first-line tx Flashcards
(153 cards)
1
Q
bacterial vaginosis (Garnerella Vaginalis)
A
metronidazole or clindamycin
2
Q
trichimoniasis (trichomonas vaginalis)
A
metronidazole or clindamycin
must also treat partner**
3
Q
candida vaginitis (candida albicans)
A
topical azoles (fluconazole)
4
Q
chronic hepB/C
A
IFN-a (HBV,HCV);
ribavirin, simeprevir, sofosbuvir (HCV only)
5
Q
strep bovis
A
penicillin prophylaxis
**evaluation for colon cancer if linked to endocarditis
6
Q
botulism
A
antitoxin
7
Q
tetanus
A
antitoxin
8
Q
HiB
A
amoxicillin +/- clavulinate (mucosal infections)
ceftriaxone (meningitis)
rifampin (prophylaxis)
9
Q
gonorrhoeae
A
(IM- if disseminated) ceftriaxone +/- doxycycline/macrolide (PO)
**add doxycycline to cover likely concurrent Chlamydia trachomatis infection
10
Q
N. meningitidis
A
penicillin/ceftriaxone, rifampin (prophylaxis)
11
Q
Legionella pneumophila
A
macrolides (azithromycin)
12
Q
pseudomonas aeruginosa
A
piperacillin/tazobactam, aminoglycosides, carbapenems, fluoroquinolones
13
Q
syphilis (treponema pallidum)
A
penicillin G
14
Q
chlamydia trachomatis
A
Doxycycline +/- ceftriaxone;
oral erythromycin for chlamydial conjunctivitis in infants
**ceftriaxone for concurrent gonorrhoeae infection
15
Q
oral thrush (candida albicans)
A
nystatin, fluconazole, caspofungin
oral and esophageal
16
Q
systemic candidiasis (candida albicans)
A
fluconazole, caspofungin, amphotericin B
17
Q
cryptococcus neoformans
A
induction w. amphotericin B and flucytosine
**maintenance w/ fluconazole (in aids pts)
18
Q
sporothrix schenckii
A
itraconazole, oral potassium iodide
19
Q
pneumocystis jirovecii
A
TMP-SMX (prophylaxis and tx in immunosuppressed pts, CD4 <200/ AIDS)
20
Q
toxoplasma gondii
A
sulfadiazine + pyrmethamine
- block folate synthesis pathway
- HSR, photosensitivity, myelosuppression
21
Q
Malaria
A
chloroquine (in regions not resistant); mefloquine, atovaquone/proguanil (for blood schizont),
Primaquine (for liver hypnozoit)
**must take mefloquine for 4 weeks after return from trip
22
Q
strep. Pyogenes
A
penicillin prophylaxis
amoxicillin (tx - GAS pharyngitis)
23
Q
strep. Pneumoniae
A
penicillin/ cephalosporin (systemic infection, pneumonia)
vancomycin (meningitis)
24
Q
staph. Aureus
A
MSSA: nafcillin, oxacillin, (dicloxacillin for mastitis) (antistaphylococcal penicillins);
MRSA: vancomycin, daptomycin, linezolid, ceftaroline (5th gen)
25
enterococci
vancomycin, aminopenicillins/ cephalosporins
26
Rickettsia rickettsii
doxycycline, chloramphenicol
27
C. difficile
oral metronidazole
if refractory (oral vancomycin)
28
M. TB
RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)
29
UTI
TMP-SMX/ciprofloxacin- uncomplicated
nitrofurantoin- pregnancy
30
influenza
oseltamivir, zanamivir
31
CMV
Ganiciclovir, foscarnet, cidofovir
32
PDA
keep open: PGE analogs; close: indomethacin
"come IN and CLOSE the door"
33
stable angina
sublingual nitroglycerine
34
malignant hyperthermia
Dantrolene
35
hypercholesterolemia
statin (first-line)
36
hypertriglyceridemia
fibrate
37
Pulmonary arterial HTN (idiopathic)
sildenafil, bosentan, epoprostenol
38
arrythmia and damaged cardiac tissue
class I B antiarrhythmic (lidocaine, mexiletine)
39
prolactinoma
cabergoline/bromocriptine (dopamine agonists)
40
central diabetes insipidus (not producing ADH)
desmopressin
41
nephrogenic diabetes insipidus (kidney dysfunction - dec water reabsorption)
hydrochlorothiazide, indomethacin, amiloride**** (DI due to lithium)
42
SIADH
fluid restriction, IV hypertonic saline (serum sodium is diluted from inc water reabsorption -> hyponatremia), conivaptan/tolvaptan, demeclocycline
43
diabetic ketoacidosis
| diabetic ketoacidosis
fluids, insulin, potassium iodide
| insulin puts K+ back into cells
44
T1DM
dietary intervention (low carb); + insulin replacement
45
T2DM
dietary intervention (low carb); + oral hypoglycemic (metformin) +/- insulin (if refractory)
sulfonylurias are most likely to cause hypoglycemia
46
pheochromocytoma
a-antagonists (ex. Phenoxybenzamine)
47
neural tube defect prevention
prenatal folic acid
48
migraine
abortive tx: sumatriptan, NSAIDs;
prophylaxis: propranolol, topiramate, CCBs, amitriptyline
49
multiple sclerosis
disease modifying therapies (IFN-B; natalizumab);
for acute flares: IV steroids
50
tonic-clonic seizures
levetiracetam, phenytoin, valproate, carbamazepine
51
Absence seizures (zoning out)
ethosuximide
52
Trigeminal neuralgia (tic doiloureux)
carbamazepine
53
hyperaldosteronism
spironolactone
54
benign prostatic hyperplasia
a1-antagonists (nonselective - zosin = both vasodilation and smooth muscle relaxation)- use for those with BPH + HTN
selective a1A inh - tamsulosin (smooth muscle relaxation only)- just BPH
5a-reductase inhibitors, PDE-5 inhibitors (prevent conversion of testosterone to DHT --> hyperplastic nodules)- takes months to work
55
infertility
Leuprolide, GnRH (pulsatile), clomiphene (PCOS)
56
medical abortion
mifepristone
57
hepatic encephalopathy
lactulose (NH3 --> NH4 conversion) --> (ammonium is excretable)
rifaximin (dec ammoniagenic bacteria)
58
erectile dysfunction
sildenafil, tadalafil, vardenafil
59
crohn disease
corticosteroids, infliximab, azathioprine
60
Ulcerative Colitis
5-ASA preparations (mesalamine), 6-mercaptopurine, infliximab, colectomy
61
Sickle cell disease
Hydroxyurea (inc fetal hemoglobin)
62
CML
imatinib (BCR-ABL TK inhibitor)
63
acute promyelocytic leukemia (M3) / AML- APL type t(15;17)
all-trans retinoic acid (vitamin A); arsenic trioxide
64
hairy cell leukemia
purine analogs (cladribine, pentostatin)
65
osteoporosis
calcium/Vit D supplementation (prophylaxis)
bisphosphonates; PTH analogs, SERMs, Calcitonin, denosumab (treatment)
66
buerger disease
smoking cessation
67
kawasaki disease
IVIG, low-dose aspirin
68
temporal arteritis
high-dose steroids
69
GPA
cyclophosphamide, corticosteroids
70
chronic gout
Xanthine oxidase inhibitors (allopurinol, feboxustat); pegloticase, probenecid
*** lower dose or stop 6-MP with allopurinol (inc toxicity due to dec metabolism by inh of XO)
**avoid uric acid rich foods (fish) and alcohol
71
acute gout attack
NSAIDs, colchine, glucocorticoids
72
osteomalacia/rickets
vitamin D supplements
73
drug of choice for anticoagulation in pregnancy or renal failure
low-molecular weight heparin
"pregnant women and kidney failure pts can't go to WAR(farin), oK?"
(competitively inhibits the vitamin K epoxide reductase complex 1 (VKORC1), an essential enzyme for activating the vitamin K available in the body)
74
heparin reversal
protamine sulfate
75
immediate anticoagulation
heparin - very short half life
76
long-term anticoagulation
warfarin, dabigatran, rivaroxaban, and apixaban
77
warfarin reversal
fresh frozen plasma (acute)
vitamin K (non-acute)
78
cyclophosphamide-induced hemorrhagic cystitis
mesna
79
breast cancer in post-menopausal women
aromatase inhibitor (anastrozole)
80
ER + breast cancer
Tamoxifen
- estrogen antagonist in breast
- estrogen agonist on endometrium (inc risk of hyperplasia --> endometrial cancer)
81
Prostate adenocarcinoma/ uterine fibroids
leuprolide, GnRH (continuous)
82
prostate adenocarcionma
flutamide (androgen R antagonist
leuprolide (continuous)
prostatectomy if local - use meds in advanced disease
83
HER2/neu + Breast cancer
trastu(2)zumab
84
anorexia
nutrition, CBT/psychotherapy, SSRIs
avoid bupropion (lower seizure threshold in anorexic and bulemic pts)
85
bulimia nervosa
SSRIs
*avoid bupropion (seizures)
86
alcoholism
disulfiram, acamprosate, naltrexone, supportive care
87
ADHD
methylphenidate, amphetamines, CBT, atomoxetine, guanfacine, clonidine
88
Alcohol withdrawal
long-acting benzodiazepines, phenobarbital
89
bipolar disorder
mood-stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics
lithium - mostly manic
valproic acid- fluctuates
lamotrigine - mostly depressed
90
depression
SSRIs (first line)
91
generalized anxiety disorder
SSRIs, SNRIs (first-line); buspirone (second-line)
public speaking - can use propranolol
92
schizophrenia (positive symptoms)
typical and atypical antipsychotics
93
schizophrenia (negative symptoms)
atypical antipsychotics
94
smoking cessation
varenicline, bupropion
95
insomnia
ramelteon, trazodone
96
opioid overdose
naloxone
97
opioid overdose- relapse prophylaxis
nalTREXone
"helps you stay on trex (track)"
98
first line of treatment for unstable bradycardia
Atropine 1mg
every 3-5 min for max dose of 3mg
NOTE: doses less than 0.5 mg IV may exacerbate bradycardia
***do not rely on atropine in Mobitz type II second deg or third deg AV block or in pts w. 3rd deg av block w/ a new wide QRS (likely remain unresponsive) -- tx w. TCP or B-adrenergic support
99
what is the first-line treatment for unstable tachycardia?
electric cardioversion
100
nephrotoxicity from platinum compounds (chemo) - ex. cisplatin
amifostine- free radical scavenger
101
cardiotoxicity from anthracyclines (chemo)- doxyrubicin, danorubicin
dexrazoxane - iron chelator
102
myelosuppression from methotrexate ("rescue")
also enhances effects of 5-fluorouracil
leucovorin (folinic acid)- THF precursor
103
hemorrhagic cystitis from cyclophosphamide/ isofosfamide
mesna- sulfhydryl compound that binds acrolein (toxic metabolite of cyclophosphamide/isofosfamide)
104
tumor lysis syndrome
Rasburicase (recombinant uricase that catalyzes metabolism of uric acid to allantoin)
105
acute n/v (usually w/in 1-2 hrs of chemo)
ondansetron, granisetron, prochlorperazine, metochlopramide
5-HT3 R antagonist
D2 R antagonist
106
delayed n/v (>24 hrs after chemo)
NK-1 R antagonist --> dec substance P, serotonin ,etc (aprepitant, fosaprepitant)
107
neutropenia (chemo-induced)
filgrastim, sargramostim
108
anemia (chemo-induced)
Epoetin Alfa
109
testicular cancer (combination therapy)
bleomycin (risk of pulmonary fibrosis- must monitor pulm. function)
cisplatin (nephrotoxic- tx w/ amifostine)
etoposide
"Cis gave him Bleo Balls so he made her an Etoposide- chick"
110
Lesch-Nyhan syndrome (HGPRT deficiency)
first line= allopurinol
| second line = febuxostat
111
SCID
prophylactic antibiotic treatment
IVIG
bone marrow transplant
*** avoid live vaccines
112
acute mastitis
dicloxacillin
113
c.perfringens (gas gangrene)
penicillin and surgical debridement
114
pasteurella multocida (cellulitis or osteomyelitis)
piperacillin/ tazobactam, penicillin/amox-clav
115
actinomycosis
penicillin
116
scabies
permethrim (topical) or ivermectin (topical or PO) or benzyl benzoate (topical)
type IV HSR to the deposition of eggs and feces - pruritic rash on webs of fingers and toes, axilla, flexor surfaces of wrist, waist, around umbilicus, areolae, groin; homeless shelters, poor hygiene, overcrowding
117
lyme disease
doxycycline
118
brucellosis
penicillin, doxycycline, aminoglycosides
119
h.pylori (DU)
3tx - clarithromycin, amoxicillin, metronidazole and PPi
PPis- cause dec absorption of Ca2+, Mg2+, and Fe2+ (req acid)--> supplement or else risk of osteoporosis, IDA; can also inc risk of pseudomembranous colitis
120
DU, gastrinoma (zollinger-ellison syndrome), GU, GERD
PPi (-prazoles)
PPis- cause dec absorption of Ca2+, Mg2+, and Fe2+ (req acid)--> supplement or else risk of osteoporosis, IDA; can also inc risk of pseudomembranous colitis
121
tularemia
streptomycin (aminoglycoside), gentamycin, ciprofloxacin
122
skin and soft tissue infections caused by streptococci and staphylococci. Also used to tx other infections of the abdomen or pelvis and infections caused by susceptible Bacterioides and other anaerobes
clindamycin
123
hook worm infections (ancylostoma duodenale or Necator americanus, strongyloides s.)
albendazole (binds tubulin and dec microtubule polymerization and dec glucose uptake)
ivermectin
124
cestode (tapeworm) or trematodes (flukes) infections
praxiquantel (inc calcium influx --> spastic paralysis)
"sPRAXIQ paralysis"
125
parkinson dz
levidopa (dopamine analog)
| carbidopa (prevents peripheral conversion --> more levidopa makes it to CNS)
126
tinea infections (jock itch, athlete's foot) and ring worm (tinea corporis)
topical terbinafine
127
B. anthracis
tx- ciprofloxacin or doxycycline
post-exposure prophylaxis - ciprofloxacin
128
yersinia pestis
streptomycin, gentamycin, ciprofloxacin, doxycycline (if untreated mortality is 100%)
129
hairy cell leukemia
cladribine, pentostatin, rituximab
130
CML
bcr-abl tyrosine kinase inh (imatinib)
131
fibromyalgia
regular exercise, antidepressants, gabapentin
132
SLE
glucocorticoids
133
colorectal carcinoma
FOLFIRI regimen (5-FU, leucovorin, irinotecan); XELIRI regimen (capecitabine and irinotecan)
134
refractory pancreatic cancer
irinotecan and 5-FU
135
testicular cancer/seminoma (combo tx)
bleomycin, etoposide, cisplatin
136
Ewing sarcoma
etoposide
137
solid tumors
vincristine or vinblastine
MOA: bind B-tubulin and inhibit its polymerization into microtubules in order to prevent formation of the mitotic spindle and cause arrest in M phase
138
ectopic pregnancy
methotrexate
139
anemia of chronic disease
address the underlying cause of inflammation, blood transfusion, EPO in CKD pts
140
schistosomiasis
praziquantel (inc permeability to calcium, leading to calcium influx and subsequent paralysis)
141
cryptococcus neoformans meningitis/encephalitis (CD4+ below 50/mm3)
Ampthotericin B 0.7-1mg/kg/day (inc membrane permeability by binding to ergosterol in the fungal plasma membrane);
- causes hypokalemia, hypomagnesemia, and renal impairments --> check labs frequently. Saline loading reduces amphotericin B nephrotoxicity
flucytosine 100mg/kg/day for 2 weeks;
followed by fluconazole 400 mg/day for 8 weeks and 200mg/day thereafter
142
candidemia in neutropenic pts with fever
caspofungin (targets fungal cell wall - chitin)
143
aspergillus
voriconazole
144
focal seizures (tonic-clonic)
first-line = carbamazepine (voltage dependent blocker of VG sodium channels)
carbamazepine adverse effects:
- SJS
- DRESS syndrome (drug reaction with eosinophilia and systemic symptoms)
- agranulocytosis
145
post herpetic neuralgia
gabapentin
146
status epilepticus
phenytoin, phenobarbital
147
MDD + anorexia
mirtazepine
148
CHF/ HTN + osteoporosis
or
HTN + nephrogenic diabetes insipidus
or
first-line HTN
or HTN + calcium nephrolithiasis
thiazides
- contraindicated in sulfa allergy and gout
- inc serum calcium (inc reapsorption)
149
HTN + hypercalemia
loop diuretics
- ototoxicity
- sulfa drug rxn (except- ethacrynic acid)
150
drug-resistant TB
streptomycin
151
latent TB
rifampin, or isoniazid (+ Vitamin B6) or both
152
giant cell arteritis (temporal arteritis)
monoclonal anti-body against IL-6
153
ankylosing spondylitis
tx- indomethacin (NSAID)
