Drug of Choice

Dr. Ranjan Kumar Patel

CONDITION DOC
Acinetobacter Carbapenems (except Ertapenem – not active for Pseudomonas and
Acinetobacter)
 In case of resistance, Colistin/ Polymyxin E is used.
 Imipenem can cause seizures especially in patients with ESRD.

Acromegaly Somatostatin analogue i.e. Octreotide/ Lanreotide

 In case of resistance to above, Pegvisomant is used.
 ADR of Pegvisomant – Pituitary adenoma
 Patients on Pegvisomant to be monitored for visual field defects.

Actinomycosis Parenteral Penicillin G (or) Oral Amoxicillin

 If patient allergic to Penicillins, Doxycycline is used.

Acute Bleeding Gastric Ulcer IV Proton Pump Inhibitors

Acute Heart Failure Positive Inotrope like Dobutamine
 In HF with Oliguria, Dopamine is DOC.
 If no response, PDE3 (-) like Milrenone and Levosimendan are
used.
 In case of Pulmonary Edema, Furosemide > IV NTG> Nesiritide
Acute Mountain Sickness Acetazolamide (CA Inhibitor)
Acute Dystonia Trihexyphenidyl (or) Benzhexol
 They are also used in Drug Induced Parkinsonism.
 Acute Dystonia is the earliest EPS to occur.
 Most common EPS is Akathesia.
Acute Panic Attack Benzodiazepines is the DOC.
SSRi are used for long term therapy.
Acute Variceal Bleeding Terlipressin (Best Drug) > Octreotide (MC used)
Addison’s Disease IV Hydrocortisone
 Fludracortisone never given for active management, but with
Hydrocortisone for long term management.
ADHD Methylphenidate
 Methylphenidate can worsen Tics.
 In Tourette Syndrome associated with Tics (or) in patients with
family h/o SUD, Etomoxetine is the DOC.
Adrenal Cancer Mitotane
 Kills adrenal cortical cells (adrenolysis) within 5 years.
 Mainstay of Rx = Surgery
 Post Mitotane Rx – Hydrocortisone + Fludrocortisone needs to
be given for adrenal deficiency.
Akathesia Propranolol (Beta Blocker)
 2nd Line – Benztropine & Benzhexol
 3rd Line – BZDs
Allergic Broncho-Pulmonary Prednisolone
Aspergillosis  Anti-Fungal of Choice = Itraconazole > Voriconazole
 Allergic Rhinitis Intranasal Steroids like Budesonide/ Fluticasone/ Beclomethasone.
 2nd line add on Rx like Anti-histaminic drugs can be used.
 For a kid with allergic rhinitis, Nasal Spray with Cromolyn Sodium
to be used.
ALL VPAD Regimen
(Vincristine + Prednisolone + Asparaginase + Daunorubicin)
AML Daunorubicin/ Idarubicin + Cytarabine (Ara – C)
 Cytarabine given as continuous IV infusion.
 Cytarabine can cause both cerebral and cerebellar toxicity.
Alzheimer’s Disease Donepezil (parasympathomimetic)
 Other parasympathomimetics are Rivastigmine and
Gallantamine.
 Memantine (NMDA Antagonist) can be used as add-on drug.
Amoebiasis (Intestinal Oral Paromomycin / Diloxanide Furoate/ Iodoquinol
Asymptomatic)
Amoebiasis (Intestinal Metronidazole
Symptomatic & Extra-intestinal
Symptomatic)
Hepatic Amoebiasis Choloroquine can be used.
Amyotrophic Lateral Sclerosis Riluzole (Gultamate Antagonist)
 Edavarone (Free Radical Scavenger) is the new FDA Approved
Drug.
 MR for symptomatic relief – Baclofen (GABA – B agonist)
Anaerobes Infections Clindamycin
(Supra-diaphragmatic)
Anaerobes Infections Metronidazole
(Infra-diaphragmatic)
Stomach Cancer Cisplatin + 5FU
 Anti – VEGF MAb approved = Ramosirumab
Oesophageal Cancer Cisplatin + 5FU
Colorectal Cancer 5 – FU + Capecitabine
 Capecitabine is an Oral Prodrug.
 ADR of Capecitabine is Hand and Foot Syndrome.
Anal Cancer IV 5 – FU + Capecitabine
Anemia of Chronic Disease Darbopoietin (Erythropoietin Analogue)
 ADR includes IDA, pure red cell aplasia, increased blood viscosity
leading to thrombosis and HTN.
Angioedema Epinephrine for an allergic etiology.
 For Hereditary Angioedema (bradykinin mediated) DOC is C1 –
esterase inhibitors.
Ankylosing Spondylitis NSAIDs
 A minimum of 2 trials with different NSAIDs to be done before,
switching to Infliximab (Anti-TNF alpha MAb)
Anovulation DOC depends on the cause.
 Hypogonadotrophic anovulation – Goserelin (GnRH Agonist)
 PCOS – Letrozole > Clomiphene Citrate
 Hyperprolacyinemia – Bromocriptine
 Aortic Dissection Labetalol > Esmolol
 Esmolol > Labetalol if patient is a k/c/o Asthma/ CHF (Shorter
t1/2)
 2nd Line – IV Nitroprusside (Only as add-on, otherwise can cause
reflec tachycardia)
 3rd Line – CCBs
Invasive Aspergillosis Voriconazole
 Voriconazole to be continued as secondary prophylaxis also.
 DOC for Primary Prophylaxis i.e. chemotherapy or transplant
patients is Posaconazole.
Aspiration Pneumonia Prophylaxis H2 Blockers like Cimetidine and Ranitidine.
Atrial Fibrillation  Cardioversion is the RxOC in Acute Management with/ without
& K+ Channel Blocker Ibutilide.
Atrial Flutter  Long Term Rate Control with Beta Blockers.
 Long Term Rhythm Control with Amiodarone.
Atropine Toxicity Physostigmine
 Neostigmine not used because it doesn’t cross BBB.
 Physostigmine is also DOC for Datura and Belladona Poisoning.
Atypical Pneumonia Macrolides (Best – Azithromycin)
 In Chlamydia and Mycoplasma related UTi, Doxycycline is the
DOC.
AIHA Prednisolone + Rituximab (Anti – CD20 MAb)
Babesiosis Atovaquone + Azithromycin
 Clindamycin + Quinine was used earlier for severe cases.
Bacterial Vaginosis Metronidazole
 Also used for Giardiasis, Amoebiasis and Trichomoniasis.
Bartonellosis Doxycycline
 Doxycycline + Gentamicin is the most common regimen used.
 Gentamicin can be replaced with Rifampicin.
Bell’s Palsy Prednisolone
 Valcyclovir is added in case of severe facial palsy.
Benzodiazepine Toxicity Flumazenil (BZD Antagonist)
 Shows some against Z – Compounds also but no action against
Barbiturates.
Beta Blocker Toxicity Glucagon (Increases cAMP)
Add-on Therapy :
 For Bradycardia – Atropine
 For Hypotension – Epinephrine
 For Hyperglycemia – Insulin
BPAD Lithium
Unipolar Resistant Depression Lithium is used to reduce suicidal tendencies.
Bird Flu Oseltamavir (TamiFlu) 75mg BD for 5 days.
 Also DOC for H. influenza A & B
 Prophylactic Dose = 75mg OD for 7 days.
 If patient doesn’t respond, proceed with Inhalation Zanamavir
10mg BD for 5 days.
 Prophylactic Dose of Zanamavir = 10mg OD for 7 days.
 CA Urinary Bladder Cisplatin
CA Ovary  Etoposide is sometimes used for CA Testes and CA Prostate.
CA Testes  BEP Regimen is used for CA Testes usually.
Benign Prostatic Hyperplasia Tamsulosin (or) Silodosin (selective Alpha 1A and 1D Blocker)
 They don’t cause postural hypotension.
 In case of patient of HTN with BPH, Prazosin/ Terazosin is the
DOC.

Borreliosis Doxycycline
 In children or pregnant mothers, Amoxicillin is the DOC.
Bradycardia Atropine (0.5 – 1.0 mg)
 Dosage of < 0.5mg will cause paradoxical bradycardia due to
cntral atropine blockade.
 If Atropine fails, Pacing/ Dopamine/ Epinephrine can be used.
Breast Cancer (ER +ve)  For pre-menopausal female – Tamoxifen
 For post-menopausal female – Letrozole
 In resistant cases, Fulvistrant (SERD)
 Treatment and Prophylaxis dome for 5 – 10 years.
Breast Cancer (HER2u +ve) Trastuzumab
 Known to cause Cardiotoxicity since HER2u receptors +nt in
heart.
 If not responding, Lapatinib (HER2 TK inhibitor)
Brain Tumors Temozolomide (Alkylating Agent)
 Nitrosoureas used earlier, discontinued due to sustained
neutropenia
 Temozolomide has higher fat solubility.
Brittle Asthma Epinephrine
 Brittle Asthma doesn’t respond well to Beta Blockers and
Steroids.
Bronchial Challenge Test Methacholine
 For diagnosis of B. Asthma
 Most potent at M2 > M3 receptor.
 Preferred over Bethanechol because of being short acting.
Bronchial Asthma  Acute Attack = Inhalational CS + Formoterol (LABA)
 Persistent Bronchial Asthma = ICS
 Exercise Induced Asthma = ICS
 Aspirin Induced Asthma = ICS
 Long Term Management = ICS
Brucellosis Doxycycline
 Doxycycline + Rifampicin is the usual regimen due to synergistic
action.
Bruxism Botulinum Toxin
Burkholderia cepacia Cotrimoxazole (or) Meropenem (or) Doxycycline
 B. cepacia shows no response to AG/ Colistin/ FQ/ 1 st & 2nd Gen.
CPS
Burn Infection Topical Silver Sulfadiazine
 Also used in Fungal Keratomycosis
 CAH  Hydrocortisone is the DOC for replacement therapy.
 Dexamethasone is the DOC for prevention of CAH in foetus.
Campylobacter jejunii Azithromycin 500mg OD for 3 days (or) Ciprofloxacin
 In case of inability to take oral drugs, Parenteral Rx with
Carbapenem/ Streptomycin/ Gentamicin is done.
Candidiasis  Topical Fluconazole for Skin infections.
 Clotrimazole torches for Oral Thrush.
 Oral Fluconazole for esophagus or mucus membranes.

Systemic Candidemia IV Liposomal Amphotericin B

Carbamate Poisoning Atropine is the DOC
 Oximes (AChE activators are never used 1 st line)
Carcinoid Syndrome Octreotide
 Telotristat (Tryptophan Hydroxylase Inhibitor) used if no
response to Octreotide.
 Loperamide is the last resort drug.
Carcinomatous Meningitis DOC for palliation is Intra-thecal Methotrexate + Leucovorin + Folinic
Acid
 Alternative to MTx is Intra-thecal Cytarabine.
 Dexamethasone is used as an add-on drug.
Cardiac Arrest  For non-shockable rhythm – Epinephrine
 For shockable rhythm – DC Shock
 Most wide spectrum anti-arrhythmic – Amiodarone
Cardiogenic Shock Nor-Epinephrine > Dopamine
CA Cervix and all Urogenital Cisplatin
Cancers
Chagas Disease/ American Benznidazone
Trypanosomiasis
Chnacroid due to H. ducreyi Azithromycin
 Ceftriaxone (or) Ciprofloxacin are the alternative drugs.
 Aspiration should be done in c/o fluctuant inguinal lymph nodes.
Cheese Reaction IV Phentolamine (Alpha Blocker)
Chemotherapy induced nausea  Mild Cases = Ondansetron (5HT3 antagonist)
and vomiting  Moderate Cases = 3 drug regime i.e Ondansetron + Aprepitant +
Dexmethasone
 Severe Cases = 3 Drug Regime + Olanzapine
 Aprepitant is a Neurokinin – 1 Inhibitor.
Cholera  Mainstay of Rx is IVF + ORS
 Antibiotic of Choice in severe diarrhoea = Doxycycline >
Azithromycin > Ciprofloxacin
Choriocarcinoma Methotrexate
 Also used as 1st Line in osteosarcoma.
 Also DOC in Psoriatic Arthritis/ RA.
 Other drug used in Choricarcinoma is Actinomycin – D aka
Dactinomycin (Anti-tumor Antibiotic).
Chlamydia UTI – Uncomplicated DO Azithromycin 1g SD (or) Doxycycline for 7d
Chlamydia UTI – Complicated Doxycycline 100mg for 7 days
+
Ceftriaxone for 7 days
Chronic CHF ACE Inhibitors (or) ARBs
 Digoxin is given for symptomatic therapy.
 If ACE(-) or ARBs are well tolerated, Sacubitril + Valsartan + Beta
Blockers are also started.
Chylomicronemia Syndrome Fibrates
 It is also the DOC for Hypertriglyceridemia.
 ADR of Fibrate is Gall Stones
CLL FCR Regimen i.e. Fludarabine + Cyclophosphamide + Rituximab
 FCR Regime is also used in low-grade NHL.

Chylothorax Octreotide
Cystitis Cotrimoxazole
 Nitrofurantoin and Fosfomycin are alternatives.
Cystinuria Tiopromin (Cystine Binder) + Potassium Citrate (Alkylating Agent)
 Acetazolamide can also be used as it causes alkalinization of
urine.

CMV Infection Valganciclovir > Ganciclovir as oral absortion is more.

 Resistant CMV = Foscarnet is the DOC.
Dabigatran Toxicity Idarucizumab
 Platelet monitoring is not usually done and bleeding profuse and
sudden.
Dracunculiasis Metronidazole
 Only helminth against which non- Anti – helminthic drugs are
useful.
Drug Induced Parkinsonism Benzhexol (or) Trihexyphenidine (Anticholinergics)
 Promethazine is an alternative drug.
Echinococcus Albendazole > Mebendazole
 Praziquantel is the DOC for most other cestodes.
E. coli/ Klebsiella/ Proteus Ceftriaxone
Infection  Only drug to be very effective against GNB.
 Ceftriaxone is inactive against Pseudomonas, Acinetobacter and
Enterobacter.
Pulmonary Edema Furosemide – Venodilatation > Diuresis
Edema due to Liver Cirrhosis Spironolactone
Cerebral Edema Mannitol
Resistant Edema Spironolactone
CML Imatinib (BCR – ABL Tyrosine Kinase Inhibitor)
 In case Imatinib fails, 2nd generation BCR – ABL TK Inhibitors are
used like Bosutinib and Nilotinib.
 If 2nd Generation fails, we use Ponatinib f/b Omacetaxane (BCR –
ABL Protein Inhibitor).
 Last line is IFN-alpha therapy.
 GIST Imatinib
 For Imatinib resistant GISTs, Sunitinib is used.
 If Sunitinib fails, Rigorafenib is used.
Endemic Mycosis (Histoplasmosis Itraconazole
etc.)  Exception is Coccidiodan Meningitis where Fluconazole is used.
Enterobacter Carbapenems
 4th Generation Cephalosporins are effective like Cefepime.
Enterococcus faecalis Ampicillin
 Add on Aminoglycoside gives better results.
Enterococcus faecium Vancomycin
 Add on Aminoglycoside gives better results.
ESBL Producing Organisms Carbapenems > Piptaz > Colistin and Tigecycline
Generalised Seizures/ GTCS/ Valproate
Grand Mal/ JME
Typical Absence Seizure Ethosuximide
Atypical Absence Seizure Valproate

Partial Seizures Carbamazepine

 Lamotrigine and Oxcarbazine can also be used.
Mixed/ Dravet Syndrome/ Lennox Valproate
Gastaut Syndrome
Infantile Spasm/ West Syndrome ACTH
Infantile Spasm with Tuberous Vigabatrin
Sclerosis
Neonatal Seizures Phenobarbital
Epilepsy in pregnancy Leviteracetam > Lamotrigine (or) Clonazepam
Status Epilepticus Lorazepam
Essential Thrombocythaemia Hydroxyurea (DNA synthesis inhibitor) + Aspirin
 Hydroxyurea is an RNR inhibitor in S – phase of DNA Synthesis.
 DOC for Polycythemia vera and SCA also.
 ADR of Hydroxurea is painful leg ulcers.
Essential Tremors Propranolol
 AEDs like Primidone, Gabapentin and Topiramate can be used.
 Nimodipine (CCBs) can also be used.
Ethylene Glycol Poisoning Fomepizole (Competitive Inhibitor of ADH)
 Also used in alcohol toxicity.
Familial Mediterranean Fever Cochicine
 Also used in treatment and pro[hy;axis of acute Gout.
 Anti – cancer effects (+)
Fibrinolytic Therapy (Alteplase) Epsilon Amino Caproic Acid (EACA) > Tranexamic Acid
 EACA is a Plasmin Antagonist.
Hairy Cell Leukemia Cladribine as continuous IV Infusion.
 Rituximab is used for consolidation.
Filariasis Di-Ethyl Carbamazine (DEC)
 3 Drug Regimen is used i.e. Albendazole + Ivermectin + DEC
Fungal Corneal Ulcer Topical Natamycin (Polyene)
 AMB and Nystatin are the alternatives.
 Gas Gangrene Penicillin – G
 Preferred antibiotic to reduce toxin production: Clindamycin
 Preferred Regimen = Pen – G + Clindamycin
Genital Warts  DOC in males is Podophylotoxin
 DOC in females is Imiquimod
GERD PPIs
 PPIs are usually stopped after symptoms improve.
 Lifelong therapy with PPIs in c/o Barrett’s Esophagus and Severe
Esophagitis.
 DOC in Pregnancy – Antacids + Sucralfate which when fails, is
replaced by PPIs.
 PPI of choice in pregnancy = Lansoprazole
Giardiasis Metronidazole
 In case of resistance to Metronidazole, Nitazoxanide is used.
 Nitazoxanide is the DOC for Cryptosporidiosis also.
Acute Congestive Glaucoma  Start Rx with Mannitol to reduce IOP.
 Then give Pilocarpine.
Closed Angle Glaucoma Pilocarpine
Open Angle Glaucoma Latanoprost > Beta Blocker
Normal Tension Glaucoma

Glucagonoma Octreotide
 Octreotide is the DOC for all metabolic tumors except
Insulinoma.
 DOC for Insulinoma = Diazoxide
Gonorrhoea Ceftriaxone
 Monotherapy not recommended.
 Ceftriaxone + Azithromycin (or) Doxycycline is used to prevent
Ceftriaxone resistance and also covers Chlamydia treatment.
Gout – Acute Pain Episode Indomethacin f/b Colchicine
Chronic Gout Allopurinol
 Uricosuric Agents like Probenecid are added if Allopurinol
monotherapy fails.
 If patient has HST reaction to Allopurinol, then switch to
Oxypurinol.
 Uricase Analogues like Pegloticase is used for treatment of
Uricosuric Resistant Gout.
Granuloma Inguinale Doxycycline
 Azithromycin and Cotrimoxazole are alternative drugs.
Grave’s Disease Methimazole
 Methimazole is known to have teratogenic effects.
 DOC of Grave’s Disease in 1st Trimester = Propyl Thio-Uracil
 PTU is known to cause Hepatotoxicity.
 Methimazole can be continued in 2nd and 3rd Trimesters.
Renal Cell Carcinoma Bevacizumab
 Anti – VEGF MAb
 Also used in Colorectal Carcinomas
Choroidal Neovascularization/ Ranibizumab (Anti – VEGF MAb)
Diabetic Retinopathy
Heparin Induced IV Ergatroban
Thrombocytopenia  Fondaparinaux can also be used.
(UFH > LMWH)  Warfarin is contraindicated.
Heparin Toxicity Protamine Sulphate
Hepatitis B Tenofovir
 Also useful against Lamivudine resistant Hepatitis B.
 Most potent agent against Hepatitis B is Entecavir.
Hepatitis C Directly acting anti-virals like Sofosubuvir/ Dasabuvir/ Beclabuvir
Hepatitis B + Hepatitis D Super- Interferon – Alpha
infection
Hepatocellular Carcinoma Sorafenib (VEGF – TK Inhibitor)
 Riborafenib and Lanvatinib are the alternaitives.
 MAb against HCC – Mevolumab
Herpes Simplex Virus Valacyclovir > Acyclovir
 In c/o Acyclovir Resistance, Foscarnet is used.

Haemophilus influenza  DOC in H. influenza meningitis = Ceftriaxone

 DOC in RTI/ Otitis media = Ampicillin Sulbactam combinations
 DOC for prophylaxis = Rifampicin
Pancreatic Cancer Gemcitabine
 Also used for CA Urinary Bladder.
 ADR – Hemolytic Uraemic Syndrome.
 In c/o Gemcitabine resistant tumors, Irinotecam + 5FU +
Oxaliplatin + Folinic Acid are used (Folfirinox Regimen).
 Irinotecan is Topoisomerase inhibitor which is also used in
Colorectal cancers.
 ADR of Irinotecan is non-secretory Diarrhoea.
HOCM Beta Blockers (Propranolol)
Hodgkin’s Lymphoma ABVD Regimen i.e. Adriamycin + Bleomycin + Vincristine + Dacarbazine
Ancylostoma duodenale Albendazole
Huntingtons’s Chorea Tetrabenazine (or) Deutetrabenazine (VMAT-2 Inhibitors)
 Atypical Antipsychotics like Risperidone and Aripiprazole are
used in moderate cases.
 Typical Antipsychotics like Haloperidol is the DOC in severe
cases.
Hymenolepis nana Praziquantel
 Niclosamide/ Nitazoxanide are alternatives.
 The only cestodes where DOC is Albendazole is
Neurocysticercosis and Echincoccosis.
Hypercalcemia of Malignancy Zolendronate (Parenteral Bisphosphonate)
 For osteoporosis, oral Bisphosphonates (Alendronate >
Risodronate) is used.
Hypercholestrolemia Statins
 Rosuvastatin (Maximum LDL decrease)
 Statins not safe in pregnancy, Bile Acid Sequestrants can be used.
 Hyperlipoproteinemia  Statins used for Type II
 Fibrates used for Type III
Hyperprolactinemia Cabergoline
 ADR associated is Cardiac Valvular Defects.
 DOC in pregnancy – Bromocriptine
Hypothyroidism Levothyroxine
Hypotension  DOC for Hypotension due to spinal anaesthesia = Phenylephrine
> Ephedrine
 Orthostatic/ Postural Hypotension = Midodrine > Fludrocortisone
 Hypotensive Shock in sepsis = Nor-Epinephrine
HYPERTENSION
Patient < 55 years ARBs / ACE(-) with or without Thiazides
Patient > 55 years CCB with or without Thiazides
Resistant HTN Spironolactone
HTN with DM/ CKD/ ACE(-) or ARBs
Scleroderma/ Nephrotic
Syndrome
HTN with Angina/ MI/ Beta Blockers
Hyperthyroidism/ Anxiety/
Migraine
HTN with Osteoporosis Thiazides
HTN with Raynaud’s CCBs
Phenomenon
HTN with BPH/ Dyslipidemia Alpha 1 Blockers like Tamsulosin
Hypertensive Emergency IV Nicardipine
Hypertensive Urgency Clonidine
HTN in pregnancy Oral Labetalol
HTN Emergency in pregnancy IV Labetalol

Idiopathic Thrombocytopenic Dexamethasone Short Course preferred over prednisolone long course.
Purpura  2nd Line is Rituximab
 3rd Line is Thrombopoietin Agonists like Romiplastin/ Eltrombopaq
Insomnia Z – Compounds
 For sleep induction – Zaleplone
 For sleep maintenance – Zopiclone
 Ramelteon is a melatonin agonist that can be used for sleep induction
that has no addictive ADRs.
Iron Toxicity Desferroxamine
Head & Neck Cancers Cituximab and Panitumumab
 EGFR inhibiting MAb.
 Also used in colorectal cancers.
IBS Poly-Ethylene Glycol (PEG) - an osmotic laxative.
DOC in Diarrhoea predominant IBS - Loperamide.
Other drugs if PEG fails:
 Lubiprostone (Type 2 Chloride channel stimulator)
 Linaclotide and Plecanatide (Increases cGMP)
Alternative to Loperamide is Alosetron (5HT3 Agonist) – approved for
females only, can cause ischaemic colitis.
 Isosporiasis Cotrimoxazole (Trimethoprim + Sulbactam)
 Alternative is Ciprofloxacin + Nitazoxanide.
Jet Lag Zaleplon and Ramelteon
Visceral Leishmaniasis IV Liposomal AMB > Oral Miltefosine
Kaposi Sarcoma Doxorubicin / Daunorubicin
 IFN – alpha is the alternative but not preferred d/t increase r/o SLE.
Taenia capitis/ Kerion Griseofulvin
 In Trichophyton causing Kerion – Griseofulvin = Terbinafine
 Microsporum causing Kerion – Only Grisofulvin is effective.
Legionella Azithromycin > Levofloxacin > Doxycycline
Leptospirosis Penicillin – G
 Alternatives are Doxycycline and Azithromycin
Listeria Meningitis Ampicillin
Fasciolopsis (F. hepatica) Triclabendazole
Clonorchiasis Praziquantel
Loa loa DEC
 In case of Loa loa + Oncocerca volvulus co-infection, start treatment
with Ivermectin and then consolidation with DEC.
Lung Cancer Cisplatin
Paragonimus westermanii Praziquantel
LGV Doxycycline
 Alternative or for a pregnant female : Azithromycin
MALARIA
Severe falciparum malaria IV Artesunate for 48 hours
P. vivax/ P. ovale Chloroquine + Primaquine
uncomplicated malaria
P. falciparum/ CQ resistant  Artesunate + Sulfadoxine + Pyrimethamine in all states
vivax and ovale  Artemether + Lumefantrine in NE states
uncomplicated
For radical cure  Primaquine is added for 14 days in case of P. vivax/ ovale
 Primaquine is given on Day 2 in case on P. falciparum.
 Primaquine therapy is withheld in pregnancy and is given post-
partum.
 Tafenaquine is also a drug used for radical cure.
Malaria in pregnancy (1st Chloroquine
Trimester)  In case of CQ Resistance, Quinine is given.
Malaria Prophylaxis  If < 6 weeks travel = Doxycycline
 If > 6 weeks travel = Mefloquine

Malignant Hyperthermia Dantrolene (Inhibits RYR gene)

Malignant Melanoma  If BRAF +ve : Vemorafenib (or) Dabrafenib
 If BRAF –ve : Pembrolizumab (or) Mivolizumab (PD1 Inhibitors)
Mania Lithium
 Use Atypical Anti-Psychotics + Lithium in case of acute manic episode.
Melioidosis Ceftazidime
Meningococcal meningitis Ceftriaxone
 For contact case : Ciprofloxacin
 Mass Chemoprophylaxis : Ciprofloxacin
Empirical DOC for Meningitis Ceftriaxone
Mesothelioma Pamitrexate
 Regimen: Pamitrexate + Cisplatin/ Carboplatin +/- Bevacizumab.
Methanol Poisoning Fomepizole
Microsporidiosis Albendazole

Migraine Triptans
 Prophylaxis DOC : Beta Blocker
 AED used for prophylaxis is Topiramate
Moraxella Ciprofloxacin
 Macrolides can be given.
 Least active FQ = Norfloxacin
 Penicillins usually avoided.
Morning Sickness FDC of Doxylamine + Pyridoxine
 If fails, proceed with Ondansetron.
Motion Sickness Scopolamine Transdermal Patch
 Phenylhydrazine/ Promethazine are alternatives.
MRSA Vancomycin
 Linezolid/ Tigecycline/ Streptogramin can be used.
 Only 5th generation Cephalosporin i.e. CEFTAROLINE is beneficial.
Mucormycosis IV Liposomal AMB
 Posaconzaole and Isavocanazole can be used.
Multiple Myeloma Botezomib + Linalidomide + Dexamethasone
Multiple Sclerosis  DOC for acute attack = IV Methylprednisolone
 RRMS = IFN beta
 SPMS = IFN beta
 PRMS = Mitozantrone
 PPMS = no drug is effective
MR for Intubation Acetyl Choline
Myasthenia Gravis  DOC for diagnosis = Tensilon Test with Edrophonium > Neostigmine
 DOC for long term management = Pyridostgmine
Myasthenia Crisis IVIG > Plasmapheresis
Mycobacterium avium  Rifampicin + Ethambutol + Clarithromycin + Aminoglycosides used for
complex Intensive Phase
 R+ E + C only for Continuous Phase
Mycoplasma  M. hominis/ ureaplasma : Doxycycline
 M. pneumonia : Azithromycin OD therapy
Myelodysplasia Azacytidine + Dacytabine
 In Myelodysplasia + 5Q Syndrome : Linalidomide
Narco - Analysis Thiopental Sodium > Scopolamine
Narcolepsy Modafinil
 Solriamfetol (DNRI) is an alternativr drug.
Reversal of NDMR Neostigmine
Nephrotic Syndrome  Minimal Change Disease : Steroids
 Steroid Resistant NS (FSGS) : Cyclosporine
 Relapsing NS in Steroid Dependant NS : Cyclophosphamide
Neuroblastoma Cyclophosphamide + Cisplatin + Doxorubicin + Etoposide
 Neurocysticercosis  Tissue form : Albendazole
 Intestinal T. solium : Praziquantel
 Prednisolone is usually given peri-therapy to reduce pre-lesional
edema, steroids started earlier than Albendazole.
Neuroleptic Malignant Dantrolene
Syndrome  Most specific drug for NMS = D2 Receptor Antagonist i.e.
Bromocriptine
Neutropenia Pegfilgastrine (Granulocyte Colony Stimulating Factor)
 ADR : Bone pain
Niacin induced flushing NSAIDs (Aspirin)
Nicotine Toxicity Atropine
 Symptomatic therapy can be done with BZDs.
OCD Fluoxetine (SSRIs)
 Anxiety is the usual side effect.
 BZDs are usually added atleast for 1 month as add-on therapy.
Oncocerciasis Ivermectin
Strongyloidiasis Ivermectin
Opioid Toxicity Parenteral Naloxone
Oral Xa Factor Toxicity Endaxanate – alpha
 Beware of sudden bleeding.
OP Poisoning Atropine
 Most specific drug = Oximes (Pralidoxime is the MC used).
Osteoporosis Bisphophonates
 Oral Alendronate preferred over Risendronate
 IV Zolendronate/ Palmidronate is used if patient is not responding.
 Should be taken on empty stomach
 ADR = Esophagitis
Nocardiosis Cotrimoxazole
 Aminoglycosides and Imipenem can be used.
Nocturnal Enuresis Desmopressin (oral > intr-nasal)
 To restrict water intake.
Low Grade NHL FCR Regimen – Fludarabine + Cyclophosphamide + Rituximab
High Grade NHL CHOPR Regimen – Cyclophosphamide + Hydroxydaunorubicin + Oncovin
(Vincristine) + Prednisolone + Rituximab
Non – Secretory Diarrhoea Loperamide
NSAID induced Ulcer PPIs
 Most specific drug for NSAID induced Ulcer = Misoprostol
Osteosarcoma High Dose Methotrexate / Cisplatin / Doxorubicin / Iphosphamide
 Usually a 2 Drug Regimen is used : Leucovorin is used to prevent
methotrexate toxicity.
CA Ovary Cisplatin + Paclitaxel/ Docitaxel
PDA  Ibuprofen > Indomethacin for closing the patency.
 Misoprostol (or) Alprostidine to maintain closure.
Paget’s Disease IV Bisphosphonates preferred.
 ADR : Osteonecrosis of jaw
Post Operative Paralytic Ileus Bethanechol
 Neostigmine is an alternative.
PNH Eculizumab (Anti – Complement V)
 PCOD  For Ovulation DOC is Letrozole > Clomiphene Citrate
 For a female not requiring pregnancy = Combined OCPs or
Intermediate Progesterone Therapy
 Spironolactone can be used for Hirsuitism not responding to any
other therapy.
PUD PPIs + Sucralfate > Bismuth
 Bismuth preferred if H. pylori infection is confirmed.
Parkinson’s Disease  Best DOC = Levodopa
 DOC for mild symptoms = Selegiline (MAO-B Inhibitors)
 DOC for <= 65 years : Pramipexole
 DOC for >65 years : Levodopa
 Levodopa causes dyskinesia which is treated with Amantidine or
Levetiracetam.
 Levodopa causes ON & OFF Phenomenon for which the DOC becomes
Entecapone (COMT Inhibitor).
 Apomorphine S/C Injection is used for Rescue Therapy.
Peripheral Neuropathies 3 first line drugs:
1. TCA : Nortryptiline and Desipramine
2. SNRI i.e. Duloxetine especially for older people.
3. GABA Releasers : Gabapentin and Pregabalin
Pertussis Macrolides (Erythromycin > Azithromycin)
 Cotrimoxazole is an alternative therapy.
Phaeochromocytoma  VCD Regimen for Malignant Form i.e. Vincristine + Cyclophosphamide
+ Dacarbazine
 In case of PCToma induced HTN (Pre-op) : 1st Alpha Blocker then Beta
Blocker
 Preferred combination for HTN (Pre-op)= Phenoxybenzamine + Any
beta blocker
 For intra-operative HTn : IV Phentolamine
Phobias SSRIs
Pinworm (E. vermicularis) Albendazole
Plague Gentamicin
 Alternative is Doxycycline > Ciprofloxacin.
 DOC for Post Exposure Prophylaxis : Oral Doxycycline
Pneumocystis jirovecii Cotrimoxazole is the universal DOC
Pneumococcal Meningitis Empirical Therapy is Vancomycin + Ceftriaxone
 Single best DOC : Vancomycin
Polycythemia vera Hydroxyurea
 Anagrelide is an alternative therapy.
Post-operative Urine Bethanechol
Retention  Neostigmine is an alternative
PPH Oxytocin
 Alternative Drugs : Misoprostol < Dinoprost < Carbaprost
Priapism Phenylephrine Intra-Cavernosal Injection
Primary Amoebic AMB
Meningoencephalitis
CA Prostate Goserelin (GnRH Agonist)
 Goserelin + Flutamide is the usual regimen.
 Providencia infection Ceftriaxone
Pseudomembranous  Vancomycin +/- Metronidazole
enterocolitis  Fidaxomycin and Rifaximin are reserve drugs to be used if
Vancomycin fails.
 MAb for prophylaxis : Bezulotoxumab
Pseudotumor cerebri Acetazolamide
Psoriasis  Oral Retinoids for mild psoriasis.
 Methotrexate for Erythrodermic/ Arthritic Psoriasis.
 Acitretin is used for Pustular Psoriasis (C/I in pregnancy).
PSVT and SVT DOC in acute attack : IV Adenosine
 Prophylaxis : Beta blockers
Pseudomonas Ceftazidime
 Aminoglycosides can be used as add on drug.
 Colistin is the DOC for MDR Pseudomonas.
Pulmonary Hypertension  No treatment for Class I
 Bosentan for Class II and III
 Epoprosterenol (PGI2 Analogue) used in Class IV
Pyelonephritis Ciprofloxacin
Rapid Cycling Disorder Valproate
Rat Bite Fever Penicillin G
Restless Leg Syndrome Pramipexole (Dopamine Agonist)
Rheumatic Chorea Valproate
 If Valproate fails, switch to Haloperidol.
 IVIG to be used for severe chorea.
Rheumatoid Arthritis Universal Drug is Methotrexate (Anchor Drug)
Raynaud’s Disease CCBs
Rhodococcus Vancomycin and other Beta lactams
Rickettsia Doxycycline
Roundworm/ Ascariasis Albendazole
Sarcocystosis and Cotrimoxazole
Cyclosporidiosis
Scabies Topical 5 % Permethrin
 1% Permethrin preferred for Head Louse.
Scadosporium Voriconazole
 It is also used for Invasive Aspergillosis
Schizophrenia Atypial AP except Clozapine and Olanzapine – Aripiprazole is the most widely
used.
 Clozapine to be used for Drug Resistant Schizophrenia.
Scorpion Bite Prazosin
Secretory Diarrhoea Octreotide
Serratia Carbapenem (Imipenem)
Shock  DOC for anaphylaxis shock = IM Epinephrine
 DOC for Septic shock = Nor-Epinephrine
 DOC for Cardiogenic Shock = NE > Dopamine
SIADH Tolvaptan after fluid restriction.
SCA Hydroxyurea which increases HbF levels.
Somastatinoma Octreotide
Sporotrichosis Itraconazole
 Streptococcus Penicillin G
For Maturity of Fetal Lung Dexamethasone
Surgical Prophylaxis Cefazoline IV
Suicidal Tendency Clozapine, Litium and ECT to be used as per patient to patient basis.
Syphilis IM Benzathine Penicillin for all stages except Neurosyphilis where it is used
as IV.
Systemic Fungal Infection IV Liposomal AMB except for Invasive Aspergillosis where DOC is
Voriconazole.
Tardive Dyskinesia Valbenazine or Deutetrabenazine (VMAT2 Inhibitors)
Tetanus Metronidazole
Thrombocytopenia due to Oprelefkin (Anti IL-11 MAb)
anti-cancer drugs
Thyroid Storm First drug to be started is Beta Blocker (Propranolol)
 Overall DOC = PTU > Methimazole
Torsades de Pointes Magnesium Sulphate
Toxoplasma Sulfadiazine + Pyrimethamine
 Spiramycin to be used in pregnancy.
Traveller’s Diarrhoea Ciprofloxacin (to be used only if fever is present).
Trichomoniasis Metronidazole
Trigeminal Neuralgia Carbamazepine > Gabapentin
T. saginata Praziquantel
Tularaemia Gentamicin
Tumor Lysis Syndrome Allopurinol (XO Inhibitor)
Typhoid  Overall DOC = Ceftriaxone
 For Oral OPD based management = Cefixime
 For Typhoid Carrier = Ciprofloxacin
nd
Urticaria 2 Generation Anti-Histamines
Varicella Zoster Virus Valacyclovir > Acyclovir due to better bioavailability and oral absorption.
V. Fib Amiodarone
V. Tach and V. arrhythmias Lidocaine and Lignocaine
&
Digoxin Toxicity
vWD Desmopressin
VRSA Daptomycin
 But in VRSA Pneumonia, Linezolid is used as Daptomycin is
inactivated by the surfactant produced.
Vanco Resistant Enterococcus Linezolid
Warfarin Toxicity  Vitamin K is used for Asymptomatic patient.
 FFP + Vitamin K is used for Symptomatic patients.
Wegener’s Granulomatosis Cyclophosphamide
Whipworm/ Trichura trichuris Albendazole
Whipple’s Disease Ceftriaxone or Carbapenem
WPW Syndrome Procainamide (Flecainide)
Xerostomia Sevimelin > Pilocarpine
Yaws Penicillin G
ZES PPIs