Giving information of medications (ATHLETICS format)

Ramipril

A: ACE inhibitor → ↓ Ang II → vasodilation (“This relaxes your blood vessels so your heart doesn’t have to work as hard.”)
T: Once daily (often at night initially)
H: With or without food
L: Long-term
E: Lowers BP, protects heart & kidneys
T: U&Es before and 1–2 weeks after starting
I: Dry cough, dizziness, high potassium, rare angioedema
C: Avoid in pregnancy; warn first-dose dizziness
⭐ If cough → switch to ARB

Losartan

A: Blocks Ang II receptor (“It relaxes your blood vessels in a similar way to ACE inhibitors but without the cough.”)
T: Once daily
H: With or without food
L: Long-term
E: Lowers BP, kidney protection
T: U&Es
I: Dizziness, hyperkalaemia
C: Avoid in pregnancy
⭐ ACEi alternative

Amlodipine

A: Calcium channel blocker → vasodilation (“It relaxes your blood vessels to lower your blood pressure.”)
T: Once daily
H: Same time each day
L: Long-term
E: Lowers BP, prevents angina
T: None routine
I: Ankle swelling, flushing, headache
C: Warn about swelling
⭐ Common OSCE counselling point

Bisoprolol

A: β1 blocker → slows heart (“It slows your heart down so it doesn’t have to work as hard.”)
T: Once daily
H: Morning preferred
L: Long-term
E: Controls heart rate, improves HF survival
T: HR, BP
I: Bradycardia, fatigue
C: Don’t stop suddenly
⭐ Safer in asthma than propranolol

Propranolol

A: Non-selective β-blocker (“It slows your heart and reduces physical symptoms of anxiety like shaking.”)
T: 2–3 times daily or PRN
H: Before anxiety trigger if needed
L: Variable
E: Reduces HR, anxiety, migraines
T: HR, BP
I: Bronchospasm, fatigue
C: Avoid in asthma
⭐ Good for performance anxiety

Digoxin

A: ↑ contractility & slows AV node (“It helps your heart beat more effectively and at a steadier rate.”)
T: Once daily
H: Same time daily
L: Long-term
E: Controls AF rate
T: Digoxin level, U&Es
I: Nausea, visual changes, arrhythmias
C: Report vision changes
⭐ Toxicity → think “yellow vision”

Verapamil

A: Slows AV node (“It slows your heart rate and helps control abnormal rhythms.”)
T: Once daily (modified-release)
H: With food
L: Long-term
E: Rate control, angina relief
T: ECG, HR
I: Constipation, bradycardia
C: Avoid with β-blockers
⭐ High-yield interaction

GTN Spray

A: Vasodilator (“It quickly widens your blood vessels to relieve chest pain.”)
T: When needed (repeat every 5 mins up to 3 doses)
H: Under tongue
L: Short-acting
E: Rapid angina relief
T: None
I: Headache, dizziness
C: Sit before use; call ambulance if pain persists
⭐ Classic OSCE station

Aspirin

A: Antiplatelet (“It makes your blood less sticky to prevent clots.”)
T: Once daily
H: With food
L: Long-term
E: Prevents heart attack/stroke
T: None routine
I: GI irritation, bleeding
C: Avoid with active ulcers
⭐ Secondary prevention staple

Clopidogrel

A: Antiplatelet (“It prevents blood clots forming in your arteries.”)
T: Once daily
H: With or without food
L: Long-term
E: Stroke/MI prevention
T: None routine
I: Bleeding
C: Report unusual bleeding
⭐ Alternative to aspirin

Apixaban

A: Factor Xa inhibitor (“It thins your blood to stop harmful clots forming.”)
T: Twice daily
H: Same times each day
L: Long-term
E: Prevents stroke/VTE
T: Renal function, no INR
I: Bleeding
C: Don’t miss doses
⭐ No routine monitoring

❗ Missed dose:

• Take as soon as remembered

  • If close to next dose → skip, DO NOT double

Dabigatran

A: Direct thrombin inhibitor (“It stops your blood clotting too easily.”)
T: Twice daily
H: Swallow whole
L: Long-term
E: Prevents clots
T: Renal function
I: Dyspepsia, bleeding
C: Keep in original packaging
⭐ Has reversal agent

❗ Missed dose:

• Take as soon as remembered

  • If close to next dose → skip, DO NOT double

Warfarin

A: Vitamin K antagonist (“It slows clotting by affecting vitamin K in your blood.”)
T: Once daily (evening)
H: Same time daily
L: Long-term
E: Prevents clots
T: INR regularly
I: Bleeding
C: Consistent vitamin K diet, many interactions
⭐ INR target usually 2–3

❗ Missed dose:

• Take as soon as remembered

  • If close to next dose → skip, DO NOT double

Furosemide

A: Loop diuretic (“It helps your body get rid of excess fluid through urine.”)
T: Once or twice daily (morning ± lunchtime)
H: Morning to avoid nocturia
L: Long-term or PRN
E: Reduces oedema, breathlessness
T: U&Es
I: Dehydration, low K⁺
C: Warn about increased urination
⭐ Rapid effect

Bendroflumethiazide

A: Thiazide diuretic (“It helps remove extra fluid and lower blood pressure.”)
T: Once daily (morning)
H: Morning dosing
L: Long-term
E: Lowers BP
T: U&Es
I: Low K⁺, ↑ uric acid
C: Caution gout
⭐ Can cause hyperglycaemia

Hydrocortisone

A: Steroid (“It reduces inflammation in your body.”)
T: 2–4 times daily (or IV in acute)
H: With food
L: Short-term (acute) or replacement
E: Reduces inflammation, treats adrenal crisis
T: Glucose, electrolytes
I: Hyperglycaemia, infection risk
C: Don’t stop abruptly if long-term
⭐ Used in adrenal crisis

• ❗ Missed dose:

  • Take when remembered (same day)

• ❗ MUST SAY:

  • NEVER stop suddenly

    • “Sick day rules” → increase dose when unwell

Prednisone / Prednisolone

A: Steroid (“It reduces inflammation and calms your immune system.”)
T: Once daily (morning)
H: With food
L: Short courses or long-term taper
E: Anti-inflammatory, immunosuppressant
T: Glucose, BP, bone profile
I: Weight gain, mood changes, osteoporosis
C: Take in morning; don’t stop suddenly
⭐ “Sick day rules” important

• ❗ Missed dose:

  • Take when remembered (same day)

• ❗ MUST SAY:

  • NEVER stop suddenly

    • “Sick day rules” → increase dose when unwell

Amoxicillin

A: Penicillin antibiotic (“It kills bacteria causing infection.”)
T: 2–3 times daily
H: With or without food
L: 5–7 days typically
E: Treats bacterial infections
T: None routine
I: Rash, diarrhoea
C: Check penicillin allergy
⭐ Common first-line

Clarithromycin

A: Macrolide (“It stops bacteria growing.”)
T: Twice daily
H: With or without food
L: 5–7 days
E: Treats respiratory infections
T: None routine
I: GI upset, QT prolongation
C: Many drug interactions
⭐ Use if penicillin allergy

Doxycycline

A: Tetracycline (“It stops bacteria multiplying.”)
T: Once daily (or BD loading)
H: With water, stay upright
L: Varies (5–14 days)
E: Broad-spectrum antibiotic
T: None routine
I: Photosensitivity, oesophagitis
C: Avoid lying down after taking
⭐ Avoid in pregnancy

Sumatriptan

A: 5-HT agonist (“It narrows blood vessels to relieve migraine.”)
T: PRN at migraine onset
H: Oral, nasal, or SC
L: As needed
E: Relieves migraine
T: None routine
I: Chest tightness
C: Avoid in IHD
⭐ Not for prevention

Amitriptyline

A: TCA (“It changes nerve signals to help pain and mood.”)
T: Once daily (night)
H: Night-time due to sedation
L: Long-term
E: Neuropathic pain, depression
T: None routine
I: Dry mouth, drowsiness
C: Overdose dangerous
⭐ Good for sleep + pain

Omeprazole

A: PPI (“It reduces stomach acid.”)
T: Once daily (morning)
H: Before food
L: Short or long-term
E: Heals ulcers, reflux
T: Mg²⁺ if long-term
I: Headache, C. diff risk
C: Long-term risks
⭐ Take before breakfast

Lansoprazole

A: PPI (“It reduces stomach acid.”)
T: Once daily
H: Before food
L: Long-term
E: Treats reflux
T: Same as omeprazole
I: Same as omeprazole
C: Same counselling
⭐ Interchangeable with omeprazole

Lactulose

A: Osmotic laxative (“It draws water into your bowel to soften stools.”)
T: 1–2 times daily
H: Oral syrup
L: Ongoing
E: Relieves constipation
T: None routine
I: Bloating, diarrhoea
C: Takes 1–2 days to work
⭐ Also used in hepatic encephalopathy

Macrogol

A: Osmotic laxative (“It helps retain water in your stool.”)
T: 1–3 sachets daily
H: Dissolve in water
L: Ongoing
E: Softens stool
T: None
I: Bloating
C: Drink plenty fluids
⭐ First-line chronic constipation

Desmopressin

A: ADH analogue (“It reduces how much urine your kidneys make.”)
T: Once daily (often night)
H: Oral/nasal
L: Long-term or PRN
E: Reduces urine production
T: Sodium levels
I: Hyponatraemia
C: Fluid restriction important
⭐ Used in DI & bedwetting

❗ MUST SAY:

• Fluid restriction ⚠ (VERY important)

Ferritin (iron therapy)

A: Replaces iron (“It helps your body make red blood cells.”)
T: Once daily
H: Empty stomach (or with food if needed)
L: Months
E: Treats anaemia
T: Hb, ferritin
I: Constipation, dark stools
C: Take with vitamin C
⭐ Continue 3 months after Hb normal

Terlipressin

A: Vasopressin analogue (“It reduces blood flow to help stop bleeding.”)
T: Every 4–6 hours (IV)
H: IV in hospital
L: Short-term
E: Controls variceal bleeding
T: Electrolytes
I: Hyponatraemia, ischaemia
C: Hospital use only
⭐ Used in variceal bleeds

Thiamine

A: Vitamin B1 (“It protects your brain from damage due to alcohol.”)
T: 1–3 times daily
H: Oral or IV
L: Short or long-term
E: Prevents Wernicke’s
T: None routine
I: Rare reactions
C: Important in alcohol misuse
⭐ Give before glucose

Methotrexate

A: Immunosuppressant (“It calms your immune system.”)
T: Once WEEKLY
H: Same day each week + folic acid
L: Long-term
E: Controls RA/psoriasis
T: FBC, LFTs
I: Liver toxicity, bone marrow suppression
C: Avoid alcohol, teratogenic
⭐ WEEKLY dosing = key safety

• ❗ Missed dose:

  • Take within 2 days

  • Otherwise skip and continue next week

• ❗ MUST SAY:

  • ONCE WEEKLY ONLY ⚠ (most tested error)

    • Take folic acid

Azathioprine

A: Immunosuppressant (“It reduces immune system activity.”)
T: Once daily
H: With food
L: Long-term
E: Autoimmune control
T: FBC, LFTs, TPMT before starting
I: Bone marrow suppression
C: Infection risk
⭐ Check TPMT

❗ MUST SAY:

• Infection signs → seek help

Sulfasalazine

A: Anti-inflammatory (“It reduces inflammation in your joints/bowel.”)
T: 2–3 times daily
H: With food
L: Long-term
E: Treats RA/IBD
T: FBC, LFTs
I: GI upset, orange urine
C: Harmless discoloration
⭐ Safe in pregnancy

Ibuprofen

A: NSAID (“It reduces pain and inflammation.”)
T: 3 times daily
H: With food
L: Short-term
E: Pain relief
T: None routine
I: GI irritation, AKI
C: Avoid in ulcers, CKD
⭐ Use lowest dose shortest time

Metformin

A: Biguanide → ↓ liver glucose production (“It helps lower your blood sugar by reducing how much sugar your liver makes.”)
T: Once or twice daily (with meals)
H: With food to reduce GI upset
L: Long-term
E: Lowers HbA1c, no weight gain
T: HbA1c, renal function (eGFR)
I: GI upset, rare lactic acidosis
C: Take with food; stop during acute illness
⭐ First-line T2DM; avoid if eGFR <30

Insulin

A: Replaces insulin (“It helps move sugar from your blood into your cells.”)
T: Depends on type (e.g. once daily long-acting, or with meals)
H: Subcutaneous injection
L: Long-term
E: Lowers blood glucose
T: Blood glucose, HbA1c
I: Hypoglycaemia, weight gain
C: Teach hypo signs (sweating, confusion) + how to treat
⭐ Always check patient can manage hypos

Gliclazide

A: Sulfonylurea → ↑ insulin release (“It helps your pancreas release more insulin.”)
T: Once or twice daily
H: With meals
L: Long-term
E: Lowers blood glucose
T: HbA1c, glucose
I: Hypoglycaemia, weight gain
C: Don’t skip meals → hypo risk
⭐ Common cause of hypoglycaemia in exams

Sitagliptin

A: DPP-4 inhibitor (“It helps your body increase insulin when needed.”)
T: Once daily
H: With or without food
L: Long-term
E: Improves glucose control
T: HbA1c, renal function
I: Generally well tolerated; rare pancreatitis
C: Report severe abdominal pain
⭐ Weight neutral

Dapagliflozin

A: SGLT2 inhibitor (“It removes excess sugar through your urine.”)
T: Once daily
H: Morning preferred
L: Long-term
E: Lowers glucose, ↓ HF risk
T: Renal function, HbA1c
I: UTIs, genital infections, dehydration
C: Sick day rules → stop during illness
⭐ Risk of euglycaemic DKA

Morphine

A: Opioid (“It blocks pain signals in your brain.”)
T: Regular (e.g. BD modified-release) + PRN
H: Oral, IV, SC
L: Short or long-term
E: Strong pain relief
T: Pain score, sedation, RR
I: Constipation, nausea, respiratory depression
C: Always take laxative; avoid alcohol
⭐ Constipation = universal

Levothyroxine

A: Thyroid hormone replacement (“It replaces the hormone your thyroid isn’t making.”)
T: Once daily (morning)
H: Empty stomach, 30 mins before food
L: Lifelong
E: Normalises thyroid levels
T: TSH (every 6–8 weeks initially)
I: Overdose → palpitations, anxiety
C: Take consistently before food
⭐ Takes weeks to work