The Top 100 Drugs. Clinical pharmacology and practical prescribing

275 Pages·2015·24.228 MB·English

by  Andrew Hitchings, Dagan Lonsdale, Daniel Burrage, Emma Baker

THE TOP 100 DRUGS
Clinical pharmacology and
practical prescribing
Dedication and acknowledgement
Dedication
This book is dedicated to our families, without whose support and patience we
would not have been able to write it.
Acknowledgement
Many students at St George’s, University of London contributed to the
development of this book. We wish to express our gratitude to them all, but most
particularly to those who participated in the projects that generated the ‘Top 100
Drugs’ list, and to the members of a focus group convened to ensure the book
would meet their needs.
THE TOP 100
DRUGS
CLINICAL PHARMACOLOGY AND PRACTICAL PRESCRIBING
Andrew Hitchings BSc(Hons) MBBS MRCP FHEA
Clinical Research Fellow
St George’s, University of London
Specialty Registrar (ST7) in Clinical Pharmacology,
General Medicine and Intensive Care Medicine
St George’s Healthcare NHS Trust, London, UK
Dagan Lonsdale BSc(Hons) MBBS MRCP FHEA
Academic Clinical Fellow
St George’s, University of London
Specialty Registrar (ST3) in Clinical Pharmacology,
General Medicine and Intensive Care Medicine
St George’s Healthcare NHS Trust, London, UK
Daniel Burrage BSc(Hons) MBBS MRCP FHEA
Academic Clinical Fellow
St George’s, University of London
Specialty Registrar (ST3) in Clinical Pharmacology and General Medicine
St George’s Healthcare NHS Trust, London, UK
Emma Baker PhD FRCP
Professor of Clinical Pharmacology
St George’s, University of London
Consultant Physician
St George’s Healthcare NHS Trust, London, UK
Edinburgh London New York Oxford Philadelphia St. Louis Sydney Toronto 2015
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Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein.
In using such information or methods they should be mindful of their own safety and the safety
of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or formula,
the method and duration of administration, and contraindications. It is the responsibility of
practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions.
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Contents
List of abbreviations ix Antipsychotics,
second-generation (atypical) 76
Introduction 1 Aspirin 78
The top 100 drugs listed Benzodiazepines 80
by system 5 Beta-agonists 82
2
The top 100 drugs listed Beta-blockers 84
by indication 9 Bisphosphonates 86
The top 100 drugs 21 Calcium and vitamin D 88
Acetylcysteine (N-acetylcysteine) 22 Calcium channel blockers 90
Activated charcoal 24 Carbamazepine 92
Adenosine 26 Cephalosporins and carbapenems 94
Adrenaline (epinephrine) 28 Clopidogrel 96
Aldosterone antagonists 30 Compound
Alginates and antacids 32 (β-agonist–corticosteroid)
2
Allopurinol 34 inhalers 98
Alpha-blockers 36 Corticosteroids (glucocorticoids),
Aminoglycosides 38 systemic 100
Aminosalicylates 40 Corticosteroids (glucocorticoids),
Amiodarone 42 inhaled 102
Angiotensin-converting enzyme Corticosteroids (glucocorticoids),
(ACE) inhibitors 44 topical 104
Angiotensin receptor blockers 46 Digoxin 106
Antidepressants, selective Dipyridamole 108
serotonin reuptake inhibitors 48 Diuretics, loop 110
Antidepressants, tricyclics Diuretics, potassium-sparing 112
and related drugs 50 Diuretics, thiazide and
Antidepressants, venlafaxine thiazide-like 114
and mirtazapine 52 Dopaminergic drugs for
Antiemetics, dopamine Parkinson’s disease 116
D-receptor antagonists 54 Emollients 118
2
Antiemetics, histamine Fibrinolytic drugs 120
H-receptor antagonists 56 Gabapentin and pregabalin 122
1
Antiemetics, phenothiazines 58 H-receptor antagonists 124
2
Antiemetics, serotonin Heparins and fondaparinux 126
5-HT-receptor antagonists 60 Insulin 128
3
Antifungal drugs 62 Iron 130
Antihistamines Laxatives, bulk-forming 132
(H-receptor antagonists) 64 Laxatives, osmotic 134
1
Antimotility drugs 66 Laxatives, stimulant 136
Antimuscarinics, bronchodilators 68 Lidocaine 138
Antimuscarinics, cardiovascular Macrolides 140
and gastrointestinal uses 70 Metformin 142
Antimuscarinics, genitourinary uses 72 Methotrexate 144
Antipsychotics, Metronidazole 146
first-generation (typical) 74 Naloxone 148
v
s Nicorandil 150 Quinolones 194
ent Nicotine replacement Statins 196
nt and related drugs 152 Sulphonylureas 198
o
C Nitrates 154 Tetracyclines 200
Nitrofurantoin 156 Thiazolidinediones 202
Non-steroidal Thyroid hormones 204
anti-inflammatory drugs 158 Trimethoprim 206
Ocular lubricants (artificial tears) 160 Vaccines 208
Oestrogens and progestogens 162 Valproate 210
Opioids, compound preparations 164 Vancomycin 212
Opioids, strong 166 Vitamins 214
Opioids, weak 168 Warfarin 216
Oxygen 170 Z-drugs 218
Paracetamol 172 5α-reductase inhibitors 220
Penicillins 174 Fluids 223
Penicillins, antipseudomonal 176 Colloids (plasma substitutes) 224
Penicillins, broad-spectrum 178 Compound sodium lactate
Penicillins, penicillinase-resistant 180 (Hartmann’s solution) 226
Phenytoin 182 Glucose (dextrose) 228
Phosphodiesterase (type 5) Potassium, intravenous 230
inhibitors 184 Sodium chloride 232
Potassium, oral 186
Prostaglandin analogue eye Self-assessment and
drops 188 knowledge integration 235
Proton pump inhibitors 190 50 single-best-answer questions 236
Quinine 192 Answers and explanations 251
vi
List of abbreviations
5-ASA 5-aminosalicylic acid DNA Deoxyribonucleic acid
5-HT 5-hydroxytryptamine DVT Deep vein thrombosis
(serotonin) ECF Extracellular fluid
ACE Angiotensin-converting ECG Electrocardiogram
enzyme EEG Electroencephalography
ACS Acute coronary syndrome eGFR Estimated glomerular filtration
ACTH Adrenocorticotropic hormone rate
ADP Adenosine diphosphate ENaC Epithelial sodium channels
AF Atrial fibrillation FBC Full blood count
ALS Advanced Life Support FH4 Tetrahydrofolate
ALT Alanine aminotransferase/ FSH Follicle-stimulating hormone
transaminase G Gauge
AMP Adenosine monophosphate g Gram
APTR Activated partial G6PD Glucose-6-phosphate
thromboplastin ratio dehydrogenase
ARB Angiotensin receptor blocker GABA Gamma-aminobutyric acid
AT Angiotensin type 1 (receptor) G-CSF Granulocyte colony
1
ATP Adenosine triphosphate stimulating factor
AV Atrioventricular GFR Glomerular filtration rate
BCG Bacillus Calmette–Guérin GI Gastrointestinal
BMI Body mass index GLP-1 Glucagon-like peptide-1
BNF British National Formulary GMP Guanosine monophosphate
BP Blood pressure GORD Gastro-oesophageal reflux
Ca2+ Calcium ion disease
cGMP Cyclic guanosine GP General practitioner
monophosphate GTN Glyceryl trinitrate
CHC Combined hormonal H+ Hydrogen ion
contraception HAS Human albumin solution
CKD Chronic kidney disease HIV Human immunodeficiency
Cl- Chloride ion virus
CNS Central nervous system HMG 3-hydroxy-3-methyl-glutaryl
CO Carbon dioxide coenzyme A
2
COC Combined oral contraceptive hr Hour
COPD Chronic obstructive hrly Hourly
pulmonary disease HRT Hormone replacement
COX Cyclooxygenase therapy
CPR Cardiopulmonary HUS Haemolytic–uraemic
resuscitation syndrome
CT Computerised tomography IBS Irritable bowel syndrome
CTZ Chemoreceptor trigger zone Ig Immunoglobulin
DEXA Dual-energy X-ray IL Interleukin
absorptiometry IM Intramuscular
DMARD Disease-modifying INR International normalised ratio
antirheumatic drug IQ Intelligence quotient
vii
s
n IR Immediate-release NOAC Novel oral anticoagulant
o
ati ISMN Isosorbide mononitrate NPH Neutral protamine Hagedorn
vi IV Intravenous NRT Nicotine replacement therapy
e
r K+ Potassium ion NSAID Non-steroidal anti-
b
b kg Kilogram inflammatory drug
a
of L Litre p Pence
st LABA Long-acting β2-agonist PCR Polymerase chain reaction
Li LAMA Long-acting antimuscarinic PD Pharmacodynamic
LDL Low density lipoprotein PDE Phosphodiesterase
L-dopa Levodopa PGE Prostaglandin
2
LH Luteinising hormone PK Pharmacokinetic
LMWH Low molecular weight PPI Proton pump inhibitor
heparin Q fever Query fever
LRTI Lower respiratory tract RNA Ribonucleic acid
infection SA Sinoatrial
m Metre SC Subcutaneous
MDI Metered dose inhaler sec Second
mg Milligram SL Sublingual
MHRA Medicines and Healthcare SNRI Serotonin and noradrenaline
products Regulatory Agency reuptake inhibitor
Min Minute SSRI Selective serotonin reuptake
mL Millilitre inhibitor
mmHg Millimetres of mercury SVT Supraventricular tachycardia
mmol Millimole T Triiodothyronine
3
MMR Measles, mumps and rubella T Thyroxine
4
MR Modified release TNF Tumour necrosis factor
MRSA Meticillin-resistant TSH Thyroid stimulating hormone
Staphylococcus aureus UC Ulcerative colitis
mV Millivolt UFH Unfractionated heparin
Na+ Sodium ion UK United Kingdom
NAPQI N-acetyl-p-benzoquinone UTI Urinary tract infection
imine VF Ventricular fibrillation
NHS National Health Service VT Ventricular tachycardia
NMS Neuroleptic malignant VTE Venous thromboembolism
syndrome WHO World Health Organization
viii
Introduction
Why should you use this book?
Learning pharmacology is hard. In the UK, nearly 2000 drugs are available in
over 20,000 medicinal products. The amount of information you could obtain for
each one is almost limitless, as is reflected in the hefty weight of conventional
pharmacology textbooks. Compounding this, medical schools have recently – and
quite appropriately in our view – begun to emphasise the importance of practical
prescribing in their curricula and examinations. The classic pharmacology texts that
once provided students with all they needed to know (and usually much more) now
appear deficient in this critically important area. Meanwhile, the prescribing manuals
and formularies used by doctors are generally impenetrable to students, and
provide insufficient detail on the clinical pharmacology that underpins the use and
understanding of drugs.
Against this backdrop, you need a place to start. You need to focus most of
your attention on the most important information about the most important drugs.
You need a bridge between a medical student’s textbook and a prescriber’s
manual. Fundamentally, you need to know what you need to know about the drugs
you are going to prescribe in practice. That is what this book seeks to provide.
What are ‘the top 100 drugs’?
We analysed data from hundreds of millions of prescriptions in primary and
secondary care to identify the drugs that were prescribed most often.1 To this list
we added a handful of ‘emergency drugs’ which, although less commonly used,
are important to know about. We tested the stability of the resulting ‘top 100’ list
over the next two years to confirm it did not change significantly. We surveyed 149
foundation doctors who told us that, on average, they prescribed 41 of the top 100
drugs at least every week and another 24 at least every month. More than
three-quarters said they rarely prescribed drugs that are not on the list.
How to use this book
Organisation of the book
The top 100 drugs are arranged in alphabetical order. We have generally identified
them by the name of the class to which they belong: thus ‘bisoprolol’ is found
under ‘beta-blockers’. We have listed common examples in order of the frequency
with which they are used, with less common but still important drugs added to this
where appropriate. Where a drug is effectively in a class of its own, we have
identified it simply by its name: thus we use ‘metformin’ rather than ‘biguanides’.
In addition to the top 100 drugs, we have provided details of five commonly used
fluid preparations in their own section at the end of the book.
To help you test and reinforce your knowledge, we have included some
single-best-answer questions. The answers to these direct you to the relevant drug
entries as appropriate. These also provide an opportunity to bring together
information from several drugs and show how it may be integrated in practice.
Using the book
We anticipate this book being used in two main ways. One is as a ‘quick reference
source’ for when you encounter a drug on the ward or in clinic and want to read
1