Medications Flashcards
Hypertension
ACEi – perindopril arginine 2.5mg starting
OR ARB – candesartan 4mg
ADD if needed
Thiazide diuretic – HCT (hydrochlorothiazide) 12.5mg (do not use <55yo, risk of DM)
CCB – amlodipine 2.5-5mg
Heart failure
ACEi – perindopril arginine 2.5mg nocte + titrate up over 3-4 weeks to 10mg
OR ARB eg Candesartan 4-32mg daily
PLUS
Beta Blocker – once stable – start low + titrate up (Bisoprolol, Carevedilol, Metoprolol SR)
If fluid overloaded ADD
Frusemide 20-40mg mane
If not responding / persistent fluid overload ADD
Spironolactone 12.5-50mg daily
Hypercholesterolaemia
Statin – Rosuvastatin 10mg daily to start
Ezetimibe
(10mg PO daily)
- Can lower LDL by 20-25% in combination with statin
Bile acid binding resin
- Example: cholestyramine 4g PO daily
- Avoid in patients with high triglycerides.
Fibrates
- Example: fenofibrate 145 mg PO daily (eGFR >60).
- Lowers triglycerides, modest reduction in LDL.
- Consider checking CK regularly if it is used in combination with statin.
Post-MI Management
Aspirin 100mg daily
Clopidogrel 75mg daily
B-blocker - Metoprolol (or Atenolol) 25-100mg BD – as long as no heart failure / block
ACEi – eg Perindopril arginine 2.5-10mg daily (in most patients)
Statin – high dose ie atorvastatin 80mg daily (regardless of cholesterol levels)
Pericarditis
Colchicine 500microg BD for 3/12
PLUS aspirin 1g TDS for 2/52 then decrease by 250mg every 1-2 weeks, then cease
Atrial fibrillation
Assess CHA2Ds2VA score and HASBLED for risk of stroke (if >2 then anti coagulate)
Rate control – Metoprolol (or atenolol) 25 - 100mg daily
** Atenolol 25mg PO daily (first line)
Rhythm control – Cardioversion electric OR try Amiodarone IV or oral as per ETG
Anti coagulate – Warfarin (if valvular) OR NOAC
Apixaban 5mg BD (do not use if CrCl <25)
Dabigatran 150mg BD (decrease to 110mg BD if >75yo or CrCl <50, CI’d in CrCl <30)
Rivaroxaban 20mg daily (CI’d if CrCl <29)
Community Acquired Pneumonia
MILD - Amoxycillin 1gm TDS oral x 5-7 days
Paeds dose 25mg/kg for 3-5 days
OR (both if not improving after 48hrs)
Doxycycline 100mg 12 hrly x 5-7 days
MODERATE IV benpen 1.2g 6 hrly + doxy 100mg BD
SEVERE IV ceftriaxone 2g daily PLUS azithromycin 500mg daily
If pseudomonas (bronchiectasis) - ciprofloxacin 750mg Q12H for 2/52
Asthma
Salbutamol 100mcg inhaler for reliever, 2-4 puffs 4 hrly via spacer PRN
ICS for preventer if needed eg. Fluticasone propionate 1-2 puffs BD
Exercise induced bronchoconstriction - fluticasone 125mcg 2 puffs daily
Paeds preventers - Flixotide 50-100mcg BD or Montelukast 50mg daily
<12yo - only ICS/LABA is fluticasone/salmeterol ie 100/50mcg BD
Pertussis
PO ABs only if cough <3 weeks
Azithromycin 500mg oral, then 250mg daily for next 4 days
Children >6mo 10mg/kg stat, then 5mg/kg next 4 days
Under 6 months old - 10mg/kg oral daily x 5 days
Influenza A
Oseltamivir 75mg BD for 5/7
Prophylaxis 75mg daily for 10/7
Bacterial Rhinosinusitis
Amoxycillin 500mg TDS x 5 days (or Doxycycline 100mg BD x 5 days if penicillin allergy)
Chronic obstructive pulmonary disease
SABA - salbutamol 100-200mcg PRN or terbutaline 500mcg PRN
SAMA - ipratropium 21mcg 2-4 puffs QID PRN
LAMA - tiotropium 5mcg daily (Spiriva 2.5mcg, 2 inh daily)
LABA - indacaterol 150-300mcg daily (Onbrez)
ICS+LABA - budenoside + formoterol 400+12mcg BD (Symbicort)
LAMA+LABA combo - vilanterol + umeclidinium 25+62.5mcg daily (Anoro)
LAMA+LABA+ICS combo - vilanterol + umeclidinium + fluticasone 25+62.5+100mcg daily (Trelegy)
Pneumocystis jirovecii pneumonia
Trimethoprim + sulfamethoxazole Q8H for 21 days
Q fever
Doxycycline 100mg BD for 14/7
Smoking cessation
Varenicline
0.5mg for 3/7 -> 0.5mg BD for 4/7, then 1mg BD for 12/52. Start 1/52 before quit date
Nortripyline
25-75mg daily, start 10-28 days before quit date, course of 12/52
Bupropion
150mg daily for 3/7, then 150g BD for 9/52. CI in seizures
NRT (aim to cease in 12/52)
21mg/24hr patch for >45kg/10cigs
14mg/24hr patch for <45kg/10cigs
EtOH abstinence
Disulfiram (Antabuse) 100mg daily up to 300mg - blocks EtOH metabolism - feels like crap
Acamprosate - 666mg TDS (>60kg) - reduces withdrawal symptoms
Naltrexone - 50mg daily - less pleasurable effects. CI in chronic opioid users
Weight reduction
Orlistat
GLP1 - liraglutide (Saxenda)
Phentermine (Duromine)
Calorie deficit 600kCal / 1hr moderate exercise 5 days a week
Paget’s Disease
Zoledronic 5mg IV over 15mins
Risedronate 30mg daily for 2/12
Osteoporosis
Alendronate 70mg weekly
Zoledronic acid 5mg IV over 15mins yearly (if normal CorCa, Vit D >50, eGFR >35)
Denosumab 60mg SC Q6mo
Raloxifene + Tibolone (<60yo postmenopausal)
Tepiramide (synthetic PTH) - only one to increase bone formation, significant criteria to meet
Bite/clenched fist injuries
Amox + clav 875/125mg Q12H for 5/7
If allergy - metronidazole 400mg Q12H PLUS doxy 100mg BD for 5/7
DVT/PE
Apixaban 10mg BD for 7/7 (CI in CrCl <25), then decrease to 5mg BD OR Rivaroxaban 15mg BD for 21/7 (CI in CrCl <30) then decrease to 20mg daily (do not require parenteral anticoag)
6/52 if isolated, provoked distal DVT
3/12 if unprovoked distal DVT, proximal DVT or PE - decide if further required
PLUS GCS 30-40mmHg
H. Pylori Eradication
Triple Therapy – Esomeprazole 20mg BD + Clarithromycin 500mg BD + Amoxycillin 1gm BD for 7 days
Salvage triple therapy (with levofloxacin) - Esomeprazole 20mg BD + Amoxicillin 500mg BD + Levofloxacin 500mg BD
Irritable Bowel Syndrome
Cramps – Buscopan (Hyoscine butylbromide) 20mg up to QID
Diarrhoea – Loperamide 4mg after bowel action, then 2mg after subsequent
Fe Replacement
100-210mg elemental Fe/day
Giardia
Tinidazole 2g single dose
parasite on soil
C difficile
Metronidazole 400mg IV/PO Q8H for 10/7
Anal Fissure
GTN 0.2% ointment, 1cm 3-4x/day w/ gloved finger
Thread/Pinworm
Albendazole 400mg single dose
Mebendazole 100mg single dose
Malaria
Malarone (proguanil 100mg + atovaquone 250mg) daily – 1-2 days prior and 1 week after returning
Doxycycline 100mg daily - 1 to 2 days prior and 4 weeks after returning
Mefloquine 250mg weekly, 2-3 weeks prior and 4 weeks after
Traveller’s diarrhoea
Azithromycin 1gm – once off initially
Azithromycin 500mg daily x 2-3 days (if blood in stool or not improved after stat dose of 1gm)
Tuberculosis
Rifampicin 600mg + Isoniazid 300mg + Pyrazinamide 25-40mg + Ethambutol 15mg/kg to 1200mg
Rifampicin + Isoniazid – DAILY for 6 months
Pyrazinamide + Ethambutol – DAILY for 2 months
Depression/Anxiety
SSRI eg Escitalopram 10mg oral mane up to 20mg / Sertraline 50mg mane to max of 150/200mg daily
SNRI – eg. Venlafaxine CR 75mg mane (Not for OCD)
Mirtazapine 15-30mg at night – good for elderly who need to eat more
Sertraline + paroxetine lowest transmission in breast milk, fluoxetine, escita/citalopram highest
Obsessive Compulsive Disorder
SSRI first line - fluvoxamine/sertraline
Clomipramine 2nd line
Bulimia
Fluoxetine 20-60mg daily
Attention Deficit Hyperactive Disorder
Methylphenidate fast (Ritatlin) + slow (Concerta) Dexamphetamine
Non generalised social anxiety disorder
Propranolol 10-40mg, 30-60mins prior to event
Bipolar Depression
SSRI PLUS prophylaxis of BPD (lithium, olanzapine, risperidone, quetiapine)
Acute Mania
Olanzapine, risperidone, haloperidol
Trigeminal Neuralgia
Carbamazepine 100mg BD – can titrate up every 7 days as needed to max 400mg BD
Also – gabapentin / pregabalin / phenytoin used
Migraine
Aspirin 900mg oral, repeat after 4 hrs as needed (OR Paracetamol 1gm OR Ibuprofen 400mg)
Metoclopramide 10mg TDS for nausea
Triptans – Sumitriptan 50-100mg PO (max 300mg/day, paeds 10-20mg >6yo) – wait 2 hrs between doses
Prophylaxis - choose for comorbidities
Amitriptyline 10-75mg nocte (insomnia, depression), pizotifen 0.5-3mg nocte, propranolol 20-160mg daily (anxiety/menopause), candesartan 4mg daily (obesity, diabetes)
Peripheral Neuropathy
Amitriptyline 25-150mg nocte
Bell’s Palsy
Prednisone 1mg/kg (max 75mg) daily for 5/7
Parkinson’s Disease
Levodopa / Carbidopa OR Pramipexole
For nausea Domperidone 10mg TDS
Dementia
First-line
Donepezil 5mg nocte x 4 weeks, if tolerated increase to 10mg nocte
Rivastigmine 4.6mg transderm/24hrs, increasing to 9.5mg after 4/52
Galantamine 8mg mane for 4/52, increasing to 16mg if tolerated
Second-line
Memantine
Behavioural disturbances - 0.25mg risperidone BD or olanzapine 2.5mg daily
in Lewy body dementia and Parkinsons, use Quetiapine 50mg BD
Narcolepsy
Modafinil 200mg daily
Restless leg
Levodopa + carbidopa OR gabapentin / pregabalin / pramipexole
Essential tremor
Propranolol 10-20mg BD or primidone 62.5mg nocte (second line)
Motor neurone disease
Riluzole (Na channel blocker) 50mg BD - slows progression by 3-6 months
Baclofen 10-25mg TDS (symptoms)
Shingles
Valaciclovir 1g Q8H for 7/7 or 10/7 for immunocompromised
Post herpetic neuralgia - ice massage, amitriptyline 10mg nocte, pregabalin 75mg nocte, transcutaneous electric nerve stimulation of 2 weeks, topical lignocaine 5% ointment
Gout
NSAID eg Ibuprofen 400mg oral 8 hrly for 3-5 days OR
Pred 15mg daily for 5 days OR
Colchicine 1mg oral then 0.5mg 1 hour later as a single one day course
AND
Allopurinol (start/continue) – start LOW + titrate up – 50-100mg daily for 2-3 weeks then increase
Max dose 900mg daily, average 300mg (lower for renal failure)
Aim urate <0.36 or <0.3 if gouty top
If not enough, add probenecid 250mg BD and titrate up to max 2g daily
Flare prophylaxis - colchicine has best evidence - 500mcg 1-2x/day, at least 6 months
Rheumatoid Arthritis
Methotrexate – weekly PO/SC, 10mg up to 25mg
Leflunomide if MTX CI’d
Folate 5-10mg
And/Or
DMARDS – including biologics
Hydroxychloroquine, sulfasalazine or leflunomide
Polymyalgia Rheumatica
Prednisolone oral 15mg/day for 4 wks, then reduce by 2.5mg every 4 wks until 10mg daily, then reduce daily by 1mg every 4-8 wks then stop (treat for 12 months)
SOME need Methotrexate start at 10mg then up to 25mg weekly PLUS 5-10mg weekly folate
Giant Cell Arteritis (Temporal)
Prednisolone 40-60mg daily (in 2 doses) for minimum 4 weeks then tapering regime over several months (If visual loss - IV Methylprednisolone 0.5-1g over an hour daily for 3 days first)
Aspirin 100mg daily
SOME – need Methotrexate also start 10mg then increase to 25mg weekly PLUS 5-10mg folate/wk
Acute Rheumatic Fever
Benzathine penicillin 900mg IM single dose (kids <20kg: 450mg) OR
Phenoxymethylpenicillin oral 500mg BD x 10 days (kids 15mg/kg)
Azithromycin 500mg daily for 5 days (if allergies)
PLUS aspirin 50-60mg/kg day for arthralgia
Prophylaxis - monthly IM benzathine penicillin until >21yo or for at least 10yrs, whichever is greater
900mg (>20kg), 450mg (<20kg)
Angioedema
Prednisolone 25-50mg daily for 3/7
Raynauds
Nifedipine CR 30-120mg OR
Amlodipine 5-10mg daily
GTN 2% ointment topically
Chilblains (pernio)
Betamethasone diproprionate 0.05% BD w/ or without occlusive dressing
Nifedipine CR 20-60mg daily
Evidence lacks for GTN
Erythromelalgia
Aspirin 300mg
Can also treat as per neuropathic pain