PRACTICAL DRUG THERAPY: A SUGGESTED STUDENT FORMULARY

Drug therapy is an important thread throughout all your undergraduate medical education, during which time you should learn about the drugs that you are most likely to use when you start clinical training, building on what you have learnt in preclinical pharmacology. However, many hundreds of drugs are available, and it is not possible to have in-depth knowledge of all of them. Therefore, in this suggested student formulary, drugs have been divided into three categories (S, B and E), as a guide to how much you should learn about each.

Category E (Emergency drugs) (Tables 1 and 2)

As a junior doctor, you should know the indications, doses and routes of administration of category E drugs when they are used in an emergency. This refers to life-threatening conditions in which the drug has to be given immediately and when you may not have time to check with colleagues or textbooks. Some of these drugs are also included in category B, but for indications outside of emergencies.

Category B (Basic drugs) (Tables 3 and 4)

As a junior doctor, you should have sufficient knowledge of a category B drug to be able to prescribe it safely, usually when requested to do so by a colleague, but also occasionally (and only in an emergency) on your own. You should be aware of important contraindications, adverse effects and drug-drug interactions, and should be able to institute the appropriate monitoring for benefit and harm and adjust the dose accordingly. In the event of uncertainty, a junior doctor would be expected to check with senior colleagues or drug information sources. A list of basic drugs by specialty, along with examples of specialist drugs, is given in Table 4.

Category S (Specialist drugs) (Table 4)

A junior doctor not undergoing specialist training would not be expected to initiate a prescription for a category S drug, but should recognise its name and class, and be aware of the main indications for its use. Before continuing a prescription for this drug, the junior doctor would be expected to consult a senior or specialist colleague, as well as other drug information reference sources (such as the British National Formulary (BNF), the British National Formulary for Children (BNF-C) or the Physicians Desk Reference). This class will also contain drugs that a junior doctor will not have heard of; in that case, the same principles apply.

Texts
To supplement bedside, seminar and lecture teaching, we recommend that students consult the following books: Grahame-Smith DG, Aronson JK. The Oxford textbook of clinical pharmacology and drug therapy. 3rd edn. Oxford: Oxford University Press; 2002. Richards D, Aronson JK. The Oxford handbook of practical drug therapy. Oxford: Oxford University Press; 2005.

Table 1 Complete list of emergency drugs (see also Table 2)

Adrenaline (epinephrine) Amiodarone Atropine Benzatropine Beta2-adrenoceptor agonists (e.g. salbutamol) Chlorphenamine Dextrose Diazepam/lorazepam Flumazenil Furosemide Glucagon Hydrocortisone Ipratropium Morphine/diamorphine Naloxone Oxygen

Table 2 Category E drugs used in emergencies

Emergency Cardiac arrest Category E drugs Adrenaline (epinephrine) Amiodarone Atropine Acute dystonias Acute pulmonary oedema Anticholinergic drugs (e.g. benzatropine) Morphine/diamorphine Furosemide Oxygen Acute severe asthma Beta2-adrenoceptor agonists (e.g. salbutamol) Ipratropium Oxygen Hydrocortisone (i.v.) Anaphylactic shock Adrenaline (epinephrine) (i.m.) Hydrocortisone (i.v.) Chlorphenamine (i.v.) Benzodiazepine intoxication Hypoglycaemia Flumazenil Dextrose (i.v.) Glucagon Hypovolaemic shock Opioid intoxication Seizures Intravenous fluids Naloxone Diazepam/lorazepam

Table 3 Complete list of basic drugs or groups of drugs (see also Table 4)
ACE inhibitors Aciclovir Activated charcoal Adenosine Allopurinol Alpha-adrenoceptor antagonists Amiodarone Anaesthetics, local Antacids/alginates Anticholinergic drugs Anticoagulants Antidiarrhoeal drugs Antihistamines (H1 receptor antagonists) Antipsychotic drugs Aspirin Benzodiazepines Beta2-adrenoceptor agonists Beta-blockers Bisphosphonates Calcium channel blockers Calcium salts Carbamazepine Carbimazole Cephalosporins Colchicine Digoxin Diuretics, loop Diuretics, thiazides Diuretics, K-sparing

Fludrocortisone Folic acid and folinic acid Gentamicin

 Glucagon Glucocorticoids Heparins Histamine H2 receptor antagonists Hormone replacement therapies Insulins Iron Laxatives Levodopa and dopa-decarboxylase inhibitors (co-careldopa, co-beneldopa) Levothyroxine and tri-iodothyronine Lithium

Macrolides Metformin Metoclopramide Metronidazole N-acetylcysteine Nitrates Nitrofurantoin NSAIDs Nystatin Opioid analgesics, including combinations (e.g. co-codamol) Oral contraceptives Oxygen Paracetamol Penicillins Phenothiazine anti-emetics Phenytoin Potassium salts Proton pump inhibitors

Quinine Quinolones Spironolactone SSRIs

 Statins Streptokinase Sulphonylureas Tetracyclines Topical glucocorticoids Tricyclic antidepressants Triptans Valproate sodium Vasopressin Venlafaxine Vitamin B12 (hydroxocobalamin) Vitamin K

Warfarin Xanthines

Table 4 Basic drugs and specialist drugs

Specialty Anaesthesia Basic drugs (category B) Local anaesthetics Intravenous fluids Cardiovascular Diuretics Loop diuretics Thiazide diuretics Spironolactone K-sparing diuretics (amiloride, triamterene) ACE inhibitors Beta-blockers Nitrates Calcium channel blockers Aspirin Streptokinase Anticoagulants (warfarin, heparin, low molecular weight heparin) Statins Digoxin Amiodarone Adenosine Dermatology Basic principles of using drugs on the skin Emollients Topical glucocorticoids Topical imidazoles Oral antihistamines (H1 receptor Topical glucocorticoids (very potent) Topical antimicrobial drugs Permethrin cream in scabies Benzoyl peroxide Topical and oral retinoids Other antiplatelet agents Other fibrinolytic agents Other anticoagulants (e.g. direct thrombin inhibitors) Other lipid-lowering agents Dobutamine Other anti-arrhythmic drugs Angiotensin II receptor antagonists Examples of specialist drugs (category S) General anaesthetics

antagonists)

Topical vitamin D analogues Coal tar

Endocrine/ metabolic

Insulins Sulphonylureas Metformin Glucagon Levothyroxine and triiodothyronine Carbimazole or methimazole Glucocorticoids Fludrocortisone

Glitazones Meglitinides Incretin mimetics Acarbose Propylthiouracil Iodine

Vasopressin and analogues Spironolactone Octreotide and analogues

ENT

Basic principles of administering drugs to the ears and nose Laxatives Antidiarrhoeal drugs Antacids/alginates Histamine H2 receptor antagonists Proton pump inhibitors Misoprostol

Gastrointestinal

Haematology

Iron Vitamin B12 (hydroxocobalamin) Folic acid and folinic acid Vitamin K

Chemotherapeutic agents

Infectious diseases

Penicillins Cephalosporins Aminoglycosides (gentamicin) Macrolides (erythromycin, clarithromycin) Nitrofurantoin

Amphotericin Carbapenems Chloramphenicol Co-trimoxazole Fusidic acid Linezolid

Quinolones (ciprofloxacin) Tetracyclines Vancomycin Metronidazole Nystatin Aciclovir

Mupirocin Trimethoprim Teicoplanin Antifungal imidazoles Antihelminthic drugs Antileprosy drugs Antimalarial drugs Antiprotozoal drugs Antituberculosis drugs Drugs used to treat HIV

Musculoskeletal

NSAIDs Glucocorticoids Allopurinol Colchicine Calcium salts Bisphosphonates Quinine

DMARDs

Uricosuric agents

Vitamin D analogues

Neurology

Carbamazepine Phenytoin Valproate Levodopa and dopa-decarboxylase inhibitors (co-careldopa, cobeneldopa) Anticholinergic drugs (e.g. procyclidine, trihexyphenidyl) Triptans

Other anti-epileptic drugs

Other drugs used in Parkinsons disease (e.g. dopamine receptor agonists, COMT inhibitors, selegiline)

Obstetrics and gynaecology Oncology

Oral contraceptives Hormone replacement therapies Basic principles of cancer chemotherapy

Oxytocic drugs Danazol All specific drugs

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Ophthalmology

Basic principles of using eye drops Drugs used in glaucoma

Antimicrobial drugs

Paediatrics

Basic principles of using drugs in children (BNF-C), including antimicrobial drugs, simple analgesia, oxygen Opioid analgesics, including combinations (e.g. co-codamol) Aspirin Paracetamol NSAIDs Metoclopramide Phenothiazine anti-emetics Domperidone Ondansetron and related drugs (5HT3 receptor antagonists) Zopiclone Zolpidem Tricyclic antidepressants SSRIs Venlafaxine Lithium Antipsychotic drugs Drugs used in the treatment of dementias Leukotriene receptor antagonists Cromones (cromoglicate) MAOIs Moclobemide Other non-opioid narcotic analgesics

Pain relief and palliative care

Psychiatric

Benzodiazepines

Respiratory

Beta2-adrenoceptor agonists Anticholinergic drugs Xanthines Glucocorticoids Oxygen

Urinary tract

Alpha-adrenoceptor antagonists

Anticholinergic drugs GnRH (goserelin) analogues

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Finasteride Flutamide, bicalutamide Self-poisoning General management Activated charcoal (single and repeated doses) N-acetylcysteine Specific antidotes

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