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USMLE step 1 > first-line tx > Flashcards

first-line tx Flashcards

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1
Q

bacterial vaginosis (Garnerella Vaginalis)

A

metronidazole or clindamycin

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2
Q

trichimoniasis (trichomonas vaginalis)

A

metronidazole or clindamycin

must also treat partner**

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3
Q

candida vaginitis (candida albicans)

A

topical azoles (fluconazole)

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4
Q

chronic hepB/C

A

IFN-a (HBV,HCV);

ribavirin, simeprevir, sofosbuvir (HCV only)

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5
Q

strep bovis

A

penicillin prophylaxis

**evaluation for colon cancer if linked to endocarditis

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6
Q

botulism

A

antitoxin

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7
Q

tetanus

A

antitoxin

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8
Q

HiB

A

amoxicillin +/- clavulinate (mucosal infections)

ceftriaxone (meningitis)

rifampin (prophylaxis)

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9
Q

gonorrhoeae

A

(IM- if disseminated) ceftriaxone +/- doxycycline/macrolide (PO)

**add doxycycline to cover likely concurrent Chlamydia trachomatis infection

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10
Q

N. meningitidis

A

penicillin/ceftriaxone, rifampin (prophylaxis)

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11
Q

Legionella pneumophila

A

macrolides (azithromycin)

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12
Q

pseudomonas aeruginosa

A

piperacillin/tazobactam, aminoglycosides, carbapenems, fluoroquinolones

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13
Q

syphilis (treponema pallidum)

A

penicillin G

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14
Q

chlamydia trachomatis

A

Doxycycline +/- ceftriaxone;

oral erythromycin for chlamydial conjunctivitis in infants

**ceftriaxone for concurrent gonorrhoeae infection

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15
Q

oral thrush (candida albicans)

A

nystatin, fluconazole, caspofungin

oral and esophageal

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16
Q

systemic candidiasis (candida albicans)

A

fluconazole, caspofungin, amphotericin B

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17
Q

cryptococcus neoformans

A

induction w. amphotericin B and flucytosine

**maintenance w/ fluconazole (in aids pts)

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18
Q

sporothrix schenckii

A

itraconazole, oral potassium iodide

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19
Q

pneumocystis jirovecii

A

TMP-SMX (prophylaxis and tx in immunosuppressed pts, CD4 <200/ AIDS)

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20
Q

toxoplasma gondii

A

sulfadiazine + pyrmethamine

  • block folate synthesis pathway
  • HSR, photosensitivity, myelosuppression
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21
Q

Malaria

A

chloroquine (in regions not resistant); mefloquine, atovaquone/proguanil (for blood schizont),

Primaquine (for liver hypnozoit)

**must take mefloquine for 4 weeks after return from trip

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22
Q

strep. Pyogenes

A

penicillin prophylaxis

amoxicillin (tx - GAS pharyngitis)

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23
Q

strep. Pneumoniae

A

penicillin/ cephalosporin (systemic infection, pneumonia)

vancomycin (meningitis)

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24
Q

staph. Aureus

A

MSSA: nafcillin, oxacillin, (dicloxacillin for mastitis) (antistaphylococcal penicillins);

MRSA: vancomycin, daptomycin, linezolid, ceftaroline (5th gen)

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25
Q

enterococci

A

vancomycin, aminopenicillins/ cephalosporins

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26
Q

Rickettsia rickettsii

A

doxycycline, chloramphenicol

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27
Q

C. difficile

A

oral metronidazole

if refractory (oral vancomycin)

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28
Q

M. TB

A

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

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29
Q

UTI

A

TMP-SMX/ciprofloxacin- uncomplicated

nitrofurantoin- pregnancy

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30
Q

influenza

A

oseltamivir, zanamivir

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31
Q

CMV

A

Ganiciclovir, foscarnet, cidofovir

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32
Q

PDA

A

keep open: PGE analogs; close: indomethacin

“come IN and CLOSE the door”

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33
Q

stable angina

A

sublingual nitroglycerine

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34
Q

malignant hyperthermia

A

Dantrolene

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35
Q

hypercholesterolemia

A

statin (first-line)

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36
Q

hypertriglyceridemia

A

fibrate

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37
Q

Pulmonary arterial HTN (idiopathic)

A

sildenafil, bosentan, epoprostenol

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38
Q

arrythmia and damaged cardiac tissue

A

class I B antiarrhythmic (lidocaine, mexiletine)

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39
Q

prolactinoma

A

cabergoline/bromocriptine (dopamine agonists)

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40
Q

central diabetes insipidus (not producing ADH)

A

desmopressin

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41
Q

nephrogenic diabetes insipidus (kidney dysfunction - dec water reabsorption)

A

hydrochlorothiazide, indomethacin, amiloride** (DI due to lithium)

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42
Q

SIADH

A

fluid restriction, IV hypertonic saline (serum sodium is diluted from inc water reabsorption -> hyponatremia), conivaptan/tolvaptan, demeclocycline

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43
Q

diabetic ketoacidosis

diabetic ketoacidosis

A

fluids, insulin, potassium iodide

insulin puts K+ back into cells

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44
Q

T1DM

A

dietary intervention (low carb); + insulin replacement

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45
Q

T2DM

A

dietary intervention (low carb); + oral hypoglycemic (metformin) +/- insulin (if refractory)

sulfonylurias are most likely to cause hypoglycemia

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46
Q

pheochromocytoma

A

a-antagonists (ex. Phenoxybenzamine)

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47
Q

neural tube defect prevention

A

prenatal folic acid

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48
Q

migraine

A

abortive tx: sumatriptan, NSAIDs;

prophylaxis: propranolol, topiramate, CCBs, amitriptyline

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49
Q

multiple sclerosis

A

disease modifying therapies (IFN-B; natalizumab);

for acute flares: IV steroids

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50
Q

tonic-clonic seizures

A

levetiracetam, phenytoin, valproate, carbamazepine

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51
Q

Absence seizures (zoning out)

A

ethosuximide

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52
Q

Trigeminal neuralgia (tic doiloureux)

A

carbamazepine

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53
Q

hyperaldosteronism

A

spironolactone

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54
Q

benign prostatic hyperplasia

A

a1-antagonists (nonselective - zosin = both vasodilation and smooth muscle relaxation)- use for those with BPH + HTN

selective a1A inh - tamsulosin (smooth muscle relaxation only)- just BPH

5a-reductase inhibitors, PDE-5 inhibitors (prevent conversion of testosterone to DHT –> hyperplastic nodules)- takes months to work

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55
Q

infertility

A

Leuprolide, GnRH (pulsatile), clomiphene (PCOS)

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56
Q

medical abortion

A

mifepristone

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57
Q

hepatic encephalopathy

A

lactulose (NH3 –> NH4 conversion) –> (ammonium is excretable)
rifaximin (dec ammoniagenic bacteria)

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58
Q

erectile dysfunction

A

sildenafil, tadalafil, vardenafil

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59
Q

crohn disease

A

corticosteroids, infliximab, azathioprine

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60
Q

Ulcerative Colitis

A

5-ASA preparations (mesalamine), 6-mercaptopurine, infliximab, colectomy

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61
Q

Sickle cell disease

A

Hydroxyurea (inc fetal hemoglobin)

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62
Q

CML

A

imatinib (BCR-ABL TK inhibitor)

63
Q

acute promyelocytic leukemia (M3) / AML- APL type t(15;17)

A

all-trans retinoic acid (vitamin A); arsenic trioxide

64
Q

hairy cell leukemia

A

purine analogs (cladribine, pentostatin)

65
Q

osteoporosis

A

calcium/Vit D supplementation (prophylaxis)

bisphosphonates; PTH analogs, SERMs, Calcitonin, denosumab (treatment)

66
Q

buerger disease

A

smoking cessation

67
Q

kawasaki disease

A

IVIG, low-dose aspirin

68
Q

temporal arteritis

A

high-dose steroids

69
Q

GPA

A

cyclophosphamide, corticosteroids

70
Q

chronic gout

A

Xanthine oxidase inhibitors (allopurinol, feboxustat); pegloticase, probenecid

*** lower dose or stop 6-MP with allopurinol (inc toxicity due to dec metabolism by inh of XO)

**avoid uric acid rich foods (fish) and alcohol

71
Q

acute gout attack

A

NSAIDs, colchine, glucocorticoids

72
Q

osteomalacia/rickets

A

vitamin D supplements

73
Q

drug of choice for anticoagulation in pregnancy or renal failure

A

low-molecular weight heparin

“pregnant women and kidney failure pts can’t go to WAR(farin), oK?”

(competitively inhibits the vitamin K epoxide reductase complex 1 (VKORC1), an essential enzyme for activating the vitamin K available in the body)

74
Q

heparin reversal

A

protamine sulfate

75
Q

immediate anticoagulation

A

heparin - very short half life

76
Q

long-term anticoagulation

A

warfarin, dabigatran, rivaroxaban, and apixaban

77
Q

warfarin reversal

A

fresh frozen plasma (acute)

vitamin K (non-acute)

78
Q

cyclophosphamide-induced hemorrhagic cystitis

A

mesna

79
Q

breast cancer in post-menopausal women

A

aromatase inhibitor (anastrozole)

80
Q

ER + breast cancer

A

Tamoxifen

  • estrogen antagonist in breast
  • estrogen agonist on endometrium (inc risk of hyperplasia –> endometrial cancer)
81
Q

Prostate adenocarcinoma/ uterine fibroids

A

leuprolide, GnRH (continuous)

82
Q

prostate adenocarcionma

A

flutamide (androgen R antagonist
leuprolide (continuous)

prostatectomy if local - use meds in advanced disease

83
Q

HER2/neu + Breast cancer

A

trastu(2)zumab

84
Q

anorexia

A

nutrition, CBT/psychotherapy, SSRIs

avoid bupropion (lower seizure threshold in anorexic and bulemic pts)

85
Q

bulimia nervosa

A

SSRIs

*avoid bupropion (seizures)

86
Q

alcoholism

A

disulfiram, acamprosate, naltrexone, supportive care

87
Q

ADHD

A

methylphenidate, amphetamines, CBT, atomoxetine, guanfacine, clonidine

88
Q

Alcohol withdrawal

A

long-acting benzodiazepines, phenobarbital

89
Q

bipolar disorder

A

mood-stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics

lithium - mostly manic
valproic acid- fluctuates
lamotrigine - mostly depressed

90
Q

depression

A

SSRIs (first line)

91
Q

generalized anxiety disorder

A

SSRIs, SNRIs (first-line); buspirone (second-line)

public speaking - can use propranolol

92
Q

schizophrenia (positive symptoms)

A

typical and atypical antipsychotics

93
Q

schizophrenia (negative symptoms)

A

atypical antipsychotics

94
Q

smoking cessation

A

varenicline, bupropion

95
Q

insomnia

A

ramelteon, trazodone

96
Q

opioid overdose

A

naloxone

97
Q

opioid overdose- relapse prophylaxis

A

nalTREXone

“helps you stay on trex (track)”

98
Q

first line of treatment for unstable bradycardia

A

Atropine 1mg
every 3-5 min for max dose of 3mg

NOTE: doses less than 0.5 mg IV may exacerbate bradycardia

***do not rely on atropine in Mobitz type II second deg or third deg AV block or in pts w. 3rd deg av block w/ a new wide QRS (likely remain unresponsive) – tx w. TCP or B-adrenergic support

99
Q

what is the first-line treatment for unstable tachycardia?

A

electric cardioversion

100
Q

nephrotoxicity from platinum compounds (chemo) - ex. cisplatin

A

amifostine- free radical scavenger

101
Q

cardiotoxicity from anthracyclines (chemo)- doxyrubicin, danorubicin

A

dexrazoxane - iron chelator

102
Q

myelosuppression from methotrexate (“rescue”)

also enhances effects of 5-fluorouracil

A

leucovorin (folinic acid)- THF precursor

103
Q

hemorrhagic cystitis from cyclophosphamide/ isofosfamide

A

mesna- sulfhydryl compound that binds acrolein (toxic metabolite of cyclophosphamide/isofosfamide)

104
Q

tumor lysis syndrome

A

Rasburicase (recombinant uricase that catalyzes metabolism of uric acid to allantoin)

105
Q

acute n/v (usually w/in 1-2 hrs of chemo)

A

ondansetron, granisetron, prochlorperazine, metochlopramide

5-HT3 R antagonist
D2 R antagonist

106
Q

delayed n/v (>24 hrs after chemo)

A

NK-1 R antagonist –> dec substance P, serotonin ,etc (aprepitant, fosaprepitant)

107
Q

neutropenia (chemo-induced)

A

filgrastim, sargramostim

108
Q

anemia (chemo-induced)

A

Epoetin Alfa

109
Q

testicular cancer (combination therapy)

A

bleomycin (risk of pulmonary fibrosis- must monitor pulm. function)

cisplatin (nephrotoxic- tx w/ amifostine)

etoposide

“Cis gave him Bleo Balls so he made her an Etoposide- chick”

110
Q

Lesch-Nyhan syndrome (HGPRT deficiency)

A

first line= allopurinol

second line = febuxostat

111
Q

SCID

A

prophylactic antibiotic treatment
IVIG
bone marrow transplant

*** avoid live vaccines

112
Q

acute mastitis

A

dicloxacillin

113
Q

c.perfringens (gas gangrene)

A

penicillin and surgical debridement

114
Q

pasteurella multocida (cellulitis or osteomyelitis)

A

piperacillin/ tazobactam, penicillin/amox-clav

115
Q

actinomycosis

A

penicillin

116
Q

scabies

A

permethrim (topical) or ivermectin (topical or PO) or benzyl benzoate (topical)

type IV HSR to the deposition of eggs and feces - pruritic rash on webs of fingers and toes, axilla, flexor surfaces of wrist, waist, around umbilicus, areolae, groin; homeless shelters, poor hygiene, overcrowding

117
Q

lyme disease

A

doxycycline

118
Q

brucellosis

A

penicillin, doxycycline, aminoglycosides

119
Q

h.pylori (DU)

A

3tx - clarithromycin, amoxicillin, metronidazole and PPi

PPis- cause dec absorption of Ca2+, Mg2+, and Fe2+ (req acid)–> supplement or else risk of osteoporosis, IDA; can also inc risk of pseudomembranous colitis

120
Q

DU, gastrinoma (zollinger-ellison syndrome), GU, GERD

A

PPi (-prazoles)
PPis- cause dec absorption of Ca2+, Mg2+, and Fe2+ (req acid)–> supplement or else risk of osteoporosis, IDA; can also inc risk of pseudomembranous colitis

121
Q

tularemia

A

streptomycin (aminoglycoside), gentamycin, ciprofloxacin

122
Q

skin and soft tissue infections caused by streptococci and staphylococci. Also used to tx other infections of the abdomen or pelvis and infections caused by susceptible Bacterioides and other anaerobes

A

clindamycin

123
Q

hook worm infections (ancylostoma duodenale or Necator americanus, strongyloides s.)

A

albendazole (binds tubulin and dec microtubule polymerization and dec glucose uptake)
ivermectin

124
Q

cestode (tapeworm) or trematodes (flukes) infections

A

praxiquantel (inc calcium influx –> spastic paralysis)

“sPRAXIQ paralysis”

125
Q

parkinson dz

A

levidopa (dopamine analog)

carbidopa (prevents peripheral conversion –> more levidopa makes it to CNS)

126
Q

tinea infections (jock itch, athlete’s foot) and ring worm (tinea corporis)

A

topical terbinafine

127
Q

B. anthracis

A

tx- ciprofloxacin or doxycycline

post-exposure prophylaxis - ciprofloxacin

128
Q

yersinia pestis

A

streptomycin, gentamycin, ciprofloxacin, doxycycline (if untreated mortality is 100%)

129
Q

hairy cell leukemia

A

cladribine, pentostatin, rituximab

130
Q

CML

A

bcr-abl tyrosine kinase inh (imatinib)

131
Q

fibromyalgia

A

regular exercise, antidepressants, gabapentin

132
Q

SLE

A

glucocorticoids

133
Q

colorectal carcinoma

A

FOLFIRI regimen (5-FU, leucovorin, irinotecan); XELIRI regimen (capecitabine and irinotecan)

134
Q

refractory pancreatic cancer

A

irinotecan and 5-FU

135
Q

testicular cancer/seminoma (combo tx)

A

bleomycin, etoposide, cisplatin

136
Q

Ewing sarcoma

A

etoposide

137
Q

solid tumors

A

vincristine or vinblastine

MOA: bind B-tubulin and inhibit its polymerization into microtubules in order to prevent formation of the mitotic spindle and cause arrest in M phase

138
Q

ectopic pregnancy

A

methotrexate

139
Q

anemia of chronic disease

A

address the underlying cause of inflammation, blood transfusion, EPO in CKD pts

140
Q

schistosomiasis

A

praziquantel (inc permeability to calcium, leading to calcium influx and subsequent paralysis)

141
Q

cryptococcus neoformans meningitis/encephalitis (CD4+ below 50/mm3)

A

Ampthotericin B 0.7-1mg/kg/day (inc membrane permeability by binding to ergosterol in the fungal plasma membrane);

  • causes hypokalemia, hypomagnesemia, and renal impairments –> check labs frequently. Saline loading reduces amphotericin B nephrotoxicity

flucytosine 100mg/kg/day for 2 weeks;

followed by fluconazole 400 mg/day for 8 weeks and 200mg/day thereafter

142
Q

candidemia in neutropenic pts with fever

A

caspofungin (targets fungal cell wall - chitin)

143
Q

aspergillus

A

voriconazole

144
Q

focal seizures (tonic-clonic)

A

first-line = carbamazepine (voltage dependent blocker of VG sodium channels)

carbamazepine adverse effects:

  • SJS
  • DRESS syndrome (drug reaction with eosinophilia and systemic symptoms)
  • agranulocytosis
145
Q

post herpetic neuralgia

A

gabapentin

146
Q

status epilepticus

A

phenytoin, phenobarbital

147
Q

MDD + anorexia

A

mirtazepine

148
Q

CHF/ HTN + osteoporosis

or

HTN + nephrogenic diabetes insipidus

or

first-line HTN

or HTN + calcium nephrolithiasis

A

thiazides

  • contraindicated in sulfa allergy and gout
  • inc serum calcium (inc reapsorption)
149
Q

HTN + hypercalemia

A

loop diuretics

  • ototoxicity
  • sulfa drug rxn (except- ethacrynic acid)
150
Q

drug-resistant TB

A

streptomycin

151
Q

latent TB

A

rifampin, or isoniazid (+ Vitamin B6) or both

152
Q

giant cell arteritis (temporal arteritis)

A

monoclonal anti-body against IL-6

153
Q

ankylosing spondylitis

A

tx- indomethacin (NSAID)

USMLE step 1 (14 decks)

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