treatments Flashcards
1
Q
trx for Tourettes
A
- habit reversal
- training anti-D2 = tetrabenazine (VMAT-2 inhibitor depletes),
- second gen antipsychotics= risperidone, aripriprazole (block)
second line- guanfacine, clonidine
2
Q
empiric treatment for UTI in v small kids
trx pyelonephritis
A
tmp-smx or nitrofurantoin
IV ceftriaxone 14 days OR amp+gent
3
Q
chlamydia (URI, STD, acute cervicitis)
A
doxycycline
azithromycin in preg
4
Q
UTI secondary to indwelling catheter (+ the MC bug)
A
ciprofloxacin for Pseudomonas coverage
5
Q
staph aureus including MRSA
A
clindamycin
6
Q
acute bacterial rhinosinusitis
A
amoxicillin + clavulanate
7
Q
medical trx for crohn
A
medical management
- TNF alpha inhibitors (infliximab)
- immunomodulators (azothioprine, 6-mercaptopurine
severe= surgery = partial bowel resection
8
Q
c. diff treatment what abx can be given to prevent c.diff from happening
A
trx : ORAL vancomycin (iv will bypass colon, pointless) if severe, fulminate - oral vanco + IV metronidazole trx w piperacillin + tazobactam prevents C diff from colonizing
9
Q
nocturnal enuresis
A
desmopressin
10
Q
empiric trx for aspiration pneumonia/ lung abscess
A
STRONG Anaerobic coverage
- -amoxicillin-clavulanate
- -ampicillin-sulbactam,
- -clindamycin + azithromycin
- -imipenem (carbapenems have strong anaerobic activity)
11
Q
path that clindamycin is used for
A
staph (including MRSA) strep bacteroides fusobacterium
12
Q
ascites
A
furosemide + spironolactone (K sparing)
13
Q
first line alternative to stimulants for ADHD
A
strattera = atomexatine
14
Q
premature ejaculation
A
SSRIs, topical lidocaine, psychotherapy / couple’s therapy
15
Q
chronic cough following a URI
A
upper respiratory cough syndrome (i.e. post nasal drip) antihistamines= chlorpheniramine, pseudoephedrine
16
Q
chronic rhinitis
A
intranasal glucocorticoids
17
Q
best agents for treating psychotic sx in Parkinsons
A
antipsychotics w low D antagonism =quetiapine, clozapine, pimavanserin
18
Q
meds to add to carbidopa/levidopa w worsening PD sx
A
pramiprexole, ropinorole
19
Q
acute gout flare-ups
A
first line = naproxen + indomethacin
IF PT IS ON ANTICOAG (ASA, clopidogrel, apixaban) = colchicine
- inhibitor of microtubule formation (from beta tubulin)
- AE= nausea, abd pain, diarrhea
- CONTRA in the elderly and those w severe renal dysfunction
- would consider glucocorticoids, as long as no complicated DM
20
Q
first line and alt trx for chronic stable angina how does each med help angina? acute angina daily meds to prevent attacks
A
ACUTE:
- 1st= nitrates ( dec preload, vasodilate)
DAILY: -
- 1st= beta blocker = dec contractility + HR -2nd=
- 2nd= ND CCBs = verapamil, diltiazem (dec contract +HR)
- 3rd= DP CCBs= nifedipine, etc = dec afterload, systemic vasodilation
- anti-angina=ranolazine (dec Ca influx into myocardium)
21
Q
babesiosis
A
azithromycin + atovaquone
22
Q
treatments for mania which drug is best for acute psychotic episode
A
mania
- -antipsychotics: clozapine (require CBCs), olanzapine, mirtazapine,
- -adjunctive benzo if needed ACUTE PSYCHOTIC EPISODE
- = olanzapine -quick onset, can be given IM
23
Q
trx for suspected snake bites
A
only given to people w severe sx (neuro, skin, CV) that is progressing (continued oozing) i.e hypotension
- antivenom = crotalidae polyvalant immune Fab and (for rattlesnake spec)= crotalidae immune F(ab’)
24
Q
primary biliary cholangitis
A
ursodeoxycholic acid
- replaced hydrophobic bile salts with hydrophilic bile salts
25
acute cellular rejection of transplant organ
high dose corticosteroids (occurs w/in 3 months)
26
first line treatment for panic attacks (panic disorder)
long term
* **SSRIs/SNRIs + CBT**
* **snri=** duloxetine, venlafaxine
acute panic attack (i.e. in ED)/ waiting for SSRI to kick in=
* **_benzos (lorazepam)_**
* (NOT beta blockers like propranolol - sometimes used for performance anxiety but not even really)
27
what kind of anxiety is buspirone used for
generalized anxiety disorder (not for panic attacks/ panic disorder)
28
enteromibus vermicularis = pinworm (2 possible drugs)
( + scotch tape test ) -albendazole OR pyrantel pamoate -treat all household contacts bc v contagious
29
trx of QRS duration \> 100 msec -to avoid what complications
IV sodium bicarbonate to dec risk of ventricular arrhythmia (PVCs)
30
myasthenia gravis
pyridostigmine + immunotherapy (steroids, azathioprine) -thymectomy
31
first line trx for ADHD clinical presentation -6+ -4-5 yo (preschool)
-6+ = methylphenidate -\<6= behavioral therapy, i.e.parent-child (effective behavior strategies and how to stay calm)
32
cyanide poisoning
sodium thiosulfate hydroxocobalamin
33
medical trx for mild-mod heavy menstrual bleeding possible AE?
intranasal desmopressin (inc release of vWF) -associated with SIADH (is an ADH analog) so watch out for hypotonic hyponatremia (acute N, fatigue)
34
ankylosing spondylitis first line and refractory
1st= NSAIDs (ibuprofen, naproxen) or COX-2 inhibitors (celecoxib) 2nd= TNFa-I (infliximab, etanercept) or anti-IL17 Ab (secukinumab)
35
impetigo trx \*possible complication?\*
local = topical mupirocin
extensive = oral cephalexin \*complications = post-strep glomerulonephritis
36
disease modifying agents for MS acute MS exacerbation
- interferon-beta and glatiramer -glucocorticoids for acute
37
meconium aspiration syndrome/ neonatal pneumonia
nitric oxide (pulmonary vasodilator)
ampicillin + gentamicin
38
idiopathic pulmonary fibrosis
antifibrotic therapy = perfenidone, nintedanib smoking cessation, possible lung transplant, O2 and pulmonary rehab avg survival = 2-3 years
39
ALS
riluzole (inc survival) can add edaravone (slow progress) +support + palliative
40
the cognitive impairment associated with Parkinson Ds vs treatment of Parkinson Disease Dementia (PDD)
anticholinesterase = donepezil
* dec PD agents
* OR add low potency anti-psychotic (pimavanserin, quetiapine)
41
neuroleptic malignant syndrome
-stop antipyschotic // restart dopamine agent + support -refractory = dantrolene or bromocriptine
42
epidural hematoma
(lens shaped "biconvex" bleed) -symptomatic= emergent neurosurg for surgical evac
43
elevated intracranial pressure
IV mannitol
44
wernicke encephalopathy
IV Vit B1 (thiamine) + IV glucose
45
acute infective endocarditis
empiric IV vancomycin
46
mucormycosis
surgical debridement + amphotericin B (HALL: palatal/orbit necrosis)
47
small intestine bacterial overload
rifamixin (abx for traveler's diarrhea or hapetic encephalopathy)
2nd line= amoxicillin/clavulanate
+metoclopramide to inc motility
48
alcohol use disorder
naltrexone acamprosate (a glutamate modulator) --\> these will decrease the cravings in someone who wants to quit but hasn't
49
secratory diarrhea
(watery diarrhea even after periods of fasting aka nocturnal) =loperamide = diphenoxylate-atropine
50
Guillan-Barre
--MONITOR autonomics and respiration (with spirometry) to see if need prophylactic intubation bc GB can cause respiratory failure --IV Ig or plasmapharesis
51
treatment resistant schizophrenia
schizophrenia associated w suicidality
clozapine
52
treatment resistant depression
phenelzine (MOA-I)
53
organophosphate poisoning
atropine then pralidoxime organophosphate = pro-cholinergic sx want to treat w anticholinergics
54
atropine toxicity
physostigmine = Ach-E inhibitor (pro-cholinergic) (can also use with any other anticholinergic toxicity)
55
high altitude sickness AMS vs cerebral edema
AMS : O2 + acetazolamide
cerebral edema (N/V/ drowsy) = O2 + dexamethasone
56
DVT anticoagulation in a patient with ESRD
**unfractioned heparin, then warfarin**
GFR \< 30 CANNOT USE: Xa inhib (fondaparineux or rivaroxaban), LMWH (enoxaparin), or
57
smoking cessation
-verenicline (contra in pts w CV ds or risk) -bupropion (contra in active or hx bulimia) -nicotine patch/gum/lozenge : for those who can't take ^^, works for long term and short term cravings
58
acute + subacute shingles
postherpetic neuralgia
* -acute/subacute shingles = NSAIDs and analegesics
* -postherpetic neuralgia = gabapentin, TCAs, pregabalin
59
giardia
metronidazole, tinidazole
60
proctalgia frugax
(recurrent episodes \<30 min of rectal pain unrelated to defecation) -reassurance -nitroglycerin cream +/- biofeedback therapy for refractory sx
61
molluscum contagiousum
reassurance (clinical dx)= common, benign sx of poxvirus self resolve in 6-12 mo
-in adults w genital lesions, can do topical cantharidin, podophyllotoxin)
62
prostatis
acute bacterial prostatis (MC) =lovafloxacin or TMP-SMX for ~6 weeks to ensure eradication
63
delusional disorder
antipsychotics (even though the dx requires no hallucinations/delusions) +CBT
64
seborrheic dermatitis
anti-fungal = ketoconazole, selenium sulfide -SD associated w Malassezia species
65
post-organ transplant, to protect from opportunistic infections due to immunosuppression
* biggest infections= pneumocystis pneumonia + CMV pneumonia (both have diffuse interstitial infiltrates but CMV is acute onset over days, pneumocystis is indolent
PCP prophylaxis = TMP-SMX (also protects against listeria, toxo, most URI pathogens) CMV prophylaxis = gancyclovir
66
sickle cell priaprism
aspirate the blood from corpus cavernosum intracavernous injection of phenylephrine (to contract vessels to push venous blood out)
67
depression characterized by insomnia and poor appetite
mirtazapine (associated w somnolence, inc appetite, weight gain) =SNRI = first line along w ssri, but better for sleep and inc appetite
68
antithrombotic prophylaxis in nonvalvular a fib
which patients need it
NON VitK antagonists: dabigatran, apixaban (-axabans)
* equally or higher reduction of embolization risk as warfarin but without bleeding risk NOT nearly as effective to use anti-plts (ASA, clopidogrel)
or warfarin
CHA2DS2VASc score
* 1 = intermediate score so give oral anticoag or ASA
* 2+ = give oral anticoag
69
akathisia
is DOSE DEPENDENT 1. decrease the dose of the current antipsychotic 2. add on either a beta blocker (PROPRANOLOL) or an antichol (BENZTROPINE) -consider changing to an antipyschotic w less EPS sx aka second gen
70
anal fissures
topical nifedipine (reduce anal sphincter pressure)
71
first line anti-hypertensives
lisinopril losartan amlodipine chlorthalidone (thiazide diuretic)
72
hepatic encephalopathy
\*presents w\* = asterixis (flapping tremor of outstretched hands), confusion and somnolence progressive over hours to days
* correct underlying cause = fluids, abx
* dec blood ammonia = **IV lactulose, rifaximin**
73
trx for plantar fasciitis
heal inserts for shoes / orthotics activity modification stretching exercises (fasciotomy only for severe, refractory cases)
74
hepatitis C
ledipasvir-sofosbuvir (HCV dx requires +virus Ab AND +Ag)
75
triglycerides
\<500 = lifestyle modification (inc exercise, reduce alc, weight loss) add statin for known CV risk \>1000 = gemfibrozil (fibrates), fish oil, alc ABSTINENCE
76
impetigo local vs systemic
local = topical mupirocin (abx) systemic = oral cephalexin
77
atopic dermatiits
(eczema) always= topical emollients acute attack 1st line = topical steroids 2nd line= topical pimecrolimus (calcineurin inhib)
78
trigeminal neuralgia
carbamezapine or oxcarbezapine
TN=compression of CNV, with episodic facial pain triggered by innocuous stimuli
* oxcarbezapine+carbamezapine = antiepileptic drugs that will inhibit action potentials via the Na channels
* ox is better tolerated: associated w inc risk of hypoNa bc inc ADH sensitivity
79
inc uric acid (chronic gout, tumor lysis syndrome)
allopurinol rasburicase febuxostat
80
allergic rhinitis
intranasal steroid + avoid trigger (nasal drip --\> cough, eye itching, "allergic salute" on nose)
81
alzheimers dementia
mild to moderate = cholinesterase inhibitors =rivastigmine , donepezil, galantamine mod-severe =NMDA antagonist =memantine
82
MDD with psychotic features i.e. depression and thinking their body is decaying from the inside
=SSRI + antipyschotic i.e. =sertraline + risperidone
83
bile acid diarrhea
~post-cholecystectomy, crohn's, abd radiation =cholestyramine, colestipol (bile acid binding resins)
84
bloody diarrhea from E Coli O157:H7, Shigella, Campylobacter, or Salmonella
supportive care only only give abx if the pt is ill appearing / severe sick
85
chronic myeloid leukemia
vs
chornic lymphocytic leukemia
CML=
* **imatinib** = works against BCR-ABL tyrosine kinase
* 9-22 **BCR-ABL** fusion--\> constitutive activation of tyrosine kinase --\> CA
CLL
* rituximab (+/- fludarabine)
* = anti CD20 mAB, expressed on B cells
* \*\*pts on trx for CLL are at inc risk of infection = one of the leading causes of morbidity and mortality\*\*
86
acute promyelocytic leukemia
(a subtype of AML) all-trans retinoic acid
87
warfarin induced intracerebral hemorrhage
(supra-therapeutic INR) warfarin refersal = -Vit K infusion (takes 12-24 hours to work) + prothrombin complex concentrate (short acting but also quick onset)
88
torsades des pointes
hemodynamically unstable = immediate defibrillation stable and conscious= IV magnesium sulfate (if w n mg levels)
89
paroxysmal SVT
acute= adenosine
90
atrial or ventricular tachycardia
**amiodarone**
may be used in polymorphic OR monomorphic vtach
vs SVT = verapamil / metoprolol
91
symptomatic sinus bradycardia
atropine
92
symptomatic AV node block
(mobitz II or type 3) atropine
93
cardiotoxicity secondary to hyperkalemia
vs
chronic, asx hyperkalemia
calcium gluconate + (IV insulin + glucose)
* EKG changes dec w severity : tall T waves --\>low/absent P waves and high degree AV block --\> QRS wide --\> sine pattern
vs
low-K diet (\<40-70 mEq/day), + oral cation exchangers (**patiromer, zirconium cyclosilicate)** to inc K excretion, avoid meds that inc K levels = NSAIDs, antiinflammatory
* ACE-Is inc K levels but their net effect is more beneficial so you keep it
* CKD pts w hypervolemia --\> furosemide/ hydrochlorthiazide
94
persistent raynaud's (more than a few episodes)
amlodipine, nifedipine (D-CCB)
95
syphillis
1. primary
2. secondary
3. tertiary
first line and the alternative if first line is CONTRA
96
myasthenia crisis
intubate + plasma exchange/ IVIG
97
hypertrophic cardiomyopathy
* metoprolol / atenolol \>\> verapamil
- dec LVOT obstruction + dec angina sx
* avoid volume depletion
* surgery if sx persist
98
osteoarthritis w sx
topical/oral NSAIDS = diclofenac
consider: dulextine, tramadol, topical capsaicin
99
preop trx of pheochromocytoma
alpha blockers
=phenoxybenzamine, prazosin, doxazosin, terazosin, phentolamine
100
antidepressants that can simultaneously treat neuropathic pain / chronic pain conditions
SNRIs = duloxetine
TCAs = amytriptiline
101
inc fecal calprotectin is associated with what
inc fecal calprotectin and leukocytes is associated w **IBD (crohn or UC)**
waterry diarrhea
102
painful rash on UE+LE
trx?
**erythema multiforme** = erythematous papules that develop into target lesions with dusky central area (inflammatory zone) surrounded by a pale area, and then another erythematous halo at the periphery
* *vs lyme with central **clearing***
=painful: episodes of rash that comes and goes
* associated with
* HSV (may have recurrent painful genital vesicles/ulcers) or mycoplasma
* sulfanomides
* malignancies
* collagen vascular ds
trx = EM is self limited, can give antihistamines or steroids
103
acute stress disorder
* brief, trauma-focused CBT
* consider meds for anxiety, insomnia
* monitor for PTSD (\> 1 month)
104
trx of brown spider bite
was burning pain, then became blister, now is a black eschat with surrounding erythema that has spread out
**brown recluse spider bite**
none- supportive wound care only + ice (cold dec venom activity)
* no surgical debridement until the lesion has stopped growing
* supportive therapy for systemic sx
* update tetanus
105
empirical treatment for bacterial meningitis in the following groups
* 2-50 yo
* \>50 yo
* immunocompromised
* skull trauma (penetrating/neurosurgery)
cefepime= 4th gen = heavy duty for immuncomp and trauma
old people and immunocomp need penicillin
everyone gets vancomycin
106
pertussis
= whooping cough
macrolides = azithryomycin
(crows on the windowsill)
107
abx prophylaxis for rheumatic fever
pts who have hx of rheuamtic fever (arthralgias after a febrile illness) may have rheumatic heart ds = chronic complication, which has inc risk of recurrance
most pts need prophylaxis to prevent recurrance
108
pt w bipolar presents to the hospital in the midst of a depressive/suicidal episode
immediate trx?
acute bipolar depression = second gen antipsychotics **quetiapine / lurasidone**
=antipsychotics, even tho depressed bc ssri will trigger manic
109
PUD from h. pylori
PPI + abx
amoxicillin + clarithromycin
110
cataracts
(opacification of lens, pts see glare and halos around bright lights)
trx- surgical replacement of the lens, done once cataracts start to impair ADLs
111
temporal lobe seizuresate associated w what
MC cause of focal epilepsy?
* olfactory hallucinations, epigastric uneasiness
* mesial temporal (hippocampal) lobe sclerosis
112
condyloma acuminata
(HPV warts)
## Footnote
=thrichloroacetic acid
(soft, verrocous growth in inguinal area)
113
hydradenitis suppurativa
doxycycline
## Footnote
=tender inflammatory nodules, often in intertriginous areas , associated with sinus tract formation and multiple open comedones
-associated w genetic predisposition, inc androgens, follicular hyperkeratosis, or colonization by c. acnes as well as climate, food, drugs (steroids, progestin only OCP)
114
what is the next best step in the management of vascular damage in an extremity due to trauma (MVC, GSW, etc)
signs of digital ischemia= absent pulses, cool extremity
115
bipolar maintenence therapy in pregnancy / trying-to-become-pregnant people
mood stabilizer: **lamotrigine**
- the safest mood stabilizer for pregnancy
- _valproate + carbamezapin_e = teratogen = most harmful in first trimester = nueral tube defects
* lithium: relatively low risk teratogen : if stable on lithium before pregnany, may continue, but switching to lithium is inappropriate
*_delay pregnancy for 3-6 months after switching meds to assess the efficacy of the new med_*
antipsychotics =
-use second generation =**quetiapine, risperidone**
116
bacterial conjunctivitis
viral conjunctivitis
allergic conjunctivitis
bacterial
* erythromycin ointment
* polymixin-trimethoprim / azithromycin drops
* (lenses) = flouroquinolone drops
viral
* warm/cold compress
* +/- antihistamine drops = olopatadine or azelastine
allergic
* olopatadine or azelastine = OTC antihistamines/ mast cell stabilizers
117
horse farmer in TX presents for 4 days of HA, myalgias, and fever+chills. PE= petechial rash over UE+LEs.
hx= MI and TIA :: labs= plts 40,000, Na=129, rest wnl
dx? management?
rocky mountain spotted fever
* throughout US, associated w summer in grassy/wooded areas
* petechial rash spreads from extremities to trunk
* trx= doxycycline
* the confusion and lethargy is NOT associated w low Na: symptomatic hyponatremic usually presents \<125
118
acute cystitis in nonpregnany Fs
* uncomplicated
* complicated
asx bateriuria
uncomplicated acute cystitis
* oral nitrofurantoin 5 days (unless Cr\<60)
* OR oral TMP-SMX 3 days
* OR one dose fosfomycin
complicated acute cystitis
* fluoroquinolones for 5-14 days
* severe= broad spectrum abx= ampicillin/gentamicin
asx bacteriura
* nitrofurantoin and repeat urine to test for cured
* (dx= 100+ colonies e. coli on routine first prenatal visit urine test)
119
acute pyelonephritis in F: nonpregnant vs pregnant
nonpregnant = floroquinolones
* inpatient = IV floroquinolones +/- ampicillin / aminoglycoside
pregnant= cephalosporine, or amoxicillin-clavulanate, or fosfomycin
120
sudden onset severe CP, diffuse
initial therapy = IV beta blockers
* labetalol, esmolol, propranolol
* = dec HR, SBP, LV contractility --\> dec rate of inc in aortic wall stress
+ pain control
- nitroprusside is a second line only if SBP remains \>120
* + hydralazine = associated w inc risk of reflex sympa activation --\> usually used in HTN emergency
121
narcolepsy
**modafinil** = nonamphetamine trx to promote daytime wakefulness
sign cataplexy (M wknss triggered by emotions)--\> antidepressants/ sodium oxybate (REM sleep suppressors)
122
trx of a clavicular frx
NO reduction:
* uncomplicated (no arterial damage) --\> non-operative healing w rest, ice, and figure 8 bandage / sling
* possible arterial damage
* soft signs --\> get CT angiography to see if there is damage
* hard signs --\> immediate surgical intervention (can nick brachial plexus, **subclavian A and V**)
123
migrain prophylactic therapies (4)
124
vasovagal syncope
=reflex syncope
recurrent= counterpressure techniques
* inc venous return and cardiac output and somtimes abort the syncopal episode
* i.e.when feel prodrome --\> synope w legs about head, legs crossed w tensing of muscles, hand grip and tense UE w clenched fists
125
topical and systemic trx
126
restless leg syndrome
pramipexole, gabapentin
associtaed w abn iron / DA in CNS
127
what are the following antifungals used for
* griseofulvin
* sulfadiazine - pyrimethamine
* amphotericin B + flucytosine
* flucanazole
griseofulvin = dermatophytes and onychomycosis
sulfadiazene-pyrumethamine = cerebral toxo
* multiple, ring enhancing lesions
Amph B+flucytosine IV 2 weeks --\> fucanazole 8 weeks = cryptococcal meningitis
* CSF india ink stain = transparent capsule : fungal stain = encapsulated yeast + sabourad agar
* subacute; acute + v severe w HIV
fluconazole \>\> itraconazole (less reliable, more AE)
-in pts w HIV and opp infections: antiretrovirals should NOT be started until 2+ weeks after antifungals are started or can worsen the infection
128
adult w lead (Pb) poisening
chelation w calcium disodium (EDTA)
129
ALS patient w orthopnea
=oft the first sign of respiratory insufficiency in ALS
**noninvasive positive pressure ventilation**
=improve survival by improving respiratory function
130
primary adrenal insufficiency treated w hydrocortisone but still have hypoNa, hyperK, and orthostatic hypotension
hydrocortisone (or can use prednisone) is a glucocorticoid w mild mineralcorticoid action
* (vs dexamethasone= only glucocorticoid action (only cortisol)
**add low dose fludrocortisone** = mineralcorticoid to help w the dec ALD in addition to the hydrocortisone which covers the cortisol
(vs adrenal insuff from hypothalamus/pituitary failure : n ALD, only need hydrocortisone)
131
hypercalcemia
symptomatic vs asymptomatic
symptomatic
* immediate= **IV saline** (restrore intravasc volume and promote Ca excretion) and **calcitonin** (inhibit osteoclast, rapid dec in Ca)
* long term= **bisphophonates** (takes 2-4 days to kick in= zoledronic acid, pamidronate)
asx= no initial trx, avoid things that make it worse
132
achilles tendinopathy
in athletes/ sudden inc activity = 2-6 cm proximal to insertion where BF is lowest
**primary** = activity modification, NSAIDS, ice+ cold compression
**chronic** = eccentric resistance (calf-strengthening) excercise= lengthening the m under load
133
diabetic gastroparesis
metoclopramide = prokinetic and antiemetic
* *small* inc risk of EPS sx
alt= erythromycin
* mild prokinetic effect but usually wears off, mostly used in short term settings = \<4 wks
134
scabies
topical permethrin
## Footnote
= v pruritic, small papules btwn fingers and toes , axillae, and along waistline
135
overflow incontinence
urge incontinence
stress incontinence
first line for all=bladder training
overflow =neurogenic bladder, i.e. periph neuropathy
* presistant dribbling, inc residual V = neurogenic bladder, i.e. periph neuropathy
* INC RESIDUAL V
* cholinergic agonist = **bethanechol**: to inc detrusor contraction and urethral relaxation --\> v severe= self-cath
urge incontinence
* sudden, ovewhelming urge may not be able to make it to bathroom, wake up at night to pee =detrusor overactivity
* n residual volume, may be unable to void w when bear down
* mAcR ANTagonists (oxybutynin, tolterodine) and beta agnoists (**mirabegron**)
stress incontinence
* leak w inc intrathoracic P bc dec urethral sphincter tone / urethral hypoermobility
* trx= Kegel (pelvic floor) excercises, continence pessary, best long term= midurethral sling procedure
* \*\*continence pessary also used for pelvic organ prolapse\*\*
136
benign paroxysmal positional vertigo
vertigo = spinning sensation
paroxysmal = intermittant, short episodes (30-60 sec) of vertigo (most associated w peripheral path)
positional = associated w rolling over in bed, standing up too quickly
* et= displacement of otoliths
* dx= dix hallpick maneuver (place in multiple positions to look for nystagmus)
* **trx= head maneuvers to reposition displaced otoliths i.e. epley maneuver**
137
intrahepatic cholestasis
extrahepatic cholestasis
extrahepatic i.e. pancreatic CA = jaundice and pruritis
* endoscopic stent placement to relieve the common bile duct obstruction
* second line = bypass surgery by making an anastamosis
intrahepatic i.e. PBC
* ursodeoxycholic acid
138
acute agitation in the hospital
* haloperidol vs lorazepam
underlying cause = delirium
* haloperidol
acute psychotic agitation
* either antipsychotic or benzo (or a combo)
* some antipsychotics can cause inc Qtc interval : in **pts w qtc interval greater than 500 --\> use lorazepam** ; haloperidol (or ziprasidone)may inc risk of torsades
due to alc withdrawal
* lorazepam
139
acute COPD exacerbation
O2
inhaled bronchodilators (i.e. albuterol, inhaled inpratropium if they take those)
**systemic glucocorticoids** associated w dec hospitalization length and improved pumonary function
140
erythematotelangiectasia rosacea
papulopustular rosacea
phymatous rosacea
ocular rosacea
chronic "rash" that waxes and wanes but is always there, may tingle before beaking out again
associated w UV lights, microbac, spicy foods..
erythematotelangiectasia = topic brimonidine + photoherapy
papulopustular = topical metrinidazole or ivermectin
phymatous= oral isoretinoin
ocular= lid scrubs and lubricants
141
pt, hx of MI, presents for sudden onset palpitations and diaphoresis and dizzy.
ecg = regular, wide qrs. PE= irregular , high amplitude jugular venous pulsations
dx?
some kind of AV dissociation post ischemic infarct
=v tach, or PVCs, or AV block
= ventricles contracting withou atria, so see high JV pulsations bc blood pushing against a closed tricuspid
* vs tricuspid regurge= prominent V wave and absent x descent (*not "high amplitude") : RA don't fill as much so you get lower amplitude and a softer diastole*
142
spinal epidural abscess
Broad spectrum abx= vancomycin + ceftriaxone
(Subacute LBP and hx of recent illness/IVDA--\> acute fever, localized back pain, neuro sx)
143
Empiric abx for community acquired bacterial meningitis *in immunocompromised pts or pts 50+ yo*
For most common causes = strep pneumo, neisseria, and hib = **ceftriaxone + vancomycin**
*in immunocomp or 50+ have to also cover listeria* _= add **ampicillin**_
144
alopecia areata
= painless patches of hair loss, + hair pull test, w thinning at the base(explanation point hairs), may itch.tingle before falling out
=genetic predisposition, autoimmune, can present in teens
* local area = intralesional/topical steroid = **triamcinolone**
* areata totali = immunotherapy (diphenylcyclopropenone) or oral steroids
145
neonatal sepsis = \<28 days
vs \>1 mo w sepsis
neonatal sepsis = ampicillin + gentamicin
* amp = GBS and listeria
* gentamicin = E. Coli
* given empirically: often presents w poor feeding and irritability, may have n T/hypo/hyperthermia, *abn leukocytes= \<4500 or \>11k*, need to have high index of suspicion
* may or may not have jaundice, respiratory distress, CNS sx : give abx while waiting on cultures
infant sepsis = \> 1 mo
* vancomycin + ceftriaxone
* these can cause hyperbili in neonate so don't use before 1 mo
146
acute pericarditis
whether viral and idiopathic
**= (ibuprofen/indomethacin) + colchicine**
(only use prednisone if contra or refractory to NSAIDs)
147
when is diclofenac used
= an NSAID
MC NSAID used in the trx of arthritic pain
diclofenac+triptan can trx Acute migraine
148
when are ergotamines used
what medication are they known to have a bad reaction with
i.e dihydroergotamine
can be an acute trx of migraines
bad reaction with triptans
* when a triptan or an ergotamine is used for an acute migraine, cannot give another triptan for the next 24 hours
* both triptans and ergotamine work on the 5HT receptors and cause vasoconstriction and dec cerebral inflammation BUT double dose would case too much vasoconstriction that can cause inc BP, MI, or stroke
149
acute vs chronic trx of migraines
acute migraine
* triptans
* ergotamines
* NSAIDs (naproxen)
* acetominophen
* metoclopramide / perchlorperazine for antiemetic
chronic migraine
* topiramate
* TCAs (amytriptyline)
* propanolol
* divalproex sodium
150
improve survivability in LV systolic dysfunction
i.e = displaced maximal point of impulse, previous ischemia and now HF...
* ACE-I / ARB,
* ALD antagonists = spironolactone/eplerenone
* beta blockers = metoprolol succinate, carvedilol, bisoprolol
151
labor protraction vs labor arrest
152
hypertriglyceridemia
fenofibrates
153
Raynaud's phenomenon
Whether idiopathic, or secondary to scleroderma/ SLE
## Footnote
first line = avoid the cold
**nifedipine** = peripheral vasodilation
154
Torsades does pointes
Magenesium sulfate = first line, whether or not there is hypokalemis
second line = temp pacemaker or IV protenerol
155
asymptomatic bacteriuria in pregnant patients
all pts are screen in the initial prenatal visit, and trx if + urine culture
MC pathogen = E. Coli
* amoxicillin - clavulanate
* cephalexin
* nitrofurantoin
* fosfomycin
156
top three anxiety
1. paxil - most anxiolytic, most sedating
2. prozac
3. zoloft
what meds are these? what is a common side effect seen with all of them that dictates how to dose?
all SSRIs!
1. paxil = paroxetine
2. prozac = fluoxetine
3. zoloft = sertraline hydrochloride
SSRIs tend to cause a dec serotonin before they cause inc serotonin --\> can cause initial inc anxiety, restless, sleep problems
* especially in anxiety pts
* start the dose low and build tolerance to avoid those AEs
buspirone : less side effects but less effective at dec anxiety
157
external hemorroids
uncomplicated = conservative management
"thrombosed" = acute onset of severe pain --\> hemorrhoidectomy
158
anorexia nervosa
bulimia nervosa
binge eating disorder
first line for ALL is CBT and behavioral therapy
+
AN= olanzapine (zyprexa)
BN= fluoxetine (prozac)
BED = SSRI/lisdexemfetamine (vyvanse)
159
sunburn
mild = cool compress, lotion, aloe vera, oral NSAIDS
severe= IV fluids + wound care hospitalization
+ *blisters*= bacterial prophylaxis = s**ilver sulfadiazine + topical mupirocin ointment**
160
threatened abortion
=vaginal bleeding w closed cervix and n FHT
* = expectant management : most will continue to have n pregnancy
* provide reassurace, do follow up US regularly to observe
* US may show subchorionic hematoma = blood between placenta and uterus
* risk for spontaenous abortion inc w inc maternal age/previous spont ab
no give R-immunoglobulin
* that is for cases of fetal-maternal hemorrhage
* =delivery, **spontaneous abortion,** abruptio placentae
161
acute a fib in WPW
vs isolated a fib w RVR
w WPW
* can be life threatining and lead to v fib
* unstable --\> electrical cardioversion
* stable --\> **procainamide**
a fb w RVR (= most common a tachy)
* unstable --\> cardioversion,
* stable --\>
* onset \>48 hours= **rate control** w *esmolol/propranolol/metopralol* + *verapamil/diltiazem (ND CCB-CONTRA in decompensated HF)*
* onset \< 48 hours = rate contol (^^)
* failure to get rate control --\> rhythm control (flecainide, propafinone, dofetilide) = CONTRA in chronic a fib/a tachy, digoxin toxicity, or high risk for thromobo-embolic :
162
CA related cachexia/anorexia
HIV related cachexia/anorexia
* CA related
* progesterone analogues = **megestrol acetate, medroxyprogesterone acetate**
* corticosteroids
* HIV related
* synthetic cannabinoids = **dronabinol**
163
acute pancreatits
IV crystalloids (fluids) = just like sepsis
* the luekocytosis and fever are from systemic infl caused by *release of pancreatic enzymes, not an infection*
* sepsis= release of too many cytokines, rather than an/the actual infection
give abx if there is a evidence of pancreatic necrosis (on CT) or extrapancreatic infection (i.e. pneumonia)
* pancreatitis non-infection is still associated w L pleural effusion
trx w IV fluid in first 48 hours = major dec in mortality and morbidity
164
acute colonic pseudobstruction
NPO, decompression (NG or rectal)
if persist \>48 hours after initial trx --\> neostigmine
165
malaria acquired in Africa
malaria acquired outside of Africa
P falcifarum is MC in African countries
* chloroquine
P vivax is MC outside of Africa
* need chloroquine and primiquine
* for dormant hepatic phase
166
what (3) vaccines are recommended in preg
what (4) are contraindicated in preg
"high risk\* = immunocomp, chronic heart/lung/liver ds
3 rec= tdap, flu, RhD
4 contra= HPV, MMR, live flu, varicella
167
hyponatremia due to high osmolality?
how does that happen?? when would this happen?
hyperglycemia --\> inc osmolality \>295 --\> kidneys respond by pumping out Na (+water) --\> worsened high osmolality but now hyponatremia too
* missed doses of DM medications / inadequate dose
168
legionella pnuemonia
(recent travel, now have GI + pulm + fever)
**levofloxacin or azithromycin/clarithromycin**
169
pt presents, on amlodipine and carbamezapine, for recent onset fatigue, nausea, and forgetfulness. labs= hyponatremia
most likely dx?
SIADH
associated w SSRIs, carbamezapine,NSAIDS
170
condyloma acuminata
nonpregnant = vaccine
pregnant = topical trichloroacetic acid
171
AEs of the following RA Ds-Modifying Agents:
* methotrexate (3)
* leflunomide (2)
* hydroxychloroquine (1)
* sulfasalazine (3)
* TNF inhibitors (4)
big AEs associated w multiple DMD = **hepatotoxicity, stomatitis, cytopenias**
methotrexate induced lung injury
* NOT dose dependent = hypersensitivity pneumonitis
* risk inc w RA, parenchymal lung ds
* clin= *exertional dyspnea, hypoxemia, pulm infiltrates w reticular thickening (fibrosis)* w negative microbio
* onset 1-12 months after start w pneumoitis --\> fibrosis = **restrictive lung ds**
* CT scan =inflammation w ground glass opacities or consolidations and.or fibrosis = reticulation
* bronchoalveolar lavage = lymphocytosis, peripheral blood= eosinophilia
* dx= trial of stopping MTX to see if sx improve
172
scleroderma renal crisis
ACE-I (to inhibit the RAAS)
* Cr will inc a little bit when you start the ACE-I, but that's okay
- steroids would make it worse by salt/water retention
173
acute psychosis (nonviolent)
aka acute schizophrenia
first line 2nd gen
**risperidone : aripriprazole : olanzapine : quetiapine : ziprasidone**
174
acute limb ischemia in the setting of PAD
IV heparin
thrombolysis
thrombectomy
175
pt came in after bee sting w anaphylactic shock. given IM Epi, resolved sx.
now, an hour later, worse hives, mild wheezing, and an episode of emesis.
next step trx?
another dose of IM Epi --\> can be given 3 times!
* = biphasic anaphylaxis
if after 3 doses IM Epi no respond / recurr ... give IV Epi
- if also have bronchoconstrictions --\> add albuterol
- if also have hypotension : add IV fluids and trendelenburg
176
photokeratitis
pain relief and lubrication
topical abx= erythromycin
eye protecting gear in future(goggles, sunglasses)
~usually resolves within 1-3 days~
177
list (4) drugs/groups of drugs that are associated with **ototoxicity** as a known AE
- aminoglycoside abx = gentamicin, tobramycin, streptomycin,
- furosemide (loop diuretic)
- cisplatin (platinum chemo)
- high dose salicylates (ASA)
178
apnea of prematurity
=intermittant episodes (seconds) of no breathing in babies a few days old, MC associated w prematurity
- if no hypoxia = no need to treat
- recurrent episodes assoiciated dec O2 sat/BP --\> trx w caffeine, noninvasive ventilation
* resolves w time
179
name 5 meds to absolutely avoid in G6PD deficiency pts
180
pt w splenectomy/asplenia develops a fever
can lead to fulminant bacterial infection v quickly
*_IMMEDIATELY_* prescribe **amoxicillin-clavulunate** bc asplenia = inc risk of encapsulated bac= strep, h flu, neisseria
181
35 yo presents w a breast mass noticed a week. ago.
mammography= 3x3 cm spiculated mass w coarse calcificaitons in upper outer quadrant
US= hyperechoic
FNB= foamy Mø
- fat necrosis
* FNB= foaomy histiocytes w fat globules
* excise mass and then reassure w routine follow uo
* =benign mass
182
describe the flow volume loop
* normal
* asthma
* laryngeal edema
* pnuemothorax
* pulmonary edema
183
13 yo presents w two months of inc fatigue throughout the day.
labs= hgb 8.4, MCV 70
PE= a few brown macules on lips and buccal mucosa
most likely dx? cause of anemia?
next best step in management?
peutz jeger
* colonic hamartoma that is bleeding or occult malignancy or intestinal obstruction causing iron deificeny anemia
* get an upper endoscopy to assess for occult bleed or malignancy
184
cervical radiculopathy
trx=
* NSAIDS and avoid provacative activities
* maintain mod activity (*no bedrest)*
* if v severe pain= oral steroids
MOST WILL GRADUALLY RESOLVE ON OWN
=acute from disk herniation (weight lifting) or progressive w spinal spondylosis
= **no imaging needed** w classic clinical suspicion and low risk pts
* MRI spine **if**: severe, progressive, or bilat neuro pain
185
pt hx of enuresis and liquid stool incontinence
constipation can cause detrusor muscle instability = enuresis
* liquid stools = around chronic constipation
* trx w laxatives can resolve both enuresis and stool incontinence
186
tricyclic OD
1. O2, intubation if needed
2. IV fluids
3. activated charcoal if present within 2 hours of ingestin
4. sodium bicarb if have inc QRS interval or ventricular arrhythmia
187
when to give the meningoccoccal booster vaccine (3)
* @ 16 yo
* before travel to endemic regions= sub-saharan (including central0 Africa and Hajj
* +/- military recruits, 1st year college
188
tetanus prophylaxis: what do you give for:
* known 3+ toxoid doses of vaccine for a clean, simple wound
* known 3+ toxoid dose for deep, dirty wound
* unknown/ \< 3 for clean, simple wound
* uknown/ \< 3 for deep, dirty wound
tetanus **immune globulin** is **ONLY** FOR _unknown/not full immunized **AND** deep dirty wound_
* = booster + IG
if fully vaccinated: only give booster if last vacc was
* 10 years+ in simple clean wound
* 5 years+ in a deep dirty wound
189
beta blocker toxicity
glucagon
190
campylobacter GI
is self-limited = supportive care only
mucusy diarrhea +/- blood
191
venous air embolism
left lateral decubitus positioning
high flow or hyperbaric O2
192
prolactinoma
=galactorrhea/amenorrhea +/- HA, visual changes
asx + \< 10 mm = no trx, just follow
sx/ \>10 mm --\>
* \< 3 **c**m = D-agonist = bromocriptine/ cabergoline
* \>3 **c**m OR worse w ^ meds = resection
193
one day old bb born to mom w uncontrolled GDM. presents w systolic ejection murmur and thickened IV septum on sonograph
= hyptertrophic cardiomyopathy
* infants from GDM have transieny HOCM that can cause HF
trx= IV fluids and beta blockers (propranolol) to inc LV volume and overcome obstruction
* will self-resolve in a few months
194
lyme prophylaxis
-what 5 criterion must be met for qualification for prophylaxis
=single dose of doxycycline
-erythema around attached tick= no means bit, just local irritation
195
nephrotic syndrome is associated with what CV complications
dec osmotic pressure bc dec protein
* = in lipid synthesis = inc LDL and TGs --\> **accelerated atherosclerotic ds**
* = **hypercoaguability**, affects veins more than As
* **inc risk renal V thrombosis, stroke, MI**
196
2 years of hand pain + stiffness, work when working w hand tools. PE= mild, hard, periarticular enlargements at multiples PIPs and DIPs
trx?
- stretching and strengthening
- oral **OR TOPICAL** NSAIDs = i.e. topical diclofenac
197
pts receiving high dose bisphosphanates need to have what medical work checked out/ done before hand
dental procedures --\> inc risk of osteonecrosis of the jaw
198
community acquired pneumonia
curb-65 score \<2 = outpatient amoxicillin+ sulbactam
curb-65 2+ (aka need hospital stay) = bata-lactam / flouroquinoloe + macrolide
* ceftriaxone + azithromycin
* levofloxacin + azithromycin : **avoid in elderly** due to inc risk of c. diff
199
chronic pancreatitis
1. **pancreatic enzyme (lipase, amylase, protease) supplementation**
1. *even if serum levels are n*
2. will provide the (-)feedback to CCK and break the cycle of hyperstimulation
2. change diet = small, frequent meals
3. cessation of tobacco+alc, fix DM
4. SECONDARY
1. pregabalin, amytriptyline
200
epiglottitis
Hib = v low bc vaccinated. but can still be caused by strep, staph, and other variants of hib
= ceftriaxone + vancomycin
201
opioid withdrawal (2 options)
methadone or buprenorphine
202
burn wound infection
i. e. loss of viable graft, erythema
systemic: pseudomonas/ s. aureas
* pepiracillin-tazobactam OR meropenem
* and vancomycin
local, nonsystemic
* cefezine, clindaymycin
203
1. good G- coverage : i.e. what bugs
2. anaerobic : what situations?
3. MRSA
4. when to use: amoxicillin-clavulunate or ampicillin-sulbactam (5 classes, total 9)
5. meningitis
6. severe, life threatening infections including nosocomial
1. G- = pseudomonas, E. coli, klebsiella
* piperacillin-tazobactam / ampicillin/sulbactam
* OR carbapenem / meropenem
* **IV aztreonam** is G- only = alternate for p*_enicillin allergy_*
* pseudomonos: only cephalosporin that is effective = cefipime, ceftazidime
2. anaerobic : clostridium, actinomyces, fusobacterium bacteroidies
* = colonic infections, dental abscess, gut flora, FOUL SMELLING
* penicillins, carbapenems, any gen cephalosporin
3. S. aureus
* vancomycin, nafcillin/oxacillin (penicillinase resistant)
* 5th gen ceph = ceftaroline
4. amoxicillin-clavulunate or ampicillin-sulbactam
* H. pylori,
* H. influ
* e. coli, listeria, salmonella, shigella, enteroccoci
* proteus,
* spirochetes
5. cross CNS BBB
* 3rd gen cephs : cefixime, ceftriaxone, ceftazidime, cefotaxime
6. 4th gen ceph =IV cefepime
204
initial COPD dx management
-what are parameters by which you base your trx?
severity and hospital/ outpt exacerbation
everyone gets a LAMA (tiotropium) UNLESS they have had no hospital / \<2 oupt exac AND its not severe = SAMA = inhaled tiotropium
205
chronic inflammatory demyelinating polyneuropathy
IV IG, glucocorticoids, plasmapharesis
206
reverse warfarin anticoag
reverse heparin anticoag
warfarin --\> vit K
heparin --\> protamine sulfate
207
head ct reveals hemorrhagic stroke
next best step
IV nicardipine / labetolol to control BP
reverse any anticoag
elevate head, sedation, mannitol = regulate ICP
208
diabetic drugs
* post prandial effects
* associated w weight loss
* associated w weight gain
* no risk of hypoglycemia
* dec cardiovascular mortality
* improve dyslipidemia
* improve BP
* contraindicated with malabsortption
* contraindicated w renal failure
* contra in heart failure
* disulfuram like reaction
* post-prandial
* insulin glusin, aspart, lispro
* amylin
* acarbose, miglitol
* associated w weight loss
* SGLT2-I (-glifazolin)
* GLP-1 agonists (-tide)
* biguanide (metformin)
* weight gain
* sulfonylureas
* thiazolidediones (glitazone)
* no risk of hypoglycemia
* biguanide (metformin)
* thiazolidinediones (-glitazone)
* GLP-1 agonists (-tide)
* DPP-4 inhibitors (gliptin)
* alpa-glucosidase inhib (miglitol, acarbose)
* dec cardiovascular mortality
* SGLT-2 inhibs (glifozolin)
* (*use in DM+CV comorbidities)*
* improve dyslipidemia
* biguanides (metformin)
* thiazolidediones (glitazone)
* improve BP
* SGLT-2 inhibs (-glifozolin)
* contraindicated with malabsortption
* alpha glucosidase inhibs (acarbose, miglitol)
* contraindicated w renal failure
* alpha glucosidase (acarbose, miglitol)
* DPP-4 inhibs (gliptins)
* SGLT2 inhibitors (flozin)
* metformin (--\> lactic acidosis)
* contraindicated in heart failure
* thiazolidediones (glitazone)
* metformin
* disulfuram like rxn
* sulfonylureas (don't drink pond water)
209
acute management of DKA (5 aspects)
what labs is best to monitor pt response to trx
dx= hyperglycemia + HAGMA
* best monitor of response = resolving anion gap (lytes and venous pH)
acute management
1. fluids
1. 0.9% saline rapid infusion
2. when glucose \<200 , add dextrose 5%
2. insulin
1. IV insulin only if K is 3.3+
2. switch to SQ insulin once: gluose \<200, anion gap \< 12, bicarb 15+
1. overlap IV and SQ 1-2 hours
3. K
1. add IV K if \<5.3 , hold if 5.3+
4. bicarb
1. consider if pH\<6.9
5. phosphate
1. conside if ph\<1 OR cardiac dysfunction OR respiratory dysfunction
2. monior Ca frequently
210
drugs that cause hyperkalemia
5 drugs
4 classes
drugs:
* cyclosporine (used to prevent transplant rejection)
* heparin
* trimethoprim (TMP)
* digoxin
* succinylcholine
classes
* ACE-I/ ARBs
* NSAIDs
* K sparing diuretics (spironolactone, amiloride, triamterene)
* beta agonist BLOCKERS
211
acute management of unstable angina / NSTEMI
(6)
t wave inversion V1-V4 = NSTEMI
* nitrates
* (CAUTION W HYPOTENSION)
* beta blocker = metoprolol, atenolol
* CONTRA in HF and pulse\<60
* antiplt
* ASA + clopidogrelP2Y12-blocker
* anticoag
* unfrx haprin, enoxaprin, fondaparineux, or bivalirudin
* statin = high intenstity = atorvastatin, rosuvastatin
* cath reperfusion w/in 12 hours
212
bisphosphonates are contra indicated in what pts?
* second line Oporosis
* denosumab requires monitoring of what
* anabolic agents require monitoring of what
* AE of SSRIs
* use of nasal calcitonin
denosumab
* monitor Ca
anabolic agents = teriparatide
* monitor Ca, uric acid, renal function
SSRI = inc risk of DVT
nasal calcitonin = dec pain of frx, modest reduction of frx risk
213
first line maintenence therapy of severe bipolar
nonsevere= maintain on lithium/valporate/quetiapine/lamotrigine
severe
(valproate or lithium) + queitiapine
* no diff between lithium or valproate
214
name 4 AEs of statins
myalgias
fatigue
hepatic dysfunction
new onset DM
215
insulin
* short acting
* intermediate acting
* long acting
w DKA?
short acting (w meals)
* insulin glusine, aspart, lispro
intermediate
* regular insulin
* NPH
long acting (bolus)
* detemir, glargine
w DKA = regular insulin bc only one that can be given IV
216
uterine atony
1st, 2nd, and 3rd line
MC cause of postpartum hemorrhage
risk = macrosomia, operative vaginal delivery —\> continuous bleeding
* first line= **bimanual uterine massage, high dose of oxytocin**
* (+correction of bladder distention, **misoprostol**)
* second line; tranexamic acid = antifibrinolytic to reduce maternal mortality from hemorrhage
* third one = carboprost, methylgonovin
217
eclampsia and pre-eclampsia
lower P acutely to decrease stroke risk =
* first line = IV labetalol = fast acting BUT can cause dizzy in bradycardia \<60 bpm
* IV hydralazine = can cause tachy
* oral nifedipine , may not be able to swallow if N/V
prevent seizures = IV/IM magnesium sulfate
ECLAMPSIA = head CT shows white matter edema
218
preterm labor (4)
prophylaxis?
preterm labor = **\< 32weeks**
* (tocolysis); \< 32 weeks = ***indomethacin***
32-34 weeks = ***nifedipine***
* causes dec prostaglandins —\> fetal vasoconstriction —\> can cause dec renal perfusion and oligohydramnios
* **betamethasone** to promote fetal lung maturity
* **magnesium sulfate** to decreased risk of cerebral palsy (fetal neuroprotection)
* **penicillin** to decrease risk of neonatal GBS infection
biggest risks = hx preterm labor, short cervix, prior cold knife conization
* screen for short cervix (if no hx) @ 16-24 weeks
* i**f \<2.5 cm on US, give vaginal progesterone** to prevent contractions and preterm labor
219
preterm and prelabor rupture of membranes
* \<34 weeks
* 34-37 weeks
\<34 weeks =
* uncomplicated
* ampicillin + azithromycin
* expectant + monitor fetus
* infection, fetal or maternal compromise
* ampicillin + gentamicin
* delivery
220
birth control in a pt w migraine w aura
contra-indications to IUD placement
migraines = NO estrogen containing contraception
CAN HAVE progestin release subnormal implant
* long actin (up to 3 years),
* reversible,
* reduce menstrual bleeding of 50%
* cause amenorrhea in 20%
* also good for patients who have difficulty w pelvic exams
IUD placement
* general contra = ds of uterus/cervix
* pregnancy,
* endometrial/cervical CA,
* unexplained vaginal bleeding,
* gestational trophoblastic disease,
* distorted endometrial cavity,
* acute pelvic infection (PID, cervicitis)
* progestin IUD
* acute liver ds
* acute breast CA
* copper IUD
* anemia
* heavy menstrual bleeding
* wilson ds
221
lieomyomata uteri
fibroids
common cause of heavy menstrual bleeding = proliferation of sm M within myometrium can cause profuse menses and irregular uterine enlargement
* **oral contraceptives** can dec bleeding duration and volume but won’t resolve
* sx anemia --\> transfusion + more **_invasive_** fibroid trx (**myomectomy, uterine artery embolization, hysterectomy**)
222
most effective emergency contraception
copper IUD
ulipristal
up to 99% efficacy; work up to 5 days later
223
vaginitis
## Footnote
- thin off white dc w fishy smell
- yellow-green malodorous dc
- thick white dc
gardnerlla= metronidazole or clindamyin
trichomonas= metronidazole + trx partner
candida = fluconazole
224
steeple sign = croup
MC= parainfluenza virus
**racemic epinephrine**
