Pharmacology mbbs
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Pharmacology — MBBS Complete Overview
Pharmacology for MBBS is divided into General Pharmacology and Systemic Pharmacology. Here is a structured, high-yield breakdown of the entire subject.
UNIT 1 — General Pharmacology
1. Basic Concepts
| Term | Definition |
|---|---|
| Pharmacokinetics (PK) | What the body does to the drug (ADME) |
| Pharmacodynamics (PD) | What the drug does to the body |
| Bioavailability (F) | Fraction of drug reaching systemic circulation unchanged |
| Volume of Distribution (Vd) | Apparent volume in which drug distributes |
| Half-life (t½) | Time for plasma concentration to fall by 50% |
| Clearance (Cl) | Volume of plasma cleared of drug per unit time |
| Steady state | Achieved after ~5 half-lives |
2. Pharmacokinetics (ADME)
Absorption
- Routes: oral, sublingual, transdermal, IM, IV, inhalation
- First-pass effect: hepatic metabolism before systemic circulation (e.g., GTN, morphine, propranolol have high first-pass)
- Factors: lipid solubility, ionization (Henderson-Hasselbalch), surface area, blood flow
Distribution
- Plasma protein binding (albumin for acidic drugs; α₁-acid glycoprotein for basic drugs)
- Blood-brain barrier: only lipid-soluble, un-ionized, non-protein-bound drugs cross
- Vd = Dose / Plasma concentration
- High Vd → tissue binding (e.g., chloroquine, digoxin)
- Low Vd → confined to plasma (e.g., heparin, warfarin)
Metabolism
- Phase I: Oxidation (CYP450), reduction, hydrolysis → may activate or inactivate
- Phase II: Conjugation (glucuronidation, sulfation, acetylation) → mostly inactivation
- Enzyme induction: Rifampicin, phenytoin, carbamazepine, barbiturates → reduce drug effect
- Enzyme inhibition: Ketoconazole, erythromycin, cimetidine, grapefruit juice → increase drug toxicity
Excretion
- Renal: glomerular filtration + tubular secretion − tubular reabsorption
- Acidifying urine → traps basic drugs (amphetamine poisoning)
- Alkalinizing urine → traps acidic drugs (aspirin poisoning)
- Also: bile (enterohepatic circulation), lungs (volatile agents), milk, sweat
3. Pharmacodynamics
Receptor Types
| Type | Mechanism | Example |
|---|---|---|
| Ionotropic (Type I) | Ligand-gated ion channel | Nicotinic ACh, GABA-A |
| G-protein coupled (Type II) | 2nd messenger | β-adrenoceptors, M receptors |
| Enzyme-linked (Type III) | Tyrosine kinase | Insulin receptor, growth factors |
| Intracellular (Type IV) | Gene transcription | Steroids, thyroid hormones |
Drug-Receptor Interactions
- Agonist: Binds + activates receptor
- Antagonist: Binds but does not activate (competitive/non-competitive)
- Partial agonist: Submaximal response even at full receptor occupancy (e.g., buprenorphine)
- Inverse agonist: Reduces basal activity below baseline
- Efficacy: Maximal effect a drug can produce (Emax)
- Potency: Dose needed to produce a given effect (EC50) — lower EC50 = more potent
Dose-Response Curve
- Graded DRC: individual response vs. dose
- Quantal DRC: population response — used to derive ED50, LD50, Therapeutic Index (TI = LD50/ED50)
- High TI = safer drug (e.g., penicillin); Low TI = narrow therapeutic index (e.g., digoxin, lithium, warfarin, aminoglycosides, phenytoin)
UNIT 2 — Autonomic Nervous System (ANS) Pharmacology
Neurotransmitters & Receptors
| Division | NT | Receptors | Effects |
|---|---|---|---|
| Sympathetic (adrenergic) | Norepinephrine, Epinephrine | α₁, α₂, β₁, β₂, β₃ | Fight or flight |
| Parasympathetic (cholinergic) | Acetylcholine | M₁, M₂, M₃, Nicotinic (Nm, Nn) | Rest & digest |
Cholinergic Pharmacology
Cholinomimetics (Direct)
- Muscarinic: Pilocarpine (glaucoma), Bethanechol (urinary retention), Carbachol
- Nicotinic: Nicotine (no therapeutic use)
Anti-ChE (Indirect cholinomimetics)
- Reversible: Neostigmine (myasthenia gravis, reversal of NMB), Physostigmine (glaucoma, atropine poisoning), Pyridostigmine, Edrophonium (diagnosis of MG — Tensilon test)
- Irreversible: Organophosphates (DDVP, malathion) — inhibit AChE permanently; treat with Atropine + Pralidoxime (2-PAM)
Anticholinergics (Antimuscarinic)
- Atropine: mydriasis, cycloplegia, antisecretory, tachycardia, antidote for organophosphate poisoning
- Scopolamine: motion sickness
- Ipratropium: COPD (inhaled)
- Tropicamide, Homatropine: ophthalmology
- Oxybutynin, Tolterodine: overactive bladder (M₃ blockers)
- Benztropine, Trihexyphenidyl: Parkinson's disease
Ganglion Blockers: Mecamylamine, Trimethaphan (hypertensive emergency, rarely used)
Neuromuscular Blocking Agents (NMBAs)
| Type | Examples | Reversal |
|---|---|---|
| Depolarizing | Succinylcholine (SCh) | None (spontaneous) |
| Non-depolarizing | Vecuronium, Rocuronium, Atracurium, Pancuronium | Neostigmine + Atropine / Sugammadex |
Adrenergic Pharmacology
Adrenergic Agonists
| Drug | Receptors | Uses |
|---|---|---|
| Adrenaline (Epinephrine) | α, β | Anaphylaxis, cardiac arrest, with LA |
| Noradrenaline | α₁, α₂, β₁ | Vasopressor in septic shock |
| Dopamine | D₁, β₁ (low dose); α (high dose) | Shock, heart failure |
| Dobutamine | β₁ | Cardiogenic shock, cardiac stress test |
| Isoprenaline | β₁, β₂ | AV block, bradycardia (historical) |
| Salbutamol | β₂ | Bronchial asthma (SABA) |
| Salmeterol/Formoterol | β₂ | COPD/asthma (LABA) |
| Clonidine | α₂ central | Hypertension, opioid withdrawal |
| Phenylephrine | α₁ | Nasal decongestant, hypotension |
Adrenergic Antagonists
Alpha blockers:
- Non-selective: Phentolamine (pheochromocytoma), Phenoxybenzamine (irreversible)
- α₁-selective: Prazosin, Tamsulosin (BPH), Doxazosin
Beta blockers:
| Drug | Selectivity | Special Feature |
|---|---|---|
| Propranolol | Non-selective (β₁+β₂) | Also: migraine, thyrotoxicosis, anxiety |
| Atenolol, Metoprolol | β₁-selective (cardioselective) | Preferred in asthma/COPD |
| Carvedilol | α₁ + β (non-selective) | HF with reduced EF |
| Labetalol | α₁ + β | Hypertension in pregnancy |
| Esmolol | β₁-selective, ultra-short | SVT in ICU |
| Timolol | Non-selective | Glaucoma (topical) |
UNIT 3 — CNS Pharmacology
Sedative-Hypnotics & Anxiolytics
Benzodiazepines — enhance GABA-A (increase frequency of Cl⁻ channel opening)
- Short-acting: Triazolam, Midazolam (procedural sedation)
- Intermediate: Lorazepam, Temazepam
- Long-acting: Diazepam, Clonazepam, Chlordiazepoxide
- Antidote: Flumazenil
Barbiturates — enhance GABA-A (increase duration of Cl⁻ channel opening)
- Thiopentone: IV induction of anesthesia
- Phenobarbitone: epilepsy
- Antidote: None specific (supportive care)
Non-BZD Hypnotics (Z-drugs): Zolpidem, Zaleplon, Zopiclone — GABA-A (BZD site)
Antiepileptics
| Drug | Mechanism | Seizure Type |
|---|---|---|
| Phenytoin | Na⁺ channel blockade | Partial, GTCS (not absence) |
| Carbamazepine | Na⁺ channel blockade | Partial, GTCS, trigeminal neuralgia |
| Valproate | Na⁺ block + GABA ↑ + T-Ca²⁺ block | Broad spectrum, drug of choice in absence |
| Ethosuximide | T-type Ca²⁺ channel block | Absence (petit mal) only |
| Phenobarbitone | GABA-A enhancer | Neonatal seizures, GTCS |
| Benzodiazepines | GABA-A enhancer | Status epilepticus (IV lorazepam/diazepam) |
| Lamotrigine | Na⁺ channel block | Partial, GTCS, bipolar |
| Levetiracetam | SV2A protein | Broad spectrum, well-tolerated |
| Gabapentin/Pregabalin | α₂δ Ca²⁺ channel | Neuropathic pain, anxiety |
Antidepressants
| Class | Examples | Mechanism |
|---|---|---|
| TCA | Imipramine, Amitriptyline | Block 5-HT + NE reuptake; anticholinergic, antihistamine |
| SSRI | Fluoxetine, Sertraline, Escitalopram | Selective serotonin reuptake inhibition |
| SNRI | Venlafaxine, Duloxetine | 5-HT + NE reuptake inhibition |
| MAOI | Phenelzine, Tranylcypromine | Irreversible MAO inhibition (tyramine interaction) |
| Mirtazapine | α₂ block + 5-HT₂/₃ block | Sedation, appetite ↑ |
| Bupropion | NE + DA reuptake inhibition | Also smoking cessation, ADHD |
Antipsychotics
Typical (1st generation) — D₂ blockade
- Low potency: Chlorpromazine (sedation, anticholinergic effects)
- High potency: Haloperidol, Fluphenazine (more EPS)
- EPS: Parkinsonism, Akathisia, Acute dystonia, Tardive dyskinesia
- NMS: Neuroleptic Malignant Syndrome (fever, rigidity, ↑CK) — treat with Dantrolene + Bromocriptine
Atypical (2nd generation) — D₂ + 5-HT₂ block
- Clozapine: most effective; risk of agranulocytosis (monitor WBC)
- Olanzapine: weight gain, metabolic syndrome
- Risperidone: highest prolactin ↑ among atypicals
- Quetiapine: sedation, used in dementia
- Aripiprazole: partial D₂ agonist; minimal metabolic effects
Opioid Analgesics
Receptors: μ (analgesia, euphoria, respiratory depression, constipation), κ, δ
| Drug | Type | Notes |
|---|---|---|
| Morphine | Full agonist | Gold standard; release histamine |
| Codeine | Prodrug (→ morphine) | Mild pain, antitussive |
| Pethidine (Meperidine) | Full agonist | Avoid in renal failure (norpethidine); Serotonin syndrome with MAOIs |
| Fentanyl | Full agonist | 100× morphine; transdermal patch |
| Buprenorphine | Partial μ agonist | Opioid dependence, chronic pain |
| Tramadol | Weak μ agonist + SNRI | Seizure risk |
| Naloxone | μ antagonist | Opioid overdose antidote (IV) |
| Naltrexone | μ antagonist (oral) | Opioid/alcohol dependence |
UNIT 4 — Cardiovascular Pharmacology
Antihypertensives
| Class | Examples | Mechanism |
|---|---|---|
| ACE Inhibitors | Enalapril, Lisinopril, Ramipril | Block ACE → ↓ Angiotensin II; cough (bradykinin ↑) |
| ARBs | Losartan, Valsartan, Telmisartan | Block AT₁ receptor; no cough |
| CCBs (Dihydropyridines) | Amlodipine, Nifedipine | L-type Ca²⁺ block (vascular) → vasodilation |
| CCBs (Non-DHP) | Verapamil, Diltiazem | Ca²⁺ block (cardiac + vascular) → ↓HR, ↓contractility |
| Beta-blockers | Atenolol, Metoprolol | ↓HR, ↓CO, ↓renin |
| Thiazide diuretics | Hydrochlorothiazide, Indapamide | ↓Na reabsorption in DCT |
| Aldosterone antagonists | Spironolactone, Eplerenone | K⁺-sparing; used in HF, hyperaldosteronism |
| Direct vasodilators | Hydralazine (arterial), Minoxidil | Refractory HTN; hydralazine in pregnancy |
Anti-Anginal Drugs
| Drug | Mechanism | Notes |
|---|---|---|
| GTN (Nitroglycerin) | NO → cGMP → vasodilation | Sublingual; tolerance with continuous use |
| Isosorbide dinitrate/mononitrate | Same as GTN | Oral; prevent tolerance with nitrate-free intervals |
| Beta-blockers | ↓HR, ↓contractility, ↓O₂ demand | Stable angina; avoid in Prinzmetal's |
| CCBs (Verapamil/Diltiazem) | ↓HR + vasodilation | Stable angina; drug of choice in Prinzmetal's |
| Ranolazine | Late Na⁺ current inhibitor | Chronic stable angina |
| Ivabradine | HCN channel block (If) | ↓HR without affecting contractility |
Antiarrhythmics (Vaughan-Williams Classification)
| Class | Mechanism | Examples |
|---|---|---|
| Ia | Na⁺ block (moderate) + K⁺ block | Quinidine, Procainamide, Disopyramide |
| Ib | Na⁺ block (weak/fast dissociation) | Lidocaine, Mexiletine |
| Ic | Na⁺ block (strong) | Flecainide, Propafenone |
| II | Beta-blockers | Propranolol, Metoprolol |
| III | K⁺ channel block (↑ AP duration) | Amiodarone, Sotalol, Ibutilide |
| IV | Ca²⁺ channel block | Verapamil, Diltiazem |
| Other | Adenosine | Drug of choice for SVT (IV) |
Amiodarone: most effective antiarrhythmic; toxicities — pulmonary fibrosis, thyroid dysfunction, corneal microdeposits, photosensitivity, blue-grey skin.
Heart Failure Drugs
- ACEi/ARBs: ↓afterload, ↓remodeling — reduce mortality
- Beta-blockers (Carvedilol, Metoprolol succinate, Bisoprolol): ↓mortality in HFrEF
- Diuretics: Furosemide (loop) — relieve congestion
- Spironolactone/Eplerenone: aldosterone antagonism — reduce mortality
- Digoxin: ↑contractility (Na⁺/K⁺-ATPase inhibitor); narrow TI; toxicity: arrhythmias, nausea, visual disturbances (xanthopsia); antidote: Digibind (anti-digoxin Fab)
- ARNI (Sacubitril/Valsartan): neprilysin inhibitor + ARB; superior to ACEi in HFrEF
- SGLT2 inhibitors (Empagliflozin, Dapagliflozin): significant CV mortality reduction in HFrEF
UNIT 5 — Diuretics
| Class | Site | Examples | Key Points |
|---|---|---|---|
| Loop diuretics | Thick ascending loop of Henle | Furosemide, Bumetanide | Most potent; cause hypokalemia, ototoxicity |
| Thiazides | DCT | HCTZ, Chlorthalidone | Hypokalemia, hyperuricemia, hyperglycemia |
| K⁺-sparing | Collecting duct | Spironolactone (aldosterone antagonist), Amiloride, Triamterene | Hyperkalemia risk |
| Carbonic anhydrase inhibitors | PCT | Acetazolamide | Glaucoma, altitude sickness, metabolic alkalosis |
| Osmotic | Proximal tubule + loop | Mannitol | ↑ICP, acute glaucoma, oliguric renal failure |
UNIT 6 — Respiratory Pharmacology
Asthma/COPD
- SABA: Salbutamol (albuterol), Terbutaline — first-line for acute attack
- LABA: Salmeterol, Formoterol — maintenance (always with ICS in asthma)
- ICS: Beclomethasone, Budesonide, Fluticasone — reduce airway inflammation
- LAMA: Tiotropium, Ipratropium — COPD (preferred); muscarinic antagonists
- Methylxanthines: Theophylline — phosphodiesterase inhibitor; narrow TI (arrhythmias, seizures)
- Leukotriene antagonists: Montelukast, Zafirlukast — aspirin-sensitive asthma
- Cromoglicate/Nedocromil: mast cell stabilizers — prophylaxis only
- Biologics: Omalizumab (anti-IgE), Mepolizumab (anti-IL-5) — severe allergic/eosinophilic asthma
Antitussives: Codeine, Dextromethorphan
Expectorants: Guaifenesin, Ambroxol, Bromhexine
Mucolytics: Acetylcysteine (NAC — also antidote for paracetamol toxicity)
UNIT 7 — GIT Pharmacology
| Drug | Use | Mechanism |
|---|---|---|
| PPIs (Omeprazole, Pantoprazole) | PUD, GERD | Irreversible H⁺/K⁺-ATPase inhibition |
| H₂-blockers (Ranitidine, Famotidine) | PUD | H₂ receptor block → ↓acid |
| Antacids (Mg(OH)₂, Al(OH)₃) | Symptomatic relief | Neutralize acid |
| Sucralfate | PUD (especially with NSAID) | Mucosal protective barrier |
| Misoprostol | NSAID-induced ulcer prevention | PGE₁ analogue → ↓acid, ↑mucus |
| Metoclopramide | GERD, vomiting | D₂ block + 5-HT₄ agonist (prokinetic) |
| Ondansetron | Nausea/vomiting (chemotherapy) | 5-HT₃ antagonist |
| Loperamide | Diarrhea | Peripheral opioid receptor agonist |
| Lactulose | Constipation, hepatic encephalopathy | Osmotic laxative |
UNIT 8 — Antimicrobial Pharmacology
Antibiotics by Mechanism
| Mechanism | Drug Class | Examples |
|---|---|---|
| Cell wall synthesis inhibition | Penicillins, Cephalosporins, Carbapenems, Vancomycin | Amoxicillin, Ceftriaxone, Meropenem |
| DNA gyrase/Topoisomerase II inhibition | Fluoroquinolones | Ciprofloxacin, Levofloxacin |
| RNA polymerase inhibition | Rifampicin | Anti-TB |
| 30S ribosome inhibition | Aminoglycosides, Tetracyclines | Gentamicin, Doxycycline |
| 50S ribosome inhibition | Macrolides, Chloramphenicol, Clindamycin, Linezolid | Azithromycin, Erythromycin |
| Cell membrane disruption | Polymyxins | Colistin |
| Folate synthesis inhibition | Sulfonamides, Trimethoprim | Co-trimoxazole |
Key Antibiotic Toxicities
| Drug | Toxicity |
|---|---|
| Aminoglycosides | Ototoxicity (irreversible), nephrotoxicity |
| Tetracyclines | Teeth discoloration in children, photosensitivity; avoid in pregnancy |
| Chloramphenicol | Grey baby syndrome, aplastic anemia |
| Fluoroquinolones | Tendon rupture (Achilles), QT prolongation, avoid in children |
| Rifampicin | Orange-red body secretions, enzyme induction, hepatotoxicity |
| Vancomycin | Red man syndrome (infusion-related), nephrotoxicity |
| Linezolid | MAO inhibition → serotonin syndrome; thrombocytopenia |
| Metronidazole | Disulfiram-like reaction with alcohol |
Anti-TB Drugs (RIPE)
| Drug | Mechanism | Key Toxicity |
|---|---|---|
| Rifampicin | RNA pol inhibition | Hepatotoxicity, enzyme inducer |
| Isoniazid (INH) | InhA inhibition (mycolic acid) | Peripheral neuropathy (↓ pyridoxine/B6), hepatitis |
| Pyrazinamide | Disrupts membrane potential | Hyperuricemia, hepatotoxicity |
| Ethambutol | Arabinosyltransferase inhibition | Optic neuritis (↓ visual acuity, green-red color) |
| Streptomycin | 30S inhibition | Ototoxicity, nephrotoxicity |
Antifungals
| Drug | Class | Mechanism | Use |
|---|---|---|---|
| Amphotericin B | Polyene | Binds ergosterol → membrane disruption | Severe systemic fungal infections |
| Fluconazole | Azole | Inhibits 14α-demethylase → ↓ergosterol | Candida, Cryptococcus |
| Itraconazole | Azole | Broader spectrum than fluconazole | Aspergillus, dermatophytes |
| Terbinafine | Allylamine | Squalene epoxidase inhibitor | Dermatophytes (nail) |
| Caspofungin | Echinocandin | β-1,3-glucan synthase inhibitor | Invasive Aspergillus, Candida |
| Griseofulvin | — | Disrupts microtubules | Dermatophytes (oral) |
Antivirals
| Drug | Use | Mechanism |
|---|---|---|
| Acyclovir | HSV, VZV | Thymidine kinase-activated; inhibits viral DNA polymerase |
| Ganciclovir | CMV | Same mechanism; more toxic |
| Oseltamivir | Influenza | Neuraminidase inhibitor |
| Ribavirin | RSV, HCV, viral hemorrhagic fevers | Purine analogue |
| Zidovudine (AZT) | HIV | NRTI (nucleoside reverse transcriptase inhibitor) |
| Tenofovir | HIV, HBV | NRTI |
| Efavirenz | HIV | NNRTI |
| Lopinavir/Ritonavir | HIV | Protease inhibitor |
| Raltegravir | HIV | Integrase inhibitor |
| Interferon-α | HBV, HCV | Immunomodulator + antiviral |
UNIT 9 — Endocrine Pharmacology
Diabetes Mellitus
| Drug | Mechanism | Key Points |
|---|---|---|
| Regular insulin | Binds insulin receptor | Short-acting; IV use |
| Glargine/Detemir | Slow absorption | Basal insulin (no peak) |
| Metformin | ↓hepatic gluconeogenesis (AMPK activation) | First-line T2DM; no weight gain; lactic acidosis risk |
| Sulfonylureas (Glibenclamide) | Close K_ATP channel → insulin ↑ | Hypoglycemia risk |
| DPP-4 inhibitors (Sitagliptin) | ↑GLP-1 and GIP | Weight neutral; risk of pancreatitis |
| GLP-1 agonists (Liraglutide) | Incretin mimetic | Weight loss; CV benefit |
| SGLT2 inhibitors (Empagliflozin) | ↓glucose reabsorption in PCT | CV and renal protection; genital infections |
| Thiazolidinediones (Pioglitazone) | PPAR-γ activation → insulin sensitization | Weight gain, edema, bladder cancer risk |
| Acarbose | α-glucosidase inhibitor | Flatulence |
Thyroid Pharmacology
- Hypothyroidism: Levothyroxine (T4) — synthetic; narrow TI
- Hyperthyroidism:
- Carbimazole / Propylthiouracil (PTU): inhibit thyroid peroxidase; PTU also inhibits peripheral T4→T3 conversion; teratogenic (carbimazole — aplasia cutis)
- Propranolol: symptomatic relief of thyroid storm
- Radioiodine (¹³¹I): ablative therapy
- Lugol's iodine (KI): pre-operative (Wolff-Chaikoff effect)
Corticosteroids
- Glucocorticoids: Hydrocortisone > Prednisolone > Methylprednisolone > Dexamethasone (increasing potency)
- Mineralocorticoid: Fludrocortisone
- Side effects: hyperglycemia, hypertension, osteoporosis, Cushing's syndrome, adrenal suppression, peptic ulcer, immunosuppression
UNIT 10 — Chemotherapy (Anticancer Drugs)
| Class | Examples | Mechanism |
|---|---|---|
| Alkylating agents | Cyclophosphamide, Chlorambucil | Cross-link DNA |
| Antimetabolites | Methotrexate, 5-FU, 6-MP | Inhibit nucleotide synthesis |
| Vinca alkaloids | Vincristine, Vinblastine | Inhibit microtubule polymerization |
| Taxanes | Paclitaxel, Docetaxel | Stabilize microtubules |
| Anthracyclines | Doxorubicin, Daunorubicin | Intercalate DNA; free radical generation; cardiotoxicity |
| Topoisomerase inhibitors | Irinotecan (I), Etoposide (II) | Block DNA unwinding |
| Platinum compounds | Cisplatin, Carboplatin | Cross-link DNA; nephrotoxic |
| Hormonal agents | Tamoxifen (SERM), Letrozole (aromatase inhibitor) | Breast cancer |
| Targeted therapy | Imatinib (BCR-ABL), Trastuzumab (HER2), Rituximab (CD20) | Targeted molecular inhibition |
UNIT 11 — Key Antidotes (High-Yield)
| Poison/Drug | Antidote |
|---|---|
| Organophosphates | Atropine + Pralidoxime (2-PAM) |
| Opioids | Naloxone |
| Benzodiazepines | Flumazenil |
| Paracetamol (Acetaminophen) | N-Acetylcysteine (NAC) |
| Heparin | Protamine sulfate |
| Warfarin | Vitamin K, Fresh Frozen Plasma |
| Digoxin | Digibind (anti-digoxin Fab) |
| CO poisoning | 100% O₂, Hyperbaric O₂ |
| Cyanide | Sodium nitrite + Sodium thiosulfate / Hydroxocobalamin |
| Iron | Deferoxamine (IM); Deferasirox (oral) |
| Lead | EDTA, BAL (dimercaprol), Penicillamine |
| Methanol/Ethylene glycol | Fomepizole (4-MP) or Ethanol + Folate/Pyridoxine |
| Methemoglobinemia | Methylene blue |
| TCA overdose | Sodium bicarbonate |
| Beta-blocker overdose | Glucagon, Calcium |
| CCB overdose | Calcium gluconate, Glucagon, Insulin-dextrose |
High-Yield One-Liners for Exams
- Drug of choice for status epilepticus: IV Lorazepam → IV Phenytoin → General anesthesia
- Drug causing Lupus-like syndrome: Hydralazine, Procainamide, INH
- Safest antihypertensive in pregnancy: Methyldopa, Labetalol, Nifedipine (avoid ACEi/ARBs)
- Drug causing pulmonary fibrosis: Amiodarone, Bleomycin, Busulfan, Methotrexate, Nitrofurantoin
- Enzyme inducer mnemonic (GRAPCS): Griseofulvin, Rifampicin, Alcohol (chronic), Phenytoin, Carbamazepine, Sulphonylureas
- Narrow Therapeutic Index drugs: Digoxin, Lithium, Phenytoin, Warfarin, Aminoglycosides, Theophylline (mnemonic: DWPALT)
- First-line in bipolar disorder: Lithium (monitor: Na⁺, TFT, renal function, levels)
- Disulfiram-like reaction: Metronidazole, Tinidazole, Cephalosporins (Cefoperazone), Chlorpropamide
- Drug of choice in Prinzmetal's (Variant) angina: CCBs (Verapamil, Diltiazem, Nifedipine)
- Drug of choice in SVT (acute): Adenosine IV
This covers the full MBBS pharmacology curriculum. Let me know if you want a deep dive into any specific unit, practice MCQs, or a topic explained with mechanisms and clinical correlations.
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