Medicine management Flashcards
HTN
Diabetic anyone: ACEi
- <55ACEi/ARB, >55/black CCB
- ACEi/ARB + CCB (Blacks prefer ARB)
- Thiazide
- more thiazide/spironolactone
HF
- ACEi/BB
- ARB/Furosemide/Spironolactone/Hydralazine + nitrate (black)
- Digoxin
Angina
- Lifestyle: smoking, weight/exercise
- Aspirin, Clopidogrel, Statin, ACEi, BB, CCB/ARB
- Symptoms: GTN spray - Surgery: PCI/CABG
Asthma
- SABA -> ICS appears to be 1st line now, SABA with exacerbations
- ICS
- LRTA antagonist (montelukast)
- LABA (instead of SABA)
- OCS (pred) (CI in paeds)
- Hospital MART (maintanance and reliever therapy)
COPD
SAMA/LAMAntagonists, ICS, theophylline + O2 if bad LAMA used 1st line maintenance SABA used 1st line rescue therapy Adjuncts: mucolytic Diet: high calories
UTI
- Nitrofurantoin/trimethoprim
2. Amoxicillin/cefalexin
Anti-HER2 breast cancer
Trastuzumab
Premeno breast cancer
Oophrectomy + tamoxifen
Postmeno breast cancer
Aromatase inhibitor Anastrozole
Diabetes
- Diet/exercise
- Metformin
- Sulfonylurea (gliclazide)
- Thiazolidinedione/Incretin/SGLT-2 inhibitor/GLP-1 agonist
- Insulin therapy -> can increase dose
Schizophrenia
- Atypical (aripiprazole)
- Add a/typical
- Clozapine
Generalised Anxiety
- SSRI
2. TCA/antipsychotic/benzo/pregabalin
Depression
- SSRI
- SNRI
- TCA/MAOI
C diff
- Vancomycin or metronidazole
- Both
- Faecal donor
RA
- DMARD + prednisolone + NSAID + PPI
Non-pregnant: methotrexate/leflunomide
Pregnant: sulfasalazine/hydroxychloroquine - Biologics
H. pylori
Omeprazole, Amoxicillin/metronidazole, clarithromycin
MS
Acute: methylprednisolone
Ongoing: complicated
GORD
- Lifestyle: weight, alcohol, smoking
- Antacids
- PPI/H2-antagonist
OA
- Lifestyle: weight, smoking, exercise/physio
- NSAIDS + steroids + PPI
- Arthroplasty
Herpes simplex/zoster
Acyclovir
Dementia
- AChEi: donepezil/galantamine/rivastigmine
2. Aspartate/NMDA inhibitor: memantine
Gonorrhoea
100mg IM Ceftriaxone
Chlamydia
Doxycycline BD 7d
Pregnant: Azithromycin
NGU
- Doxycycline 7d, Azithromycin 2d
3. Moxifloxacin 10d
HPV6/11/16/18
Gardasil
PID
- Ceftriaxone + Doxycycline + Metronidazole
Pubic lice
Lyclear permethrin cream + malathion
Delirium
- Underlying disease
- Haloperidol + olanzapine/risperidone
- Benzodiazepine (any withdrawal)
Ischaemic stroke
<4.5h: thrombolytic alteplase + thrombectomy + aspirin 300mg for 2W/clopidogrel + atorvastatin after 48h
>4.5h/thrombolysis contraindicated: Aspirin 300mg + atorvastatin after 48h
AF: warfarin
Secondary prevention:
1. Clopidogrel, atorvastatin, HTN treatment
AF: anticoagulant
Epileptic fit (including monitoring)
Monitoring: ECG + BP
<5mins: 1st aid
>5mins: Rectal diazepam, IV lorazepam, Buccal midazolam
Status epilepticus
20-40mins: Alert anaesthetist + Levetiracetam/s valproate/Phenytoin/fosphenytoin
40-60mins: propofol/midazolam/thiopental
Polymorphonuclear meningitis
including contact prophylaxis
1200mg penicillin/Ig cefotaxime + dexamethosone
Contact: rifampicin
AF (stable, unstable, prophylaxis)
Stable: - Rate 1. BB/CCB (verapamil) 2. Digoxin 3. Digoxin + BB + CCB (diltiazem) -Rhythm: defibrillation HC: amiodarone No HC: sotalol, flecainide, propafenone Unstable: 1. Defib + heparin 2. Defib + amiodarone Prophylaxis: warfarin + dab/riv/apix
Osteoporosis (including vits)
Vitamins (calcium + vit D
- Alendronate
- Denosumab
- Oestrogens/testosterone
- PTH injection?
Ankylosing spondylitis/psoriatic arthritis
- Morning exercise/physio
- NSAIDS + PPI
- Methotrexate
- TNF-alpha
GCA
Prednisolone
- Fugax: IV pred
ICP
- Mannitol
- Sedation (propofol + morphine)
- Cut skull
Cerebral oedema
dexamethosone
Migraines (including preventon)
Paracetamol/NSAIDS/triptans/High dose aspirin/Metocloperamide (antiemetic)
Prevention: topiramate, propranolol, amitryptiline, botox
Cluster
O2 + topiramate/triptan
Trigeminal neuralgia
Carbemazepine
TB chronic meningitis
Pred, rifampicin, isoniazid, pyrazinamide
SAH
nimodipine
Myasthenia gravis
Neostigmine, Pred+ azathioprine, ventilation
Motor neuron disease
Riluzole
Parkinson’s
Co-careldopa (carbidopa, levodopa)
HIV
2NRTIs + 1 other
PEPSE (including days)
Tenovir + Raltegravir 28d
Postural hypotension
Fludrocortisone
Midodrine
Bulaemia
Fluoxetine
Anorexia
Fluoxetine + atypical?
Delirium tremens
Chlordiazepoxide (long acting benzo) + B1 injection
Alcohol relapse prevention
Acamprosate
Disulfiram
Naltrexone
Nasal polyps
- Fluticasone/mometasone spray
2. Surgery
Benzo OD
Flumazenil
Essential tremor
Propranolol/little alcohol
Bipolar disorder 2
Carbamazepine + lamotrigine
Otitis externa
Vinegar + flumetasone/clioquinol/ + suction + NSAIDS/paracetamol
Otitis media (including AB treatment criteria)
paracetamol +NSAIDS +/- amoxicillin
- Amox if really bad or bilateral, or <2Y/O
Cholesteatoma (surgery, no drugs)
Mastoid sac debris removal
Tonsillitis (including course length)
Salt water + pred + 10d ABs
- Amoxicillin/methylpenicillin + pred
- Erythromycin + pred
Wet macular degeneration
Anti-VEGF
Gonococcal conjunctivitis
Penicillin
Non-gonococcal conjunctivitis
Chloramphenicol
Chlamydial conjunctivitis
erythromycin
Viral conjunctivitis
Corneal involvement: steroid eyedrops
Herpes simplex conjunctivitis
Acyclovir
Allergic conjunctivitis
Olopatadine
Darycocystitis
Cefalexin
Blepharitis
Chloramphenicol
Trachoma
Azithromycin
Open angle glaucoma
timolol, latanoprost, acetazolamide
Closed angle glaucoma
pilocarpine + acetazolamide
CRAO
aspirin + acetazolamide
Amaurosis fugax
Aspirin
CRVO
Glaucoma treatment
Hyperprolactinaemia
Dopamine agonist/surgery
Acromegaly
somatostatin/dopamine agonist/surgery
Pruritus eczema
Antihistamine
Eczema
Emolient: creams -> ointments
Corticosteroid: hydrocortisone -> eumovate -> betnovate -> dermovate
Anaemia
- Diet/underlying cause
- Ferrous sulphate
- Ferrous GLuconate
Pernicious anaemia: B12
Acne vulgaris
General: anticomedonal + antikeratolytic + antibiotic
Mild: Adapaline, Benzoyl peroxide, topical erythromycin
Moderate: COC (females) + oral doxycycline/lymecycline
Severe: Isotretinoin (anticomedonal)
Cellulitis (including patient position)
Flucloxacillin/benzylpenicillin + leg raise
Pen allergy: clarithromycin
Impetigo (including MRSA)
- Fusicid cream 3x 7d
- Oral flucloxicillin/erythromycin/clarithromycin
MRSA: mupirocin
Yeast infection
Miconazole
Non-yeast fungal infection (including infection location determining route)
Terbinafine
- Skin: topical
- Widespread/nails: oral
Asthma exacerbation
Status asthmaticus
O2 + salbutamol (SABA) + prednisolone (IV)
- ABs if infection signs
- MgSO4 life-threatening
“ and ipratroprium bromide (SAMA)
COPD exacerbation (including ABs regime + prophylaxis)
O2 + SAMA/SABA + pred + ABs + ventilation + LMWH
Theophylline: if SAMA fails
ABS:
1. Amoxicillin + doxycycline 5d -> doxycycline 4d more
2. Clarithromycin 5d
Doxapram: if no ventilator
Prophylaxis: pneumococcal vaccine + flu jab
Ulcerative colitis/Crohn’s
UC flare suppression: Crohn's Budesonide instead of mesalazine 1. Mesalazine 2. Corticosteroid 3. Azathioprine 4. Infliximab 5. Vedolizumab 6. Colectomy UC maintenance: mesalazine Crohn's maintenance: methotrexate/azathioprine
Hep B (serious)
Tenovir
DVT (including prophylaxis + cancer patients)
Acute:
1. LMWH/UFH (5d) + NOAC (rivaroxaban) (6M)
- Cancer: LMWH/UFH (3M)
Prophylaxis: LMWH/warfarin
PE
DVT + O2 + morphine DVT: Acute: 1. LMWH/UFH (5d) + NOAC (rivaroxaban) (6M) - Cancer: LMWH/UFH (3M) Prophylaxis: LMWH/warfarin - Pregnant prophylaxis: LMWH only Haemodynamic instability: thrombolytic alteplase
Epididymo-orchitis (STI, UTI, dunno)
STI: cef + doxycycline
UTI: trimethoprim/nitrofurantoin
Dunno: ofloxacin
Hyperemesis gravidarum
- Pyridoxine (B6) +/- Doxylamine (antihistamine) + Thiamine (B1)
- Metocloperamide/ondansetron
- Hydrocortisone -> pred when better -> gradual dose decrease
Postnatal depression
Sertraline
Gestational diabetes
- Lifestyle: diet + exercise
- Metformin
- Glibenclamide
- Insulin
Erectile dysfunction
Sildenafil, vacuum, prosthesis
Ectopic pregnancy
Methotrexate
Miscarriage
Misoprostol +/- Anti-D -> maybe vacuum
Minimise PPH from placental delivery
Oxytocin
Uterine atony -> PPH
- Massage
- Oxytocin
- Carboprost
- Misoprostol
Labour induction (Bishop’s score) ARNOP
- Ripen cervix -> prostaglandin pessarie
- INduction: antiprogesterone, relaxin, NO, oxytocin, prostaglandin
Failed ripening: C-section
<34W delivery
OCS + nifedipine + atosiban + MgSO4
PROM
OCS + antibiotics
Female subfertility
Clomiphene/GnRH/Donor/IVF
Menorrhagia
- Minera coil/COC/NSAIDS
- Progesterone (norethisterone)
- Hysterectomy
Endometriosis
Contraception: COC + NSAIDS
Surgery: removal/organ removal
Endometrial hyperplasia
Mirena coil
CO poisoning
High flow O2
Paracetamol OD
Acetylcysteine
Opioids OD
Naloxone + ventilation
Batteries swallowed
Endoscopic removal
Methymoglobulinaemia
O2 + methylene blue
Salicylates OD
electrolyte rebalance (K), urine alkalinisation, haemodialysis
TCA OD
Tachycardia: sodium bicarbonate
Decreased cardiac output/arrhythmia: amiodarone + ventilation
Digoxin OD
Arrhythmia: atropine
Decreased cardiac output: digoxin-fab
Antifreeze (ethylene glycol)
Fomepizole + haemodialysis
Cocaine OD
Cooling + diazepam
HTN: CCB
Angina: GTN
Alcohol
Correct GLU + ventilation
Delayed puberty (boys + girls)
Boys: oxandrolon
Girls: estradiol
Paeds asthma <5y/o
- SABA
- ICS
- LRTA montelukast
Pre-eclampsia prophylaxis (high risk)
Aspirin +/- Ca2+ 12W -> delivery
Pregnancy HTN
Nifedipine/labetalol/methyldopa
Labour convulsion
Lorazepam + CTG
Pre-eclampsia
Nifedipine/labetalol/methyldopa + hydralazine
Severe pre/eclampsia: MgSO4 +/- emergency c-section
Tall stature
sex steroids -> fuse bone plates
Pertussis whooping cough
erythromycin
Abortion prep antibiotics
Metronidazole + Doxy/azithromycin + NSAIDS
Medical abortion
mifepristone + misoprostol
Surgical
<16W vacuum
<24W dilate + evacuate
Morning sickness
Ginger/antiemetic/antihistamine
PCOS
COC/minera coil
Clomiphene
Obesity/diabetic treatment
BD acute mania
Lorazepam, antipsychotic, Li/S. valproate
Bipolar disorder type 1
Lithium, valproate, olanzapine
Allergic reaction
Antihistamine +/- corticosteroid
Anaphylactic shock
500ug adrenaline IM + O2 + antihistamine + corticosteroid
Fluid resus
ABCDE
- 500ml NaCl/15mins
- ABCDE
- 250ml-500ml
- > 2L -> seek help
Diabetes insipidus
Desmopressin
Endocarditis ABs (including prophylaxis)
Acute: Vancomycin +/- gentamicin +/- antifungal
Prophylaxis: amoxicillin
Cystic fibrosis
Tobramycin + Dornase alpha + Creon
High QRISK: (lower cholesterol)
- Atorvastatin
- Try 2 other statins
- Ezetimibe
Acute lower limb infarction (embolus + thrombus)
Embolus: anticoagulation (warfarin/heparin) + percutaneous catheter-directed thrombolysis
Thrombus: antiplatelet (aspirin/clopidogrel) + embolectomy/catheter angioplasty/bypass)
Paediatrics constipation
- Movicol
- Senna + lactulose/docusate
Maintenance: docusate
Bone pain/metastasis
Bisphosphonates
Neuropathic pain
- Amitriptyline (X heart problem)
- Gabapentin (pregabalin if intolerated)
- Amitriptyline + gabapentin
- SPCT referral
Croup
Adrenaline + steroids
Hemochromatosis
Deferoxamine
Pompholyx
Betamethosone + Burow’s solution
Urticaria
Non-sedating antihistamine
Acne rosacea
- Metronidazole
2. Doxycycline/lymecycline
Colocky pain (GI, urinary)
Hycoscine butylbromide
Muscle cramp/spasm pain
Baclofen, benzos
Opioid side effect management
Senna +/- docusate regularly, PRN metoclopramide
Constipation (soft + hard + neurological)
Soft: senna (stimulator)
Hard: docusate (softner)
Neurogenic: docusate -> senna
Metastatic spinal cord compression
dexamethasone + PPI + analgesia
Distress/agitation (Just-in case-meds)
midazolam
Sedation risk/psychosis/delirium (just-in case-meds)
haloperidol
Malignant hypercalcaemia
IV fluid rehydration -> bisphosphonate
Breathlessness (Just-in case-meds)
morphine/midazolam + O2
respiratory secretions (including HF)
HF: furosemide
- Hyoscine butyl/hydrobromide
- Glycopyrronium
Prostate cancer
GnRH agonist goserelin, leuprorelin
Lymphoma
steroids + chemo + radio
Ascites diuretics
- Spironolactone
2. Furosemide
Post-MI (COBRA)
Clopidogrel O? Beta blocker Ramipril Atorvastatin + aspirin
Ectopic beat
Adenosine
Septic arthritis + osteomyelitis
ABs: flucloxacillin + fusidic acid
Renal anaemia
EPO
Reactive arthritis (including chronic)
- NSAIDS
- Cortcosteroids
Chronic: sulfasalazine
Current infection: ABs
Gout (acute and prophylaxis)
- NSAIDS + prednisolone
- Colchicine
Preventative - Allopurinol
- Febuxostat
Carpal tunnel syndrome
Triamcinolone
Fibromyalgia
Pregabalin/duloxetine/ibuprofen
Breakthrough pain
1/6 dose oromorph (max dose 6 times/day)
Frozen shoulder
NSAIDS + steroid injection + local anaesthetic
Vasculitis/connective tissue disease (induction, maintenance + end-organ failure)
Induction remission: Prednisolone + PPI
Maintenance therapy: methotrexate
End-organ failure: cyclophosphamide
HSP (self-limiting unless glomerulonephritis)
- Glomerulonephritis management is same as vasculitis :)
WOOO
BPH
- Lifestyle + monitor
- Tamsulosin/Finasteride/Sildenafil
- Doxazosin + Finasteride
- Surgery
Bad prostate cancer
Bicalutamide + goserelin
Renal stones (including prophylaxis and UTI from stones)
Tamsulosin
Prophylaxis: water + potassium citrate
UTI: gentamicin
Postnatal depression
Sertraline
Post-partum psychosis
Olanzepine +/- lorazepam
HRT (womb and wombless)
Womb: progesterone + oestrogen
No womb: oestrogen
Hot flush menopause
Paroxetine (SSRI)
Fibroid (wants/doesn’t want pregnancy)
Wants: COC/minera -> shrinks fibroid
Doesn’t want: hysterectomy/polyp removal
Stillbirth
prostaglandins/misoprostol
Bacterial sinusitis in immunocompromised
co-amoxiclav
Bad sinusitis
Decongestants + corticosteroid spray
Vertigo
prochlorperazine
Fibroadenosis
Evening primrose, bromocriptine, tamoxifen
Mastitis
Flucloxacillin
Gynaecomastia
Danazol/clomiphene/tamoxifen/surgical
Gall stones -> acute cholecystitis (1 drug, 2 surgical options)
Hycoscine, shockwaves, cholecystectomy
Acute cholangitis
IV antibiotics
Acute pancreatitis
Resus, NG tube/nil-by-mouth, sepsis 6, surgery
Cholangiocarcinoma
Palliative
Cirrhosis ascites diuretic
Spironolactone
Hepatic encephalopathy
Lactulose + rifaximin -> liver transplant
Acute abdominal pain
Fluids + analgesia + underlying cause
Acute GI bleed
including something to help endoscopy visualisation
ABCDE + NG tube + fluids/O2/coagulation
- Metoclopramide (prokinetic)
Acute GI bleed clotting management
prothrombin complex (1972)
Oesophageal varices bleed
ceftriaxone, terlipressin, ligation/surgery
Achalasia
nifedipine/nitrates
Oesophageal stricture
PPI + endoscopic dilation + surgery
Chronic pancreatitis
Creon + omeprazole
CAP (1/6, 2/6, 3/6, s. aureus)
- 1/6: outpatient treatment -> amoxicillin 5d (pen allergic -> doxy)
- 2/6: hospital admission -> amoxicillin + clarithromycin (all 5d)
- 3/6: severe -> ITU (co-amoxiclav + clarithromycin)
Staph aureus: fluclox IV
HAP (non/severe + MRSA)
- 1/6: co-amoxiclav
- 3/6: piperacillin/tazobactam
- MRSA: vancomycin
Aspiration pneumonia/Mendelson’s syndrome
Metronidazole
TB
Latent: isoniazid
Active: see chronic TB meningitis
Pulmonary HTN
CCB + warfarin + furosemide
IBS (general + C+ D + M)
IBS: Fibre + decrease stress, caffeine, lactose, fructose
- C: ispaghula + citalopram + hyoscine
- D: loperamide
- M: both prescribed
Coeliac
gluten free + vit supplements + pneumococcal vaccine
Whipple’s disease
ceftriaxone
Bacterial overgrowth
Rifaximin
Diverticulitis
High fibre, hydration, co-amoxiclav
Severe dehydration
IV Ringer’s lactate solution rapid infusion
Anal fissure
laxatives + GTN ointment
Haemorrhoids
ligation/sclerotherapy/electrotherapy
External - surgery
Ascites
spironolactone, restriction (Na + H2O), drainage, ciprofloxacin
Infected eczema
Treat as cellulitis (flucloxacillin)
Shingles pain (including post-herpatic neuralgia)
amitriptyline/pregabalin -> carbamazepine
Paronychia
Mupirocin
Hyperkalaemia
- Ca2+ 2. Insulin 3. Glucose
Pregnancy herpes
Acyclovir last 6W gestation + elective C-section
Sciatica
6W physio + normal activity -> unresolved -> MRI -> steroid injection + neuro pain management
Scarlet fever
penicillin
Pain control on MAX breakthrough
30% increase regular morphine
Bronchoscopy
midazolam + lidocaine + atropine
Smoking cessation (lifestyle + meds)
Lifestyle: self-help, group support, smoking clinic, behavioural therapy
Meds: nicotine, bupropion, varenicline
Flu (general, ABs criteria, at-risk prophylaxis)
General: flu jab, paracetamol, rest, fluids
ABs: chronic bronchitis, heart/renal disease
At risk prophylaxis: oseltamivir (Tamiflu)
Acute bronchitis (incl. asthmatics)
Self-limiting
Asthmatics (SABA)
OSA (lifestyle + intervention)
Lifestyle: weight loss, alcohol, driving
Intervention: CPAP
Bronchiectasis
Sputum physio + ABs + SABA/SAMA + ICS/OCS + flu/pneumococcal vaccine
Pneumothorax
- Air needle aspiration
- Intercostal tube drain
- Surgery