Drug of Choice Cheatsheet — Cardiology Focus (MRCP Part 1)
- Crack Medicine
- Oct 17
- 3 min read
TL;DR
This drug of choice cheatsheet — cardiology focus (MRCP Part 1) condenses the most frequently tested first-line therapies from NICE and BNF guidance. It covers key cardiovascular conditions, mini-cases, and high-yield pitfalls. Use it as your rapid-revision layer before tackling mock tests or Free MRCP MCQs.
Why this matters
Cardiology pharmacology dominates both papers of MRCP Part 1. Questions rarely ask for mere names; they assess mechanism, contraindication, and evidence hierarchy. Knowing the “drug of choice” reflects safe, guideline-based reasoning — not guesswork.
This cheatsheet brings together NICE-aligned first-line therapies with quick context notes, helping you recall faster and avoid traps under time pressure.
High-Yield Cardiology Drugs of Choice (NICE / BNF aligned)
Condition | Drug of Choice | MRCP-Relevant Notes |
Stable angina | Sublingual glyceryl trinitrate (GTN) for acute relief; β-blocker (atenolol / bisoprolol) long-term | Avoid with PDE-5 inhibitors (e.g. sildenafil) |
Unstable angina / NSTEMI | Aspirin + ticagrelor + LMWH | Dual antiplatelet therapy is central (NICE CG94) |
STEMI (primary PCI) | Aspirin + ticagrelor + heparin + ACE inhibitor + statin | Give oxygen only if hypoxic |
Heart failure (HFrEF) | ACE inhibitor + β-blocker + mineralocorticoid antagonist; add SGLT2 inhibitor (dapagliflozin) | Follows NICE NG106 stepwise protocol |
Atrial fibrillation (rate control) | β-blocker or rate-limiting CCB | Digoxin if sedentary / heart-failure dominant |
Atrial fibrillation (rhythm control) | Flecainide (no structural disease) or amiodarone (with structural disease) | Confirm <48 h duration before cardioversion |
SVT (acute) | Adenosine (6 → 12 → 12 mg IV) | Contraindicated in asthma; use verapamil instead |
Ventricular tachycardia (stable) | Amiodarone IV | Lidocaine if post-MI |
Ventricular fibrillation | Defibrillation + adrenaline after 3 shocks | ALS algorithm 2021 |
Hypertension (NICE CG136) | ACE inhibitor (<55 y, non-Black) / CCB (≥55 y or Black) | Know stepwise escalation |
Hypertrophic cardiomyopathy | β-blocker or verapamil | Avoid nitrates & diuretics – reduce preload |
Pericarditis | NSAID (ibuprofen) + colchicine | Colchicine lowers recurrence |
Endocarditis prophylaxis | Not routinely recommended | NICE CG64 – common exam trap |
Pulmonary hypertension | Endothelin-receptor antagonist (bosentan) / PDE-5 inhibitor (sildenafil) | Tailored to WHO functional class |
Source alignment: BNF – Cardiovascular System, NICE Guidelines.
Practical mini-cases
Case 1 – Paroxysmal SVTA 25-year-old woman, HR 180 bpm, narrow complex, BP 110/70.👉 First-line: Adenosine IV (transient AV block).Exam tip: Avoid in asthmatics; verapamil is safe alternative.
Case 2 – New-onset AF in elderly with HFpEF82-year-old with COPD & heart failure presents in AF.👉 First-line: Bisoprolol for rate control. Why: Improves mortality; CCBs can worsen HF.
Case 3 – Post-MI heart failure (EF 35 %)65-year-old on loop diuretic only.👉 Step up: ACE inhibitor + β-blocker + spironolactone; later add dapagliflozin. Exam angle: MRCP often tests full quadruple therapy order.
Study-Tip Checklist
Group by mechanism: Learn AV-node blockers or RAAS drugs together.
Map to guidelines: MRCP mirrors NICE hierarchies.
Use flashcards: “Condition → DOC + contra.”
Test in context: Reinforce via Free MRCP MCQs.
Simulate exam pressure: Attempt full mock tests weekly.
Revise every 7 days: Spaced recall cements drug mechanisms.
Cross-check with BNF: Always confirm dosage & contraindications.
Common pitfalls (remember these 5)
❌ Mixing up rate vs rhythm control in AF.
❌ Giving nitrates in HCM – worsens obstruction.
❌ Starting β-blockers in acute decompensated HF.
❌ Using adenosine in asthma / COPD.
❌ Forgetting updated NICE positions (e.g. no routine IE prophylaxis).
FAQs
1. Are MRCP Part 1 drug choices identical to NICE guidelines?
Broadly yes. MRCP aligns with UK standards (NICE & BNF) but omits local formulary nuance.
2. What’s the fastest way to memorise them?
Condition-based flashcards + mock repetition. The Crack Medicine App offers adaptive recall for each drug class.
3. Do they test doses?
Rarely. Expect drug class and mechanism, not exact mg.
4. Are U.S. guidelines (AHA/ACC) relevant?
No – stick to UK sources like NICE and BNF.
5. Where can I practise more?
Use Crack Medicine’s Free MRCP MCQs and timed mock tests for integrated pharmacology review.
Ready to start?
Mastering cardiology pharmacology can elevate your MRCP Part 1 score. Review this cheatsheet, then reinforce it using the MRCP Part 1 overview, targeted Free MRCP MCQs, and structured mock tests. Deep-dive explanations await in Crack Medicine Lectures. Consistency = confidence.
Sources
MRCP(UK) Part 1 Examination Curriculum
BNF – Cardiovascular System
NICE Guidelines – Cardiovascular Conditions
European Society of Cardiology Guidelines 2023
Comments