Must know drugs for Medicine and Pharmacology Practicals
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Synthesized by Beta cells of pancreas.
Discovered by Best and Banting.
Administered subcutaneously using Insulin syringe, insulin pens, insulin pumps.
1.Insulin facilitates entry of glucose inside the cells.
2.Inhibits hepatic glycogenolysis (so that the blood glucose levels do not rise).
4.Promotes protein synthesis and lipogenesis.
5.Causes potassium uptake into the cells.
1.Type 1 DM
2.Type 2 DM not responding to oral drugs
3.DKA (Diabetic ketoacidosis)
4.Hyperosmolar hyperglycemic state
Lipodystrophy (Fat atrophy and hypertrophy at the site of injection)
Allergy to insulin
Short acting: (LAG)
Intermediate acting: Lente and NPH (isophane)
1.Hypocalcemia (1-2 g iv over 2 hours)
3.Hydrofluoric acid burns
4.MgSO4 overdose (in pregnancy-eclampsia)
High calcium in blood and urine
Dose: 0.5 ml of 1:1000 solution sc/im
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).
Prolongs the Duration on local anesthesia
Ischemic heart disease
Congestive cardiac failure
Rise in BP
It is a short acting glucocorticoid.
Rapid onset and short duration of action.
4.Immunosuppressive (in Rhematoid arthritis, Graft rejection, Gullian Barre syndrome)
Dose in Anaphylactic shock: 200 mg iv
1.Cushing’s habitus- Moon face, Buffalo hump, thin limbs
5.Sodium retention leading to oedema and rise in BP
7.Immunosuppression leading to increased susceptibility to infections
8.Suppression of hypothalamic-pituitary-adrenal axis (rare with short acting steroids like hydrocortisone)
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.
2mg iv stat, should be repeated every 5-10 mins doubling the dose, till signs of atropinisation occur.
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
1.Dryness of mouth
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
It is a cholinesterase reactivator.
2gm iv slowly
(effective in the first 48 hours)
Reduced kidney function
Neostigmine is an anticholinesterase.
It inhibits cholinesterase and increases the action of acetylcholine at the NMJ.
Dose: 15-30 mg oral
2 mg im
4.Myasthenia gravis (improves muscle power)
6.Postoperative urinary retention
7.To reverse pupillary dilatation after refraction testing (miotic)
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 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.
Acute pulmonary edema
Mild hyperkalemia and hypercalcemia
Ototoxicity (deafness, tinnitus, vertigo)
Sodium bicarbonate combines with Hydrochloric acid in the stomach to form sodium chloride, water and carbon dioxide.
It is a systemic antacid.
2.To render urine alkaline in Urinary tract infection.
3.To prevent precipitation of uric acid.
4.Congestive cardiac failure
2.Retention of sodium
3.Perforation in patients with gastric ulcer because of distension caused by release of carbon dioxide
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.
1.Acute Myocardial infarction
2.Deep vein thrombosis
4.Acute ischemic stroke
Dose: 1.5 million units iv as an infusion over 1 hour.
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
Dose: 10,000 units iv
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.
1.Acute Myocardial infarction
2.Deep vein thrombosis
3.Transient ischemic attack
Heparin induced thrombocytopenia
Heparin induced thrombocytopenia (HIT)
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.
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.
Beta-2 agonist, it is short acting (rapid onset and short duration of acting).
2.Relaxation of pregnant uterus
3.Promote uptake of potassium into the cells
5.They cause tremors
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
Short acting beta-2 agonists: Salbutamol, Terbutaline
Long acting beta-2 agonists: Salmeterol, Formoterol
It is a class III antiarrhythmic drug.
Blocks potassium channels
Blocks sodium channels
Blocks calcium channels
Blocks Beta adrenergic receptors
Hence, it has a wide spectrum of action.
150 mg iv over 10 mins, then
1mg/min for 6 hours, then
0.5 mg/min for next 12 hours
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)
Pigmentation of skin
Amiodarone is the longest acting antiarrhythmic drug.
Amiodarone has a low incidence of torsades de pointes.
Dose: 0.25 mg/ml iv till digitalisation occurs.
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
1.Congestive cardiac failure (CCF)
4.Paroxysmal supraventricular tachycardia (PSVT)
Digoxin has a narrow margin of safety.
1.Arrhythmias like Ventricular premature beats, ventricular tachycardia, pulsus bigeminy
4.Headache, confusion, disorientation
It is a synthetic catecholamine.
Acts on Beta 1, Beta 2, Alpha 1 receptors.
Increase cardiac output
Acute heart failure
Rise in blood pressure
Development of tolerance
It is a calcium channel blocker belonging to class phenylalkylamine.
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)
1.Stable angina (Exertional angina)
5.Prophylaxis of migraine
May precipitate CCF
It is a calcium channel blocker belonging to class dihydropyridine.
It is a potent arterial dilator and reduces peripheral vascular resistance.
2.Variant angina (it is angina due to coronary vasospasm)
3.Prevention and treatment of cerebral vasospasm
5.Used as a uterine relaxant in premature labour
It is a calcium channel blocker belonging to class benzothiazepine.
It has actions of both verapamil and nifidepine.
•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
1.Generalized tonic clonic seizures
2.Simple partial seizures
3.Complex partial seizures
5.Trigeminal neuralgia (2nd choice of drug)
Side effects (note the H’s)
1.Hypertrophy and Hyperplasia of gums
3.Hyperglycemia (reduced insulin secretion)
7.Fetal Hydantoin syndrome (cleft lip, cleft palate, digital hypoplasia, etc due to teratogenic effect)
10.Nystagmus, vertigo, ataxia
11.Cardiac arrhythmia (on iv use)
Alpha(1) + Beta (1 and 2) blocker
5.Open angle glaucoma
2.Hypoglycemia (therefore they should be used with caution in diabetics, also they mask the symptoms of hypoglycemia)
Action: It inhibits neuraminidase enzyme and hence interferes with the release of progeny virions from infected cells.
For prophylaxis– 75 mg OD for 7 days
For treatment– 75 mg BD for 5 days
Swine flu (H1N1)
Bird flu (H5N1)
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
Artesunate causes damage to the proteins of the parasite and also causes lipid peroxidation, leading to the death of the parasite.
1.Treatment of chloroquine resistant plasmodium falciparum malaria infection.
2.Treatment of severe or complicated Plasmodium falciparum malaria infection (cerebral malaria).
Prolongation of QT interval
Mild gastrointestinal disturbances
Dose: 450-600 mg/day orally
3.Meningitis(prophylaxis of Hemophilus influenzae and meningocoocal meningitis)
4.Atypical mycobacterial pneumonia
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)
It is a catecholamine.
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.
3.Severe heart failure with renal impairment
Side effects are due to sympathetic stimulation.