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Name Class MOA Indications Contraindications Cautions Organ cautions Side effects Interactions Warfarin P450 Status Monitoring Dose

150 mg/kg in 200 ml 5% glucose IVI over 15 mins

Allergy
Acetyl cysteine Glutathione precursor Paracetamol overdose Asthma 50 mg/kg in 500 ml over 4 hours
Bronchospasm
100 mg/kg in 1 litre over 16 hours

Corrosive poisons 50 mg PO
OD up to 1 hr post-ingestion
Activated charcoal Binds and reduces absorption of tablets/poisons Reduced GI motility Single dose for paracetamol + most drugs
(Longer if MR/SR preparation or muscarininc drugs)
Aspiration risk 4 hourly for certain specific drugs or MR/SR preparations

Bronchospasm
Heart transplant Hypotension
Asthma
Slows AVN conduction time Paroxysmal SVT AF/Flutter Transient arrhythmias Dipyridamole 3-6 mg IV over 2 secs via central line/large vein
Adenosine Purine nucleoside 2nd/3rd degree AV block ECG
Dilates coronary arteries Reduces rate in NCT/BCT to reveal underlying rhythm Raised QT Angina Theophyllines Double dose and repeat every 1-2 mins (max 12 mg/dose)
Sick sinus syndrome COPD Flushing
Unpleasant feelings

Cerebrovascular disease Tachycardia

Arrhythmias Hypertension Dopexamine
Alpha agonist
Hypertension Anxiety TCAs
Beta 1 agonist CPR H CPR: 1 mg IV, or 2-3 mg via ET tube, in 10 ml water. Every 3-5 mins
Adrenaline Sympathomimetic Diabetes Peripheral vasoconstriction Ergotamine BP
Beta 2 agonist Anaphylaxis E Anaphylaxis: 0.5 mg IM. Repeat every 5 mins if no response
Angle closure glaucoma Psychological disturbance Oxytocin
Blocks mast cell cytokine release
Labour (esp. 2nd stage) Hyperglycaemia Digoxin
Hyperthyroidism Urinary retention
Oesophageal reactions
Delayed GI emptying GI upset
Osteoporosis treatment Hypocalcaemia Upper GI disorders Hypocalcaemia 10 mg mane
Alendronic acid Bisphosphonates Reduces osteoclast bone resorption R
Osteoporosis prophylaxis (e.g. steroids) Severe renal failure (gastritis, peptic ulcer) Hypophosphataemia 70 mg weekly for post-menopausal osteoporosis
Pregnancy / Breastfeeding Peptic ulcer
Myalgia

GI upset
R
Gout Severe skin reactions Azathioprine 100 mg OD
Acute gout Renal impairment L LFTs if hepatic impairment
Allopurinol Gout and hyperuricaemia Xanthine oxidase inhibitor Urate or calcium oxalate renal stones Neuropathy Theophyllines + Increase to 300 mg TDS if necessary
Liver disease P Report rashes
Prophylaxis of tumour lysis syndrome Gynaecomastia Salicylates Reduce dose in liver/kidney failure
B
Vasculitis

Recent haemorrhage, trauma, or surgery

Nausea + Vomiting
Stroke with convulsion, diabetes, hypoglycaemia
Alteplase Acute myocardial infarction Risk of bleeding Bleeding
Coagulation defects / Bleeding diatheses L
(r-tPA) Catalyzes the conversion of plasminogen to plasmin Pulmonary embolism External chest compression Reperfusion arrhythmias Blood pressure 10 - 15 mg IV initially
Thrombolytic agents Aortic dissection / Aneurysm P
=> Fibrin breakdown Acute ischaemic stroke Elderly Cerebral / Pulmonary reperfusion oedema Signs of haemorrhage Then 50 - 90 mg IVI over 1 - 3 hrs depending on indication
CVD / PU / Coma / Severe HTN / Varices E
Occluded central venous access devices Hypertension Hypotension
Pancreatitis / Pericarditis / Bacterial endocarditis

Other cardiac drugs

Nausea + vomiting
Sinus bradycardia Phenytoin
L Interstitial lung disease TFTs
Sinoatrial heart block TCAs 200 mg TDS loading
Increases refractory period of conducting system Tachyarrhythmias Porphyria R Hepatotoxicity LFTs
Amiodarone Class III antiarrhythmic Conduction disturbance Lithium + Inhibitor 200 mg BD or according to response
Negative ionotrope CPR/Periarrest Hypokalaemia H Conduction disturbances Potassium
Thyroid disease/iodine sensitivity Antibiotics + antivirals ALS: 300 mg in 10 ml 5% glucose slow IV
E Photosensitivity CXR
Pregnancy / Breastfeeding Antimalarials
Malaise/Fatigue

L Antimuscarinic effects
MI within 3 months Cardiac disease
Depression (esp. with insomnia, reduced appetite, agitation) H Cardiac effects
Tricyclic antidepressant Arrhythmias Thyroid disease Depression :75 mg nocte, Increase to 200 mg/day if required
Amitriptyline Tricyclics and related antidepressants Neuropathic pain P Weight gain Substrate
Blocks NA and 5HT reuptake Mania Epilepsy Pain: 10 mg nocte, Increase to 75 mg nocte if required
Migraine prophylaxis B Sedation
Liver failure Glaucoma
E Seizures

Flushing
ACS
Headache
HTN Cardiogenic shock Prostatic hypertrophy
Amlodipine Calcium channel blockers Dihydropyridine calcium channel antagonist Ankle oedema Theophyllines 5 - 10 mg OD
Angina (esp. Prinzmetal's) Aortic stenosis Acute porphyria
Dizziness
Hypotension

Mild pneumonias
UTI Allergy Probenicid
EBV/CMV infection Pneumonia: 500-1000 mg TDS PO/IV
Amoxicillin Broad spectrum penicillins Inhibition of cell wall synthesis Listeria meningitis Penicillin or cephalosporin allergy Rash (not true allergy) Allopurinol
ALL, CLL Mild/Moderate infections: 250-500 mg TDS PO
Endocarditis prophylaxis N+V+D Methotrexate

Children
Asthma
Peptic ulcer L Anticoagulants
Pain/Pyrexia Dehydration GI irritation Pain/Pyrexia: 300-900 mg 4-6 hourly
COX-1 and COX-2 inhibitor NSAID hypersensitivity R NSAIDs
Aspirin Antiplatelet IHD HTN Bleeding Thromboembolism prophylaxis: 75 mg OD
Reduces prostaglandin and thromboxane synthesis Haemophilia P SSRIs
Thromboembolic stroke Gout Hypersensitivity Thromboembolism treatment: 300 mg stat
Severe renal / liver impairment E Venlafaxine
G6PD deficiency
Breastfeeding

Bradycardia
Asthma / Bronchospasm
1. HTN COPD Hypotension Verapamil/Diltiazem 1. 25-50 mg OD PO
Peripheral arterial disease
2. Angina 1st degree heart block Peripheral vasoconstriction Nifedipine 2. 100 mg OD PO
Atenolol Beta-blockers Mildly cardioselective beta blocker Uncontrolled heart failure
3. MI DM Fatigue Alpha blockers 3. 5 mg IV, then 50 mg PO, then 50 mg BD PO
Conduction abnormalities
4. Arrhythmias MG Depression Other cardiac drugs 4. 50-100 mg OD PO
Metabolic acidosis
Sleep disturbance

Down's syndrome Transient bradycardia

Angle closure glaucoma GORD Tachycardia
Blocks vagal SAN / AVN stimulation Severe bradycardia or heart block Myaesthenia gravis Diarrhoea P Arrhythmias Bradycardia/HB: 0.3-1.0 mg IV
Atropine Anti-muscarinics (anti-spasmodics) Bronchodilates CPR Paralytic ileus UC B Antimuscarinic effects CPR: 3 mg IV / 6 mg in 10 ml saline via ET tube
Reduces oropharyngeal secretions Organophosphate/anticholinesterase poisoning/OD Pyloric stenosis Acute MI E N+V Poisoning: 1-2 mg IM/IV every 10-30 mins (max. 100 mg in 24 hrs)
Bladder neck obstruction HTN Confusion
Tachycardia Dizziness

Beclometasone dipropionate
Oral candidiasis
Reduces airway oedema Hoarse voice
Inhaled corticosteroids Chronic asthma TB 200 - 2000 micrograms BD
Reduces mucous secretion Glaucoma
Systemic steroid effects

Beclometasone dipropionate
Skin thinning
Untreated bacterial/fungal/viral skin lesions Worsening of infection
Children
Acne Striae atrophicae
Topical corticosteroids (skin, nasal) Reduces inflammation Severe inflammatory skin disorders Psoriasis (rebound relapse) Apply thinly OD - BD
Rosacea Telangiectasia
Use on face
Perioral dermatitis Dermatitis
Depigmentation

Hypokalaemia Dehydration
Lithium
Hyponatraemia Porphyria Postural hypotension
Oedema P NSAIDs
Reduces Na+ / Cl- reabsorption from DCT Hypercalcaemia Gout Hypokalaemia Oedema: Initially 5-10 mg PO OM, then reduce freq. if possible
Bendroflumethiazide Thiazide and related diuretics Hypertension B Oestrogens
Stimulates K+ excretion Addison's DM GI upset HTN/Hypercalciuria: 2.5 mg PO OD
Renal stone prophylaxis in hypercalcuria E Carbemazepine
Symptomatic hyperuricaemia SLE Impotence
Amphotericin
Severe liver / renal impairment Hyponatraemia

Severe skin infections

Hypersensitivity
Meningitis Probenicid
Benzylpenicillin Diarrhoea 0.6 - 1.2 g IV QDS
Penicillin Inhibits formation of cell wall peptidoglycan cross-links Endocarditis Penicillin hypersensitivity History of allergy R Allopurinol
(Penicillin G) Blood disorders Severe: 2.4 g 4-hourly
ENT infections
CNS toxicity
Pneumococcal pneumonia

1 tablet OD
Calcium and cholecalciferol Hypercalcaemia Hypercalcaemia Anticonvulsants Calcichew D3 = 500 mg Ca++ / 5 micrograms (200IU) colecalciferol
Minerals / Vitamins Vitamin D deficiency Renal dysfunction R Serum calcium
(Calcichew D3 / Adcal D3) Metastatic calcification GI upset Thiazides Adcal D3 = 600 mg Ca++ / 10 micrograms (400 IU) cholecalciferol

Calcium resonium
Aluminium hydroxide
GI upset
Obstructive bowel disease Aluminium carbonate
Polystyrene sulphonate ion-exchange resin P Hypokalaemia 15 g PO TDS/QDS
Ion exchange resin Chronic hyperkalaemia with oligo-anuria Diseases likely to precipitate hypercalcaemia Magnesium hydroxide
Takes 24-48 hrs to work B Hypomagnesaemia 30 g PR (With clensing and wash-out enemas)
Lithium
Hypercalcaemia
Levothyroxine

N+V
Anpaced AV conduction defects Cardiac disease L Headache / Drowsiness U+Es
Antiepileptic Epilepsy (GTC and partial seizures) P450 inducer
Stabilizes inactivated state of voltage-gated Na channels BM suppression Skin disorders R Dizziness / Vertigo LFTs 100 - 200 mg OD/BD
Carbamazepine Mood stabiliser Prophylaxis of bipolar disorder MAOIs
Potentiates GABA receptors Acute porphyria Haematological drug Rxn P Ataxia FBC Slowly increase to max. 1.6 - 2 g/day
Analgesic Neuralgia
MAOIs Glaucoma B Visual disturbance Serum levels
Skin and blood reactions
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Name Class MOA Indications Contraindications Cautions Organ cautions Side effects Interactions Warfarin P450 Status Monitoring Dose

Recent other Abx (cf C. diff) GI upset

Mild RTIs
Age Allergy 250 mg PO QDS
UTIs (Incl. prophylaxis) Probenicid
Beta lactam antibiotic Severe underlying disease AKI 500 mg PO TDS in severe infections
Cefalexin 1st generation cephalosporin External infections Beta lactam hypersensitivity Warfarin (mild)
Disrupts peptidoglycan synthesis in bacterial cell walls Long hospital stay Interstitious nephritis
Pregancy (very safe)
GI surgery Hepatic dysfunction UTI prophylaxis: 125 mg PO ON
PPI use CNS disturbance

Recent other Abx (cf C. diff) GI upset

Mild RTIs
Age Allergy
UTIs (Incl. prophylaxis) Probenicid
Beta lactam antibiotic Severe underlying disease AKI
Cefradine 1st generation cephalosporin External infections Beta lactam hypersensitivity Warfarin (mild) 250-500 mg PO QDS or 0.5-1 g BD
Disrupts peptidoglycan synthesis in bacterial cell walls Long hospital stay Interstitious nephritis
Pregancy (very safe)
GI surgery Hepatic dysfunction
PPI use CNS disturbance

Recent other Abx (cf C. diff) GI upset Respiratory infections: 250-500 mg BD PO

Respiratory infections
Age Allergy UTIs: 125 mg BD PO
UTIs Probenicid
Beta lactam antibiotic Severe underlying disease AKI Pyelonephritis: 250 mg BD PO
Cefuroxime 2nd generation cephalosporin Pyelonephritis Beta lactam hypersensitivity Warfarin (mild)
Disrupts peptidoglycan synthesis in bacterial cell walls Long hospital stay Interstitious nephritis Severe infections: 0.75-1.5 g TDS/QDS IV
Severe infections (IV)
GI surgery Hepatic dysfunction Meningitis: 3 g TDS IV
Pre-operative prophylaxis (IV)
PPI use CNS disturbance Pre-operative prophylaxis: 1.5 g IV (+/- 750 mg IV/IM TDS for 24 hr)

Epilepsy
Acute porphyria Prostatism Mild antimuscarinic effects
Allergy R
Cetirizine Non-sedating antihistamines Selective peripheral H1 antagonist / Antimuscarinic Pregnancy Urinary retention Very mild sedation 10 mg PO OD or 5 mg PO BD
Urticaria L
Breastfeeding Glaucoma Headache
Pyloroduodenal obstruction

Pyloroduodenal obstruction Drowsiness

Urinary retention / Prostatism R Paradoxical stimulation Allergy: 4 mg PO 4-6 hrly (max. 24 mg/24 hrs)
Allergies
Thyrotoxicosis L Antimuscarinic effects Phenytoin Substrate Anaphylaxis: 10 mg IV over 1 min
Chlorphen(ir)amine Antihistamines H1 antagonist Anaphylaxis Antihistamine hypersensitivity
Asthma P GI upset MAOIs Inhibitor Blood transfusion reaction: 10-20 mg SC (max. 40 mg/24 hrs)
Blood transfusion reaction
Brochitis / Bronchiectasis B Arrhythmias
Severe cardiovascular disease Hypotension

Parkinson's L Sedation Alcohol

CNS depression Long QT drugs R Extrapyramidal side-effects Antihypertensives
Schizophrenia
Elderly patients MG H Antimuscarinic effects TCAs Substrate FBC 25 - 300 mg PO TDS
Chlorpromazine Typical antipsychotics Dopamine antagonist Acute sedation
Hx of blood dyscrasias Phaeo P Seizures Lithium Inhibitor BP 25 - 50 mg IM TDS/QDS (painful)
Hiccups
Severe CVD Angle-closure glaucoma B Weight gain Ritonavir
Prostatism E Postural hypotension Cimetidine

GI upset
250 - 750 mg BD PO
GI infections (Salmonella, Shigella, Campylobacter) Hx of seizures Pancreatitis Theophyllines
100 - 400 mg BD IVI over 1 hour
Respiratory infections (Pseudomonas) Hypersensitivity to quinolones MG Neuropsychological effects NSAIDs
Ciprofloxacin Quinolones Inhibits DNA gyrase R Inhibitor
GU infections (UTIs, Cystitis, Gonorrhoea) Prognancy / Breastfeeding G6PD deficiency Tendinitis Ciclosporin
Cystitis: 500 mg PO single dose
Anthrax Children Chest pain Iron sulphate + antacids
Gonorrhoea: 100 mg IV single dose
Oedema

Epilepsy GI upset, Weight loss

Depression Current ECT Insomnia
Active mania
Panic disorder Hx of mania Agitation Substrate
Citalopram Serotonin-specific re-uptake inhibitors SSRI Long QT MAOIs 20 - 40 mg OD PO
Hx of bleeding disorder Headache
MAOIs within 2 weeks
Useful if polypharmacy - Less interactions + cautions Heart disease Hypersensitivity
Diabetes Withdrawal syndrome

GI upset (Incl. AAC)

Atypical pneumonia Macrolide mypersensitivity
Dry itchy skin
H. pylori triple therapy Terfenadine
Long QT Hypersensitivity (SJS, TEN) Substrate 250 - 500 mg BD PO
Clarithromycin Macrolides Binds 50S ribosome Chlamydia/GU infections Pimozide
Porphyria Arrhythmias Inhibitor 500 mg BD IV
Campylobacter enteritis Ergotamine
Reversible hearing loss
Penicillin allergy Dihydroergotamine
Cholestratic jaundice

Haemorrhage
Atherothrombotic prophylaxis post-MI (12 months)
Increased bleeding risk GI upset
MI Active bleeding 75 mg OD
Trauma R Peptic ulcer FBC
Clopidogrel Antiplatelet ADP receptor antagonist Ischaemic stroke (6 months) Severe liver impairment ACS: 300 mg loading, then 75 mg OD
Surgery P Pancreatitis Signs of occult bleeding
Peripheral arterial disease Breastfeeding Pre-PCI: 300 - 600 mg
Warfarin Headache
ACS
Fatigue

Lanosterol 14 α-demethylase
Clotrimazole Anti-fungal drugs External candida infections Can damage condoms/disphragms 1 % cream, BD - TDS. Continue for 14 days after lesion healed
Disrupts fungal cell wall

1 tablet mane
Oedema BP
Co-amilofruse Potassium sparing diuretics with other diuretics Amiloride / Furosemide combination
(Keeps potassium stable) U+Es
Available in 2.5/20, 5/40 and 10/80 strengths

UTIs EBV/CMV infection

R Rash 250 mg TDS PO
Amoxicillin + Clavulanic acid Respiratory/Skin/Soft tissue infection ALL / CLL Probenicid
Co-amoxiclav Broad spectrum penicillins Penicillin hypersensitivity L N+V+D 500 mg TDS PO if severe
(Inhibits beta-lactamase) Anticoagulated Allopurinol
P Hypersensitivity 1 g TDS/QDS IV/IVI
Esp. when beta-lactamase-producing strain suspected Risk of cholestasis

Pulmonary / Cardiovascular disease Dyskinesias

Closed-angle glaucoma Psychiatric disease Abdominal upset Neuroleptics
Co-careldopa MAO-A inhibitors Endocrine disorder L Postural hypotension Bupropion 50 mg (of levodopa) TDS/QDS initially
Dopaminergic parkinsonism drugs L-dopa with peripheral dopa-decarboxylase inhibitor Parkinsonism
(Carbidopa/levodopa) Melanoma Open angle glaucoma R Arrhythmias MAOIs Increase to maintenance 400 - 800 mg/day
Pregnancy / Breastfeeding Osteomalacia Drowsiness / Aggression Halothane
Hx of peptic ulcer or convulsions Psychiatric disturbance

Alcohol dependance Constipation

Decreased respiratory reserve N+V Pain level / Toxicity Two tablets QDS/PRN PO
Acute respiratory depression
Mild / moderate pain Obstructive airways disease L Respiratory depression MAOIs
Co-codamol Compound analgesic preparations Codeine + Paracetamol Risk of ileus + (If prolonged) Substrate
Hypotension/Shock R Rash Warfarin (prolonged use) Ultrarapid metabolisers: Toxicity Limited by paracetamol max. 4 g / day
Raised ICP / Head injury / Coma
Biliary tract disorders Hypotension Poor metabolisers: Pain Available in 8/500, 15/500, 30/500
Bowel obstruction Sedation

Alcohol dependance Constipation

Decreased respiratory reserve N+V Pain level / Toxicity Two tablets QDS/PRN PO
Acute respiratory depression
Mild / moderate pain Obstructive airways disease L Respiratory depression MAOIs
Co-dydramol Compound analgesic preparations Dihydrocodeine + Paracetamol Risk of ileus + (If prolonged) Substrate
Hypotension/Shock R Rash Warfarin (prolonged use) Ultrarapid metabolisers: Toxicity Limited by paracetamol max. 4 g / day
Raised ICP / Head injury / Coma
Biliary tract disorders Hypotension Poor metabolisers: Pain Available in 10/500, 20/500, 30/500
Bowel obstruction Sedation

Reduced respiratory reserve Constipation / Nausea / Vomiting

L
Acute respiratory depression Obstructive airways disease Sedation MAOIs (Don't give within 2/52) 30 - 60 mg PO/IM up to 4 hourly
Mild / Moderate pain R
Weak opioid Risk of ileus Hypotension / Shock / Delayed gastric emptying Respiratory depression Ciprofloxacin Max. 240 mg/day
Codeine Opioids for moderate pain Diarrhoea P Substrate
Metabolised to morphine Raised ICP Acute abdomen / Bowel obstruction / IBD Hypotension Antihistamines
Anti-tussive B
Head injury / Coma Biliary tract disorders / Pancreatitis Pulmonary oedema / Oedema Alcohol NB Genetic variations (plus and minus) in metabolism
E
Acute alcoholism Bronchospasm

Pyloroduodenal obstruction Drowsiness / Stimulation

N+V Urinary retention / Prostatism R Psychoactive effects
Vertigo Antihistamine hypersensitivity Thyrotoxicosis L Antimuscarinic effects Phenytoin
Cyclizine Anti-histamine antiemetics H1-receptor antagonist 50 mg PO/IM/IV TDS
Motion sickness Severe heart failure Asthma P GI upset MAOIs
Labyrinthine disorders Brochitis / Bronchiectasis B Arrhythmias
Severe cardiovascular disease Hypotension

Haemorrhagic disorders FBC (if >5 days)

Haemorrhage Prophylaxis: 2500 - 5000 units OD SC
Thrombocytopaenia U+Es (if >7 days)
HIT Treatment: 200 units/kg OD SC (max. 18000 units OD)
DVT/PE treatment and prophylaxis Severe HTN GTN
Dalteparin Low molecular weight heparin Antithrombin III activator => Factor IIa/Xa inactivation Hyperkalaemia Hypersensitivity ACS: 120 units/kg BD SC (max. 10000 units BD)
ACS PU NSAIDs In renal failure, pregnancy, extremes of weight:
Hyperkalaemia
Acute bacterial endocarditis Anti-Xa levels (3 - 4 hrs post-dose)
Osteoporosis (prolonged use) Review treatment dose if >8 days needed
Recent cerebral haemorrhage

Moisturising / Barrier / Antimicrobial:

Liquid paraffin Eczema

Dermol 500 Emollients PRN
Isopropyl myristate Dermatitis
Benzalkonium chloride
Chlorhexidine hydrochloride

Respiratory depression
Seizures Respiratory disease
Neuromuscular respiratory weakness R Status epilepticus: 10 mg IV over 2 mins
Acute alcohol withdrawal Muscle weakness (incl. MG) Respiratory depression
Sleep apnoea P Metabolised by P450 Alcohol withdrawal: 15 mg QDS reducing to 5 mg OD
Diazepam Long-acting benzodiazepine GABA agonist Anxiety Hx of drug/alcohol abuse Drowsiness Substrate Oxygen sats if high dose IV/IM
Acute pulmonary insufficiency B Anxiety/Muscle spasm: 2 mg TDS PO, up to 30 mg/day
Insomnia Personality disorder Dependence
Chronic psychosis E Insomnia: 5 - 15 mg nocte PO
Muscle spasm Porphyria
Depression
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Name Class MOA Indications Contraindications Cautions Organ cautions Side effects Interactions Warfarin P450 Status Monitoring Dose

Pain / Inflammation - Esp. musculoskeletal Asthma / Allergic disorders GI upset / Bleeding / PU Other GI bleed risks
RA Uncontrolled HTN AKI Other renal risks
Aspirin / NSAID hypersensitivity
Osteoarthritis IHD / PVD / CVD Hypersensitivity reactions SSRIs 25 - 50 mg TDS PO or 75 mg BD PO (or IM for max. 2 days)
Diclofenac Non-steroidal anti-inflammatory drugs Non-selective COX inhibitor Acitve / Hx of PU/GI bleed/Perforation + (Mild) Substrate
Acute gout Cardiovascular risk factors Fluid retention / Oedema Venlafaxine 75 - 150 mg per day PR
Severe renal/hepatic/cardiac impairment
Migraine Connective tissue disorders Headache / Dizziness Ciclosporin
Post-op and dental pain Coagulopathy Thrombotic events Warfarin (mild)

Complete heart block GI upset CCBs (Esp. verapamil)

Recent MI
2nd degree AV block Arrhythmias Amiodarone
Slows AVN conduction AF Hypokalaemia / Hypothyroidism R Non-acute AF/SVT: 125 - 250 ug BD PO loading, then 62.5 - 250 ug OD
VF Heart block Propafenone U+Es
Digoxin Cardiac glycosides Raises vagal tone SVTs Sick sinus syndrome E HF: 62.5 - 125 ug OD
VT Neuropsychological disturbance Quinidine Digoxin levels (6 hrs post-dose)
Weak inotrope HF AF mimics P Acute AF/SVT: 0.75 - 1 mg IVI over 2 hrs / 500 ug PO, repeat @ 12 hrs
HOCM Fatigue Antimalarials
SVTs secondary to WPW Weakness Itraconazole

Liquid paraffin
White soft paraffin
Diprobase Emollients Dry skin conditions
Cetomacrogol
Cetostearyl alcohol

Recent MI GI upset
Inhibits phosphodiesterases Unstable angina Dizziness 200 mg BD PO of MR (Persantin retard)
Inhibits thromboxane synthase Aortic stenosis Myalgia Cholinesterase inhibitors
Secondary prevention of ischaemic TIA/stroke H
Dipyridimole Antiplatelet Inhibits thromboxane receptor Coagulation disorders Headache Adenosine + 100 - 200 mg TDS PO
Prosthetic valve thromboprophylaxis (warfarin adjunct) B
Inhibits adenosine reuptake Hypotension Hypotension / Tachycardia Warfarin
Inhibits adenosine deaminase MG Hot flushes

Rash
N+V R
Inhibits central nausea chemoreceptor trigger zone Prolactinoma Allergy 10 mg TDS PO (up to max. 20 mg QDS)
Domperidone Anti-emetic dopamine blockers Parkinson's disease GI obstruction P
Poor BBB penetration => Less central SEs Liver failure Raised prolactin 60 mg BD PR
Migraine B
Extrapyramidal effects

Postural hypotension
1st dose hypotension 1 mg OD PO (before bed)
L
Systemic vasodilation Dizziness / Headache Other antihypertensives
HTN Postural hypotension H
Doxazosin Alpha blockers Relaxation of internal urethral sphincter Breastfeeding Urinary incontinence HTN: Titrate up to max. 16 mg/day
Prostatic hypertrophy Micturition syncope P
GI upset Prostatic hypertrophy: Titrate up to max. 8 mg/day
E
Drowsiness / Fatigue

Haemorrhagic disorders / PU FBC (if >5 days)

Haemorrhage Prophylaxis: 2500 - 5000 units OD SC
Thrombocytopaenia U+Es (if >7 days)
R HIT Treatment: 200 units/kg OD SC (max. 18000 units OD)
Antithrombin III (AT) activator DVT/PE treatment and prophylaxis Severe HTN GTN
Enoxaparin Heparin Hyperkalaemia P Hypersensitivity ACS: 120 units/kg BD SC (max. 10000 units BD)
=> Factor Xa inactivation ACS Breastfeeding NSAIDs In renal failure, pregnancy, extremes of weight:
E Hyperkalaemia
Acute bacterial endocarditis Anti-Xa levels (3 - 4 hrs post-dose)
Osteoporosis (prolonged use) Review treatment dose if >8 days needed
Recent cerebral haemorrhage
GI upset
Dry, itchy skin
Atypical pneumonia Terfenadine L
Hypersensitivity
Chlamydia/GU infections Pmozide Long QT R Substrate 500 mg QDS PO
Erythromycin Macrolides Binds 50S ribosome Arrhythmias +
Campylobacter enteritis Ergotamine Porphyria P Inhibitor 50 mg/kg IV in 4 divided doses
Chest pain
Penicillin allergy Dihydroergotamine B
Reversible hearing loss

Hx / severe risk of venous / arterial thrombus

Risk factors for VTE / Arterial disease N+V / Abdominal cramps
Heart disease c pulmonary HTN / risk of embolus
Migraine Liver impairment / Hepatic tumours
Sclerosing treatment for varicose veins
Hx / FHx of hypertriglyceridaemia Fluid retention, HTN
Contraception Migraine with aura BMI
Ethinylestradiol Female sex hormones 17β-estradiol derivative Hyperprolactinaemia Thrombosis Substrate 20 - 40 ug OD PO (with progestogen)
Menstrual symptoms TIAs BP
History of severe depression Changes in lipid metabolism
SLE with antiphospholipid antibodies
Undiagnosed breast mass Headache, depression, chorea
Acute porphyria
Obesity Nervousness, irritability

Dark stools
Rx: 200 mg BD/TDS PO
Ferrous sulphate Iron Iron replacement Iron deficiency GI upset
Px: 200 mg OD PO
Change in bowel habit

Difficulty in swallowing Flatulence

Fibogel Intestinal obstruction Abdominal distension
Bulk forming laxatives Bulk forming laxative Constipation Inadequate fluid intake 1 sachet (3.5 g) BD after meals
(Ispaghula husk) Colonic atony Gastro-intestinal obstruction / impaction
Faecal impaction Hypersensitivity

Ca prostate (masks PSA rise) Sexual dysfunction

5-alpha reductase inhibitor Prostatic hypertrophy Obstructive uropathy Testicular pain Prostatic hypertrophy: 5 mg OD PO
Finasteride 5-alpha reductase inhibitors Substrate
Reduces dihydrotestosterone production Male pattern baldness Pregnancy: Semen / Handing Gynaecomastia Male pattern baldness: 1 mg OD PO
Hypersensitivity

Hypersensitivity
β-lactamase producing Staph infections Probenicid
Inhibits peptidoglycan cross-linkage Penicillin hypersensitivity History of allergy Diarrhoea 250 - 500 mg QDS PO/IM
Flucloxacillin Penicillinase-resistant penicillins Esp. skin Allopurinol
=> Blocks Gram-positive cell wall synthesis Hx of flucloxacillin-associated herpatic dysfunction Liver failure (risk of cholestatic jaundice) Blood disorders Up to 2 g QDS IV
Also osteomyelitis, endocarditis, pneumonia adjunct
CNS toxicity

Hypotension
LVF Hypokalaemia Hypotension Hypokalaemia / Hyponatraemia Digoxin, Flecainide, Sotalol
L
Resistant HTN Hyponatraemia Prostatic hypertrophy Hypo- Ca, Mg, Cl NSAIDs 20 - 80 mg PO/IM/IV OD in divided doses
Furosemide Loop diuretics Inhibits Na/K pump in ascending loop of Henle P U+Es
Oliguria secondary to AKI Cirrhosis Porphyria Raised urate / gout Vencomycin, Gentamycin Higher dose required in acute LVF / oliguria
B
Anuric renal failure Diabetes GI upset Antidiabetics
Impaired glucose tolerance

Fatigue / Somnolence
R Dizziness Initiall 300 mg PO OD
Increases synaptic concentration of GABA Neuropathic pain
Hx of psychosis P Cerebellar effects Antidepressants Increase to max. 1.2 g PO TDS
Gabapentin GABA analogue Enhances GABA responses at non-synaptic sites Partial epileptic seizures (adjunct)
Diabetes B Diplopia / Amblyopia Antimalarials
Reduces release of mono-amine neurotransmitters
E Headache Stop slowly
Rhinitis

Alginate raft-forming oral suspension Dyspepsia

Gaviscon Compound alginates and indigestion preparations 10–20 mL after meals and at bedtime
(Na alginate, Na bicarbonate, Ca carbonate) GORD

Loop diuretics
Severe infections esp. sepsis, meningitis, endocarditis R 5 - 7 mg/kg IVI OD
Ototoxicity / Nephrotoxicity Cephalosporins, Vancomycin
Pyelonephritis / Prostatitis P Serum levels (trough)
Gentamicin Aminoglycosides Inhibits ribosomal 30S subunit Myaesthenia gravis Obesity Hypersensitivity Amphotericin
Biliary tract infections B Auditory / Vestibular function 1 - 1.6 mg/kg IM/IV/IVI TDS
Ciclosporin / Tacrolimus
Pneumonia E
Muscle relaxants

Chloramphenicol
L Sulphonamides
Hypoglycaemia Initially 40 - 80 mg mane, with food
Ketoacidosis R Sulfinpyrazole
Binds sulfonylurea receptors on pancreatic beta-cells GI upset Increase to max. 320 mg OD
Gliclazide Short-acting sulphonylureas T2DM Acute porphyria Intercurrent illness P Antifungals
=> Stimulates insulin release Weight gain
B Warfarin
Hypersensitivity MR: Max. 120 mg OD
E NSAIDs

Hypotension / Hypovolaemia
Recent MI
Severe anaemia Hypotension
Hypothyroidism Sildenafil
Coronary artery dilatation => Increased O2 supply Aortic / mitral stenosis Headache 2 sprays SL PRN
Angina Hypothermia L Tadalafil
Glyceryl trinitrate Nitrates Systemic vein dilatation => Reduced preload Constrictive pericarditis / Tamponade Dizziness
LVF Head trauma R Vardenafil
HOCM Flushing Acute MI/LFV: 10 - 200 ug/min IVI, titrated to response + BP
Cerebral haemorrhage IV heparins
Closed-angle glaucoma Tachycardia
Malnutrition

Parkinson's L 1.5 - 5 mg BD/TDS PO

Extrapyramidal side-effects
Acute sedation CNS depression Long QT drugs R 2 - 10 mg IM/IV 4-8 hourly
Neuroleptic malignant syndrome
Dopamine antagonist Schizophrenia Elderly patients MG H Amiodarone Substrate
Haloperidol Typical antipsychotics Sedation
D2/3 > D1/4 Bipolar disorder Hx of blood dyscrasias Phaeo P Anticonvulsants Inhibitor N+V: 0.5 - 2 mg TDS IM/SC/IV
Hypoglycaemia
Nausea + vomiting Severe CVD Angle-closure glaucoma B
SIADH
Prostatism E 4-weekly depot available

Untreated infection Skin atrophy

Inflammatory skin conditions Substrate
Hydrocortisone Topical corticosteroids (skin, nasal) Mild-strength topical corticosteroid Rosacea Worsening of infections 1% cream: Apply thinly OD/BD
Esp. eczema Inducer
Acne Acne
front back

Name Class MOA Indications Contraindications Cautions Organ cautions Side effects Interactions Warfarin P450 Status Monitoring Dose

GI/GU smooth-muscle spasm Closed-angle glaucoma H

GI obstruction Antimuscarinic effects Metoclopramide: - effect 20 mg QDS PO
Antimuscarinic e.g. Biliary colic, diverticulitis, IBS Myaesthenia gravis P
Hyoscine butylbromide Anti-muscarinics (anti-spasmodics) Prostatic hypertrophy / Urinary retention Drowsiness Sublingual nitrates: - effect
Does not cross BBB Megacolon B
Tachycardia Confusion Beta-agonists: + tachycardia 20 mg IM/IV, mac. 100 mg/day
Dysmenorrhoea Prostatic hypertrophy E

Hypromellose Tear deficiency, ocular lubricants and astringents Artificial tears Keratoconjunctivitis sicca 1 drop PRN, max. 4-6 times/day (due to preservative)

N+V
Inhibits peptidoglycan cross-linkage Severe hospital-acquired infections Hypersensitity R Diarrhoea
Imipenem with Cilastatin Carbapenem 500 mg IVI QDS / 1 g IVI TDS
=> Blocks cell wall synthesis Polymicrobial infections CNS disorders P Eosinophilia
Rash

Injection site reactions

Hypersensitivity to egg
Influenza vaccine Vaccines and antisera Propiolactone-inactivated virus (surface antigen) Influenza prophylaxis Febrile convulsions 0.5 ml IM
Severe intercurrent illness
Transient thrombocytopenia

Insulin Inducer

Muscarinic antagonist
COPD Angle-closure glaucoma P COPD: 20 - 40 ug TDS/QDS INH
Ipratropium Antimuscarinic bronchodilators Bronchodilator Minimal antimuscarinic effects
Acute bronchospasm Bladder outflow obstruction B Acute bronchospasm: 250 - 500 ug 4-hourly NEB
Reduces bronchial secretions

Hypotension / Hypovolaemia
Recent MI
Severe anaemia Hypotension
Hypothyroidism Sildenafil
Coronary artery dilatation => Increased O2 supply Aortic / mitral stenosis Dizziness 10 - 40 mg BD/TDS PO
Angina Hypothermia L Tadalafil
Isosorbide mononitrate Nitrates Systemic vein dilatation => Reduced preload Constrictive pericarditis / Tamponade Flushing
LVF Head trauma R Vardenafil
HOCM Tachycardia MR available
Cerebral haemorrhage IV heparins
Closed-angle glaucoma Headache
Malnutrition

Constipation: 15 ml OD/BD
Osmotic laxative Flatulence
Constipation GI obstruction
Lactulose Osmotic laxatives Bulking agent Lactose intolerance Distension Hepatic encephalopathy: 30 - 50 ml TDS
Hepatic encephalopathy Galactosaemia
Acidifies gut => NH3 excretion Abdominal pain
Take with plenty of water

GI upset
Headache 15-30 mg PO OD
Peptic ulcer Rx/Px
L Dizziness
GORD Substrate
Lansoprazole Proton pump inhibitors Inhibits H+/K+ ATPase on parietal cells Can mask symptoms of gastric cancer P Arthralgia + (Mild) 15 mg PO OD maintenance
H. pylori eradication Inhibitor
B Weakness
Zollinger-Ellison syndrome
Skin reactions

Severe asthma Change in iris colour

Aphakia Blurred vision
Glaucoma P
Latanoprost Prostaglandin analogues (glaucoma) Increases uveoscleral outflow Pseudophakia Local reactions / Skin darkening 1 drop 0.01 % OD
Occular HTN B
Uveitis Long eyelashes
Macular oedema

Panhypopituitarism
Digoxin
Predisposition to adrenal insufficiency P
Hypothyroidism Features of hyperthyroidism Antidiabetics 25 - 200 micrograms mane
Levothyroxine Thyroid hormones Synthetic T4 Hyperthyroidism Chronic hypothyroidism B + Baseline ECG
Myxoedema coma (with liothyronine) Osteoporosis TCAs Titrate up slowly
HTN / IHD E
Propranolol
DI / DM

L Dizziness / Drowsiness / Confusion Antiphyschotics Ventricular arrhythmias:

Severe myocardial depression H Tinnitus Dolasetron 50 - 100 mg IV at 25 - 30 mg/min
Epilepsy
Reduces conduction in Purkinje / ventricular fibres Ventricular arrhythmias (esp. post-MI) SAN disorders P Blurred vision Quinu-/dalfo-pristin Then 4 mg/min IVI for 30 mins
Lidocaine Class Ib antiarrhythmic Severe hypoxia / hypovolaemia Substrate ECG during IV administration
Blocks axonal sodium channels Local anaesthesia Atrioventricular block (any) B Paraesthesia Antiarrhythmics Then 2 mg/min IVI thereafter
Severe bradycardia
Porphyria E GI upset Beta blockers
Arrhyrthmias / Hypotension / Bradycardia Suxamethonium Local: 3 mg/kg or 7 mg/kg with adrenaline

Constipation / Ileus
Constipation
Megacolon
Abdominal cramps
Invasive bacterial enterocolitis Initially 4 mg
Synthetic opioid analogue Young patients (=> electrolyte abnormalities) L Bloating
Loperamide Antimotility drugs Diarrhoea Abdominal distension Then 2 mg after each loose stool
Binds peripheral opioid receptors in GI tract Can make serious GI conditions P Dizziness
Active UC/AAC Max. 16 mg/day for 5 days
Drowsiness
Pseudomembranous colitis
Fatigue

HTN (esp. 1st dose) NSAIDs

L
RAS Renal failure Diuretics 25 - 50 mg PO OD
R
Blocks RAAS HTN Pregnancy HOCM Hyperkalaemia TCAs
Losartan Angiotensin-II receptor antagonists E Substrate
Does not inhibit bradykinin (cf ACEi's) Px of T2DM nephropathy Breastfeeding Mitral / Aortic stenosis Acidosis Antipsychotics Increase to max. 100 mg OD
P
Hyperkalaemia Hypersensitivity Lithium
B
Photosensitivity Antidiabetics

Flushing
Life-threatening asthma
Smooth / striated muscle relaxant Hypotension 4 - 8 mmol IVI over 20 mins
Serious arrhythmias (esp. torsades) L
Inhibits action potentials in myometrial muscle cells GI upset Use < 20% solution
Magnesium Electrolytes MI Monitor BP, resp rate, urine o/p R Calcium channel blockers
Reduces acetylcholine release Thirst
Eclampsia / Pre-eclampsia
Competitively inhibits Ca2+ influx Reduced reflexes / Weakness IVI up to 160 mmol over up to 5 days as required
Symptomatic hypomagnesaemia
Confusion / Drowsiness

Hypersensitivity 135 - 150 mg TDS before food

Mebevarine Anti-muscarinics (anti-spasmodics) Musculotropic antimuscarinic antispasmodic GI smooth muscle cramps: IBS, Diverticulitis Paralytic ileus Porphyria P
Skin reactions 200 mg BD of SR

GI upset
Salicylate hypersensitivity
Blood disorders Asacol: 400 - 800 mg PO TDS / 500 mg PR TDS
Bowel-specific aminosalicylate Coagulopathy P Lactulose
- Report bruising, fever, malaise U+Es
Mesalazine Aminosalicylates Anti-inflammatory UC Severe renal impairment B NSAIDs
Hypersensitivity FBC NB Preparations not interchangeable:
Immunosuppressant Severe liver impairment E Azathioprine
Renal failure Asacol, Ipocol, Mazavant, Mesren, Pentasa, Salofalk

DKA
Risk of lactic acidosis L GI upset 500 g mane initially, with meal
T2DM Recent MI / Recent general anaesthetic R Taste disturbance Increase to 1 g BD
Metformin Biguanides Raises insulin sensitivity
PCOS Recent contrast P Reduced vit. B12 absorption
Liver / Renal impairment B Lactic acidosis MR tablets available
Pregnancy / Breastfeeding

Acute respiratory depression

Reduced respiratory reserve Nausea, Vomiting, Constipation MAOIs (Don't give within 2/52)
Acute severe obstructive airways disease L
Obstructive airways disease Respiratory depression Voriconazole / Cimetidine
Risk of paralytic ileus / Delayed gastric emptying R Starting dose: 10 - 20 mg PO OD
Hypotension / Shock Hypotension Ciprofloxacin Substrate
Methadone Drugs used in substance dependence Long-acting opioid agonist Opioid withdrawal Biliary colic P Increase by 10 - 20 mg OD titrating to signs of withdrawal
Acute abdomen / Bowel obstruction / IBD Pulmonary oedema / Oedema Antihistamines Inhibitor
Acute alcoholism B Can give SC/IM
Biliary tract disorders Bronchospasm Baclofen
Raised ICP / Head injury E
Pancreatitis Sedation Alcohol

Extrapyramidal effects (Esp. elderly / Female)

NSAIDs
GI obstruction / perforation / haemorrhage L Drowsiness / Restlessness
Dopamine D2 antagonist Epilepsy Ciclosporin
N+V Phaeochromocytome R GI upset Substrate
Metoclopramide Anti-emetic dopamine blockers Acts at central CTZ and directly on GI tract Porphyria Antipsychotics 10 mg TDS PO/SC/IM/IV
Esp. GI / opiate / chemotherapy induced Breastfeeding P Behavioural / Mood effects Inhibitor
=> Increased motility SSRIs
3 - 4 days post-GI surgery E Raised prolactin
TCAs
Skin reactions

Anaerobic and protozoal infections

Abdominal sepsis Busulfan
Avoid alcohol L GI upset
Aspiration pneumonia Lithium 500 mg TDS IVI
Metronidazole Nitroimidazole antibiotic Binds DNA of anaerobic bacteria / protozoa Hypotension P Taste disturbance +
C. diff. / H. pylori / Giardia / Entamoeba Phenytoin 400 mg TDS PO
Acute porphyria B Skin reactions
Bacterial vaginosis Warfarin
PID
front back

Name Class MOA Indications Contraindications Cautions Organ cautions Side effects Interactions Warfarin P450 Status Monitoring Dose

Epilepsy
L Sedation / Weight gain Other sedatives
ECT
R Insomina / Agitation MAOIs 15 mg nocte
Hx of mania or bleeding disorder
Noradrenergic and specific serotonergic antidepressant Depression Active mania H Headache TCAs Increase to max. 45 mg OD
Mirtazapine Other antidepressants Heart disease FBC if ?agranulocytosis
(NaSSA) Esp. in elderly or if insomnia P Hypersensitivity Benzodiazepines
DM
B Withdrawal effects Clozapine/ Haloperidol NB Lower doses more sedating than higher doses
Angle-closure glaucoma
E Blood disorders incl. agranulocytosis Lithium

Acute respiratory depression

Reduced respiratory reserve Nausea, Vomiting, Constipation MAOIs (Don't give within 2/52)
Acute severe obstructive airways disease L
Venodilatation Obstructive airways disease Respiratory depression Ritonavir Pain: 5 - 20 mg SC/IM 4 hr-ly / 2.5 - 15 mg IV 4 hr-ly
Severe pain Risk of paralytic ileus / Delayed gastric emptying R
Peripheral venous pooling Hypotension / Shock Hypotension Ciprofloxacin MI: 5 - 10 mg IV
Morphine sulphate Opioids for severe pain Acute MI Biliary colic P
Reduction of pulmonary congestion Acute abdomen / Bowel obstruction / IBD Pulmonary oedema / Oedema Antihistamines LCF: 5 - 10 mg IV
Acute LVF Acute alcoholism B
Anxiolytic Biliary tract disorders Bronchospasm Baclofen
Raised ICP / Head injury E
Pancreatitis Sedation Alcohol

Constipation: 1–3 sachets daily in divided doses

Intestinal perforation or obstruction Abdominal distension and pain Maintenance: 1–2 sachets daily
Movicol Chronic constipation P
Osmotic laxatives Osmotic laxative Paralytic ileus Fluid and electrolyte disturbance Nausea
(Macrogol) Faecal impaction B
Severe GI inflammatory conditions Flatulence Faecal impaction: 4 sachets on first day
Increase in steps of 2 sachets daily to max. 8 sachets daily

0.4 - 2 mg IV/SC/IM
Repeat every 2 mins up to 10 mg until response
Cardiovascular disease
Naloxone Opioid receptor antagonist Opioid receptor antagonist Opioid overdose Cardiotoxic drugs H
May require IVI as short acting
Physical opioid dependence
Certain opioids (e.g. tramadol) require much larger doses

Asthma / Allergic disorder L GI upset / Bleeding / Peptic ulcer Aspirin / Clopidogrel

Rheumatic disease Hx of aspirin / NSAID hypersensitivity Uncontrolled HTN R AKI Anti-coagulants
Moderate strength NSAID Acute musculoskelatal pain Active / Hx of PU/GI bleed or perforation IHD / PVD / Cerebrovascular disease H Hypersensitivity Corticosteroids 500 mg BD PO
Naproxen Non-steroidal anti-inflammatory drugs + (Mild) Substrate
Non-selective COX inhibitor Dysmenorrhoea Severe liver / renal / cardiac dysfunction Connective tissue disorders P Fluid retention / Oedema SSRIs, Venlafaxine, Erlotinib Max. 1.25 g / day
Acute gout Pregnancy 3rd trimester Coagulopathy B Headache / Dizziness / Nervousness Digoxin, Quinolones, Lithium
IBD E Depression / Drowsiness / Insomnia Methotrexate, AZT

(Initial) Headache
Potassium channel activator:
Flushing
=> Arterial dilatation => Reduced afterload Hypotension - Esp. cardiogenic shock Hypovolaemia
Dizziness Catastrophic hypotension:
Nicorandil Nicorandil Angina Px/Rx (Second line) LVF with reduced filling pressures Acute pulmonary oedema P 5 - 30 mg BD
Weakness Silden-/tadal-/varden-afil
Nitrate component: Breastfeeding ACS with LVF and reduced filling pressures
N+V
=> Venous dilatation => Reduced preload
Hypotension / Tachycardia

DM 50 mg QDS PO
Activated by bacterial flavoproteins (nitrofuran reductase) G6PD deficiency
Lung disease GI upset Increase to 100 mg QDS for severe recurrent infection
=> Modulates / damages ribosomal proteins + DNA Acute porphyria
UTIs Anaemia L Pulmonary reactions (effusions / fibrosis)
Nitrofurantoin Nitrofuran / Imidazolidine => Inhibition of DNA, RNA, protein, cell wall synthesis Renal impairment False-positive urine dip for glucose
(Not pyelonephritis) Vitamin B / folate deficiency E Peripheral neuropathy 50 mg nocte for prophylaxis
Infants
Electrolyte imbalance Hypersensitivity
Action confined to urine only Prognancy / Breastfeeding
Susceptibility to peripheral neuropathy Take with food

Polyene antifungal Oral: 0.5 - 1 million units QDS PO. Take after food
Candida infections GI upset
Nystatin Anti-fungal drugs Binds to ergosterol in fungal cell membrane
(Skin / Mucous membranes / GI) Skin reactions
=> K+ pores => K+ leakage => Death Cream: 100,000 units/g TDS

Drugs increasing QT Sedation / Weight gain Metabolised by P450 Blood glucose / HbA1c
L
Schizophrenia Angle closure glaucoma Dementia / Parkinson's / Epilepsy Ankle oedema Carbemazepine, Smoking LFTs / U+Es / FBC
R 5 - 20 mg PO OD / Nocte
Maina Breastfeeding Cardiovascular disease Deranged LFTs Valproate / Ciprofloxacin Prolactin
Olanzapine Atypical antipsychotics D1, D2, D4, 5HT2 antagonist H
Bipolar prophylaxis If giving IM: DM / Prostatic hypertrophy Postural hypotension Sibutramine Weight / Lipids
P Acute sedation: 5 - 10 mg IM
Acute sedation Acute MI / ACS / Hypotension / Bradycardia / SSS Blood disorders Hyperglycaemia Long QT drugs CK if ?NMS
E
Paralytic ileus Extrapyramidal / Anticholinergic effects General anaesthetics Cardiorespiratory function if given IV

GI upset
Headache Initially 20 mg PO OD
Peptic ulcer Rx/Px
L Dizziness Max. 40 mg PO OD if severe
GORD Substrate
Omeprazole Proton pump inhibitors Inhibits H+/K+ ATPase on parietal cells Can mask symptoms of gastric cancer P Arthralgia + (Mild) 10 mg PO OD maintenance
H. pylori eradication Inhibitor
B Weakness
Zollinger-Ellison syndrome
Skin reactions Can give 40 mg IV/IVI OD

Constipation 8 mg BD PO
L Diarrhoea 16 mg OD PR
Nausea + Vomiting GI obstruction (incl. subacute) Tramadol
Ondansetron Anti-emetic 5HT3 antagonists Central / GI 5HT3 antagonist P Headache Substrate 8 mg 2 - 8 hrly IV/IM/IVI
Esp. if resistant / severe / post-op / chemo-induced Long QT Long QT drugs
B Sedation / Fatigue
Dizziness Max. 24 mg/day

Bladder outflow obstruction Prostatic hypertrophy

L
GI obstruction Autonomic neuropathy Antimuscarinic Initially 5 mg BD/TDS PO
Detrusor instability R
M3-selective anticholinergic Urinary retention Hiatus hernia with reflux GI upset Increase to max. 5 mg QDS if required
Oxybutynin Antimuscarinics (bladder) Neurogenic bladder instability H
=> Antispasmodic Severe UC / Toxic megacolon Hyperthyroidism Palpitations / Tachycardia
Nocturnal enuresis P
Angle-closure glaucoma IHD / Arrhythmias Skin reactions MR + Patch versions available
E
Myaesthenia gravis Porphyria

Milk impairs absorption

Age <12 (Stains teeth) GI upset
Acne vulgaris Myaesthnia gravis Anatcids
Acute porphyria Oesophageal irritation
Oxytetracycline Tetracylines Inhibits 30S ribosomal protein synthesis Rosacea SLE L Fe/Al/Ca/Mg/Zn salts 500 mg BD PO for at least 16 weeks
Renal impairment Headache
Porphyria Retinoids
Pregnancy / Breastfeeding Dysphagia
Warfarin

Vitamin C (Ascorbic acid)

Vitamin B1 (Thiamine)
Wernicke's encephalopathy Suspected WE: 2 pairs TDS IV/IM for 3 days, Then 1 pair OD IV/IM for 3 - 5 days
Paprinex Vitamins, folic acid Vitamin B2 (Riboflavin) Ensure given BEFORE carboydrate load Anaphylaxis For anaphylaxis
Acute vitamin deficiency (Esp. thiamine) High risk of WE: 1 pair OD IV/IM for 3 - 5 days
Vitamin B3 (Nicotinamide)
Vitamin B6 (Pyridoxine)

L 0.5 - 1 g PO/PR/IV QDS

Rash
Pain Alcohol dependance R 15 mg/kg if <50 kg
Paracetamol Severe liver disease Blood disorders Warfarin (if prolonged use) + (Prolonged use)
Pyrexia
Hepatic failure
Max. 4 g /day / 3 g/day IV

ENT infections
Hypersensitivity
As benzylpenicillin but active orally Skin infections (esp. ersipelas) Probenicid
Diarrhoea
Phenoxymethylpenicillin Penicillins Rheumatic fever prophylaxis Penicillin hypersensitivity History of allergy Allopurinol 0.5 - 1 g QDS PO on empty stomach
Blood disorders
Inhibits formation of cell wall peptidoglycan cross-links Strep. pneumoniae prophylaxis (esp. post-splenectomy)
CNS toxicity

If given IV: Acute: Drowsiness / Cerebellar effects

OCP FBC
Sinus bradycardia L Rash / Nausea / Vomiting 150 - 500 mg/day PO in 1 - 2 divided doses
DM Doxycycline Drug levels (narrow therapeutic index)
All forms of epilepsy except absence seizures Stokes-Adams syndrome H Diplopia / Dyskinesia - (Usually) Substrate
Phenytoin Antiepileptic Blocks sodium channels Porphyria Calcium antagonists
Status epilepticus SAN block P Chronic: Gum hypertrophy / Coarse facies May + Inducer IV: Loading:18 mg/kg at max. 50 mg/min
Hypotension Warfarin If IV: BP, ECG / QTc
2nd/3rd degree heart block B Hirsutism / Acne / Low folate Maintenance: 100 mg TDS/QDS
Many others
Acute porphyria Dupuytren's / Peripheral neuropathy

Oedema (esp. if HTN/CCF)

Anaemia
ACS / Hx of ACS
Weight gain 15 - 30 mg OD
Reduces peripheral insulin resistance Heart failure Rifampicin LFTs
Pioglitazone Thiazolidinediones T2DM (Second / Third line) CVD peri-operatively R GI upset / Headache Inducer
Blocks hepatic gluconeogenesis Liver impairment Gemfibrozil Signs of heart failure
Distal fractures Max. 45 mg OD
Pregnancy / Breastfeeding
Hepatotoxicity

GI ulcer / stricture Sando-K = 12 mmol/tablet. Start with 2 - 4 tablets/day, with food

Hypekalaemia Nausea + Vomiting
Potassium Electrolytes Potassium Hypokalaemia Hiatus hernia R U+Es
Severe renal impairment GI ulceration
Other drugs raising potassium Kay-Cee-L = 1 mmol/ml. Start with 25 - 50 ml/day in divided doses

Predisposition to dysfunction vi: Metabolic / Endocrine / Infective

Rifampicin / Carbemazepine 2.5 - 15 mg PO OD for maintenance
Metabolic / Endocrine / Infective GI
Anti-inflammatory (e.g. RA, IBD, asthma, eczema) Phenytoin / Phenobarbital
GI / Cardiac Cardiac
Prednisolone Glucocorticoid therapy Glucocorticoid / Mild mineralocorticoid Immunosuppression (e.g. Transplant, leukaemia) Systemic infections (unless Abx cover) Erythromycin / Ketoconazole Inducer May require 20 - 60 mg PO OD initially
Musculoskeletal Musculoskeletal
Glucocorticoid replacement (e.g. Addison's, hypopituitarism) Itraconazole / Ciclospirin
Neurological / Psychiatric Neurological / Psychiatric
Amphotericin / Digoxin Available as once/twice weekly IM injection
Occular Occular

CNS depression / Elderly patients Sedation Alcohol

Acutely: 20 mg PO, then 10 mg 2 hr later
Hx of blood dyscrasias Extrapyramidal side-effects Antihypertensives
IM: 12.5 mg
Severe CVD Antimuscarinic effects TCAs FBC
Prochlorperazine Phenothiazines and related drugs Phenothiazine dopamine antagonist Nausea + Vomiting PR: 25 mg
Parkinson's / Long QT drugs Seizures Lithium BP
MG / Phaeo / Angle-closure glaucoma Weight gain Ritonavir
Prophylaxis: 5 - 10 mg BD/TDS PO
Prostatism Postural hypotension Cimetidine
front back

Name Class MOA Indications Contraindications Cautions Organ cautions Side effects Interactions Warfarin P450 Status Monitoring Dose

Sedation / Weight gain Blood glucose / HbA1c

Carbemazepine, Smoking Needs titrating
Schizophrenia L Ankle oedema LFTs / U+Es / FBC
Cardiovascular disease Valproate / Ciprofloxacin Initially 25 mg BD PO
Dopamine, serotonin, and adrenergic antagonist Maina R Deranged LFTs Prolactin
Quetiapine Atypical antipsychotics Breastfeeding Hx of epilepsy Sibutramine Substrate Increase daily to max. 800 mg/day
Potent antihistamine Depression in bipolar prophylaxis E Postural hypotension Weight / Lipids
Long QT drugs Long QT drugs
Psychosis / Behavioural disorders P Hyperglycaemia CK if ?NMS
General anaesthetics MR form available
Extrapyramidal / Anticholinergic effects Cardiorespiratory function if given IV

Visual disturbance incl. temporary blindness Flecainide

Optic neuritis Tinnitus / Vertigo / Deafness Digoxin Blood glucose
Cardiac disease H
Reduces response of the motor end-plate to ACh Tinnitus GI upset / Rash / Flushing Pimozide / Moxifloxacin
Quinine sulphate Nocturnal leg cramps (Incl. conduction defects, AF, Block) P Substrate 200 - 300 mg PO nocte
=> Reduced excitability Haemoglobinuria Headache / Confusion Amiodarone ECG if elderly
G6PD deficiency E
Myaesthenia gravis Hypoglycaemia Mefloquine U+Es if given IV
Hypersensitivity Artemether / Lumefantrine

Hypotension (incl. first-dose)

Renal failure NSAIDs
Hypertension Renovascular disease L
Symptomatic aortic stenosis Dry cough Diuretics
Angiotensin converting enzyme inhibitor Heart failure Angioedema / Hypersensitivity R
Ramipril Angiotensin converting enzyme inhibitors Hx of idiopathic / hereditary angioedema Hyperkalaemia / Acidosis TCAs / Antipsychotics U+Es - Baseline + after 2 weeks 6.25 - 75 mg BD PO
=> Reduced angiotensin II production Post-MI Porphyria B
Drugs raising potassium Hypersensitivity / Photosensitivity Lithium
CVD prophylaxis Pregnancy E
Taste disturbance / GI upset Antidiabetics

GI upset
L Initially 150 mg BD PO / 300 mg nocte PO
Dizziness / Confusion / Fatigue
Peptic ulcer Rx/Px Acute porphyria R Increase to 600 mg /day if necessary
Ranitidine H2-receptor antagonists Reduces parietal cell acid secretion Blurred vision / Headache Inhibitor
Reflux oesophagitis May mask symptoms of gastric cancer P
Deranged LFTs
B 50 mg TDS/QDS IV/IM/IVI
Rash

Fine tremor / Headache / Nervousness

Cardiovascular disease
Short-acting beta 2 agonist Chronic / Acute asthma Tachycardia / Palpitations/ Arrhythmias / Long QT 100 - 400 micrograms PRN Inh
(Arrhythmias / Long QT / HTN) p Potassium
Salbutamol Beta 2 agonists Dilates bronchial smooth muscle / endometrium Hyperkalaemia Hypokalaemia Methyldopa 2.5 - 5 mg PRN Neb
DM B Glucose
Inhibits mast-cell mediator release Premature labour Muscle cramps 5 - 20 microgram/min IVI
Hyperthyroidism
Paradoxical bronchospasm

Fine tremor / Headache / Nervousness

Cardiovascular disease
Long-acting beta 2 agonist Tachycardia / Palpitations/ Arrhythmias / Long QT
(Arrhythmias / Long QT / HTN) p
Salmeterol Beta 2 agonists Dilates bronchial smooth muscle / endometrium Asthma - Second-line Hypokalaemia Methyldopa Substrate 50 - 100 micrograms BD Inh
DM B
Inhibits mast-cell mediator release Muscle cramps
Hyperthyroidism
Paradoxical bronchospasm

Stimulant laxative GI cramps 2 - 4 tablets nocte

Senna Stimulant laxatives Increases gastric fluid secretion and bowel motility Constipation GI obstruction P Atonic non-functioning colon with prolonged use
Takes 8 - 12 hrs to work Hypokalaemia Available as syrup

Salmeterol:
50 (Accuhaler) or 25 (Evohaler) micrograms
Asthma
Seretide Compound bronchodilators
COPD
Fluticasone:
50 - 500 micrograms

Recent CVA / MI / ACS CVD / LV outflow obstruction Headache / Flushing / Dizziness

Phosphodiesterase type-5 inhibitor Erectile dysfunction Nitrates / Nicorandil
Hypotension (systolic <90) Bleeding disorders R GI upset Erectile dysfunction: 50 - 100 mg 1 hr before sexual activity
=> Increases local effects of NO Pulmonary artery hypertension Antivirals
Sildenafil Drugs for erectile dysfunction Hereditory retinal disorders Active PU P Visual disturbances Substrate
=> Smooth muscle relaxation Digital ulceration Alpha blockers
Hx of non-arteritic AION Anatomical deformation of penis B Nasal congestion Pulmonary HTN: 20 mg TDS
=> Increased blood flow Keto-/itra-conazole
Severe liver disease / heart failure Predisposition to prolonged erection Hypersensitivity

Hepatitis Fibrates
HMG-CoA reductase inhibitor Hypercholesterolaemia Acute porphyria Myositis Macrolide antiobiotics
Hypothyroidism 10 - 80 mg Nocte PO
Blocks cholesterol synthesis Prophylaxis of atherosclerotic diseases Liver impairment R Headache Azole antifungals LFTs
Simvastatin Statins Alcohol abuse + (Mild) Substrate
Increases LDL uptake Primary prevention of IHD / CVA / PVD Pregnancy GI upset Nicotinic acid CK if symptoms of myositis develop
Hx of liver disease Increase dose slowly over at least 4 weeks
Mildly lowers triglycerides Breastfeeding Rash Fusidic acid
Colchicine

Sedation / Cerebellar effects / Headache Antimalarials (esp. mefloquine)

GI upset / Weight gain / Ankle swelling Antidepressants / Antipsychotics
Acute porphyria SLE R LFTs
Antiepileptic Epilepsy Alopecia / Skin reactions Some antiepileptics Initially 300 mg BD
Sodium valproate Potentiates and increases GABA levels Hx / FHx severe liver dysfunction Increased bleeding risk P + (Mild) FBC
Mood stabiliser Mania Cognitive / Motor impairment Cimetidine / Carbopenems Increase to max. 2.5 g/day
Active liver disease B Serum levels (pre-dose)
Psychiatric disturbance / Encephalopathy Aspirin / Primidone
Hepatotoxicity / Pancreatitis / Blood disorders Olanzapine / Warfarin

Hyperkalaemia / Hypernatraemia
Ascites (esp. secondary to cirrhosis / malignancy)
Hyperkalaemia Gynaecomastia
Oedema L Digoxin 100 - 400 mg/day PO
Aldosterone antagonist at distal tubule Hyponatraemia GI upset / N+V / Hypotension
Spironolactone Aldosterone antagonists Heart failure Porphyria R Lithium U+Es
Potentiates loop / thiazide diuretics Addison's Impotence
Nephrotic syndrome E NSAIDs Heart failure: 25 mg OD PO
Pregnancy / Breastfeeding Rash / Confusion / Headache
Primary hyperaldosteronism
Hepatotoxicity / Blood disorders

Recent haemorrhage, trauma, or surgery

Nausea + Vomiting
Stroke with convulsion, diabetes, hypoglycaemia
Acute myocardial infarction Risk of bleeding Bleeding Acute MI: 1.5 million units IVI over 60 mins
Coagulation defects / Bleeding diatheses L
Catalyses conversion of plasminogen to plasmin Arterial thromboembolism (incl. PE / Central retinal artery) External chest compression Reperfusion arrhythmias Blood pressure Other: 250,000 units IVI over 30 mins, then 100,000 units/hr for 12 - 72 hr
Streptokinase Thrombolytic agents Aortic dissection / Aneurysm P
=> Fibrin degradation Venous thromboembolism (incl. DVT / Central retinal vein) Elderly Cerebral / Pulmonary reperfusion oedema Signs of haemorrhage
CVD / PU / Coma / Severe HTN / Varices E
Hypertension Hypotension Only give once in a lifetime
Pancreatitis / Pericarditis / Bacterial endocarditis

GI upset (Esp. reduced appetite / weight)

Slow acetylators RA: 500 mg - 3 g /day PO
R Hepatotoxicity
Hx of any allergy LFTs Acute UC / Crohn's: 1 - 2 g QDS PO
5-aminosalicylic acic plus Sulfapyridine RA Sulphonamide / Salicylate hypersensitivity L Blood disorders
Sulphasalazine Aminosalicylates Porphyria U+Es UC / Crohn's maintenance: 500 mg QDS PO
Blocks eicosanoid / cytokine production UC / Crohn's (Second line) Severe renal impairment P Hypersensitivity
G6PD deficiency FBC
B Seizures
Can also give 0.5 - 1 g PR BD after motion in addition to PO dose
Lupus

Hypersensitivity
Extended-spectrum penicillin + β-lactamase inhibitor Severe Gram-positive / Gram-negative infection Nausea / Vomiting Probenicid
Tazosin
Antipseudomonal penicillins Inhibits cell wall synthesis Severe anaerobe infection Penicillin hypersensitivity History of allergy Diarrhoea Allopurinol 4.5 g TDS/QDS IV
(Piperacillin/tazobactam)
Pseudomonas Blood disorders
CNS toxicity

Respiratory depression
Respiratory disease
Neuromuscular respiratory weakness
Muscle weakness (incl. MG) Respiratory depression 10 mg nocte
Sleep apnoea Metabolised by P450
Temazepam Benzodiazepines GABA agonist Insomnia Hx of drug/alcohol abuse Drowsiness Can increase dose if tolerant
Acute pulmonary insufficiency
Personality disorder Dependence Max. 4 week treatment
Chronic psychosis
Porphyria
Depression

Recent haemorrhage, trauma, or surgery

Nausea + Vomiting
Stroke with convulsion, diabetes, hypoglycaemia
Risk of bleeding L Bleeding (But less than alteplase)
Acute myocardial infarction Coagulation defects / Bleeding diatheses 30 - 50 mg IV bolus according to weight
Tenecteplase Catalyzes the conversion of plasminogen to plasmin External chest compression P Reperfusion arrhythmias Blood pressure
Thrombolytic agents Aortic dissection / Aneurysm
(r-tPA) => Fibrin breakdown Elderly E Cerebral / Pulmonary reperfusion oedema Signs of haemorrhage
CVD / PU / Coma / Severe HTN / Varices Needs concurrent IV heparin for 24 - 48 hrs
Hypertension B Hypotension
Pancreatitis / Pericarditis / Bacterial endocarditis

Dry mouth
COPD 18 micrograms Inh OD (Spiriva HandiHaler)
Tiotropium Antimuscarinic bronchodilators Long-acting muscarinic antagonist R Urinary retention
Asthma 5 micrograms Inh OD (Spiriva Respimat)
Glaucoma

Bladder outflow obstruction / Urinary retention Prostatic hypertrophy

L
GI obstruction Autonomic neuropathy Antimuscarinic Amiodarone
R 1 - 2 mg BD PO
Detrusor instability Severe UC / Toxic megacolon Hiatus hernia with reflux GI upset Disopyramide
Tolterodine Antimuscarinics (bladder) Antimuscarinic / Antispasmodic H
Urinary Incontinence / Frequency / Urgency Angle-closure glaucoma Hyperthyroidism Palpitations / Tachycardia Flecainide
P MR preparation available: 4 mg OD PO
Myaesthenia gravis IHD / Arrhythmias / Porphyria Skin reactions Sotalol
E
Pregnancy / Breastfeeding Drugs causing long QT

Acute respiratory depression Reduced respiratory reserve Sedation / Confusion MAOIs (Don't give within 2/52)
Risk of ileus Obstructive airways disease Constipation / Nausea / Vomiting SSRIs / TCAs / Antipsychotics 50 - 100 mg PO/IM/IV up to 4 hourly
L
Opioid Moderate / Severe pain Raised ICP Hypotension / Shock / Delayed gastric emptying Respiratory depression Carbemazepine / Ondansetron Max. 400 mg/day
Tramadol Opioids for moderate pain R + (Mild) Substrate
Increases 5HT/noradrenergic transmission Esp. musculoskeletal Head injury / Coma Acute abdomen / Bowel obstruction / IBD Hypotension Ciprofloxacin
E
Uncontrolled epilepsy Biliary tract disorders / Pancreatitis Pulmonary oedema / Oedema Antihistamines / Alcohol Post. op: 50 mg every 10-20 min PRN, Max. 250 mg in first hr / 600 mg/day
Pregnancy / Breastfeeding Acute alcoholism Bronchospasm Warfarin

Skin reactions / Rash

Phenytoin
Blood disorders: Neutropenia, Thrombocytopenia,
R Amiodarone
BM suppression, Agranulocytosis
Blood disorders Low folate / Predisposition to P Pyrimethamine 200 mg BD PO
Trimethoprim Antifolate antibiotic Inhibits dihydrofolate reductase UTIs Nausea / Vomiting / Diarrhoea + Inhibitor Signs of blood disorder if long-term
Esp. megaloblastic anaemia Porphyria B Ciclosporin / Azathioprine 100 mg nocte for chronic infections or prophylaxis
Nephrotoxicity / Hepatotoxicity
E Mercaptopurine / Methotrexate
Hypersensitivity
Warfarin
front back

Name Class MOA Indications Contraindications Cautions Organ cautions Side effects Interactions Warfarin P450 Status Monitoring Dose

Nephrotoxicity / Ototoxicity
R Serum levels (Monitor after 3rd dose)
Serious Gram-positive infections Hx of deafness Blood disorders / Rash / Hypersensitivity Ciclosporin 1 - 1.5 g BD IVI over 100 mins
P U+Es
Vancomycin Glycopeptide antibiotic Inhibits cell wall synthesis in Gram-positive bacteria (Incl. endocarditis / MRSA) IBD (If given PO) Nausea Loop diuretics
B FBC
Antibiotic-associated colitis Anaphylaxis with rapid infusion fever Suxamethonium AAC: 125 mg QDS PO
E Urinalysis
Phlebitis / Irritation

GI upset MAOIs (Never give within 2 weeks)

High risk of serious ventricular arrhythmia L Hypertension Aspirin / NSAIDs
37.5 - 187.5 mg BD PO (Start low)
SNRI Depression Uncontrolled HTN R Withdrawal effects (even if few hrs late) Selegiline / Sibutramine BP / ECG if heart disease
Venlafaxine Other antidepressants Hx of mania / seizures / glaucoma + (Mild) Substrate
Generalised anxiety disorder Pregnancy H Rash / Insomina / Agitation Artemether / Lumefantrine Emergence of rash
MR OD preparation available
Severe liver / renal impairment B Dry mouth / Sexual dysfunction / Weight gain Clozapine
Drowsiness / Dizziness / SIADH / Long QT Warfarin

Haemorrhage
Severe HTN Rash / Fever
L Alcohol
Peptic ulcer Recent surgery Diarrhoea / GI upset
Warfarin Oral anticoagulant Blocks vitamin K dependent clotting factors Treatment / Prophylaxis of thromboembolism R Cranberry juice Substrate Variable
Bacterial endocarditis Purple-toe syndrome
B P450 modulators
Pregnancy Skin necrosis
Hepatotoxicity / Hypersensitivity

Respiratory failure
Severe sleep apnoea
Psychiatric disorders GI upset
Marked neuromuscular respiratory weakness R Ritonavir
Short-acting cyclopyrrolone hypnotic Hx of drug abuse Taste disturbance
Zopiclone Z-drugs Insomnia (short-term) Unstable myaesthenia gravis P Erythromycin 7.5 - 15 mg nocte PO
Potentiates GABA pathways Muscle weakness Behavioural / Psychiatric disturbance
Severe liver impairment E Other sedatives / alcohol
Myaesthenia gravis Hypersensitivity
Breastfeeding