Lines + Conditions Flashcards
Acute porphyrias
Haem arginate
Adrenal insufficiency
Hydrocortisone (similar to cortisol)
Fludrocortisone (for aldosterone deficiency)
Adrenal insufficiency sick day rules
Double dose of hydrocortisone
In severe consider IM or IV hydrocortisone
Adrenal crisis
Hydrocortisone
Rehydration using sodium chloride 0.9%
Dry macular degeneration
Smoking cessation
Counselling and support
Visual aids
Wet macular degeneration 1st line
Anti VEGF (aflibercept, ranibizumab or bevacizumab)
Wet macular degeneration 2nd line
Add photodynamic therapy
Alcohol withdrawal symptoms
Chlordiazepoxide or diazepam
Delirium tremens 1st line
Oral lorazepam
Delirium tremens 2nd line
Parenteral lorazepam or haloperidol
Alcohol dependence 1st line/mild
CBT
Alcohol dependence 2nd line/want pharmacological treatment
Acamprosate calcium or oral naltrexone hydrochloride
Alcohol dependence 3rd line
Disulfiram
Wernickes encephalopathy
Thiamine
Preventer of sickle cell acute chest syndrome, reducer of painful crises and reducer transfusion requirements
Hydroxycarbamide
Acute anal fissure (<6 wks) 1st line
Bulk forming laxatives e.g. ispaghula husk
Acute anal fissure (<6 wks) 2nd line
Osmotic laxative e.g. lactulose
Acute anal fissure (<6 wks) prolonged burning pain following defecation
Topical local anaesthetic e.g. lidocaine
Simple analgesia
Chronic anal fissure (>6 wks) 1st line
Glyceryl trinitrate rectal ointment
Chronic anal fissure (>6 wks) 2nd line
Refer to specialist for local injection of botulinum toxin type A
Chronic anal fissure (>6 wks) 3rd line
Surgery
Anthrax treatment
Ciprofloxacin or doxycycline (>12 yrs) + 1 or 2 of
- benzylpenicillin
- clindamycin
- rifampicin
- vancomycin
Anthrax post exposure prophylaxis
Ciprofloxacin, doxycycline or amoxicillin
Acute AF + haemodynamic instability
Emergency electrical cardioversion
Acute AF + >48 hrs or onset uncertain
Rate control
Urgent rate control in AF
IV beta blocker
Rate control AF other
Calcium channel blockers e.g. verapamil (LVEF >40%, avoid of acute HF)
Digoxin
Pharmacological cardioversion in AF - no structural or IHD present
Flecainide
Pharmacological cardioversion in AF - structural or IHD present
Amiodarone
When can electrical cardioversion be done in AF
Delay until patient has been anticoagulated for >3 wks
Drugs to maintain sinus rhythm in AF 1st line
Beta blockers
Drugs to maintain sinus rhythm in AF 2nd line following cardioversion
Dronedarone
Drugs to maintain sinus rhythm in AF - coexisting HF
Amiodarone
Paroxysmal supra ventricular tachycardia 1st line
Vagal manoeuvres
Paroxysmal supra ventricular tachycardia 2nd line
IV adenosine
Paroxysmal supra ventricular tachycardia 3rd line
IV verapamil (CI if on beta blockers)
Paroxysmal supra ventricular tachycardia + haemodynamically unstable
Direct current cardioversion
Bradycardia 1st line
IV atropine
Bradycardia 2nd line
Adrenaline/epinephrine
Pulseless ventricular tachycardia or ventricular fibrillation
Resuscitation
Sustained VT + harmodynamically unstable
Direct current cardioversion
Sustained VT
Amiodarone
Non sustained VT
Beta blocker
Torsade de pointes
IV magnesium sulfate
ADHD
Methylphenidate
Septicaemia (community) 1st line
Piperacillin w/ taxobactam or cefuroxime
Septicaemia (community) + MRSA
Add vancomycin or teicoplanin
Septicaemia (community) + anaerobic infection
Add metronidazole to broad spectrum cephalosporin
Septicaemia (community) + other resistant organism
Meropenem
Septicaemia (hospital) 1st line
Piperacillin w/ tazobactam, ceftazidime or meropenem
Septicaemia (hospital) + MRSA
Add vancomycin or teicoplanin
Septicaemia (hospital) + anaerobic
Add metronidazole to broad spectrum cephalosporin
Meningococcal septicaemia 1st line
Benzylpenicillin or cefotaxime or ceftriaxone
Meningococcal septicaemia + can’t have other drugs
Chloramphenicol
HER2 +ve breast cancer
Trastuzumab (herceptin) and pertuzumab
Oestrogen receptor +ve breast cancer
Tamoxifen
Post menopausal women ER +ve breast cancer
Anastrozole
Severe acute hypocalcaemia or hypocalcaemic tetany
Slow IV calcium gluconate 10%
Severe hypercalcaemia 1st line
IV sodium chloride 0.9%
Stop thiazides + vit D compounds
Severe hypercalcaemia 2nd line
Pamidronate disodium (bisphosphonate)
Hypercalcaemia from malignancy
Calcitonin
Hypercalciuria
Increase fluid intake
Bendroflumethiazide
SAH
Nimodipine
Native valve endocarditis - blind
Amoxicillin +/- gentamicin
Native valve endocarditis, penicillin allergic or MRSA or severe sepsis - blind
Vancomycin + gentamicin
Native valve endocarditis, severe sepsis w/ gram -ve - blind
Vancomycin + meropenem
Prosthetic valve endocarditis - blind
Vancomycin + rifampicin + gentamicin
Native valve endocarditis staphylococci
Flucloxacillin >4 wks
Native valve endocarditis staphylococci - penicillin allergic or MRSA
Vancomycin + rifampicin >4 wks
Prosthetic valve endocarditis staphylococci
Flucloxacillin + rifampicin + gentamicin 6 wks
Prosthetic valve endocarditis staphylococci - penicillin allergic or MRSA
Vancomycin + rifampicin + gentamicin 6 wks
Meningitis empirical - community
Benzylpenicillin
Meningitis empirical - hospital, 3months - 50 yrs
Cefotaxime or ceftriaxone 10 days
Meningitis empirical - hospital, >50 yrs
Cefotaxime or ceftriaxone + amoxicillin 10 days
Meningitis caused by meningococcal
Benzylpenicillin or cefotaxime 7 days
Meningitis caused by pneumococci or haemophilus influenzae
Cefotaxime + dexamethasone 14 days (pneumococci) 10 days ( h. Influenzae)
Meningitis caused by listeria
Amoxicillin + gentamicin 21 days
Meningitis caused by listeria - penicillin allergic
Co trimoxazole 21 days
Cholestatic pruritis
Colestyramine
Intrahepatic cholestasis in pregnancy
Ursodeoxycholic acid
Cluster headache - acute
Sumatriptan
100% 15L O2
Cluster headache prophylaxis
Verapamil
Croup 1st line
Dexamethasone single dose
Croup 2nd line
Nebulised adrenaline/epinephrine solution 1 in 1000
Cushing’s syndrome
Metyrapone
Endogenous cushing’s syndrome
Ketoconazole
CF - 1st line mucolytic
Dornase Alfa
CF - 2nd line mucolytic
Add hypertonic sodium chloride
Hyperuricaemia (tumour lysis syndrome)
Allopurinol
Hyperuricaemia in haematological malignancy
Rasburicase
Mild-moderate Alzheimer’s
Donepezil, galantamine or rivastigmine
Moderate Alzheimer’s + CI acetylcholinesterase inhibitor or severe Alzheimer’s
Memantine
Mild-moderate Lewy body dementia
Donepezil or rivastigmine
Pre existing T2 DM in pregnancy
5 mg folic acid
All anti diabetic drugs except metformin stopped
Gestational DM - 1st line, fasting glucose <7
Diet and exercise
Gestational DM - 2nd line, fasting glucose <7
Metformin
Gestational DM - 3rd line, fasting glucose <7
Insulin
Gestational DM - 1st line, fasting glucose >7
Insulin +/- metformin
DKA step 1
IV fluid
DKA step 2
IV insulin
DKA step 3
Potassium + glucose administration
Oedema and ascites caused by cirrhosis of liver
Spironolactone
Galactorrhoea
Bromocriptine
Prolactinomas
Bromocriptine
Suppression of lactation
Cabergoline
Mild otitis externa
Acetic acid 2%
Otitis externa - pseudomonas
Ciprofloxacin
Otitis externa - no penicillin allergy
Flucloxacillin
Otitis externa - penicillin allergy
Clarithromycin or azithromycin or erythromycin
Otitis externa 1st line
Topical antibiotic or topical antibiotic + steroid
Otitis externa 2nd line
Oral antibiotics
Otitis media 1st line - no penicillin allergy
Amoxicillin
Otitis media 2nd line - no penicillin allergy
Co amoxiclav
Otitis media 1st line - penicillin allergy
Clarithromycin or erythromycin
When to consider Abx in otitis media
Symptoms >4 days or not improving Systemically unwell Immunocompromised <2 yrs w/ bilateral If they have perforation +/or discharge in canal
Eczema 1st line
Emollients
Eczema 2nd line
Topical steroids
Emergency contraception - time allowed for an IUD
Up to 120 hrs (5 days)
Emergency contraception - time allowed for levonorgestrel
72 hrs (3 days) (efficacy decreases over time)
Emergency contraception - time allowed for ullipristal acetate
120 hrs (5 days) More effective than levonorgestrel
Emergency contraception - BMI >26 or >70kg, hormonal option
Ullipristal acetate OR
Double dose levonorgestrel
Emergency contraception - when is levonorgestrel 1st line
Females on regular combined hormonal contraception who have missed contraception within the 1st week of restarting their contraceptive
Emergency contraception - when to restart contraception following levonorgestrel
Immediately
Emergency contraception - when to start contraception following ulipristal acetate
5 days after + use barrier/abstain during this period
Endometriosis - 1st line
Paracetamol +/- NSAID
Endometriosis - 2nd line
COCP or POP
Endometriosis - 3rd line (after referring)
Gonadotropin releasing hormones for 3 months
Endometriosis - 4th line
Laparoscopic excision or ablation
Endometriosis - 5th line
Hysterectomy
Erectile dysfunction
Avanafil, sildenafil or vardenafil
Huntington’s chorea
Tetrabenazine
Tardive dyskinesia
Tetrabenazine
Essential tremor
Propranolol
MND ALS
Riluzole
Exocrine pancreatic insufficiency
Pancreatin
Purulent conjunctivitis
Chloramphenicol eye drops
Trachoma (eye thing) from chronic infection w/ chlamydia
Oral azithromycin
Hyperkalaemia - stabilisation of cardiac membrane (1st step)
IV calcium chloride 10% or calcium gluconate 10%
Hyperkalaemia - short term shift in K+ from ECF to ICF (2nd step)
Combined insulin/dextrose infusion
Nebulised salbutamol
Hyperkalaemia - removal of K+ from body (3rd step)
Calcium resonium
Loop diuretics
Dialysis
Gallstones - mild-moderate pain
Paracetamol or NSAID
Gallstones - severe pain 1st line
IM diclofenac
Gallstones - severe pain 2nd line
IM morphine or IM penthidine
Gallstones - definitive management
Laparoscopic cholecystectomy
Campylobacter enteritis
Clarithromycin or azithromycin or erythromycin
Suspected or confirmed uncomplicated acute diverticulitis
Oral co amoxiclav
Suspected or confirmed complicated acute diverticulitis
IV co amoxiclav OR IV cefuroxime w/ metronidazole OR IV amoxicillin w/ gentamicin and metronidazole
Salmonella
Ciprofloxacin or cefotaxime
Shigellosis
Ciprofloxacin or azithromycin
Typhoid fever
Cefotaxime or ceftriaxone
1st episode c diff - 1st line
Oral vancomycin
1st episode c diff - 2nd line
Fidaxomicin
Further episode of c diff (infection within 12 wks) - 1st line
Fidaxomicin
Life threatening c diff
Oral vancomycin + IV metronidazole
Biliary tract infection
Ciprofloxacin or gentamicin or a cephalosporin
Peritonitis
A cephalosporin + metronidazole OR gentamicin or metronidazole + clindamycin OR piperacillin w/ tazobactam
Peritonitis - peritoneal dialysis associated
Vancomycin + ceftazidime added to dialysis fluid OR vancom added to dialysis fluid + ciprofloxacin by mouth
GORD - 1st line
PPI for 4 or 8 wks
GORD - 2nd line
Histamine 2 receptor antagonist
Bacterial vaginosis
Oral metronidazole 5-7 days or single high dose metronidazole
Alternative: topical metronidazole for 5 days or topical clindamycin for 7 days
Chlamydia
Azithromycin or doxycycline
Gonorrhoea - 1st line
IM ceftriaxone
Gonorrhoea - needle phobia
Oral cefixime + oral azithromycin
PID
Doxycycline + metronidazole + single dose IM ceftriaxone
Early syphilis (<2 yrs)
Single dose benzylpenicillin
Early syphilis (<2 yrs) - penicillin allergic
Doxycycline or erythromycin for 14 days
Late latent syphilis (asymptomatic >2 yrs)
Benzylpenicillin once weekly for 2 wks
Asymptomatic contacts of patients w/ infectious syphilis
Doxycycline for 14 days
Chronic open angle glaucoma - 1st line
360° selective trabeculoplasty
Chronic open angle glaucoma - first line if 360° SLT not used/while waiting
Topical prostaglandin analogues e.g. latanoprost
Chronic open angle glaucoma - 2nd line
Topical beta blocker e.g. timolol OR topical carbonic anhydrase inhibitor e.g. brinzolamide OR topical sympathomimetic e.g. brimonidine OR a combination of these
Chronic open angle glaucoma - 3rd line
Surgery
Acute gout attack
Colchicine or high dose NSAID
Long term control of gout - 1st line
Allopurinol + colchicine (for 6 months after acute attack)
Long term control of gout - 2nd line
Febuxostat
H pylori, no penicillin allergy - 1st line
PPI + amoxicillin + clarithromycin or metronidazole
7 days
H pylori, no penicillin allergy - 2nd line
PPI + amoxicillin + clarithromycin or metronidazole (whichever wasn’t used 1st line)
7 days
H pylori, penicillin allergy - 1st line
PPI + clarithromycin + metronidazole
Heavy menstrual bleeding - 1st line
IUS
Heavy menstrual bleeding - IUS unsuitable
Tranexamic acid
NSAID
COCP
Fibroids that cause enlarged or distorted uterus
Gonadotropin releasing analogue then myomectomy or hysterectomy
Chronic hepatitis B
Entecavir, peginterferon alfa, tenofovir alafenamide or tenofovir disoproxil
Chronic hepatitis C
Sofosbuvir w/ ribavirin
Systemic treatment of VZV
Aciclovir
Systemic and topical treatment of HSV of skin and mucus membranes
Aciclovir
HIV initial treatment
2 NRTIs as backbone regimen + 1 of…
- INI
- NNRTI
- PI
Hyperhydrosis
Topical 20% aluminium chloride
Primary hyperparathyroidism - 1st line
Parathyroidectomy
Primary hyperparathyroidism - surgery unsuccessful or not suitable
Cinacalet
Graves’ disease - 1st line
Radioactive iodine
Graves’ disease - 1st line if radioactive iodine unsuitable
Carbimazole
Graves’ disease - 2nd line or pregnant/trying to conceive
Propylthiouracil
Thyrotoxicosis without hyperthyroidism
Beta blockers
Hypoglycaemia, BG >4
Small carb snack
Hypoglycaemia, BG <4 - conscious and able to swallow
Glucose tablet, gel, pure fruit juice
Hypoglycaemia, BG <4 - oral stuff doesn’t work
IM glucagon or glucose 10% IV
Hypoglycaemia + unconsciousness - 1st line
Glucagon
Hypoglycaemia + unconsciousness - 2nd line (no response after 10 mins)
Glucose 20% IV infusion
Infertility in PCOS
Clomifene
Hypothyroidism
Levothyroxine
What is given to reduce the possibility of methotrexate toxicity
Folic acid
Acute immune thrombocytopenic purpura
Prednisolone
Persistent or chronic immune thrombocytopenic purpura
Thrombopoietin receptor agonists OR fostamatinib
immune thrombocytopenic purpura - drug therapy has failed
Splenectomy
Influenza
Oseltamivir or zanamivir
Iron overload associated with haemochromatosis - 1st line
Repeated venesection
Iron overload associated with haemochromatosis - 1st line CI
Desferrioxamine
Leprosy
Dapsone + rifampicin + clofazimine
Acute low back pain
NSAIDs
Acute low back pain - NSAID not tolerated
Weak opioid +/- paracetamol
Severe sciatica
Epidural injections of local anaesthetic +/or corticosteroid
Lyme disease
Doxycycline
Lyme disease - doxycycline CI
Amoxicillin
Hypomagnesaemia - symptomatic
IV or IM magnesium sulfate
Hypomagnesaemia - asymptomatic
Oral magnesium glycerophosphate
Malaria prophylaxis - 1 wk before travel
Chloroquine + proguanil hydrochloride
Malaria prophylaxis - 2-3 wk before travel
Mefloquine
Malaria prophylaxis - 1-2 days before travel
Atovaquone w/ proguanil hydrochloride or doxycycline
How long should malaria prophylaxis be continued for after leaving the area
4 wks
Except Atovaquone w/ proguanil hydrochloride, which should be stopped 1 wk after leaving
Uncomplicated p. falciparum malaria
Artemether w/ lumefantrine
Severe or complicated p. falciparum malaria
IV artesunate
Uncomplicated non falciparum malaria
Artemether w/ lumefantrine or artenimol w/ piperaquine phosphate or chloroquine
Uncomplicated non falciparum malaria - prevention of relapses
Primaquine
Complicated non falciparum malaria
IV artesunate
Acute mania or hypo mania - 1st line
Haloperidol, olanzapine, quetiapine or risperidone
Acute mania or hypo mania - 2nd line
Add Lithium or valproate
Long term management of bipolar disorder - 1st line
Lithium
Long term management of bipolar disorder - 2nd line or if lithium CI
Add valproate/valproate alone
Depression + bipolar
Fluoxetine
Acute migraine - 1st line
Aspirin or ibuprofen or sumitriptan
Acute migraine - 2nd line
Sumatriptan + naproxen
Migraine antiemetic - 1st line
Metoclopramide or prochlorperazine
Migraine antiemetic - 2nd line
Domperidone
Migraine prophylaxis- 1st line
Propranolol
Migraine prophylaxis - 2nd line (non child bearing)
Topiramate
Migraine prophylaxis - other
Amitriptyline, sodium valproate
MND muscle cramps - 1st line
Quinine
MND muscle cramps - 2nd line
Baclofen
MND muscle spasticity, stiffness or increased tone
Baclofen, dantrolene, tizanidine or gabapentin
Active relapsing remitting MS
DMARDs
Reducing relapse risk in MS - 1st line
Natalizumab
Reducing relapse risk in MS - other
Fingolimod
Beta interferon
Glatiramer acetate
MS acute relapse
High dose oral or IV methylprednisolone for 5 days
Spasticity in MS
Baclofen or gabapentin
Osteomyelitis
Flucloxacillin 6 wks
Osteomyelitis - penicillin allergic
Clindamycin 6 wks
Osteomyelitis - MRSA suspected
Vancomycin or teicoplanin 6 wks
Septic arthritis
Flucloxacillin 4-6 wks
Septic arthritis - penicillin allergic
Clindamycin 4-6 wks
Septic arthritis - MRSA suspected
Vancomycin or teicoplanin
Septic arthritis - gonococcal arthritis or gram -ve
Cefotaxime or ceftriaxone 4-6 wks
Menieres - acute
Antihistamines e.g, cyclizine or prochloperazine
Menieres - reducer if severity and frequency
Betahistine dihydrochloride
myasthenia gravis - 2nd line
Prednisolone + azathioprine
myasthenia gravis - 3rd line
Ciclosporin, methotrexate or mycophenolate mofetil
Myasthenia gravis - 1st line
Pyridostigmine
Myasthenic crisis
Plasmapheresis + IV immunoglobulins
Lambert Eaton syndrome
Prednisolone +/- azathioprine
Trigeminal neuralgia
Carbamazepine
Nocturnal enuresis - 1st line
Behaviour type advice
Nocturnal enuresis - 2nd line
Enuresis alarm
Nocturnal enuresis - 3rd line
Desmopressin
Sinusitis - 1st line
Phenoxymethylpenicillin
Sinusitis - 2nd line
Co amoxiclav
Sinusitis - 1st line, penicillin allergic
Doxycycline or clarithromycin (erythromycin in pregnancy)
Obesity - BMI >30
Orlistat
Obesity - BMI >40 or 35-40 w/ T2 DM or high BP
Bariatric surgery
Abortion
Mifepristone + misoprostol
Induction of labour - 1st line
Membrane sweep
Induction of labour - 2nd line
Vaginal prostaglandin E2
Induction of labour - 3rd line
Oxytocin infusion
Induction of labour - 4th line
Amniotomy
Induction of labour - 5th line
Cervical ripening balloon
Uterine hyperstimulation
Stop oxytocin
Terbutaline
Ectopic pregnancy
Methotrexate
Thrush from inhaler use - 1st line
Rinse mouth with water or clean teeth after use
Thrush from inhaler use - 2nd line
Nystatin or miconazole
Gingivitis
Metronidazole or amoxicillin
Mouth abscess - 1st line
Phenoxymethylpenicillin or amoxicillin
Mouth abscess - penicillin allergy
Clarithromycin
Mouth abscess + signs of spreading infection
Add metronidazole
Acute sore throat
Phenoxymethylpenicillin 5-10 days
Acute sore throat - penicillin allergic
Clarithromycin or erythromycin 5 days
Osteoarthritis - 1st line
Paracetamol +/- topical NSAID
Osteoarthritis - 2nd line
Oral NSAID or codeine
Osteoarthritis - moderate to severe
Intra articular corticosteroid injection
Osteoporosis - 1st line
Smoking cessation
Calcium + vitamins D
Osteoporosis - 2nd line
Oral bisphosphonate - alendronic acid or risedronate sodium
Osteoporosis - 3rd line
Denosumab
Osteoporosis - severe, very high risk, vertebral fractures
Teriparatide or romosozumab
When should bisphosphonate therapy be reviewed
After 5 years
Parkinson’s w/ motor symptoms that decrease their quality of life - 1st line
Levodopa + co careldopa or co beneldopa
Parkinson’s w/ motor symptoms that do not decrease their quality of life - 1st line
Levodopa OR non ergotic dopamine receptor agonist (pramipexole, ropinirole or rotigotine) OR monoamine oxidase B inhibitors (rasagiline or selegiline)
Parkinson’s w/ dyskinesia or motor symptoms despite optimal levodopa therapy should be offered…
Adjunct - non ergotic dopamine receptor agonist (pramipexole, ropinirole or rotigotine) OR monoamine oxidase B inhibitors (rasagiline or selegiline) OR COMT inhibitors (entacapone or tolcapone)
Parkinson’s - What to offer if symptoms not controlled w/ levodopa + non ergotic dopamine agonists
Ergot derived dopamine agonist e.g. bromocriptine, cabergoline or pergolide
Parkinson’s + excessive daytime sleepiness
Modafinil
Parkinson’s psychotic symptoms - 1st line
Quetiapine
Parkinson’s psychotic symptoms - 2nd line
Clozapine
Parkinson’s drooling
Glycopyrronium bromide
Hyperphosphateaemia + stage 4/5 CKD - 1st line
Dietary management + dialysis optimised
Hyperphosphateaemia + stage 4/5 CKD - 2nd line
Calcium acetate (phosphate binder)
Hyperphosphateaemia + stage 4/5 CKD - 3rd line
Selelamer (non calcium based phosphate binder)
Superficial basal cell carcinoma
Imiquimod + topical fluorouracil
actinic keratosis
Fluorouracil +/- salicylic acid
Pneumocystis jirovecii - 1st line
Co trimoxazole
Pneumocystis jirovecii - 2nd line
Atovaquone
If severe - pentamidine IV
PCOS symptoms
COCP
Primary biliary cholangitis
Ursodeoxycholic acid
Schizophrenia - illness not responded to 2 different antipsychotic drugs
Clozapine
Severe bronchiolitis caused by RSV
Ribavirin
Prophylaxis against RSV
Palivizumab
Epiglottitis (h. Influenzae)
Cefotaxime or ceftriaxone
Bronchiectasis acute exacerbation - 1st line
Amoxicillin, clarithromycin or doxycycline
Bronchiectasis acute exacerbation - 2nd line
Co amoxiclav or levofloxacin
COPD acute exacerbation - 1st line
Amoxicillin, clarithromycin or doxycycline 5 days
COPD acute exacerbation - 2nd line
Try one of the other 1st line drugs
Co amoxiclav, levofloxacin or co trimoxazole 5 days
Pneumonia, community acquired - low severity, 1st line
Amoxicillin
Pneumonia, community acquired - low severity, 1st line, penicillin allergy
Clarithromycin, doxycycline or erythromycin (pregnancy)
Pneumonia, community acquired - moderate severity, 1st line
Amoxicillin
Pneumonia, community acquired - moderate severity, 1st line, atypical suspected
Amoxicillin + clarithromycin or erythromycin (pregnancy)
Pneumonia, community acquired - moderate severity, 1st line, penicillin allergic
Clarithromycin or doxycycline
Pneumonia, community acquired - high severity, 1st line
Co amoxiclav + clarithromycin or erythromycin
Pneumonia, community acquired - high severity, 1st line, penicillin allergic
Levofloxacin
Pneumonia, hospital acquired - low severity, 1st line
Co amoxiclav
Pneumonia, hospital acquired - low severity, 1st line, penicillin allergic
Doxycycline, cefalexin, co trimoxazole or levofloxacin
Pneumonia, hospital acquired - high severity, 1st line
IV piperacillin w/ tazobactam, ceftazidime, ceftriaxone, cefuroxime, levofloxacin or meropenem
Pneumonia, hospital acquired - high severity, MRSA suspected
Add vancomycin or teicoplanin or linezolid
Rheumatoid arthritis - 1st line
DMARD - methotrexate, leflunomide or sulfasalazine
Rheumatoid arthritis - 2nd line
DMARD combination therapy - methotrexate, leflunomide, sulfasalazine or hydroxychloroquine
Rheumatoid arthritis - 3rd line
TNF alpha inhibitor - adalimumab, etanercept, golimumab or infliximab
OR biological DMARD - abatacept, sarilumab or tocilizumab
OR targeted synthetic DMARD - baricitinib, filgotinib, tofacitinib
Rheumatoid arthritis - 4th line
Rituximab + methotrexate
Rosacea - mild
Topical metronidazole
Rosacea - predominant flushing but limited telangiectasia
Topical brimonidine gel
Rosacea - severe
Oral antibiotics e.g. oxytetracycline
Rosacea - prominent telangiectasia
Laser therapy
Severe dandruff/seborrhoeic dermatitis
Ketoconazole shampoo
Hirsutism - mild-moderate
Eflornithine
Hirsutism - moderate-severe
Co-cyprindiol
Pityriasis versi color
Ketoconazole shampoo
Scabies - 1st line
Permethrin
Scabies - 2nd line
Malathion
Scabies - 3rd line
Ivermectin
Head lice - 1st line
Dimeticone
Head lice - 2nd line
Malathion
Crab lice - 1st line
Permethrin or malathion
Impetigo, localised non bullous, systemically well - 1st line
Hydrogen peroxide 1% cream
Impetigo, localised non bullous, systemically well - 2nd line
Fusidic acid
Impetigo, widespread non bullous impetigo, systemically well
Topical or oral antibiotic
Impetigo, non bullous + systemically unwell or bullous - 1st line
Flucloxacillin
Impetigo, non bullous + systemically unwell or bullous - 1st line, penicillin allergy
Clarithromycin or erythromycin (pregnancy)
Cellulitis/erysipelas - 1st line
Flucloxacillin
Cellulitis/erysipelas - 1st line, penicillin allergic
Clarithromycin, erythromycin (pregnancy) or doxycycline
Cellulitis/erysipelas near eyes or nose - 1st line
Co amoxiclav
Cellulitis/erysipelas near eyes or nose - 1st line, penicillin allergic
Clarithromycin + metronidazole
Cellulitis/erysipelas, severe - 1st line
IV co amoxiclav, clindamycin, cefuroxime or ceftriaxone
Cellulitis/erysipelas, severe - 1st line, MRSA suspected
Add IV vancomycin or teicoplanin or linezolid
Human/animal bite - 1st line
Co amoxiclav
Human/animal bite - 1st line, penicillin allergic
Doxycycline + metronidazole
Mastitis during breast feeding
Flucloxacillin 10-14 days
Mastitis during breast feeding , penicillin allergic
Erythromycin
Ankylosing spondylitis - 1st line
NSAIDs + physiotherapy
Ankylosing spondylitis - 2nd line
TNF alpha inhibitor
Ankylosing spondylitis - 3rd line
Try another TNF alpha inhibitor
Ankylosing spondylitis - 4th line
Ixekizumab or secukinumab
Psoriatic arthritis - non progressive mono arthritis
Local corticosteroid injections
Psoriatic arthritis - peripheral polyarthritis, oligoarthritis or persistent mono arthritis
DMARDs - methotrexate, leflunomide or sulfasalazine
Angina - acute attack
Sublingual glyceryl trinitrate
Angina - prophylaxis, 1st line
Beta blocker - atenolol, bisoprolol, metoprolol or propranolol
Angina - prophylaxis, 1st line if beta blockers CI
Rate limiting calcium channel blocker - verapamil or diltiazem
Angina - prophylaxis, 2nd line
Beta blocker + calcium channel blocker
Angina - prophylaxis, 3rd line
Long acting nitrate, ivabradine, nicorandil or ranolazine mono therapy
TIA
Aspirin
Ischaemic stroke <4.5 hrs onset
Alteplase
Stroke long term management - 1st line
Clopidogrel
Statin
Stroke long term management - 1st line not tolerated
Aspirin + dipyridamole
Statin
Opioid dependence
Methadone or buprenorphine
TB - initial phase
Rifampicin + ethambutol + pyrazinamide + isoniazid for 2 months
TB - continuation phase
Rifampicin + isoniazid for 4 months
Latent TB, <65 yrs + treatment indicated e.g. HIV
Isoniazid + rifampicin for 3 months
Isoniazid for 6 months
T1 DM - 1st line
Basal-bolus
Acute mild-moderate UC - 1st line
Topical aminosalicylate
Acute mild-moderate UC - 2nd line
Oral aminosalicylate
Acute severe UC - 1st line
IV corticosteroids - hydrocortisone or methylprednisolone
Acute severe UC - 2nd line
IV ciclosporin
Acute severe UC - 3rd line
Infliximab
Maintaining remission in UC - 1st line
Rectal aminosalicylate +/- oral aminosalicylate
Maintaining remission in UC - 2nd line (2+ exacerbations in 12 months that required systemic corticosteroids, or remission not maintained with first line)
Oral azathioprine or mercaptopurine
Urgency incontinence - 1st line
Bladder training
Urgency incontinence - 2nd line
Oxybutinin
Stress incontinence - 1st line
Pelvic floor muscle training
Stress incontinence - 2nd line
Duloxetine
Benign prostatic hyperplasia - 1st line
Alpha-1 antagonists e.g. tamulosin
Benign prostatic hyperplasia - 1st line, raised PSA, high risk of progression
5 alpha reductase inhibitor e.g. finasteride
Benign prostatic hyperplasia - 2nd line
Alpha-1 selective adrenoceptor blocker + 5 alpha reducesse inhibitor
Benign prostatic hyperplasia - 3rd line
TURP
Lower UTI, not pregnant - 1st line
Trimethoprim or nitrofurantoin
Lower UTI, not pregnant - 2nd line
Nitrofurantoin (if not used 1st line), fosfomycin, pivmecillinam
Lower UTI, pregnant, 1st trimester - 1st line
Nitrofurantoin
Lower UTI, pregnant, 3rd trimester - 1st line
Amoxicillin or cefalexin
Lower UTI, pregnant, 1st trimester - 2nd line
Amoxicillin or cefalexin
Acute prostatitis - 1st line
Ciprofloxacin or ofloxacin
Alternative: trimethoprim
Acute prostatitis - 2nd line
Levofloxacin or co trimoxazole
Pyelonephritis - oral first line
Cefalexin or ciprofloxacin
Pyelonephritis - IV first line (severely unwell)
Gentamicin, ceftriaxone, cefuroxime, ciprofloxacin
Catheter associated UTI, no upper UTI symptoms - 1st line
Amoxicillin, nitrofurantoin or trimethoprim
Catheter associated UTI, no upper UTI symptoms - 2nd line
Pivmecilinam
Catheter associated UTI, upper UTI symptoms - oral 1st line
Cefalexin, ciprofloxacin, co amoxiclav or trimethoprim
Catheter associated UTI, upper UTI symptoms - IV 1st line
Gentamicin, ceftriaxone, cefuroxime, ciprofloxacin or co amoxiclav
Vulvovaginal candidiasis
Oral fluconazole or itraconzaole OR pessary/cream clotrimazole, miconazole
Vulvovaginal candidiasis in pregnancy
Intravaginal clotrimazole
VTE prophylaxis - mechanical
Anti embolism stockings
Proximal DVT or PE - 1st line
Apixaban or rivaroxaban
Proximal DVT or PE - 2nd line
LMWH for 5 days then dabigatran or edoxaban
How long anticoagulation after provoked DVT/PE
3 months
How long anticoagulation after unprovoked DVT/PE
6 months
Anogenital warts - multiple non keratinised, 1st line
Topical podophyllotoxin
Anogenital warts - solitary keratinised, 1st line
Cryotherapy
Anogenital warts - 2nd line
Imiquimod
Acute dystonia 2⁰ to antipsychotics
Procyclidine
