Gulf licensing exams are written as short patient cases. This book trains exactly that reasoning, and these notes collect the decisions that come up again and again.
How this book helps in the exam
- Choosing first-line therapy for a patient with other conditions.
- Spotting the drug to stop, adjust or avoid (renal impairment, pregnancy, elderly).
- Monitoring: which lab value, when, and what result means toxicity.
- Counselling points the patient must be told.
What the book covers
12 high-yield topics. Each has the points most often examined and links to practise them.
1Hypertension cases
- With diabetes and albuminuria, an ACE inhibitor or ARB is preferred because it protects the kidney.
- In pregnancy, labetalol, nifedipine or methyldopa are used; ACE inhibitors and ARBs are contraindicated.
- Check potassium and creatinine one to two weeks after starting or raising an ACE inhibitor or ARB.
- Thiazide plus ACE inhibitor is a common step-two combination; avoid ACE inhibitor plus ARB together.
2Heart failure with reduced ejection fraction
- Four drug pillars reduce mortality: ACE inhibitor/ARB/ARNI, beta blocker, MRA and SGLT2 inhibitor.
- Loop diuretics relieve congestion but do not improve survival.
- Avoid NSAIDs, non-dihydropyridine calcium channel blockers and pioglitazone in HFrEF.
- Leave 36 hours between the last ACE inhibitor dose and starting sacubitril-valsartan.
3Acute coronary syndrome
- Dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor) usually continues for about 12 months.
- Every patient leaves on a high-intensity statin unless contraindicated.
- Beta blockers and ACE inhibitors are started when stable, especially with reduced ejection fraction.
- Sublingual GTN must not be used within 24–48 hours of a PDE-5 inhibitor.
4Atrial fibrillation and anticoagulation
- CHA2DS2-VASc estimates stroke risk; HAS-BLED flags bleeding risks to correct, not a reason to withhold therapy.
- DOACs are preferred over warfarin except with mechanical valves or moderate-severe mitral stenosis.
- Dabigatran depends most on the kidney; check renal function before choosing and dosing a DOAC.
- Rate control uses beta blockers or diltiazem; avoid diltiazem and verapamil in HFrEF.
5Type 2 diabetes
- Metformin is first line unless contraindicated; review the dose when eGFR falls below 45 and stop below 30.
- With heart failure or chronic kidney disease, add an SGLT2 inhibitor; with atherosclerotic disease, a GLP-1 agonist or SGLT2 inhibitor.
- Relax HbA1c targets in frail older adults to avoid hypoglycaemia.
- Insulin is titrated to fasting glucose, for example 2 units every 3 days.
6Asthma and COPD
- In asthma, a LABA is never used without an inhaled corticosteroid.
- Current guidance favours as-needed low-dose budesonide-formoterol over salbutamol alone.
- In COPD, LAMA or LABA bronchodilators come first; inhaled steroids are added for frequent exacerbations with raised eosinophils.
- Rinse the mouth after inhaled steroids to prevent oral thrush.
7Common infections
- Uncomplicated cystitis in non-pregnant women: nitrofurantoin or trimethoprim for a short course.
- Community-acquired pneumonia: severity scores (CURB-65) guide oral versus intravenous therapy.
- Clostridioides difficile: stop the triggering antibiotic and treat with oral vancomycin or fidaxomicin.
- Reassess IV antibiotics at 48–72 hours and switch to oral when the patient is stable.
8Renal dose adjustment
- Cockcroft-Gault creatinine clearance is used for most drug dosing decisions.
- Drugs to reduce or avoid include aminoglycosides, vancomycin, dabigatran, metformin and enoxaparin.
- Morphine metabolites accumulate in renal failure; fentanyl or oxycodone in low doses are safer choices.
- Avoid NSAIDs in chronic kidney disease, especially with ACE inhibitors and diuretics.
9Pain management
- Use the analgesic ladder: paracetamol, then weak opioids, then strong opioids, adding NSAIDs where safe.
- Prescribe a laxative with every regular opioid.
- Neuropathic pain responds to amitriptyline, duloxetine, gabapentin or pregabalin rather than to opioids.
- Paracetamol dose should be reduced in low body weight and liver disease.
10Depression and anxiety
- SSRIs are first line; review response after 4 weeks and continue for at least 6 months after remission.
- Taper antidepressants to avoid discontinuation symptoms, especially with paroxetine.
- Benzodiazepines are for short-term use only because of dependence.
- Lithium needs level checks and kidney and thyroid monitoring; thiazides and NSAIDs raise its level.
11Pregnancy and breastfeeding
- Folic acid before conception prevents neural tube defects; use a higher dose in high-risk women.
- Avoid warfarin, ACE inhibitors, isotretinoin, valproate and tetracyclines in pregnancy.
- Paracetamol is the preferred analgesic in pregnancy; NSAIDs are avoided in the third trimester.
- Most antibiotics such as penicillins and cephalosporins are compatible with breastfeeding.
12Older adults
- The Beers criteria list drugs to avoid, such as strongly anticholinergic drugs and long-acting benzodiazepines.
- Falls are linked to sedatives, antihypertensives and hypoglycaemic drugs.
- Start low and go slow; renal function declines even when serum creatinine looks normal.
- Deprescribe medicines whose harms now outweigh their benefits.
These are PharmaPrep's own notes on the knowledge this book teaches. No text, tables or figures are reproduced from it. Read the book for full explanations, and check doses and laws against current official sources.
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