48 to 60 hours

12 hours

24 hours

7 days

Renal tubular secretion

First-pass metabolism

Pulmonary absorption

Plasma protein synthesis only

It remains primarily in the plasma compartment

It is easily removed by haemodialysis

It distributes extensively into peripheral tissues

It has a very short half-life

Drug B is more efficacious than Drug A

Drug B is more potent than Drug A

Drug A is more potent than Drug B

Drug A has a wider therapeutic index

First-order elimination with a long half-life

Rapid hepatic conjugation

Increased renal clearance at higher levels

Zero-order (saturable) elimination kinetics

Continue clopidogrel at standard dose

Switch to an alternative antiplatelet not dependent on CYP2C19

Double the clopidogrel dose

Add aspirin and continue clopidogrel at standard dose

HLA-B*5701 screening

CYP2D6 genotyping

TPMT enzyme assay

G6PD quantification

Inadequate pain relief due to poor conversion

Hepatotoxicity from excessive drug accumulation

Severe nausea requiring antiemetic therapy

Excessive morphine production and respiratory depression

CYP3A4

CYP2C9

TPMT

NAT2

Increased risk of serotonin syndrome

Inadequate analgesic response

Enhanced analgesia requiring dose reduction

Rapid development of physical dependence

Obtaining specialist consultation for all controlled substances

Referring the patient to a pain management clinic

Checking the prescription drug monitoring programme database

Requiring a psychiatric evaluation before prescribing

Empiric prescribing

Protocol-based prescribing

Defensive prescribing

Rational prescribing

Off-label prescribing

Investigational prescribing

Formulary exception

Therapeutic substitution

Brand name recognition among patients

Evidence-based efficacy, safety, and cost-effectiveness

Manufacturer rebate programmes

Prescriber preference and familiarity

The prescriber's medical school graduation year

The patient's insurance policy number

Specific directions for use including dose, route, and frequency

A diagnosis code for the treated condition

Thiazide diuretic

Non-dihydropyridine calcium channel blocker

Alpha-adrenergic blocker

ACE inhibitor

Hold warfarin and consider oral vitamin K

Administer intravenous fresh frozen plasma immediately

Continue warfarin at the same dose and recheck in one week

Switch to a direct oral anticoagulant immediately

Amlodipine

Spironolactone

Hydralazine alone

Digoxin

Hypernatraemia

Peripheral oedema

Persistent dry cough

Weight gain

The patient's renal function and creatinine clearance

The patient's body mass index

The patient's preference for once-daily dosing only

The patient's serum albumin level

Long-acting beta-2 agonist monotherapy

Low-dose inhaled corticosteroid

Oral leukotriene receptor antagonist alone

Short-acting beta-2 agonist scheduled four times daily

Inhaled corticosteroid monotherapy

Oral theophylline

Long-acting muscarinic antagonist (tiotropium)

Systemic corticosteroids daily

Allergic reaction to the propellant — switch formulations

Bacterial pharyngitis — prescribe antibiotics

Lichen planus — refer to dermatology

Oral candidiasis — use a spacer and rinse mouth after inhalation

Anti-IL-5 monoclonal antibody

Anti-IgE therapy regardless of IgE levels

Intravenous immunoglobulin

Oral methotrexate

LABAs can be used alone for mild intermittent asthma

LABAs must always be combined with an inhaled corticosteroid in asthma

LABAs replace the need for rescue inhalers entirely

LABAs are contraindicated in all asthma patients

SGLT2 inhibitor

Sulfonylurea

Thiazolidinedione

Alpha-glucosidase inhibitor

Continue metformin without interruption

Permanently discontinue metformin

Switch to a sulfonylurea before the procedure

Hold metformin on the day of contrast and for 48 hours after

1 week after starting therapy

6 to 8 weeks after starting therapy

24 hours after the first dose

Only at the annual physical examination

Viral gastroenteritis

Hyperosmolar hyperglycaemic state

Euglycaemic diabetic ketoacidosis

Lactic acidosis from metformin

Take the medication with food to reduce nausea

Crush the tablet for easier swallowing

Take the medication at bedtime for best absorption

Take upright with plain water and remain upright for 30 minutes

Continue the broad-spectrum regimen for the full course

Add an aminoglycoside for synergy

Narrow therapy to a penicillin-based regimen

Discontinue all antibiotics since the patient is improving

Peak serum drug level only

Trough serum drug level

Urine output over 24 hours only

Serum potassium level

First-generation cephalosporins

Fluoroquinolones

Macrolides

Nitrofurantoin

Efflux pump overexpression

Target site methylation

Decreased outer membrane permeability

Beta-lactamase enzyme production

Azole monotherapy with fluconazole

Amphotericin B deoxycholate

Echinocandin (such as caspofungin)

Topical nystatin

24 to 48 hours

3 to 5 days

One week

2 to 6 weeks

Neuroleptic malignant syndrome

Anticholinergic toxicity

Serotonin syndrome

Benzodiazepine withdrawal

Monthly electroencephalogram

Fasting glucose, lipid panel, weight, and blood pressure

Serum prolactin level only

Annual brain MRI

Tardive dyskinesia

Acute dystonia

Drug-induced parkinsonism

Akathisia

Risk of hepatotoxicity

Drug-induced hypertension

Risk of QT prolongation

Increased fall risk and cognitive impairment

Gabapentin or duloxetine

Oral morphine

Ibuprofen

Paracetamol alone

Well-controlled type 2 diabetes

History of peptic ulcer disease

Mild seasonal allergies

Controlled hypothyroidism

Administer activated charcoal

Start intravenous fluids and observe

Administer flumazenil

Administer naloxone

Monotherapy with dose escalation

Patient-controlled analgesia

Multimodal analgesia

Pre-emptive analgesia

Physical dependence is a normal physiological adaptation, while addiction involves compulsive use despite harm

Physical dependence only occurs with intravenous opioids

Addiction always develops after physical dependence is established

Physical dependence and addiction are clinically synonymous terms

Continue the PPI indefinitely since the symptoms resolved

Gradually taper and attempt to discontinue the PPI

Switch to a higher-dose PPI for prophylaxis

Add sucralfate to the current PPI regimen

Dopamine D2 receptor

Histamine H1 receptor

Neurokinin NK1 receptor

Serotonin 5-HT3 receptor

Bismuth quadruple therapy

Standard clarithromycin-based triple therapy

PPI monotherapy for 8 weeks

Sucralfate and antacids alone

Hepatotoxicity

Hyperkalaemia

Hypomagnesaemia

Hypernatraemia

Increasing corticosteroid dose for long-term maintenance

Immunomodulator or biologic (anti-TNF) therapy

Loperamide monotherapy

Proton pump inhibitor therapy

Prescribe the standard dose and monitor for side effects

Double the dose to ensure therapeutic levels

Calculate creatinine clearance and adjust the dose accordingly

Avoid all antibiotics in CKD stage 4

Discontinue the NSAID and substitute with paracetamol

Continue the NSAID but add a gastroprotective agent

Switch to a selective COX-2 inhibitor, which is renal-safe

Increase the NSAID dose for better pain control

Its route of administration

The time of day the drug was given

Its hepatic metabolism rate

Its molecular weight, protein binding, and dialyser membrane type

Erythropoiesis-stimulating agent

Phosphate binder

Calcineurin inhibitor

Loop diuretic

Use the standard dose with no modifications

Give the standard dose but increase the frequency

Reduce the dose and extend the dosing interval

Double the dose to compensate for reduced absorption

Prescribe combined oral contraceptives at a lower oestrogen dose

Prescribe combined oral contraceptives with aspirin for thromboprophylaxis

Prescribe combined oral contraceptives after obtaining a baseline ECG

Advise that combined contraceptives are contraindicated and offer alternatives

Valproate is safe in pregnancy if taken with high-dose folic acid

Valproate is a teratogen and an alternative antiepileptic should be considered before conception

Valproate should be doubled during pregnancy to maintain seizure control

Valproate only poses risk in the third trimester

Oestrogen-only therapy

Progestogen-only therapy

Combined oestrogen-progestogen therapy

Testosterone-only therapy

Magnesium sulphate

Phenytoin

Diazepam

Carbamazepine

Monoamine oxidase inhibitors

Tricyclic antidepressants at high doses

Lithium

Selective serotonin reuptake inhibitors

150 mg

500 mg

250 mg

75 mg

Low-dose melatonin

Trazodone at a low dose

Benzodiazepines

Sleep hygiene counselling

Start a cholinesterase inhibitor for suspected dementia

Review and reduce anticholinergic burden by discontinuing unnecessary agents

Add a benzodiazepine for agitation

Order a brain CT before any medication changes

Neonates have higher hepatic enzyme activity

Neonates have greater renal clearance

Neonates absorb less drug from the GI tract

Neonates have immature liver and kidney function with slower drug clearance

Deprescribing

Therapeutic duplication

Formulary restriction

Medication reconciliation

Pharmacodynamic antagonism reducing warfarin efficacy

CYP450 inhibition increasing warfarin levels and bleeding risk

Protein displacement with no clinical significance

Enhanced warfarin absorption from the GI tract

The contraceptive will become more effective during treatment

No interaction exists between these medications

The contraceptive dose should be doubled

Contraceptive efficacy may be significantly reduced and alternative methods are needed

Type A (augmented) reaction

Type C (chronic) reaction

Type B (bizarre) reaction

Type D (delayed) reaction

Erythromycin and haloperidol

Amoxicillin and paracetamol

Metformin and lisinopril

Amlodipine and atorvastatin

St John's wort will increase carbamazepine toxicity

St John's wort may reduce carbamazepine levels, risking breakthrough seizures

No interaction exists between herbal and prescription medications

Carbamazepine will enhance the antidepressant effect of St John's wort

At the same level as expert opinion

Below individual case-control studies

At the top of the evidence hierarchy

Below individual randomised controlled trials

25

50

4

2

Drug utilisation review

Formulary management

Pharmacovigilance

Medication reconciliation

Paternalistic prescribing

Shared decision-making

Protocol-driven prescribing

Defensive medicine

Pharmacovigilance

Drug utilisation review

Therapeutic drug monitoring

Post-marketing surveillance