SPLE Clinical Sciences notes
High-yield, original notes for the SPLE Clinical Sciences domain (35% of the exam, SCFHS blueprint Area 4.0). Every fact below carries its primary source. No sign-up, no cost.
SCFHS SPLE Applicant Guide SPLE0622, Appendix B Area 4.0 Clinical Sciences (35%): 4.1 drug information, 4.2 clinical pharmacokinetics / therapeutic drug monitoring, 4.3 clinical pharmacogenomics, 4.4 disease prevention, 4.5 patient assessment (4.5.5 laboratory values, 4.5.6 calculations), 4.6 clinical pharmacology and therapeutic decision making.
Contents
Cardiovascular drugs
Blueprint 4.6. The rows below teach the exact facts tested by the cardiovascular quiz questions.
| Drug | Class | Key side effects / warnings | Key interactions / cautions | Antidote / reversal | Source |
|---|
| Lisinopril | ACE inhibitor | Persistent dry, tickly cough, explained on the label by increased bradykinin | Drugs acting on the renin-angiotensin system can cause fetal injury and death — stop in pregnancy | — | DailyMed — ZESTORETIC (LISINOPRIL AND HYDROCHLOROTHIAZIDE) TABLET label, 6 Adverse Reactions — Cough; Clinical Pharmacology (bradykinin)
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| Sildenafil | PDE5 inhibitor | Hypotension when combined with nitrates | Contraindicated with organic nitrates in any form and with riociguat | — | DailyMed — SILDENAFIL TABLET, FILM COATED label, 4 Contraindications — Concomitant organic nitrates
Fact note-cv-02 · Report a mistake |
| Digoxin | Cardiac glycoside | Toxicity: nausea, visual disturbance, palpitations. Hypokalaemia, hypercalcaemia, hypomagnesaemia, low body weight, advanced age and impaired renal function predispose to toxicity | Check electrolytes and renal function; obtain a serum digoxin level when toxicity is suspected | — | DailyMed — DIGOXIN TABLET label, 5 Warnings and Precautions — Risk factors for digoxin toxicity (hypokalaemia)
Fact note-cv-03 · Report a mistake |
| Prazosin | Alpha-1 blocker | Marked first-dose postural hypotension and syncope | Take the first dose with caution about standing up quickly, classically at night | — | DailyMed — PRAZOSIN HYDROCHLORIDE CAPSULE label, 5 Warnings and Precautions — First-dose postural hypotension and syncope
Fact note-cv-04 · Report a mistake |
| Furosemide | Loop diuretic | Fluid and electrolyte depletion, including low potassium, with worsening renal function | Monitor serum electrolytes, renal function and blood pressure | — | DailyMed — FUROSEMIDE TABLET label, 5 Warnings and Precautions — Fluid and electrolyte monitoring (potassium, renal function, blood pressure)
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| Sacubitril/valsartan | ARNI (neprilysin inhibitor + ARB) | Angioedema risk | Contraindicated with a history of angioedema from an ACE inhibitor or ARB, and with concomitant ACE inhibitors — allow a 36-hour washout when switching | — | DailyMed — SACUBITRIL AND VALSARTAN TABLET, FILM COATED label, 4 Contraindications — History of angioedema; 36-hour ACE-inhibitor washout
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| Clopidogrel | P2Y12 antiplatelet (prodrug) | Bleeding; diminished antiplatelet effect in CYP2C19 poor metabolizers because activation is reduced | Avoid concomitant omeprazole or esomeprazole (CYP2C19 inhibitors) | — | DailyMed — CLOPIDOGREL BISULFATE TABLET label, Boxed Warning — Diminished antiplatelet effect in CYP2C19 poor metabolizers (prodrug activation)
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Antidotes and reversal agents
Blueprint 4.6 and toxicology. Match the agent to the drug — protamine, vitamin K, idarucizumab and naloxone are not interchangeable.
| Toxicity / drug to reverse | Reversal agent | Key point | Source |
|---|
| Dabigatran anticoagulation | Idarucizumab | Labelled for reversal of the anticoagulant effects of dabigatran when needed, e.g. urgent procedures or major bleeding | DailyMed — PRAXBIND (IDARUCIZUMAB) INJECTION label, 1 Indications and Usage — Reversal of dabigatran anticoagulation
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| Heparin anticoagulation | Protamine sulfate | Protamine neutralises heparin; it should not be given when bleeding occurs without prior heparin use | DailyMed — PROTAMINE SULFATE INJECTION, SOLUTION label
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| Coumarin (warfarin-type) anticoagulation | Phytonadione (vitamin K) | Labelled for anticoagulant-induced hypoprothrombinaemia caused by coumarin or indanedione derivatives, from faulty formation of factors II, VII, IX and X | DailyMed — PHYTONADIONE TABLET label
Fact note-rv-03 · Report a mistake |
| Opioid overdose | Naloxone hydrochloride injection | An opioid antagonist labelled for reversal of opioid overdose, including respiratory depression | DailyMed — NALOXONE HYDROCHLORIDE INJECTION, SOLUTION label
Fact note-rv-04 · Report a mistake |
| Benzodiazepine effects | Flumazenil | A benzodiazepine receptor antagonist — it reverses benzodiazepines, not opioids or barbiturates | DailyMed — FLUMAZENIL INJECTION, SOLUTION label
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Infectious disease drugs
Blueprint 4.6. Boxed warnings and counselling points dominate this table, including the tuberculosis drugs.
| Drug | Class | Key side effects / warnings | Key interactions / cautions | Antidote / reversal | Source |
|---|
| Levofloxacin | Fluoroquinolone | Boxed warning: tendinitis and tendon rupture, peripheral neuropathy and central nervous system effects | Counsel active patients to report tendon pain, numbness or tingling | — | DailyMed — LEVOFLOXACIN TABLET, FILM COATED label, Boxed Warning — Tendinitis, Tendon Rupture, Peripheral Neuropathy and CNS Effects
Fact note-id-01 · Report a mistake |
| Metronidazole | Nitroimidazole antibiotic | Disulfiram-like reaction with alcohol | Avoid alcohol during treatment | — | DailyMed — METRONIDAZOLE TABLET label, 5 Warnings and Precautions — Alcohol interaction (disulfiram-like reaction)
Fact note-id-02 · Report a mistake |
| Rifampin | Rifamycin (tuberculosis drug) | Reddish-orange discoloration of urine, sweat, sputum and tears; soft contact lenses may stain | Counsel patients before starting so the colour change is not mistaken for blood | — | DailyMed — RIFAMPIN CAPSULE label, 17 Patient Counseling Information — Discoloration of body fluids
Fact note-id-03 · Report a mistake |
| Isoniazid | Tuberculosis drug | Boxed warning: severe and sometimes fatal hepatitis. Also peripheral neuropathy | Give pyridoxine (vitamin B6) to prevent peripheral neuropathy in at-risk patients, e.g. diabetes | — | DailyMed — ISONIAZID TABLET label, Boxed Warning — Severe and Fatal Hepatitis (hepatotoxicity)
Fact note-id-04 · Report a mistake |
| Gentamicin | Aminoglycoside | Nephrotoxicity and neurotoxicity manifested by ototoxicity, both vestibular and auditory | Risk is greater with impaired renal function, high dosage or prolonged therapy. Determine BUN, serum creatinine or creatinine clearance periodically; serial audiograms when feasible | — | DailyMed — GENTAMICIN SULFATE IN SODIUM CHLORIDE (GENTAMICIN SULFATE) INJECTION, SOLUTION label, Boxed Warning / 5 Warnings and Precautions — Nephrotoxicity and Ototoxicity
Fact note-id-05 · Report a mistake |
| Ethambutol | Tuberculosis drug | Optic neuritis: decreased visual acuity and loss of red-green colour discrimination | Vision testing, including acuity and colour discrimination, is required; do not use in known optic neuritis unless benefit outweighs risk | — | DailyMed — ETHAMBUTOL HYDROCHLORIDE TABLET label, 4 Contraindications / 5 Warnings and Precautions — Optic neuritis and visual monitoring
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| Doxycycline | Tetracycline | Use in pregnancy can cause fetal harm: permanent tooth discoloration and effects on bone growth | Avoid tetracyclines in pregnancy unless no suitable alternative and benefit justifies risk | — | DailyMed — DOXYCYCLINE HYCLATE TABLET, FILM COATED DOXYCYCLINE HYCLATE CAPSULE DOXYCYCLINE POWDER, FOR SUSPENSION label, 8 Use in Specific Populations — Pregnancy (fetal bone and tooth effects)
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Neurology and psychiatry drugs
Blueprint 4.2 (therapeutic drug monitoring) and 4.6. Lithium levels, clozapine ANC and MAOI interactions.
| Drug | Class | Key side effects / warnings | Key interactions / cautions | Antidote / reversal | Source |
|---|
| Lithium carbonate | Mood stabiliser | Toxicity is closely related to serum lithium levels and can occur at doses close to therapeutic levels: tremor, nausea, unsteady gait | NSAIDs have been reported to increase steady-state plasma lithium concentrations (indomethacin and piroxicam significantly) — monitor lithium levels closely when an NSAID is started or stopped | — | DailyMed — LITHIUM CARBONATE TABLET, EXTENDED RELEASE label, 7 Drug Interactions — NSAIDs decrease renal lithium clearance
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| Clozapine | Antipsychotic | Boxed warning: severe neutropenia (agranulocytosis), with risk of serious and potentially fatal infections | Obtain baseline ANC before starting; initiation is not recommended with a baseline ANC below 1500/µL (below 1000/µL in benign ethnic neutropenia) | — | DailyMed — VERSACLOZ (CLOZAPINE) SUSPENSION label, Boxed Warning — Severe Neutropenia (Agranulocytosis); ANC monitoring
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| Phenelzine | MAOI antidepressant | Serotonin syndrome and hypertensive crisis with serotonergic or sympathomimetic agents | Contraindicated / avoid with serotonergic opioids such as meperidine (pethidine) | — | DailyMed — PHENELZINE SULFATE TABLET, FILM COATED label, 4 Contraindications; 7 Drug Interactions — Serotonergic agents and serotonin syndrome
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| Carbamazepine | Anticonvulsant | Enzyme induction lowers levels of many co-prescribed drugs | A potent CYP3A4 inducer: it increases clearance of CYP3A4 substrates, including hormonal contraceptives, which can cause contraceptive failure | — | DailyMed — CARBAMAZEPINE TABLET, FILM COATED, EXTENDED RELEASE label, 7 Drug Interactions; 12 Clinical Pharmacology — CYP3A4 enzyme induction
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Lipids, gout and immune suppression
Blueprint 4.3 (pharmacogenomics: HLA-B*58:01) and 4.6.
| Drug | Class | Key side effects / warnings | Key interactions / cautions | Antidote / reversal | Source |
|---|
| Simvastatin | Statin (HMG-CoA reductase inhibitor) | Myopathy risk rises sharply with strong CYP3A4 inhibitors | Contraindicated with strong CYP3A4 inhibitors, including selected azole antifungals and macrolide antibiotics such as clarithromycin | — | DailyMed — SIMVASTATIN TABLET, FILM COATED label, 4 Contraindications — Strong CYP3A4 inhibitors
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| Atorvastatin | Statin | Myopathy and rhabdomyolysis: unexplained muscle pain, weakness or fever with dark urine needs urgent assessment | Report unexplained muscle symptoms promptly so muscle and kidney tests can be checked | — | DailyMed — ATORVASTATIN CALCIUM TABLET, FILM COATED label, 5 Warnings and Precautions — Myopathy and Rhabdomyolysis
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| Allopurinol | Xanthine oxidase inhibitor | Severe cutaneous reactions. The HLA-B*58:01 allele is a genetic marker for severe skin reactions to allopurinol | Consider HLA-B*58:01 screening before the first dose in higher-risk ancestry groups | — | DailyMed — ALLOPURINOL TABLET label, 5 Warnings and Precautions — Severe cutaneous reactions; pharmacogenomic screening (HLA-B*58:01)
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| Methotrexate | Antifolate / immunosuppressant | Pancytopenia and antifolate toxicity, e.g. mouth ulcers and fatigue on weekly therapy | Inhibits dihydrofolate reductase, blocking tetrahydrofolate production and DNA synthesis | Administer folic acid or folinic acid to reduce the risk of methotrexate adverse reactions; leucovorin rescue is labelled for high-dose methotrexate | DailyMed — METHOTREXATE INJECTION, SOLUTION label, 12 Clinical Pharmacology — Mechanism of Action (dihydrofolate reductase inhibition)
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Emergency, prevention and counselling points
Blueprint 4.4 (disease prevention) and 4.6. Short counselling facts that are tested as single-best-answer questions.
| Situation | Action / fact | Why it matters | Source |
|---|
| Anaphylaxis (peanut, lip swelling, wheeze, hypotension) | Give epinephrine intramuscularly into the anterolateral (mid-outer) thigh with the auto-injector, through clothing if necessary | This is the labelled first-line route and site; deltoid, subcutaneous abdominal and intravenous bolus are not the auto-injector route | DailyMed — EPIPEN (EPINEPHRINE) INJECTION EPIPEN JR (EPINEPHRINE) INJECTION label, 2 Dosage and Administration — Intramuscular injection into the anterolateral thigh
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| Inhaled fluticasone for asthma | Rinse the mouth with water and spit after each inhaled dose | Reduces oral candidiasis and dysphonia (hoarse voice, white mouth patches) | DailyMed — FLOVENT HFA (FLUTICASONE PROPIONATE) AEROSOL, METERED label, 17 Patient Counseling Information — Rinse mouth after inhalation (oral candidiasis prevention)
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| Stomach protection in a patient on clopidogrel | Avoid concomitant omeprazole or esomeprazole with clopidogrel where the label advises | These CYP2C19 inhibitors reduce clopidogrel's active metabolite and platelet inhibition | DailyMed — CLOPIDOGREL BISULFATE TABLET label, Boxed Warning — Diminished antiplatelet effect in CYP2C19 poor metabolizers (prodrug activation)
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| Severe acne in a woman who could become pregnant | Oral isotretinoin is supplied only under a strict pregnancy-prevention programme with regular pregnancy testing | Isotretinoin carries a boxed warning for embryo-fetal toxicity (major birth defects) | DailyMed — ZENATANE (ISOTRETINOIN) CAPSULE, GELATIN COATED label, Boxed Warning — Embryo-Fetal Toxicity; REMS pregnancy-prevention programme
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| Influenza prevention (live intranasal vaccine, FluMist) | Do not administer to a person who has had a severe allergic reaction (e.g. anaphylaxis) to any component of the vaccine, including egg protein, or after a previous dose of any influenza vaccine | Immunisation is a Clinical Sciences blueprint topic (4.4); allergy history is checked before vaccination | DailyMed — FLUMIST (INFLUENZA VACCINE LIVE INTRANASAL) SPRAY label
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Lab values used in dosing decisions
Blueprint 4.5.5. These are thresholds stated in the cited drug labels, not a substitute for your local laboratory reference ranges.
| Test | Label threshold / range | How it changes the decision | Source |
|---|
| eGFR (metformin) | Do not use below 30 mL/min/1.73 m² | Metformin is contraindicated below this threshold because of lactic acidosis risk | DailyMed — METFORMIN HYDROCHLORIDE TABLET, FILM COATED label, 4 Contraindications; 5 Warnings and Precautions — Lactic Acidosis
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| eGFR (metformin) | Initiation is not recommended at 30 to 45 mL/min/1.73 m²; assess risk/benefit of continuing if eGFR falls below 45, and discontinue if it falls below 30 | Starting, continuing and stopping metformin are all eGFR decisions | DailyMed — METFORMIN HYDROCHLORIDE TABLET, FILM COATED label, 4 Contraindications; 5 Warnings and Precautions — Lactic Acidosis
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| Serum digoxin | Levels below 0.5 ng/mL have been associated with diminished efficacy; levels above 2 ng/mL with increased toxicity without increased benefit | Use the level, with symptoms and electrolytes, to judge digoxin effect and toxicity | DailyMed — DIGOXIN TABLET label, 5 Warnings and Precautions — Risk factors for digoxin toxicity (hypokalaemia)
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| Serum lithium | Therapeutic range 0.8 to 1.2 mEq/L; toxic concentrations are ≥1.5 mEq/L | The narrow gap between therapeutic and toxic levels is why lithium is a therapeutic-drug-monitoring drug | DailyMed — LITHIUM CARBONATE TABLET, EXTENDED RELEASE label, 7 Drug Interactions — NSAIDs decrease renal lithium clearance
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| Absolute neutrophil count (clozapine) | Initiation is not recommended below 1500/µL (below 1000/µL in benign ethnic neutropenia) | Baseline and ongoing ANC monitoring guard against severe neutropenia | DailyMed — VERSACLOZ (CLOZAPINE) SUSPENSION label, Boxed Warning — Severe Neutropenia (Agranulocytosis); ANC monitoring
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| INR (warfarin) | Regular INR monitoring is required in all treated patients; no single target is stated here because the target depends on the indication | Drugs, dietary changes and other factors move the INR — recheck after changes | DailyMed — WARFARIN SODIUM TABLET label, 2 Dosage and Administration — INR monitoring; 12 Clinical Pharmacology
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| Serum potassium (digoxin) | Hypokalaemia predisposes to digoxin toxicity, as do hypercalcaemia and hypomagnesaemia | Correct low potassium in any patient on digoxin with palpitations, nausea or visual symptoms | DailyMed — DIGOXIN TABLET label, 5 Warnings and Precautions — Risk factors for digoxin toxicity (hypokalaemia)
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Renal and hepatic dose rules
Blueprint 4.5 and 4.6. When kidney or liver function changes, these label rules change the prescription.
| Rule | Detail | Source drug | Source |
|---|
| Metformin and iodinated contrast | Metformin may need to be discontinued at the time of, or prior to, iodinated contrast imaging procedures in at-risk patients, and kidney function reassessed before restarting | Metformin label, 5 Warnings and Precautions | DailyMed — METFORMIN HYDROCHLORIDE TABLET, FILM COATED label, 5 Warnings and Precautions — Lactic Acidosis; hold for iodinated contrast procedures
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| Gentamicin in renal impairment | Nephrotoxicity risk is greater in patients with impaired renal function and in those who receive high dosage or prolonged therapy; determine BUN, serum creatinine or creatinine clearance periodically | Gentamicin label | DailyMed — GENTAMICIN SULFATE IN SODIUM CHLORIDE (GENTAMICIN SULFATE) INJECTION, SOLUTION label, Boxed Warning / 5 Warnings and Precautions — Nephrotoxicity and Ototoxicity
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| Lithium and NSAIDs | NSAIDs have been reported to increase steady-state plasma lithium concentrations, and lithium toxicity has resulted from NSAID and lithium interactions — monitor lithium levels closely when NSAID use starts or stops | Lithium label, 7 Drug Interactions | DailyMed — LITHIUM CARBONATE TABLET, EXTENDED RELEASE label, 7 Drug Interactions — NSAIDs decrease renal lithium clearance
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| Digoxin in renal impairment | Impaired renal function predisposes to digoxin toxicity, especially with low body weight or advanced age | Digoxin label, 5 Warnings and Precautions | DailyMed — DIGOXIN TABLET label, 5 Warnings and Precautions — Risk factors for digoxin toxicity (hypokalaemia)
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| Isoniazid and the liver | Severe and sometimes fatal hepatitis is associated with isoniazid; dark urine, itching and jaundice with raised liver enzymes mean stop and monitor liver function | Isoniazid label, Boxed Warning | DailyMed — ISONIAZID TABLET label, Boxed Warning — Severe and Fatal Hepatitis (hepatotoxicity)
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Worked calculations
Blueprint 4.5.6 and 4.6.2. Four worked examples. Do each step yourself before reading the answer.
note-calc-01
- Creatinine clearance (Cockcroft–Gault) — a 70-year-old man, weight 70 kg, serum creatinine 1.4 mg/dL. Gentamicin dosing decisions use creatinine clearance, so estimate it first.
- CrCl = [(140 − age) × weight (kg)] ÷ [72 × serum creatinine (mg/dL)]
- = [(140 − 70) × 70] ÷ [72 × 1.4] = 4900 ÷ 100.8
- Answer: CrCl ≈ 49 mL/min. This is reduced kidney function: gentamicin dose and interval must follow the label's renal guidance, with BUN, creatinine or creatinine clearance checked periodically. (For women, multiply the result by 0.85.)
Source: DailyMed — GENTAMICIN SULFATE IN SODIUM CHLORIDE (GENTAMICIN SULFATE) INJECTION, SOLUTION label, Boxed Warning / 5 Warnings and Precautions — Nephrotoxicity and Ototoxicity · Fact note-calc-01 · Report a mistake
note-calc-02
- Body mass index — a patient weighs 85 kg and is 1.70 m tall.
- BMI = weight (kg) ÷ height² (m²) = 85 ÷ (1.70 × 1.70) = 85 ÷ 2.89
- Answer: BMI ≈ 29.4 kg/m², in the WHO overweight range (25.0–29.9); obesity is ≥30.0. BMI is a patient-assessment calculation under blueprint 4.5.6.
Source: WHO, Obesity: Preventing and Managing the Global Epidemic (WHO Technical Report Series 894), 2000 · Fact note-calc-02 · Report a mistake
note-calc-03
- Anion gap — Na⁺ 140 mmol/L, Cl⁻ 102 mmol/L, HCO₃⁻ 18 mmol/L.
- Anion gap = Na⁺ − (Cl⁻ + HCO₃⁻) = 140 − (102 + 18) = 140 − 120
- Answer: anion gap = 20 mmol/L, a raised anion gap. In diabetic ketoacidosis assessment the anion gap is used with glucose, ketones and pH to grade severity and track closure of the gap during treatment.
Source: American Diabetes Association, Standards of Care in Diabetes (Diabetic Ketoacidosis section), 2025 · Fact note-calc-03 · Report a mistake
note-calc-04
- Insulin volume from a U-100 pen — the prescription is insulin glargine 18 units at bedtime. U-100 insulin contains 100 units in 1 mL.
- Volume = dose ÷ concentration = 18 units ÷ 100 units/mL
- Answer: 0.18 mL delivers 18 units. With a pen, dial 18 units — never draw glargine into a syringe mixed with another insulin, because the label states it must not be diluted or mixed.
Source: DailyMed — INSULIN GLARGINE-ALDY INJECTION, SOLUTION label, 2 Dosage and Administration — Do not dilute or mix with other insulins · Fact note-calc-04 · Report a mistake
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Sources checked 2026-11-02. These notes are independent practice material, not official SCFHS material and not a substitute for the current drug label or guideline. If a fact here disagrees with a current label, the label wins — please report it.