Must know drugs for Medicine and Pharmacology Practicals
Click on the following drugs to read further.
Insulin
Synthesized by Beta cells of pancreas.
Discovered by Best and Banting.
Administered subcutaneously using Insulin syringe, insulin pens, insulin pumps.
Actions:
1.Insulin facilitates entry of glucose inside the cells.
2.Inhibits hepatic glycogenolysis (so that the blood glucose levels do not rise).
3.Inhibits gluconeogenesis.
4.Promotes protein synthesis and lipogenesis.
5.Causes potassium uptake into the cells.
Uses:
1.Type 1 DM
2.Type 2 DM not responding to oral drugs
3.DKA (Diabetic ketoacidosis)
4.Hyperosmolar hyperglycemic state
5.Gestational DM
6.Hyperkalemia
Side effects:
Hypoglycemia
Allergy
Lipodystrophy (Fat atrophy and hypertrophy at the site of injection)
Contraindications:
Hypoglycemia
Obesity
Allergy to insulin
Insulin analogues
Short acting: (LAG)
L-Lispro
A-Aspart
G-Glulisine
Intermediate acting: Lente and NPH (isophane)
Long acting:
Detemir
Degludec
Glargine
Calcium gluconate
Uses
1.Hypocalcemia (1-2 g iv over 2 hours)
2.Hyperkalemia
3.Hydrofluoric acid burns
4.MgSO4 overdose (in pregnancy-eclampsia)
Side effects
Constipation
Nausea
Cardiac arrhythmia
Bradycardia
Contraindications
Kidney stone
High calcium in blood and urine
Ventricular fibrillation
Adrenaline/Epinephrine
Dose: 0.5 ml of 1:1000 solution sc/im
Actions
Adrenaline is a catecholamine secreted by adrenal medulla.
It is a non-selective sympathomimetic.
Alpha -1, 2; Beta-1, 2,3 agonist.
Produces vasoconstriction (by action on Alpha 1) and arrests bleeding.
Produces bronchodilation (by action on Beta 2 receptors).
Uses
Anaphylactic shock
Bronchial asthma
Cardiac resuscitation
Prolongs the Duration on local anesthesia
Controls Epistaxis
Glaucoma
Contraindications
Hypertension
Ischemic heart disease
Congestive cardiac failure
Cardiac arrhythmias
Side effects
Rise in BP
Tachycardia
Palpitations
Tremors
Headache
Hydrocortisone
It is a short acting glucocorticoid.
Rapid onset and short duration of action.
Uses
1.Addison’s disease
2.Anaphylactic shock
3.Status asthmaticus
4.Immunosuppressive (in Rhematoid arthritis, Graft rejection, Gullian Barre syndrome)
Dose in Anaphylactic shock: 200 mg iv
Side effects
1.Cushing’s habitus- Moon face, Buffalo hump, thin limbs
2.Peptic ulcers
3.Hyperglycemia
4.Hypokalemia
5.Sodium retention leading to oedema and rise in BP
6.Weight gain
7.Immunosuppression leading to increased susceptibility to infections
8.Suppression of hypothalamic-pituitary-adrenal axis (rare with short acting steroids like hydrocortisone)
Atropine
Atropine is an anticholinergic agent.
It acts by blocking the muscarinic receptors.
There is loss of light reflex and loss of accommodation with atropine use.
Uses
1.Organophosphorous poisoning
2mg iv stat, should be repeated every 5-10 mins doubling the dose, till signs of atropinisation occur.
2.Mushroom poisoning
3.Curare poisoning (along with neostigmine, to counteract the muscarinic side effects of neostigmine)
4.For fundoscopic examination as a mydriatic
5.Used in sialorrhea or hypersalivation
Side effects
1.Dryness of mouth
2.Urinary retention
3.may precipitate acute congestive glaucoma.
4.Atropine poisoning (Belladonna poisoning) symptoms include:
Hot as a hare-Increase in body temperature
Red as a beetroot- Red and flushed skin due to cutaneous vasodilation
Dry as a bone-Due to reduced secretions
Blind as a bat-Blurring of vision, Photophobia
Mad as a hatter– Restlessness, hallucinations
Pralidoxime
It is a cholinesterase reactivator.
Uses
Organophosphorous poisoning
2gm iv slowly
(effective in the first 48 hours)
Contraindications
Reduced kidney function
Enlarged prostate
Side effects
Local irritation
Tachycardia
Hypotension
Neostigmine
Neostigmine is an anticholinesterase.
It inhibits cholinesterase and increases the action of acetylcholine at the NMJ.
Dose: 15-30 mg oral
2 mg im
Uses:
1.Alzheimer’s disease
2.Atropine poisoning
3.Curare poisoning
4.Myasthenia gravis (improves muscle power)
5.Paralytic ileus
6.Postoperative urinary retention
7.To reverse pupillary dilatation after refraction testing (miotic)
Side effects
Muscarinic side effects- increased sweating, salivation, vomiting, diarrhoea
Nicotinic side effects- Tremors, fasciculations
Neostigmine does not cross the Blood Brain barrier and hence does not cause any central side effects.
Furosemide
Furosemide is a loop diuretic.
Site of action is the thick ascending limb of the Loop of Henle.
It blocks the Na+ K+ 2Cl- cotransporter.
Loop diuretics are high ceiling diuretics as they are highly effective (have maximum sodium excreting capacity as compared to other diuretics).
Rapid onset and short duration of action.
Uses
Renal edema
Cardiac edema
Hepatic edema
Cerebral edema
Acute pulmonary edema
Mild hyperkalemia and hypercalcemia
Side effects
Hyponatremia
Hypokalemia
Hypocalcemia
Hyopomagnesaemia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Ototoxicity (deafness, tinnitus, vertigo)
Hypersensitivity
Sodium bicarbonate
Sodium bicarbonate combines with Hydrochloric acid in the stomach to form sodium chloride, water and carbon dioxide.
It is a systemic antacid.
Uses
1.Metabolic acidosis.
2.To render urine alkaline in Urinary tract infection.
3.To prevent precipitation of uric acid.
Contraindications
1.Renal failure
2.Hypertension
3.Edema
4.Congestive cardiac failure
Side effects
1.Systemic alkalosis
2.Retention of sodium
3.Perforation in patients with gastric ulcer because of distension caused by release of carbon dioxide
Streptokinase
It is a thrombolytic agent derived from Beta-hemolytic streptococci.
Mechanism: Streptokinase converts plasminogen to plasmin. Plasmin degrades fibrin into fibrin degradation products and hence it dissolves the blood clot rapidly.
Uses
1.Acute Myocardial infarction
2.Deep vein thrombosis
3.Pulmonary embolism
4.Acute ischemic stroke
Dose: 1.5 million units iv as an infusion over 1 hour.
Contraindications
1.Active bleeding (except menses)
2.Severe uncontrolled hypertension
3.History of hemorrhagic stroke
4.Ischemic stroke in the last 3 months
5.Suspected aortic dissection
6.Known intracranial neoplasm, aneurysm or arteriovenous malformation
Side effects
1.Bleeding
2.Hemorrhagic stroke
3.Hypotension
4.Anaphylaxis
Unfractionated Heparin
Dose: 10,000 units iv
Action
1.Heparin strengthens the action of antithrombin III by forming a complex with it which inhibits the activated clotting factors like IIa, IXa, Xa, XIa, XIIa and XIIIa by forming a complex with them.
2.At low concentration, heparin inhibits the conversion of prothrombin to thrombin.
3.At high concentration, heparin has an antiplatelet action.
4.Heparin reduces blood lipid levels by releasing lipoprotein lipase from vessel wall and tissues.
Uses
1.Acute Myocardial infarction
2.Deep vein thrombosis
3.Transient ischemic attack
4.Ischemic stroke
Contraindications
Hemophiliacs
Hypertension (severe)
intracranial Hemorrhage
Heparin induced thrombocytopenia
Renal failure
Side effects
Bleeding
Heparin induced thrombocytopenia (HIT)
Hypersensitivity
Osteoporosis
Reversible alopecia
Heparin has a narrow therapeutic range and hence requires aPTT monitoring.
Bleeding is the most common side effect.
Heparin overdose is treated with protamine sulphate (heparin antagonist).
Low molecular weight Heparins
They are administered subcutaneously.
Action: Low molecular weight Heparins produce anticoagulant effect mainly by inhibition of factor Xa through antithrombin.
Examples: Dalteparin, Enoxaparin
Uses, side effects and contraindications are same as unfractionated heparin.
Advantages:
1.Have a higher bioavailability than unfractionated heparin.
2.Have a longer duration of action.
3.They do not require routine aPTT monitoring.
4.Have a lower incidence of thrombocytopenia (HIT) and osteoporosis.
Salbutamol
Beta-2 agonist, it is short acting (rapid onset and short duration of acting).
Action:
1.Bronchodilation
2.Relaxation of pregnant uterus
3.Promote uptake of potassium into the cells
4.Promote glycogenolysis
5.They cause tremors
Uses:
1.Bronchial asthma and Chronic obstructive pulmonary disease (COPD): It is administered using a metered dose inhaler in the form of aerosol. Dose is 100-200 microgram every 6 hours or as needed.
2.Used in premature labour to delay the onset of labour
3.Hyperkalemia
Side effects
Tremor
Tachycardia
Hyperglycemia
Hypokalemia
Short acting beta-2 agonists: Salbutamol, Terbutaline
Long acting beta-2 agonists: Salmeterol, Formoterol
Amiodarone
It is a class III antiarrhythmic drug.
Action:
Blocks potassium channels
Blocks sodium channels
Blocks calcium channels
Blocks Beta adrenergic receptors
Hence, it has a wide spectrum of action.
Dose:
150 mg iv over 10 mins, then
1mg/min for 6 hours, then
0.5 mg/min for next 12 hours
Uses
1.Used to slow down the ventricular rate and restore normal sinus rhythm in Atrial fibrillation
2.Used to prevent recurrent Ventricular tachycardia
Side effects: (4H, 4P)
Hypotension
Hypothyroidism
Hyperthyroidism
Hepatotoxic
Peripheral neuropathy
Pulmonary fibrosis
Pigmentation of skin
Photosensitivity
Amiodarone is the longest acting antiarrhythmic drug.
Amiodarone has a low incidence of torsades de pointes.
Digitalis/Digoxin
Dose: 0.25 mg/ml iv till digitalisation occurs.
Actions
1.Positive inotropic effect- increases the force of contraction of the heart
2.Negative chronotropic effect- decreases the heart rate
3.Reduces AV nodal conduction and Purkinje fibre conduction
Uses
1.Congestive cardiac failure (CCF)
2.Atrial fibrillation
3.Atrial flutter
4.Paroxysmal supraventricular tachycardia (PSVT)
Side effects
Digoxin has a narrow margin of safety.
1.Arrhythmias like Ventricular premature beats, ventricular tachycardia, pulsus bigeminy
2.Gynaecomastia
3.Nausea, vomiting
4.Headache, confusion, disorientation
5.Hallucinations
Dobutamine
It is a synthetic catecholamine.
Action
Acts on Beta 1, Beta 2, Alpha 1 receptors.
Inotropic effect
Increase cardiac output
Uses
Acute heart failure
Cardiogenic shock
Side effects
Tachycardia
Rise in blood pressure
Development of tolerance
Verapamil
It is a calcium channel blocker belonging to class phenylalkylamine.
Action:
1.Negative inotropic effect (decreases force of contraction)
2.Negative chronotropic effect (decreases heart rate)
3.Negative dromotropic effect (depresses SA node and slows down AV node conduction)
Uses
1.Stable angina (Exertional angina)
2.Hypertension
3.Hypertrophic cardiomyopathy
4.Supraventricular arrhythmia
5.Prophylaxis of migraine
Side effects
Sinus bradycardia
May precipitate CCF
Oedema
Constipation
Nifidepine
It is a calcium channel blocker belonging to class dihydropyridine.
Action:
It is a potent arterial dilator and reduces peripheral vascular resistance.
Uses:
1.Stable angina
2.Variant angina (it is angina due to coronary vasospasm)
3.Prevention and treatment of cerebral vasospasm
4.Raynaud’s phenomenon
5.Used as a uterine relaxant in premature labour
6.Hypertension
Side effects
Postural hypotension
Reflex tachycardia
Palpitations
Oedema
Diltiazem
It is a calcium channel blocker belonging to class benzothiazepine.
Action:
It has actions of both verapamil and nifidepine.
Uses
Hypertension
Stable angina
Variant angina
Side effects
Hypotension
Bradycardia
Oedema
Headache
Phenytoin sodium
Action
•Delays recovery of sodium channels from the inactivated state.
•At high concentration, phenytoin inhibits calcium influx into the neuron, reduces glutamate levels and increases response to GABA (GABA is an inhibitory neurotransmitter).
Hence, phenytoin stabilizes the neuronal membrane.
Dose: 200-400 mg
Uses
1.Generalized tonic clonic seizures
2.Simple partial seizures
3.Complex partial seizures
4.Status epilepticus
5.Trigeminal neuralgia (2nd choice of drug)
Side effects (note the H’s)
1.Hypertrophy and Hyperplasia of gums
2.Hirsutism
3.Hyperglycemia (reduced insulin secretion)
4.Hypocalcemia
5.Hypersensitivity reactions
6.Hepatic necrosis
7.Fetal Hydantoin syndrome (cleft lip, cleft palate, digital hypoplasia, etc due to teratogenic effect)
8.Osteomalacia
9.Megaloblastic anemia
10.Nystagmus, vertigo, ataxia
11.Cardiac arrhythmia (on iv use)
Labetalol
Alpha(1) + Beta (1 and 2) blocker
Dose:200-1000 mg
Uses
1.Essential hypertension
2.Hypertensive emergencies
3.Thyrotoxic crisis
4.Anxiety neurosis
5.Open angle glaucoma
Side effects
1.Postural hypotension
2.Hypoglycemia (therefore they should be used with caution in diabetics, also they mask the symptoms of hypoglycemia)
3.Bronchospasm
4.Hepatotoxicity
Oseltamivir
Action: It inhibits neuraminidase enzyme and hence interferes with the release of progeny virions from infected cells.
Route: oral
Dose:
For prophylaxis– 75 mg OD for 7 days
For treatment– 75 mg BD for 5 days
Uses
Influenza A
Swine flu (H1N1)
Bird flu (H5N1)
Influenza B
Side effects
Nausea
Vomiting
Abdominal discomfort
Artesunate
Dose
2mg/kg iv/im stat, repeat at 12 hours and 24 hours.
Then give once a day till the patient is able to take oral medication.
Oral dose : 100 mg BD for 3 days
Action
Artesunate causes damage to the proteins of the parasite and also causes lipid peroxidation, leading to the death of the parasite.
Uses
1.Treatment of chloroquine resistant plasmodium falciparum malaria infection.
2.Treatment of severe or complicated Plasmodium falciparum malaria infection (cerebral malaria).
Side effects
Prolongation of QT interval
Mild gastrointestinal disturbances
Neutropenia
Reticulocytopenia
Rifampicin
Dose: 450-600 mg/day orally
Uses
1.Tuberculosis
2.Leprosy
3.Meningitis(prophylaxis of Hemophilus influenzae and meningocoocal meningitis)
4.Atypical mycobacterial pneumonia
5.Brucellosis
6.Diphtheria
Side effects (4R)
1.Redness and watering of eyes.
2.Orange Red urine and secretions.
3.Renal failure and shock (nephrotoxic)
4.Respiratory syndrome (breathlessness and shock)
Dopamine
It is a catecholamine.
Action
At low dose (<2mcg/kg/min), it acts on D1 receptors. This dilates renal, mesenteric and coronary blood vessels and hence, increased GFR and urine output.
At moderate dose (2-5 mcg/kg/min), it acts on Beta-1 receptors of the heart and hence, increases myocardial contractility and cardiac output.
At high dose (>10 mcg/kg/min), it acts on Alpha-1 receptors which cause generalized vasoconstriction. This causes reduced blood flow to renal, mesenteric and other organs. Therefore, at high doses, dopamine is not beneficial to the body.
Uses
1.Cardiogenic shock
2.Septic shock
3.Severe heart failure with renal impairment
Side effects are due to sympathetic stimulation.
1.Hypertension
2.Tachycardia
3.Cardiac arrhythmias
4.Angina