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Treatments Flashcards

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1
Q

Asthma step 1

A

SABA

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2
Q

Asthma step 2

A

SABA and low-dose ICS

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3
Q

Asthma step 3

A

SABA + low-dose ICS + LABA or med-dose ICS

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4
Q

Asthma step 4

A

Med-dose ICS + LABA

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5
Q

Asthma step 5

A

High-dose ICS + LABA

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6
Q

Asthma step 6

A

High-dose ICS + LABA + PO CS

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7
Q

Mild exacerbation of asthma

A

SABA

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8
Q

Moderate exacerbation of asthma

A

Correction of hypoxemia with supplemental oxygen

Reversal of airflow obstruction with SABA and early administration of systemic corticosteroids

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9
Q

Severe exacerbation of asthma

A

Immediate oxygen, high dose of SABA and systemic corticosteroid (IV magnesium sulfate produces a detectable improvement in airflow)

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10
Q

Acute bronchitis

A

Supportive (encourage hydration, expectorants, anti-tussives, B2 agonists)

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11
Q

Chronic bronchitis

A

1st line- bronchodilators (anticholinergics): LAA (Tiotroprium-Spiriva) + SABA + ICS
Mucolytics, prevention (vaccines), pulmonary rehab

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12
Q

Acute exacerbation of chronic bronchitis

A

1st line: 2nd gen cephalosporin
2nd line: macrolide or Bactrim
Abx indicated for elderly, IC, cough > 7 days and pt with underlying cardiopulmonary disease

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13
Q

Complicated acute exacerbation of chronic bronchitis

A

FQ (Moxifloxacin or Levofloxacin, Gemifloxacin)

Augmentin

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14
Q

Emphysema

A 
Stop smoking
Anticholinergic inhalers > B2 agonists
SABA for acute exacerbations
Abx and CS for acute exacerbations
Vaccinations: pneumonia and influenza
Supplemental oxygen
Encourage physical activity- pulmonary rehab
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15
Q

Sarcoidosis

A

Modest maintenance dose of corticosteroids
NSAIDs for athralgias and rheumatic complaints
Refractory: Methotrexate, azathioprine, inflixamab, lung transplant

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16
Q

Outpatient management of bacterial pneumonia (CAP)

A

No recent abx: macrolide (clarithromycin or azithromycine) or doxycycline
Comorbidities, risk for drug resistance or recent abx use: respiratory FQ (moxi, gemi, levo) or a macrolide + beta-lactam (Amox HD or augmentin)
Regions of high resistance: Respiratory FQ (Moxi, gemi, levo) or macrolide + beta-lactam

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17
Q

Hospital acquired pneumonia

A

Low-risk of MRSA or MDR pathogens: Cefepime, piperacillin-tazobactam, meropenem, Levofloxacin
More severe: Vancomycin + (Cefepime or Piperacilin-tazobactam or Meropenem)
If legionella suspected, add Levo or Azithromycin
If pseudomonas, high mortality, or MDR gm-neg suspected: add Cipro, levo, or tobramycin or amikacin

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18
Q

Pleural effusion

A 
Treat the underlying disease
Thoracentesis
Chest tube drainage
Tunneled pleural catheter placement
Surgical drainage
Pleurodesis
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19
Q

Pneumothorax

A

If small, stable spontaneous primary pneumothorax, observe
Supplemental oxygen
Simple aspiration drainage if large or progressive primary pneumothorax
Serial CXRs every 24 hrs
With secondary, large, tension pneumo- chest tube placement
Avoid exposure to high altitudes, flying in an unpressurized aircraft and scuba diving

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20
Q

ARDS

A

Identify and treat underlying conditions

Supportive care for severe respiratory dysfunction (intubation with positive pressure ventilation and low level PEEP)

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21
Q

Hyaline membrane disease

A

Mechanical ventilation

Adminstration of exogenous surfactant

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22
Q

Hordeolum

A

External: warm compresses only
Internal: Dicloxicillin (250-500 mg q6h) + warm compresses
If CA-MRSA: TMP/SMX DS (2 tablets BID)

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23
Q

Macular degeneration

A

Refer to ophthalmology
Neovascular: photodynamic therapy, VEGF inhibitors
Atrophic: Magnifying glasses and visual aids help
Antioxidants (Vit C and E), zinc, copper, carotenoids

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24
Q

Optic neuritis

A

Referral to ophthalmology and neurology
Admit- IV methylprednisolone 250 mg QID x 3 days with oral steroid taper
Plasma exchange

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25
Orbital cellulitis
Admit! Consults! Monitor vision status and CNS change. Broad-spectrum IV abx for GP, GN, and anaerobic organisms Vancomycin 15-30 mg/kg IV q8-12h + ceftriaxone 2 gm IV q24h + metronidazole 1 gm IV q12h Piperacillin/tazobactam 4.5 gm IV q8h
26
Pterygium
No tx for inflammation- artificial tears only May use topical NSAIDs or weak CS (fluoromethalone or lotepredonal) BUT MD Surgery indicated for growth that threatens the visual axis, marked induced astigmatism, or severe irritation
27
Blepharitis
Proper hygiene, warm dry compresses, baby shampoo scrubs, artificial tears (for dry eyes) (S. aureus) 1st line: bacitracin or erythromycin 0.5% ointment 2nd line: FQ solution
28
Cataract
No medication to treat or slow cataracts | Refer to surgery if affecting ADLs
29
Chalazion
Small chalazia often resolve without intervention, warm compresses help larger chalazia
30
Allergic conjunctivitis
Washes, PO antihistamines, artificial tears
31
Chlamydial conjunctivitis
Azithromycin 1 g once
32
Bacterial conjunctivitis
FQ solution: Cipro
33
Gonococcal conjunctivitis
Ceftriaxone 1 gm IM (adult)
34
Corneal abrasion
Heal with time Prophylaxis abx given in contact lens wearers- FQ drops Moxifloxacin drops Contact lens wearers: Cipro drops or Levofloxacin drops
35
Dacryoadenitis
Viral (self-limiting, supportive, warm compresses, PO NSAIDs) Bacterial (1st gen cephalosporins- cephalexin 500 mg QID) Referral for ENT, ophthalmology, and ID
36
Acute angle closure glaucoma
Requires surgical tx; IOP reduction within 6 hr IOP reduction: start carbonic anhydrase inhibitor (acetazolamide orally and topical BB) Surgical iridectomy
37
Primary open-angle glaucoma
Prostaglandin analogues: latanoprost B-adrenergic antagonist: timolol (Avoid with asthma/COPD) Acetylcholinesterase inhibitor: Pilocarpine 1-4%
38
Erythema multiforme
Largely symptomatic: antihistamines, analgesics, skin care, topical steroids. For serious cases, hospitalization focus on much the same care as severe burns: fluid replacement, wound care, pain management Cimetidine: H2 blocker Dapsone
39
Scabies
``` Immunocompetent Permethrin 5% cream. Apply to entire skin from chin down to and including toes Leave on for 8-14 hrs Repeat in 1-2 wks Safe for children age > 2 mos Reapply to hands after handwashing Norwegian or crusted scabies in IC pts: Ivermectin on days 1, 2, 8, 9, and 15 + Permethrin 5% cream daily X 7 days ```
40
Basal cell carcinoma
Surgical removal Topical 5% imiquimod, 5-fluorouracil, or Interferon cream Radiation if not surgical candidate
41
Pityriasis rosea
For pruritis sx: topical steroids, PO antihistamines, oatmeal baths Avoidance of water, sweat and soap Topical zinc oxide and calamine lotion for itching UV radiation therapy In severe, persistent cases, topical steroid (e.g., triamcinolone) or oral corticosteroid (e.g., prednisone)
42
Psoriasis
Topical steroids (high strength) Tar-based Anthralin Vit D analogs (calcipotriene) and retinoids (vit A analogs) Biologic immune agents: Methotrexate, cyclosporine A, alefacept Kenalog intralesional injections
43
Melanoma
Full surgical excision is the standard of care
44
Squamous cell carcinoma
Low risk cutaneous SCC: electrodessication and currettage Invasion cutaneous SCC: surgical excision and Mohs micrographic surgery Chemoradiation therapy Reserved for high-risk metastatic cases or for pts who are unable to undergo surgical excision
45
Atopic dermatitis
High strength topical steroids and antihistamines for itching; calcineurin inhibitors (ex: Tacrolimus) Acute lesions: wet dressings, topical or systemic abx (cephalexin, dicloxacillin) Chronic lesions: daily hydration with unscented bath oils. PO antihistamines used for itching
46
Paronychia
``` Warm soaks Hygiene! Stop nail biting, wash hands Bacterial: I and D; culture TMP-SMX DS 1-2 tab PO BID while waiting for culture result Fungal: Topical amphotericin B, clotrimazole, econazole, miconazole, or nystatin tid/qid x 7-14 days Viral: Acyclovir 400 mg PO TID x 10 days Famciclovir 250 mg PO TID x 7-10 days Valacyclovir 1000 mg PO BID x 7-10 days ```
47
Molluscum contagiosum
Wash hands! Retin A- apply daily LN2 tx Podophyllin- wash off in 1-2 hrs, repeat Q2 weeks prn Direct lesion trauma agents: Tetinoin, salicylic acid, potassium hydroxide, cantharidin, silver nitrate, phenol, and tricholoroacetic acid Immune response stimulation: Imiquimod cream, intralesional interferon alfa, streptococcal antigen injection Antiviral therapy: Ritonavir, Cidofovir, Zidovudine
48
Varicella zoster
Chickenpox: In otherwise healthy pts, symptomatic therapy only IV acyclovir recommended for immunosuppressed or IC pts Calamine lotion, oral antihistamines may be used as antipruritic agents Shingles: Calamine lotion, NSAIDs For difficult/sever/IC cases Oral corticosteroids (prednisone) Antivirals (acyclovir, valacyclovir) Opioid pain control (e.g., oxycodone)
49
Cellulitis
Hygiene LE cellulitis inpt: Pcn, cephalosporin (IV allergy), vanc/linezolid (I allergy) LE cellulitis outpt: PEN VK, amoxicillin, cephalosporin, macrolide MSSA outpt: Dicloxicillin, doxycyline, Bactrim (last two are second line) MSSA inpt: Naficillin, Oxacillin, Vanc Dog/cat bite tx with augmentin
50
Infectious esophagitis
Candida: PO fluconazole CMV: ganciclovir HSV: acyclovir
51
Eosinophilic esophagitis
Remove foods that incite allergic response, inhaled steroids
52
Pill-induced esophagitis
Drink pills with greater than or equal to 4 oz water, avoid recumbency 30-60 mins afterwards
53
Caustic esophagitis
Supportive, pain meds, IV fluids
54
Mallory-Weiss tear
Supportive if no active bleed, hemodynamic stabilization if yes
55
GERD
Lifestyle modifications, H2RA (mild), PPI (severe)
56
Barrett's esophagitis
Lifetime PPI, screen every 3-5 yrs
57
Esophageal cancer
Esophagectomy (S0-2A), chemotherapy + radiation
58
Achalasia
Botox, nitrates, CCBs, pneumatic dilation of LES, esophagomyomectomy
59
Nutcracker esophagus
CCBs, nitrates, botox, sildenafil
60
Esophageal varices
Octreotide in acute bleed and endoscopic band, BBs for prevention
61
H. pylori infection
Clarithro + amoxicillin + PPI (metro if PCN allergic)
62
NSAID/acute gastritis
Tx H. pylori if present, remove causative factor, PPI/H2RA
63
Acute pericarditis
Most cases are self-limited and resolve in 2-6 wks Treat the underlying cause NSAIDs are the mainstay of tx (Colchicine is often used) Glucocorticoids may be tried if pain does not respond to NSAIDs (avoid if at all possible) Admit if fever, leukocytosis, large pericardial effusion, hx of warfarin tx, elevated troponins, or IC state
64
Pericardial effusion
Pericardiocentesis is not indicated unless there is evidence of tamponade, if small and clinically insignificant, repeat echo in 1-2 wks
65
Cardiac tamponade
Non-hemorrhagic: If hemodynamically unstable, monitor closely (echo, CXR, ECG), if known renal failure, HD is more helpful than pericardiocentesis Hemorrhagic: If bleeding is unlikely to stop on its own, emergent surgery Pericardiocentesis is only temporizing measure and is not definitive ts. Surgery should NOT be delayed to perform pericardiocentesis
66
Giant cell myocarditis
Supportive tx for CHF and arrhythmias (medications and pacemaker or AICD), heart transplant, immunosuppressive drugs (cyclosporin, azathioprine, prednisone)
67
Endocarditis
Native valve endocarditis: Vanc + Ceftriaxone Vanc + Gentamicin Prosthetic valve endocarditis: Vanc + Gentamicin + Rifampin IVDU: Nafcillin + Gentamicin (for MSSA) or Vanc + Gentamicin (MRSA) +/- Rifampin (for prosthetic valve)

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