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Treatments 1 Flashcards

1
Q

Bacterial meningitis <1 month

A

Ampicillin (Listeria) + cefotaxime/gentamicin (E. coli, GBS)

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2
Q

Bacterial meningitis (1 month-60 yrs)

A

Cefotaxime/Ceftriaxone (S. pneumo, N. meningitidis), Vancomycin (MRSA), Dexamethasone

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3
Q

Bacterial meningitis > 60 yrs

A

Ampicillin (Listeria), Cefotaxime/Ceftriaxone (S. pneumo, N. meningitidis), Vancomycin (MRSA), Dexamethasone

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4
Q

Prophylaxis, meningococcal/HiB meningitis

A

Rifampin or Ciprofloxican

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5
Q

Fungal meningitis

A

Amphotericin B intrathecally

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6
Q

TB active infection (meningitis, pulmonary)

A

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

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7
Q

Viral meningitis

A

Supportive, empiric abx until bacterial meningitis excluded, Acyclovir if suspected HSV

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8
Q

Reye syndrome

A

Supportive

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9
Q

Viral encephalitis

A

Supportive, maintain normal ICP, Acyclovir until HSV r/o

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10
Q

Brain abscess empiric abx for comorbid oral, sinus, ear infx

A

Metronidazole + 3rd gen ceph (ceftriaxone)

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11
Q

Brain abscess empiric abx for hematologous spread, neurosurgery

A

Ceftriaxone + vancomycin (MRSA)

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12
Q

Brain abscess

A

Empiric abx, corticosteroids for mass effect (to decrease swelling), usu need neurosurgical drainage

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13
Q

Rabies

A

Clean wound thoroughly, Rabies IG + vaccine

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14
Q

Tension HA

A

NSAIDs, can use triptans, dihydroergotamine

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15
Q

Cluster HA

A

100% O2 (>6 L/min on non-rebreather for >15-20 min)

Can use triptans, dihydroergotamine

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16
Q

Migraine HA

A

Triptans (sumatriptan) or Dihydroergotamine (vasoconstrictors), NSAIDs, anti-emetics (chlorpromazine, prochlorperazine, metoclopramide) in varying combos

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17
Q

Pseudotumor cerebri

A

Acetazolamide (first line, start low and increase)
Discontinue inciting agents (vit A, Accutane, long term tetracyclines for acne, corticosteroid withdrawal), weight loss if obese
Invasive - serial LPs, optic nerve sheath decompression, lumboperitoneal shunting

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18
Q

Trigeminal neuralgia

A

Carbamazepine (first line), Baclofen (alone or combo), Anticonvulsants, Surgical decompression

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19
Q

First TIA

A

ASA + statin if LDL >100

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20
Q

TIA/stroke due to AF

A

Warfarin + statin if LDL >100

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21
Q

TIA/stroke + CAD

A

Clopidogrel + statin if LDL >100

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22
Q

Repeat TIA/stroke while on ASA

A

Clopidogrel or Aggrenox + statin if LDL >100

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23
Q

CAD surgical indications

A

Carotid endarterectomy:
Symptomatic patients w/ narrowing 70-99%
Symptomatic men w/ narrowing 50-69%
Asymptomatic patients w/ narrowing 80-99% if life expectancy >5 yrs

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24
Q

CAD nonsurgical treatments

A

HTN 35, TG <7%

Smoking cessation, exercise, red wine (avoid heavy drinking), ASA/Aggrenox/Clopidogrel

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25
Q

Ischemic stroke

A

Thrombolysis w/i 3-4.5 hrs, 6 hrs if direct catheter to brain and no C/I (hemorrhagic - look at CT/MRI, recent surgery/bleed, current AC, BP >185/100)
Antiplatelet started w/i 48 hrs (ASA/Clopidogrel/Aggrenox, Warfarin)
Statin started w/i 3 days
BP control if >220/120 or if CAD (wait for BP control in ischemic, may decrease perfusion)
PT, treat underlying disorders

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26
Q

Hemorrhagic stroke

A 
Reverse AC (restart 2 wks after stable)
Control BP
Control ICP
Surgical decompression w/ shunt if blood collection
Usu need neurosurgery consult
PT, treat underlying disorders
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27
Q

Control increased ICP

A

Mannitol (lasts 4-5 hrs)
Hyperventilation
Anesthesia
Head of bed to 30 degrees

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28
Q

Parenchymal hemorrhage

A

Supportive, control ICP
Seizure prophylaxis w/ anticonvulsants
Surgical decompression if large
AVM or aneurysm repair if needed

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29
Q

SAH

A

Reverse and d/c AC
Systolic BP <150 if cognitive fxn intact (Labetalol, avoid nitroprusside and nitroglycerine - can +ICP)
Nimodipine (CCB) to prevent vasospasm
Good brain environment (avoid hypoxia, hypoglycemia; maintain normal pH, euvolemia, normothermia)
Ventriculostomy to monitor ICP in some patients
Surgical clipping/coiling if aneurysm

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30
Q

Epidural hematoma

A 
Control ICP, good brain environment
Drain blood (surgical burr hole, drain w/ radiographic guidance)
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31
Q

Subdural hematoma

A

Supportive monitoring if no neural deficits

Surgical drainage if needed

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32
Q

Normal pressure hydrocephalus

A

Ventricoperitoneal shunt

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33
Q

Grand-mal (tonic-clonic) seizures

A

Valproate, Carbamazepine, Phenytoin, Lamotrigine, Topiramate

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34
Q

Partial seizures

A

Carbamazepine, Lamotrigine, Phenytoin > Valproate, Topiramate

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35
Q

Absence seizures

A

Ethosuximide (Valproate second line)

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36
Q

Myoclonic seizures

A

Valproate

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37
Q

Non-medical treatment for recurrent seizures

A

Surgery (especially partial)

Vagal nerve stimulator (refractory)

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38
Q

Status epilepticus

A 
ABC
IV benzos immediately
Phenytoin to prevent recurrence
Phenobarbital for refractory (last resort)
Treat underlying disorder
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39
Q

Eclampsia - seizures

A

IV magnesium sulfate (first line)
Deliver baby
Benzos (last resort)

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40
Q

Depression

A

SSRI/SNRI (first line)
TCA (second line)
MAOI (third line)
ECT (refractory, psychotic, can’t wait, catatonic stupor)

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41
Q

Atypical depression

A

MAOI > TCA (SSRI also work)

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42
Q

Depression w/ seasonal pattern

A

Phototherapy (first line)

SSRI/Bupropion (second line)

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43
Q

Serotonin syndrome

A

D/c serotonergic agents
Supportive care
Sedation w/ benzos (or cyproheptadine, serotonin antagonist if refractory)
Sedation, paralysis and ET tube for temp >41.1

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44
Q

NMS

A

Dantrolene

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45
Q

Nephrogenic DI caused by lithium toxicity

A

HCTZ + amiloride (closes Na channels in CT where lithium acts)

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46
Q

Bipolar disorder

A

Mood stabilizer (first line)
Atypical antipsychotic (first/second line)
AD (not first line)
ECT

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47
Q

Cyclothymia

A

Mood stabilizer

Psychotherapy

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48
Q

Anxiety disorders (in general)

A

SSRI/SNRI (first line)
TCA (much less), MAOI (rarely)
Buspirone
Benzos

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49
Q

GAD

A

SSRI/SNRI (Venlafaxine)
Buspirone
Beta blocker
CBT

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50
Q

Panic disorder

A

CBT
SSRI
Benzo (acute)
Relaxation training

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51
Q

Specific phobia

A

Systematic desensitization

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52
Q

Social anxiety disorder

A 
CBT
Beta blockers
SSRI (severe)
MAOI (refractory)
Benzo (acute)
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53
Q

PTSD

A

Psychotherapy (behavioral/exposure, CBT)
SSRI (first line med)
TCA/MAOI
Mood stabilizers (carbamazepine/valproate) for impulsive behavior, arousal, flashbacks
Alpha-blockers (prazosin) for nightmares/sleep problems
Atypical antipsychotics (refractory)

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54
Q

Benzodiazepine OD

A

Flumazenil

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55
Q

Schizophrenia

A

Atypical antipsychotics (first line), Typical antipsychotics (second line), Clonazapine (third line)

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56
Q

Acute dystonia (typical AP side effect)

A

Anticholinergic (benztropine or diphenhydramine)

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57
Q

Tardive dyskinesia

A

Stop offending medication and start one with less movement AE

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58
Q

Parkinson’s

A 
1st line: Levodopa-Carbidopa (Sinemet)
2nd line: DA agonists (bromocriptine, etc.)
Selegiline (MAOI), early disease
COMT inhibitors (potentiate LD)
Anticholinergics (tremor)
Amantadine (increases DA release)
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59
Q

ALS

A

Riluzole

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60
Q

Huntington disease

A

DA antagonists (antipsychotics, tetrabenazine)

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61
Q

Alzheimer’s disease

A

Donepezil, Rivastigmine, Galantamine (ACHase inhibitors)

Memantine (MNDA receptor blocker)

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62
Q

MS

A

Corticosteroids (very high dose; acute attacks), IFN-B (maintenance)
Methotrexate, Glatiramer (maintenance), Natalizumab

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63
Q

Syringomyelia

A

Surgical decompression, shunting for recurrence

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64
Q

Nephrogenic DI

A

HCTZ

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65
Q

Benign essential tremor

A 
Beta blockers (propranolol)
Self medicated w/ alcohol
Benzodiazepines
Primidone
Thalamotomy/DBS (refractory)
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66
Q

Chorea

A

Treat underlying disorder (hyperthyroidism, Huntington, SLE, rheumatic fever, levodopa use)

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67
Q

Athetosis

A

Treat underlying disorder (cerebral palsy, encephalopathy, Huntington, Wilson)

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68
Q

Dystonia

A

Levodopa/Carbidopa
Botulinum toxin
Treat underlying disorder

69
Q

Hemiballismus

A

Haloperidol

70
Q

Tics

A

DA antagonist (fluphenazine, pimozide, tetrabenazine)

71
Q

Guillain-Barre syndrome

A 
Supportive care (monitor for respiratory distress)
Plasmapheresis/IVIG
NO steroids
72
Q

Lambert-Eaton

A

Treat cancer
ACHase inhibitors (neostigmine, pyridostigmine)
Immunosuppressors (prednisone, azathioprine)
Plasmapheresis

73
Q

Myasthenia Gravis

A

ACHase inhibitors (neostigmine, pyridostigmine)
Immunosuppressors (prednisone, azathioprine)
Thymectomy
Plasmapheresis, IVIG (refractory)

74
Q

Bell’s palsy

A

Eye care to prevent corneal damage
Glucocorticoids
+/- Valacyclovir

75
Q

Enuresis

A

Benzos (not in kids) (decrease N3 sleep)

76
Q

Night terrors

A

Benzos (decrease N3 sleep)

77
Q

Narcolepsy

A

Modafinil (stimulant) - first line; other ADHD stimulants
Venlafaxine, fluoxetine, atomoxetine - for cataplexy
Avoid drugs that cause sleepiness
Scheduled naps
Support group

78
Q

Insomnia

A 
Melatonin (OTC)
Valerian (OTC)
Antihistamines
Trazodone
TCAs
Benzodiazepines (short term)
Zolpidem/Zaleplon (short term)
Eszopiclone (long term)
Ramelteon (non-addictive)
79
Q

Restless leg syndrome

A

Avoid caffeine, increase exercise
Pramipexole or ropinirole (DA agonists) or Levodopa, Carbidopa
Iron replacement
Clonazepam, Gabapentin, Opioids

80
Q

Empiric therapy in ER w/ LOC

A

Glucose (with thiamine first)

Naloxone (opioid OD)

81
Q

Febrile seizures

A

Acetaminophen/Ibuprofen
Respiratory support if needed
Parental reassurance

82
Q

Childhood hydrocephalus

A

Acetazolamide or furosemide

Surgical shunting

83
Q

Tay Sach’s

A 
Supportive care (death within a few years)
Genetic counseling
84
Q

NTD

A

Surgical repair unless mild, shunting, PT

85
Q

CP

A

For spasms: botulinum toxin, dantrolene, baclofen, benzos; PT, bracing, shunting, surgery
Speech therapy, special education, social and psychological support

86
Q

Retinoblastoma

A

Enucleation (large tumors w/ no vision potential)
Radiation (b/l tumors, tumors near optic nerve)
Cryotherapy or laser photocoagulation (smaller tumors)
Chemotherapy (mets or vision salvage)

87
Q

Myopia

A

Corrective lenses, laser correction

88
Q

Hyperopia

A

Corrective lenses, laser correction

89
Q

Astigmatism

A

Corrective lenses

90
Q

Strabismus

A

Vision training, surgery frequently required

91
Q

Amblyopia

A

Vision training, levodopa/carbidopa

92
Q

Conjunctivitis

A

Self-limited
Topical sulfonamides or erythromycin reduce duration of bacterial
Antihistamines improve allergy symptoms
handwashing

93
Q

Uveitis

A

Topical antibiotics if caused by infection

Systemic corticosteroids if not (treat underlying condition)

94
Q

Chalazion

A

Usu self-limiting

Can treat w/ surgical excision and/or steroid injection

95
Q

Hordeolum (stye)

A

Hot compress 3-4x/day for 10-15 min
I&D if unresolved in 48 hrs
+/- antibiotic ointment q3 hrs

96
Q

Anterior blepharitis

A

Wash lid margins daily w/ shampoo
Remove scales daily w/ cotton ball
Antibiotic ointment qd to lid margins

97
Q

Cataracts

A

Lens replacement surgery

98
Q

Open angle glaucoma

A

Topical BB (timolol) and carbonic anhydrase inhibitors (acetazolamide)
Prostaglandin analogues
Alpha-adrenergic agonists and cholinergic agonists (pilocarpine)

99
Q

Acute open or closed angle glaucoma

A

Pilocarpine (cholinergic agonist) = DOC

100
Q

Closed angle glaucoma

A

Eye drops (BB, adrenergic agonists, cholinergic agonists, prostaglandin analogues)
Acetazolamide (oral)
Mannitol (IV) (refractory)
Laser peripheral iridotomy

101
Q

Macular degeneration

A

Vitamin C, E, B-carotene, copper, zinc
Intravitreal ranibizumab (VEGF inhibitor) (exudative)
Laser photocoagulation
Treatment effectiveness limited

102
Q

Retinal detachment

A

Laser photocoagulation or cryotherapy (halt progression)

Surgical reattachment of retina

103
Q

Retinal artery occlusion

A

Thrombolysis w/i 8 hours of onset

Acetazolamide and O2 to decrease congestion and increase perfusion

104
Q

Retinal vein occlusion

A

Laser photocoagulation

105
Q

Corneal abrasion

A

Thorough eye exam w/ foreign body removal by irrigation
Topical antibiotics (erythromycin, sulfacetamide, cipro, oflaxacin)
OTC lubricant
Pressure patching optional 3 mm, diminished vision

106
Q

Preeclampsia

1) HTN emergency
2) Uncomplicated HTN

A

1) IV Labetalol or Hydralazine (nifedipine second line) followed by Magnesium Sulfate when HTN controlled
2) Labetalol, Nifedipine, Methyldopa (less efficacious), Furosemide (second line)

107
Q

Active TB

A

Rifampin, Isoniazide (INH), Pyrazinamide, Ethambutol

108
Q

Optic neuritis

A 
Think MS (esp in young female)
High dose steroids (500-1000 mg/day) for several days
109
Q

Acute otitis media

A

May just observe (mild disease)
Amoxicillin x 10 days
Amoxicillin-clavulanic acid or stronger cephalosporin (cefdinir) for resistant strians
Tympanic tubes for recurrence

110
Q

Otitis externa (“swimmer’s ear”)

A

Topical polymyxin, neomycin, fluoroquinolone (cipro), hydrocortisone
Oral cephalosporin or cipro for Pseudomonas or infx that spreads to skull
Topical drying agents after water to prevent recurrence

111
Q

BPPV

A

Epley maneuver

112
Q

Meniere disease

A 
Anticholinergics, antiemetics, antihistamines
Salt restriction and thiazide diuretics
Surgical decompression (refractory)
113
Q

Acoustic neuroma

A

Surgical excision

114
Q

Bullous myringitis

A 
Mycoplasma pneumoniae is common organism
Oral macrolide (erythromycin, clarithromycin, azithromycin)
115
Q

Acute vestibular neuritis / labyrinthitis

A

Usu subsides spontaneously w/i weeks
Corticosteroid taper
Treat symptoms for first 48 hrs only (scopolamine patch, meclizine, metoclopramide, promethazine)
Vestibular rehabilitation exercises

116
Q

Cholesteatoma

A

Surgical removal

117
Q

Ramsay Hunt syndrome (herpes zoster oticus)

A

Valacyclovir, famciclovir or acyclovir

118
Q

Personality disorders

A

Mostly psychotheraphy
Cluster A - sometimes low-dose antipsychotics (paranoid, schizoid, schizotypal)
Borderline - low-dose antipsychotics, SSRIs, mood stabilizers

119
Q

Delirium tremens (DTs)

A

Benzodiazepines (long acting)

Lorazepam, Diazepam, Chlordiazepoxide

120
Q

Alcoholism treatment

A

AA
Naltrexone, disulfiram
Topiramate, acamprosate

121
Q

Wernicke-Korsakoff

A

IV thiamine

122
Q

Cocaine OD

A

Benzodiazepine, antipsychotic

Phentolamine for HTN (alpha antagonist)

123
Q

Amphetamine OD

A

Benzodiazepine, antipsychotic

Phentolamine for HTN (alpha antagonist)

124
Q

Hallucinogen OD

A

Isolation, benzos, antipsychotics

125
Q

Marijuana abuse

A

Counseling

126
Q

Nicotine abuse

A

Patch, gum, lozenge
Varenicline
Bupropion

127
Q

Opioid OD

A

Naloxone, Naltrexone

Methadone therapy

128
Q

PCP OD

A

Isolation, benzos, antipsychotics

129
Q

OCD

A

CBT + SSRI

130
Q

Anorexia

A

Psychotherapy
May need inpatient treatment
SSRIs don’t help unless associated depression
Anxiolytic before meals

131
Q

Bulimia

A

SSRI + psychotherapy

132
Q

ADHD

A

Psychostimulants (methylphenidate, dextroamphetamine)
Atomoxetine
Refractory: Bupropion, alpha agonists (Clonidine), TCAs

133
Q

Tourette’s

A 
Psychotherapy
*DA antagonists low-dose for tics (fluphenazine, pimozide, tetrabenazine)
SSRI for comorbid behavior disorders
Botox for focal motor or vocal tics
Clonidine/SSRI for impulse control
134
Q

DM Type I

135
Q

DM Type II

A

Oral hypoglycemic agents, possibly insulin

136
Q

DKA/HHNS

A

Admit to ICU
IVF (isotonic)
IV insulin (switch to SC when anion gap closes in DKA; when blood sugar lowers may give IV glucose)
IV KCl (in DKA acidosis drives K out of cells, insulin drives K into cells)
Electrolyte correction
Treat underlying disorder

137
Q

Diabetic retinopathy

A

Control diabetes
HTN therapy
Annual ophthalmology visit
Laser photocoagulation (neovascularization)
Intervitreal corticosteroid injection to reduce macular edema

138
Q

Diabetic nephropathy

A

Control diabetes
ACE/ARB (esp if microalbuminuria)
Dialysis may eventually be needed

139
Q

Diabetic neuropathy (sensory)

A

Control diabetes
Gabapentin, Pregabalin, Duloxetine
(TCAs, phenytoin, carbamazepine
Narcotics or Tramadol for persistent pain)

140
Q

Diabetic neuropathy (gastroparesis)

A

Dx w/ gastric emptying study

Short term metoclopromide or erythromycin

141
Q

Diabetic atherosclerosis

A 
Control diabetes
Control HTN and hyperlipidemia
Statin
ASA
Smoking cessation
142
Q

Graves disease

A

Definitive: radioablation w/ radioactive iodine (MC) or
subtotal thyroidectomy (surgery)
Methimazole / PTU to stop thyroid hormone production
BB for symptomatic relief

143
Q

Toxic adenoma / Toxic MNG

A

Radioablation
Surgical resection
Methimazole / PTU (less often in MNG)

144
Q

Subacute thyroiditis

A

Self-limited
NSAIDs/BB for symptoms
May need thyroid replacement if hypothyroid during gland recovery

145
Q

Silent thyroiditis

A

During pregnancy
Self-limited
NSAIDs/BB for symptoms

146
Q

Thyroid storm

A

ICU monitoring
Methimazole / PTU (higher doses / more frequent)
Beta blockers
IV sodium iodine (helps block thyroid hormone release)
Hydrocortisone (inhibits conversion of T4 to T3)

147
Q

Thyroid cancer (malignant)

A

Surgical resection + radioiodine ablation
Radiation (local extension)
Chemotherapy (metastases)
Thyroid replacement after surgery

148
Q

Hypothyroidism

A

Levothyroxine

149
Q

Cretinism

A

Levothyroxine ASAP (from birth)

150
Q

Primary hyperparathyroidism

A 
Surgical resection (single adenoma)
Surgical resection and replacement of one gland into forearm (four-gland hyperplasia)
IVF and bisphosphonates (hypercalcemia)
151
Q

Hypercalcemia

A

IVF (first line)
Loop diuretics (furosemide) (2nd line)
Bisphosphonates

152
Q

Hyperparathyroidism due to CRD

A

Hypophosphatemia
Dietary phosphate restriction
Oral phosphate binders (Ca carbonate and acetate)
Renal osteodystrophy
Calcitriol, other vitamin D analog, cinacalcet (Ca mimetic) to suppress PTH

153
Q

Hypoparathyroidism

A

Ca and vitamin D supplementation

154
Q

Pseudohypoparathyroidism

A

Ca and vitamin D supplementation

155
Q

Hyperprolactinemia

A 
DA agonists (cabergoline>bromocriptine, pergolide)
Transsphenoidal surgery, radiation therapy if refractive
156
Q

Acromegaly

A

Surgical resection of adenoma
Cabergoline or Octreotide to lessen effects
Radiation therapy if refractory

157
Q

Hypopituitarism - GH deficiency

A

Recombinant GH

158
Q

Hypopituitarism - LH/FSH deficiency

A

Testosterone (men)
Estrogen-progesterone (women)
Luprolide (GNRH agonist) for people desiring fertility

159
Q

Hypopituitarism - TSH deficiency

A

Levothyroxine

160
Q

Hypopituitarism - Prolactin deficiency

A

No need to treat

161
Q

Hypopituitarism - ACTH deficiency

A

Hydrocortisone, Dexamethasone, Prednisone

162
Q

Cushing syndrome

A 
Adjust steroid dosage
Surgical resection/irradiation (pituitary tumor)
Surgical resection (adrenal tumor)
Chemo/radiation + octreotide (SCLC)
Cortisol replacement after surgery
163
Q

SCLC

A

Chemo and radiation (non-resectable)

164
Q

Hyperaldosteronism (Conn syndrome)

A

Surgical resection of otumor
Treat underlying disorder
Aldosterone antagonists (spironolactone) to improve hypokalemia until definitive therapy

165
Q

Adrenal insufficiency

A

Treat underlying disease
Glucocorticoid and mineralocorticoid replacement
DHEA in women (maybe)
Hydration

166
Q

Addison / adrenal crisis

A

IV glucose
Hydrocortisone
Vasopressors

167
Q

Pheochromocytoma

A

Alpha blockers FIRST then BB

Surgical resection

168
Q

Addison’s disease

A

Replace glucocorticoids and mineralocorticoids

Step 2 DIT 😱 (23 decks)

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