Medications Flashcards
Meniere Disease
1) HCTZ 25mg OD
1) HCTZ/Amiloride 50/5mg OD
1) ICTZ/Triamterense 25/50mg OD
Otitis Externa without fungal infection
1) Dex/Framycetin/Gramicidin 3 drops tds for 7 days (SOFRADEX)
1) Flumethoasone/Clioquinol - 3 drops tds for 7 days (Locorten Vioform)
AVOID AMINOGFLYCOSIDES IF ?PERF
Use ciprofloxacin/hydrocort - 3 drops BD for 7 days (CiproHC - ~$50)
Otitis Externa with fungal infection
DEBRIDE AND AURAL TOILET
1) flumetheasone/clioquinol - 3 drops tds 7 days (locorten Vioform)
1) Triamcinlone/neomycin/gramicidin/nystatin - 3 drops tds 7 days (Otocomb)
Tonsilitis
1) Phenoxymethylpenicillin 500mg BD for 10 days
For children (preference for liquid formulation)
1) Amoxicillin 1g (50mg/kg) OD for 10 days
1) Amoxicillin 500mg (25mg/kg) BD for 10 days
Penicillin sensitivity
- Cefalexin 1g (25mg/kg) BD for 10 days if nonsevere allergy
- Azithromycin 500mg (12mg/kg) OD for 5 days
Otitis media
Amoxicillin 500mg (15mg/kg) TDS for 5 days
OR
Amoxicillin 1g (30mg/kg) BD for 5 days
IF PENICILLIN ALLERGY
1) Cefuroxime 500mg (15mg/kg) BD for 5 days
2) Trimethoprim + Sulfamethoxazole 160+800 (4+20kg/mg) BD for 5 days
Non responsive Otitis media (After 48-72hrs of treatment)
1) Augmentin 875+125mg (22.5+3.2mg/kg) for 5-7 days
Chronic Ottorhoea / Chronic suppurative Otitis media
Augmentin PO 875+125mg (22.5+3.2mg/kg) BD for 5-7 days
PLUS
Ciprofloxacin 0.3% ear drops 5 drops into affected ear BD until middle ear free of discharge for at least 3 days
Mild to moderate croup
1) Prednisolone PO 1mg/kg (Up to 50mg) as single dose
OR
2) Dexamethasone PO 0.15mg/kg (up to 12mg) as a single dose
Severe croup
Adrenaline 0.1% (1:1000 1mg/ml) solution 5ml by inhalation via nebuliser
PLUS
1) Prednisolone 2mg/kg (50mg MAX) then 1-2mg/kg (50mg MAX) PO 24hrs later
1) Dexamethasone 0.6mg/kg (12mg MAX) as a single dose
1) Dexamethasone 0.6mg/kg (12mg MAX) IM or IV as single dose (if nauseous)
Migraines
(Non-Pharmacological)
- Cold packs over the forehead or back of the skull
- Hot packs over the neck and shoulders
- Neck stretches and self-mobilisation
- Rest in a quiet dark room
Migraines Acute pharmacological management - non-opioids
1) Aspirin soluble 900-1000mg PO, repeat 4-6hrly (Max 4g in 24hr)
1)Ibuprofen 400-600mg, PRN 4-6hrly (Max 2.4g in 24hr)
2) Diclofenac sodium 50mg PO, 4-6hrly PRN (Max 200mg in 24hr)
2) Naproxen 500-750mg PO 4-6hrly (Max 1250mg in 24hrs)
2) Paracetamol 1g PO QID PRN (Max 4g in 24hr)
Migraines Acute antiemetic
1) Metoclopramide 10mg PO TDS PRN (Max 30mg/day)
2) Domperidone 10-20mg TDS PRN (Max30mg/day)
2) Ondansteron 4-8mg TDS PRN (Max 16mg/day)
2) Prochlorperazine 5-10mg TDS PRN (Max 30mg/day)
Migraines acute pharmacological - triptans
1) Eletriptan 40-80mg PO, wait at least 2hrs before repeating dose (Max 160mg/24hr)
1) Naratriptan 2.5mg PO, wait 4 hrs before repeating dose (Max 5mg/24hr)
1) Rizatriptan 10mg PO, wait 2hrs before repeating dose (Max 30mg/day)
1) Sumatriptan
- PO 50-100mg, wait 2hrs (Max 300mg/day)
- Intranasal 20mg, wait 2hrs (Max 40mg/day)
- SC 6mg, wait 1 hr (12mg/24hr)
1)Zolmitriptan 2.5mg PO, wait 2hrs (Max 10mg/24hr)
Migraine management during pregnancy
NON-OPIOID ANALGESIA
Paracetamol 1g QID
AVOID NSAIS/aspirin in the first trimester and after 30 weeks
Can sparingly use codeine if not responsive to paracetamol
ANTIEMETIC
Metoclopramide
SEVERE REFRACTORY MIGRAINE
Prednisolone 50mg PO OD for 2 days then cease
Status Migrainosus
1) Sumatriptan 6mg SC
- Only if triptan has not been given in the last 2 hrs
2) Ketorolac 30mg by slow deep injection IM
- Only if PO NSAID has not been given in the last 4-6hrs
Migraine prophylaxis
1) Amytriptyline 10mg PO NOCTE
1) Candesartan 4mg PO OD
1) Nortriptyline 10mg PO NOCTE
1) Pizotifen 0.5mg PO NOCTE
1) Propanolol 20 PO NOCTE
1) Sodium valproate 200 PO NOCTE
1) Topiramate 25mg PO NOCTE
1) Verapamil SR 90mg PO OD
Tinea (Topical)
1) Terbinafine 1% cream or gel OD-BD for 1-2 weeks
2)
- Bifonazole 1% cream OD for 2-4 weeks
- Clotrimazole 1% cream BD-TDS for 2-4 weeks
- Econazole 1% cream BD-TDS for 2-4 weeks
Ketoconazole 2% cream OD-BD for 2-4 weeks
- Miconazole 2% cream BD for 2-4 weeks
Tina Oral therapy (Not scalp or nails)
1) Terbinafine 250mg OD for 2 weeks
2) Fluconazole 150mg once weekly for 6 weeks
3) Itraconazole 100mg PO OD, 2 weeks for tinea cruris/corporis // 4 weeks for tinea pedis
Tinea Oral therapy (Scalp)
1) Terbinafine 250mg OD for 4 weeks
If Microsporum species identified
- Griseofulvin 500mg PO OD for 6-8 weeks
Shingles (Antivirals)
Should be commenced within 72hrs of rash onset
1) Valaciclovir 1g PO TDS for 7 days
1) Famciclovir 500mg TDS for 7 days (10 days if immunocompromised)
2) Aciclovir 800mg PO 5 times daily for 7 days
If immunocompromised with disseminated disease
- Aciclovir 10mg/kg IV TDS
Pain associated with singles (herpes zoster)
Herpes zoster ophthalmicus
Consult Ophthal for ALL cases
Topical aciclovir has NO role in the initial management
1) Valaciclovir PO 1g TDS for 7 days
2) Famciclovir 500mg PO TDS for 7 days
2) Aciclovir 800mg PO 5 times daily for 7 days
Medications for Palliative care (Syringe driver)
- Morphine (Pain/Dyspnoea)
- Clonazapam/Midazolam (Agitation/Dyspnoea)
- Glycopyrronium/ Hyoscine butylbromide (Resp tract secretions)
- haloperidol (Agitation/ N/V)
- Metoclopramide (N/V)
Cellulitis/Erysipelas WITHOUT systemic features
- Suspecting S.pyogenes
(Nonpurulent, recurrent or spontaneous, rapid spreading cellulitis)
1)
- Phenoxymethylpenicillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days
- procaine benzylpenicillin 1.5 g (child: 50 mg/kg up to 1.5 g) intramuscularly, daily for at least 3 days.
Delayed non-severe hypersensitivity to penicillin
- cefalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days.
Immediate/delayed severe hypersensitivity to penicillin
- clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly for 5 days
Cellulitis/Erysipelas WITHOUT systemic features
- Suspecting S.aureus
(Penetrating trauma / associated ulcer)
1) dicloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days
1) flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days.
Delayed non-severe hypersensitivity to penicillin
- cefalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days.
MRSA risk / immediate/delayed hypersensitivity to penicillins
1) trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly for 5 days
2) clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly for 5 days
Cellulitis/Erysipelas WITH systemic features
If suspecting S pyogenes
- benzylpenicillin 1.2 g (child: 50 mg/kg up to 1.2 g) intravenously, 6-hourly.
If suspecting S.aureus
- flucloxacillin 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly
MRSA concerns:
- vancomycin intravenously
OR consider Clindamycin IV // Lincomycin IV
If Penicillin hypersensitivity
- cefazolin 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly.
Streptococcal pharyngitis/Tonsilitis
1) phenoxymethylpenicillin 500 mg (child: 15 mg/kg up to 500 mg) orally, 12-hourly for 10 days
Amoxicillin preferred for children if needing liquid formulation:
- 50 mg/kg up to 1 g orally, daily for 10 days;
- 25 mg/kg up to 500 mg orally, 12-hourly for 10 days
If difficulty adhering to 10 day regime:
- benzathine benzylpenicillin intramuscularly
Delayed nonsevere penicillin allergy
- cefalexin 1 g (child: 25 mg/kg up to 1 g) orally, 12-hourly for 10 days
Immediate/delated severe penicillin allergy
- azithromycin 500 mg (child: 12 mg/kg up to 500 mg) orally, daily for 5 days.
Periorificial Dermatitis
- If perioral may leave a clear rim around the mouth
Treat as per rosacea
Consider
- Ceasing topical corticosteroids
- Ceasing occlusive cosmetics/creams
- Use emollient soap free cleanser
Mild:
1) ivermectin 1% cream topically, once daily
2) metronidazole 0.75% gel or cream topically, once or twice daily
Severe:
1) doxycycline 50 to 100 mg orally, once daily until a response is seen (usually 3 to 4 weeks, but can be up to 8 weeks) - AVOID in 2nd/3rd trimester pregnancy
2) erythromycin 250 to 500 mg orally, twice daily until a response is seen (usually 3 to 4 weeks, but can be up to 8 weeks)
Trigeminal neuralgia
1) Carbamazepine MR 100mg PO BD
2) Oxcarbazepine 300mg PO BD
3)
- Baclofen 5mg PO BD
- Gabapentin 300mg PO NOCTE
Indications for abx treatment for Otitis media
- <6 months
- <2yo with BL otitis media
- Systemically unwell
- Otorrhoea present
- Children at high risk of complications
- Certain populations of ATSI children (remote areas, perf, history of CSOM)
Painful peripheral neuropathy
1) Amytriptyline 25mg PO NOCTE
2)
- Duloxetine 60mg PO OD
- gabapentin 300mg PO OD
- Pregabalin 75mg PO BD
Narcolepsy
1) Modafinil 20mg PO MANE
2) Armodafinil 150-250mg PO MANE
Allergic Rhinitis
Oral Antihistamines
- Cetirizine 10mg PO OD
- Desloratadine 5mg PO OD
- Fexofenadine 120-180mg PO OD
- Loratadine 10mg PO OD
Intranasal antihistamines
- Azelastine 1mg/ml, 1 spray into each nostril, BD
- Levocabastine 0.5mg/ml, 2 sprays into each nostril, BD-QID
- No benefit from combining PO / IN antihistamines
Intranasal corticosteroids
- Mometasone 100mcg, 1 spray each nostril OD
- beclomethasone 100mcg, 1 spray BD
Montelukast
- used in combo with antihistamine + IN corticosteroid
Allergic conjunctivitis eye drops
Antihistamine/Mast cell stabiliser eye drops:
- Azelastine 0.05% eye drops, BD-QID
- Ketotifen 0.025% eye drops, BD
- Olopatadine 0.1% eye drops, BD
Essential tremor
- Propanolol 10mg PO BD (Can increase up to 160mg daily in divided doses)
- Primidone 62.5mg PO NOCTE (up to 250mg)
Parkinsons
1) Levodopa+Benserazide 50+12.5mg PO TDS
1) Levodopa+Carbidopa 50+12.5mg PO TDS
2) Pramipexole 0.125mg PO TDS
2) Pramipexole MR 0.375mg PO OD
2) Rotigotine 2mg transdermal OD for 24hrs
AVOID METOCLOPRAMIDE AND PROCHLORPERAZINE
- Instead use domperidone
Salivary gland hypofunction / Xerostomia
Symptomatic management
- Adequate hydration
- Oral lubricants (Olive oil, Biotene, Oral 7, Xylimelts)
Saliva stimulation
- Chewing sugar free gum
- Pharmacological (Pilocarpine)
- Electro-stimulating devices
General advice
- reduce exposure to irritants (alcohol, smoking, spicy foods)
- Ensure adequate fit of denture
- Regular dental visits
2 month vaccinations
- DTP, hep B, polio, Hib
- Rota virus
- Pneumococcal
ATSI
- Meningococcal B - prophylaxis with paracetamol recommended
4 month vaccinations
- DTP, hep B, polio, Hib
- Rota virus
- Pneumococcal
ATSI
- Meningococcal B
6 month vaccinations
- DTP, hep B, polio, Hib
Children with risk factors
- Pneumococcal
ATSI
- Pneumococcal
- Meningococcal B
Annually from 6 months to 5yo
- Influenza (initially minimum of 2 doses spaced 1 month apart)
12 month vaccinations
- Meningococcal ACWY
- MMR
- Pneumococcal
ATSI
- Meningocccal B
18 month vaccinations
- Hib
- MMRV
- DTP
ATSI
- Hep A
4 year vaccinations
- DTP, polio
Children with risk factors
- Pneumococcal
ATSI
- Pneumococcal
- Hep A
Mild to Moderate Asthma
Child 1-5yo
- Salbutamol (100mcg) MDI 2-6 actuations, repeat as required
Adult/6yo+
- Salbutamol (100mcg) MDI 4-12 actuations, repeat as required
Severe asthma
Child 1-5yo
- Salbutamol 6 actuations via MDI/spacer, repeat every 20min for 1st hour
PLUS
- Ipratropium bromide 4 actuations via MDI/spacer, repeat ever 20min for 1st hour
Adult/6yo+
- Salbutamol 12 actuations via MDI/spacer, repeat every 20min for 1st hour
PLUS
- Ipratropium (21mcg) 8 actuations via MDI/spacer, repeat every 20min for 1st hour
Can also consider nebs (<6yo/>6yo)
- Salbutamol 2.5/5mg via intermittent neb every 20min for 1st hour
- Ipratropium 250/500mcg via intermittent neb every 20min for 1st hour
Life threatening asthma
Salbutamol 2.5/10mg at a time via continuous neb
PLUS
Ipratropium 250/500mcg added to neb solution every 20min for 1st hour
(<6yo/>6yo)
Other things to consider:
- IV Magnesium sulfate
- IM Adrenaline 1mg/kg (1:1000) solution - 0.01mg/kg up to 0.5mg
Steroid therapy for asthma
ADULTS
1) Prednisolone 37.5-50mg PO within 1hr, continue for 5-10 days
2) Dexamethasone 16mg PO within 1 hr, repeat dose once the next day
Children
1)Prednisolone 1ng/kg (MAX 50mg) OD for 3 days
2) Dexamethasone 0.6ng/kg (MAX 16mg) OD for 2 days
If unable to tolerate oral
- IV hydrocortisone OR
- IV methylprednisolone
Impetigo (localised skin sores)
Mupirocin 2% ointment or cream to crusted areas TDS for 5 days
Impetigo (multiple skin sores or recurrent infection)
1) Dicloxacillin 500mg QID for 7 days
1) Flucloxacillin 500mg QID for 7 days
In children can consider cefalexin due to liquid formulation
Penicillin allergy:
- Trimethoprim + Sulfamethoxazole 160+800mg BD for 3 days
Impetigo in endemic settings
1) Benzathine benzylpenicillin IM as single dose
1) Trimethoprim
Bronchiectasis (Not colonised with P aeruginosa)
1) Amoxicillin 1g TDS for 14 days
1) Doxycycline 100mg BD for 14 days
Give Augmentin if suspecting:
- B-lactamase-producing strain of H influenzae
- Moraxella catarrhalis
Bronchiectasis (Colonised with P aeruginosa)
Should initially manage with Amox or Doxy
If Pseudomonas identified use:
Ciprofloxacin 750mg PO BD for 14 days
Mycoplasma pneumonia
- Young person with dry cough / headache / fever
- May have ill defined opacities on CXR
- Not responsive to amoxi/augmentin
1) Doxycycline 100mg BD for 7 days
2) Azithromycin 500mg OD for 3 days
2) Clarithromycin 500mg BD for 7 days
Uncomplicated Chlamydia
- Genital or pharyngeal infection
1) Doxycycline 100mg PO BD for 7 days
2) Azithromycin 1g PO STAT
- Consider if poor compliance with daily treatment
Chlamydia
- Anorectal infection
1) Doxycycline 100mg PO BD for 7 days if asymptomatic (21 days if symptomatic)
2) Azithromycin 1g PO STAT, repeat in 12-24 hrs
Gonnorhoea
- Uncomplicated genital and anorectal infection
Ceftriaxone 500mg IMI STAT in 2ml 1% lignocaine
PLUS
Azithromycin 1g PO STAT
Gonnorhoea
- Uncomplicated pharyngeal infection
Ceftriaxone 500mg IMI STAT in 2ml 1% lignocaine
PLUS
Azithromycin 2g PO STAT
Adult gonococcal conjunctivitis
Ceftriaxone 1g IMI STAT in 2ml 1% lignocaine
PLUS
Azithromycin 1g PO STAT
Early syphilis (primary, secondary, early latent)
Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, Stat, given as 2 injections containing 1.2 MU (0.9 g)
Late syphilis or syphilis of unknown duration (late latent > 2 years)
Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, given as 2 injections containing 1.2 MU (0.9 g)
weekly for 3 weeks
Trichomoniasis
Metronidazole 400 mg PO with food, BD for 7 days
Symptomatic bacterial vaginosis
Metronidazole 400 mg PO, BD with food for 7 days.
OR
Metronidazole 0.75% gel 5 g, intravaginally nocte for 5 nights (not on PBS).
OR
Clindamycin 2% vaginal cream 5 g, one applicator intravaginally nocte for 7 days (not on PBS).
Genital herpes
Valaciclovir 500mg PO
- Initial episode: BD for 5- 10 days
- Recurrence: BD for 3 days
- Suppressive therapy: OD for 6 months
- Suppression in pregnancy: BD from 36 weeks til birth
Q fever (Coxiella burnetti)
Doxycycline 100mg BD for 2 weeks
Leptospirosis (Leptospirosa interrogans)
Doxycycline 100mg BD for 1 week
