Lines + Conditions Flashcards
(419 cards)
1
Q
Acute porphyrias
A
Haem arginate
2
Q
Adrenal insufficiency
A
Hydrocortisone (similar to cortisol)
Fludrocortisone (for aldosterone deficiency)
3
Q
Adrenal insufficiency sick day rules
A
Double dose of hydrocortisone
In severe consider IM or IV hydrocortisone
4
Q
Adrenal crisis
A
Hydrocortisone
Rehydration using sodium chloride 0.9%
5
Q
Dry macular degeneration
A
Smoking cessation
Counselling and support
Visual aids
6
Q
Wet macular degeneration 1st line
A
Anti VEGF (aflibercept, ranibizumab or bevacizumab)
7
Q
Wet macular degeneration 2nd line
A
Add photodynamic therapy
8
Q
Alcohol withdrawal symptoms
A
Chlordiazepoxide or diazepam
9
Q
Delirium tremens 1st line
A
Oral lorazepam
10
Q
Delirium tremens 2nd line
A
Parenteral lorazepam or haloperidol
11
Q
Alcohol dependence 1st line/mild
A
CBT
12
Q
Alcohol dependence 2nd line/want pharmacological treatment
A
Acamprosate calcium or oral naltrexone hydrochloride
13
Q
Alcohol dependence 3rd line
A
Disulfiram
14
Q
Wernickes encephalopathy
A
Thiamine
15
Q
Preventer of sickle cell acute chest syndrome, reducer of painful crises and reducer transfusion requirements
A
Hydroxycarbamide
16
Q
Acute anal fissure (<6 wks) 1st line
A
Bulk forming laxatives e.g. ispaghula husk
17
Q
Acute anal fissure (<6 wks) 2nd line
A
Osmotic laxative e.g. lactulose
18
Q
Acute anal fissure (<6 wks) prolonged burning pain following defecation
A
Topical local anaesthetic e.g. lidocaine
Simple analgesia
19
Q
Chronic anal fissure (>6 wks) 1st line
A
Glyceryl trinitrate rectal ointment
20
Q
Chronic anal fissure (>6 wks) 2nd line
A
Refer to specialist for local injection of botulinum toxin type A
21
Q
Chronic anal fissure (>6 wks) 3rd line
A
Surgery
22
Q
Anthrax treatment
A
Ciprofloxacin or doxycycline (>12 yrs) + 1 or 2 of
- benzylpenicillin
- clindamycin
- rifampicin
- vancomycin
23
Q
Anthrax post exposure prophylaxis
A
Ciprofloxacin, doxycycline or amoxicillin
24
Q
Acute AF + haemodynamic instability
A
Emergency electrical cardioversion
25
Acute AF + >48 hrs or onset uncertain
Rate control
26
Urgent rate control in AF
IV beta blocker
27
Rate control AF other
Calcium channel blockers e.g. verapamil (LVEF >40%, avoid of acute HF)
Digoxin
28
Pharmacological cardioversion in AF - no structural or IHD present
Flecainide
29
Pharmacological cardioversion in AF - structural or IHD present
Amiodarone
30
When can electrical cardioversion be done in AF
Delay until patient has been anticoagulated for >3 wks
31
Drugs to maintain sinus rhythm in AF 1st line
Beta blockers
32
Drugs to maintain sinus rhythm in AF 2nd line following cardioversion
Dronedarone
33
Drugs to maintain sinus rhythm in AF - coexisting HF
Amiodarone
34
Paroxysmal supra ventricular tachycardia 1st line
Vagal manoeuvres
35
Paroxysmal supra ventricular tachycardia 2nd line
IV adenosine
36
Paroxysmal supra ventricular tachycardia 3rd line
IV verapamil (CI if on beta blockers)
37
Paroxysmal supra ventricular tachycardia + haemodynamically unstable
Direct current cardioversion
38
Bradycardia 1st line
IV atropine
39
Bradycardia 2nd line
Adrenaline/epinephrine
40
Pulseless ventricular tachycardia or ventricular fibrillation
Resuscitation
41
Sustained VT + harmodynamically unstable
Direct current cardioversion
42
Sustained VT
Amiodarone
43
Non sustained VT
Beta blocker
44
Torsade de pointes
IV magnesium sulfate
45
ADHD
Methylphenidate
46
Septicaemia (community) 1st line
Piperacillin w/ taxobactam or cefuroxime
47
Septicaemia (community) + MRSA
Add vancomycin or teicoplanin
48
Septicaemia (community) + anaerobic infection
Add metronidazole to broad spectrum cephalosporin
49
Septicaemia (community) + other resistant organism
Meropenem
50
Septicaemia (hospital) 1st line
Piperacillin w/ tazobactam, ceftazidime or meropenem
51
Septicaemia (hospital) + MRSA
Add vancomycin or teicoplanin
52
Septicaemia (hospital) + anaerobic
Add metronidazole to broad spectrum cephalosporin
53
Meningococcal septicaemia 1st line
Benzylpenicillin or cefotaxime or ceftriaxone
54
Meningococcal septicaemia + can’t have other drugs
Chloramphenicol
55
HER2 +ve breast cancer
Trastuzumab (herceptin) and pertuzumab
56
Oestrogen receptor +ve breast cancer
Tamoxifen
57
Post menopausal women ER +ve breast cancer
Anastrozole
58
Severe acute hypocalcaemia or hypocalcaemic tetany
Slow IV calcium gluconate 10%
59
Severe hypercalcaemia 1st line
IV sodium chloride 0.9%
| Stop thiazides + vit D compounds
60
Severe hypercalcaemia 2nd line
Pamidronate disodium (bisphosphonate)
61
Hypercalcaemia from malignancy
Calcitonin
62
Hypercalciuria
Increase fluid intake
| Bendroflumethiazide
63
SAH
Nimodipine
64
Native valve endocarditis - blind
Amoxicillin +/- gentamicin
65
Native valve endocarditis, penicillin allergic or MRSA or severe sepsis - blind
Vancomycin + gentamicin
66
Native valve endocarditis, severe sepsis w/ gram -ve - blind
Vancomycin + meropenem
67
Prosthetic valve endocarditis - blind
Vancomycin + rifampicin + gentamicin
68
Native valve endocarditis staphylococci
Flucloxacillin >4 wks
69
Native valve endocarditis staphylococci - penicillin allergic or MRSA
Vancomycin + rifampicin >4 wks
70
Prosthetic valve endocarditis staphylococci
Flucloxacillin + rifampicin + gentamicin 6 wks
71
Prosthetic valve endocarditis staphylococci - penicillin allergic or MRSA
Vancomycin + rifampicin + gentamicin 6 wks
72
Meningitis empirical - community
Benzylpenicillin
73
Meningitis empirical - hospital, 3months - 50 yrs
Cefotaxime or ceftriaxone 10 days
74
Meningitis empirical - hospital, >50 yrs
Cefotaxime or ceftriaxone + amoxicillin 10 days
75
Meningitis caused by meningococcal
Benzylpenicillin or cefotaxime 7 days
76
Meningitis caused by pneumococci or haemophilus influenzae
```
Cefotaxime + dexamethasone
14 days (pneumococci) 10 days ( h. Influenzae)
```
77
Meningitis caused by listeria
Amoxicillin + gentamicin 21 days
78
Meningitis caused by listeria - penicillin allergic
Co trimoxazole 21 days
79
Cholestatic pruritis
Colestyramine
80
Intrahepatic cholestasis in pregnancy
Ursodeoxycholic acid
81
Cluster headache - acute
Sumatriptan
| 100% 15L O2
82
Cluster headache prophylaxis
Verapamil
83
Croup 1st line
Dexamethasone single dose
84
Croup 2nd line
Nebulised adrenaline/epinephrine solution 1 in 1000
85
Cushing’s syndrome
Metyrapone
86
Endogenous cushing’s syndrome
Ketoconazole
87
CF - 1st line mucolytic
Dornase Alfa
88
CF - 2nd line mucolytic
Add hypertonic sodium chloride
89
Hyperuricaemia (tumour lysis syndrome)
Allopurinol
90
Hyperuricaemia in haematological malignancy
Rasburicase
91
Mild-moderate Alzheimer’s
Donepezil, galantamine or rivastigmine
92
Moderate Alzheimer’s + CI acetylcholinesterase inhibitor or severe Alzheimer’s
Memantine
93
Mild-moderate Lewy body dementia
Donepezil or rivastigmine
94
Pre existing T2 DM in pregnancy
5 mg folic acid
| All anti diabetic drugs except metformin stopped
95
Gestational DM - 1st line, fasting glucose <7
Diet and exercise
96
Gestational DM - 2nd line, fasting glucose <7
Metformin
97
Gestational DM - 3rd line, fasting glucose <7
Insulin
98
Gestational DM - 1st line, fasting glucose >7
Insulin +/- metformin
99
DKA step 1
IV fluid
100
DKA step 2
IV insulin
101
DKA step 3
Potassium + glucose administration
102
Oedema and ascites caused by cirrhosis of liver
Spironolactone
103
Galactorrhoea
Bromocriptine
104
Prolactinomas
Bromocriptine
105
Suppression of lactation
Cabergoline
106
Mild otitis externa
Acetic acid 2%
107
Otitis externa - pseudomonas
Ciprofloxacin
108
Otitis externa - no penicillin allergy
Flucloxacillin
109
Otitis externa - penicillin allergy
Clarithromycin or azithromycin or erythromycin
110
Otitis externa 1st line
Topical antibiotic or topical antibiotic + steroid
111
Otitis externa 2nd line
Oral antibiotics
112
Otitis media 1st line - no penicillin allergy
Amoxicillin
113
Otitis media 2nd line - no penicillin allergy
Co amoxiclav
114
Otitis media 1st line - penicillin allergy
Clarithromycin or erythromycin
115
When to consider Abx in otitis media
```
Symptoms >4 days or not improving
Systemically unwell
Immunocompromised
<2 yrs w/ bilateral
If they have perforation +/or discharge in canal
```
116
Eczema 1st line
Emollients
117
Eczema 2nd line
Topical steroids
118
Emergency contraception - time allowed for an IUD
Up to 120 hrs (5 days)
119
Emergency contraception - time allowed for levonorgestrel
72 hrs (3 days) (efficacy decreases over time)
120
Emergency contraception - time allowed for ullipristal acetate
```
120 hrs (5 days)
More effective than levonorgestrel
```
121
Emergency contraception - BMI >26 or >70kg, hormonal option
Ullipristal acetate OR
| Double dose levonorgestrel
122
Emergency contraception - when is levonorgestrel 1st line
Females on regular combined hormonal contraception who have missed contraception within the 1st week of restarting their contraceptive
123
Emergency contraception - when to restart contraception following levonorgestrel
Immediately
124
Emergency contraception - when to start contraception following ulipristal acetate
5 days after + use barrier/abstain during this period
125
Endometriosis - 1st line
Paracetamol +/- NSAID
126
Endometriosis - 2nd line
COCP or POP
127
Endometriosis - 3rd line (after referring)
Gonadotropin releasing hormones for 3 months
128
Endometriosis - 4th line
Laparoscopic excision or ablation
129
Endometriosis - 5th line
Hysterectomy
130
Erectile dysfunction
Avanafil, sildenafil or vardenafil
131
Huntington’s chorea
Tetrabenazine
132
Tardive dyskinesia
Tetrabenazine
133
Essential tremor
Propranolol
134
MND ALS
Riluzole
135
Exocrine pancreatic insufficiency
Pancreatin
136
Purulent conjunctivitis
Chloramphenicol eye drops
137
Trachoma (eye thing) from chronic infection w/ chlamydia
Oral azithromycin
138
Hyperkalaemia - stabilisation of cardiac membrane (1st step)
IV calcium chloride 10% or calcium gluconate 10%
139
Hyperkalaemia - short term shift in K+ from ECF to ICF (2nd step)
Combined insulin/dextrose infusion
| Nebulised salbutamol
140
Hyperkalaemia - removal of K+ from body (3rd step)
Calcium resonium
Loop diuretics
Dialysis
141
Gallstones - mild-moderate pain
Paracetamol or NSAID
142
Gallstones - severe pain 1st line
IM diclofenac
143
Gallstones - severe pain 2nd line
IM morphine or IM penthidine
144
Gallstones - definitive management
Laparoscopic cholecystectomy
145
Campylobacter enteritis
Clarithromycin or azithromycin or erythromycin
146
Suspected or confirmed uncomplicated acute diverticulitis
Oral co amoxiclav
147
Suspected or confirmed complicated acute diverticulitis
IV co amoxiclav OR IV cefuroxime w/ metronidazole OR IV amoxicillin w/ gentamicin and metronidazole
148
Salmonella
Ciprofloxacin or cefotaxime
149
Shigellosis
Ciprofloxacin or azithromycin
150
Typhoid fever
Cefotaxime or ceftriaxone
151
1st episode c diff - 1st line
Oral vancomycin
152
1st episode c diff - 2nd line
Fidaxomicin
153
Further episode of c diff (infection within 12 wks) - 1st line
Fidaxomicin
154
Life threatening c diff
Oral vancomycin + IV metronidazole
155
Biliary tract infection
Ciprofloxacin or gentamicin or a cephalosporin
156
Peritonitis
A cephalosporin + metronidazole OR gentamicin or metronidazole + clindamycin OR piperacillin w/ tazobactam
157
Peritonitis - peritoneal dialysis associated
Vancomycin + ceftazidime added to dialysis fluid OR vancom added to dialysis fluid + ciprofloxacin by mouth
158
GORD - 1st line
PPI for 4 or 8 wks
159
GORD - 2nd line
Histamine 2 receptor antagonist
160
Bacterial vaginosis
Oral metronidazole 5-7 days or single high dose metronidazole
Alternative: topical metronidazole for 5 days or topical clindamycin for 7 days
161
Chlamydia
Azithromycin or doxycycline
162
Gonorrhoea - 1st line
IM ceftriaxone
163
Gonorrhoea - needle phobia
Oral cefixime + oral azithromycin
164
PID
Doxycycline + metronidazole + single dose IM ceftriaxone
165
Early syphilis (<2 yrs)
Single dose benzylpenicillin
166
Early syphilis (<2 yrs) - penicillin allergic
Doxycycline or erythromycin for 14 days
167
Late latent syphilis (asymptomatic >2 yrs)
Benzylpenicillin once weekly for 2 wks
168
Asymptomatic contacts of patients w/ infectious syphilis
Doxycycline for 14 days
169
Chronic open angle glaucoma - 1st line
360° selective trabeculoplasty
170
Chronic open angle glaucoma - first line if 360° SLT not used/while waiting
Topical prostaglandin analogues e.g. latanoprost
171
Chronic open angle glaucoma - 2nd line
Topical beta blocker e.g. timolol OR topical carbonic anhydrase inhibitor e.g. brinzolamide OR topical sympathomimetic e.g. brimonidine OR a combination of these
172
Chronic open angle glaucoma - 3rd line
Surgery
173
Acute gout attack
Colchicine or high dose NSAID
174
Long term control of gout - 1st line
Allopurinol + colchicine (for 6 months after acute attack)
175
Long term control of gout - 2nd line
Febuxostat
176
H pylori, no penicillin allergy - 1st line
PPI + amoxicillin + clarithromycin or metronidazole
| 7 days
177
H pylori, no penicillin allergy - 2nd line
PPI + amoxicillin + clarithromycin or metronidazole (whichever wasn’t used 1st line)
7 days
178
H pylori, penicillin allergy - 1st line
PPI + clarithromycin + metronidazole
179
Heavy menstrual bleeding - 1st line
IUS
180
Heavy menstrual bleeding - IUS unsuitable
Tranexamic acid
NSAID
COCP
181
Fibroids that cause enlarged or distorted uterus
Gonadotropin releasing analogue then myomectomy or hysterectomy
182
Chronic hepatitis B
Entecavir, peginterferon alfa, tenofovir alafenamide or tenofovir disoproxil
183
Chronic hepatitis C
Sofosbuvir w/ ribavirin
184
Systemic treatment of VZV
Aciclovir
185
Systemic and topical treatment of HSV of skin and mucus membranes
Aciclovir
186
HIV initial treatment
2 NRTIs as backbone regimen + 1 of…
- INI
- NNRTI
- PI
187
Hyperhydrosis
Topical 20% aluminium chloride
188
Primary hyperparathyroidism - 1st line
Parathyroidectomy
189
Primary hyperparathyroidism - surgery unsuccessful or not suitable
Cinacalet
190
Graves’ disease - 1st line
Radioactive iodine
191
Graves’ disease - 1st line if radioactive iodine unsuitable
Carbimazole
192
Graves’ disease - 2nd line or pregnant/trying to conceive
Propylthiouracil
193
Thyrotoxicosis without hyperthyroidism
Beta blockers
194
Hypoglycaemia, BG >4
Small carb snack
195
Hypoglycaemia, BG <4 - conscious and able to swallow
Glucose tablet, gel, pure fruit juice
196
Hypoglycaemia, BG <4 - oral stuff doesn’t work
IM glucagon or glucose 10% IV
197
Hypoglycaemia + unconsciousness - 1st line
Glucagon
198
Hypoglycaemia + unconsciousness - 2nd line (no response after 10 mins)
Glucose 20% IV infusion
199
Infertility in PCOS
Clomifene
200
Hypothyroidism
Levothyroxine
201
What is given to reduce the possibility of methotrexate toxicity
Folic acid
202
Acute immune thrombocytopenic purpura
Prednisolone
203
Persistent or chronic immune thrombocytopenic purpura
Thrombopoietin receptor agonists OR fostamatinib
204
immune thrombocytopenic purpura - drug therapy has failed
Splenectomy
205
Influenza
Oseltamivir or zanamivir
206
Iron overload associated with haemochromatosis - 1st line
Repeated venesection
207
Iron overload associated with haemochromatosis - 1st line CI
Desferrioxamine
208
Leprosy
Dapsone + rifampicin + clofazimine
209
Acute low back pain
NSAIDs
210
Acute low back pain - NSAID not tolerated
Weak opioid +/- paracetamol
211
Severe sciatica
Epidural injections of local anaesthetic +/or corticosteroid
212
Lyme disease
Doxycycline
213
Lyme disease - doxycycline CI
Amoxicillin
214
Hypomagnesaemia - symptomatic
IV or IM magnesium sulfate
215
Hypomagnesaemia - asymptomatic
Oral magnesium glycerophosphate
216
Malaria prophylaxis - 1 wk before travel
Chloroquine + proguanil hydrochloride
217
Malaria prophylaxis - 2-3 wk before travel
Mefloquine
218
Malaria prophylaxis - 1-2 days before travel
Atovaquone w/ proguanil hydrochloride or doxycycline
219
How long should malaria prophylaxis be continued for after leaving the area
4 wks
| Except Atovaquone w/ proguanil hydrochloride, which should be stopped 1 wk after leaving
220
Uncomplicated p. falciparum malaria
Artemether w/ lumefantrine
221
Severe or complicated p. falciparum malaria
IV artesunate
222
Uncomplicated non falciparum malaria
Artemether w/ lumefantrine or artenimol w/ piperaquine phosphate or chloroquine
223
Uncomplicated non falciparum malaria - prevention of relapses
Primaquine
224
Complicated non falciparum malaria
IV artesunate
225
Acute mania or hypo mania - 1st line
Haloperidol, olanzapine, quetiapine or risperidone
226
Acute mania or hypo mania - 2nd line
Add Lithium or valproate
227
Long term management of bipolar disorder - 1st line
Lithium
228
Long term management of bipolar disorder - 2nd line or if lithium CI
Add valproate/valproate alone
229
Depression + bipolar
Fluoxetine
230
Acute migraine - 1st line
Aspirin or ibuprofen or sumitriptan
231
Acute migraine - 2nd line
Sumatriptan + naproxen
232
Migraine antiemetic - 1st line
Metoclopramide or prochlorperazine
233
Migraine antiemetic - 2nd line
Domperidone
234
Migraine prophylaxis- 1st line
Propranolol
235
Migraine prophylaxis - 2nd line (non child bearing)
Topiramate
236
Migraine prophylaxis - other
Amitriptyline, sodium valproate
237
MND muscle cramps - 1st line
Quinine
238
MND muscle cramps - 2nd line
Baclofen
239
MND muscle spasticity, stiffness or increased tone
Baclofen, dantrolene, tizanidine or gabapentin
240
Active relapsing remitting MS
DMARDs
241
Reducing relapse risk in MS - 1st line
Natalizumab
242
Reducing relapse risk in MS - other
Fingolimod
Beta interferon
Glatiramer acetate
243
MS acute relapse
High dose oral or IV methylprednisolone for 5 days
244
Spasticity in MS
Baclofen or gabapentin
245
Osteomyelitis
Flucloxacillin 6 wks
246
Osteomyelitis - penicillin allergic
Clindamycin 6 wks
247
Osteomyelitis - MRSA suspected
Vancomycin or teicoplanin 6 wks
248
Septic arthritis
Flucloxacillin 4-6 wks
249
Septic arthritis - penicillin allergic
Clindamycin 4-6 wks
250
Septic arthritis - MRSA suspected
Vancomycin or teicoplanin
251
Septic arthritis - gonococcal arthritis or gram -ve
Cefotaxime or ceftriaxone 4-6 wks
252
Menieres - acute
Antihistamines e.g, cyclizine or prochloperazine
253
Menieres - reducer if severity and frequency
Betahistine dihydrochloride
254
myasthenia gravis - 2nd line
Prednisolone + azathioprine
255
myasthenia gravis - 3rd line
Ciclosporin, methotrexate or mycophenolate mofetil
256
Myasthenia gravis - 1st line
Pyridostigmine
257
Myasthenic crisis
Plasmapheresis + IV immunoglobulins
258
Lambert Eaton syndrome
Prednisolone +/- azathioprine
259
Trigeminal neuralgia
Carbamazepine
260
Nocturnal enuresis - 1st line
Behaviour type advice
261
Nocturnal enuresis - 2nd line
Enuresis alarm
262
Nocturnal enuresis - 3rd line
Desmopressin
263
Sinusitis - 1st line
Phenoxymethylpenicillin
264
Sinusitis - 2nd line
Co amoxiclav
265
Sinusitis - 1st line, penicillin allergic
Doxycycline or clarithromycin (erythromycin in pregnancy)
266
Obesity - BMI >30
Orlistat
267
Obesity - BMI >40 or 35-40 w/ T2 DM or high BP
Bariatric surgery
268
Abortion
Mifepristone + misoprostol
269
Induction of labour - 1st line
Membrane sweep
270
Induction of labour - 2nd line
Vaginal prostaglandin E2
271
Induction of labour - 3rd line
Oxytocin infusion
272
Induction of labour - 4th line
Amniotomy
273
Induction of labour - 5th line
Cervical ripening balloon
274
Uterine hyperstimulation
Stop oxytocin
| Terbutaline
275
Ectopic pregnancy
Methotrexate
276
Thrush from inhaler use - 1st line
Rinse mouth with water or clean teeth after use
277
Thrush from inhaler use - 2nd line
Nystatin or miconazole
278
Gingivitis
Metronidazole or amoxicillin
279
Mouth abscess - 1st line
Phenoxymethylpenicillin or amoxicillin
280
Mouth abscess - penicillin allergy
Clarithromycin
281
Mouth abscess + signs of spreading infection
Add metronidazole
282
Acute sore throat
Phenoxymethylpenicillin 5-10 days
283
Acute sore throat - penicillin allergic
Clarithromycin or erythromycin 5 days
284
Osteoarthritis - 1st line
Paracetamol +/- topical NSAID
285
Osteoarthritis - 2nd line
Oral NSAID or codeine
286
Osteoarthritis - moderate to severe
Intra articular corticosteroid injection
287
Osteoporosis - 1st line
Smoking cessation
| Calcium + vitamins D
288
Osteoporosis - 2nd line
Oral bisphosphonate - alendronic acid or risedronate sodium
289
Osteoporosis - 3rd line
Denosumab
290
Osteoporosis - severe, very high risk, vertebral fractures
Teriparatide or romosozumab
291
When should bisphosphonate therapy be reviewed
After 5 years
292
Parkinson’s w/ motor symptoms that decrease their quality of life - 1st line
Levodopa + co careldopa or co beneldopa
293
Parkinson’s w/ motor symptoms that do not decrease their quality of life - 1st line
Levodopa OR non ergotic dopamine receptor agonist (pramipexole, ropinirole or rotigotine) OR monoamine oxidase B inhibitors (rasagiline or selegiline)
294
Parkinson’s w/ dyskinesia or motor symptoms despite optimal levodopa therapy should be offered…
Adjunct - non ergotic dopamine receptor agonist (pramipexole, ropinirole or rotigotine) OR monoamine oxidase B inhibitors (rasagiline or selegiline) OR COMT inhibitors (entacapone or tolcapone)
295
Parkinson’s - What to offer if symptoms not controlled w/ levodopa + non ergotic dopamine agonists
Ergot derived dopamine agonist e.g. bromocriptine, cabergoline or pergolide
296
Parkinson’s + excessive daytime sleepiness
Modafinil
297
Parkinson’s psychotic symptoms - 1st line
Quetiapine
298
Parkinson’s psychotic symptoms - 2nd line
Clozapine
299
Parkinson’s drooling
Glycopyrronium bromide
300
Hyperphosphateaemia + stage 4/5 CKD - 1st line
Dietary management + dialysis optimised
301
Hyperphosphateaemia + stage 4/5 CKD - 2nd line
Calcium acetate (phosphate binder)
302
Hyperphosphateaemia + stage 4/5 CKD - 3rd line
Selelamer (non calcium based phosphate binder)
303
Superficial basal cell carcinoma
Imiquimod + topical fluorouracil
304
actinic keratosis
Fluorouracil +/- salicylic acid
305
Pneumocystis jirovecii - 1st line
Co trimoxazole
306
Pneumocystis jirovecii - 2nd line
Atovaquone
| If severe - pentamidine IV
307
PCOS symptoms
COCP
308
Primary biliary cholangitis
Ursodeoxycholic acid
309
Schizophrenia - illness not responded to 2 different antipsychotic drugs
Clozapine
310
Severe bronchiolitis caused by RSV
Ribavirin
311
Prophylaxis against RSV
Palivizumab
312
Epiglottitis (h. Influenzae)
Cefotaxime or ceftriaxone
313
Bronchiectasis acute exacerbation - 1st line
Amoxicillin, clarithromycin or doxycycline
314
Bronchiectasis acute exacerbation - 2nd line
Co amoxiclav or levofloxacin
315
COPD acute exacerbation - 1st line
Amoxicillin, clarithromycin or doxycycline 5 days
316
COPD acute exacerbation - 2nd line
Try one of the other 1st line drugs
| Co amoxiclav, levofloxacin or co trimoxazole 5 days
317
Pneumonia, community acquired - low severity, 1st line
Amoxicillin
318
Pneumonia, community acquired - low severity, 1st line, penicillin allergy
Clarithromycin, doxycycline or erythromycin (pregnancy)
319
Pneumonia, community acquired - moderate severity, 1st line
Amoxicillin
320
Pneumonia, community acquired - moderate severity, 1st line, atypical suspected
Amoxicillin + clarithromycin or erythromycin (pregnancy)
321
Pneumonia, community acquired - moderate severity, 1st line, penicillin allergic
Clarithromycin or doxycycline
322
Pneumonia, community acquired - high severity, 1st line
Co amoxiclav + clarithromycin or erythromycin
323
Pneumonia, community acquired - high severity, 1st line, penicillin allergic
Levofloxacin
324
Pneumonia, hospital acquired - low severity, 1st line
Co amoxiclav
325
Pneumonia, hospital acquired - low severity, 1st line, penicillin allergic
Doxycycline, cefalexin, co trimoxazole or levofloxacin
326
Pneumonia, hospital acquired - high severity, 1st line
IV piperacillin w/ tazobactam, ceftazidime, ceftriaxone, cefuroxime, levofloxacin or meropenem
327
Pneumonia, hospital acquired - high severity, MRSA suspected
Add vancomycin or teicoplanin or linezolid
328
Rheumatoid arthritis - 1st line
DMARD - methotrexate, leflunomide or sulfasalazine
329
Rheumatoid arthritis - 2nd line
DMARD combination therapy - methotrexate, leflunomide, sulfasalazine or hydroxychloroquine
330
Rheumatoid arthritis - 3rd line
TNF alpha inhibitor - adalimumab, etanercept, golimumab or infliximab
OR biological DMARD - abatacept, sarilumab or tocilizumab
OR targeted synthetic DMARD - baricitinib, filgotinib, tofacitinib
331
Rheumatoid arthritis - 4th line
Rituximab + methotrexate
332
Rosacea - mild
Topical metronidazole
333
Rosacea - predominant flushing but limited telangiectasia
Topical brimonidine gel
334
Rosacea - severe
Oral antibiotics e.g. oxytetracycline
335
Rosacea - prominent telangiectasia
Laser therapy
336
Severe dandruff/seborrhoeic dermatitis
Ketoconazole shampoo
337
Hirsutism - mild-moderate
Eflornithine
338
Hirsutism - moderate-severe
Co-cyprindiol
339
Pityriasis versi color
Ketoconazole shampoo
340
Scabies - 1st line
Permethrin
341
Scabies - 2nd line
Malathion
342
Scabies - 3rd line
Ivermectin
343
Head lice - 1st line
Dimeticone
344
Head lice - 2nd line
Malathion
345
Crab lice - 1st line
Permethrin or malathion
346
Impetigo, localised non bullous, systemically well - 1st line
Hydrogen peroxide 1% cream
347
Impetigo, localised non bullous, systemically well - 2nd line
Fusidic acid
348
Impetigo, widespread non bullous impetigo, systemically well
Topical or oral antibiotic
349
Impetigo, non bullous + systemically unwell or bullous - 1st line
Flucloxacillin
350
Impetigo, non bullous + systemically unwell or bullous - 1st line, penicillin allergy
Clarithromycin or erythromycin (pregnancy)
351
Cellulitis/erysipelas - 1st line
Flucloxacillin
352
Cellulitis/erysipelas - 1st line, penicillin allergic
Clarithromycin, erythromycin (pregnancy) or doxycycline
353
Cellulitis/erysipelas near eyes or nose - 1st line
Co amoxiclav
354
Cellulitis/erysipelas near eyes or nose - 1st line, penicillin allergic
Clarithromycin + metronidazole
355
Cellulitis/erysipelas, severe - 1st line
IV co amoxiclav, clindamycin, cefuroxime or ceftriaxone
356
Cellulitis/erysipelas, severe - 1st line, MRSA suspected
Add IV vancomycin or teicoplanin or linezolid
357
Human/animal bite - 1st line
Co amoxiclav
358
Human/animal bite - 1st line, penicillin allergic
Doxycycline + metronidazole
359
Mastitis during breast feeding
Flucloxacillin 10-14 days
360
Mastitis during breast feeding , penicillin allergic
Erythromycin
361
Ankylosing spondylitis - 1st line
NSAIDs + physiotherapy
362
Ankylosing spondylitis - 2nd line
TNF alpha inhibitor
363
Ankylosing spondylitis - 3rd line
Try another TNF alpha inhibitor
364
Ankylosing spondylitis - 4th line
Ixekizumab or secukinumab
365
Psoriatic arthritis - non progressive mono arthritis
Local corticosteroid injections
366
Psoriatic arthritis - peripheral polyarthritis, oligoarthritis or persistent mono arthritis
DMARDs - methotrexate, leflunomide or sulfasalazine
367
Angina - acute attack
Sublingual glyceryl trinitrate
368
Angina - prophylaxis, 1st line
Beta blocker - atenolol, bisoprolol, metoprolol or propranolol
369
Angina - prophylaxis, 1st line if beta blockers CI
Rate limiting calcium channel blocker - verapamil or diltiazem
370
Angina - prophylaxis, 2nd line
Beta blocker + calcium channel blocker
371
Angina - prophylaxis, 3rd line
Long acting nitrate, ivabradine, nicorandil or ranolazine mono therapy
372
TIA
Aspirin
373
Ischaemic stroke <4.5 hrs onset
Alteplase
374
Stroke long term management - 1st line
Clopidogrel
| Statin
375
Stroke long term management - 1st line not tolerated
Aspirin + dipyridamole
| Statin
376
Opioid dependence
Methadone or buprenorphine
377
TB - initial phase
Rifampicin + ethambutol + pyrazinamide + isoniazid for 2 months
378
TB - continuation phase
Rifampicin + isoniazid for 4 months
379
Latent TB, <65 yrs + treatment indicated e.g. HIV
Isoniazid + rifampicin for 3 months
| Isoniazid for 6 months
380
T1 DM - 1st line
Basal-bolus
381
Acute mild-moderate UC - 1st line
Topical aminosalicylate
382
Acute mild-moderate UC - 2nd line
Oral aminosalicylate
383
Acute severe UC - 1st line
IV corticosteroids - hydrocortisone or methylprednisolone
384
Acute severe UC - 2nd line
IV ciclosporin
385
Acute severe UC - 3rd line
Infliximab
386
Maintaining remission in UC - 1st line
Rectal aminosalicylate +/- oral aminosalicylate
387
Maintaining remission in UC - 2nd line (2+ exacerbations in 12 months that required systemic corticosteroids, or remission not maintained with first line)
Oral azathioprine or mercaptopurine
388
Urgency incontinence - 1st line
Bladder training
389
Urgency incontinence - 2nd line
Oxybutinin
390
Stress incontinence - 1st line
Pelvic floor muscle training
391
Stress incontinence - 2nd line
Duloxetine
392
Benign prostatic hyperplasia - 1st line
Alpha-1 antagonists e.g. tamulosin
393
Benign prostatic hyperplasia - 1st line, raised PSA, high risk of progression
5 alpha reductase inhibitor e.g. finasteride
394
Benign prostatic hyperplasia - 2nd line
Alpha-1 selective adrenoceptor blocker + 5 alpha reducesse inhibitor
395
Benign prostatic hyperplasia - 3rd line
TURP
396
Lower UTI, not pregnant - 1st line
Trimethoprim or nitrofurantoin
397
Lower UTI, not pregnant - 2nd line
Nitrofurantoin (if not used 1st line), fosfomycin, pivmecillinam
398
Lower UTI, pregnant, 1st trimester - 1st line
Nitrofurantoin
399
Lower UTI, pregnant, 3rd trimester - 1st line
Amoxicillin or cefalexin
400
Lower UTI, pregnant, 1st trimester - 2nd line
Amoxicillin or cefalexin
401
Acute prostatitis - 1st line
Ciprofloxacin or ofloxacin
| Alternative: trimethoprim
402
Acute prostatitis - 2nd line
Levofloxacin or co trimoxazole
403
Pyelonephritis - oral first line
Cefalexin or ciprofloxacin
404
Pyelonephritis - IV first line (severely unwell)
Gentamicin, ceftriaxone, cefuroxime, ciprofloxacin
405
Catheter associated UTI, no upper UTI symptoms - 1st line
Amoxicillin, nitrofurantoin or trimethoprim
406
Catheter associated UTI, no upper UTI symptoms - 2nd line
Pivmecilinam
407
Catheter associated UTI, upper UTI symptoms - oral 1st line
Cefalexin, ciprofloxacin, co amoxiclav or trimethoprim
408
Catheter associated UTI, upper UTI symptoms - IV 1st line
Gentamicin, ceftriaxone, cefuroxime, ciprofloxacin or co amoxiclav
409
Vulvovaginal candidiasis
Oral fluconazole or itraconzaole OR pessary/cream clotrimazole, miconazole
410
Vulvovaginal candidiasis in pregnancy
Intravaginal clotrimazole
411
VTE prophylaxis - mechanical
Anti embolism stockings
412
Proximal DVT or PE - 1st line
Apixaban or rivaroxaban
413
Proximal DVT or PE - 2nd line
LMWH for 5 days then dabigatran or edoxaban
414
How long anticoagulation after provoked DVT/PE
3 months
415
How long anticoagulation after unprovoked DVT/PE
6 months
416
Anogenital warts - multiple non keratinised, 1st line
Topical podophyllotoxin
417
Anogenital warts - solitary keratinised, 1st line
Cryotherapy
418
Anogenital warts - 2nd line
Imiquimod
419
Acute dystonia 2⁰ to antipsychotics
Procyclidine
