Common Diagnoses Flashcards
Pediatric Acute otitis media
amoxicillin (80-90kg/kg/day) bid for 7-10 days Next augmentin (90mg/kg/day), then cefdinir (14mg/kg/day) for 7-10 days
optimal therapy length
for children younger than 2 or with severe symptoms, a 10 day course is recommended;
a 7 day course may be adequate for children 2-5 years with mild or moderate symptoms
for children 6 years and older with mild to moderate symptoms, a 5-7 day course is adequate
Adult AOM treatment
Augmentin (amoxicillin/clavulanate) 875/125mg bid for 7-10 days
or amoxicillin 500mg tid for 5-7 days or 875 mg bid
Adult AOM treatment with penicillin allergy
Cefdinir, 300 mg orally twice daily or 600 mg once daily.
Community-acquired pneumonia s/sx
more severe and came on very quickly with high fevers with pronounced consolidation (s.pneumoniae)
Atypical pneumonia s/sx
caused by a different organism not covered by amoxicillin-patient is not quite as sick, seems like a viral illness but they also have crackles and a cough; less obvious xray findings but may have some abnormalities
treatment of pediatrics CAP
amoxicillin 90mg/kg/day tid for 7-10 days
cefdinir or clindamycin may be used as an alternative for penicillin allergy
treatment of atypical pneumonia in pediatrics
azithromycin 10mg/kg day one, then 5mg.kg for days 2-5
Treatment of CAP in adults
(macrolides) azithromycin 500mg day 1 then 250mg day 2-5
doxycycline (tetracycline) 100mg bid for 7-10 days
Z-PAK (azithromycin) has who type of properties?
anti-inflammatory effects which make people feel better, even if their illness is viral and the abx isn’t treating the virus
Treatment for bacterial vaginosis
metronidazole 500mg bid for 7 days
If treating with metronidazole, what do you need to educate your patient about?
No alcohol until 48 hours after last dose
Other BV treatments
metronidazole gel 0.75%, one full applicator (5g) intravaginally once daily for 5 days
Clindamycin cream 2% one full applicator (5g) intravaginally at bedtime for 7 days
How do you diagnose BV
wet prep, UA, PCR testing-PCR is more definitive than wet prep
How quickly do you need to look at trichomonas on the slide?
within 15 minutes or it will be missed
S/Sx of BV
thin, gray, foul, distinct fishy odor
s/sx of yeast infection
irritated vulvar area, thick, white discharge
If a patient presents to the clinic for BV, should you treat it?
yes-usually doesn’t get better on its own and the patient is very uncomfortable with it. Especially if pregnant or symptomatic
UTI treatment in women
nitrofurantoin 100mg bid for 5 days or TMP/SMX (bactrim) 160/800mg double strength bid for 3 days
UTI treatment in men
ciprofloxacin 1000mg daily or 500mg bid for 14 days
Pediatric (2-24months) UTI treatment
TMP/SMX 8-12 mg/kg trimethoprim component BID for 7-10 days (<5 year old) or 3-5 days if > than 5 years old
augmentin 25mg/kg/day bid for 7-14 days
or cephalexin 50mg/kg/day bid for 7-14 days
UTI treatment in pregnancy
cephalexin 250-500mg QID for 7 days or nitrofurantoin (macrobid) 100mg QID for 7 days
Macrobid should be avoided in patients with?
renal failure or if concerns for pyelonephritis as it will not work in the renals (fever, CVA tenderness, chills, body aches)
Bactrim failure is what percent with e coli?
20%
do men have uncomplicated UTI’s?
no, so you need 14 days of cipro
what medication can you prescribe for UTI if the patient has renal impairment?
keflex
What medication is used for pyelonephritis?
Cipro
First-line medication treatment of depression?
SSRI
Starting dose of fluoxetine?
Prozac: 20mg daily
starting dose of sertraline?
zoloft: 50mg daily
Starting dose of paroxetine?
Paxil 20mg daily
Sarting dose of citalopram>
celexa: 20mg daily
Starting dose of escitalopram?
Lexapro: 10mg daily
SNRI dosages:
Venlafaxine
Desvenlafaxine
Duloxetine
Effexor: 37.5mg daily
Pristiq: 50mg daily
Cymbalta: 60mg daily
Dopamine Norepinephrine Reuptake Inhibitor medication and dose
Bupoprion (wellbutrin) 150mg daily
Goal of dosing anti-depressants
start low and slow but do not leave it at this dose: follow up in 6 weeks to titrate up
Treatment failure of anti-depressants due to?
lack of titrating medication up
Zoloft is typically used for patients with?
social anxiety
What side effects are most bothersome
sexual side effects of SSRI
Risk vs benefit of standard-dose to max-dose?
may have more side effects with max dose and no additional benefit that they feel
Hypertension first line treatments
thiazide diuretics, ACE, ARB, CCB
Hypertension first line treatments for AA
thiazide diuretics, CCB
Thiazide diuretic medication and dose
HCTZ 12.5-25mg once daily
chlorthalidone 12.5-25 mg once daily
ACE
Lisinopril 10-20 mg once daily
benazepril 1-20mg once daily
have kidney protection so they are preferred for DM2
ARB
Valsartan 40-80mg once daily
losartan 50mg once daily
CCB
amlodipine 2.5-5mg once daily
Diltiazem ER 180-240 mg once daily
Hyperlipidemia medications
Atorvastatin and rosuvastatin
More body aches associated with which HLD med?
atorvastatin
More medication interactions associated with which HLD med?
simvastatin
Atorvastatin intensities and dosages
medium: 10-20mg/day
high 40-80mg/day
rosuvastatin intensities and dosages
medium: 5-20mg/day
high: 20-40mg/day
Influenza treatment choices
zanamivir (relenza)
oseltamivir (tamiflu)
Zanamivir treatment dosages
Age 7 and up: 10mg, 2 inhalations, twice daily for 5 days
Zanamivir chemoprophylaxis dosage
Ages 5 and up: 10mg, 2 inhalations, once daily for 10 days
Oselamivir treatment dosages
Adults: 75mg bid for 5 days Peds (starting at 1 year old): <15kg=30mg bid for 5 days 15-23kg=45mg bid for 5 days 24-40kg=60mg bid for 5 days >40mg=75mg bid for 5 days
Oseltamivir chemoprophylaxis treatment for adults
Adults 75mg once daily for 10 days
Oseltamivir chemoprophylaxis treatment for pediatrics greater than 1 year old
Peds (starting at 1 year old): <15kg=30mg daily for 10 days
15-23kg=45mg daily for 10 days
24-40kg=60mg daily for 10 days
>40mg=75mg daily for 10 days
Tamiflu can do what?
decrease the severity and duration of the infection if given within 72 hours of infection
Is prophylaxis of tamiflu indicated for everyone?
not needed for healthy immunocompetent individuals in the household
Adult acute sinusitis treamtent
Amoxicillin/clavulanate (augmentin) 875mg bid for 7 days
Pediatric acute sinusitis treatment
3 months and older
Augmentin 20-45mg/kg/dau bid for 7 days
treatment for sinusitis in adults if allergic to amoxicillin
doxycycline 100mg bid for 7 days or levofloxacin 750mg daily for 5 days
Treatment of acute sinusitis in pediatrics who are allergic to amoxicillin
cefdinir: 6-12 years old= 14mg/kg/day once daily for 7 days
13 and older= 600mg once daily for 7 days
strep throat treatment in adults
penicillin V=500mg bid or tid for 10 days
amoxicillin= 1g daily or 500mg bid for 10 days
strep throat treamtent in pediatrics
penicillin V=<27kg=250mg BID or TID for 10 days
>27kig=500mg bid or tid for 10 days
Amoxicillin 50mg/kg daily for 10 days
strep throat treatment in adults if amoxicillin allergy
cephalexin=500mg bid for 7-14 days
clindamycin 20mg/kg/day tid
azithromycin 500mg on day one then 250mg days 2-5
strep throat treatment in pediatrics if allergic to amoxicillin
cephalexin: 50mg/kg/day bid for 10 days
azithromycin= 12mg/kg/day once daily for 5 days (max dose 500mg)
Need to treat strep throat for how long and why?
10 days to prevent rheumatic heart disease
Why is amoxicillin used for kids?
It is easy and they like the taste
Treatment for type 2 DM
metformin 500mg bid or 850mg once daily
metformin common side effect?
diarrhea, but usually improves over time: ER can usually help with this as well
Other treatments for DM2
diabetic educator, dietician, eye exam
Acute bacterial conjunctivitis treatment for non contact lens wearer
trimethoprim-polymycin B one drop to affected eyes four times daily for 7-10 days: 5 days may be sufficient but for sure use it 2 full days beyond when all of the symptoms are gone
Acute bacterial conjunctivitis treatment for contact lens wearers
ciprofloxacin opthalmic solution 0.3% one to two drops every 2 hours while awake for 2 days, then 1-2 drops every 4 hours while awake for the next 5 days
allergic rhinitis treatment orally
ceftirizine (zyrtec), fexofenadine (allegra), loratadine (claritin)
allergic rhinitis treatment with nasacort
intranasal steroids triamcinolone acetonide (nasacort) 2-5 y.o 1 spray each nostril daily 6-11 year old=2 sprays each nostril daily 12 and up=2 sprays each nostril once or twice daily
allergic rhinitis treatment with budesonide
intranasal steroid rhinocort
6 years and up 2 sprays each nostril twice daily for 4 sprays each nostril in the morning
allergic rhinitis treatment with fluticasone
flonase intranasal steroid
4 years and up 1 spray each nostril daily
adult=2 sprays each nostril daily
allergic rhinitis treatment with intranasal antihistamines
azelastine (astelin)
6-11 years old=1 spray twice daily
12 years and older=1-2 sprays twice daily
