Appendix Some important pharmacological agents

Students may feel overwhelmed by the number of pharmacists play a crucial role) grapple with choosing described in pharmacology textbooks. We would empha- which individual drugs to stock in the pharmacy. There sise that it is more important to understand general phar- is a play-off between stocking several individual drugs macological principles, and to appreciate the pharmacology of one category, for each of which there is good evidence of the main classes of , than to attempt to memorise of efficacy for distinct indications, and stocking a more details of individual agents. Specific drugs are best learned restricted choice based on indirect evidence that efficacy about when they are encountered in the setting of particu- is likely to be a common feature of different members of lar topics (e.g. noradrenergic transmission), during practi- a class of drugs. Local variations will be encountered (e.g. cal classes or (for therapeutic drugs) near a patient’s as to which angiotensin-converting enzyme inhibitor or bedside. We provide a list (www.studentconsult.com) of non-steroidal anti-inflammatory drugs are stocked in the examples of some of the most important pharmacological hospital pharmacy). If the student or clinician (e.g. doctor, agents. It is not intended as a starting point to learning dentist, veterinarian or nurse) comes to these (e.g. when pharmacology, and we would caution against attempting changing to a job in a new hospital) with a sound appre- to memorise lists of names and properties. The important ciation of the general principles of pharmacology and of agents we list here were selected subjectively; they include the specifics of the various classes of agent involved, he or (but are not limited to) the 100 drugs most likely to be she will be able to look up and understand the details of prescribed by newly qualified doctors in the UK Baker ( agents favoured locally and use them sensibly. Drugs are et al., 2011) and are divided into agents of primary and grouped broadly as in the chapters of the text, and some secondary importance. For students of some subjects, and appear more than once in the lists. in different geographical areas, one or another class of drug will have more or less importance (e.g. anthelmintics are very important for veterinarians and for all clinicians in REFERENCES regions where helminthiasis is common), so these catego- Baker, E.H., Pryce Roberts, A., Wilde, K., et al., 2011. Development of a ries are meant only as a broad guide. The list includes not core drug list towards improving prescribing education and reducing only drugs used therapeutically, but also endogenous errors in the UK. Br. J. Clin. Pharmacol. 71, 190–198. mediators/transmitters (med/trnsm) and certain impor- GMC (General Medical Council), 2009. Tomorrow’s Doctors: Outcomes tant drugs used mainly as experimental tools (exp.tool) – and standards for undergraduate medical education. Online: especially important for students studying basic or applied (accessed July 2014). pharmacology as a science subject – and drugs used for recreational (recreat) rather than therapeutic purposes. Some endogenous mediators (e.g. adrenaline [epine- KEY phrine]) are also important therapeutic drugs. The General Medical Council’s ‘Tomorrow’s Doctors’ (Note: designation does not exclude a separate therapeu- (2009) specifies that students should be able to- demon tic role – for example, nicotine and cocaine are used thera- strate knowledge of drug actions; therapeutics and phar- peutically as well as recreationally, adrenaline is used macokinetics; drug side effects and interactions, including therapeutically as well as being a mediator; conversely, for multiple treatments, long-term conditions and non- some primarily therapeutic drugs such as morphine or prescribed ; and also includingUnitedVRG effects of drugs other opioid analgesics are used recreationally by some on the population, such as the spread of antibiotic resist- individuals.) ance. A working knowledge of drugs in the ‘primary importance’ category should be built up gradually as they med/trnsm = mediator/transmitter are encountered during training. For drugs in the second exp.tool = experimental tool category, it is usually sufficient to be aware of the mecha- recreat = drug used especially for recreational purposes nism of action, supplemented by understanding how antag = antagonist they differ from those in the primary category when This appendix was originally adapted from that in Dale, relevant. M.M., Dickenson, A.H., Haylett, D.G. 1996. Companion The choice of drugs in clinical use is somewhat to Pharmacology, second ed. Churchill Livingstone, arbitrary. Hospital formulary committees (on which Edinburgh, with permission.

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vip.persianss.ir APPENDIX

Primary Secondary Primary Secondary

Cholinergic transmission (see Ch. 13) Purines (Ch. 16)

Agonists Drugs/mediators acting on purinoceptors or purine uptake acetylcholine (med/trnsm) carbachol adenosine (med/trnsm) dipyridamole suxamethonium pilocarpine ( therapeutic: Ch. 21) nicotine (recreat) + theophylline, aminophylline prasugrel (Chs 24 and 28) Antagonists atropine tropicamide caffeine (recreat) tubocurarine (exp.tool) pancuronium hexamethonium (exp.tool) atracurium ATP (med/trnsm) vecuronium α-bungarotoxin (exp.tool) ADP (med/trnsm) oxybutinin tolterodine botulinum toxin clopidogrel (presynaptic action) Anticholinesterases and related drugs neostigmine pyridostigmine edrophonium pralidoxime (cholinesterase donepezil reactivator) Local hormones (Chs 17 and 18) Cytokines (all: med/trnsm) (Ch. 18) interleukins chemokines tumour necrosis factor Noradrenergic transmission (Ch. 14) Tumour necrosis factor antagonists: etanercept, infliximab interferons (med/trnsm) adrenaline (epinephrine) clonidine colony-stimulating factors (med/trnsm) (Ch. 26) (med/trnsm) noradrenaline (norepinephrine) phenylephrine

(med/trnsm) Histamine and H1 and H2 antagonists (Ch. 17) isoprenaline (isoproterenol) dopamine (med/trnsm) histamine (med/trnsm) fexofenadine (exp.tool) cetirizine cyclizine salbutamol dobutamine promethazine ranitidine Antagonists cimetidine propranolol prazosin atenolol doxazosin Lipid-derived mediators (Ch. 18) metoprolol tamsulosin E and F Platelet-activating factor bisoprolol (med/trnsm) (med/trnsm) I (med/trnsm) latanoprost Drugs affecting noradrenergic neurons 2 thromboxane A (med/trnsm) lipoxins (med/trnsm) cocaine (recreat) (Ch. 48) guanethidine (exp.tool) 2 leukotrienes (med/trnsm) tyramine (exp.tool) reserpine (exp.tool) methyldopa (Ch. 22) amitryptyline (Ch. 46) Inflammatory peptides (Ch. 18) amphetamine (recreat) (Ch. 48) α-methyltyrosine (exp.tool) bradykinin icatibant (bradykinin phenelzine (Ch. 46) antagonist) substance P UnitedVRGcalcitonin-gene-related peptide (CGRP) neurokinin A

5-Hydroxytryptamine (serotonin) (Ch. 15)

Drugs acting on 5-HT receptors (see Ch. 46 for 5-HT reuptake inhibitors) 5-HT (serotonin) (med/trnsm) ergotamine/ dihydroergotamine LSD (recreat) metoclopramide ondansetron granisetron methysergide pizotifen triptans (e.g. sumatriptan) ketotifen 5-HT, 5-hydroxytryptamine; LSD, lysergic acid diethylamide. 723.e1

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Primary Secondary Primary Secondary

Cannabinoids and related drugs (Ch. 19) Vascular system (Ch. 22)

9 Antihypertensive drugs (A, B, C and D) Δ -tetrahydrocannabinol nabilone (recreat) A: angiotensin-converting enzyme inhibitors and anandamide (med/trnsm) angiotensin II (AT1 receptor) antagonists captopril lisinopril ramipril trandolapril losartan irbesartan candesartan Nitric oxide (Ch. 20) B: β-adrenoceptor antagonists metoprolol nitric oxide (med/trnsm) C: calcium antagonists amlodipine L-NG-monomethyl arginine (L-NMMA) (exp.tool) nifedipine D: thiazides and related diuretics bendroflumethiazide hydrochlorothiazide Heart (Ch. 21) indapamide chlortalidone

Antidysrhythmic drugs (Vaughan Williams classification) α1-adrenoceptor antagonists Class I lidocaine flecainide doxazosin Class II metoprolol sotalol Other vasodilators Class III amiodarone hydralazine minoxidil Class IV verapamil nitroprusside Unclassified adenosine aliskiren (renin inhibitor) digoxin Centrally acting drugs methyldopa Antianginal drugs moxonidine Nitrates Drugs used in heart failure and shock glyceryl trinitrate Diuretics (see also Ch. 29) isosorbide mononitrate furosemide nicorandil (combined with K+-channel activation) amiloride β Blockers metoprolol eplerenone Angiotensin-converting enzyme inhibitors and AT1 Calcium antagonists antagonists diltiazem Cardiac glycoside digoxin Drugs acting on adrenoceptors carvedilol dobutamine bisoprolol dopamine metoprolol Vasodilators hydralazine UnitedVRGK+-channel activators isosorbide mononitrate Pulmonary hypertension epoprostenol iloprost sildenafil bosentan

Atherosclerosis and dyslipidaemia (Ch. 23)

simvastatin ezetimibe atorvastatin pravastatin fibrates (gemfibrozil, fenofibrate) nicotinic acid derivatives resins (colestyramine, colesevelam) 723.e2 fish oil

vip.persianss.ir APPENDIX

Primary Secondary Primary Secondary

Haemostasis and thrombosis (Ch. 24) Skin (Ch. 27)

Oral anticoagulants and related drugs Topical glucocorticoids Biologicals (specialist warfarin rivaroxiban hydrocortisone use) vitamin K (antag) clobetasone butyrate adalimumab dabigatran etexilate beclomethasone dipropionate infliximab clobetasol propionate Heparin-related drugs and related drugs heparin protamine (antag) Topical calcineurin inhibitors Topical vitamin D enoxaparin fondaparinux ciclosporin derivatives calcitriol Antiplatelet drugs aspirin dipyridamole Topical retinoids clopidogrel epoprostenol tretinoin abciximab prasugrel Fibrinolytic drugs and inhibitors of fibrinolysis streptokinase tissue plasminogen activator tranexamic acid (inhibitor) Respiratory system (Ch. 28)

β2-adrenoceptor agonists salbuterol terbutaline salmeterol formeterol Haematinics and related drugs (Ch. 25) Inhaled glucocorticoids ferrous sulfate filgrastim beclometasone desferrioxamine hydroxycarbamide (iron chelator) (hydroxyurea) Inhaled muscarinic antagonists ipratropium tiotropium folic acid eculizumab Xanthine alkaloids hydroxocobalamin theophylline epoietin Leukotriene antagonists and 5-lipoxygenase inhibitors montelukast zileutin Anti-immunoglobulin E Anti-inflammatory and immunosuppressant drugs omalizumab (Ch. 26) Antitussive drug codeine Cyclo-oxygenase inhibitors (NSAIDs) aspirin (see also Ch. 24) indometacin paracetamol (acetaminophen) diclofenac ibuprofen coxibs (e.g. celecoxib) naproxen Disease-modifying anti-rheumatic drugs (DMARDs) methotrexate goldUnitedVRG complexes (e.g. tumour necrosis factor auranofin) antagonists: etanercept, hydroxychloroquine infliximab penicillamine glucocorticoids (e.g. sulfasalazine prednisolone) Immunosuppressant drugs azathioprine anakinra (interleukin-1 ciclosporin antagonist) tacrolimus methotrexate prednisolone Drugs used in gout NSAIDs (see above) colchicine allopurinol (prophylaxis) probenecid (prophylaxis) sulfinpyrazone NSAID, non-steroidal anti-inflammatory drug. 723.e3

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Kidney and urinary system (Ch. 29) Endocrine pancreas and related drugs (Ch. 31)

Thiazides and related diuretics Hormones bendroflumethiazide insulin amylin (med/trnsm) Loop diuretics insulin glargine somatostatin (med/trnsm) furosemide bumetanide insulin lispro glucagon K+-sparing diuretics incretins (GIP, GLP1) spironolactone triamterene amiloride eplerenone Drugs that act on the sulfonylurea receptor tolbutamide nateglinide Osmotic diuretics gliclazide gliburide mannitol Biguanide Carbonic anhydrase inhibitors metformin acetazolamide α-Glucosidase inhibitor Antidiuretic hormone (vasopressin) V2 agonists and acarbose antagonists desmopressin demeclocycline (antag) Thiazolidinediones rosiglitazone Anion exchange resin pioglitazone sevelamer Incretin-mimetics and related drugs exenatide vildagliptin sitagliptin

Gastrointestinal system (Ch. 30)

Antacids and ulcer-healing drugs magnesium or aluminium salts sucralfate (aluminium Obesity (Ch. 32) alginates complex) leptin (med/trnsm) neuropeptide Y

H2-receptor antagonists (med/trnsm) ranitidine cimetidine orlistat Proton pump inhibitors omeprazole lansoprazole Pituitary and adrenal cortex (Ch. 33) Antibiotics for Helicobacter pylori amoxicillin Glucocorticoids and related drugs clarithromycin hydrocortisone (med/trnsm) metyrapone (blocks metronidazole prednisolone synthesis) Prostaglandin analogues dexamethasone misoprostol Mineralocorticoids (and their antagonists) Laxatives aldosterone (med/trnsm) eplerenone (antag) lactulose sodium picosulfate fludrocortisone senna spironolactone (antag) bulk-forming (e.g. ispaghula UnitedVRGPituitary hormones and related drugs husk) corticotropin (adrenocorticotrophic Antiemetics hormone) (med/trnsm) phenothiazines growth hormone (med/trnsm) sermorelin (growth antihistamines hormone-releasing domperidone granisetron hormone analogue) metoclopramide nabilone somatostatin (med/trnsm) ondansetron aprepitant octreotide lanreotide vasopressin (med/trnsm) desmopressin Antidiarrhoeal drugs oxytocin (med/trnsm) codeine prolactin (med/trnsm) loperamide gonadorelin Drugs for inflammatory bowel disease bromocriptine prednisolone mesalazine sulfasalazine Antispasmodics hyoscine cyclizine 723.e4 Gastric secretagogues gastrin (med/trnsm) pentagastrin

vip.persianss.ir APPENDIX

Primary Secondary Primary Secondary

Thyroid (Ch. 34) CNS mediators (Ch 37–39)

Hormones and precursors Neurotransmitters and related drugs thyroxine (med/trnsm) amino acids liothyronine (med/trnsm) glutamate (med/trnsm) calcitonin (med/trnsm) NMDA (exp.tool) ketamine (NMDA-channel iodine/iodide blocker) glycine (med/trnsm) strychnine (exp.tool) Antithyroid drugs (glycine antag) carbimazole GABA (med/trnsm) baclofen (GABA ) propylthiouracil B bicuculline (GABA antag) radioiodine (131I) A Other transmitters noradrenaline (norepinephrine) melatonin (med/trnsm) (med/trnsm) nitric oxide (med/trnsm) dopamine (med/trnsm) Reproductive system (Ch. 35) 5-hydroxytryptamine (med/trnsm) Oestrogens acetylcholine (med/trnsm) oestradiol (med/trnsm) histamine (med/trnsm) ethinylestradiol adenosine triphosphate (ATP) Antioestrogen (med/trnsm) tamoxifen clomiphene Progestin (med/trnsm) Antiprogestogen Neurodegenerative diseases (Ch. 40) Parkinson’s disease Androgen levodopa selegiline testosterone (med/trnsm) carbidopa trihexyphenidyl and related drugs bromocriptine hydrochloride cyproterone orphenadrine pramipexole flutamide finasteride (5-α-reductase inhibitor) amantadine apomorphine Gonadotrophin-releasing hormone analogues MPTP (exp.tool) buserelin goserelin Amyotrophic lateral sclerosis riluzole Drugs acting on the uterus ergometrine atosiban Alzheimer’s disease oxytocin donepezil memantine rivastigmine galantamine dinoprostone (prostaglandin E2) Erectile dysfunction sildenafil tadalafil UnitedVRGGeneral anaesthetics (Ch. 41) Inhalational fluranes (isoflurane, desflurane, ether, chloroform, Bone (Ch. 36) sevoflurane) halothane (historical nitrous oxide interest) parathyroid hormone (med/trnsm) calcitonin Intravenous vitamin D teriparatide propofol midazolam calcium salts cinacalcet etomidate thiopental ketamine oestrogen (med/trnsm) alendronate etidronate risedronate strontium ranelate

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Primary Secondary Primary Secondary

Analgesics and related substances (Ch. 42) Antiepileptic drugs and centrally acting muscle relaxants (Ch. 45) Opioids and related drugs morphine oxycodone carbamazepine phenobarbital codeine buprenorphine diazepam fentanyl remifentanyl (anaesthesia) pethidine methadone vigabatrin clonazepam naloxone (antag) diamorphine (heroin) (recreat) gabapentin (and pregabalin) ethosuximide naltrexone (antag) lamotrigine leveteracetam Mild analgesics baclofen aspirin and other NSAIDs paracetamol phenytoin Other analgesic drugs tramadol (and tapentadol) ketamine carbamazepine gabapentin (and pregabalin) Antipsychotic drugs (Ch. 46) amitriptyline duloxetine Classic chlorpromazine fluphenazine Others related to nociception haloperidol flupentixol enkephalins and endorphins thioridazine (med/trnsm) dynorphin (med/trnsm) Atypical capsaicin (exp.tool) clozapine risperidone olanzapine sulpiride aripiprazole quetiapine

Local anaesthetics and other drugs that affect sodium channels (Ch. 43) Drugs used in affective disorders (Ch. 47) Local anaesthetics (Ch. 43) lidocaine tetracaine (amethocaine) Tricyclic antidepressants bupivacaine (and ropivacaine amitriptyline imipramine levobupivacaine) mepivacaine Selective serotonin (5-HT) reuptake inhibitors articaine (dentistry) fluoxetine fluvoxamine Selective sodium channel blocker (Ch. 43) sertraline escitalopram tetrodotoxin (exp.tool) Monoamine oxidase inhibitors moclobemide (‘RIMA’) phenelzine tranylcypromine Miscellaneous antidepressants venlafaxine trazodone Anxiolytic and hypnotic drugs (Ch. 44) duloxetine bupropion atomoxetine Antidepressants used as anxiolyticUnitedVRG drugs (see also Ch. 47) fluoxetine Mood stabilisers paroxetine lithium atypical antipsychotic sertraline carbamazepine drugs (e.g. olanzapine) Benzodiazepines and related drugs temazepam nitrazepam diazepam lorazepam midazolam flumazenil (antag) zopiclone Other

buspirone (5-HT1A receptor propranolol agonist) antiepileptic drugs, e.g. gabapentin, valproate

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vip.persianss.ir APPENDIX

Primary Secondary Primary Secondary

Central nervous system stimulants and psychotomimetics Antiviral agents (Ch. 52) (Ch. 48) DNA polymerase inhibitors amphetamine (recreat) LSD (recreat) aciclovir foscarnet ganciclovir cocaine (recreat) ketamine (recreat) tribavirin (ribavirin) caffeine (recreat) mephedrone (recreat) Reverse transcriptase inhibitors methylphenidate zidovudine (AZT) didanosine lamivudine MDMA (‘ecstasy’) efavirenz (non-nucleoside modafinil inhibitor) Protease inhibitor saquinavir indinavir Immunomodulators Drug dependence and drug abuse (Chs 49 and 19) interferons (med/trnsm)

9 Neuraminidase inhibitor opiates (morphine, diamorphine Δ -tetrahydrocannabinol [heroin]) (recreat) (recreat) zanamivir nicotine (recreat) amphetamine (recreat) Inhibitor of HIV fusion with host cells enfurvitide ethanol (recreat) solvents (recreat) Inhibitor of viral entry cocaine (recreat) benzodiazepines (recreat) maraviroc methadone buprenorphine naltrexone Antifungal drugs (Ch. 53) acamprosat Polyene antibiotics bupropion amphotericin B nystatin Azoles fluconazole miconazole Antibacterial agents (Ch. 51) Antimetabolite flucytosine Bacterial cell wall inhibitor benzylpenicillin piperacillin Others amoxicillin terbinafine flucloxacillin echinocandin B cephalosporins (cefadroxil, cefotaxime, ceftriaxone) vancomycin Topoisomerase inhibitor ciprofloxacin Antiprotozoal drugs (Ch. 54) Folate inhibitors UnitedVRGAntimalarials trimethoprim sulfonamides chloroquine pyrimethamine plus quinine sulfadoxine Bacterial protein synthesis inhibitors artemisinin gentamicin primaquine amikacin tetracycline For Pneumocystis pneumoniae chloramphenicol co-trimoxazole (high dose) pentamidine erythromycin Amoebicidal drug clarithromycin metronidazole Antianaerobe drug Leishmanicidal drugs metronidazole benzyl penicillin antimonials (e.g. stibogluconate) Antimycobacterial agents pentamidine isoniazid ethambutol Trypanosomicidal drugs rifampicin streptomycin suramin pentamidine pyrazinamide dapsone Toxoplasmicidal drug clofazimine pyrimethamine–sulfadiazine 723.e7

vip.persianss.ir APPENDIX

Primary Secondary Primary Secondary

Anthelmintic drugs (Ch. 55) Treatment of poisoning (Ch. 57)

Broad spectrum acetylcysteine mebendazole naloxone (Ch. 42) Roundworm, threadworm piperazine levamisole (roundworm) Schistosomes praziquantel River blindness ivermectin

Anticancer drugs (Ch. 56)

Alkylating agents and related compounds cyclophosphamide lomustine melphalan busulfan cisplatin chlorambucil Antimetabolites cytarabine fluorouracil methotrexate mercaptopurine thioguanine pentostatin gemcitabine Cytotoxic antibiotics doxorubicin bleomycin dactinomycin Plant derivatives vinca alkaloids (vincristine, etoposide vinblastine) taxanes (paclitaxel, docetaxel) irinotecan Hormones and related drugs prednisolone dexamethasone flutamide buserelin anastrozole tamoxifen Monoclonal antibodies rituximab erlotinib trastuzumab UnitedVRGserafinib panitumumab bevacizumab

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