Clinical Pharmacology Therapeutics and

Prescribing

MBBS Student Formulary

2014-15 Edition

MBBS STUDENT FORMULARY 2014-15 This formulary has been produced to assist your learning of clinical pharmacology and therapeutics to provide learning objectives that are realistic and attainable. It has been developed in consultation with all course directors and lists the drugs of which you should have acquired ‘core knowledge’ by the end of your undergraduate training.

The formulary has the same structure as the British National Formulary, with drugs appearing in the same section and in the same order. The order in which drugs appear does not necessarily indicate the order of preference of use.

We emphasise that the formulary is a minimum knowledge base. You should not restrict your reading and learning to these drugs alone, particularly if you encounter other drug therapy in patients you see. It is acknowledged that different drugs within the same class may be used in different hospitals.

Clinical Pharmacology, Therapeutics and Prescribing Learning Outcomes

Phase I outcomes

Essential drugs (shown in CAPITALS in the formulary) and important drugs (shown in LOWERCASE in the formulary)

Describe the mechanism of action and clinical use of [the drug/class of drug]

Describe any major pharmacokinetic characteristics which affect the clinical use of [the drug/class of drug]

Describe the major side effects of [the drug]

Phase II outcomes

Essential drugs (shown in CAPITALS in the formulary)

Explain the appropriate route, frequency and duration of administration (drug doses are not expected to be memorised) of [the drug]

Identify all clinically relevant contraindications, interactions and adverse drug reactions of [the drug]

Explain how to monitor the effects of [the drug]

Explain the salient features of [the drug] to the patient

Important drugs (shown in LOWERCASE in the formulary)

Define the class of [the drug]

Explain the mechanism of action of [the drug]

Describe common indications for use of [the drug]

Identify the most important or serious contraindications, interactions and adverse drug reactions of [the drug]

Some drugs are used under specialist supervision only and are highlighted in ITALICS. They are included because they may demonstrate a novel mechanism of action or may have important adverse reactions or interactions that you should be aware of and be able to recognise.

A student who achieves these targets should be able to cope effectively and safely with most of the prescribing challenges that they will face in their early postgraduate years whether in hospital or in general practice.

BNF Section 1 Drugs Acting on the Gastro-Intestinal System

MAIN DRUGS ALTERNATIVES

1.1 Antacids Aluminium hydroxide

1.2 Antispasmodics and other drugs altering gut motility

Antimuscarinic Hyoscine butylbromide

Smooth muscle relaxant Mebeverine

Motility Stimulant Metoclopramide

1.3 Ulcer healing drugs H2-receptor Antagonists RANITIDINE

Proton Pump Inhibitors OMEPRAZOLE LANSOPRAZOLE

1.4 Anti-diarrhoeal Drugs Antimotility Drugs Loperamide

1.5 Treatment of Chronic Diarrhoea/ Inflammatory Bowel Disease

Aminosalicylates Mesalazine

Cytokine modulators Infliximab

1.6 Laxatives Bulk-forming drugs ISPAGHULA HUSK

Stimulant Laxatives SENNA

Sodium docusate

Osmotic Laxatives Lactulose Macrogols

BNF Section 2 Drugs used in the Treatment of Disease of the Cardiovascular System

MAIN DRUGS ALTERNATIVES

2.1 Positive Inotropic Drugs Cardiac glycosides DIGOXIN

2.2 Diuretics Thiazides BENDROFLUMETHIAZIDE

Loop diuretics FUROSEMIDE

Potassium sparing diuretics Amiloride

Aldosterone Antagonist SPIRONOLACTONE

2.3 Anti-arrhythmic Drugs Drugs for arrhythmias ATROPINE ADENOSINE

AMIODARONE

Flecainide

2.4 Beta-adrenoreceptor blocking drugs BISOPROLOL Atenolol Propranolol

2.5 Antihypertensive Therapy Alpha-adrenoceptor antagonists Doxazosin

ACE inhibitors LISINOPRIL RAMIPRIL

Angiotensin II antagonists Losartan

Centrally acting antihypertensives Methyldopa

2.6 Nitrates and other Vasodilators, and Calcium Channel Blocking drugs

Nitrates GLYCERYL TRINITRATE ISOSORBIDE MONONITRATE

Calcium Channel Blockers AMLODIPINE Diltiazem Verapamil

NIFEDIPINE

Potassium channel activator Nicorandil

2.7 Sympathomimetics Vasoconstrictor Sympathomimetics Norepinephrine

Cardiopulmonary resuscitation EPINEPHRINE

2.8 Anticoagulants Parenteral Anticoagulants Heparin (unfractionated)

ENOXAPARIN Tinzaparin

Oral anticoagulants WARFARIN

Dabigatran

2.9 Antiplatelet Drugs ASPIRIN

CLOPIDOGREL

2.10 Fibrinolytic Drugs ALTEPLASE (rt-PA)

2.11 Antifibrinolytic drugs and Haemostatics

Blood-related products Dried Prothrombin Complex

Factor VIII fraction

Fresh Frozen Plasma

2.12 Lipid-regulating drugs HMG-CoA Reductase Inhibitors SIMVASTATIN ATORVASTATIN

Absorption inhibitors Ezetimibe

Fibrates Bezafibrate

BNF Section 3 Drugs Acting on the Respiratory System

MAIN DRUGS ALTERNATIVES

3.1 Bronchodilators Selective 2 Adrenoreceptor

Stimulants

SALBUTAMOL Salmeterol

Antimuscarinic Bronchodilators IPATROPIUM BROMIDE Tiotropium

Xanthines Theophylline Aminophylline

Inhaler Devices and Nebulisers Metered Dose Inhaler Dry Powder Device Breath Activated Device Spacer Device Nebuliser

3.3 Inhaled Corticosteroids BECLOMETASONE Fluticasone

3.3 Cromoglicate and related therapy Leukotriene receptor antagonist Montelukast

3.4 Antihistamines, hyposensitisation and allergic emergencies

Antihistamines CETIRIZINE CHLORPHENAMINE

Allergic Emergencies EPINEPHRINE Hydrocortisone

3.6 Oxygen OXYGEN Oxygen concentrator

3.7 Mucolytics Carbocisteine

BNF Section 4 Drugs Acting on the Central Nervous System

MAIN DRUGS ALTERNATIVES

4.1 Hypnotics and Anxiolytics DIAZEPAM Lorazepam Zopcilone

TEMAZEPAM CHLORDIAZEPOXIDE

4.2 Drugs used in Psychoses and

Related Disorders

Antipsychotic drugs HALOPERIDOL (oral, im, depot) OLANZAPINE Risperidone Quetiapine Clozapine

Aripiprazole Amisulpiride

Antimanic drugs LITHIUM Valproic acid

Lamotrigine

4.3 Antidepressant Drugs Tricyclic and related antidepressant drugs

AMITRIPTYLINE Trazodone

Monoamine oxidase inhibitors Phenelzine

Selective serotonin reuptake inhibitors FLUOXETINE Sertraline Citalopram

Other antidepressant drugs Mirtazapine Venlafaxine

4.6 Drugs used in Nausea and Vertigo Antihistamines CYCLIZINE

Phenothiazines and related drugs PROCHLORPERAZINE METOCLOPRAMIDE

DOMPERIDONE

5-HT3 receptor antagonists Ondansetron

4.7 Analgesics Non-opioid analgesics and compound analgesic preparations

ASPIRIN PARACETAMOL NAPROXEN

IBUPROFEN Diclofenac

Opioid Analgesics CODEINE MORPHINE Tramadol

DIAMORPHINE

Neuropathic pain Gabapentin Amitriptyline

Antimigraine drugs Sumatriptan

4.8 Antiepileptics (anticonvulsants) Control of the epilepsies CARBAMAZEPINE PHENYTOIN SODIUM VALPROATE Lamotrigine

Drugs used in status epilepticus DIAZEPAM PHENYTOIN

LORAZEPAM

4.9 Drugs used in Parkinsonism and related disorders

Dopaminergic drugs CO-CARELDOPA Bromocriptine Selegiline Entacapone Apomorphine

Antimuscarinics Procyclidine

4.10 Drugs used in Substance Dependence Nicotine dependence NICOTINE

Opioid dependence Methadone

4.11 Drugs for dementia Donepezil Rivastigmine Galantamine Memantine

BNF Section 5 Drugs used in the Treatment of Infections

MAIN DRUGS ALTERNATIVES

5.1 Antibacterial drugs

Penicillins BENZYLPENICILLIN AMOXICILLIN FLUCLOXACILLIN Co-amoxiclav Piperacillin with tazobactam

Cephalosporins, cephamycins and other

Cefalexin Cefotaxime

Carbapenems Meropenem

Tetracyclines Doxycycline

Aminoglycosides Gentamicin

Macrolides CLARITHROMYCIN ERYTHROMYCIN

Sulfonamides and trimethoprim TRIMETHOPRIM Co-trimoxazole

Anti-tuberculosis drugs Rifampicin Isoniazid Pyrazinamide Ethambutol

Metronidazole and tinidazole METRONIDAZOLE

Quinolones Ciprofloxacin

Other antibacterials Nitrofurantoin Clindamycin Vancomycin

5.2 Antifungal Drugs Triazole antifungals Fluconazole

Other antifungals NYSTATIN

5.3 Antiviral drugs HIV infection Efavirenz Tenofovir Darunavir

Herpes virus infections Aciclovir

5.4 Antiprotozoal Drugs Antimalarials Quinine

Chloroquine

5.5 Anthelmintics

Drugs for threadworms Piperazine

BNF Section 6 Drugs Used in the Treatment of Disorders of the Endocrine System

MAIN DRUGS ALTERNATIVES

6.1 Drugs used in Diabetes Insulins INSULIN (soluble) INSULIN (Isophane) Insulin Aspart Insulin Glargine

Sulphonylureas GLICLAZIDE

Biguanides METFORMIN

Other antidiabetics Pioglitazone

Treatment of Hypoglycaemia GLUCOSE 20%

Glucagon

6.2 Thyroid & Antithyroid Drugs Thyroid Hormones LEVOTHYROXINE

Antithyroid drugs Carbimazole

6.3 Corticosteroids Replacement therapy Fludrocortisone

Glucocorticoid therapy PREDNISOLONE HYDROCORTISONE

6.4 Sex Hormones Oestrogens and HRT CONJUGATED OESTROGENS

Progestogens NORETHISTERONE

Male Sex Hormones Testosterone

6.5 Hypothalamic and Pituitary Hormones and Anti-oestrogens

Anti-oestrogens Clomifene citrate

Anterior pituitary hormones Tetracosactide

Somatropin (recombinant human

growth hormone)

Posterior pituitary hormones Desmopressin

6.6 Drugs Affecting Bone Metabolism Bisphosphonates Alendronic acid

BNF Section 7 Drugs used in Obstetrics, Gynaecology and Urinary Tract Disorders

MAIN GENERIC DRUGS BRANDED DRUG*

7.1 Drugs used in Obstetrics Prostaglandins and oxytocics Dinoprostone Ergometrine Oxytocin

e.g Prostin E2 e.g Syntometrine e.g Syntocinon

Anti-progestogen Mifepristone

7.2 Treatment of Vaginal and Vulval Conditions

Topical Oestrogens Conjugated oestrogens

Fungal infections Clotrimazole (cream, pessaries)

7.3 Contraceptives Combined Oral Contraceptives ETHINYLOESTRADIOL/ LEVONORGESTREL

e.g Microgynon

Progesterone-Only Contraceptives DESOGESTREL Medroxyprogesterone Acetate (depot)

e.g Cerazette e.g Depo-Provera

Intra-Uterine Devices Intrauterine progestogen-only system Copper device

e.g Mirena

7.4 Drugs for Genito-urinary Disorders Drugs for Urine retention - alpha-blockers

Tamsulosin

Drugs used for Urinary Frequency, Enuresis and Incontinence

Oxybutynin

Drugs for erectile dysfunction Sildenafil

*An example of a commonly used brand is provided in this section only as you may encounter these drugs being prescribed by brand in your clinical attachment.

BNF Section 8 Drugs used in the treatment of Malignant Disease and Immunosuppression

MAIN DRUGS

8.1 Cytotoxic drugs Alkylating Agents Cyclophosphamide

Anthracyclines Doxorubicin

Antimetabolites METHOTREXATE

Vinca Alkaloids and Etoposide Vincristine

Platinum compounds Cisplatin

Protein kinase inhibitors Imatinib

8.2 Drugs Affecting the Immune Response

Anti-proliferative immunosupressants

Azathioprine

Corticosteroids and other immunosuppressants

PREDNISOLONE Ciclosporin

8.3 Sex hormones and hormone antagonists in malignant disease

Hormone Antagonists Tamoxifen

Gonadorelin analogues Leuroprelin

Anti-androgens Flutamide

BNF Section 9 Drugs Affecting Nutrition and Blood

MAIN DRUGS

9.1 Anaemias and some other blood disorders

Iron deficiency anaemia FERROUS SULPHATE

Drugs used in Megaloblastic Anaemias

FOLIC ACID HYDROXOCOBALAMIN

Drugs used in Hypoplastic, haemolytic and Renal Anaemias

Epoietins

9.2 Fluids and Electrolytes Oral Potassium POTASSIUM CHLORIDE

Intravenous administration SODIUM CHLORIDE GLUCOSE

Plasma and plasma substitutes Albumin

9.5 Minerals Calcium supplements Calcium salts

Magnesium Magnesium sulfate

9.6 Vitamins Vitamin B group THIAMINE

Vitamin D Alfacalcidol Colecalciferol

Vitamin K PHYTOMENADIONE

BNF Section 10 Drugs used in the Treatment of Musculoskeletal and Joint Disease

MAIN DRUGS ALTERNATIVES

10.1 Drugs used in Rheumatic Diseases and Gout

Non-steroidal anti-inflammatory drugs (NSAIDs)

NAPROXEN Celecoxib

IBUPROFEN Diclofenac

Corticosteroids PREDNISOLONE Methylprednisolone (intra-articular injection)

Drugs affecting the immune response

METHOTREXATE Azathioprine

Cytokine modulators ETANERCEPT

Gout and cytotoxic-induced hyperuricaemia

ALLOPURINOL

10.2 Drugs used in Neuromuscular Disorders

Drugs that enhance neuromuscular transmission

Pyridostigmine

Skeletal Muscle Relaxants DIAZEPAM Baclofen

BNF Section 11 Drugs Acting on the Eye

MAIN DRUGS ALTERNATIVES

11.3 Topical Anti-Infective Preparations Antibacterials CHLORAMPHENICOL

11.4 Corticosteroids and other anti-inflammatory preparations

Corticosteroids PREDNISOLONE BETAMETHASONE

11.5 Mydriatics and cycloplegics Antimuscarinics Tropicamide Atropine

11.6 Treatment of Glaucoma Beta-blockers Timolol

Prostagladin analogues and prostamides

Latanoprost

Carbonic anhydrase inhibitors and systemic drugs

Dorzolamide

Miotics Pilocarpine

11.8 Miscellaneous Ophthalmic Preparations

Tear Deficiency,ocular lubricants and astringents

Hypromellose

Ocular diagnostic preparations Fluorescein sodium

BNF Section 12 Drugs used in the treatment of the Ear Nose and Oropharynx

MAIN DRUGS ALTERNATIVES

12.1 Drugs Acting in the Ear Otitis externa BETAMETASONE ear drops Gentamicin ear drops Gentamicin and hydrocortisone ear drops

12.2 Drugs Acting on the Nose Drugs used in Nasal Allergy BECLOMETASONE nasal spray

12.3 Drugs Acting on the Oropharynx

Drugs for oral ulceration and inflammation

Benzydamine hydrochloride

Oropharyngeal anti-infective drugs NYSTATIN

BNF Section 13 Drugs Acting on the Skin

MAIN DRUGS ALTERNATIVES

13.2 Emollients and barrier preparations

Emollient bath and shower preparations

Aqueous cream Epaderm

13.4 Topical Corticosteroids BETAMETHASONE HYDROCORTISONE

13.5 Preparations for Eczema and Psoriasis

Topical preparations for Psoriasis Coal Tar Dithranol Calcipotriol

Drugs affecting immune response Methotrexate Azathioprine Ciclosporin Etanercept

13.6 Acne and Rosacea Topical preparations for acne Benzoyl peroxide

Oral preparations for acne Oxytetracycline Isotretinoin

13.10 Anti-infective skin preparations Antibacterial preparations Mupirocin

Antifungal preparations Clotrimazole

Antiviral preparations Aciclovir

Parasiticidal preparations Permethrin

BNF Section 14 Immunological Products and Vaccines

14.4 Vaccine and antisera Routine UK immunisation schedule Diptheria, Tetanus, Pertussis (Acellular component), Poliomyelitis (Inactivated) and Haemophilus Influenza type b Vaccine (Hib) Measles Mumps & Rubella, Live (MMR) Vaccine Meningococcal Group C conjugate Vaccine Pneumococcal Polysaccharide conjugate vaccine Human Papilloma Virus (HPV) vaccine Rotavirus vaccine

Vaccines in high-risk groups BCG vaccine Hepatitis A Vaccine Hepatitis B Vaccine Influenza Vaccine Shingles vaccine

14.5 Immunoglobulins Anti-D(Rho) Immunoglobulin

BNF Section 15 Drugs used in Anaesthesia

MAIN DRUGS

15.1 General Anaesthesia Intravenous anaesthetics Propofol Thiopental sodium

Inhalation anaesthetics Isoflurane Nitrous oxide

Anti-muscarinic drugs ATROPINE

Neuromuscular blocking drugs Atracurium Suxamethonium

Antagonists for central and respiratory depression

Flumazenil NALOXONE

15.2 Local Anaesthesia LIDOCAINE

Emergency Treatment of Poisoning

MAIN DRUGS

Removal and Elimination Prevention of absorption ACTIVATED CHARCOAL

Agents used in Poisoning due to Specific Drugs

Paracetamol ACETYLCYSTEINE

Opioid NALOXONE

Iron Desferrioxamine

Organophosphates ATROPINE Pralidoxime

Acknowledgements: Formulary originally devised by Prof Simon Thomas and Dr Ruben Thanacoody, Institute of Cellular Medicine, Newcastle University. Edited by Dr Guilding and Dr Ball, School of Medical Education.