Treatments 1 Flashcards
(168 cards)
1
Q
Bacterial meningitis <1 month
A
Ampicillin (Listeria) + cefotaxime/gentamicin (E. coli, GBS)
2
Q
Bacterial meningitis (1 month-60 yrs)
A
Cefotaxime/Ceftriaxone (S. pneumo, N. meningitidis), Vancomycin (MRSA), Dexamethasone
3
Q
Bacterial meningitis > 60 yrs
A
Ampicillin (Listeria), Cefotaxime/Ceftriaxone (S. pneumo, N. meningitidis), Vancomycin (MRSA), Dexamethasone
4
Q
Prophylaxis, meningococcal/HiB meningitis
A
Rifampin or Ciprofloxican
5
Q
Fungal meningitis
A
Amphotericin B intrathecally
6
Q
TB active infection (meningitis, pulmonary)
A
Rifampin, Isoniazid, Pyrazinamide, Ethambutol
7
Q
Viral meningitis
A
Supportive, empiric abx until bacterial meningitis excluded, Acyclovir if suspected HSV
8
Q
Reye syndrome
A
Supportive
9
Q
Viral encephalitis
A
Supportive, maintain normal ICP, Acyclovir until HSV r/o
10
Q
Brain abscess empiric abx for comorbid oral, sinus, ear infx
A
Metronidazole + 3rd gen ceph (ceftriaxone)
11
Q
Brain abscess empiric abx for hematologous spread, neurosurgery
A
Ceftriaxone + vancomycin (MRSA)
12
Q
Brain abscess
A
Empiric abx, corticosteroids for mass effect (to decrease swelling), usu need neurosurgical drainage
13
Q
Rabies
A
Clean wound thoroughly, Rabies IG + vaccine
14
Q
Tension HA
A
NSAIDs, can use triptans, dihydroergotamine
15
Q
Cluster HA
A
100% O2 (>6 L/min on non-rebreather for >15-20 min)
Can use triptans, dihydroergotamine
16
Q
Migraine HA
A
Triptans (sumatriptan) or Dihydroergotamine (vasoconstrictors), NSAIDs, anti-emetics (chlorpromazine, prochlorperazine, metoclopramide) in varying combos
17
Q
Pseudotumor cerebri
A
Acetazolamide (first line, start low and increase)
Discontinue inciting agents (vit A, Accutane, long term tetracyclines for acne, corticosteroid withdrawal), weight loss if obese
Invasive - serial LPs, optic nerve sheath decompression, lumboperitoneal shunting
18
Q
Trigeminal neuralgia
A
Carbamazepine (first line), Baclofen (alone or combo), Anticonvulsants, Surgical decompression
19
Q
First TIA
A
ASA + statin if LDL >100
20
Q
TIA/stroke due to AF
A
Warfarin + statin if LDL >100
21
Q
TIA/stroke + CAD
A
Clopidogrel + statin if LDL >100
22
Q
Repeat TIA/stroke while on ASA
A
Clopidogrel or Aggrenox + statin if LDL >100
23
Q
CAD surgical indications
A
Carotid endarterectomy:
Symptomatic patients w/ narrowing 70-99%
Symptomatic men w/ narrowing 50-69%
Asymptomatic patients w/ narrowing 80-99% if life expectancy >5 yrs
24
Q
CAD nonsurgical treatments
A
HTN 35, TG <7%
Smoking cessation, exercise, red wine (avoid heavy drinking), ASA/Aggrenox/Clopidogrel
25
Ischemic stroke
Thrombolysis w/i 3-4.5 hrs, 6 hrs if direct catheter to brain and no C/I (hemorrhagic - look at CT/MRI, recent surgery/bleed, current AC, BP >185/100)
Antiplatelet started w/i 48 hrs (ASA/Clopidogrel/Aggrenox, Warfarin)
Statin started w/i 3 days
BP control if >220/120 or if CAD (wait for BP control in ischemic, may decrease perfusion)
PT, treat underlying disorders
26
Hemorrhagic stroke
```
Reverse AC (restart 2 wks after stable)
Control BP
Control ICP
Surgical decompression w/ shunt if blood collection
Usu need neurosurgery consult
PT, treat underlying disorders
```
27
Control increased ICP
Mannitol (lasts 4-5 hrs)
Hyperventilation
Anesthesia
Head of bed to 30 degrees
28
Parenchymal hemorrhage
Supportive, control ICP
Seizure prophylaxis w/ anticonvulsants
Surgical decompression if large
AVM or aneurysm repair if needed
29
SAH
Reverse and d/c AC
Systolic BP <150 if cognitive fxn intact (Labetalol, avoid nitroprusside and nitroglycerine - can +ICP)
Nimodipine (CCB) to prevent vasospasm
Good brain environment (avoid hypoxia, hypoglycemia; maintain normal pH, euvolemia, normothermia)
Ventriculostomy to monitor ICP in some patients
Surgical clipping/coiling if aneurysm
30
Epidural hematoma
```
Control ICP, good brain environment
Drain blood (surgical burr hole, drain w/ radiographic guidance)
```
31
Subdural hematoma
Supportive monitoring if no neural deficits
| Surgical drainage if needed
32
Normal pressure hydrocephalus
Ventricoperitoneal shunt
33
Grand-mal (tonic-clonic) seizures
Valproate, Carbamazepine, Phenytoin, Lamotrigine, Topiramate
34
Partial seizures
Carbamazepine, Lamotrigine, Phenytoin > Valproate, Topiramate
35
Absence seizures
Ethosuximide (Valproate second line)
36
Myoclonic seizures
Valproate
37
Non-medical treatment for recurrent seizures
Surgery (especially partial)
| Vagal nerve stimulator (refractory)
38
Status epilepticus
```
ABC
IV benzos immediately
Phenytoin to prevent recurrence
Phenobarbital for refractory (last resort)
Treat underlying disorder
```
39
Eclampsia - seizures
IV magnesium sulfate (first line)
Deliver baby
Benzos (last resort)
40
Depression
SSRI/SNRI (first line)
TCA (second line)
MAOI (third line)
ECT (refractory, psychotic, can't wait, catatonic stupor)
41
Atypical depression
MAOI > TCA (SSRI also work)
42
Depression w/ seasonal pattern
Phototherapy (first line)
| SSRI/Bupropion (second line)
43
Serotonin syndrome
D/c serotonergic agents
Supportive care
Sedation w/ benzos (or cyproheptadine, serotonin antagonist if refractory)
Sedation, paralysis and ET tube for temp >41.1
44
NMS
Dantrolene
45
Nephrogenic DI caused by lithium toxicity
HCTZ + amiloride (closes Na channels in CT where lithium acts)
46
Bipolar disorder
Mood stabilizer (first line)
Atypical antipsychotic (first/second line)
AD (not first line)
ECT
47
Cyclothymia
Mood stabilizer
| Psychotherapy
48
Anxiety disorders (in general)
SSRI/SNRI (first line)
TCA (much less), MAOI (rarely)
Buspirone
Benzos
49
GAD
SSRI/SNRI (Venlafaxine)
Buspirone
Beta blocker
CBT
50
Panic disorder
CBT
SSRI
Benzo (acute)
Relaxation training
51
Specific phobia
Systematic desensitization
52
Social anxiety disorder
```
CBT
Beta blockers
SSRI (severe)
MAOI (refractory)
Benzo (acute)
```
53
PTSD
Psychotherapy (behavioral/exposure, CBT)
SSRI (first line med)
TCA/MAOI
Mood stabilizers (carbamazepine/valproate) for impulsive behavior, arousal, flashbacks
Alpha-blockers (prazosin) for nightmares/sleep problems
Atypical antipsychotics (refractory)
54
Benzodiazepine OD
Flumazenil
55
Schizophrenia
Atypical antipsychotics (first line), Typical antipsychotics (second line), Clonazapine (third line)
56
Acute dystonia (typical AP side effect)
Anticholinergic (benztropine or diphenhydramine)
57
Tardive dyskinesia
Stop offending medication and start one with less movement AE
58
Parkinson's
```
1st line: Levodopa-Carbidopa (Sinemet)
2nd line: DA agonists (bromocriptine, etc.)
Selegiline (MAOI), early disease
COMT inhibitors (potentiate LD)
Anticholinergics (tremor)
Amantadine (increases DA release)
```
59
ALS
Riluzole
60
Huntington disease
DA antagonists (antipsychotics, tetrabenazine)
61
Alzheimer's disease
Donepezil, Rivastigmine, Galantamine (ACHase inhibitors)
| Memantine (MNDA receptor blocker)
62
MS
Corticosteroids (very high dose; acute attacks), IFN-B (maintenance)
Methotrexate, Glatiramer (maintenance), Natalizumab
63
Syringomyelia
Surgical decompression, shunting for recurrence
64
Nephrogenic DI
HCTZ
65
Benign essential tremor
```
Beta blockers (propranolol)
Self medicated w/ alcohol
Benzodiazepines
Primidone
Thalamotomy/DBS (refractory)
```
66
Chorea
Treat underlying disorder (hyperthyroidism, Huntington, SLE, rheumatic fever, levodopa use)
67
Athetosis
Treat underlying disorder (cerebral palsy, encephalopathy, Huntington, Wilson)
68
Dystonia
Levodopa/Carbidopa
Botulinum toxin
Treat underlying disorder
69
Hemiballismus
Haloperidol
70
Tics
DA antagonist (fluphenazine, pimozide, tetrabenazine)
71
Guillain-Barre syndrome
```
Supportive care (monitor for respiratory distress)
Plasmapheresis/IVIG
NO steroids
```
72
Lambert-Eaton
Treat cancer
ACHase inhibitors (neostigmine, pyridostigmine)
Immunosuppressors (prednisone, azathioprine)
Plasmapheresis
73
Myasthenia Gravis
ACHase inhibitors (neostigmine, pyridostigmine)
Immunosuppressors (prednisone, azathioprine)
Thymectomy
Plasmapheresis, IVIG (refractory)
74
Bell's palsy
Eye care to prevent corneal damage
Glucocorticoids
+/- Valacyclovir
75
Enuresis
Benzos (not in kids) (decrease N3 sleep)
76
Night terrors
Benzos (decrease N3 sleep)
77
Narcolepsy
Modafinil (stimulant) - first line; other ADHD stimulants
Venlafaxine, fluoxetine, atomoxetine - for cataplexy
Avoid drugs that cause sleepiness
Scheduled naps
Support group
78
Insomnia
```
Melatonin (OTC)
Valerian (OTC)
Antihistamines
Trazodone
TCAs
Benzodiazepines (short term)
Zolpidem/Zaleplon (short term)
Eszopiclone (long term)
Ramelteon (non-addictive)
```
79
Restless leg syndrome
Avoid caffeine, increase exercise
Pramipexole or ropinirole (DA agonists) or Levodopa, Carbidopa
Iron replacement
Clonazepam, Gabapentin, Opioids
80
Empiric therapy in ER w/ LOC
Glucose (with thiamine first)
| Naloxone (opioid OD)
81
Febrile seizures
Acetaminophen/Ibuprofen
Respiratory support if needed
Parental reassurance
82
Childhood hydrocephalus
Acetazolamide or furosemide
| Surgical shunting
83
Tay Sach's
```
Supportive care (death within a few years)
Genetic counseling
```
84
NTD
Surgical repair unless mild, shunting, PT
85
CP
For spasms: botulinum toxin, dantrolene, baclofen, benzos; PT, bracing, shunting, surgery
Speech therapy, special education, social and psychological support
86
Retinoblastoma
Enucleation (large tumors w/ no vision potential)
Radiation (b/l tumors, tumors near optic nerve)
Cryotherapy or laser photocoagulation (smaller tumors)
Chemotherapy (mets or vision salvage)
87
Myopia
Corrective lenses, laser correction
88
Hyperopia
Corrective lenses, laser correction
89
Astigmatism
Corrective lenses
90
Strabismus
Vision training, surgery frequently required
91
Amblyopia
Vision training, levodopa/carbidopa
92
Conjunctivitis
Self-limited
Topical sulfonamides or erythromycin reduce duration of bacterial
Antihistamines improve allergy symptoms
handwashing
93
Uveitis
Topical antibiotics if caused by infection
| Systemic corticosteroids if not (treat underlying condition)
94
Chalazion
Usu self-limiting
| Can treat w/ surgical excision and/or steroid injection
95
Hordeolum (stye)
Hot compress 3-4x/day for 10-15 min
I&D if unresolved in 48 hrs
+/- antibiotic ointment q3 hrs
96
Anterior blepharitis
Wash lid margins daily w/ shampoo
Remove scales daily w/ cotton ball
Antibiotic ointment qd to lid margins
97
Cataracts
Lens replacement surgery
98
Open angle glaucoma
Topical BB (timolol) and carbonic anhydrase inhibitors (acetazolamide)
Prostaglandin analogues
Alpha-adrenergic agonists and cholinergic agonists (pilocarpine)
99
Acute open or closed angle glaucoma
Pilocarpine (cholinergic agonist) = DOC
100
Closed angle glaucoma
Eye drops (BB, adrenergic agonists, cholinergic agonists, prostaglandin analogues)
Acetazolamide (oral)
Mannitol (IV) (refractory)
Laser peripheral iridotomy
101
Macular degeneration
Vitamin C, E, B-carotene, copper, zinc
Intravitreal ranibizumab (VEGF inhibitor) (exudative)
Laser photocoagulation
Treatment effectiveness limited
102
Retinal detachment
Laser photocoagulation or cryotherapy (halt progression)
| Surgical reattachment of retina
103
Retinal artery occlusion
Thrombolysis w/i 8 hours of onset
| Acetazolamide and O2 to decrease congestion and increase perfusion
104
Retinal vein occlusion
Laser photocoagulation
105
Corneal abrasion
Thorough eye exam w/ foreign body removal by irrigation
Topical antibiotics (erythromycin, sulfacetamide, cipro, oflaxacin)
OTC lubricant
Pressure patching optional 3 mm, diminished vision
106
Preeclampsia
1) HTN emergency
2) Uncomplicated HTN
1) IV Labetalol or Hydralazine (nifedipine second line) followed by Magnesium Sulfate when HTN controlled
2) Labetalol, Nifedipine, Methyldopa (less efficacious), Furosemide (second line)
107
Active TB
Rifampin, Isoniazide (INH), Pyrazinamide, Ethambutol
108
Optic neuritis
```
Think MS (esp in young female)
High dose steroids (500-1000 mg/day) for several days
```
109
Acute otitis media
May just observe (mild disease)
Amoxicillin x 10 days
Amoxicillin-clavulanic acid or stronger cephalosporin (cefdinir) for resistant strians
Tympanic tubes for recurrence
110
Otitis externa ("swimmer's ear")
Topical polymyxin, neomycin, fluoroquinolone (cipro), hydrocortisone
Oral cephalosporin or cipro for Pseudomonas or infx that spreads to skull
Topical drying agents after water to prevent recurrence
111
BPPV
Epley maneuver
112
Meniere disease
```
Anticholinergics, antiemetics, antihistamines
Salt restriction and thiazide diuretics
Surgical decompression (refractory)
```
113
Acoustic neuroma
Surgical excision
114
Bullous myringitis
```
Mycoplasma pneumoniae is common organism
Oral macrolide (erythromycin, clarithromycin, azithromycin)
```
115
Acute vestibular neuritis / labyrinthitis
Usu subsides spontaneously w/i weeks
Corticosteroid taper
Treat symptoms for first 48 hrs only (scopolamine patch, meclizine, metoclopramide, promethazine)
Vestibular rehabilitation exercises
116
Cholesteatoma
Surgical removal
117
Ramsay Hunt syndrome (herpes zoster oticus)
Valacyclovir, famciclovir or acyclovir
118
Personality disorders
Mostly psychotheraphy
Cluster A - sometimes low-dose antipsychotics (paranoid, schizoid, schizotypal)
Borderline - low-dose antipsychotics, SSRIs, mood stabilizers
119
Delirium tremens (DTs)
Benzodiazepines (long acting)
| Lorazepam, Diazepam, Chlordiazepoxide
120
Alcoholism treatment
AA
Naltrexone, disulfiram
Topiramate, acamprosate
121
Wernicke-Korsakoff
IV thiamine
122
Cocaine OD
Benzodiazepine, antipsychotic
| Phentolamine for HTN (alpha antagonist)
123
Amphetamine OD
Benzodiazepine, antipsychotic
| Phentolamine for HTN (alpha antagonist)
124
Hallucinogen OD
Isolation, benzos, antipsychotics
125
Marijuana abuse
Counseling
126
Nicotine abuse
Patch, gum, lozenge
Varenicline
Bupropion
127
Opioid OD
Naloxone, Naltrexone
| Methadone therapy
128
PCP OD
Isolation, benzos, antipsychotics
129
OCD
CBT + SSRI
130
Anorexia
Psychotherapy
May need inpatient treatment
SSRIs don't help unless associated depression
Anxiolytic before meals
131
Bulimia
SSRI + psychotherapy
132
ADHD
Psychostimulants (methylphenidate, dextroamphetamine)
Atomoxetine
Refractory: Bupropion, alpha agonists (Clonidine), TCAs
133
Tourette's
```
Psychotherapy
*DA antagonists low-dose for tics (fluphenazine, pimozide, tetrabenazine)
SSRI for comorbid behavior disorders
Botox for focal motor or vocal tics
Clonidine/SSRI for impulse control
```
134
DM Type I
Insulin
135
DM Type II
Oral hypoglycemic agents, possibly insulin
136
DKA/HHNS
Admit to ICU
IVF (isotonic)
IV insulin (switch to SC when anion gap closes in DKA; when blood sugar lowers may give IV glucose)
IV KCl (in DKA acidosis drives K out of cells, insulin drives K into cells)
Electrolyte correction
Treat underlying disorder
137
Diabetic retinopathy
Control diabetes
HTN therapy
Annual ophthalmology visit
Laser photocoagulation (neovascularization)
Intervitreal corticosteroid injection to reduce macular edema
138
Diabetic nephropathy
Control diabetes
ACE/ARB (esp if microalbuminuria)
Dialysis may eventually be needed
139
Diabetic neuropathy (sensory)
Control diabetes
Gabapentin, Pregabalin, Duloxetine
(TCAs, phenytoin, carbamazepine
Narcotics or Tramadol for persistent pain)
140
Diabetic neuropathy (gastroparesis)
Dx w/ gastric emptying study
| Short term metoclopromide or erythromycin
141
Diabetic atherosclerosis
```
Control diabetes
Control HTN and hyperlipidemia
Statin
ASA
Smoking cessation
```
142
Graves disease
Definitive: radioablation w/ radioactive iodine (MC) or
subtotal thyroidectomy (surgery)
Methimazole / PTU to stop thyroid hormone production
BB for symptomatic relief
143
Toxic adenoma / Toxic MNG
Radioablation
Surgical resection
Methimazole / PTU (less often in MNG)
144
Subacute thyroiditis
Self-limited
NSAIDs/BB for symptoms
May need thyroid replacement if hypothyroid during gland recovery
145
Silent thyroiditis
During pregnancy
Self-limited
NSAIDs/BB for symptoms
146
Thyroid storm
ICU monitoring
Methimazole / PTU (higher doses / more frequent)
Beta blockers
IV sodium iodine (helps block thyroid hormone release)
Hydrocortisone (inhibits conversion of T4 to T3)
147
Thyroid cancer (malignant)
Surgical resection + radioiodine ablation
Radiation (local extension)
Chemotherapy (metastases)
Thyroid replacement after surgery
148
Hypothyroidism
Levothyroxine
149
Cretinism
Levothyroxine ASAP (from birth)
150
Primary hyperparathyroidism
```
Surgical resection (single adenoma)
Surgical resection and replacement of one gland into forearm (four-gland hyperplasia)
IVF and bisphosphonates (hypercalcemia)
```
151
Hypercalcemia
IVF (first line)
Loop diuretics (furosemide) (2nd line)
Bisphosphonates
152
Hyperparathyroidism due to CRD
Hypophosphatemia
Dietary phosphate restriction
Oral phosphate binders (Ca carbonate and acetate)
Renal osteodystrophy
Calcitriol, other vitamin D analog, cinacalcet (Ca mimetic) to suppress PTH
153
Hypoparathyroidism
Ca and vitamin D supplementation
154
Pseudohypoparathyroidism
Ca and vitamin D supplementation
155
Hyperprolactinemia
```
DA agonists (cabergoline>bromocriptine, pergolide)
Transsphenoidal surgery, radiation therapy if refractive
```
156
Acromegaly
Surgical resection of adenoma
Cabergoline or Octreotide to lessen effects
Radiation therapy if refractory
157
Hypopituitarism - GH deficiency
Recombinant GH
158
Hypopituitarism - LH/FSH deficiency
Testosterone (men)
Estrogen-progesterone (women)
Luprolide (GNRH agonist) for people desiring fertility
159
Hypopituitarism - TSH deficiency
Levothyroxine
160
Hypopituitarism - Prolactin deficiency
No need to treat
161
Hypopituitarism - ACTH deficiency
Hydrocortisone, Dexamethasone, Prednisone
162
Cushing syndrome
```
Adjust steroid dosage
Surgical resection/irradiation (pituitary tumor)
Surgical resection (adrenal tumor)
Chemo/radiation + octreotide (SCLC)
Cortisol replacement after surgery
```
163
SCLC
Chemo and radiation (non-resectable)
164
Hyperaldosteronism (Conn syndrome)
Surgical resection of otumor
Treat underlying disorder
Aldosterone antagonists (spironolactone) to improve hypokalemia until definitive therapy
165
Adrenal insufficiency
Treat underlying disease
Glucocorticoid and mineralocorticoid replacement
DHEA in women (maybe)
Hydration
166
Addison / adrenal crisis
IV glucose
Hydrocortisone
Vasopressors
167
Pheochromocytoma
Alpha blockers FIRST then BB
| Surgical resection
168
Addison's disease
Replace glucocorticoids and mineralocorticoids
