirocin (Bactroban)
Nasal infection, sinitus ‘common cold’
aminoglycosides
Azelastine HCl (Rhinolast)
Ipratropium bromide (Rinatec)
nasal inflammation, allergic/nonallergic rhinitis
antihistamine
antimuscarinic
Beclometasone dipropionate (Beconase)
Budesonide (Rhinocort)
Fluticasone (Avamys)
Fluticasone with azelastine (Dymista)
Mometasone furoate (Nasonex)
Triamcinolone acetonide (Nasocort)
corticosteroids, nose
- Biotene Oralbalance gel, Xerotin
- BioXtra, Glandosane, Saliva Orthana, Saliveze
- Saliveze pastilles
Artificial saliva products
- any condition to dry mouth
- dry mouth associated only with radiotherapy or sicca syndrome
- salivary stimulant
Chlorhexidine (Corsodyl)
Hexetidine (Oraldene)
Hydrogen peroxide (Peroxyl)
Sodium Chloride
oral hygiene
gingivitis, oral candidiasis
sodium fluoride
prophylaxis of dental caries
Lidocaine HCl (Anbesol)
mouth ulcer
benzydamine HCl (Difflam)
sore throat
Choline salicylate (bonjela)
mild oral lesions
miconazole (Daktarin oral gel)
Nystatin
oropharyngeal fungal infections
oral thrush
barrier creams and oitnments (Sudocrem)
emollient bath and shower products, antimicrobial-containing (Dermol 200 shower emollient, Dermol 600 bath emoillient, Dermal wash emulsion, oilatum plus)
emollient bath and shower products, paraffin-containing (Dermalo, doublebase, E45, hydromol, QV bath oil/gentle wash, Zerolatum)
emollient bath and shower products, soya-bean oil-containing (Balneum)
emollient creams and ointments, antimicrobial-containing (Dermol 500)
emollient creams and ointments, colloidal oatmeal-containing (Aveeno)
emollient creams and ointments, paraffin-containing (AproDerm, Epimax, Cetraben, Diprobase, E45, ZeroAQS, Zerobase, Epaderm, 50:50
emollients, urea-containing (Eucerin, Flexitol)
barrier preparations, skin
emollients
dry and pruritic skin conditions including eczema and dermatitis
dry skin conditions
dry skin conditions, eczema
eczema, ichthyosis, xeroderma, hyperkeratosis
dry skin of feet/heels
metronidazole (Rozex)
clotrimazole (Canesten 1% solution, Canesten 1%/2%/10%)
bacterial skin infection
inflammatory papules, pustules and erythema of rosacea
fungal skin infection
Ketoconazole (Dandrozol, Nizoral)
treatment/prophylaxis of dermatitis and dandruff
Amorolfine
fungal nail infection
Terbinafine (Lamisil)
Griseofulvin
Undecenoic acid with zinc undecenoate (Mycota)
tinea pedis (athlete’s foot)
- benzoic acid with salicylic acid
- benzyl benzoate/permethrin
- dimeticone/malathion/permethrin
- aciclovir (Zovirax)
- coal tar (Alphosyl 2 in 1, Neutrogena T/gel)
- coal tar with coconut oil and salicylic acid (Capasal)
- tacrolimus (Protopic)
- ringworm
- scabies
- head lice, crab lice
- cold sore
- psoriasis, scaly scalp disorder such as psoriasis, eczema, seborrhoeic dermatitis and dandruff
- 5+cradle cap
- atopic eczema
- betamethasone (Audavate), fluocinolone acetonide (Synalar), mometasone (Elocon)
- Calcipotriol with betamethasone (Dovobet, Enstilar)
- Clobetasol propionate (Dermovate, Etrivex)
- Clobetasol butyrate (Eumovate)
- betamethasone with clotrimazole (Lotriderm)
- betamethasone with salicylic acid (Diprosalic)
- clobetasone butyrate with nystatin and oxytetracycline (Trimovate)
- Hydrocortisone with benzalkonium chloride, dimeticone and nystatin (Timodine), hydrocortisone with clotrimazole (Canesten HC), hydrocortisone with fusidic acid (Fucidin H), hydrocortisone with miconazole (Daktacort)
- severe inflammatory skin disorder, psoriasis
- scalp psoriasis
- short-term treatment only of severe resistant inflammatory skin disorder, moderate scalp psoriasis
- eczemas and dermatitis of all types, maintenance between courses of more potent corticosteroids
- short-term treatment of ringworm infections and candidiasis
- severe inflammatory skin disorders such as eczema and unresponsive to less potent corticosteroids, psoriasis
- steroid-responsive dermatoses where candidal or bacterial infection is present
- Mild inflammatory skin disorder associated with infection
Isotretinoin
retinoid
severe acne
***PPP
**neuropsychiatric reactions and sexual dysfunction: erectile dysfunction and decreased libido, depression
Caution: Avoid blood donation during treatment and for at least 1 month after treatment
Glycopyrronium bromide
aluminium chloride hexahydrate (Driller)
hyperhidrosis
Levomenthol 0Dermacool, Menthoderm)
Crotamiton (Eurex)
pruritis (itchy skin)
Clindamycin (Dalacin T)
Co-cyprindiol (Clairette, Dianette, Teragezza)*
Erythromycin with zinc acetate (Zineryt)
Benzoyl peroxide (Acnecide)
Benzoyl peroxide with clindamycin (Duac)
Azelaic acid (Skinoren)
Adapalene (Differin)
Adapalene with benzoyl peroxide (Epiduo)
Acne vulgaris
acne in females*
Ivermectin
rosacea
minoxidil (Regaine)
androgenetic alopecia
Povidone-iodine
Chlorhexidine (Hibiscrub, Hydrex)
Chlorhexidine with cetrimide (Savlon)
antiseptic and disinfectant
Silver nitrate
Imiquimod (Aldara, genital)
salicylic acid with lactic acid (Salataxc)
warts, verrucas
