Phase II Flashcards
Antacids
Aluminium & magnesium hydroxide/calcium carbonate
MoA - Gastric acid neutralisation
Indication - Dyspepsia, heartburn
Adverse effects - Nausea
Aluminium & magnesium hydroxide/calcium carbonate
Antacids
MoA - Gastric acid neutralisation
Indication - Dyspepsia, heartburn
Adverse effects - Nausea
What would you prescribe for dyspepsia or heartburn?
Antacids
Aluminium & magnesium hydroxide/calcium carbonate
MoA - Gastric acid neutralisation
Adverse effects - Nausea
Antacids + alginates
Sodium alginate with sodium bicarbonate
MoA - Gastric acid neutralisation
Indication - Gastric reflux
Adverse effects - Abdominal distension
What would you prescribe for gastric reflux?
Antacids + Alginates (sodium alginate with sodium bicarbonate)
or
PPIs (omeprazole, lansoprazole)
H2-receptor antagonists
Ranitidine, Cimetidine
MoA - Blockade of gastric H2 histamine receptors
Indication - Stomach ulcers
Adverse effects - Dizziness
Ranitidine, cimetidine
H2-receptor antagonists
MoA - Blockade of gastric H2 histamine receptors
Indication - Stomach ulcers
Adverse effects - Dizziness
What would you prescribe for stomach ulcers?
H2-receptor antagonists (ranitidine, cimetidine)
or
PPIs (lansoprazole, omeprazole)
PPIs
Omeprazole, Lansoprazole
MoA - Blockade of stomach acid transporters
Indication - Stomach & duodenal ulcers, gastric reflux
Adverse effects - Headache, diarrhoea
Interactions - Warfarin
Pancreatic enzymes
Pancreatin
MoA - Restoration of pancreatic enzymes
Indication - Pancreatic insufficiency - Cystic fibrosis, pancreatitis
What would you prescribe for pancreatic insufficiency (ie. in cystic fibrosis or pancreatitis)?
Pancreatin
Bulk laxatives
Methylcellulose, isphagula husk
MoA - Water absorption in intestinal lumen to bulk stools
Indication - Constipation
Adverse effects/Interactions - Rare
Methylcellulose, isphagula husk
Bulk laxatives
MoA - Water absorption in intestinal lumen to bulk stools
Indication - Constipation
Adverse effects/Interactions - Rare
Faecal softener
Docusate, arachis oil
MoA - Stimulates water and electrolyte secretion into intestinal lumen
Indication - Constipation
Adverse effects/interactions - rare
Docusate, arachis oil
Faecal softener
MoA - Stimulates water and electrolyte secretion into intestinal lumen
Indication - Constipation
Adverse effects/interactions - rare
Osmotic laxatives
Macrogol (PEG), lactulose, magnesium sulphate, magnesium hydroxide
MoA - Water retention in intestinal lumen
Indication - Constipation
Adverse effects - Stomach cramps
Interactions - Antiepileptics
Macrogol (PEG), lactulose, magnesium sulphate, magnesium hydroxide
Osmotic laxatives
MoA - Water retention in intestinal lumen
Indication - Constipation
Adverse effects - Stomach cramps
Interactions - Antiepileptics
Stimulant laxatives
Bisacodyl, Senna
MoA - Increase intestinal motility
Indication - Constipation
Adverse effects - Nausea
Opioid anti-motility agents
Loperamide, codeine
MoA - Agonist for µ-opioid receptors in myenteric plexus. Blocks intestinal muscarinic receptors
Indication - Diarrhoea
Adverse effects/interactions - Rare
Loperamide, codeine
Opioid anti-motility agents
MoA - Agonist for µ-opioid receptors in myenteric plexus. Blocks intestinal muscarinic receptors
Indication - Diarrhoea
Adverse effects/interactions - Rare
Carbonic anhydrase inhibitor
Acetazolamide
MoA - Reduces aqueous humour volume
Indication: Intra-ocular pressure - open & acute closed angle glaucoma
Adverse effects - Paraesthesia
Acetazolamide
Carbonic anhydrase inhibitor
MoA - Reduces aqueous humour volume
Indication: Intra-ocular pressure - open & acute closed angle glaucoma
Adverse effects - Paraesthesia
Osmotic diuretics
Mannitol
MoA - Elevates plasma osmolarity
Indication - Cerebral oedema, intra-ocular pressure
Adverse effects - Hypotension
Mannitol
Osmotic diuretics
MoA - Elevates plasma osmolarity
Indication - Cerebral oedema, intra-ocular pressure
Adverse effects - Hypotension
Loop diuretics
Furosemide
MoA - Inhibits Na+/K+/2Cl- transporter in loop of Henle
Indication - Left ventricular heart failure, oedema
Adverse effects - Nausea, dizziness
Interactions - NSAIDs, ACE inhibitors
Furosemide
Loop diuretic
MoA - Inhibits Na+/K+/2Cl- transporter in loop of Henle
Indication - Left ventricular heart failure, oedema
Adverse effects - Nausea, dizziness
Interactions - NSAIDs, ACE inhibitors
Thiazides
Indapamide, Bendroflumethiazide,
Chlorthalidone
Hydrochlorothiazide
MoA - Decreases sodium and chloride reabsorption
Indication - Hypertension
Adverse effects - Electrolyte imbalance, exacerbation or precipitation of gout
Interactions - NSAIDs, digoxin
Indapamide, Bendroflumethiazide,
Chlorthalidone
Hydrochlorothiazide
Thiazides
MoA - Decreases sodium and chloride reabsorption
Indication - Hypertension
Adverse effects - Electrolyte imbalance, exacerbation or precipitation of gout
Interactions - NSAIDs, digoxin
Potassium sparing diuretics
Spironolactone, eplerenone (mineralocorticoid receptor blockade)
Amiloride (Blockade of sodium reabsorption via ENaC channel)
Indication - Oedema, congestive heart failure
Adverse effects - GI
Interactions - NSAIDs, ACEi
Spironolactone, eplerenone
Potassium sparing diuretics (mineralocorticoid receptor blockade)
Indication - Oedema, congestive heart failure
Adverse effects - GI
Interactions - NSAIDs, ACEi
Amiloride
Potassium sparing diuretics (Blockade of sodium reabsorption via ENaC channel)
Indication - Oedema, congestive heart failure
Adverse effects - GI
Interactions - NSAIDs, ACEi
Mannitol
Osmotic diuretic
MoA - Elevates plasma osmolarity
Indication - Cerebral oedema, intra-ocular pressure
Adverse effects - Hypotension
Acetazolamide
Carbonic anhydrase inhibitor
MoA - Reduces aqueous humour volume
Indication - Intra-ocular pressure - open & acute closed angle glaucoma
Adverse effects - Paraesthesia
Ramipril, captopril, lisinopril
ACE inhibitors
MoA - Inhibits conversion of angiotensin I to angiotensin II. Blocks vasoconstriction.
Indication - hypertension, diabetic nephropathy, heart failure
Adverse effects - cough, hyperkalaemia
Interactions - Lithium, NSAIDs
Losartan, valsartan
ARBs
MoA - Blocks angiotensin-renin system
Indication - hypertension, diabetic nephropathy, heart failure
Adverse effects - hypotension, fatigue
Interactions - Diuretics
Sacubitril (in combination with the ARB valsartan)
Neprilysin inhibitors (used in combination with an ARB)
MoA - Inhibition of natriuretic peptide breakdown
Indication - Heart failure (with reduced ejection fraction)
Adverse effects - hypokalaemia, hypoglycaemia (from BNF)
Bisoprolol, atenolol
Beta-blockers (Beta-1 selective)
MoA - Negative inotropic/chronotropic agent
Indication - Hypertension, stable angina
Adverse effects - Bradycardia, bronchospasm
Interactions - NSAIDs, digoxin
Propranolol
Beta-blockers (Beta-1 and beta-2 selective)
MoA - Negative inotropic/chronotropic agent
Indication - Hypertension, stable angina
Adverse effects - Bradycardia, bronchospasm
Interactions - NSAIDs, digoxin
Doxazosin
Alpha adrenergic blockers
MoA - vasodilator, decreases total peripheral resistance
Indication - Hypertension
Adverse effects - dizziness, headache
Interactions - hypotensive drugs
Amlodipine, nifedipine, diltiazem
Calcium channel blockers
MoA - Blockade of vascular smooth muscle contraction
Indication - Hypertension, stable angina
Adverse effects - ankle swelling, oedema
Interactions - beta blockers, digoxin
Glyceryl trinitrate (GTN), Isosorbide Mononitrate (ISMN)
Nitrates
MoA - Nitric oxide release, leading to smooth muscle relaxation and vasodilation
Indication - Acute angina pectoris (GTN), heart failure
Adverse effects - Hypotension, headache
Interactions - Antihypertensives
Adrenaline, dobutamine, noradrenaline
Sympathomimetics
MoA - Adrenergic stimulation, increased inotropy
Indication - Cardiac arrest, cariogenic shock
Adverse effects - Arrhythmia
Aspirin, clopidogrel
Antiplatelet drugs
MoA:
Aspirin - Inhibition of thromboxane synthesis
Clopidogrel - Inhibition of platelet activation by ADP
Indication - Primary and secondary relief for CVD, anticoagulant prophylaxis
Adverse effects - GI irritation and bleeding
Interactions - Anticoagulants
Warfarin
Anticoagulants - coumarin
MoA - Inhibition of vitamin K epoxide reductase complex 1 (VKORC1) enzyme.
Indication - DVT, prophylaxis of stroke from AF
Adverse effects - Abnormal bleeding
Interactions - multiple drug interactions, notably NSAIDs, diuretics
Dabigatran
Anticoagulants - direct thrombin inhibitor
MoA - Inhibition of thrombin (also called Factor IIa)
Indication - Prophylaxis of venous thromboembolism post-surgery
Adverse effects - Abnormal bleeding
Apixaban, Edoxaban, Rivaroxaban
Anticoagulants - direct Factor Xa inhibitor
MoA - Inhibition of Factor Xa in coagulation cascade
Indication - Prophylaxis of stroke from atrial fibrillation; DVT
Adverse effects - Abnormal bleeding
Dalteparin, tinzaparin, enoxaparin (low molecular weight); unfractionated heparins
Anticoagulants - Heparins
MoA - Inactivation of thrombin and Factor Xa via complexing antithrombin III
Indication - Prophylaxis of venous thrombosis and pulmonary embolism
Adverse effects - abnormal bleeding
Alteplase, streptokinase, urokinase
Thrombolytics/fibrinolytics
MoA - Activation of plasminogen for proteolytic breakdown of thrombus fibrin
Indication - Myocardial infarction, ischaemic stroke
Simvastatin, atorvastatin (statins)
HMG-CoA Reductase inhibitors
MoA - Inhibition of mavelonate pathway required for cholesterol synthesis
Indication - Hypercholesterolaemia, risk of CVD and stroke
Adverse effects - Myalgia
Interactions - Verpamil, macrolides
Disopyramide, Quinidine
Class Ia anti-arrhythmic drugs,
Sodium channel blockers
MoA - Voltage-sensitive sodium channel blockade
Prolong QT interval, increase QRS duration.
Indications - Ventricular and supra ventricular arrhythmias
Adverse effects - oedema
Lidocaine
Class Ib anti-arrhythmic drug,
Sodium channel blocker
MoA - Voltage-sensitive sodium channel blockade
Prolong QT interval, increase QRS duration
Indication - CPR (used IV)
Adverse effects - oedema
Flecainide, Propafenone
Class Ic anti-arrhythmic drug,
Sodium channel blocker
MoA - Voltage-sensitive sodium channel blockade
Prolong QT interval, increase QRS duration
Indication - Paroxysmal atrial fibrillation and ventricular ectopic beats “pill in pocket”
Adverse effects - oedema
Class II anti-arrhythmic drugs
Beta-blockers:
Atenolol, bisoprolol, metoprolol
MoA - Beta-adrenergic receptor blockade – reduction in adrenergic effects on rate and inotropy
Indication - Prophylaxis of paroxysmal atrial tachycardia or fibrillation
Adverse effects - Hypotension
Amiodarone, dronedarone, sotalol
Class III Anti-Arrhythmic drugs – potassium channel blockers
(Sotalol also has some beta blocker activity)
MoA - Potassium channel blockade, also evidence of beta blocker and calcium channel blocker properties – prolong QT interval
Indication - Supraventricular, nodal and ventricular tachyarrhythmias, atrial fibrillation, (CPR - used IV)
Adverse effects - Nausea, vomiting
Verapamil, diltiazem
Class IV anti-arrhythmics – calcium channel blockers (phenylalkylamine & benzothiazepine subclasses)
MoA - Cardiac calcium channel blockade – reduction of action potential & cardiac output
Indication - Supraventricular tachycardia (especially paroxysmal SVT)
Adverse effects - Hypotension (verapamil), Constipation (diltiazem)
Digoxin
Cardiac glycosides
MoA - reduces conductivity of AV node
Indication - arrhythmias, AF, congestive heart failure
Adverse effects - fatigue, nausea
Adenosine
MoA - Activates adenosine receptors – causes hyperpolarization,
Slows conduction through AV Node
Indication - supraventricular tachycardia
Adverse effects - Nausea; contraindicated in obstructive airway disease
Atropine
Antimuscarinic
MoA - Blockade of vagal muscarinic acetylcholine receptors
Indication - Emergency bradycardia
Adverse effects - Urinary retention
Magnesium sulphate (IV)
MoA - Unclear – possible alteration of Na+, K+ and Ca2+ ion balance via ion channels and transporters
Indication - Emergency arrhythmia
(Also used IV for emergency asthma)
Adverse effects - Electrolyte irregularities
Salbutamol, terbutaline
Short-acting Beta-2 adrenergic agonists
MoA - Dilates bronchial smooth muscle
Indications - Asthma, reversible airways obstruction
Adverse effects - Tachycardia, tremor
Interactions - Diuretics
Ipratropium
Short-acting anti-muscarinic
MoA - Blocks muscarinic receptors to promote bronchial dilation
Indication - Acute asthma, bronchiospasm in COPD
Adverse effects - Dry mouth, constipation
Tiotropium
Long-acting anti-muscarinic
MoA - Blocks muscarinic receptors to promote bronchial dilation
Indication - Acute asthma, bronchiospasm in COPD
Adverse effects - Dry mouth, constipation
Theophylline, aminophylline
Methylxanthines
MoA - Bronchodilator, increases cAMP in smooth muscle
Indications - Acute asthma, reversible airways obstruction
Adverse effects - Headache, nausea
Interactions - Antidepressants, salbutamol
Beclomethasone, Prednisolone, Hydrocortisone, Fluticasone
Glucocorticoids
MoA - Reduction of inflammation and mucus production
Indications - Asthma, allergic rhinitis
Adverse effects - Cough
Interactions - Aspirin
Montelukast, zafirlukast
Leukotriene antagonists
MoA - Blockade of leukotriene receptors
Indications - Asthma, allergic rhinitis
Adverse effects - Abdominal pain
Interactions - Phenobarbital
Dornase alfa
Mucolytic
MoA - Synthetic DNAse 1 – breakdown of extracellular DNA to reduce sputum viscosity
Indication - Cystic fibrosis
Dopaminergics
Levodopa (precursor); Pramipexole, Ropinirole, Rotigotine (synthetic agonists)
MoA - Increased dopamine synthesis and dopaminergic function
Indication - Parkinson’s Disease
Adverse effects - Confusion, agitation
Interactions - MAOI
Dopa-decarboxylase inhibitor
Carbidopa, Benserazide
MoA - Stops breakdown of Levadopa in the periphery by inhibiting dopa-decarboxylase
Indication - Parkinson’s Disease
Adverse effects - Confusion, agitation
Inhibitors of Monoamine Oxidase B (MAOI)
Selegiline, Rasagiline
MoA - Inhibition of dopamine breakdown
Indication - Parkinson’s Disease
COMT (catechol-O-methyl transferase) Inhibitors
Entacapone, Tolcapone
MoA - Blockade of dopamine precursor breakdown by inhibition of COMT
Indication - Parkinson’s Disease
Adverse effects - N+V
Anticholinergics
Orphenadrine, Procyclidine, Trihexphenidyl
MoA - Muscarinic cholinergic receptor antagonist
Adverse effects - Dry mouth, constipation
Dopamine-depleting drugs
Tetrabenazine
MoA - Blocks VMAT, preventing uptake of DA into vesicles
Indications - Huntingdon’s chorea
Class/Group
Selective serotonin reuptake inhibitors (SSRIs)
Sertraline, Citalopram, Fluoxetine
MoA - Inhibition of serotonin (5HT) reuptake pump in synaptic cleft
Indications - depression, generalised anxiety disorder
Adverse effects - Insomnia, nausea
Interactions - NSAIDs, lithium
Reversible Inhibitor of Monoamine Oxidase type A (RIMA)
Moclobeminde
MoA - Inhibits monoamine oxidase A, preferentially decreases breakdown of serotonin and noradrenaline
Indications - Depression
Adverse effects - Tachycardia
Tricyclic antidepressants (TCAs)
Amitriptyline, Nortriptyline, Dosulepin
MoA - Inhibition of noradrenaline and serotonin reuptake in synaptic cleft, H1 antagonist, M1 antagonist, Adrenergic antagonist
Indications - Depression
Adverse effects - Anticholinergic syndrome
Atypical antidepressants
Reboxetine, Venlafaxine, Buproprion, Agomelatine, Mirtazepine
MoA - Noradrenaline reuptake inhibitor (Reboxetine); Noradrenaline/serotonin reuptake inhibitor (Venlafaxine); Noradrenaline /Dopamine reuptake inhibitor (Buproprion); Melatonin agonist (Agomelatine); Alpha-2 antagonist (Mirtazepine)
Indications - Depression
Antipsychotics – Classical (also known as First Generation)
Chlorpromazine, Haloperidol
MoA - Selective D2 dopamine receptor blockade
Indication - Schizophrenia
Adverse effects -
Blurred vision, tremor,
Extrapyramidal symptoms, hypotension
Antipsychotics – Atypical (also known as Second Generation)
Olanzapine, Risperidone, Quetiapine, Clozapine, Amisulpride
MoA - Selective D2 dopamine receptor blockade
Indication - Schizophrenia
Adverse effects - Extrapyramidal symptoms (less than classical antipsychotics), hypotension
Mood stabiliser
Lithium carbonate
MoA - Unclear – possible neuronal calcium channel blockade
Indication - Bipolar Disorder
Adverse effects - Tremor, hypothyroidism
Interactions - NSAIDs, ACE inhibitors
Cholinesterase inhibitors
Donepezil, Galantamine, Rivastigmine
MoA - Inhibition of acetylcholinesterase (reversible)
Indications - Alzheimer’s Disease, mild to moderate dementia
Adverse effects - N+V
NMDA receptor antagonist
Memantine
MoA - VD blocker of NDMA receptors
Indications - Alzheimer’s Disease, moderate to severe dementia
Adverse effects - constipation, hypertension
Anxiolytics
Benzodiazepines, buspirone
MoA - GABA PAM (γ-subunit); 5-HT1A partial agonist (Buspirone)
Indication - Anxiety and related disorders
Non-benzodiazepine hypnotic
Zopiclone
MoA - GABA PAM (γ-subunit)
Enhanced effects of GABA
Adverse effects - Insomnia
Anti-epilepsy drugs (AEDs)
Sodium Valproate, Lamotrigine, Carbemazepine, Ethosuximide
MoA - Na+ channel blockers;
(Ethosuximide – Ca2+ channel blocker)
Indication - Epilepsy
Adverse effects - Nausea, blurred vision
Interactions - Macrolide antibiotics
Benzodiazepines
Lorazepam, Midazolam, Diazepam, Zolpidem (BDZ-like)
MoA - GABA PAM (γ-subunit)
Enhanced effects of GABA
Indications - Epilepsy, Acute seizures
Adverse effects - Drowsiness, dependence
Interactions - Sedatives
BDZ antagonist
Flumazenil
MoA - Antagonises GABA signalling
Indications - Reversal of BDZ sedation
Barbiturates
Phenobarbitone, Pentobarbitone, Primidone
MoA - GABA PAM (β-subunit)
Enhanced effects of GABA
Indications - Epilepsy, Acute seizures
Adverse effects - Drowsiness, fainting
Interactions - Sedatives, anti-coagulants
Weak analgesic/antipyretic
Paracetamol
MoA - Unclear – possible COX inhibitor in CNS
Indications - Mild-moderate pain, pyrexia
Adverse effects - constipation
Interactions - Warfarin
Non-steroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen, Diclofenac, Naproxen
MoA - Non-selective COX inhibitors, blockade of prostaglandin synthesis
Indications - Mild-moderate pain, inflammation
Adverse effects - GI disturbance, hypertension, Aspirin not suitable for under 16s
Interactions - Diuretics, ACE inhibitors,
COX2-selective NSAIDs
Etoricoxib, Celecoxib
MoA - COX-2 inhibition, localised prostaglandin blockade
Indications - Pain, inflammation
Adverse effects - Indigestion
Interactions - ACE inhibitors, SSRIs
Weak opioid analgesics
Codeine, Dihydrocodeine
MoA - Stimulation of analgesic opioid receptors
Indication - Mild-moderate pain
Adverse effects - Constipations, nausea
Interactions - sedatives
Strong opioid analgesics
Morphine, Diamorphine, Pethidine, Fentanyl
MoA - Stimulation of analgesic opioid receptors
Indications - Severe pain
Adverse effects - constipation, nausea
Interactions - sedatives
Partial/mixed agonist opioid analgesics
Buprenorphine, pentazocine
MoA - Modulation of analgesic opioid receptors (µ and kappa)
Indications - moderate to severe pain
Adverse effects - constipation, nausea
Interactions - sedatives
Opioid antagonist
Naloxone, naltrexone
Indications - Opiate overdose, respiratory depression
Adverse effects - nausea, tachycardia
Opioid addiction management
Methadone, Buprenorphine
MoA - Narcotic opioid replacement; opioid receptor agonist/modulator
Indication - Opiate addiction
Adverse effects - Constipation
Interactions - Sedatives
Drugs for neuropathic pain
Gabapentin, Pregabalin, Amitriptyline
MoA - VDCC antagonist (gabapentin, pregabalin)/ TCA (amitriptyline)
Indication - neuropathic pain
Adverse effects - dizziness, fatigue
Interactions - Antidepressants
Inhaled analgesics
Nitrous oxide + oxygen mixture (“Gas & Air”)
Entonox
MoA - unclear
Indications - analgesia during childbirth
Adverse effects - Decreased vitamin B12 synthesis
Propofol, isoflurane, sevoflurane
General anaesthetic
MoA - Unclear - possiblel enhancement of GABA function
Indication - Induction of anaesthesia throughout major surgery
Adverse effect - hypotension
Ketamine
General anaesthetic
MoA - NMDA receptor blockade
Indication - Induction of anaesthesia throughout major surgery
Adverse effect - hypotension
Local anaesthetic
Lidocaine, Bupivacaine, Levobupivacaine
MoA - Voltage-gated sodium channel blockade
Adverse effects - Rash
Non-depolarising neuromuscular blockers
Atracurium besilate, Vecuronium
MoA - Competitive antagonist at AChR
Indication - Tracheal intubation and mechanical ventilation during surgery
Adverse effects - hypotension, skin flushing
Depolarising neuromuscular blocker
Suxamethonium
MoA - Initially depolarisation and desensitisation of AChR
Indication - Tracheal intubation and mechanical ventilation during surgery
Adverse effects - hypotension, skin flushing
Sugammadex
Drugs for reversing neuromuscular block
MoA - Oligosaccharide that forms a complex with NMBs removing them from NMJ
Indication - Immediate reversal of NMB to reduce post-operative pulmonary complications
Neostigmine
Drugs for reversing neuromuscular blocker
MoA - Peripheral acetylcholinesterase inhibitor
Indication - Immediate reversal of NMB to reduce post-operative pulmonary complications (sugammadex)
(Neostigmine also used for myasthenia gravis)
Muscle relaxants and sedatives
Temazepam (BDZ), Zolpidem,
Dexmedetomidine (alpha-2 agonist)
Alfentanil, Fentanil, Remifentanil (opioids)
MoA (alpha-2 agonist) - inhibits sympathetic activity
Indication - Maintain sedation and relaxed muscle tone
Adverse effect - Bradycardia (alpha-2 agonist)
Cyclizine
Anti-emetic (H1-receptor antagonist)
MoA - Histamine H1 receptor blockade
Indications - N+V
Adverse effects - Dry mouth, sedation
Interactions - Sedatives
Domperidone
Anti-emetic (D2-receptor antagonist)
MoA - Dopamine D2 receptor blockade in the Chemoreceptor Trigger Zone
Indications - N+V
Adverse effects - cardiac disease
Amoxicillin, Co-amoxiclav, Piperacillin-Tazobactam (Tazocin), Flucloxacillin,
Phenoxymethylpenicillin
Penicillins (Beta lactam)
MoA - Beta-lactam: Inhibition of bacterial cell wall synthesis
Indications - Respiratory infection, pneumonia, H pylori
Adverse effects - Rash, hypersensitivity
Interactions - Warfarin, methotrexate
Meropenem
Carbapenems (Beta lactam)
MoA - Beta-lactam: Inhibition of bacterial cell wall synthesis
Indications - Meningitis, hospital-acquired septicaemia
Adverse effects - Abdominal pain, pruritus
Ceftriaxone
Cephalosporins (Beta lactam)
MoA - Beta-lactam Inhibition of bacterial cell wall synthesis
Indications - Gram-negative infections (third generation), meningitis
Adverse effects - GI disturbances, colitis
Interactions - Warfarin
Trimethoprim
Antifolate antibiotic
MoA - Inhibition of dihydrofolate reductase
Indications - UTI
Adverse effects - Rash, GI disturbances
Interactions - Methotrexate
Ciprofloxacin
Fluoroquinolones
MoA - Inhibition of bacterial DNA gyrase
Indications - Respiratory tract infection
Adverse effects - Nausea, convulsions
Interactions - Iron salts, NSAIDs
Erythromycin, Azithromycin
Macrolide antibiotics
MoA - Inhibition of bacterial protein synthesis
Indications - pneumonia
Adverse effects. - GI disturbance, headache
Interactions - Digoxin, theophylline, statins
Doxycycline
Tetracycline antibiotics
MoA - Inhibition of bacterial protein synthesis
Indications - Community-acquired pneumonia
Nitrofurantoin
Nitrofuran
MoA - Bacterial DNA interference
Indications - UTI
Adverse effects - peripheral neuropathy
Gentamicin
Aminoglycoside antibiotic
MoA - Inhibition of bacterial protein synthesis
Indication - Opthalmic infection
Vancomycin
Glycopeptide antibiotic
MoA - Inhibition of cell wall synthesis in gram-positive bacteria
Indication - C. difficile infection
Adverse effects - Neutropenia, renal impairment
Metronidazole
Nitroimidazole (anti-aerobe agent) - antibiotic
MoA - Inhibition of bacterial DNA synthesis
Indication - Anaerobic bacterial infection: leg ulcers, pressure sores
Isoniazid, Ethambutol, Rifampicin, Pyrazinamide
Antituberculosis drugs
(Used in combination)
MoA - Inhibition of mycobacterial cell wall synthesis (Isoniazid, Ethambutol); inhibition of mycobacterial RNA synthesis (Rifampicin)
Indication - Tuberculosis
Adverse effects - hepatotoxicity
Interferon alpha
Therapeutic cytokines
MoA - Activation of antiviral intracellular and immune responses
Indications - Hepatitis B and C
Adverse effects - Flu-like symptoms, loss of appetite
Aciclovir, Ganciclovir
DNA polymerase inhibitors
MoA - Virus replication blockade via inhibiting viral DNA polymerase
Indications - Herpes simplex infection
Cytomegalovirus infection
Adverse effects - nausea, diarrhoea
Oseltamivir
Neuraminidase inhibitors
MoA - Prevention of viral budding and infectivity
Indications - Influenza virus infection
Adverse effects - N+V
Ribavirin
Nucleoside analogues
MoA - Disrupts viral RNA synthesis
Indications - Hepatitis C, RSV
Tenofovir
Nucleoside reverse transcriptase inhibitors (NRTI)
MoA - Blockade of viral reverse transcriptase function essential for viral genetic replication
Indications - HIV infection
Adverse effects - Rash, Stevens-Johnson syndrome
Efavirenz
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
MoA - Blockade of viral reverse transcriptase function essential for viral genetic replication
Indications - HIV infection
Adverse effects - Rash, Stevens-Johnson syndrome
Lopinavir
Viral protease inhibitors
MoA - Blockade of viral protease required for virus particle assembly
Indications - HIV infection
Adverse effects - GI bleeding
Dolutegravir
Integrase inhibitors
MoA - Disrupts integration of HIV genome into host chromosomes
Indications - HIV infection
Enfuvirtide
Viral fusion inhibitors
MoA - Blockade of virus fusion to target cell membrane
Indications - HIV infection
Maraviroc
Chemokine receptor/CCR5 antagonist
MoA - Blockade of HIV binding to co-factor for cell entry
Indications - HIV infection
Adverse effects - Nausea, diarrhoea
Fluconazole
Triazole anti-fungal agent
MoA - Disruption of fungal membrane function
Indications - Candida infection
Adverse effects - Nausea, abdominal pain
Insulin
Blood glucose-reducing hormones
MoA - Stimulation of glucose uptake by cells
Indications - Type 1 and type 2 diabetes mellitus
Adverse effects - Hypoglycaemia
Interactions - Digoxin, beta-blockers
Oral biguanide
Metformin
MoA - Increases insulin sensitivity, inhibits hepatic gluconeogenesis
Indications - Type 2 diabetes
Adverse effects - N+V
Interactions - Diuretics, digoxin
Gliclazide
Sulphonylureas
MoA - Stimulates pancreatic insulin secretion
Indications - Type 2 diabetes
Adverse effects - hypoglycaemia
Interactions - Warfarin, NSAIDs
Pioglitazone
Thiazolidinediones
MoA - Increases insulin sensitivity in muscle and adipose tissue
Indications - Type 2 diabetes
Adverse effects - weight gain
Exenatide
Glucagon-like peptide-1 receptor (GLP-1) agonist
MoA - Incretin analogue – improves glucose control
Indications - Type 2 diabetes
Adverse effects - asthenia
Sitagliptin
Dipeptidyl peptidase-4 (DPP-4) Inhibitor
MoA - Reduces inactivation of incretins
Indications - Type 2 diabetes
Adverse effects - Headache
Empagliflozin, Dapagliflozin
SGLT-2 Inhibitor
MoA - Blockade of renal Na-glucose transporter – increases urinary excretion of blood glucose
Indications - Type 2 diabetes
Adverse effects - urinary infection
Orlistat
Lipase inhibitor
MoA - Inhibition of GI uptake of dietary fat
Indications - Obesity, especially in presence of Type-2 diabetes
Adverse effects - Oily stools, faecal urgency
Levothyroxine sodium (T4) Liothyronine sodium (T3)
Thyroid hormones
MoA - Synthetic hormones
Indications - Hypothyroidism
Adverse effects - Diarrhoea, vomiting
Interactions - oral anticoagulants
Methotrexate
Antifolate antiproliferative
MoA - Inhibition of dihydrofolate reductase and DNA synthesis for lymphocyte proliferation
Indications - Rheumatoid arthritis
Adverse effects - nausea, hair loss
Interactions - warfarin, corticosteroids
Azathioprine
Antimetabolite immunosuppressant
MoA - Unclear – possible inhibition of DNA synthesis and lymphocyte proliferation
Indications - Rheumatoid arthritis (also Crohn’s Disease)
Adverse effects - alopecia
Adalimumab, Etanercept, Infliximab
Cytokine modulators
MoA - TNF-alpha blockade
Indications - Rheumatoid arthritis
Adverse effects - alopecia
Sulfasalazine, Mesalazine
Aminosalicylates
MoA - Unclear – possible COX inhibition. Possible free radical scavenging, T cell suppression
Indications - Rheumatoid arthritis (also Crohn’s Disease)
Adverse effects - Nausea
Interactions - Digoxin, warfarin
Desogestrel and ethinyl-estradiol
Oral combination pill contraceptives
MoA -Mimics ovulation, reduces LH and FSH
Indication - Hormonal contraception, PCOS
Adverse effects - weight gain, depression, DVT risk
Desogestrel,
Levonorgestrel (emergency)
Oral mini-pill contraceptives
Progestogen-only
MoA - Mimics ovulation, reduces LH and FSH, endometrial changes
Indications - Hormonal contraception
Adverse effects - depression
Etonogestrel
Implants/ injectable contraceptives
MoA - Mimics ovulation, reduces LH and FSH
Indications - Hormonal contraception
Adverse effects - Weight gain, depression
Estradiol, Noresthisterone, Medroxyprogesterone
Hormone replacement therapy (HRT)
MoA - Restores decreased hormone level and function
Indication - menopause
Adverse effects - weight gain, depression
Dinoprostone
Induction of labour
MoA - Prostaglandin E2 – stimulates cervical ripening
Indications - delay in labour
Oxytocin
Augmentation agents
MoA - Stimulation of uterine contraction
Indications - Delay in labour
Mifepristone with Misoprostol
Antiprogestogen/Prostaglandin for medical termination
MoA - Steroidal antiprogestogen in combination with synthetic prostaglandin
Indication - Termination of pregnancy
Adverse effects - GI cramps, uterine contractions, vaginal bleeding
Tranexamic acid
Antifibrinolytic for menorrhagia
MoA - Inhibits fibrin clot breakdown by plasmin
Indications - Menorrhagia
Adverse effects - Nausea
Mefenamic acid
NSAID (for dysmenorrhoea)
MoA - Inhibition of prostaglandin synthesis
Indications - dysmenorrhoea
Adverse effects - GI bleeding
Tamsulosin
Alpha-1 blocker
MoA - Smooth muscle relaxant acting on bladder neck
Indications - BPH, urinary retention
Adverse effects - dizziness
Interactions - hypotensive drugs
Oxybutinin
Urinary antispasmodic (Antimuscarinic)
MoA - Blockade of acetylcholine receptors leading to bladder smooth muscle relaxation
Indications - Overactive bladder
Adverse effects - dry mouth, tachycardia (preceded by transient bradycardia)
Mirabegron
Beta-3-agonist
MoA - Stimulation of Beta-3 adrenergic receptors, leading to detrusor smooth muscle relaxation
MoA - Overactive bladder
Adverse effects - Bladder pain
Finasteride
Anti-androgens
MoA - Inhibition of synthesis of dihydrotestosterone
Indication - Benign prostatic hyperplasia
Adverse effects - impotence
Chlorphenamine, Cetirizine
Anti-histamines
MoA - H1 histamine receptor blockade
Indications - Hay fever, urticaria
Adverse effects - Dry mouth, sedation
Interactions - TCAs
Prednisolone, hydrocortisone,
Dexamethasone
Glucocorticoids
MoA - Intracellular transcription factor interactions, gene expression
Indications - Suppression of inflammatory diseases (e.g. Crohn’s, RA)
Adverse effects - Weight gain, muscle atrophy
Interactions - oral antidiabetics
Cyclosporin, tacrolimus
Calcineurin inhibitor
MoA - Inhibition of T cell signalling
Indications - Solid organ transplantation,
Eczema (topical)
Adverse effects - Hypertension
Interactions - Aspirin
Cyclophosphamide
Classical alkylating agents
MoA - DNA crosslinking
Indication - Broad spectrum of malignancies
Adverse effects - Hair loss, bone marrow suppression, nausea
Paclitaxel, Docetaxel
Taxanes
MoA - Inhibition of microtubule assembly in mitotic spindle
Indication - Broad spectrum of malignancies
Adverse effects - Hair loss, bone marrow suppression, nausea
Vincristine, vinblastine
Vinca alkaloids
MoA - Inhibition of microtubule assembly in mitotic spindle
Indication - Broad spectrum of malignancies
Adverse effects - Hair loss, bone marrow suppression, nausea
Methotrexate
Antifolates
MoA - Inhibition of dihydrofolate reductase and DNA synthesis
Indication - Broad spectrum of malignancies
Fluorouracil, Cytarabine
Antipyrimidines
MoA - Inhibition of RNA and DNA synthesis
Indication - Broad spectrum of malignancies
Adverse effects - Hair loss, bone marrow suppression, nausea
Mercaptopurine, thioguanine
Antipurines
MoA - Inhibition of RNA and DNA synthesis
Indications - Broad spectrum of malignancies
Adverse effects - Hair loss, bone marrow suppression, nausea
Doxorubicin
Anthracycline antibiotics
MoA - DNA intercalation; Inhibition of RNA and DNA synthesis
Indication - Broad spectrum of malignancies
Adverse effects - Hair loss, bone marrow suppression, nausea
Trastuzumab
Antineoplastic monoclonal antibodies
MoA - Targeting of cells overexpressing Human Epidermal Growth Factor Receptor-2 (HER2) for tumour reduction & destruction
Indication - Early breast cancer
Adverse effects - fever, chills
Rituximab
Antineoplastic monoclonal antibodies
MoA - Targeted destruction of CD20+ B cells
Indication -
Follicular lymphoma, Non-Hodgkin’s lymphoma
Adverse effects - fever, chills
Nivolumab
Antineoplastic monoclonal antibodies
MoA - Stimulation of anti-tumour responses via blocking PD-1
Indication - melanoma
Adverse effects - fever, chills
Lenolidamide
Immunomodulator
MoA - Stimulation of T cell responses
Indication - myeloma
Adverse effects - foetal risk
Tamoxifen
Selective estrogen receptor modulator (SERM)
MoA - Inhibition of oestrogen receptor function and cell proliferation in breast
Indication - Breast cancer
Goserelin
Luteinising hormone releasing hormone (LHRH) receptor agonist
MoA - Synthetic analogue of LHRH. Activates LHRH receptor function leading to sustained reduction in testosterone
Indication - Prostate cancer
Calcitonin
Therapeutic Hormones
MoA - Inhibits mobilisation of calcium from bones
Indications - osteoporosis, hypercalcaemia
Adverse effects - Abdominal pain
Interactions - antacids
Alendronate, Pamidronate
Bisphosphonates
MoA - Inhibits osteoclast function and bone resorption
Indications - osteoporosis, hypercalcaemia
IV calcium gluconate, vitamine D, parathyroid hormone
Drugs for hypocalcaemia
MoA - Restoration of calcium levels and metabolism
Indications - Hypocalcaemia, bone loss
Vitamin D (colecalciferol, calcitriol (1,25-dihydroxyvitamin D)
Vitamin D deficiency
MoA - Restoration of vitamin D levels
Indications - Vitamin D deficiency
Raloxifene
Selective estrogen receptor modulator (SERM) (for osteoporosis)
MoA - Stimulation of oestrogen function in bone
Indications - prevention of bone fractures
Adverse effects - hot flushes
Interactions - warfarin
Denosumab
Monoclonal antibody
MoA - Inhibition of osteoclast function and bone resorption
Indication - osteoporosis
Adverse effects - hypocalcaemia
Ferrous sulphate
Oral iron compound
MoA - iron provision
Indication - Iron-deficient anaemia
Adverse effects - constipation
Interactions - Antacids
Folic acid
Water soluble vitamin
MoA - Supports nucleic acid synthesis
Indications - Folate-deficient anaemia
Vitamin B12 (parenteral)
Water soluble vitamin
MoA - Enzyme cofactor
Indications - Pernicious anaemia
