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
SLE (systemic lupus erythromatosus)
Hydroxychloroquine 200-400mg daily
Kawasaki Disease
Aspirin 3-5mg/kg, minimum 6/52 until normal ECHO f/u
IV Ig 2g/kg
** no live vaccines for 11 months post IVIg
Erythema nodosum
Prednisolone 25mg daily for 2/52, then taper
Acne
Benzoyl Peroxide 5% + Clindamycin 1% (if inflammatory) OR benzoyl peroxide + adapalene 0.1% (if comedomal) topically, once daily for 6 weeks
OR
Topical Tretinoin 0.025% daily for 6 weeks
OR if more severe
Oral doxycycline 50-100mg daily for 6 weeks
OR if pregnant
Erythromycin 250-500mg BD for 6 weeks
+/-
Spironolactone 50-100mg daily / OCP (Yaz, Diane-35) / refer for isotretinoin
Psoriasis + Eczema
Mild - Hydrocortisone 1% for kids / faces
Moderately potent – Betamethasone Valerate 0.02% - (betnovate or celestone)
Potent – Methylprednisolone Aceponate 0.1% (Advantan Fatty Ointment)
Ultra Potent – Betamethasone Diproprionate 0.05% in Optimised Vehicle (Diprosone OV)
Psoriasis - coal tar 1% as maintenance
Perioral dermatitis + Rosacea
0.75% metronidazole gel BD OR
Doxycycline 50-100mg daily for minimum 6 weeks
Shingles
Valaciclovir 1gm 8 hrly x 7 days
SCC + BCC (unless superficial)
Excision with 3-4mm margin
Bowens disease on biopsy (SCC in situ) + Superficial BCC
Topical Imiquimod or 5% Fluorouracil
Bowens must be excised if involves hair follicles due to risk of development into SCC
Melanoma
Excisional biopsy with 2mm margin
IF positive refer for WIDE excision + Sentinel Node Biopsy if depth >1cm
Seborrhoeic dermatitis
Hydrozole (hydrocort 1% + clotrimazole 1%) cream BD topically for up to 14 days
Tinea (not scalp or nails)
Terbinafine 1% cream/gel topically, 1-2 times day for 7 to 14 days
Tinea capitis
Terbinafine 250mg oral, daily for 4 weeks (child <20kg: 62.5mg, child 20-40kg: 125mg)
Onychomycosis
Terbinafine 250mg daily for 12 weeks if toes, 6 weeks if fingers
Pityriasis Versicolor
Econazole 1% solution topically to wet skin, leave overnight, for 3 days
OR Ketoconazole 2% shampoo, once daily for 5 mins then wash off, for 5 days
OR if not resolving
Fluconazole oral 450mg, single dose
Impetigo
Mupirocin 2% TDS for 5/7 for localised lesions
Flucloxacillin 500mg or cephalexin 500mg (both 12.5mg/kg) Q6H for 7/7
Endemic
Benzathine benylpenicillin IM single dose
Trimethoprim + sulfamethoxazole 4+20mg/kg Q12H for 3/7
Scabies
Permethrin 5% from neck down, leave minimum 8hrs. Repeat in 7/7
Actinic keratoses
Cryotherapy
Topical Imiquimod 3x/week for 3-4 weeks
5% Fluorouracil 1-2x/day for 2-6 weeks
Diabetes
Biguanide (Metformin) – GIT side effects, care with renal
Max 1g daily if CrCl 30-60, CI if <30
Sulfonylureas (Gliclazide) – weight gain, risk of hypos
DPP-4 inhibitors (Sitagliptin) – GIT, rash, pancreatitis (rare)
* contraindicated for pancreatitis and heart failure
GLP-1 agonist (Exanetide) – weight loss, nausea, vomits, pancreatitis
* contraindicated thyroid/endocrine cancer, pancreatitis
SGLT2 inhibitor (Empagliflozin) – weight loss, increase urogenital infections, dehydration, dizziness. Risk of DKA
Cease if CrCl <45
* reduces risk of CVD risk/mortality
Acarbose – flatulence, bloating
Thiazolidinediones (pioglitazone) – risk of heart failure, bladder cancer, weight gain, #s in women
Insulin – risk of hypos, weight gain - start with 0.2U/kg
Add fenofibrate 145mg daily if diabetic retinopathy
Consider bariatric surgery if BMI >40
Consider meds if BMI >27 - orlistat, liralutide, phentermine, naltrexone+buproprion
Hypothyroidism
Start thyroxine 1.6mcg/kg, adjust every 4-8 weeks
Thyroiditis (Graves)
Carbimazole 10-30mg/day in 2-3 doses. Titrate 4 weekly as required to avoid hypothyroidism
If T3/T4 drops by 1/2, reduce dose by 1/2
Cease after 12-18mos
Use propylthiouracil in pregnant women
Subacute thyroiditis
Aspirin 600mg QID
If severe, pred 40mg daily, decrease over 2-4 weeks
Post-partum thyroiditis
Symptomatic tx with propranolol during hyper phase
Thyroxine during hypo phase, continue for 6-12 mos
Cystitis (women)
Trimethroprim 300mg PO daily for 3/7 OR Cephalexin 500mg PO Q12H for 5/7
Paeds dosing: Trimeth 4mg/kg BD or cephalic 25mg/kg TDS both for 3/7
If pregnant - nitrofurantoin 100mg Q6H for 5/7
Cystitis (men)
Trimethroprim 300mg orally x 7 days – OR
Cephalexin 500mg oral 12 hrly x 7 days
Pyelonephritis
Empiric
Augmentin Duo Forte 1 tab BD for 10-14 days
Allergy
Ciprofloxacin 500mg BD for 7 days
Specific
1st line: Amoxicillin 500mg 8hrly for 14 days
2nd line: Cephalexin 500mg 6 hrly x 10-14 days
Bacterial Vaginosis
Metronidazole 400mg oral, 12 hrly x 5 days
OR metronidazole gel 0.75% nocte for 5/7
Thrush (vaginal)
Clotrimazole 1% cream intravaginally nocte x 6 nights (or 2% x 3 nights)
OR / if not working
Fluconazole oral 150mg STAT (if not pregnant)
Trichomoniasis
Metronidazole 2gm oral , single dose – If RELAPSES needs:
Metronidazole 400mg oral, 12 hrly x 5 days
- not notifiable, all partners to be informed
Chlamydia
Azithromycin 1gm oral STAT
** notifiable (by lab not Dr), partners in last 6 months
Gonorrhoea
Azithromycin 1gm oral STAT
PLUS Ceftriaxone 500mg in 2ml 1% lidocaine IM injection
** notifiable, partners in last 2 months
Pelvic Inflammatory Disease (NON SEXUALLY Acquired)
Amoxycillin + Clavulanate 875+125mg (Aug DF) oral 12 hrly for 14 days AND
Doxycycline 100mg 12 hrly for 14 days
Pelvic Inflammatory Disease (SEXUALLY Acquired)
Ceftriaxone 500mg in 2ml of 1% lidocaine IM injection AND
Azithromycin 1gm oral STAT AND
Metronidazole 400mg oral 12 hrly for 14 days PLUS
Doxycycline 100mg 12 hrly for 14 day
OR Azithromycin 1gm oral STAT one week later (pregnant or non compliant to doxy)
Prostatitis
Sexually acquired - As for PID but without Metronidazole
Non sexually acquired - trimethoprim 300mg for 2/52 or cephalex 500mg Q6H for 2/52
Chronic prostatitis
Ciprofloxacin 500mg Q12H for 4/52
OR trimethoprim 300mg for 4/52 OR norfloxacin 400mg Q12H for 4/52
Syphilis
Benzathine penicillin 1.8gm(2.4 million units) IM STAT dose OR
Doxycycline 100mg oral BD x 14 days
** notifiable, primary syphilis - partners in last 3 months, secondary syphilis - partners in last 6 months
Genital Herpes
Initial – Valaciclovir 500m BD x 5 days
Recurrence – Valaciclovir 500mg BD x 3 days
Suppression – Valaciclovir 500mg daily x 6 months
Genital Warts
Imiquimod 5% 3x/wk until resolved (~8-16 weeks) OR
Podophyllotoxin 0.5% paint, BD for 3/7, then 4/7 day break (~4-6 cycles)
Erectile dysfunction
Sildenafil (Viagra) (PDE5 inhibitor) 50mg one hour before sex (one dose per 24 hours)
Tadalafil (Cialis) 10mg pre sex once per 24 hours OR 2.5-5mg daily as a regular dose
Premature ejaculation
Dapoxetine 30mg 1-2hrs before sex
Topical lignocaine + prilocaine 2.5+2.5% 10-20mins before sex
Priapism
2 hrs - pseudoephedrine 120mg
4 hrs - repeat above
6hrs - aspiration + drainage of corpora cavernosum
Hormone Replacement Therapy
PO or Transdermal oestrogen +/- cyclical or continuous progesterone or IUD
Combined HRT should not be used for >5yrs due to increased risk of breast Ca
OR venlafaxine (37.5mg) / paroxetine (7.5mg)/ gabapentin (300mg)/ clonidine (50mg)
Lichen sclerosus
Clobestasol 0.05% + dermatology referral
** different from clobetasone 0.05%
Vaginal atrophy
Topical oestrogen 1mg/g - nocte daily for 2-3 weeks, then 1-2x/week
Benign Prostate Hypertrophy
Tamsulosin 400mcg (alpha blocker) – once daily OR Prazosin 1mg (alpha blocker) OR a combo Tamsulosin 400mcg /Dutasteride 500mcg (5 a-reductase inhibitor) – once daily
Menorrhagia
NSAIDS – Ibuprofen 400mg TDS
Tranexamic Acid – 1 to 1.5g oral, 3-4 times daily for first 3-5 days of period
Mirena (best results) or Implanon
OCP
Oral progesterone – Norethisterone 5mg TDS on days 5-26 of 28 day cycle for up to 6 months
Can also use this starting a few days before period to avoid it eg. young girls on holiday
Severe heavy bleeding
Tranexemic acid 1g 6-8 hourly until bleeding stops
Norethisterone 5-10mg 4-8 hourly until bleeding stops
Mastitis
Flucloxacillin (or Cephalexin) 500mg oral 6 hrly x 5 days
Urinary incontinence
Non selective antimuscarinic - oxybutynin 5mg TDS
M3 selective antimusc - solifenacin (vesicare)
Beta adrenergic agonists - mirabegron (betmiga) 25mg daily
Emergency contraception
Copper IUD within 5 days (>99%)
Levonorgestrel 1.5mg within 72 hrs (~85%), repeat if vomit within 2 hrs
Ulipristal 30mg within 120hrs (~85%) - cannot BF for a week, repeat if vomit within 3 hrs
Otitis Media
Amoxycillin 15mg/kg TDS x 5 days (if indicated) or 30mg/kg BD
THEN - Augmentin (amoxycillin + clavulanate) 22.5+3.2mg/kg BD x 5 days - if not improving
PLUS - cipro 0.3% drops - 5 drops Q12H until no d/c for 3/7 if chronic otorrhea present
ATSI
OM - PO Abs for at least 7/7, increase to 14/7 if TM still bulging
OM with perf - Amox for 14/7, if persistent, change to Augmentin for another 2-4 weeks
Otitis Externa
Dex / framycetin / gramicidin (Otodex / Sofradex) 3 drops TDS for 7/7
If perf’d TM - cipro + dex 0.2/1% 3 drops BD for 7 days
Drying (long term mx) - acetic acid + isopropyl alcohol drops after water exposure
Menieres disease
Betahistine for symptom relief
Epiglottitis
Ceftriaxone 1 g (child 1 month or older: 50 mg/kg up to 1 g) IV, daily for 5 days
PLUS prophylaxis for pt + close contacts (rifampicin for HiB clearance)
Strep tonsillitis/Scarlet fever
Phenoxymethylpenicillin 500mg (kids 15mg/kg) oral, 12 hrly x 10 days OR single dose IM benzathine benzylpenicillin
Dacrocystitis
Cephalexin 500mg Q6H
Sinusitis
Amoxicillin 500mg Q8H for 5/7 If allergy - Doxy 100mg Q12H for 5/7
Vestibular neuronitis
Pred 1mg/kg (max 75mg) for 5/7, taper dose over 15 days and stop
Acute angle closure glaucoma
Urgent referral to ophthalmologist
Timolol 0.5% drop (B-blocker) – one drop.
then 1 minute later
Pilocarpine 2% - one drop
Repeat above 3 times at ~5 minute intervals
PLUS Acetazolamide oral 500mg (reduces IOP)
Bacterial keratitis
Urgent referral to ophthalmologist for scraping
Cipro 0.3% 1-2 drops Q15min for 6hrs, then Q1H for 48hrs, then Q4H until healed
HSV keratitis
** Referral to ophthalmologist
Acyclovir 3% ointment 5x/day for 2/52 or 3 days post healing, whichever is earlier
HSV ophthalmicus
PO valacyclovir 1g TDS for 7/7
Addison crisis
** Urgent referral to ED via ambulance for endocrinologist management
Hydrocort 100mg IV , then 50-100mg Q4-6H until stable
Anaphylaxis
Adrenaline 10mcg/kg IM lateral thigh, adults 0.5mg (0.5ml of 1:1000 adrenaline)
Promethazine (Phenergan®) 25-50mg IM/IV (NOT oral ever)
Seizure
Midazolam 5-10mg (paeds 0.2mg/kg) IV / IM (repeat once after 15mins if still seizing)
Paeds 0.3mg/kg buccal/IN/IM, 0.1mg/kg IV
Sedation – for drug overdose or delirium
Diazepam oral 20mg if pt will take it,
Diazepam 2.5-5mg IV, repeat 3 to 4 mins as needed to max of 20 -30mg
Midazolam 2.5-5mg IV/IM, repeat every 3-4 mins as needed to max 20mg
Hypoglycaemia
Rule of 15 - 15g quick acting carb, recheck in 15mins, repeat if not improving
Glucagon 1mg IM
50ml 50% dextrose/glucose IV
Asthma severe attack
Salbutamol 5mg (2.5mg in <6yo) nebulised - may give continuously
Ipratropium 500mcg (250mcg in <6yo) nebulised (every 20 mins for 1st hour, rpt every 4-6 hrs as needed)
Prednisolone 1mg/kg (max 50mg) PO - within 1 hour
Magnesium 0.1-0.2mmol/kg (max 10mmol) if no improvement
Croup
Mild to mod - 1mg/kg pred + repeat following evening
Severe
Adrenaline 5ml of 1:1000 (5mg) via nebuliser, rpt after 30 mins if needed, PLUS
Prednisolone 2mg/kg (max 50mg), single dose OR dexamethasone 0.6mg/kg (max 12mg)
SVT
Valsalva → if fails
6mg IV adenosine (rapidly) → if ineffective, 2nd bolus of 12mg IV → if still ineffective further 18mg bolus → if fails cardiologist
Atrial flutter/AF
Stable = Metoprolol 5mg IV over 5mins, may repeat Unstable = synchronised shock 70J
VT
Conscious = amiodarone 300mg IV over 20mins, then 900mg IV infusion over 24hrs Unstable = sedate with Midazolam 2mg IM/IV, then synchronised shock 150J Unconscious = shock
Bradyarrhythmias
Atropine 500mcg IV (may repeat, max 3mg) +/- external pacing
ACS
300mg oral aspirin
GTN spray/tab 0.4mg 1-2 (may repeat every 5mins to 3 doses)
IV line / cannulate
Transfer immediately to hospital via ambulance
Morphine for pain IV 5mg , rpt after 5-10 mins, titrate to pain
Close monitoring of vital signs- BP, Pulse rate, SaO2
Oxygen ONLY IF sats are low
APO
- Frusemide IV STAT
- High flow O2 if sat low
If not responding to above: GTN spray/tab 1-2 (may repeat every 5mins)
Opioid overdose
Naloxone 400mcg IM/IV (may repeat every 2mins, max 10mg)
Serotonin syndrome
Mild-mod - benzo
If no improvement - cryptoheptadine 12mg PO single dose
Acute dystonic reaction
Benzatropine 1-2mg IV/IM followed with PO if required
Sepsis
Benzylpenicillin 1.2g IM/IV
Meningitis
Ceftriaxone 2g (paeds 50mg/kg) IM/IV OR 2.4g Benpen IM/IV
Cellulitis
Flucloxacillin 500mg QID 5-10 days
Clindamycin 450mg TDS if penicillin allergy
Paeds Analgesia
Paracetamol 15mg/kg 4 hrly to max of 4 doses daily
Ibuprofen 10mg/kg 6 hrly to max 3 doses daily
Stings
Box jelly - vinegar + antivenom
Irukandji - resus
Blue bottle - NO vinegar, hot water instead
Redback spider - analgesia, antivenom rarely used
Funnel web - as per snake bite
Syringe driver
Morphine, metoclopramide, haloperidol, clonazepam, hyoscine butyl bromide
Hayfever
Oral
- loratadine 10mg daily
- montelukast 50mg daily (concurrent asthma)
Intranasal
- azelastine 1mg/mL 1 spray BD
- azelastine + fluticasone 1 spry BD
- ipratropium (rhinorrhoea)
Eyes
- olopatadine 0.1% 1 drop BD
Epiglottitis
Minimal handling, comfort position, defer examination
Ceftriaxone 25mg/kg (1g) IV for 5/7 days
Isotretinoin - ADRs
Teratogen
Need contraceptive
Increased skin sensitivity to UV light
Can cause myalgia and joint stiffness
Cannot take tetracycline ABx (i.e. doxycycline) due to risk of raised intracranial pressure
Acne - non-pharmacological
- Wash face daily only
- Avoid oil-based products
- Avoid hot/humid environment
- Do not pick at pimples
Menopause
Intravaginal
- Estradiol pessary: 10mcg PV nocte for 2 weeks then twice weekly
Cyclical combined (if uterus present) - Mirena IUD + daily oral oestrogen
Non-hormonal
- Escitalopram 10mg mane
- Clonidine 50mg daily
Wernicke’s encephalitis
- Thiamine 300mg IV or IM for 3 days
- Followed by 100mg TDS for 1-2 weeks
- Followed by 100mg daily
