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OSLER > Treatments > Flashcards

Treatments Flashcards

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
Q

Orbital cellulitis

A

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

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26
Q

Pterygium

A

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

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27
Q

Blepharitis

A

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
Q

Cataract

A

No medication to treat or slow cataracts

Refer to surgery if affecting ADLs

29
Q

Chalazion

A

Small chalazia often resolve without intervention, warm compresses help larger chalazia

30
Q

Allergic conjunctivitis

A

Washes, PO antihistamines, artificial tears

31
Q

Chlamydial conjunctivitis

A

Azithromycin 1 g once

32
Q

Bacterial conjunctivitis

A

FQ solution: Cipro

33
Q

Gonococcal conjunctivitis

A

Ceftriaxone 1 gm IM (adult)

34
Q

Corneal abrasion

A

Heal with time
Prophylaxis abx given in contact lens wearers- FQ drops
Moxifloxacin drops
Contact lens wearers: Cipro drops or Levofloxacin drops

35
Q

Dacryoadenitis

A

Viral (self-limiting, supportive, warm compresses, PO NSAIDs) Bacterial (1st gen cephalosporins- cephalexin 500 mg QID)
Referral for ENT, ophthalmology, and ID

36
Q

Acute angle closure glaucoma

A

Requires surgical tx; IOP reduction within 6 hr
IOP reduction: start carbonic anhydrase inhibitor (acetazolamide orally and topical BB)
Surgical iridectomy

37
Q

Primary open-angle glaucoma

A

Prostaglandin analogues: latanoprost B-adrenergic antagonist: timolol (Avoid with asthma/COPD)
Acetylcholinesterase inhibitor: Pilocarpine 1-4%

38
Q

Erythema multiforme

A

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
Q

Scabies

A 
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
Q

Basal cell carcinoma

A

Surgical removal
Topical 5% imiquimod, 5-fluorouracil, or Interferon cream
Radiation if not surgical candidate

41
Q

Pityriasis rosea

A

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
Q

Psoriasis

A

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
Q

Melanoma

A

Full surgical excision is the standard of care

44
Q

Squamous cell carcinoma

A

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
Q

Atopic dermatitis

A

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
Q

Paronychia

A 
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
Q

Molluscum contagiosum

A

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
Q

Varicella zoster

A

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
Q

Cellulitis

A

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
Q

Infectious esophagitis

A

Candida: PO fluconazole
CMV: ganciclovir
HSV: acyclovir

51
Q

Eosinophilic esophagitis

A

Remove foods that incite allergic response, inhaled steroids

52
Q

Pill-induced esophagitis

A

Drink pills with greater than or equal to 4 oz water, avoid recumbency 30-60 mins afterwards

53
Q

Caustic esophagitis

A

Supportive, pain meds, IV fluids

54
Q

Mallory-Weiss tear

A

Supportive if no active bleed, hemodynamic stabilization if yes

55
Q

GERD

A

Lifestyle modifications, H2RA (mild), PPI (severe)

56
Q

Barrett’s esophagitis

A

Lifetime PPI, screen every 3-5 yrs

57
Q

Esophageal cancer

A

Esophagectomy (S0-2A), chemotherapy + radiation

58
Q

Achalasia

A

Botox, nitrates, CCBs, pneumatic dilation of LES, esophagomyomectomy

59
Q

Nutcracker esophagus

A

CCBs, nitrates, botox, sildenafil

60
Q

Esophageal varices

A

Octreotide in acute bleed and endoscopic band, BBs for prevention

61
Q

H. pylori infection

A

Clarithro + amoxicillin + PPI (metro if PCN allergic)

62
Q

NSAID/acute gastritis

A

Tx H. pylori if present, remove causative factor, PPI/H2RA

63
Q

Acute pericarditis

A

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
Q

Pericardial effusion

A

Pericardiocentesis is not indicated unless there is evidence of tamponade, if small and clinically insignificant, repeat echo in 1-2 wks

65
Q

Cardiac tamponade

A

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
Q

Giant cell myocarditis

A

Supportive tx for CHF and arrhythmias (medications and pacemaker or AICD), heart transplant, immunosuppressive drugs (cyclosporin, azathioprine, prednisone)

67
Q

Endocarditis

A

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)

OSLER (1 decks)

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