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Inhibit hydrogen- potassium ATP enzyme system

Gastric and duodenal ulcers and those caused by NSAIDs, used with combination of antibiotics for eradication of H.pylori, GORD, dyspepsia.

May mask sysmtoms of gastric cancer, osteoporosis patients should maitain adequate vit D + Ca intake

SE: GI disturbances, headache

- Omezaprole – oral/iv
- Lansoprazole – avoid n breast feeding



Inhibit HMG CoA reductase => reduce LDL cholesterol conc

Given to those with symptomatic cardiovascular disease, DM >40yrs old, if total cholesterol conc to HDL ratio exceeds.
Hypothyroidism needs treating before, use cautiously in alcoholics liver disease, rhabdomyolosis or myopathy, avoided in pregnancy.

SE: myalgia, myopathy, myostits, rhabdomyolysis, alter LFT, GI disturbance, headache etc

Simvastatin- primary hypercholesterolemia, homozygous familial hypercholesterolemia, combined hyperlipidaemia



Uses; HF, hypertension (dose at bedtime), diabetic nephropathy, prophylaxis of cardiovascular risk

SE: risk of hyperkalaemia, first dose can cause hypotension, renal impairment, persistent dry cough avoided in preggers unless essential

Ramipiril – hypertension, MI, prevent cardiovasc disease



Irreversibly In COX 1 - antiplatelet & analgesic

Cautions; asthma, peptic ulcers, uncontrolled hypertension; avoid in severe bleeding, hepatic or renal impairment , avoid use in 3rd trimester of pregs, and breast feeding (reyes syndrome risk). SE: bronchospasm, GI irritation, haemorrhage.

Analgesic – mild to moderate pain, pyrexia. Avoid asthma, allergic, dehydration, not use in children under 16yrs


Beta 2 agonists

Bronchodilator, relief of asthma,

Cautions – hypothyroidism, cardiovascular disease

SE: hypokalaemia, fine tremour, nervous tension, headache

- Salbutamol – short acting, can be used in labour, lactic acidosis may occur at high doses (ventolin = product name)

- Salmeterol long acting, (can be given IV in emergency)., treat COPD, prevent exercise induced asthma. SE: nausea, dizziness


Beta blockers

Angina,hypertension , slow heart and can depress myocardium

Avoided in unstable HF, Avoided in asthma patients as cause brochoconstriction.

SE: coldness of extrematies, tiredness, sleep disturbances, affects carb metabolism, not give to pregs

- Atenolol – water-soluble so less likely to affect brain


Ca Channel Blockers

Amlodipine - hypertension, prophylaxis of angina

SE: abdo pain, nausea, palaptation, oedema etc


Broad spectrum penicillins

- Amoxicillin – staph aureus, e.coli, staphylococci, lymes disease, oral infections.

SE: renal impairment, crystaluria with high doses, nausea, vomiting diarrhoea, rashes, allergic reaction

- Co-amoxiclav – (amoxillicn and clavulanic acid), beta-lactamase producing strains – resp, GI, urinary, bone + joint infections

SE same as above and Stevens-Johnson sydrome, hepatitis, etc


Combination analgesia

Co-codamol – paracetamol and codeine phosphate, mild to moderate pain

SE: constipation, skin rashes, dizziness etc

- Co-dydramol – paracetamol and dihydrocodeine tartrate

SE; allergic reaction, abdo pain, GI probs



Decreases production of prostaglandins by inhibiting cox enzymes; analgesic and anti-inflam.

Not use in severe HF, renal impairment, caution with hepatic impairment

SE: Gi disturbances, hypersensitivity, longterm --? Female fertility problems

Diclofenac – pain and inflam in rheumatic disease, acute gout, migraine, post op pain, fever in kids. not use in ischaemic heart disease etc


Loop diuretics

Pulmonary oedema due to LV failure, CHF. Inhibit reabsoprtion from the ascending LOH. Correct hypovolaemia and hypotention corrected before use

SE: GI disturbances, pancreatitis, postural hypotension, hypo-natraemia/kalaemia/calcaemia/chloaemia/magnesium

- Frusemide – oedema and reisitant hypertension. SE: above and intrahepatic cholestasis and gout


Osmotic laxatives

Increases amount of water in large bowel

- Lactulose – produces osmotic diarrhoea if low faecal pH. Use; constipation + hepatic encephalopathy.SE: naseau, vomiting, cramps, abdo discomfort

- Movicol – SE: abdo distension, pain, nausea, discontinue if electrolyte or fluid disturbance



Short term relief of severe anxiety, sedation. May cause resp depression

- Diazepam – mild sedation with amnesia.

SE: drowsiness, confusion, ataxia, dependence, muscle weakness, paradoxical increase in aggression

- Temazepam


Stimulant laxatives

Increase intestinal motility and can cause cramp, avoid in intestinal obstruction. Excessive use can lead to hypokalaemia

Senna –use in constipation



Depression, better tolerated and safer in overdose. Caution in epilepsy, also may effect performance of skilled tasks, withdrawal can occur. Should not be started until 2 weeks after stopping MAOI

SE: GI effects, anorexia, weight loss, hypersensitivity, uretica etc

Citalopram- depression and panic disorder. SE: see above and papaltations, hepatitis, tachycardia, oedema etc


Thiazide and related diuretics

Inhibit sodium reabsoption at the beginning of thedistal convoluted tubule. Use – hypertension, HF. Can exacerbate diabetes, gout, SLE. Avoided in severe liver disease, preggers

SE: GI disturbances, postural hypotension, hypokalaemia, hyponatreamia, hypomagnesia, hypercalcaemia, hypergycaemia

Bendroflumethazide – mild to moderate heart failure, used for hypertension (not first choice), oedema


B Vitamins

Thiamine (B1) – alcholosim => severe deficiency status (Wernicke’s encephalopathy + Karsakoff’s psychosis). Anaphylaxis may occur

Folic acid – undiagnosed megaloblastic anaemia, folate deficient megablastic anaemia, (poor nutrition, pregs, epileptic drugs),prohylaxis in chronic haemolytic/renal dialysis/malabsorption/pregs, in prevention of methotextrate induced side effects.

SE: rate- GI disturbances



Vasodilator effects, used in angina – decrease venous return => decreased LV work

SE: flushing, headache, postural hypotension,. Tolerance may rapidly occurs

Isosorbide mononitrate – prophylaxis of angina, congestive HF. SE; see below

Gylcerol trinitrate – rapid alleviation of angina, short acting, anal fissure, extravasation, hypertension, MIS

E: postural hypotension, tachycardia, throbbing headache


Calcium and Vitamin C & D

C => scurvy, D => rickets.. Combined – used for osteoporosis, those with combined deficiency eg calcium and ergocaliferol (Vit D2)


Inhaled corticosteroids (not asthma)

Allergic rhinitis

SE: dryness, irritation of nose, troat and epistaxis

Beclometasone dipropionate – prophalxis and treatment of allergic rhinitis (also oral ulceration), asthma


Inhaled corticosteroids asthma

anti-inflam, requires low mineralocorticoid activity to accompany it. Long term treatment may lead to the adverse effects may >than benefit. Not used in septic shock or head injury.

Used for asthma, RA, autoimmune hepatitis, sarcoidosis. May lead to remission of haemolytic anaemia, nephritic syndrome, thrombocytopenic purpura.

Long term => withdrawal symptoms so wean off, increase chance of infections, psychiatric reactions

SE: hypertension, diabetes, osteoporosis, muscle wasting, high doses => Cushing's syndomre; suppression of growth.GI disturbances, endocrine effects etc

Prednisolone - taken orally, long-term disease suppression of inflam and allergic disorders, IBS, asthma, croup, immunosupression, rheumatic disease


Alpha AdR blockers

Relax smooth muscle – prostate hyperplasia increase urinary flow, hypertension

SE: decrease BP (can be too rapid so watch first dose), syncope, dizziness, headache, asthenia, Gi disturbance avoided in patients with postural hypertension and micronutiration syncope, caution in cataract surgery

Doxazosin – benign prostatic hyperplasia, hypertension

SE: dyspnoea, coughing, fatigue, vertigo, paraesthesia, sleep disturbance, anxiety


AT-II receptor blockers

Similar action to ACEi but don’t inhibit bradykinins breakdown therefore no dry cough

HF and diabetic neuropathy. Caution in renal artery stenosis, avoided in pregs

SE: symptomatic hypotension including dizziness, hyperkalaemia

Losartan – hypertension, chronic HF, diabetic neuropathy

SE: as above, vertigo, GI disturbances angina


Thyroid hormones

Hyothyroidism, diffuse non-toxic goitre, Hashimoto’s thyroiditis, , thyroid carcinoma.

Levothyroxine – caution in elderly, predisposed to adrenal insuffuency, panhypopitutarism., contra-indicated in thyrotoxicosis

SE: norm due to excess doses – diarrhoea, vomiting, anginal pain, arrhythmias, palapitations, tachycardia etc



Decreases gluconeogenesis and increases peripheral use of glucose, only effective if some residual functioning pancreatic islet cells

Metformin – polycystic ovary syndrome, diabetic mellitus first drug of choice in overweight whose dieting not worked, hypoglycaemia not norm occur

SE: GI disturbances, anorexia, nausea, vomiting, diarrhoea, abdo pain, taste disturbances, latic acidosis (rare). Contraindications ketoacidosis



Injected subcutaneous route in arm, thighs, buttocks, abdo
Lipodystrophy may occur but can be reduced by rotation of the site of injection. Given before meals (short acting) and long acting (once/twice daily)

- Short acting insulin – soluble, IV/IM eg novorapid
- Intermediate + long acting – eg levimir, insultard
- Biphasic insulin – eg novomix



Antangonises the effects of Vit K, take 48-72hrs to work, norm 3-9mg but depends on INR (2.5-3.5 – monitored often at first then every 12 weeks after).

Adverse effect- haemorrhage (give phytomenadione), stopped 5 days pre-op, should not be given in first trimester



Soothes, smooths and hydrates the skin, for dry scaly disorders, applied freq as short lived – eczematous disorders and ?psoriasis. Applied in direction of hair follicles to reduce folliculitis

- Diprobase – dry skin conditions
- Dermol 500 – has antimicrobials, for dry, pruritic skin conditions including eczema and dermatitis



Ferrous sulphate – 200mg 3/2x a day, iron-deficiency anaemia SE: GI irritation, nausea, epigastric pain, constipation. May discolour stools, if taken after food may decrease GI SE although best absorbed on empty stomach


TCA & Related antidepressants

Block the uptake of serotonin and NA.
Caution in cardiovascular disease due to causing arrhythmias, antimuscarininc property therefore caution in prostatic hypertrophy, constipation etc.
Overdose has high risk of fatality.

Withdrawal symptoms – flu like symptoms, insomnia, vivid dreams, movement disorders, and mania

SE: arrhythmias, heart block, postural hypotension, tachycardia, CNS effects (anxiety, dizziness, agitation, confusion etc), dry mouth, blurred vision, constipation and urinary retention, breast enlargement, galactorrhoea, changes in BS, weight loss etc

Amytriptyline – depressive illness, neuropathic pain, migraine prophylaxis. sedative property, very dangerous in OD. SE: above+ abdo pain, stomatitis, palpitaions, oedema etc



Nasal allergens, urticaria, pruritis and bites, drug allergies.
Sedating anti-histamines have anti-muscarininc effects not used in liver disease too.

SE: drowsiness, headache, psychomotor impairment, anti-musc effects (eg urinary retention)

Chlorphenamine – symptomatic relief of allergy such as hayfever, uriticaria, food allergy, drug reaction, emergency treatment of anaphylactic reaction; less sedating,

Cetirizine – symptomatic relief of allergy such as hay fever, chronic idiopathic urticaria, non-sedative

SE: above+ exfoliative dermatitis, and tinnitus



Augment insulin production, only effective when some residual pancreatic beta cell activity present. For non-overweight patients or whose not tolerate metformin. Avoided in severe renal impairment and monitored in mild-moderate

SE: encourage weight gain, GI disturbances (nausea, vomiting, constipation, diarrhoea), occasionally lead to disturbances in liver function, hypersensitivity

Gliclazide – T2DM


Beta lactams

Eg Cephalosporins

Broad spectrum antibiotics; septicaemia, pneumonia, meningitis, biliary tract infections, peritonitis, UTIs. Renal excretions

SE: hypersensitivity (HX of immediate hypersensitivity to penicillins should not receive a cephalosporin)

- Cefradine –oral activation, infections due to sensitive gram +ve and –ve bact. SE: diarrhoea, nausea, vomiting, GI discomfort, headache, and allergic reaction.

- Cefalexin – oral activation, infections due to sensitive gram +ve and –ve bact. SE: diarrhoea, nausea, vomiting, GI discomfort, headache, and allergic reaction

- Cefuroxime - infections due to sensitive gram +ve and –ve bact, and surgical prophylaxis, more active against H.influenzae and Lyme disease. SE: diarrhoea, nausea, vomiting, GI discomfort, headache, allergic reaction.

- Imipenem – aerobic and anaerobic Gram +ve & -ve, hospital acquired septicaemia, (NOT CNS infections). SE: nausea, vomiting, diarrhoea, eosinophilia, rash etc


Bisphosphates and drugs affecting bone metabolism

Adsorbed onto hydroxyapatite crystals in bone slowing the rate of growth and dissolution therefore reducing the rate of bone turnover. For osteoporosis, pagets disease, hypercalaemia of malignancy

Alendronic acid – osteoporosis. SE: oesophageal reactions, abdo pain and distension, dyspepsia, regurgitation, melaena, diarrhoea, constipation, flatulence, MSK pain, headache


Antimuscarinic bronchodilators

Caution in prostatic hyperplasia, bladder, outflow obstruction, glaucoma

SE: dry mouth, GI disturbances, cough, headache

- Ipratropium – reversible airway obstruction; short term relief in chronic asthma, mild COPD. SE: above + dizziness, vomiting etc

- Tiotropium –COPD, caution with patients with cardiac rhythm disorders, SE: above + taste disturbance, oropharangeal candidias, dizziness, epistaxis, pruritis



Alternatives in penillin allergics eg campylobacter enteritis, resp infections and skin infections. Caution in patients with prolonged QT intervals

SE : nausea, vomiting, abdo discomfort, diarrhoea

- Erythromycin – also used in syphilis, Chlamydia, urethitis, oral infections, skin infection, chronic prostasis, etc. SE: nausea, vomiting, diarrhoea

- Clarithromycin – resp tract infections, skin and soft-tissue infections, otitis media, lyme disease, prevention of pertussis, H.plyori eradication. Avoid in pregs esp 1st trimester. SE: as above + dyspepsia, taste disturbances, headache, insomnia, hyperhidrosis



Not inactivated by penicillinases therefore used against penicillin resistant staphylococci (eg otitis externa),

- Flucloxacillin – taken orally, well absorbed from gut. Resistant staphylococcus, adjunct in pneumonia, impetigo, cellulitis, osteomyelitis, staph endocarditis

SE: hypersensitivity reaction e.g. urticaria, fever, joint pain, rashes, angioedema, anaphylaxis



Antimicrobial drug for anaerobic infections (inc dental eg bacteroides fragilis), c.diff, tetanus, protozoal infection (inc trichomal vaginitis), H. pylori eradication, fistualting crohn’s disease, skin infections.

SE: GI disturbance, taste disturbance, furred tongue, oral mucositis, anorexia


Cardiac glycosides

Digoxin – increases the force of hearts myocardial contraction and decreases AV conduction. For; HF, supraventricular arrhythmias (AF & atrial flutter). Hypokalaemia predisposes people to digitalis toxicity – managed by giving potassium sparing diuretics. Caution in recent MI, sick sinus syndrome, thyroid disease etc. Don’t give for heart block patients. Measure renal impairment to assess toxicity (increases with electrolyte disturbance)

SE: nausea, vomiting, diarrhoea, arrhythmia, conduction disorders, dizziness, blurred vision, rash, eosinophilia


Benzylpenicillin and phenoxymethylpenicillin

BUT inactivated by bacterial beta-lactamases. Streptococcal, gonococcol and meniginococcal, anthrax, diptheria, gas-gangrene, leptospirosis and lyme disease

Benzylpenicillin is inactivated by the gastric acid and therefore injection is preferred - used for syphilis

Phenoxymethylpenicillin is gastric acid stable, not used for serious infections as absorption is unstable

SE: hypersensitivity (urticaria, fever, joint pain, rashes)


H2 Receptor antagonists

Allow healing of gastric and duodenal ulcers, by blocking H2 receptors and therefore gastric acid secretion. Also used in GORD, functional dyspepsia. May mask symptoms of gastric cancer. SE: diarrhoea, headache, dizziness, rash

- Ranitidine- SE: above + blurred vision, pancreatitis etc(rare)



Non- benzodiazepine hypnotics

- Zopiclone – insomnia

SE: taste disturbances, nausea, vomiting, dizziness etc. If hepatic impairment – can precipitate coma



Prevention of atherothrombotic events in peripheral artery disease/acute coronary syndrome, prevention on thrombotic events in AF when warfarin unsuitable

SE: dyspepsia, abdo pain, diarrhoea, bleeding disorders etc


Anti-emetic DA R Is

- Metoclopramide – nausea and vomiting incl that precipitated by acute migraine, delay-chemo induced, radio-therapy induced and post op. SE: extrapyramidal effects, hyperprolactinaemia, galactorrhoea, gynaecomastia, menstrual chages

- Domperidone – relief of nausea and vomiting SE: dry mouth, less commonly diarrhoea, drowsiness, malaise, headache etc


Atypical Antipsychotics

Used in schizophrenia

Caution in patients with cardiovascaular disease, parkinsons, epilepsy, depression, myasthenia gravis. High risk of relapse if drug stopped after 1-2 years

- Quetiapine – Schizophrenia, mania, depression in bipolar, major depressive disorder - Dopamine D1, D2, 5-HT2, alpha-adrenoreceptor and histamine -1 receptor antag – SE: extrapyramidial effects, dyspnoea, elevated plasma-trigylceride and cholesterol levels, peripheral oedema, increased appetite, sleep disturbances etc

- Olanzapine – Schizophrenia, mania, bipolar disorder -Dopamine D1,2, 4, 5-HT2, histamine-1, and muscarininc receptor antag – SE: extrapyramidal side effects, increased appetitie, hypertriglyceridaemia, hypercholesteraemia, bradycardia, arthralgia, oedema, malaise


Tear deficienc, ocular lubricants and astringents

Hypromellose - tear deficiency - may need to be given hourly for adequate relief



UTIs, acute and chronic bronchitis, pneumocystis pneumonia, caution in predisposition to foliate deficiency. SE: GI disturbances, nausea, vomiting, pruritis, rashes, hyperkalaemia, depression of haematopoiesis etc


Nicotine replacement therapies

Help cessation of smoking, patches, gum, lozenges, nasal spray, oral spray, inhalers

SE: may get confused with withdrawal symptoms (malaise, headache, dizziness, sleep disturbances coughing, flu-like symptoms, irritability, depression). Irritation may occur at beginning of treatment eg patches cause skin irritation; dry mouth common side effect, GI disturbances, palpitations, arrhythmias (with patches and spray)



Opioid dependence, long acting opioid agonist, (withdrawal can take 4 weeks in hosp setting, 12 in community), avoided in pregs. SE: QT interval prolongation, torsade de pointes, hypothermia, restlessness, raised intracranial pressure, dysmenorrhea, dry eyes, hyperprolactinaemia


Antimuscarinics (antispasmodics)

IBS, diverticulitis disease, arrythmias, asthma, motion sickness, parkinosism, uriniary incontience, mydriasis and cycloplegia. Used in caution in downs syndrome, GORD, diarrhoea, ulcerative collius. Not to be used with myasthenia gravis, paralytic ileus, pyloric stenosis, toxic megacolon.

SE: constipation, transient bradycardia, reduced bronchial secretions, urinary urgency and retention, dilation of pupils and loss of accommodation, photophobia, dry flushed skin

- Hyoscine – Gi and genito-urinary disorders characterised by smooth mucle spasm, bowel colic, excessive resp secretions

- Atropine – GI disorders characterised by smooth muscle contractions, mydriasis, cycloplegia, premedication

- Mebeverine – GI disorders characterised by smooth muscle spasms. SE: allergic reaction


Compound bronchodilators

Seretide – containing fluticasone propionate (corticosteroid) and salmeterol (B2 agonist). Prophylaxis of asthma, COPD (with FEV in 1 sec


Gout treatments

Allopurinol – Prophylaxis of gout and uric acid and calcium oxylate renal stones, prophylaxis of hyperuricaemia associated with chemo. xanthine-oxidase inhibitor to prevent formation of uric acid from purines. Started 1-2 weeks after an acute attack of gout. Useful in patients with renal impairment or urate stones

SE: rash, GI disturbances


Prostglandin analogues

Glaucoma treatment

Increase uveosacral outflow and therefore decrease intra-ocular pressure

SE: change in blood pressure, headache, ocular discomfort, conjunctival disorder, brown pigmentation, blepharitis

Latanoprost - raised intra-ocular oressure in open- angle glaucoma, ocular hypertension. SE: above + nasopharyngitis, pyrexia, iris cyst



SE: local irritation and hypersensitivity reaction (mild burning, erythema, itching)

Clotrimazole – fungal skin infections, vaginal candidiasis, otitis externa eg canesten, apply 2-3x a day

Nystatin – skin infections due to cansisa spp, oral fungal infections


Antimuscarinics (bladder)

Reduce symptoms of urgency and urge incontinence and increase bladder capacity. Avoided in patients with myasthenia gravis, bladder flow obstruction/retention or GI obstruction

SE: dry mouth, GI disturbances, taste disturbance dry eyes, , drowsiness, dizziness, fatigue, difficulty in microurition

Oxybutynin – direct relaxant effect on urinary smooth muscle. Urinary freq, urgency and incontinence, neurogenic bladder instability and nocturnal enuresis associated with overactive bladder

Tolterodine SE: above + chest pain, peripheral oedema, sinusitis, bronchitis, paraesthesia, fatigue, vertigo, weight gain.


Other antidepressants

Venlafaxine – major depression, generalised anxiety disorder. Causes serotonin and NA reuptake inhibitor. No sedative and antimuscarinic effects but higher risk of withdrawals.

SE: Constipation, nausea, anorexia, weight changes, vomiting, hypertension, palpatation, vasodilation, changes in serum cholesterol, chills + LOTS more

Mirtazepine – major depression – causes presynaptic alpha2-adrenoreceptor antag, increases central noradrenergic and serotinergic neurotransmission, few antimuscarininc effects but causes sedation at first

SE: increased appetite, weight gain, dry mouth, postural hypotension, oedema, drowsiness, fatigue, tremor, dizziness, abnormal dreams, confusion anxiety, insominia, arthralgia, myalgia


Aldosterone antagonists
(Potassium sparing diuretics)

Spironolactone - oedema, ascites in liver cirrhosis, nephrotic syndrome, oedema in CHF, moderate to severe HF, resistant hypertension, treatment of primary hyperaldosteronism. DO not use in hyperkalemia, addisons disease or anuria

SE: GI disturbance, heptotoxicity, malaise, confusion, drowsiness, dizziness, gynaecomastica, benign breast tumour, menstrual disturbance, changes in libido, electrolyte disturbance (hyperkalaemia, hyponatraemia), acute renal failure, hyperuricaemia


Typical Antipsychotics (D

Anti DA effects

Alleviate positive symptoms well, used in caution with patients with cardiovascular disease.

SE:extrapyramidal (parkinsonisian symptoms, dystonia, dyskinesia, akathisia, tardive dyskinesia), hyperglycaemia, , hypotension and interference with temperature regulation, drowsiness, apathy, agitation, excitment, insomnia, convulsion, dizziness, headache, confusion, GI disturbances, antimuscarinic symptoms

Haloperidol - Schizophrenia, psychoses, mania, hypomania, organic brain damage, agitation and restlessness in the elderly, management of mental or behavioural problems such as aggression. Don't use if QT prolongation, bradycardia. SE: above but less sedating and antimuscarininc side effects; pigmentation and photosensitivity rare, depression, weight loss.

Chloropromazine - schizophrenia, mania, other psychosis, severe anxiety short term, psychomotor agitation, dangerous impulsive behaviour, antiemetic in palliative care. SE: above + hyperglycaemia, pronounced sedative effects, moderate antimuscarininc and extrapyramidal effects, postural hypotension


Quinine sulphate

Treatment of falciparum malaria, nocturnal leg cramps. Don’t give in haemoglobinuria, myasthenia gravis, optic neuritis or tinnitus

SE: cinchonism (tinnitus, hearing impairment, blurred vision, vertigo, headache, nausea, abdo pain), agitation, confusion, cardiovascular effects (eg AF), dyspnoea, hypersensitivity reactions.


Phenothiazine and related drugs

Phenothiazine are dopamine antagonist, act centrally blocking chemoreceptor trigger zones. Prophylaxis and treatment of nausea and vomiting

Prochlorperazine – severe nausea, vomiting, vertigo, labyrinthinedisorders, schizophrenia and other psychosis disorders. SE: not very sedating, extrapyramidal symptoms (esp dystonias), respiratory depression, hypergylceamia, drownsiness apathy etc (same as anti-psychotic drugs)



Focal seizures with/without secondary generalisation – NOT recommended if tonic, atonic, absence or myoclonic seizures present; migraine prophylaxis ; peripheral neuropathic pain. Avoid abrupt withdrawal

SE: nausea, vomiting, gingivitis, diarrhoea, abdo pain, dyspepsia, constipation, dry mouth, flatulence, weight gain, increased appetite, anorexia, hypertension, vasodilation



Potassium channel activator with a nitrate component. Arterial and venous vasodilation properties. Used in treatment and prophylaxis of stable angina. Contra-indication cardiogenic shock, LV failure, hypotension

SE: nausea, vomiting, rectal bleeding, cutaneous vasodilatation with flushing, increase in HR, dizziness, headache, weakness



Caution in patients with epilepsy, G6PD deficiency, myasthenia gravis. SE: nauseas, vomiting, diarrhoea, headache, dizziness, photosensitivity, tendon damage

Ciprofloxacin – antibiotic against gram –ve and +ve bacteria esp G-ve (salmonella, shigella, campylobacter, neisseria, pseudomonas). Resp tract infections (not pneumococcal pneumonia), UTIs, GI infections, bone and joint infections, gonorrhoea, septicaemia; fistulating crohn’s disease.

SE: above+ flatulence, pain, phlebitis (if injected).



Anticoagulation (inhibit PDE – stop platelet aggregation) -prophylaxis of thromboembolism with prosthetic heart valve, prevention of ischaemic stroke and TIA. Caution in rapidly worsening angina (as causes vasodilatation), aortic stenosis and recent MI

SE: GI effects, dizziness, mylagia, throbbing headache, hypotension, hot flushes, tachycardia, worsen coronary heart disease symptoms, hypersensitivity, bronchiospasm, worse bleeding after surgery



Need to measure renal functions throughout, as well as looking for blood disorders. Avoided in salicyate hyoersensitivity.

SE: diarrhoea, nausea, vomiting, abdo pain, exacerbation of colitis symptoms, headache, SLE like symptoms, hypersensitivity.

- Mesalazine – 5-aminosalicyclic acid – treatment of mild to moderate ulcerative colitis and maintence of remission

- Sulphasalazine – 5-aminosalicyclic acid + sulfapyridine – treatment of mild, moderate, severe ulcerative colitis and maintenance of remission, active crohn’s disease, rheumatoid arthritis. Caution: asthma, g6pd deficiency. SE: cough, insomnia, dizziness, fever, blood disorders, proteinuria, tinnitus, stomatisis, taste disturnances, pruritis


Antimotility drugs

Prolong prolong the duration of intestinal transit by binding to opioid receptors in the GI tract

Loperamide – used for faecal incontinence after the underlying cause has been addressed, acute diarrhoea, chronic diarrhoea (adults only); not cross the BBB. SE: nausea, flatulence, headache, dizziness. Avoid if abdo distension occurs.


Sodium valproate

Epilepsy, migraine prophylaxis, mania. Avoid abrupt withdrawal and monitor liver function. SE: nausea, gastric irritation, diarrhoea, weight gain, hyperammonaemia, thrombocytopenia, transient hair loss



Pioglitazone – reduces peripheral insulin resistance  decrease blood glucose levels, can be used in conjuction with other diabetic drugs therefore used in T2DM.. Need to monitor liver function. Contraindications – if got/had bladder cancer, HF, macroscopic haematuria. DO NOT use in pregs/breast feeding. SE: GI disturbances, oedema, anaemia, headache, visual disturbances, dizziness, arthralgia, hypoaesthesia, haemoturia, impotence

Rosiglitazone – NOT in BNF (but works in same way as above) – bind to PPAR receptors on fat cells making them more sensitive to insulin


5-Alpha reductase inhibitors

Inhibits testosterone metabolism => reduction in prostate size and increase urinary flow . Caution - decrease prostate cancer markers (eg PSA), also excreted in semen therefore condom use is recommended

SE: erectile dysfunction, decreased labido, ejaculation disorders, breast tenderness and enlargement.

Finasteride – beingn prostatic hyperplasia, male pattern baldness in men. SE: above + testicular pain, hypersensitivity reactions, male breast cancer



Tonic-clonic and focal seizures, status epilepticus, prevention of seizures following neurosurgery/ injury, trigeminal neuralgia. May exacerbate absence or myoclonic seizures . Narrow therapeutic window

SE: phenytoin toxicity (nystagmus, diplopia, slurred speech, ataxia, confusion and hyperglycaemia), coarsening of facial appearance, acne, hirsutism, gingival hyperplasia, nausea, vomiting, constipation, drowsiness, insomnia, transient nervousness, termour, paraesthesia etc


Topical Corticosteroids

Treat inflam of the skin – eczema, contact dermatitis, insect stings, eczema of scabies. Relief symptoms and suppress signs of disorders. Short term use. Children very susuceptible to SE. Cream, oils, ointments, lotions. Contraindicated in untreated bacterial, fungal or viral skin infections, in acne, roascea, widespread psoriasis.

SE: spread and worsening of untreated infection, thinning of the skin, irreversible striae atrophicae and telangiectasia, contact dermatitis, perioral dermatitis, acne, mild depigmentation, hypertrichosis

- Hydrocortisone – mild inflam skin disorders eg eczma; nappy rash.
- Beclometasone dipropionate – severe inflam skin disorders such as eczema that not respond to less potent corticosteroids; psoriasis



Broad spectrum antibiotics, Chlamydia, rickettsia, brucella, spirochaete, resp and genital mycoplas,a infections, acne, periodontal disease, exacerbation of chronic bronchitis. NOT be given to children under 12 and pregs/breast feeding woman, patients with renal failure. SE: nausea, vomiting, diarrhoea, dysphagia, oesophageal irritation, stain teeth and bone if growing; may exaserbate SLE, muscle weakness in myasthenia gravis.

- Oxytetracycline – also used for acne vulgaris and rosacea



Simple and focal seizure, generalised tonic-clonic seizure, trigeminal neuralgia, prophylaxis of bipolar disorder unresponsive to lithium, adjunct to acute alcohol withdrawal. Initiate at low dose and build up over 2 weeks

SE: dose related (headache, ataxia, drowsiness, nausea, blurred vision, dizziness, allergic skin reaction), dry mouth, oedema, fatigue, hyponatraemia, blood disorders, dermatitis, urticaria. Not use if AV conduction abnormalities (unless paced), acute porphyria, or history of bone marrow depression


Bulk forming laxatives

Relieve constipation by increasing faecal mass and stimulating peristalsis, may take some days to work. Not required unless fibre cannot be increased in diet. Used in patients with colostomy, ileostomy, haemorrhoids, anal fissure, chronic diarrhoea associated with diverticulitis disease, adjunct to ulcerative colitis. Adequate fluid intake required to avoid intestinal obstruction.

Ispaghula husk – SE: flatulence, abdominal distension, GI obstruction or impaction, hypersensitvity


Dopaminergic parkinsonism drugs

Can use receptor agonists or analogues. Levidopa is amino acid precursor to dopamine given with extracerebral dopa-decarboxylase inhibitor to reduce extracerebral conversion to dopamine to reduce SE (eg nausea, cardiovascular effects etc).

- Co-careldopa (carbidopa + levodopa) –Parkinson’s disease. SE: nausea, vomiting, taste disturbance, dry mouth, anorexia, arrhythmias, palpatations, postural hypotension, syncope, drowsiness, fatigue, dementia, psychosis, confusion, euphoria, abnormal dreams, insomnia, depression


Drugs for erectile dysfunction

Sildenafil – erectile dysfunction, pulmonary hypertension. Phospdiesterase type 5 inhibitor. Contraindicated in patients using nitrates, hypotension. SE: dyspepsia, nausea, vomiting, headache, flushing, dizziness, myalgia, back pain, visual disturbances, nasal congestion



Rapid anticoagulant with short half life. For DVT or PE. If haemorrhage that needs reversing use protamine sulphate. SE: haemoorhage, thrombocytopenia (deficiency of platelets in blood), rebound hyoerlipademia, priapism, hyperkalaemia, osteoporosis, alopecia over long term use, local injection reactions. Contraindicated in haemophilia, recent cerebral haemorrhage, hypertension or thrombocytopenia.

- Enoxaparin – prophylaxis and treatment of DVT and PE, treatment of acute ST-segment elevation MI.

- Dalteparin –prophylaxis and treatment of DVT and PE, can be used in pregs


Antihistamine anti-emetics

Less effective at motion sickness but better tolerated, Used for post-op nausea and vomiting.

- Cyclizine – nausea, vomiting, vertigo, motion sickness, labyrinthine disorders. SE: drowsiness, headache, psychomotor impairment, anti-muscarininc effects, hypertension, paraethesia, twitching. May counteract hemodynamic benefits of opiods


Anti-emetic 5HT3 anatagonists

Ondansetron – moderate-severe emetogenic chemotherapy or radiotherapy. Not use if congenital prolonged QT syndrome. SE: constipation, headache, flushing, injection site reactions, rarely – hiccups, hypotension, bradycardia, chest pain, arrhythmias, movement disorders, seizures.



Bactericidal, active against some G+ve and many G-ve organisms. Not absorbed from gut so must be given by injection for systemic infections. SE: irreversible ototoxicity, nephrotoxicity. NOT given in patients with myasthenia gravis as impair neuromuscular transmission. Avoid in preg unless essential.

Gentamicin – used for serious illness, broad spectrum but inactive against anaerobes, poor activity against haemolytic streptococci and pneumococci; used with other antibiotics for treatment of endocarditis. Used in septicaemia, neonatal sepsis; meningitis, other CNS infections, acute pyelonephritis or prostatsis, biliary tract infection, pneumonia in hospital etc.
Loading dose and doses calculated on patients weight and renal function. Most SE are dose related. SE: above + nausea, vomiting, antibiotic associated colitis, electrolyte disturbance (hypomagnesia, hypokalceamia, hypocalcaemia), peripheral neuropathy, stomatitis



Potassium – may be needed in those taking digoxin or anti-arrhythmic drugs where potassium depletion may cause arrhythmias, when 2ndry hyperaldosteronisum occurs, excessive loss in faeces (eg diarrhoea) - preferably given as liquid eg potassium chloride SE: nausea, vomiting, abdo pain, diarrhoea, flatulence. Severe hypokalaemia calls fro urgent treatment with calcium gluconate to protect against myocardial excitability temporarily

Magnesium – loss due to diarrhoea, stoma, fistula, alcoholism. Given IV/IM with magnesium sulfate. Been suggested good for emergency treatment of arrhythmias, prevent seizures in pre-eclampsia. Magnesium sulphate – SE: hypermagnesia, nausea, vomiting, thirst, flushing of skin, hypotension, arrhythmias, coma, resp depression, drowsiness, confusion, loss of tendon reflexes, muscle weakness, colic, diarrhoea



Gylcopeptide antibiotic, bacteriocidal against aerobic and anaerobic G+ve bacteria including multi-reisistant staphylococci, long duration of action so given every 12 hours. Given orally for 10-14 days for C.diff. Avoid rapid infusion due to risk of anaphyaxis. Monitor renal function sregularly

SE: nephrotoxicity, ototoxicity, blood disorders including neutropenia



Arrhythmias – paroxysmal supraventricular, nodal and ventricular tachycardias, AF, atrial flutter, ventricular fibrillation; tachyarryhtmias associated with Wolff-Parkinson- White Syndrome, IV for cardiopulmonary resuscitation in VF or pulseless tachycardia unresponsive to other things. Long half-life only needs to be given once daily.

SE: corneal microdeposits, thyroid function problems (as contains iodine), nausea, vomiting, taste disturbances, raised serum transaminases, jaundice, bradycardia, pulmonary toxicity, tremor, sleep disorder, phototoxicity etc. Contraindications – sinus bradycardia, SA heart block, thyroid dysfunction, iodine sensitivity, avoid IV use in resp failure


Antipseudomonal penicillins

Piperacillin only available with beta-lactamase inhibitor tazobactam. Broad spectrum against G+ve and G-ve bacteria and anaerobes. SE: high doses may lead to hypernatraemia

- Piperacillin-tazobactam – hospital acquired pneumonia, speticaemia, complicated intra-abdo infections, complicated infections involving the urinary tract or skin and soft tissues, infections in neutropenic patients. SE: hypersensitivity reactions (see benzypenicillin) +nausea, vomiting, diarrhoea, stomatis, dyspepsia, constipation, jaundice, hypotension, headache, insomnia



UTI (most common is E.coli, Staphyloccous saprophyticus also common in sexually active young women). Contraindications – infants les than 3 months, G6PD deficiency, acute porphyria, avoid if eGFR is less than 60 ml/min/1.73m2

SE: anorexia, nausea, vomiting, diarrhoea, acute and chronic pulmonary reactions, peripheral neuropathy, hypersensitivity


Acetyl cysteine

A mucolytic – tear deficiency, impaired or abnormal mucus production, protects liver in paracetamol overdose if taken within 24 hours of taking the OD, most effective in first 8 hours.

SE: hypersensitivity reaction – managed by reducing infusion rate or suspending till rash settled; slight increase in INR and prothrombin time


Activated charcoal

Reduction of absorption of poisons in the GI system, enhances the elimination of Carbamazepine, Dapsone, Phenobarbital, Quinine, Theophylline

SE: black stools, caution in drowsy/comatose patients or with reduced GI motility. NOT to be used if poisoned with petroleum distillates, corrosive substance, alcohol, malathion, cyanides and metal salts including iron and lithium salts



Rapidly terminates paroxysmal supraventricular tachycardia including those associated with accessory conducting pathways (eg wolff-Parkinson-White syndrome); aid to diagnosis of broad or narrow complex supraventricular tachycardias. Very short duration of action. Contraindications- sick sinus, 2nd or 3rd degree heart block, long QT syndrome, severe hypotension, decompensate HF and chronic obstructive lung disorder

SE: nausea, arrhythmia (have ECG on and resus facilities on hand), sinus pause, AV block, flushing, angina, dizziness, dyspnoea, headache, apprehension


Calcium resonium

Hyperkalaemia associated with anuria or severe oliguria, and in dialysis patients. Need to monitor for electrolyte disturbances. Contraindicated in patients with obstructive bowl disease, neonates with reduced gut motility, hyperparathyroidism, multiple myeloma, sarcoidosis or metastatic cancer

SE: faecal impaction when taken PR, GI concretions when taken orally, gastric irritation, anorexia, nausea, vomiting, constipation, diarrhoea, hypomagnesium, GI obstruction, ulceration, necrosis, hypocalcaemia



IM 0.5mL (1 in 1000) – dose can be repeated after 5 min intervals if needed. (Can be given by slow IV if patient severely ill and doubt to circulation and absorption). Emergency treatment of acute anaphylaxis; angioedema, cardiopulmonary resuscitation, priapism

SE: nausea, vomiting, dry mouth, anorexia, hypersalivation, arrhythmias, tachycardias, angina, MI, pallor, palpitations, cold extremities, hypertension, anxiety, tremor, restlessness, headache, insomnia, confusion, weakness, dizziness psychosis, hyperglycaemia, urinary retention, difficulty in micrturition, hypokalaemia



Local anaesthetic – duration of block 90 mins; ventricular arryhtmias esp after MI, ventricular tachycardia in haemodynamically stable patients, ventricular fibrillation, pulseless ventricular tachycardia in cardiac arrest. Contraindications – sino-atrial disorders, AV block, severe myocardial depression

SE: dizziness, paraesthesia, drowsiness, confusion, resp depression, convulsions, hypotension, bradycardia, hypersensitivity reactions



Overdose with opioids, reversal of post-op resp depression, reversal of neonatal resp and CNS depression due to opiod administration to mother during labour. Caution in cardiovascular disease or those receiving cardiotxic drug. Has short duration of action. SE: nausea, vomiting, hypotension, hypertension, tachycardia, headache, dizziness, diarrhoea, dry mouth, bradycardia, arrhythmias, hyperventilation, tremor, sweating



Activating plasminogen to form plasmin, which degrades fibrin and so, breaks up thrombi. Treatment of MI. Used in caution if there is a risk of bleeding, external chest compression, elderly and hypertensive. Contraindicated in those with recent haemorrhage, trauma or surgery, coagulation defects, bleeding diathesis, aortic dissection, aneurysm, coma etc (p165)

SE: nausea, vomiting, bleeding, reperfusion arrhythmias and recurrent ischaemia and angina; reperfusion leading to cerebral and pulmonary oedema, hypotension, allergic reactions.

Streptokinase – acute MI, DVT, PE, acute arterial thromboembolism central retinal venous or arterial thrombosis

rt-PA (alteplase) – acute MI, PE, acute ischaemic stroke, treatment of occluded central venous access devices. Need to monitor BP. Contraindications – above + hypersensitivity to gentamicin, hypo/hyperglycaemia, convulsions accompanying stroke. SE: above + risk of cerebral bleeding increased in acute stroke

Tenecteplase – acute MI