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Patient management > Dosages > Flashcards

Dosages Flashcards

1
Q

Acute gastritis

A

NPO, suspend NSAIDS/Cortisone tx.
Metclopramide or anti-H2 PPI

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2
Q

PUD

A

Triple tx: PPI (omeprazole 40mg/12hr) + amoxicillin 1g/12h + clarithromycin 500mg/12 hr for 10-14 days
Quadruple tx: PPI + Metronidazole 250mg/6h + tetracycline 500mg/6h + bismuth (an antiacid) 120mg/6h 10-14 days

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3
Q

Non variceal bleeding tx

A

Pre endoscopic: IV PPI 80 mg bolus, and 8mg/hr drip until EGDS

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4
Q

Variceal bleeding tx (acronym is VARICEAL)

A

Vasopressors: terlipressin/octreotide (vasopressor) 50mcg bolus or /hr
Antibiotics: ceftriaxone 1g IV
Resuscitation: ringer lactate
ICU
Endoscopy band ligation and sclerothx
Alternative tx: TIPS
BB: non selective nadolol 40mg/day

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5
Q

Uncomplicated diverticulitis tx

A

Meperidine for anti-spasm
Metronidazole 500mg/8h + ciprofoxacin 500mg/12hr or augmentic 875/12hr

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6
Q

Complicated diverticulitis tx

A

Inpatient management with broad spectrum antibiotics: pip/tazo 4.5mg/gh IV or ceftriaxone 1g/day + metronidazole 500mg/8h IV
Surgery (CT guided percutaneous drainage for abscess>4cm)
Emergency colectomy if pt has generalised peritonitis

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7
Q

Treatment of pancreatitis

A

IV fluids ringers lactate 30ml/kg/hr
TPN/NG tuge
Analgesics merepiridine 100-150 mcg/3-4h/IM
Antibx only if severe according to marshall score/apache>8 –> imipenen if severe. Metronidazole +ciprofloxacin or pip/tazo+fluconazle in immunocompromised

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8
Q

TX of hemorroids

A

non prolapsing: high fiber diet, hygiene, corticosteroids
prolapsing: band ligatoin or stapling

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9
Q

TX for anal fissures

A

Fiber rich diet, stool softeners, antrolin (nifedipin+lidocaine suppositories) + mesalazina (NSAID suppositories)

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10
Q

TX for acute diarrhea

A

Hydration+Loperamide+Bismith

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11
Q

TX for specific pathogens in acute diarrhea:

A

Salmonella: Ciprofloxacin 500mgx2/die if severely ill; consider Ceftriaxone 2g/day IV.
● ETEC: Empiric therapy Ciprofloxacin 500mgx2/die for 3-5days or Azithromycin 500mg/day for 3 days.
● Campylobacter: Quinolones + Azithromycin
● C. difficile: Metronidazole 500mg x3/die for 14 days; if relapse Vancomycin 125mg 4/day per 14 days
● Listeria: Ampicillin + Gentamycin or Trimethoprim/ Sulfamethoxazole
● Entamoeba histolytica: Metronidazole 500-750mg 3/day for 7-10 days followed by Paromomycin
25-35mg/kg/die for 7 days
● Giardia: Metronidazolo 250mg/8h

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12
Q

TX for chronic diarrhea

A

Loperamide (scheduled rather than when needed)
- Octreotide only if Loperamide does not work.
- Bile acid binding resins in bile acid malabsorption
- Fecal transplant
- Cure the underlying disease

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13
Q

Acute pharmacotherapy for acute coronary syndromes

A

Morphine 2-4mg IV
Oxygen 15L/min (non-rebreather mask if spO2<90)
Nitroglycerin 0.3-04 mg sublingual or 1-2 sprays
Aspirin 300mg chewable then 75-100mg/die (or clopidogrel 300mg-600mg)

Anti-coagulant: Fondaparinux 2.5mg SC for 8 days or UFH 60U/kg for 2 days.
Fibrinolysis with ALTEPLASE 15mg bolus + 0.75mg/kg/30min + 0.5mg/kg/60min (MAX 100mg)
Bisoprolol 5-10mg/die
Ramipril 1.25-10mg/die
Atorvastatin 10-20mg/die
Valsartan 20mgx2/die
Amlodipine 5-10mg/die

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14
Q

TX of unstable Pulmonary embolism

A

BP<90 and/or PaO2 <60 and/or diuresis <0.5ml/kg/h: ALTEPLASE (tPA) 10mg bolus + 90mg/2h + Fluids and Vasopressors.
If failure of thrombolysis/likelihood shock/death before rTPA have effect perform catheter based thrombectomy.
If failure of above therapies SURGICAL THROMBECTOMY

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15
Q

Tx of stable pulmonary embolism

A

Heparin 80U/kg IV + 18U/kg/h for 5 days then oral anticoagulants for 3-6 months + dual antiplatelet therapy

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16
Q

TX for tachycardia

A

Amiodarone 300mg 10-20min or 20-60min; 900mg over 24hours.
Adenosine 6mg, 12mg, 12mg
Magnesium Sulphate 2g 10 min

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17
Q

Bradycardia tx

A

Atropine 500mcg bolus up to max 3mg.
Isoprenaline 5mcg/min if BAV III
Adrenaline 2-10mcg/min
Glucagon if the patient is taking beta-blockers

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18
Q

TX for cardiac arrest

A

Adrenaline 1mg Bolus
Amiodarone 300mg Bolus after 3rd shock and 150mg after 5th shock

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19
Q

TX for anaphylactic shock

A

Adrenaline 0.5ml (0.01mg/kg)
Fluid replacement 1.5L
Salbutamol (puffs)
Methylprednisone 125mg or Dexamethasone 200mg

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20
Q

TX for septic shock

A

Antibiotics:
- Vancomycin 1g loading dose + 2g/12-24h
- Pip/Tazo 4.5g/3h every 6-8hours
- Meropenem 1g/3hours every 6-8hours and 2g every 8h for meningitis
- Ceftriaxone 2g/24hours, every 12hours if meningitis
- Levofloxacin 750mg every 24 hours
Fluids 30ml/kg/h
Vasopressors: Noradrenaline 40mg/L infusion rate from 0.005-1mcg/kg/min

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21
Q

TX for hemorrhagic shock

A

Massive Transfusion Protocol: 6:6:1
Platelets only if <50.000
FFP only if Fibrinogen <1g/L or PT>1.5
PCC if patients is taking TAO
Tranexamic Acid

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22
Q

Acute endocarditis on native valve tx

A

Ampicillin 12g/day + Oxacillin + Gentamycin
Vancomycin 30mg/kg/day + Gentamycin 3mg/kg/day

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23
Q

TX of pericarditis

A

NSAIDs (Ibuprofen 300-800mg/6-8h or Aspirin 800mg/6-8h) for 3-4weeks (gradual tapering, consider PPI).
Colchicine 0.5-1mg/ day
Glucocorticoids (Prednisone 1mg/kg/day only in refractory patients).

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24
Q

Tx of myocarditis

A

Do a biospy to confirm fulminant myocarditis/giant cell myocarditis
Treat HF and arrythmias. Give immunosupression if needed

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25
Q

TX for aortic dissection

A

Stable patient w/o suspicion of ascending aortic involvement: CT angio medical therapy if no evidence of malperfusion: 1) MAINTAIN <60 BPM (esmolol or labetalol; if not tolerated, non-DHT or nicardipine)
2) ONCE <60 BP, IF
SBP > 120, vasodilators (nitroprusside infusion or nicardipine infusion). + IV analgesia (fentanyl).
Unstable patient OR strong suspicion of ascending aortic involvement: TEE Surgical emergency.

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26
Q

TX of aortic stenosis

A

aortic valve replacement if severe
Do TAVI is not suitable for replacement

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27
Q

TX of stress induced cardiomyopathy

A

hydration and resolution of physical/emotional stress

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28
Q

HF therapy step wise approach

A

At any step, Furosemide to relieve S&S of congestion.
1) ACE-I/ARBs
2) ACE-I/ARBs + Beta-blocker
3) ACE-I/ARBs + Beta-blocker + Spironolactone
4) ACE-I/ARBs + Beta-blocker + Spironolactone + Ivabradine (LVEF ≤35% & HR at rest ≥70)
5) ACE-I/ARBs + Beta-blocker + Spironolactone + CRT (QRS <120) or ICD (QRS>120)
6) ACE-I/ARBs + Beta-blocker + Spironolactone + Digoxin or Isosorbide/Dinitrate/Hydralazine
7) ACE-I/ARBs + Beta-blocker + Spironolactone + LVAD or BiVAD…………..Transplant

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29
Q

TX of hemoptysis

A

If massive hemoptysis (200-600 ml/<24h) treat the patient as you try to determine the underlying condition:
Early chest CT (source of bleeding) bronchoscopy arteriography surgery.
In the meantime:
- position of the patient + intubation to avoid aspiration;
- ensure adequate gas exchange and CV function: bronchodilators, Ringer, coagulopathy correction: FFP
(anticoagulation tx, increased INR, PT or aPTT), PLT (thrombocytopenic or antiplatelet tx);
- if the patient keeps coughing: codeine.

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30
Q

TX of sepsis in CAP

A

Ceftriaxone + Levofloxa/Azitromicina (+ Levofloxacin if you suspect Legionella)

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31
Q

TX of sepsis HAP

A

Pip/Tazo or Meropenem + Levofloxacin + Vancomycin

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32
Q

Pneumonia in an old pt tx

A

Levofloxacin 750mg/die or Doxycycline

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33
Q

Pneumonia in a young pt TX

A

Amoxicillin 500mg/8h (3xdie) + Clarithromycin 500mg/12h (if walking pneumonia) –
if not Levofloxacin 750mg/die (considering higher risk for resistance and Achille’s tendon rupture).
According to CURB65 consider: Amoxi Amoxi + Claritro Amoxi-Clavu + Claritro

34
Q

TX of TB

A

2 months Isoniazid + Rifampicin + Pyrazinamide + Ethambutol followed by 4-6 months Isoniazid + Rifampicin

35
Q

TX of sarcoidosis

A

50% spontaneous resolution without therapy. NSAIDs or Prednisone 0.5mg/kg for 4-6 weeks.
Immunosuppression: Methotrexate.

36
Q

TX of asthma

A

1) SABA reliever
2) ICS (inhaled corticosteroids) Low Dose + SABA reliever
3) ICS Low Dose + LABA + SABA reliever
4) ICS Med Dose + LABA + SABA reliever
5) Refer add-on treatment e.g. Anti-IgE Omalizumab

37
Q

Acute exacerbation of asthma

A

SABA + ICS Ipratropium (Anti-Cholinergic) Magnesium Sulphate

38
Q

TX for COPD

A

1) SABA
2) LABA/LAMA + SABA
3) LABA + LAMA + SABA OR LABA + ICS + SABA
4) LAMA + LABA + ICS + SABA ± Roflumilast ± ABX (Azitromycin)

39
Q

TX of acute exacerbation of COPD

A

NIV: BiLevel + Treatment of Exacerbation: Oral corticosteroids (prednisolone 30 mg), Nebulised
SABA (Salbutamol 5 mg), LAMA (Ipratropium Bromide 500 μg)

40
Q

TX for interstitial lung disease

A

corticosteroids/anti-inflammatory

41
Q

Orthostatic hypotention tx

A

Midodrine 2.5-10mg up to 2-4/die;
Fludrocortisone 0.05-0.3mg/die;
Droxidopa 100-600mg 3x/die;
Pyridostigmine 30-60mg x3/die;
Paroxetine 10-20mg/die or Reboxetine 2-4mg/die.

42
Q

TX for autoimmune autonomic ganglionopathy

A

Prednisone 25mg x2/die + Azathioprine 50mg x3/die.
Maintenance: Mycophenolate 1000mg x2/die + Midodrine.

43
Q

TX for carotid sinus syncope

A

Cardiac pacing with ICD if cardio-depressive. If not educational therapy.

44
Q

TX for cardiac structural/electrical related syncope

A

Structural: Manage myocardial ischemia (pharmacological and revascularisation); Valvular disease (percutaneous or
surgical replacement); Hypertrophic cardiomyopathy (ICD); etc.
Arrhythmias: Tachyarrthymia and Bradyarrhythmia management. Pay attention to QT prolongating drugs.

45
Q

TX for hypertensive emergency and urgency

A

Emergency defined as diastolic BP >120 with evidence of acute end-organ damage IV medications such as Labetalol, Sodium Nitroprusside, Nicardipine, Nitrates and Furosemide.
Hypertensive crisis in a pregnant woman: labetalol or alpha-methyl-dopa or clonidine.
Urgency is a severe hypertensive episode diastolic BP >120 in an asymptomatic patient.

46
Q

Side effects of drugs

A

CCBs: headache, dizziness, lower extremity edema, hypotension, altered HR, constipation.
DHPs: Tachycardia.
ACE-I: cough, angioneurotic edema, hyperkalemia.
Thiazide diuretics: diarrhea, hypercalcemia, hyponatremia.
Loop diuretics: hypocalcemia, dizziness, headache, diarrhea & vomiting.
Beta blockers: bradycardia, fatigue, erectile dysfunction, depression, hypotension, and bronchospasm
Other side effects:
●Flecainide: nightmares, headaches, paresthesia, and proarrhythmia
●Sotalol: bradycardia, Q–T prolongation, and proarrhythmia
●Amiodarone: bradycardia and nausea, short and long term there is risk of neuropathy, thyroid, lung, and liver toxicity

47
Q

Major contraindications of anti-HTN drugs

A

Thiazides not in gout, hypokalemia, pregnancy.
Beta blockers not in asthma, high-grade SAN or AVNB. Avoided in diabetics.
ACEi contraindicated in pregnancy.
DHP avoided in edema, tachyarrhythmias (can give Verapamil)
Non DHP not to be given in bradycardia, compromised LVEF, high grade SAN block/ AVN.
No Beta-blockers and Non-DHP concomitantly negative inotropic effect acute decompensation.
No ACEi + ARBs together complete block of the RAAS, renal compensation failure.

48
Q

Uncomplicated HTN tx

A

(1) INITIAL DUAL THERAPY (1 PILL): ACEi/ARB + CCB/Diuretic
(2) TRIPLE COMBINATION (1 PILL): ACEi/ARB + CCB + Diuretic
(3) TRIPLE COMBINATION + SPIRONOLACTONE (2 PILLS) (or other diuretic, alpha lytic – could cause orthostatic hypotension or BB)
Consider BB at any tx step, when there is specific indication for their use: e.g. HF, angina, post-MI, AF, younger women desiring pregnancy.

49
Q

HTN + HFrEF tx

A

(1) INITIAL THERAPY: ACEi/ARB + DIURETIC (or LOOP) + BETA-BLOCKER
(2) STEP 2: ACEi/ARB + DIURETIC (or LOOP) + BETA-BLOCKER + MRA

50
Q

How to tx a hypertensive crisis in a pregnant woman

A

Clonidine IV or in patches (methyldopa or labetalol)

51
Q

TX of toxic megacolon

A

Supportive + TPN + Discontinue all anti-motility agents +
- If IBD: Glucocorticoids/ Sulfamesalazine / Infliximab / Cyclosporine if fails Surgery
- If C. difficile: Vancomycin 500mg 4/die NGT (if ileus rectal enema) + Metronidazole IV 500mg/8h fecal transplant if complicated (colonic perforation, necrosis, ischemia, compartment syndrome, peritonitis, MOF)
Surgery
- If HIV: Surgery
- If Pregnant (UC): Corticosteroids IV

52
Q

TX for biliary colic

A

Anti-spastics Buscopan 1fl IM or IV followed by 1-2fl continuous infusion;
Analgesics: avoid Morphine, good option Meperidine or NSAIDs;
Antibiotics: ONLY IF FEVER and/or SHIVERING and/or LEUKOCYTOSIS, good option Ceftriaxone or Amoxicillin.
Oral Therapy: Ursodesossicolic acid Deursil 50-150-300mg. C/I: malfunctioning gall bladder, cholecystitis, partial
obstruction, cholangitis, acute or chronic hepatitis, cirrhosis, GI disorders, CKD.

53
Q

TX for cholangitis

A

Charcot’s Triad (Murphy positive, Fever, Jaundice) Raynaud’s pentad (AMS + Hypotension/Shock)
Antibiotics: Ciprofloxacin 250mg/12h IV or Ceftriaxone + Metronidazole
Endoscopy: If no response within 24hrs ERCP followed by Elective Laparoscopic Cholecystectomy

54
Q

TX for acute cholecystitis

A

NGT if nausea/ vomiting/ ileus.
Re-hydration & Analgesia
Antibiotics: Ampicillin 1g/4h or Ceftriaxone 1g/12h IV for 7 days, if severe Metronidazole for anaerobes coverage.
Surgery: Early Laparoscopic Cholecystectomy

55
Q

TX of acute mesenteric ischemia

A

Colonic/ Mesenteric/ Venous Ischemia (Arterial) Resuscitation + Antibiotics + Surgery/ Interventional
Radiology + Reversal of Anti-coagulation/ Anti-aggregation.

56
Q

TX of intra-abdominal infections

A

ESBL NEGATIVE: PIP/TAZO
ESBL POSITIVE: Meropenem

57
Q

PID TX

A

Outpatient: Doxycycline + Metronidazole + Ceftriaxone IM
● Inpatient: Cefotetan + Doxycycline

58
Q

UTI TX

A

Woman with cystitis Nitrofurantoin or Phosphomycin
SEPSIS UTI ESBL -: Piperacillin/Tazobactam
SEPSIS UTI ESBL +: Meropenem

59
Q

TX of chronic ascites

A

Norfloxacin or Ciprofloxacin 500mg PO/die

60
Q

TX of hepatic encephalopathy

A

Impaired hepatic transformation of Ammonia into Glutamine
1. Triage: grade I – outpatient; grade II (lethargy confusion)– check confusion; grade III-IV(stupor/coma) – ICU
2. Supportive care: coma intubation; agitation restraints, haloperidol; diet no protein intake restriction, avoid fasting, dehydration, correct electrolytes
3. Acute treatment: correct precipitating agents: drugs (benzo, CNS depressants) dehydration/hypovolemia (vomiting, diarrhea,
diuretics, paracentesis), PS shunt, vascular occlusion (PV and HV thrombosis), HCC, ↑NH3
production/absorption/entry in the brain (hypoglycaemia and excess protein intake, GIB, hypoK+constipation, metabolic alkalosis)
lower blood ammonia (regardless of value): lactulose 20-30 g BID/QID x os or enema (↓ pH conversion of NH3 to NH4 trapped in colon); if no improvement after 48 h add rifaximin 400 mg TID per os correct hypokalemia: IV K
+ replacement (KCl) [NB hypoK+ increases renal ammonia production]

61
Q

TX of acetaminophen overdose?

A

acetyl cysteine

62
Q

TX for wilsons dx

A

: Ceruloplasmin Low + Keyser Flesher Rings + 24h-urinary Cu
Treatment: Chelators (bind free copper, biliary excretion) & Zinc (decreases copper absorption) Transplant

63
Q

TX of hemochromatosis

A

Transferrin & Ferritin
Treatment: Phlebotomy & Transplant

64
Q

TX of PBC

A

Chronic cholestatic liver disease, non-suppurative granulomatous cholangitis,
duct destruction and ductopenia and portal fibrosis BILIARY CIRRHOSIS.
Diagnosis: ALP/GGT; AMA+; Diagnostic Histology
Symptoms: fatigue, pruritus, xantelasma, dry mouth. Associated with autoimmune diseases: Thyroid, Sicca, CREST,
Raynaud, Celiac disease, Rheumatoid arthritis.
Therapy: UDCA 13-15mg/kg/die or Obetycholic Acid + FIBRATES or BUDESONIDE or CORTICOSTEROIDS
AZATHIOPRINE LIVER TRANSPLANT

65
Q

TX of PSC

A

Cholangitis, intra and extra-hepatic biliary tree involvement, Immune-mediated (not autoimmuune), aspecific inflammation. Mostly affects men. Associated with Cholangiocarcinoma & IBDs (strong predisposition to colon cancer) and Autoimmune Pancreatitis. Progressive condition Cirrhosis.
Diagnosis: cholangiography, MRI strictures + p-ANCA and p-ANNA positive.
Treatment: ERCP for stenosis + UDCA (no real benefit) + Increase surveillance for cancer.

66
Q

TX for acute generalised edema in heart

A

1) Exclude liver, kidney probs (US, CXR, Urinalysis and blood tests)
2) Oxygen SpO2<90% + Opiates SBP is good
3) Vasodilators (Nitroglycerin SBP) + Furosemide 40-80mg
4) Inotropes (Dobutamine) / Vasopressor (Norepinephrine)
5) Fluids (If negative fluid balance)
6) Prophylaxis thrombo-embolism
7) ACE-I/ Beta-block/ MRA/ Digoxin

67
Q

TX for acute generalised edema renal

A

ute Generalised Edema (Renal):
1) Exclude heart and liver probs with US and CXR
2) Stabilise ABC
3) Obtain Blood Tests and Urinalysis (focus of proteinuria)
4) If Renal Insufficiency/ Nephrotic Syndrome is confirmed LOOP DIURETIC FUROSEMIDE HIGH DOSE
40-80mg Administer as frequently as necessary to maintain response + THIAZIDE (25-100mg according
to severity) or SPIRONOLACTONE (if potassium needs correcting).
5) Emergency Dialysis if: refractory edema, K+ >6.5, pH<7.2, signs of uremia (pericarditis, AMS,
encephalopathy) overall inability to control blood volume and pressure.

68
Q

TX of acute generalised edema hepatic

A

1) Exclude heart and kidney problems (with US, CXR, Urinalysis)
2) Stabilise ABC
3) Sodium restriction 2 g day + FUROSEMIDE 40-80mg + SPIRONOLACTONE 100mg (Increase until
response MAX 160mg Furosemide and 400mg Spironolactone)
4) If no response Clonidine 0.075mg 1-2x/die with SBP >135mmHg ± 20g Albumin/week
5) If no response IV Terlipressin 2mg/die ± 20g Albumin/week
6) Last resource Paracentesis + Albumin 8g/L di Ascite
7) TIPS
8) Identify etiology of liver failure (alcohol/ NASH/ HCV-HBV/ Autoimmune)
9) Strategies to target key factors in pathogenesis: rifaximin, longterm albumin administration, statins
(↓inflammation), bB (↓portal hypertension)

69
Q

TX for adrenal insufficiency

A
  1. Hydrocortisone 100mg IV every 6-8hours for 24 hours.
  2. If SHOCK: 1L NS over 1h + 5% Dextrose
  3. Improvement should be seen in 4-6hrs: recognise and treat any infection that may have precipitated the adrenal crisis.
  4. Hydrocortisone after 24hrs: 50mg IM every 6hours
  5. Hydrocortisone oral 40mg morning 20mg at 6pm 20mg morning 10mg at 6pm (chronic therapy)
70
Q

TX of myxedema coma

A
  1. Mechanical ventilation (correction of hypoxia and hypercapnia) in alternative NIV/CPAP
  2. Correct hypothermia, hypovolemia, hypoglycemia, electrolyte abnormalities.
  3. T4 100-500mcg/day IV 75-100mcg/day IV oral replacement.
  4. Give Hydrocortisone 100mg/8hrs until you exclude adrenal insufficiency caused by hypopituitarism.
  5. Pay attention to patient taking long-term amiodarone could be a cause of non-functioning thyroid.
71
Q

TX for hypoglycemia

A

IV dextrose if you can’t give IV then Glucagon 1mg IM
IV access: 50ml 20% IV over 1-3 minutes or 15g sugar Re-test in 15 min Re-treat if under 70

72
Q

TX of DKA

A

Confirm diagnosis: Hyperglycemia (>250 mg/dl and glycosuria); ketonemia and ketonuria; metabolic acidosis (pH<7.25, bicarbonate <15, anion gap >10).
1. Replace fluid deficits: isotonic saline over 48 h (usually < 20 cc/kg)
2. Correct acidosis and hyperglycemia:
IV low-dose Insulin (0.1 U/kg/h) in continuous infusion with <100mg/dl/h decrease in serum glucose + Dextrose when glucose is about 250 mg/dl or falling faster than 100 mg/dl/h (AVOID STOPPING INSULIN INFUSION!). Continue Insulin infusion until acidosis is cleared: pH > 7.3, Bicarbonates >15, Anionic gap 10±2
3. Correct electrolyte imbalance: serum K
+ can be elevated despite total body potassium depletion (extracellular shift // intracellular H
+ shift, due to acidosis) K phosphate, K acetate, KCl IV if [K+] = 5-6 or <5
4. Treat the underlying cause
5. Monitor for possible treatment complications (cerebral edema) @6-10 hours after initiation of treatment

73
Q

TX of HHS

A

Clinical presentation similar to DKA (dehydration, AMS, high glucose, polyuria, abdominal pain and distension),
triggered by infection or drugs (steroids, thiazides), but no ↓pH, ↓HCO3
, serum and urinary ketones. Most important
features: high glycemia (>600 mg/dl!) and serum osmolarity (>320).
1. Replace fluid deficit
2. Correction of hyperglycemia via Insulin
3. Correct electrolyte imbalance
4. Treatment of underlying cause
5. Monitor for possible treatment complications

74
Q

TX of hemorrhagic stroke

A
  1. Control BP, ICP: CPP (MAP-ICP) at least 70. IV medications to lower SBP <160mmHg
  2. Surgery to control hemostasis Decompressive Craniectomy
  3. Anticoagulation reversal: Warfarin (PCC/ Vit K) Dabigatran (Idarucizumab) Heparin (Protamine Sulphate)
75
Q

TX of ischemic stroke

A
  1. Within 4.5 hours: Alteplase 0.9mg/kg 10% in bolo 90% in 1h (MAX 90mg)
  2. Clot retrieval within 6h if Alteplase if contraindicated
  3. If IV fibrinolysis and mechanical thrombectomy are contraindicated or patient has arrived late: Aspirin 325mg/die
  4. Target SBP 160-180 DBP 90-110 (Lower if thrombolytics):
    - SBP >220 DBP >120 Labetalol 5-20mg IV or Clonidine 0.12-0.3mg IV/TC
    - DBP >140 Nitroglycerin 5mg IV (1-4mg/h/IV)
    - Nicardipine 5mg/h IV infusion
    Long term management similar to ACS
76
Q

seizures

A

diazepam

77
Q

Status epilepticus

A

Diazepam/ Lorazepam INTUBATE + Midazolam Valproic Acid/ Phenytoin Phenobarbital

78
Q

Meningitis tx

A

Ceftriaxone + Ampicillin (Steroids prior), if you suspect MRSA Vancomycin
MENINGITIS POST-CHIR: Meropenem + Vancomycin

79
Q

TX for palpable purpura

A

1ST line: NSAIDs + Colchicine 0.6mg + Prednisone 60-80mg
2nd line: Mycophenolate / Methotrexate / Cyclophosphamide / Azathioprine
ITP: Oral corticosteroids IVIG Splenectomy if refractory (remember to perform vaccines before splenectomy).
TTP: IV corticosteroids Plasmapheresis
HUS: IV Corticosteroids, Blood transfusions, Dialysis
DIC: Supportive and treat SEPSIS

80
Q

TX of obesity

A

ORLISTAT (Inhibitor of pancreatic lipase, risk of oxalate kidney stones, no reabsorption of Vit.A).
LORCASERIN (Serotinin 2C receptor agonist, reduces appetite.
Sympathomimetic drugs (only for short term)
Buproprion & Topiramate
Vagal Blockade

Patient management (11 decks)

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