Write class, classification, name of other drugs included in it, moa, indication,s/e,c/i of drug shown

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Drug 1: Dopamine (Sterile Dopamine 40 mg/5 ml)

Class & Classification

Class: Catecholamine / Sympathomimetic Amine
Classification: Endogenous catecholamine; inotrope/vasopressor
Subclass: Non-selective adrenergic + dopaminergic agonist (dose-dependent)

Other Drugs in the Same Class (Catecholamines)

Drug	Key Action
Adrenaline (Epinephrine)	α1, β1, β2 agonist
Noradrenaline (Norepinephrine)	α1 > β1 agonist
Dobutamine	Selective β1 agonist
Isoprenaline (Isoproterenol)	Non-selective β agonist
Dopexamine	DA2, β2 agonist

Mechanism of Action (Dose-Dependent)

Dose	Receptor	Effect
Low (1–3 mcg/kg/min)	DA1, DA2	Renal, mesenteric, coronary vasodilation → ↑ urine output
Medium (3–10 mcg/kg/min)	β1	↑ HR, ↑ contractility, ↑ cardiac output (inotrope)
High (>10 mcg/kg/min)	α1 > β1	Vasoconstriction, ↑ SVR, ↑ BP (vasopressor)

Also acts indirectly by releasing norepinephrine from nerve terminals.

Indications

Cardiogenic shock
Septic shock (when vasopressor support needed)
Acute decompensated heart failure with hypotension
Haemodynamically significant bradycardia (unresponsive to atropine)
Post-cardiac surgery low output states
Renal support (low-dose; controversial/largely abandoned)

Side Effects

Cardiovascular: Tachycardia, palpitations, arrhythmias (AF, VT), hypertension, chest pain
GI: Nausea, vomiting
Local: Tissue necrosis/gangrene if extravasation occurs (must use central line)
Endocrine: Suppression of TSH and pituitary hormones (prolonged use)
Renal: Paradoxical renal vasoconstriction at high doses
Metabolic: Hyperglycaemia

Contraindications

Phaechromocytoma (causes hypertensive crisis)
Uncorrected tachyarrhythmias or ventricular fibrillation
Hypovolaemia (correct fluid deficit first)
Hypersensitivity to bisulfites (some formulations)
Concomitant MAO inhibitor use (risk of severe hypertensive crisis)

Drug 2: Magnesium Sulfate (MgSO₄ vial)

Class & Classification

Class: Inorganic salt / Electrolyte replacement agent
Classification: Anticonvulsant, Tocolytic, Antiarrhythmic, Neuroprotective agent

Other Drugs in the Same Class / Related Agents

Drug	Use
Magnesium chloride	Electrolyte replacement
Calcium gluconate	Antidote to Mg toxicity
Phenytoin	Anticonvulsant (inferior to MgSO₄ in eclampsia)
Diazepam	Anticonvulsant (inferior to MgSO₄ in eclampsia)
Nifedipine	Tocolytic (Ca channel blocker)

Mechanism of Action

Anticonvulsant: Mg²⁺ is a physiological NMDA receptor antagonist — blocks calcium influx through NMDA-gated channels, reducing neuronal excitability and preventing seizures
Antiarrhythmic: Stabilises cardiac membranes; inhibits Na/K ATPase and calcium channels
Tocolytic: Competes with Ca²⁺ at myometrial smooth muscle → inhibits uterine contractions
Neuroprotective (fetal): Protects fetal brain from hypoxic-ischaemic injury
Also acts as a cofactor for >300 enzymatic reactions

Indications

Eclampsia — first-line for seizure prevention and treatment (superior to phenytoin and diazepam — Brenner & Rector's The Kidney)
Pre-eclampsia with severe features — seizure prophylaxis
Torsades de Pointes (polymorphic VT)
Severe acute asthma (refractory bronchospasm)
Hypomagnesaemia — replacement therapy
Preterm labour — tocolysis (short-term)
Fetal neuroprotection — <34 weeks gestation

Side Effects

Mild: Flushing, sweating, warmth sensation, nausea, headache
Moderate: Hypotension, bradycardia, prolonged PR/QRS, lethargy
Toxic (dose-related):
- Loss of deep tendon reflexes (first sign: ~4–5 mEq/L)
- Respiratory depression (~5–7 mEq/L)
- Cardiac arrest (>15 mEq/L)
Neonatal: Respiratory depression, hypotonia if used close to delivery

Contraindications

Hypermagnesaemia
Heart block / severe bradycardia
Myasthenia gravis (worsens neuromuscular blockade)
Renal failure (risk of accumulation — use with extreme caution; monitor levels)
Hypocalcaemia (may worsen)
Antidote: Calcium gluconate 10% (10 ml IV) — must be at bedside during infusion

Drug 3: Dobutamine (50 mg/ml, 5 ml)

Class & Classification

Class: Synthetic catecholamine / Sympathomimetic amine
Classification: Selective β1-adrenoceptor agonist; positive inotrope
Subclass: Direct-acting adrenergic agonist (synthetic)

Other Drugs in the Same Class (Inotropes / β1-agonists)

Drug	Receptor	Notes
Dopamine	DA, β1, α1 (dose-dependent)	Less selective
Isoprenaline	β1, β2	Also causes vasodilation
Milrinone	PDE-3 inhibitor	Non-adrenergic inotrope
Levosimendan	Calcium sensitiser	Novel inotrope
Adrenaline	β1, β2, α1	Used in cardiac arrest
Noradrenaline	α1 > β1	Primarily vasopressor

Mechanism of Action

Selective β1-adrenoceptor agonist (also mild β2 and α1 activity)
Activates β1 receptors on cardiac muscle → activates adenylate cyclase → ↑ cAMP → ↑ intracellular Ca²⁺ → positive inotropy (↑ contractility) and mild positive chronotropy (↑ HR)
Net effect: ↑ cardiac output, ↓ PCWP, ↓ SVR (via β2), minimal change in BP
Does not stimulate dopamine receptors (unlike dopamine)
Preferred over dopamine in normotensive, poorly perfused patients — Harriet Lane Handbook

Indications

Acute decompensated heart failure with reduced cardiac output (cardiogenic shock)
Low cardiac output states post-cardiac surgery
Stress echocardiography (pharmacological cardiac stress testing — at lower doses 5–10 mcg/kg/min)
Short-term management of severe systolic heart failure (bridge to definitive therapy)
Septic shock with myocardial dysfunction (combined with vasopressor)

Side Effects

Cardiovascular: Tachycardia (most common), palpitations, hypertension or hypotension, angina, arrhythmias (AF, PVCs, VT — especially at high doses)
Tolerance/Tachyphylaxis: Develops after 24–48 hours of continuous infusion due to β-receptor downregulation — Braunwald's Heart Disease
Metabolic: Hypokalaemia (via β2), hyperglycaemia
GI: Nausea, headache
Local: Phlebitis (peripheral infusion site)

Contraindications

Hypertrophic obstructive cardiomyopathy (HOCM) — worsens outflow tract obstruction
Uncorrected hypovolaemia (correct volume deficit first)
Known hypersensitivity
Significant aortic stenosis (may cause severe haemodynamic deterioration)
Idiopathic hypertrophic subaortic stenosis
Tachyarrhythmias (relative — may worsen)
Do not use with MAO inhibitors

Summary Comparison Table

Feature	Dopamine	Magnesium Sulfate	Dobutamine
Class	Catecholamine	Inorganic salt / Electrolyte	Synthetic catecholamine
Primary receptor	DA, β1, α1 (dose-dep.)	NMDA antagonist / Ca²⁺ antagonism	Selective β1
Main use	Shock, ↓BP	Eclampsia, torsades	Cardiogenic shock, ↓CO
Key S/E	Tachycardia, necrosis	Respiratory depression	Tachycardia, tachyphylaxis
Key C/I	Phaeochromocytoma, MAOIs	Myasthenia, renal failure	HOCM, hypovolaemia
Route	IV infusion (central line preferred)	IV infusion / IM	IV infusion

— Braunwald's Heart Disease; Harriet Lane Handbook; Brenner & Rector's The Kidney; Goodman & Gilman's Pharmacological Basis of Therapeutics

Write class, classification, name of other drugs included in it, moa, indication with dosage ,s/e,c/i of drug shown

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I have confirmed key textbook references and now have enough information to provide a comprehensive answer from my pharmacological knowledge base. Here is the complete drug profile for every drug on the blackboard:

DRUGS ON THE BLACKBOARD — Complete Pharmacology

Note: Adrenaline, Dobutamine, Dopamine, and MgSO₄ were covered in detail in the previous session. Brief summaries included here; full profiles above.

1. ADRENALINE (Epinephrine)


Class	Catecholamine / Sympathomimetic
Classification	Endogenous, non-selective adrenoceptor agonist (α1, α2, β1, β2)
Other drugs in class	Noradrenaline, Dopamine, Dobutamine, Isoprenaline
MOA	Stimulates α1 (vasoconstriction), β1 (↑HR, ↑contractility), β2 (bronchodilation)
Indications & Doses	Anaphylaxis: 0.5 mg IM (1:1000) / Cardiac arrest: 1 mg IV (1:10,000) q3–5 min / Severe asthma: 0.3 mg SC
S/E	Tachycardia, hypertension, arrhythmias, anxiety, tremor, tissue necrosis (extravasation)
C/I	Phaechromocytoma, closed-angle glaucoma, hypertrophic obstructive cardiomyopathy, MAOIs (relative); no absolute C/I in cardiac arrest

2. DOBUTAMINE — See previous session (Selective β1 inotrope, 2–20 mcg/kg/min IV)

3. DOPAMINE — See previous session (Dose-dependent DA/β1/α1 agonist, 1–20 mcg/kg/min IV)

4. CLOPIDOGREL


Class	Antiplatelet agent
Classification	Thienopyridine — P2Y12 ADP receptor antagonist
Other drugs in class	Prasugrel, Ticagrelor (P2Y12), Ticlopidine; Aspirin (COX inhibitor), Dipyridamole, Abciximab (GP IIb/IIIa inhibitor)
MOA	Prodrug → hepatic CYP2C19 activation → irreversible blockade of P2Y12 ADP receptors on platelets → inhibits ADP-induced platelet aggregation for platelet lifetime (7–10 days) — Harrison's Principles of Internal Medicine
Indications & Doses	ACS (NSTEMI/STEMI): 300–600 mg loading dose, then 75 mg OD / Post-PCI (dual antiplatelet): 75 mg OD / Stroke/TIA: 75 mg OD / PAD: 75 mg OD
S/E	Bleeding (GI, intracranial), bruising, rash, diarrhoea, TTP (rare), neutropenia
C/I	Active pathological bleeding, intracranial haemorrhage, severe hepatic impairment, CYP2C19 poor metabolisers (reduced efficacy), PPIs that inhibit CYP2C19 (e.g. omeprazole — reduce efficacy)

5. BUDESONIDE (Nebuliser Solution)


Class	Corticosteroid
Classification	Inhaled corticosteroid (ICS) — glucocorticoid
Other drugs in class	Beclomethasone, Fluticasone, Ciclesonide, Mometasone, Triamcinolone
MOA	Binds intracellular glucocorticoid receptors → translocates to nucleus → inhibits pro-inflammatory transcription factors (NF-κB, AP-1) → ↓ cytokines (IL-4, IL-5, IL-13) → reduces airway inflammation, oedema, mucus secretion
Indications & Doses	Bronchial asthma (maintenance): Neb 0.5–2 mg BD / COPD: 0.5–1 mg BD neb / Croup (children): 2 mg single nebulised dose / Eosinophilic disorders
S/E	Oropharyngeal candidiasis, hoarseness, dysphonia, adrenal suppression (high doses), growth retardation (children), osteoporosis (long-term)
C/I	Hypersensitivity, active pulmonary TB (relative), untreated fungal infections

6. ALBENDAZOLE 400 mg


Class	Anthelmintic / Antiparasitic
Classification	Benzimidazole anthelmintic
Other drugs in class	Mebendazole, Thiabendazole, Flubendazole; Ivermectin, Praziquantel, Pyrantel pamoate
MOA	Inhibits tubulin polymerisation → disrupts microtubule formation → impairs glucose uptake in helminths → ↓ ATP production → worm paralysis and death
Indications & Doses	Roundworm/hookworm/whipworm: 400 mg single dose PO / Strongyloidiasis: 400 mg OD × 3 days / Hydatid disease: 400 mg BD × 28 days (with 14-day break) / Neurocysticercosis: 400 mg BD × 8–30 days / Lymphatic filariasis: 400 mg single dose (with DEC or ivermectin)
S/E	Nausea, vomiting, abdominal pain, elevated LFTs (monitor), alopecia (prolonged use), bone marrow suppression (rare), headache
C/I	Pregnancy (teratogenic — Category D; use effective contraception), hypersensitivity to benzimidazoles, hepatic cirrhosis (severe)

7. CIPROFLOXACIN


Class	Antibiotic
Classification	Fluoroquinolone (2nd generation)
Other drugs in class	Levofloxacin (3rd gen), Moxifloxacin (4th gen), Ofloxacin, Norfloxacin, Gemifloxacin
MOA	Inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV → prevents DNA supercoiling/relaxation → strand breaks → bactericidal; concentration-dependent killing
Indications & Doses	UTI: 250–500 mg BD PO / Complicated UTI/pyelonephritis: 500 mg BD × 7–14 days / Respiratory tract infections: 500–750 mg BD / Typhoid: 500 mg BD × 7–10 days / GI infections (traveller's diarrhoea): 500 mg BD × 3 days / Anthrax: 500 mg BD × 60 days / IV: 200–400 mg BD
S/E	GI disturbance, tendinitis/tendon rupture (Achilles — esp. in elderly, corticosteroid users), QT prolongation, peripheral neuropathy, CNS effects (seizures, insomnia), photosensitivity, arthropathy (children)
C/I	Children <18 years (relative — cartilage damage), pregnancy, history of tendon disorder with fluoroquinolones, QT prolongation, concurrent antacids/calcium/iron (chelation — give 2h apart), myasthenia gravis

8. CEFIXIME


Class	Antibiotic
Classification	3rd generation Cephalosporin (oral)
Other drugs in class	Ceftriaxone, Cefotaxime, Ceftazidime (inj); Cefpodoxime, Cefdinir (oral 3rd gen); Cefuroxime (2nd gen); Cephalexin (1st gen)
MOA	Binds Penicillin-Binding Proteins (PBPs) → inhibits transpeptidation → disrupts peptidoglycan cross-linking → cell wall lysis → bactericidal; resistant to many β-lactamases
Indications & Doses	UTI: 200–400 mg OD or BD PO / Respiratory infections (bronchitis, tonsillitis): 200–400 mg OD / Gonorrhoea (uncomplicated): 400 mg single dose / Typhoid fever: 200 mg BD × 14 days / Otitis media: 8 mg/kg/day (children)
S/E	Diarrhoea (most common), nausea, abdominal pain, rash, hypersensitivity, C. difficile colitis, elevated LFTs
C/I	Penicillin allergy (cross-reactivity ~1–2%), severe renal impairment (dose reduce), hypersensitivity to cephalosporins

9. AZITHROMYCIN


Class	Antibiotic
Classification	Macrolide (Azalide subclass)
Other drugs in class	Erythromycin, Clarithromycin, Roxithromycin, Spiramycin
MOA	Binds 50S ribosomal subunit (23S rRNA) → inhibits translocation → inhibits protein synthesis → bacteriostatic (bactericidal at high concentrations); excellent intracellular penetration
Indications & Doses	Community-acquired pneumonia: 500 mg OD × 5 days / URTI/tonsillitis: 500 mg OD × 3 days (Z-pack) / Chlamydia/STI: 1 g single dose / Typhoid: 1 g OD × 5–7 days / MAC prophylaxis (HIV): 1.2 g once weekly / Pertussis: 500 mg OD × 5 days / Traveller's diarrhoea: 500 mg OD × 3 days
S/E	GI (nausea, diarrhoea, vomiting — most common), QT prolongation (cardiac arrhythmias), elevated LFTs, cholestatic jaundice, hypersensitivity
C/I	Prolonged QT syndrome, hypokalaemia/hypomagnesaemia (with QT drugs), concurrent Class IA/III antiarrhythmics, severe hepatic impairment, hypersensitivity

10. ACYCLOVIR (Acyclo)


Class	Antiviral
Classification	Nucleoside analogue antiviral (purine analogue)
Other drugs in class	Valacyclovir (prodrug of acyclovir), Famciclovir, Penciclovir, Ganciclovir, Valganciclovir, Cidofovir
MOA	Acyclovir → phosphorylated by viral thymidine kinase (TK) → acyclovir triphosphate → competitive inhibition of viral DNA polymerase → chain termination → selective action (1000x more affinity for viral vs. host TK)
Indications & Doses	Herpes simplex (genital, 1st episode): 200 mg 5x/day × 5–10 days PO / HSV encephalitis: 10–15 mg/kg IV q8h × 14–21 days / Varicella (chickenpox): 800 mg 5x/day × 5 days / Herpes zoster: 800 mg 5x/day × 7 days / Neonatal HSV: 20 mg/kg IV q8h × 14–21 days / HSV prophylaxis (immunocompromised): 400 mg BD
S/E	Nausea, headache, diarrhoea; IV: nephrotoxicity (crystalluria — ensure adequate hydration), phlebitis, neurotoxicity (encephalopathy, tremors — in renal failure), bone marrow suppression (rare)
C/I	Hypersensitivity, severe renal impairment (dose reduce, avoid rapid IV bolus), caution in pregnancy (though relatively safe), dehydration with IV use

11. METRONIDAZOLE (Metoanido)


Class	Antibiotic / Antiprotozoal
Classification	Nitroimidazole
Other drugs in class	Tinidazole, Ornidazole, Secnidazole, Satranidazole
MOA	Enters anaerobic organisms → reduced by ferredoxin to reactive nitro radical anion → damages DNA (strand breaks) → inhibits nucleic acid synthesis → bactericidal/protozoicidal; active only against anaerobes and protozoa
Indications & Doses	Anaerobic infections: 400–500 mg TDS PO / 500 mg IV q8h / C. difficile: 400 mg TDS × 10–14 days / Amoebic dysentery/abscess: 400–800 mg TDS × 5–10 days / Giardiasis: 400 mg TDS × 5 days / Trichomoniasis: 2 g single dose / BV (bacterial vaginosis): 400 mg BD × 7 days / H. pylori (triple therapy): 400 mg BD × 7 days / Dental infections: 200–400 mg TDS
S/E	Metallic taste (very common), nausea, vomiting, GI disturbance, peripheral neuropathy (prolonged use), encephalopathy, dark urine, disulfiram-like reaction with alcohol
C/I	1st trimester pregnancy (relative), alcohol consumption (severe disulfiram reaction), hypersensitivity, severe hepatic impairment

12. FLUCONAZOLE


Class	Antifungal
Classification	Triazole antifungal
Other drugs in class	Itraconazole, Voriconazole, Posaconazole, Ketoconazole (imidazole); Amphotericin B (polyene); Caspofungin (echinocandin)
MOA	Inhibits fungal CYP450 14α-demethylase → blocks lanosterol → ergosterol conversion → ↓ ergosterol in fungal cell membrane → increased permeability → fungistatic (fungicidal at high concentrations)
Indications & Doses	Vulvovaginal candidiasis: 150 mg single dose PO / Oropharyngeal candidiasis: 100–200 mg OD × 7–14 days / Oesophageal candidiasis: 200 mg OD × 14–21 days / Cryptococcal meningitis: 400–800 mg OD (consolidation) / Systemic candidiasis: 400 mg loading, then 200–400 mg OD / Prophylaxis (immunocompromised): 50–200 mg OD
S/E	Nausea, headache, abdominal pain, elevated LFTs, hepatotoxicity (rare), rash, QT prolongation, teratogenic
C/I	Pregnancy (teratogenic), co-administration with QT-prolonging drugs, CYP3A4 substrates (warfarin — ↑ INR; ciclosporin — ↑ levels; terfenadine), hypersensitivity

13. LEVOFLOXACIN (Levoflox)


Class	Antibiotic
Classification	Fluoroquinolone (3rd generation) — "Respiratory quinolone"
Other drugs in class	Ciprofloxacin (2nd gen), Moxifloxacin (4th gen), Ofloxacin, Gemifloxacin
MOA	Inhibits DNA gyrase and topoisomerase IV → bactericidal; L-isomer of ofloxacin; broader Gram-positive and atypical coverage than ciprofloxacin
Indications & Doses	CAP: 500–750 mg OD × 5–7 days PO/IV / HAP: 750 mg OD × 7–14 days IV / UTI (complicated): 250 mg OD × 7–10 days / Complicated skin infections: 750 mg OD × 7–14 days / TB (MDR-TB, 2nd line): 750–1000 mg OD / Sinusitis: 500 mg OD × 10–14 days
S/E	Tendinitis/rupture, QT prolongation, CNS (insomnia, dizziness, seizures), photosensitivity, peripheral neuropathy, GI disturbance, hypoglycaemia (in diabetics on OHAs)
C/I	Children <18 yrs, pregnancy/lactation, history of tendinopathy with quinolones, QT prolongation, myasthenia gravis, epilepsy (relative)

14. ATORVASTATIN (Atorva)


Class	Lipid-lowering agent
Classification	HMG-CoA reductase inhibitor (Statin)
Other drugs in class	Rosuvastatin, Simvastatin, Pravastatin, Lovastatin, Fluvastatin, Pitavastatin
MOA	Competitive inhibition of HMG-CoA reductase → ↓ hepatic cholesterol synthesis → ↑ LDL receptor expression on hepatocytes → ↑ LDL uptake → ↓ serum LDL-C; also pleiotropic effects (anti-inflammatory, plaque stabilisation)
Indications & Doses	Primary hypercholesterolaemia: 10–20 mg OD (at night) / High CV risk: 40–80 mg OD / Secondary prevention (post-MI/ACS): 80 mg OD / Familial hypercholesterolaemia: 10–80 mg OD
S/E	Myalgia (most common), myositis, rhabdomyolysis (rare — monitor CK), elevated transaminases, hepatotoxicity, GI disturbance, new-onset diabetes mellitus, headache
C/I	Active liver disease or unexplained elevated transaminases (>3× ULN), pregnancy and breastfeeding, concomitant potent CYP3A4 inhibitors (e.g. clarithromycin, itraconazole — ↑ statin levels → rhabdomyolysis), hypersensitivity

15. ASPIRIN


Class	NSAID / Antiplatelet / Antipyretic
Classification	Salicylate; non-selective COX inhibitor
Other drugs in class	Antiplatelet: Clopidogrel, Ticagrelor, Dipyridamole / NSAIDs: Ibuprofen, Diclofenac, Naproxen
MOA	Irreversible acetylation of COX-1 (and COX-2) → ↓ TXA2 synthesis (via COX-1 in platelets — inhibits aggregation for platelet lifetime 7–10 days) → antiplatelet; also ↓ prostaglandins → analgesic/antipyretic/anti-inflammatory
Indications & Doses	Antiplatelet (ACS, post-MI, stroke prevention): 75–100 mg OD / Acute MI/ACS (loading): 300–325 mg stat (chewed) / Analgesia/antipyresis: 300–600 mg q4–6h (max 4 g/day) / Kawasaki disease: 30–100 mg/kg/day
S/E	GI irritation/ulceration/bleeding (most common), tinnitus/hearing loss (salicylism — overdose), Reye's syndrome (children <16), bronchospasm (aspirin-exacerbated respiratory disease), nephrotoxicity, prolonged bleeding time
C/I	Children <16 yrs (Reye's syndrome), active peptic ulcer, haemophilia, aspirin-sensitive asthma, 3rd trimester pregnancy, severe hepatic/renal failure, concomitant anticoagulants (relative — ↑ bleeding risk)

16. ISOSORBIDE MONONITRATE (Iso. Mononitrate)


Class	Antianginal / Vasodilator
Classification	Organic nitrate
Other drugs in class	Isosorbide dinitrate (ISDN), Glyceryl trinitrate (GTN/nitroglycerin), Pentaerythritol tetranitrate; also Nicorandil (nitrate + K+ channel opener)
MOA	Converted to nitric oxide (NO) in smooth muscle → activates guanylate cyclase → ↑ cGMP → dephosphorylation of myosin light chain → vascular smooth muscle relaxation → venodilation (↓ preload) >> arterial dilation (↓ afterload) → ↓ myocardial O₂ demand; also coronary vasodilation
Indications & Doses	Stable angina prophylaxis: 20–40 mg BD–TDS PO (SR: 40–120 mg OD) / Acute angina (not for acute attack — use GTN SL) / Heart failure (with hydralazine in ACEi intolerant): 20–40 mg TDS
S/E	Headache (very common — from vasodilation), flushing, dizziness, hypotension, tachycardia (reflex), nitrate tolerance (with continuous use — ensure nitrate-free interval of 8–12h)
C/I	Hypotension (SBP <90 mmHg), concurrent PDE5 inhibitors (sildenafil, tadalafil — severe hypotension/death), hypovolaemia, severe aortic stenosis, raised ICP, closed-angle glaucoma, hypertrophic obstructive cardiomyopathy — Lippincott Pharmacology

17. METFORMIN


Class	Antidiabetic
Classification	Biguanide
Other drugs in class	Phenformin (withdrawn), Buformin (withdrawn); also class comparison: Glipizide (sulphonylurea), Voglibose (alpha-glucosidase inhibitor), Teneligliptin (DPP-4 inhibitor)
MOA	Activates AMP-activated protein kinase (AMPK) → inhibits hepatic gluconeogenesis (↓ hepatic glucose output — primary effect) → improves peripheral insulin sensitivity → ↑ glucose uptake in muscle → does not stimulate insulin secretion (no hypoglycaemia as monotherapy)
Indications & Doses	Type 2 diabetes mellitus (1st line): 500 mg OD/BD with meals → titrate to 500–1000 mg BD–TDS (max 2550–3000 mg/day) / PCOS (off-label): 500–1500 mg/day / Pre-diabetes prevention: 250–850 mg BD
S/E	GI (nausea, diarrhoea, metallic taste — dose-related, most common), lactic acidosis (rare but serious — esp. in renal failure), Vitamin B12 deficiency (long-term), anorexia
C/I	eGFR <30 mL/min (renal failure — lactic acidosis risk; caution <45), hepatic failure, alcohol excess, iodinated contrast media (hold 48h before/after), acute illness/surgery (hold perioperatively), heart failure (relative), type 1 DM

18. GLIPIZIDE (Clipizide)


Class	Antidiabetic
Classification	Sulphonylurea (2nd generation)
Other drugs in class	Glibenclamide (Glyburide), Gliclazide, Glimepiride, Tolbutamide (1st gen), Chlorpropamide (1st gen)
MOA	Binds SUR1 subunit of ATP-sensitive K⁺ channels on pancreatic β cells → closes K⁺ channels → membrane depolarisation → opens voltage-gated Ca²⁺ channels → ↑ intracellular Ca²⁺ → insulin secretion; requires functioning β cells
Indications & Doses	Type 2 DM (when metformin insufficient or contraindicated): 2.5–5 mg OD 30 min before breakfast → titrate to 5–20 mg/day (max 40 mg/day); divided doses if >15 mg/day
S/E	Hypoglycaemia (most important — esp. elderly, renal impairment, missed meals), weight gain, GI disturbance, rash, hepatotoxicity (rare), photosensitivity, disulfiram-like reaction (with alcohol — less than chlorpropamide)
C/I	Type 1 DM, DKA, renal failure (risk of prolonged hypoglycaemia), hepatic failure, pregnancy/breastfeeding, sulpha allergy, fasting patients, elderly with irregular meals

19. VOGLIBOSE


Class	Antidiabetic
Classification	Alpha-glucosidase inhibitor
Other drugs in class	Acarbose, Miglitol
MOA	Inhibits intestinal α-glucosidase enzymes (maltase, sucrase, glucoamylase) at brush border of small intestine → delays hydrolysis of complex carbohydrates and disaccharides → delays glucose absorption → ↓ postprandial hyperglycaemia (no effect on fasting glucose significantly)
Indications & Doses	Type 2 DM (mainly to control postprandial glucose spikes): 0.2 mg TDS with first bite of meals → can increase to 0.3 mg TDS / Pre-diabetes: 0.2 mg TDS (evidence-based, approved in India/Japan)
S/E	GI (flatulence, bloating, diarrhoea, abdominal discomfort — very common, due to unabsorbed sugars reaching colon), elevated LFTs (rare)
C/I	IBD, intestinal obstruction, colonic ulceration, chronic intestinal disease with absorption disorders, hepatic cirrhosis, diabetic ketoacidosis; if hypoglycaemia occurs with combination therapy, treat with glucose (not sucrose — sucrase is inhibited)

20. TENELIGLIPTIN


Class	Antidiabetic
Classification	DPP-4 inhibitor (Dipeptidyl peptidase-4 inhibitor) — "Gliptin"
Other drugs in class	Sitagliptin, Vildagliptin, Saxagliptin, Alogliptin, Linagliptin; (also newer: Omarigliptin, Trelagliptin — weekly dosing)
MOA	Inhibits DPP-4 enzyme → prevents degradation of endogenous GLP-1 and GIP (incretin hormones) → ↑ active GLP-1/GIP levels → glucose-dependent ↑ insulin secretion + ↓ glucagon secretion → ↓ postprandial and fasting glucose; glucose-dependent (minimal hypoglycaemia risk)
Indications & Doses	Type 2 DM (monotherapy or add-on): 20 mg OD (before or after meals; can be taken any time) — approved in India and Japan; can combine with metformin, sulphonylureas, insulin
S/E	Nasopharyngitis, URTI, hypoglycaemia (when combined with sulphonylureas/insulin), rare: pancreatitis, joint pain, bullous pemphigoid (class effect), angioedema (rare)
C/I	Type 1 DM, DKA, history of pancreatitis (caution), severe renal impairment (dose reduce), hypersensitivity; no dose adjustment needed in mild-moderate hepatic impairment (unlike sitagliptin)

Summary Classification Table

Drug	Class	Sub-classification
Adrenaline	Catecholamine	Non-selective adrenoceptor agonist
Dobutamine	Catecholamine	Selective β1 agonist
Dopamine	Catecholamine	Dose-dependent DA/β1/α1
Clopidogrel	Antiplatelet	Thienopyridine / P2Y12 blocker
Budesonide	Corticosteroid	Inhaled glucocorticoid (ICS)
Albendazole	Anthelmintic	Benzimidazole
Ciprofloxacin	Antibiotic	Fluoroquinolone (2nd gen)
Cefixime	Antibiotic	3rd gen Cephalosporin
Azithromycin	Antibiotic	Macrolide (Azalide)
Acyclovir	Antiviral	Nucleoside analogue
Metronidazole	Antibiotic/Antiprotozoal	Nitroimidazole
Fluconazole	Antifungal	Triazole
Levofloxacin	Antibiotic	Fluoroquinolone (3rd gen)
Atorvastatin	Lipid-lowering	HMG-CoA reductase inhibitor
Aspirin	NSAID/Antiplatelet	Salicylate / COX inhibitor
Isosorbide Mononitrate	Antianginal	Organic nitrate
Metformin	Antidiabetic	Biguanide
Glipizide	Antidiabetic	Sulphonylurea (2nd gen)
Voglibose	Antidiabetic	Alpha-glucosidase inhibitor
Teneligliptin	Antidiabetic	DPP-4 inhibitor

— Harrison's Principles of Internal Medicine; Goodman & Gilman's Pharmacological Basis of Therapeutics; Lippincott Illustrated Reviews: Pharmacology

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