💊 Complete Drug Pharmacology Reference

1. ASCARD 75mg = Aspirin (Acetylsalicylic Acid)


MOA	Irreversibly acetylates and inhibits platelet COX-1 enzyme → blocks thromboxane A2 (TXA2) synthesis → prevents platelet aggregation. At low doses (75–325 mg), antiplatelet effect predominates.
Clinical Uses	Antiplatelet: ACS, MI prevention, ischemic stroke, post-CABG, PCI. Also analgesic/antipyretic/anti-inflammatory at higher doses.
Adverse Effects	GI ulceration/bleeding, GI upset, tinnitus (high doses), bleeding risk, hypersensitivity (aspirin-exacerbated respiratory disease), Reye's syndrome (children)
Contraindications	Active GI ulcer/bleeding, hemophilia, children with viral illness (Reye's), aspirin hypersensitivity/asthma, last trimester of pregnancy

2. BETNOVATE-N Ointment = Betamethasone Valerate + Neomycin Sulfate


MOA	Betamethasone (potent corticosteroid): binds glucocorticoid receptors → suppresses phospholipase A2 → reduces arachidonic acid → anti-inflammatory. Neomycin (aminoglycoside): binds 30S ribosomal subunit → mistranslation of mRNA → bactericidal
Clinical Uses	Infected inflammatory skin conditions: infected eczema, infected dermatitis, otitis externa, secondarily infected psoriasis
Adverse Effects	Skin atrophy, striae, telangiectasia, hypertrichosis, contact dermatitis to neomycin, HPA axis suppression (if large area/prolonged), local neomycin sensitization
Contraindications	Untreated fungal/viral skin infections (herpes, varicella), rosacea, perioral dermatitis, acne, use on face (prolonged), hypersensitivity to neomycin

3. TRAMAL 100mg = Tramadol


MOA	Dual mechanism: (1) Weak μ-opioid receptor agonist (partial); (2) Inhibits reuptake of serotonin and norepinephrine in descending pain pathways → central analgesia
Clinical Uses	Moderate-to-severe pain (post-operative, cancer pain, musculoskeletal, neuropathic pain), chronic pain management
Adverse Effects	Nausea, vomiting, dizziness, constipation, somnolence, seizures (dose-related), serotonin syndrome (with SSRIs/MAOIs), dependence/withdrawal, respiratory depression (less than morphine)
Contraindications	Concurrent MAOI use, seizure disorders (↓ threshold), acute intoxication with alcohol/opioids/psychotropics, severe hepatic/renal impairment, pregnancy, under 12 years

4. ROVISTA 20mg = Rosuvastatin


MOA	Competitively inhibits HMG-CoA reductase (rate-limiting enzyme in cholesterol biosynthesis in the liver) → ↓ hepatic cholesterol → upregulation of LDL receptors → ↑ LDL clearance from blood
Clinical Uses	Hypercholesterolemia, mixed dyslipidemia, cardiovascular risk reduction (primary & secondary prevention), hypertriglyceridemia; also used in ACS as high-intensity statin
Adverse Effects	Myalgia, myopathy, rhabdomyolysis (rare but serious), raised LFTs/hepatotoxicity, headache, GI disturbances, new-onset diabetes mellitus
Contraindications	Active liver disease, unexplained persistent ↑ LFTs, pregnancy & breastfeeding, concurrent use with certain antivirals (protease inhibitors), severe renal impairment

5. NOSPA 2ml = Drotaverine (No-Spa)


MOA	Selective PDE-4 inhibitor (phosphodiesterase 4) → ↑ intracellular cAMP → smooth muscle relaxation (antispasmodic). More selective for smooth muscle than papaverine; no anticholinergic activity.
Clinical Uses	Smooth muscle spasms: biliary colic, renal colic, ureteral colic, intestinal/colonic spasm, dysmenorrhea, uterine spasm in labor
Adverse Effects	Dizziness, headache, hypotension, nausea, tachycardia, palpitations (generally well tolerated)
Contraindications	Severe hepatic/renal/cardiac failure, hypotension, hypersensitivity; caution in hypotension

6. CALCIUM GLUCONATE (IV)


MOA	Provides ionized calcium (Ca²⁺) → membrane stabilization (cardiac myocytes); counteracts hyperkalemia by stabilizing cardiac membrane potential; activates enzyme systems; required for coagulation cascade
Clinical Uses	Hypocalcemia, hyperkalemia (cardiac protection — does NOT lower K⁺), hypocalcemic tetany, magnesium toxicity antidote, citrate toxicity (massive transfusion), black widow spider envenomation
Adverse Effects	Bradycardia/cardiac arrest if given too fast IV, hypercalcemia, tissue necrosis if extravasation occurs, flushing, nausea
Contraindications	Hypercalcemia, ventricular fibrillation, digoxin toxicity (↑ risk of arrhythmia), concurrent thiazide diuretics (risk of hypercalcemia)

7. NEZKIL 600mg = N-Acetylcysteine (NAC)


MOA	Precursor to glutathione → replenishes glutathione stores → antioxidant; also mucolytic (cleaves disulfide bonds in mucus glycoproteins → reduces viscosity); in paracetamol overdose, regenerates glutathione to detoxify NAPQI
Clinical Uses	Mucolytic (COPD, cystic fibrosis, bronchiectasis), paracetamol/acetaminophen overdose (gold standard antidote), contrast-induced nephropathy prevention, hepatic failure
Adverse Effects	Nausea, vomiting, rash, anaphylactoid reaction (IV infusion — flushing, bronchospasm, urticaria), unpleasant odor
Contraindications	Hypersensitivity to NAC; caution in asthma (may precipitate bronchospasm — especially IV)

8. METXONE 5mg = Metoclopramide


MOA	D2 receptor antagonist (central & peripheral) + 5-HT4 agonist → ↑ gastric motility and gastric emptying, ↑ lower esophageal sphincter tone, central antiemetic (blocks CTZ dopamine receptors)
Clinical Uses	Nausea & vomiting (post-op, chemo, gastroparesis), gastroesophageal reflux, diabetic gastroparesis, as prokinetic agent
Adverse Effects	Tardive dyskinesia (long-term use — irreversible), acute dystonia/extrapyramidal reactions, akathisia, Parkinsonism, hyperprolactinemia (galactorrhea, amenorrhea), drowsiness
Contraindications	GI obstruction/perforation, pheochromocytoma, Parkinson's disease, history of tardive dyskinesia, epilepsy, concurrent dopamine agonists; avoid >3 months (tardive dyskinesia risk)

9. TRES-ORIX FORTE Syrup = Cyproheptadine + B-vitamins + Lysine


MOA	Cyproheptadine: first-gen H1 antihistamine + serotonin (5-HT2) antagonist → appetite stimulation (blocks serotonin-mediated satiety signals) + antiallergic effects. B-vitamins (B1, B2, B6, B12): cofactors in metabolism. Lysine: essential amino acid for protein synthesis.
Clinical Uses	Poor appetite/anorexia, failure to thrive, weight gain stimulation, allergic conditions (rhinitis, urticaria), prevention of migraines
Adverse Effects	Drowsiness, sedation, dry mouth, urinary retention, constipation, weight gain, dizziness
Contraindications	Glaucoma, BPH/urinary retention, asthma/COPD (may thicken secretions), MAOIs, neonates/premature infants, elderly (increased CNS effects)

10. LOWPLAT 75mg = Clopidogrel


MOA	Prodrug → activated by CYP2C19 in liver → active metabolite irreversibly binds P2Y12 ADP receptor on platelets → inhibits ADP-induced platelet aggregation (irreversible for platelet's lifetime ~7–10 days)
Clinical Uses	ACS (with or without PCI), ischemic stroke/TIA, peripheral arterial disease; dual antiplatelet therapy (DAPT) with aspirin post-stent
Adverse Effects	Bleeding (major concern), GI bleeding, TTP (rare but serious), rash, neutropenia, bruising
Contraindications	Active bleeding, peptic ulcer, intracranial hemorrhage, severe hepatic impairment (impaired prodrug activation), CYP2C19 poor metabolizers (reduced efficacy), concomitant strong CYP2C19 inhibitors (e.g., omeprazole — reduces efficacy)

11. VADIL 3.125mg = Carvedilol


MOA	Non-selective β1 + β2 blocker + α1 blocker → negative chronotropy/inotropy (β) + vasodilation (α1 blockade) + antioxidant properties. No intrinsic sympathomimetic activity.
Clinical Uses	Heart failure with reduced EF (HFrEF) — reduces mortality, hypertension, post-MI LV dysfunction, stable angina
Adverse Effects	Bradycardia, hypotension, dizziness, fatigue, worsening HF on initiation, bronchospasm (β2 blockade), hyperglycemia masking, peripheral coldness, fluid retention
Contraindications	Acute decompensated HF, severe bradycardia/heart block (2nd/3rd degree), cardiogenic shock, severe asthma/COPD, sick sinus syndrome without pacemaker

12. ALDACTONE 100mg = Spironolactone


MOA	Competitive aldosterone receptor antagonist in collecting tubules → blocks Na⁺/K⁺ exchange → natriuresis + K⁺ sparing. Also has anti-androgenic properties (weak).
Clinical Uses	Heart failure (HFrEF) — reduces mortality, hyperaldosteronism (primary & secondary), hypertension, ascites in cirrhosis, edema, female-pattern hair loss, PCOS
Adverse Effects	Hyperkalemia (most dangerous), gynecomastia/breast tenderness (males), menstrual irregularities, GI upset, metabolic acidosis
Contraindications	Hyperkalemia, severe renal failure (eGFR <30), Addison's disease, concurrent use of other K⁺-sparing agents or ACE inhibitors (risk of dangerous hyperkalemia), anuria

13. MERONEM 1gm = Meropenem


MOA	Carbapenem β-lactam antibiotic → binds penicillin-binding proteins (PBPs) → inhibits bacterial cell wall synthesis (transpeptidation of peptidoglycan) → bactericidal. Resistant to most β-lactamases including ESBLs.
Clinical Uses	Severe/life-threatening infections: hospital-acquired pneumonia, septicemia, intra-abdominal infections, meningitis, febrile neutropenia, complicated UTIs, Pseudomonas infections
Adverse Effects	GI upset (nausea, diarrhea), C. difficile colitis, hypersensitivity reactions, seizures (less than imipenem), thrombophlebitis at injection site, elevated LFTs
Contraindications	Hypersensitivity to carbapenems; caution with penicillin allergy (cross-reactivity ~1%); reduces valproate levels (avoid combination — risk of seizures)

14. RISEK 40mg = Omeprazole


MOA	Proton Pump Inhibitor (PPI) → prodrug activated in acidic environment → irreversibly inhibits H⁺/K⁺-ATPase (proton pump) on gastric parietal cells → profound, long-lasting suppression of gastric acid secretion
Clinical Uses	GERD, peptic ulcer disease, H. pylori eradication (triple therapy), Zollinger-Ellison syndrome, NSAID-induced ulcer prevention, stress ulcer prophylaxis, erosive esophagitis
Adverse Effects	Headache, GI upset, hypomagnesemia (long-term), ↓ B12 absorption (long-term), C. difficile risk (long-term), osteoporosis/fractures (long-term), CYP2C19 inhibition (↓ clopidogrel efficacy)
Contraindications	Hypersensitivity; caution with clopidogrel (reduces antiplatelet efficacy); note: this patient is on both! Consider switching to pantoprazole.

15. LASIX = Furosemide


MOA	Loop diuretic → inhibits Na⁺/K⁺/2Cl⁻ cotransporter (NKCC2) in the thick ascending limb of Loop of Henle → massive natriuresis and diuresis; also causes venodilation (reduces preload acutely)
Clinical Uses	Acute pulmonary edema, chronic heart failure, hypertension, edema (hepatic, renal, cardiac), hypercalcemia, hyperkalemia (adjunct), ascites
Adverse Effects	Hypokalemia, hyponatremia, hypomagnesemia, metabolic alkalosis, dehydration, ototoxicity (high doses/IV), hyperuricemia (gout), hyperglycemia, hypocalcemia
Contraindications	Anuria/severe oliguria, sulfonamide hypersensitivity, hepatic coma, severe hypokalemia/hyponatremia, pre-coma states in hepatic cirrhosis

16. HUMAN ALBUMIN 20% (IV)


MOA	Exogenous colloid → ↑ oncotic pressure in plasma → expands intravascular volume; also binds and transports drugs, hormones, fatty acids; maintains vascular integrity
Clinical Uses	Hypoalbuminemia, cirrhotic ascites (post-paracentesis albumin replacement), spontaneous bacterial peritonitis (SBP prophylaxis), hepatorenal syndrome, burns, nephrotic syndrome, hypovolemic shock
Adverse Effects	Fluid overload/pulmonary edema (if given too fast/too much), anaphylactic reactions, fever, chills, hypotension, risk of volume overload in cardiac/renal disease
Contraindications	Cardiac failure with fluid overload, severe anemia, pulmonary edema, hypersensitivity to albumin products

17. GRAVINATE 50mg = Dimenhydrinate


MOA	Combination of diphenhydramine (H1 antihistamine) + 8-chlorotheophylline → blocks H1 receptors in vestibular nucleus and vomiting center (CTZ) + anticholinergic (muscarinic) blockade → antiemetic and anti-vertigo
Clinical Uses	Motion sickness (prevention & treatment), nausea & vomiting, vertigo, Ménière's disease, post-op nausea
Adverse Effects	Sedation/drowsiness (main effect), dry mouth, blurred vision, urinary retention, constipation, paradoxical excitation (in children)
Contraindications	Glaucoma, BPH, epilepsy, porphyria, neonates/premature infants, concurrent MAOI therapy, severe hepatic disease

18. HEPARIN 5000 IU/ml (Unfractionated)


MOA	Highly negatively charged polysaccharide → binds antithrombin III (AT-III) → conformational change in AT-III → 1000× acceleration of AT-III's inhibition of thrombin (IIa), Factor Xa, IXa, XIa, XIIa → anticoagulation
Clinical Uses	DVT/PE (treatment & prophylaxis), ACS, cardiopulmonary bypass, hemodialysis circuit anticoagulation, disseminated intravascular coagulation (DIC), VTE prophylaxis (low-dose SC)
Adverse Effects	Bleeding, Heparin-Induced Thrombocytopenia (HIT) — type I (mild, non-immune) and type II (immune-mediated, paradoxical thrombosis — serious), osteoporosis (long-term), hyperkalemia (↓ aldosterone), hypertransaminasemia
Contraindications	Active major bleeding, HIT (type II), hypersensitivity, severe thrombocytopenia, intracranial hemorrhage; caution in severe hypertension, recent surgery
Antidote	Protamine sulfate (reverses unfractionated heparin)

19. EUROCAP NS = Normal Saline (0.9% NaCl)


MOA	Isotonic crystalloid solution → distributes into extracellular fluid (intravascular + interstitial); expands plasma volume; does not significantly shift fluid into cells
Clinical Uses	IV fluid resuscitation, hypovolemia, hyponatremia (symptomatic), maintenance IV fluid, drug dilution/infusion vehicle, metabolic alkalosis replacement
Adverse Effects	Hyperchloremic metabolic acidosis (large volumes), fluid overload, hypertension, dilutional hyponatremia (if used inappropriately), edema
Contraindications	Hypernatremia, hyperchloremia, congestive heart failure (use cautiously), conditions requiring fluid restriction

⚠️ Clinically Important Drug Interaction in This Prescription

Clopidogrel (Lowplat) + Omeprazole (Risek): Omeprazole inhibits CYP2C19, which is required to activate clopidogrel to its active metabolite. This reduces clopidogrel's antiplatelet efficacy. Consider switching to Pantoprazole (weaker CYP2C19 inhibitor) if PPI is needed alongside clopidogrel.

Heparin + Aspirin + Clopidogrel (Triple therapy): Significantly ↑ bleeding risk — monitor closely.

Tramadol + any serotonergic drug: Risk of serotonin syndrome — review full drug list.

Sources: Harrison's Principles of Internal Medicine 22E, Katzung's Basic & Clinical Pharmacology 16th Ed, Goodman & Gilman's Pharmacological Basis of Therapeutics, Braunwald's Heart Disease, Lippincott Illustrated Reviews: Pharmacology

This is a shared conversation. Sign in to Orris to start your own chat.