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Medicine management Flashcards

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1
Q

HTN

A

Diabetic anyone: ACEi

  1. <55ACEi/ARB, >55/black CCB
  2. ACEi/ARB + CCB (Blacks prefer ARB)
    • Thiazide
    • more thiazide/spironolactone
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2
Q

HF

A
  1. ACEi/BB
  2. ARB/Furosemide/Spironolactone/Hydralazine + nitrate (black)
  3. Digoxin
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3
Q

Angina

A
  1. Lifestyle: smoking, weight/exercise
  2. Aspirin, Clopidogrel, Statin, ACEi, BB, CCB/ARB
    - Symptoms: GTN spray
  3. Surgery: PCI/CABG
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4
Q

Asthma

A
  1. SABA -> ICS appears to be 1st line now, SABA with exacerbations
  2. ICS
  3. LRTA antagonist (montelukast)
  4. LABA (instead of SABA)
  5. OCS (pred) (CI in paeds)
  6. Hospital MART (maintanance and reliever therapy)
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5
Q

COPD

A 
SAMA/LAMAntagonists, ICS, theophylline + O2 if bad
LAMA used 1st line maintenance
SABA used 1st line rescue therapy 
Adjuncts: mucolytic
Diet: high calories
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6
Q

UTI

A
  1. Nitrofurantoin/trimethoprim

2. Amoxicillin/cefalexin

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7
Q

Anti-HER2 breast cancer

A

Trastuzumab

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8
Q

Premeno breast cancer

A

Oophrectomy + tamoxifen

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9
Q

Postmeno breast cancer

A

Aromatase inhibitor Anastrozole

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10
Q

Diabetes

A
  1. Diet/exercise
  2. Metformin
    • Sulfonylurea (gliclazide)
  4. Thiazolidinedione/Incretin/SGLT-2 inhibitor/GLP-1 agonist
  5. Insulin therapy -> can increase dose
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11
Q

Schizophrenia

A
  1. Atypical (aripiprazole)
  2. Add a/typical
  3. Clozapine
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12
Q

Generalised Anxiety

A
  1. SSRI

2. TCA/antipsychotic/benzo/pregabalin

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13
Q

Depression

A
  1. SSRI
  2. SNRI
  3. TCA/MAOI
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14
Q

C diff

A
  1. Vancomycin or metronidazole
  2. Both
  3. Faecal donor
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15
Q

RA

A
  1. DMARD + prednisolone + NSAID + PPI
    Non-pregnant: methotrexate/leflunomide
    Pregnant: sulfasalazine/hydroxychloroquine
  2. Biologics
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16
Q

H. pylori

A

Omeprazole, Amoxicillin/metronidazole, clarithromycin

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17
Q

MS

A

Acute: methylprednisolone
Ongoing: complicated

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18
Q

GORD

A
  1. Lifestyle: weight, alcohol, smoking
  2. Antacids
  3. PPI/H2-antagonist
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19
Q

OA

A
  1. Lifestyle: weight, smoking, exercise/physio
  2. NSAIDS + steroids + PPI
  3. Arthroplasty
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20
Q

Herpes simplex/zoster

A

Acyclovir

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21
Q

Dementia

A
  1. AChEi: donepezil/galantamine/rivastigmine

2. Aspartate/NMDA inhibitor: memantine

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22
Q

Gonorrhoea

A

100mg IM Ceftriaxone

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23
Q

Chlamydia

A

Doxycycline BD 7d

Pregnant: Azithromycin

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24
Q

NGU

A
  1. Doxycycline 7d, Azithromycin 2d

3. Moxifloxacin 10d

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25
HPV6/11/16/18
Gardasil
26
PID
1. Ceftriaxone + Doxycycline + Metronidazole
27
Pubic lice
Lyclear permethrin cream + malathion
28
Delirium
1. Underlying disease 2. Haloperidol + olanzapine/risperidone 3. Benzodiazepine (any withdrawal)
29
Ischaemic stroke
<4.5h: thrombolytic alteplase + thrombectomy + aspirin 300mg for 2W/clopidogrel + atorvastatin after 48h >4.5h/thrombolysis contraindicated: Aspirin 300mg + atorvastatin after 48h AF: warfarin Secondary prevention: 1. Clopidogrel, atorvastatin, HTN treatment AF: anticoagulant
30
Epileptic fit (including monitoring)
Monitoring: ECG + BP <5mins: 1st aid >5mins: Rectal diazepam, IV lorazepam, Buccal midazolam
31
Status epilepticus
20-40mins: Alert anaesthetist + Levetiracetam/s valproate/Phenytoin/fosphenytoin 40-60mins: propofol/midazolam/thiopental
32
Polymorphonuclear meningitis | including contact prophylaxis
1200mg penicillin/Ig cefotaxime + dexamethosone | Contact: rifampicin
33
AF (stable, unstable, prophylaxis)
``` Stable: - Rate 1. BB/CCB (verapamil) 2. Digoxin 3. Digoxin + BB + CCB (diltiazem) -Rhythm: defibrillation HC: amiodarone No HC: sotalol, flecainide, propafenone Unstable: 1. Defib + heparin 2. Defib + amiodarone Prophylaxis: warfarin + dab/riv/apix ```
34
Osteoporosis (including vits)
Vitamins (calcium + vit D 1. Alendronate 2. Denosumab 3. Oestrogens/testosterone 4. PTH injection?
35
Ankylosing spondylitis/psoriatic arthritis
1. Morning exercise/physio 2. NSAIDS + PPI 3. Methotrexate 4. TNF-alpha
36
GCA
Prednisolone | - Fugax: IV pred
37
ICP
1. Mannitol 2. Sedation (propofol + morphine) 3. Cut skull
38
Cerebral oedema
dexamethosone
39
Migraines (including preventon)
Paracetamol/NSAIDS/triptans/High dose aspirin/Metocloperamide (antiemetic) Prevention: topiramate, propranolol, amitryptiline, botox
40
Cluster
O2 + topiramate/triptan
41
Trigeminal neuralgia
Carbemazepine
42
TB chronic meningitis
Pred, rifampicin, isoniazid, pyrazinamide
43
SAH
nimodipine
44
Myasthenia gravis
Neostigmine, Pred+ azathioprine, ventilation
45
Motor neuron disease
Riluzole
46
Parkinson's
Co-careldopa (carbidopa, levodopa)
47
HIV
2NRTIs + 1 other
48
PEPSE (including days)
Tenovir + Raltegravir 28d
49
Postural hypotension
Fludrocortisone | Midodrine
50
Bulaemia
Fluoxetine
51
Anorexia
Fluoxetine + atypical?
52
Delirium tremens
Chlordiazepoxide (long acting benzo) + B1 injection
53
Alcohol relapse prevention
Acamprosate Disulfiram Naltrexone
54
Nasal polyps
1. Fluticasone/mometasone spray | 2. Surgery
55
Benzo OD
Flumazenil
56
Essential tremor
Propranolol/little alcohol
57
Bipolar disorder 2
Carbamazepine + lamotrigine
58
Otitis externa
Vinegar + flumetasone/clioquinol/ + suction + NSAIDS/paracetamol
59
Otitis media (including AB treatment criteria)
paracetamol +NSAIDS +/- amoxicillin | - Amox if really bad or bilateral, or <2Y/O
60
Cholesteatoma (surgery, no drugs)
Mastoid sac debris removal
61
Tonsillitis (including course length)
Salt water + pred + 10d ABs 1. Amoxicillin/methylpenicillin + pred 2. Erythromycin + pred
62
Wet macular degeneration
Anti-VEGF
63
Gonococcal conjunctivitis
Penicillin
64
Non-gonococcal conjunctivitis
Chloramphenicol
65
Chlamydial conjunctivitis
erythromycin
66
Viral conjunctivitis
Corneal involvement: steroid eyedrops
67
Herpes simplex conjunctivitis
Acyclovir
68
Allergic conjunctivitis
Olopatadine
69
Darycocystitis
Cefalexin
70
Blepharitis
Chloramphenicol
71
Trachoma
Azithromycin
72
Open angle glaucoma
timolol, latanoprost, acetazolamide
73
Closed angle glaucoma
pilocarpine + acetazolamide
74
CRAO
aspirin + acetazolamide
75
Amaurosis fugax
Aspirin
76
CRVO
Glaucoma treatment
77
Hyperprolactinaemia
Dopamine agonist/surgery
78
Acromegaly
somatostatin/dopamine agonist/surgery
79
Pruritus eczema
Antihistamine
80
Eczema
Emolient: creams -> ointments Corticosteroid: hydrocortisone -> eumovate -> betnovate -> dermovate
81
Anaemia
1. Diet/underlying cause 2. Ferrous sulphate 3. Ferrous GLuconate Pernicious anaemia: B12
82
Acne vulgaris
General: anticomedonal + antikeratolytic + antibiotic Mild: Adapaline, Benzoyl peroxide, topical erythromycin Moderate: COC (females) + oral doxycycline/lymecycline Severe: Isotretinoin (anticomedonal)
83
Cellulitis (including patient position)
Flucloxacillin/benzylpenicillin + leg raise | Pen allergy: clarithromycin
84
Impetigo (including MRSA)
1. Fusicid cream 3x 7d 2. Oral flucloxicillin/erythromycin/clarithromycin MRSA: mupirocin
85
Yeast infection
Miconazole
86
Non-yeast fungal infection (including infection location determining route)
Terbinafine - Skin: topical - Widespread/nails: oral
87
Asthma exacerbation Status asthmaticus
O2 + salbutamol (SABA) + prednisolone (IV) - ABs if infection signs - MgSO4 life-threatening " and ipratroprium bromide (SAMA)
88
COPD exacerbation (including ABs regime + prophylaxis)
O2 + SAMA/SABA + pred + ABs + ventilation + LMWH Theophylline: if SAMA fails ABS: 1. Amoxicillin + doxycycline 5d -> doxycycline 4d more 2. Clarithromycin 5d Doxapram: if no ventilator Prophylaxis: pneumococcal vaccine + flu jab
89
Ulcerative colitis/Crohn's
``` UC flare suppression: Crohn's Budesonide instead of mesalazine 1. Mesalazine 2. Corticosteroid 3. Azathioprine 4. Infliximab 5. Vedolizumab 6. Colectomy UC maintenance: mesalazine Crohn's maintenance: methotrexate/azathioprine ```
90
Hep B (serious)
Tenovir
91
DVT (including prophylaxis + cancer patients)
Acute: 1. LMWH/UFH (5d) + NOAC (rivaroxaban) (6M) - Cancer: LMWH/UFH (3M) Prophylaxis: LMWH/warfarin
92
PE
``` DVT + O2 + morphine DVT: Acute: 1. LMWH/UFH (5d) + NOAC (rivaroxaban) (6M) - Cancer: LMWH/UFH (3M) Prophylaxis: LMWH/warfarin - Pregnant prophylaxis: LMWH only Haemodynamic instability: thrombolytic alteplase ```
93
Epididymo-orchitis (STI, UTI, dunno)
STI: cef + doxycycline UTI: trimethoprim/nitrofurantoin Dunno: ofloxacin
94
Hyperemesis gravidarum
1. Pyridoxine (B6) +/- Doxylamine (antihistamine) + Thiamine (B1) 2. Metocloperamide/ondansetron 3. Hydrocortisone -> pred when better -> gradual dose decrease
95
Postnatal depression
Sertraline
96
Gestational diabetes
1. Lifestyle: diet + exercise 2. Metformin 3. Glibenclamide 4. Insulin
97
Erectile dysfunction
Sildenafil, vacuum, prosthesis
98
Ectopic pregnancy
Methotrexate
99
Miscarriage
Misoprostol +/- Anti-D -> maybe vacuum
100
Minimise PPH from placental delivery
Oxytocin
101
Uterine atony -> PPH
1. Massage 2. Oxytocin 3. Carboprost 4. Misoprostol
102
Labour induction (Bishop's score) ARNOP
1. Ripen cervix -> prostaglandin pessarie 2. INduction: antiprogesterone, relaxin, NO, oxytocin, prostaglandin Failed ripening: C-section
103
<34W delivery
OCS + nifedipine + atosiban + MgSO4
104
PROM
OCS + antibiotics
105
Female subfertility
Clomiphene/GnRH/Donor/IVF
106
Menorrhagia
1. Minera coil/COC/NSAIDS 2. Progesterone (norethisterone) 3. Hysterectomy
107
Endometriosis
Contraception: COC + NSAIDS Surgery: removal/organ removal
108
Endometrial hyperplasia
Mirena coil
109
CO poisoning
High flow O2
110
Paracetamol OD
Acetylcysteine
111
Opioids OD
Naloxone + ventilation
112
Batteries swallowed
Endoscopic removal
113
Methymoglobulinaemia
O2 + methylene blue
114
Salicylates OD
electrolyte rebalance (K), urine alkalinisation, haemodialysis
115
TCA OD
Tachycardia: sodium bicarbonate | Decreased cardiac output/arrhythmia: amiodarone + ventilation
116
Digoxin OD
Arrhythmia: atropine | Decreased cardiac output: digoxin-fab
117
Antifreeze (ethylene glycol)
Fomepizole + haemodialysis
118
Cocaine OD
Cooling + diazepam HTN: CCB Angina: GTN
119
Alcohol
Correct GLU + ventilation
120
Delayed puberty (boys + girls)
Boys: oxandrolon Girls: estradiol
121
Paeds asthma <5y/o
1. SABA 2. ICS 3. LRTA montelukast
122
Pre-eclampsia prophylaxis (high risk)
Aspirin +/- Ca2+ 12W -> delivery
123
Pregnancy HTN
Nifedipine/labetalol/methyldopa
124
Labour convulsion
Lorazepam + CTG
125
Pre-eclampsia
Nifedipine/labetalol/methyldopa + hydralazine | Severe pre/eclampsia: MgSO4 +/- emergency c-section
126
Tall stature
sex steroids -> fuse bone plates
127
Pertussis whooping cough
erythromycin
128
Abortion prep antibiotics
Metronidazole + Doxy/azithromycin + NSAIDS
129
Medical abortion
mifepristone + misoprostol
130
Surgical
<16W vacuum | <24W dilate + evacuate
131
Morning sickness
Ginger/antiemetic/antihistamine
132
PCOS
COC/minera coil Clomiphene Obesity/diabetic treatment
133
BD acute mania
Lorazepam, antipsychotic, Li/S. valproate
134
Bipolar disorder type 1
Lithium, valproate, olanzapine
135
Allergic reaction
Antihistamine +/- corticosteroid
136
Anaphylactic shock
500ug adrenaline IM + O2 + antihistamine + corticosteroid
137
Fluid resus
ABCDE 1. 500ml NaCl/15mins 2. ABCDE 3. 250ml-500ml 4. >2L -> seek help
138
Diabetes insipidus
Desmopressin
139
Endocarditis ABs (including prophylaxis)
Acute: Vancomycin +/- gentamicin +/- antifungal Prophylaxis: amoxicillin
140
Cystic fibrosis
Tobramycin + Dornase alpha + Creon
141
High QRISK: (lower cholesterol)
1. Atorvastatin 2. Try 2 other statins 3. Ezetimibe
142
Acute lower limb infarction (embolus + thrombus)
Embolus: anticoagulation (warfarin/heparin) + percutaneous catheter-directed thrombolysis Thrombus: antiplatelet (aspirin/clopidogrel) + embolectomy/catheter angioplasty/bypass)
143
Paediatrics constipation
1. Movicol 2. Senna + lactulose/docusate Maintenance: docusate
144
Bone pain/metastasis
Bisphosphonates
145
Neuropathic pain
1. Amitriptyline (X heart problem) 2. Gabapentin (pregabalin if intolerated) 3. Amitriptyline + gabapentin 4. SPCT referral
146
Croup
Adrenaline + steroids
147
Hemochromatosis
Deferoxamine
148
Pompholyx
Betamethosone + Burow's solution
149
Urticaria
Non-sedating antihistamine
150
Acne rosacea
1. Metronidazole | 2. Doxycycline/lymecycline
151
Colocky pain (GI, urinary)
Hycoscine butylbromide
152
Muscle cramp/spasm pain
Baclofen, benzos
153
Opioid side effect management
Senna +/- docusate regularly, PRN metoclopramide
154
Constipation (soft + hard + neurological)
Soft: senna (stimulator) Hard: docusate (softner) Neurogenic: docusate -> senna
155
Metastatic spinal cord compression
dexamethasone + PPI + analgesia
156
Distress/agitation (Just-in case-meds)
midazolam
157
Sedation risk/psychosis/delirium (just-in case-meds)
haloperidol
158
Malignant hypercalcaemia
IV fluid rehydration -> bisphosphonate
159
Breathlessness (Just-in case-meds)
morphine/midazolam + O2
160
respiratory secretions (including HF)
HF: furosemide 1. Hyoscine butyl/hydrobromide 2. Glycopyrronium
161
Prostate cancer
GnRH agonist goserelin, leuprorelin
162
Lymphoma
steroids + chemo + radio
163
Ascites diuretics
1. Spironolactone | 2. Furosemide
164
Post-MI (COBRA)
``` Clopidogrel O? Beta blocker Ramipril Atorvastatin + aspirin ```
165
Ectopic beat
Adenosine
166
Septic arthritis + osteomyelitis
ABs: flucloxacillin + fusidic acid
167
Renal anaemia
EPO
168
Reactive arthritis (including chronic)
1. NSAIDS 2. Cortcosteroids Chronic: sulfasalazine Current infection: ABs
169
Gout (acute and prophylaxis)
1. NSAIDS + prednisolone 2. Colchicine Preventative 1. Allopurinol 2. Febuxostat
170
Carpal tunnel syndrome
Triamcinolone
171
Fibromyalgia
Pregabalin/duloxetine/ibuprofen
172
Breakthrough pain
1/6 dose oromorph (max dose 6 times/day)
173
Frozen shoulder
NSAIDS + steroid injection + local anaesthetic
174
Vasculitis/connective tissue disease (induction, maintenance + end-organ failure)
Induction remission: Prednisolone + PPI Maintenance therapy: methotrexate End-organ failure: cyclophosphamide
175
HSP (self-limiting unless glomerulonephritis) | - Glomerulonephritis management is same as vasculitis :)
WOOO
176
BPH
1. Lifestyle + monitor 2. Tamsulosin/Finasteride/Sildenafil 3. Doxazosin + Finasteride 4. Surgery
177
Bad prostate cancer
Bicalutamide + goserelin
178
Renal stones (including prophylaxis and UTI from stones)
Tamsulosin Prophylaxis: water + potassium citrate UTI: gentamicin
179
Postnatal depression
Sertraline
180
Post-partum psychosis
Olanzepine +/- lorazepam
181
HRT (womb and wombless)
Womb: progesterone + oestrogen | No womb: oestrogen
182
Hot flush menopause
Paroxetine (SSRI)
183
Fibroid (wants/doesn't want pregnancy)
Wants: COC/minera -> shrinks fibroid | Doesn't want: hysterectomy/polyp removal
184
Stillbirth
prostaglandins/misoprostol
185
Bacterial sinusitis in immunocompromised
co-amoxiclav
186
Bad sinusitis
Decongestants + corticosteroid spray
187
Vertigo
prochlorperazine
188
Fibroadenosis
Evening primrose, bromocriptine, tamoxifen
189
Mastitis
Flucloxacillin
190
Gynaecomastia
Danazol/clomiphene/tamoxifen/surgical
191
Gall stones -> acute cholecystitis (1 drug, 2 surgical options)
Hycoscine, shockwaves, cholecystectomy
192
Acute cholangitis
IV antibiotics
193
Acute pancreatitis
Resus, NG tube/nil-by-mouth, sepsis 6, surgery
194
Cholangiocarcinoma
Palliative
195
Cirrhosis ascites diuretic
Spironolactone
196
Hepatic encephalopathy
Lactulose + rifaximin -> liver transplant
197
Acute abdominal pain
Fluids + analgesia + underlying cause
198
Acute GI bleed | including something to help endoscopy visualisation
ABCDE + NG tube + fluids/O2/coagulation | - Metoclopramide (prokinetic)
199
Acute GI bleed clotting management
prothrombin complex (1972)
200
Oesophageal varices bleed
ceftriaxone, terlipressin, ligation/surgery
201
Achalasia
nifedipine/nitrates
202
Oesophageal stricture
PPI + endoscopic dilation + surgery
203
Chronic pancreatitis
Creon + omeprazole
204
CAP (1/6, 2/6, 3/6, s. aureus)
- 1/6: outpatient treatment -> amoxicillin 5d (pen allergic -> doxy) - 2/6: hospital admission -> amoxicillin + clarithromycin (all 5d) - 3/6: severe -> ITU (co-amoxiclav + clarithromycin) Staph aureus: fluclox IV
205
HAP (non/severe + MRSA)
- 1/6: co-amoxiclav - 3/6: piperacillin/tazobactam - MRSA: vancomycin
206
Aspiration pneumonia/Mendelson's syndrome
Metronidazole
207
TB
Latent: isoniazid Active: see chronic TB meningitis
208
Pulmonary HTN
CCB + warfarin + furosemide
209
IBS (general + C+ D + M)
IBS: Fibre + decrease stress, caffeine, lactose, fructose - C: ispaghula + citalopram + hyoscine - D: loperamide - M: both prescribed
210
Coeliac
gluten free + vit supplements + pneumococcal vaccine
211
Whipple's disease
ceftriaxone
212
Bacterial overgrowth
Rifaximin
213
Diverticulitis
High fibre, hydration, co-amoxiclav
214
Severe dehydration
IV Ringer's lactate solution rapid infusion
215
Anal fissure
laxatives + GTN ointment
216
Haemorrhoids
ligation/sclerotherapy/electrotherapy | External - surgery
217
Ascites
spironolactone, restriction (Na + H2O), drainage, ciprofloxacin
218
Infected eczema
Treat as cellulitis (flucloxacillin)
219
Shingles pain (including post-herpatic neuralgia)
amitriptyline/pregabalin -> carbamazepine
220
Paronychia
Mupirocin
221
Hyperkalaemia
1. Ca2+ 2. Insulin 3. Glucose
222
Pregnancy herpes
Acyclovir last 6W gestation + elective C-section
223
Sciatica
6W physio + normal activity -> unresolved -> MRI -> steroid injection + neuro pain management
224
Scarlet fever
penicillin
225
Pain control on MAX breakthrough
30% increase regular morphine
226
Bronchoscopy
midazolam + lidocaine + atropine
227
Smoking cessation (lifestyle + meds)
Lifestyle: self-help, group support, smoking clinic, behavioural therapy Meds: nicotine, bupropion, varenicline
228
Flu (general, ABs criteria, at-risk prophylaxis)
General: flu jab, paracetamol, rest, fluids ABs: chronic bronchitis, heart/renal disease At risk prophylaxis: oseltamivir (Tamiflu)
229
Acute bronchitis (incl. asthmatics)
Self-limiting | Asthmatics (SABA)
230
OSA (lifestyle + intervention)
Lifestyle: weight loss, alcohol, driving Intervention: CPAP
231
Bronchiectasis
Sputum physio + ABs + SABA/SAMA + ICS/OCS + flu/pneumococcal vaccine
232
Pneumothorax
1. Air needle aspiration 2. Intercostal tube drain 3. Surgery

Medicine Management (1 decks)

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