Drug of Choice Cheatsheet — Neurology (MRCP Part 1)

Crack Medicine
Nov 5
5 min read

TL;DR

This drug of choice cheatsheet — neurology focus (MRCP Part 1) gives you a concise list of first-line treatments for key neurological conditions you’re likely to face in the MRCP Part 1 exam. Use it as a rapid revision tool to pair condition with the most exam-preferred drug, and anchor your pharmacology memory.

Why this matters

Neurology questions within MRCP Part 1 frequently test your ability to select the single best treatment choice rather than recall every possible option. The exam expects you to know which drug is first-line, contraindicated, or preferred in specific settings (e.g., pregnancy, renal impairment). For example, in epilepsy sub-types or movement disorders, the choice of drug influences both question outcome and clinical reasoning.

By condensing the “drug of choice” list into a clear cheatsheet, you can streamline your revision and spend more time practising recall and application (via MCQs or timed mocks) rather than trying to memorise every fringe option. This resource is designed to work alongside your revision of the full syllabus linked via the MRCP Part 1 overview hub.

High-Yield Neurology Drug of Choice Table

Condition / Scenario	Drug of Choice	Key Notes
Generalised tonic-clonic epilepsy	Sodium valproate	Broad spectrum; avoid in pregnancy unless no alternative. Young Epilepsy+2PMC+2
Focal onset seizures	Carbamazepine	Good for focal; induces hepatic enzymes; care with comorbidity. cfpr.org +1
Absence seizures	Ethosuximide	Especially in children/younger patients; where absence predominates. NCBI
Status epilepticus (in hospital)	IV lorazepam	First-line benzodiazepine; rapidly control convulsions. NCBI+1
Parkinson’s disease, symptomatic	Levodopa + carbidopa	Standard choice when symptoms affect quality of life. NHS Dorset
Essential tremor	Propranolol	Non-invasive, first-line; primidone alternative.
Myasthenia gravis (symptomatic)	Pyridostigmine	Cholinesterase inhibitor; monitor for cholinergic crisis.
Multiple sclerosis (relapsing-remitting)	Interferon-beta	Immunomodulator; exam may ask for first-line in typical case.
Cluster headache (acute)	High-flow oxygen or subcutaneous sumatriptan	Acute management first; prophylaxis different.
Migraine prophylaxis	Propranolol	One of the first-line preventives; alternatives if contraindicated.
Raised intracranial pressure (tumour/trauma)	Mannitol IV	Acute management of raised ICP; monitor osmolality.
Idiopathic intracranial hypertension	Acetazolamide	Weight-loss also essential adjunct.
Alzheimer’s disease	Donepezil	First-line cholinesterase inhibitor in mild-moderate disease.
Acute ischaemic stroke (within window)	IV alteplase (tPA)	Time-sensitive thrombolysis after bleed exclusion.
Ischaemic stroke secondary prevention	Aspirin (or clopidogrel) + statin + BP control	Exam may ask the “single best antiplatelet” in non-cardioembolic stroke.
Subarachnoid haemorrhage vasospasm prevention	Nimodipine	Calcium-channel blocker for vasospasm risk.

Note: Always check local guidelines and patient-specific factors; these are “general” exam-style best choices.

The Five Most Tested Neurology Subtopics

Epilepsy management – Knowing first-line antiepileptic drugs (AEDs) by seizure type is critical. PMC+1
Movement disorders / Parkinson’s disease – Understanding when levodopa is first-line vs. when other agents may be chosen. NHS Dorset+1
Headache therapy – Differentiating acute treatment vs prophylaxis in migraine, cluster, and tension headaches.
Neuromuscular junction disorders – First-line symptomatic therapies (e.g., pyridostigmine in myasthenia gravis) and associated immunotherapy.
Demyelinating diseases / MS – Recognising first-line immunomodulatory therapy in relapse-remitting MS and how pharmacology differs from acute relapse management.

Practical Example / Mini-Case

MCQ styled case: A 32-year-old woman with a known diagnosis of idiopathic intracranial hypertension presents with headaches and papilloedema. She is overweight and wishes to conceive. Which drug is the most appropriate first-line pharmacologic therapy in this scenario?A) AcetazolamideB) MannitolC) PropranololD) Interferon-beta Answer: A) Acetazolamide — it is the pharmacologic first-line for idiopathic intracranial hypertension in conjunction with weight loss. Explanation: In idiopathic intracranial hypertension, the aim is to reduce intracranial pressure and prevent optic nerve damage. Weight loss is fundamental and acetazolamide is the standard drug of choice. Mannitol is for acute raised ICP (e.g., trauma), propranolol is for migraine prophylaxis / essential tremor, and interferon-beta is for MS. This illustrates how knowing the correct “drug of choice” swiftly can save time in an MRCP-style MCQ.

Medical trainee revising neurology drug choices for MRCP Part 1 using QBank and flashcards.

How to Use a QBank & Mock Tests Effectively

Timed practice: Use the Free MRCP MCQs section to simulate exam conditions (100 questions per paper in 3 hours, as per the format for the exam). Royal Colleges of Physicians UK+1
Error review: After each set, review all incorrect answers and link them back to your “drug of choice” sheet. Ask: Was the wrong answer because I chose the wrong drug type?
Flashcards + spaced repetition: Turn each row of the table above into a flashcard (condition ↔ drug). Review daily until you recall instantly.
Mock tests: Use the Start a mock test resource to do full-length mock papers under timed conditions. Focus on finishing within time and maintaining accuracy.
Integration with the app (when used): If using an app with subject-wise QBank, monthly new mocks and performance analytics, track your time per question and your strength in neurology drug questions.

Common Pitfalls (and How to Avoid Them)

Mixing seizure types and using the wrong drug (e.g., using carbamazepine in absence seizures which can worsen outcome).
Neglecting pregnancy/child-bearing considerations especially for valproate in women of childbearing age.
Confusing acute vs prophylactic therapy (e.g., giving propranolol for acute cluster headache instead of oxygen/sumatriptan).
Ignoring drug-interactions and side-effect profile (e.g., enzyme inducers like carbamazepine interfering with oral contraception).
Memorising brands and proprietary names rather than generic names (MRCP uses generic).
Overlooking guideline updates — always link back to sources like NICE for current first-line treatments.

FAQs

Q1: Is the drug of choice always the only drug tested in MRCP Part 1?

A: Not always — the exam may ask for “single best choice” among several options, so knowing the first-line is most helpful, though alternate choices may appear.

Q2: Do I need to memorise drug doses for MRCP Part 1?

A: Generally no — the exam focuses on which drug rather than specific dose regimens, though you should know typical dosing considerations.

Q3: How current must my pharmacology knowledge be for MRCP Part 1?

A: Very current — guidelines change (e.g., new AEDs or new first-line options), so always refer to UK-based sources such as the NICE guideline on epilepsy (NG217) and NICE guideline on Parkinson’s (NG71).

Q4: Can I rely solely on a cheatsheet like this for revision?

A: No — this cheatsheet is a supplementary tool. You must integrate it with full syllabus revision, app-based practice, and guided lectures.

Q5: Are brand names tested in MRCP Part 1 pharmacology questions?

A: Unlikely — the exam uses generic names to avoid regional brand confusion; focus on generic names such as carbamazepine, valproate, and levodopa.

Ready to start?

If you are serious about mastering MRCP Part 1, use this cheatsheet as a core revision tool and pair it with high-quality question practice. Head over to the Free MRCP MCQs section to test your recall, follow the structured revision in our Crack Medicine Lectures for deep dives, and set up full-length mock papers via Start a mock test to fine-tune your timing and accuracy. Your success in this exam starts with one drug recall at a time — keep practising, keep refining, and trust the process.