Cardiovascular Drugs

•    Beta-blockers

o    ↓ HR and BP via β1 blockade

o    Indications: angina, HF, AF, post-MI

o    Cautions: avoid in asthma/COPD (bronchospasm), bradycardia, fatigue

o    Examples: bisoprolol, atenolol

•    ACE inhibitors (ACEi)

o    ↓ BP, proteinuria, post-MI and HF mortality

o    Adverse effects: cough, angioedema, hyperkalaemia, ↑ creatinine

o    Monitor U&Es 1–2 weeks after initiation

o    Example: ramipril

•    Angiotensin receptor blockers (ARBs)

o    Similar to ACEi but no cough

o    Monitor for hyperkalaemia, renal function

o    Example: losartan

•    Calcium channel blockers (CCBs)

o    Dihydropyridines (e.g. amlodipine): vasodilation → ankle oedema, flushing

o    Non-dihydropyridines (e.g. verapamil, diltiazem): rate control, avoid with beta-blockers

•    Diuretics

o    Loop diuretics (furosemide): potent; risk of hypokalaemia, hypovolaemia, ototoxicity

o    Thiazides (bendroflumethiazide, indapamide): cause hypercalcaemia, 

                                                                                            hyponatraemia, gout, impaired glucose tolerance

•    Anticoagulants

o    Warfarin: inhibits vitamin K-dependent factors (II, VII, IX, X); INR monitoring required

o    Many interactions (e.g. antibiotics, amiodarone)

o    DOACs (rivaroxaban, apixaban): fixed doses, renal dose adjustment, no monitoring

•    Antiplatelets

o    Aspirin: irreversible COX-1 inhibitor; risk of GI irritation, bleeding

o    Clopidogrel: P2Y12 inhibitor; metabolised by CYP2C19 → variable response

Endocrine Pharmacology

•    Insulin

o    Types: rapid (aspart), long-acting (glargine), premixed

o    Basal–bolus regimen preferred in Type 1

o    Risk: hypoglycaemia (tremor, confusion, seizures)

•    Oral hypoglycaemics

o    Metformin: 1st line in T2DM; GI upset; risk of lactic acidosis if eGFR <30

o    Sulfonylureas (gliclazide): risk of hypoglycaemia, weight gain

o    SGLT2 inhibitors (dapagliflozin): CV benefit, ↓ HbA1c, weight loss; UTI, DKA risk even with normal glucose

•    Thyroid drugs

o    Levothyroxine: monitor TSH every 6–8 weeks when starting or adjusting

o    Carbimazole/PTU: risk of agranulocytosis (check FBC with sore throat/fever)

•    Steroids

o    Routes: oral, IV, inhaled, topical

o    Adverse effects: weight gain, osteoporosis, diabetes, psychosis, infections

o    Long-term use → consider bisphosphonates and PPI cover

Gastrointestinal Pharmacology

•    PPIs (omeprazole, lansoprazole)

o    Indications: GORD, PUD, Barrett’s

o    Risks with long-term use: ↓ Mg²⁺, ↓ B12, C. difficile, fractures

•    Laxatives

o    Stimulant (senna): risk of cramping, dependence

o    Osmotic (lactulose): draws fluid in; also used in hepatic encephalopathy to ↓ ammonia

•    Anti-emetics

o    Metoclopramide: risk of extrapyramidal side effects, avoid long-term

o    Ondansetron: QT prolongation, constipation

Neurology and Psychiatry

•    Antiepileptics

o    Phenytoin: narrow therapeutic index, zero-order kinetics, enzyme inducer

o    Valproate: hepatotoxic, teratogenic (NTDs); avoid in women of childbearing age if possible

•    Antipsychotics

o    Typical (haloperidol): EPS, QT prolongation

o    Atypical (risperidone): less EPS, ↑ prolactin

o    Clozapine: reserved for resistant schizophrenia; agranulocytosis, myocarditis → requires regular FBC

•    Antidepressants

o    SSRIs (sertraline, citalopram): 1st line; hyponatraemia, GI bleeding (esp. with NSAIDs), serotonin syndrome

o    TCAs (amitriptyline): anticholinergic, cardiotoxic in overdose, QT prolongation

•    Mood stabilisers

o    Lithium: narrow therapeutic index, nephrotoxic, thyroid dysfunction

o    Monitor levels, U&Es, TFTs every 3–6 months

Rheumatology and Immunosuppressive Therapy

•    NSAIDs

o    Risks: renal impairment, peptic ulcers, cardiovascular events

o    Use gastroprotection (e.g. PPI) in high-risk patients

•    Methotrexate

o    Weekly dosing; co-prescribe folic acid

o    Monitor FBC, LFTs, renal function

o    Contraindicated in pregnancy

•    Biologics (e.g. infliximab, etanercept)

o    Screen for latent TB and hepatitis B/C before initiation

o    Risk of reactivation and infections

•    Steroids

o    Taper if >3 weeks to avoid adrenal suppression

o    Bone protection (vitamin D + calcium ± bisphosphonate) if long-term

Infectious Diseases

•    Antibiotics

o    Penicillins: common cause of rash, anaphylaxis

o    Aminoglycosides (gentamicin): nephrotoxic, ototoxic; monitor levels

o    Macrolides (erythromycin): enzyme inhibitors, QT prolongation

o    Quinolones (ciprofloxacin): tendon rupture, QT risk

•    Antivirals

o    Aciclovir: risk of crystalluria, AKI if IV without adequate hydration

•    Anti-TB therapy

o    Rifampicin: enzyme inducer, orange secretions

o    Isoniazid: peripheral neuropathy (prevent with pyridoxine)

o    Pyrazinamide: hepatotoxic, hyperuricaemia

o    Ethambutol: optic neuritis (check visual acuity)