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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.