Contents

- Treatments
- Associations
- Screening
- Vaccinations

Treatments
 HA
o Migraine
 Acute: NSAIDS, Ergotamine
 PPx: -blocker, Amitryptiline
o Tension
 Acute: NSAIDs
 PPx: decrease stress
o Cluster
 Acute: O2 6L/min, Triptans
 PPx: Verapamil
 Glaucoma
o Open-angle: -blocker, 2-agonist (clonidine, brimonidine), Carbonic anhydrase
inhibitor (CAI) (“-azolamide,” acetazolemide, methazolemide), PG analogue
(lanaprost)
o Closed-angle: Pilocarpine, CAI
o Summary: Open (, 2, CAI, PG), Closed (Pilocarpine, CAI)
 Eye Lid Probs
o Chalazion (Painless inflammation of mabomian gland)
 Warm compress
o Hordoleum (Stye) (Painfull inflammation of hair follicle)
 Warm compress +/- ABX
 Conjunctivits
o Bacterial
 Erythromycin or Sulfacetamide
 Gonococcal  “Gono = Oh No!!!”  Emergency
 Vertigo
o Peripheral (more drastic sympts, tilt test extinguishes rapidly)
o Central (less drastic)
o Benign Positional, Menteneir’s, Viral Laberinthitis
 Meclizine, Dramamine
 Croup  Racemic Epinephrine
 Complications from Strep Pharyngitis
o PSGN – Amox and Diuretics
 HTN
o 1st line – HCTZ
o Use ACEi in DM, CHF and vascular disease
o If >20/10 more than goal  add another (usually HCTZ/ACEi)
o AA  CCB and HCTZ
 o Pregnant  Labetalol, Hydralazine, Methyldopa
 Arrhythmia
o A-fib
 -block, CCB (vera or dilt)
o V-tach
 Amioderon; 2nd “caine” (lidocaine, procaineamide)
o Asystole
 Epinephrine or Atropine
 Angina
o Prinzmetal’s Angina (2/2 vasospasm, so…) – Nitrates and CCBs (vera)
o Cocaine-induced – NGT (nitroglycerine tabs)
 HLD
o Statins (LDL)  Niacin/Binders  Fibrates
Rx SE
Statins Myopathy, LFTs, CPK
Niacin Flushing, glu, uric
acid, LFTs, CPK
Fibrate Gallstones,
gynecomastia, weight
gain, LFTs
Cholesterol binders GI discomfort

 CHF
o -blocker, ACEi, Diuretic
o If NYHA class 3-4  Add Spirinolactone
 Ulcerative colitis
o Colonoscopy: 8 yr after dx, Q2-3yr after that
 GERD – 1st H2-blocker (ranitidine, cimetidine), 2nd PPI
 UTI – 1st TMP-SMX, 2nd Quinolone
 HIV PPx
o CD4 <200  Bactrim (TMP-SMX) for PCP
o CD4 <75  Azithromycin for MAC
 Fibromyalgia – Amitryptiline
 Mycosis
o Tinea Versicolor – Selenium
o Tinea corporis – topical miconazole, lamisil
o Tinea capitis – oral Gresofulvin
 Pertussis - erythromycin
 IBD
o Crohn’s – Aminosalicylates, methyltrexate, azathioprine
o U.C. – aminosalicylates, CS
 Poisoning
o Lead - Succimear or EDTA
o Iron – deferoxamine
 Preeclampsia – MgSO4
 Cholestasis of preg – pruritis and bilirubin
o Antihistamines and cholesterimine/ursodeoxycholic acid
 Derm in Preg
o PUPPP – antihistamine and topical CS
o Herpes gestationalis – CS
 Thyroid
o Storm - -blocker, PTU
o Hyper – PTU (can cause PMN), Methamizole or carbamizole
 Travelers Diarrhea – Ciprofloxacin (also TMP-SMX can be used)
 Smoking Cessation
o Rx: Bupropion and Varenicline
o Bupropion – CI in MAOI use or seizure disorder; NE and DA
o Varenicline – CI in behavior disorders; partial Nicotinic Agonist
 Essential Tremor
o 1st – Propranolol or Primidone (anticonvulsant)
o 2nd – Gabapentin
 Parkinson
o Resting tremor, bradykinesia, posteural instability, masked facies, asymmetric
onset
o 1st – Levodopa and carbidopa (to prevent peripheral destruction); or
bromocriptine, pergolide or pramipexole (all of which are inferior to levodopa)
o 2nd – MAOIs or Catechol O-methyltransferrase inhibitors (“-capone”)(after motor
complications of levodopa develop)
o Note: when dyskinetic movements increase there is TOO MUCH levodopa
(COMTi will just increase the sympts)
 Tick disorders
o Severe – Haloperidole or pimozide
o Mild – Clonidine or guanfacine
 Acute Gouty Arthritis
o Chochicine
 PID
o Fluoroquinolone and Doxycycline
 Diverticulitis
o Quinolone and Metronidazole
 Depression
o SSRIs (fluoxetine, paroxitine): Wt gain, sex dysfxn, fatigue
o SNRI (DMV; mirtazapine, venlafaxine, duloxetine)
o TCA (amitryptyline): OD, anti-cholinergic effects (dry mouth, urine retention),
sedation
o MAOI (phenylzine, tranylcypromine): HTN, interact with TCAs
o Bupropion: seizures
o Trazodone: Priapism
 SSRIs Fat, tired, sexless
TCAs Tired, dead, anti-cholinergic
MAOIs HTN
Bupropion Seizures
Trazodone Boner

 Bipolar
o Mood stabilizers: Carbamazapine, Li, Valproate
 Mastitis
o Dicloxacillin or Keflex
 Alzheimers
o Donepezil – dizzy, n/v, HA
o Galantamine – SEs include arrhythmia, bradycardia and urinary obstruction
o Tacrine – SE hepatotox
 Wt loss
o Orilstat (diarrhea), Silbutramine (HTN)
o Bariatric Sx if BMI>40 (or >35 and comorbidities)
 IBS
o Psych component - SSRIs, TCAs
o Constipation – Lubiprostone
o Mild abd pain – dicyclomine
 Pneumocystis Carnii Pneumonia
o TMP-SMX
 Animal Bite – Augmentin (amoxicillin/clavulanate)
o Human  Ekinella
o Dog/Cat  Pasteurella
 Arrhythmia
o A-fib with RVR – Digoxin
o SVT - -blocker, CCB, cold on face, carotid massage
 G6PD
o Can be exacerbated by Nitrofuranitoin (tx of UTI in pregnancy)
 HTN in preg  Labetolol or hydralazine
 Tocolysis
o Tertbutyline, nifedepine, ritodrine, indomethacin, Mg
o SEs of each: Tert (Pulm edema, glu), nifedepine (CHF, MI), Mg (resp
depression, pulm edema), Indo (close PDA)
 Turner’s Synd (hypergonadotropic hypogonadism)
o Tx: hGH and then OCPs (to prevent osteoporosis)

Associations
 Celiac Disease
o Derm – dermatitis herpatiformis, intestinal lymphoma
o ABs – TTG, gliadin, endomesial
 Diarrhea
 o Bloody Diarrhea -> SECSY (salmonella, e. coli, campylobacter, shigella,
yersenia)
o Shiga Toxin – seizures, (“The shiga shakes”)
o Yersenia – pseudoappendicitis
o Salmonella – do not treat with ABX, prolongs by releasing toxin
 Chronic HTN/Ecclampsia/Gestational HTN
o 20 wk is cutoff for chronic/superimposed
o 300mg/day is proteinuria
o PreE is associated with hemorrhage (hepatic and cerebral)
 Ottawa Ankle/Knee Rules
o Ankle
 Must be: Adult, <10 days from injury, not mentally impaired
 Needs 1 of these: bear weight, point tenderness over distal 6cm of fibula,
navicular or 5th metatarsal
o Knee
 Needs 1 of these: >55yo, tender fibular head or patella, cannot flex
>90degrees, cannot take 4 steps
 Tubulointerstitial Nephritis
o PCN, cephalexin, or NSAIDs
o Will see eosinophils on Urine Micro
 Calcium Homeostasis
o PTH - Ca and Phos
 Bone - Increases osteoclasts
 Renal – Increases Ca resorbtion, Phos excretion
 Calcitrol (1,25 Dihydroxyvitamin D) – stimulates the formation, and
increases gut absorbtion of Ca and Phos
o Calcitonin - Ca
 Bone – Decreases osteoclastic activity
 Renal – increases excretion of both Ca and Phos
 Enteritis
o Sympts after 6hr = S. Aureus, 8-12hr = Perfringens, 12-14hr = E. Coli
 CI to breast feeding
o Infxn: HIV, TB, HSV
o Cancer tx: Radioisotope or chemotherapy
o Galactosemia of baby (G1PUD)
 Thyroiditis
o Subacute Granulomatous – Painful
 Seen after viral infxn
o Subacute Lymphocytic – Painless
 seen after pregnancy
o Gain = Pain
o Lymph = Less
 PID in preg
o Treat with Azithro (doxycycline is CI in preg)
  Hemophilus Ducreyi  Azith or Ceftriaxone


Screening
 Cancer
o Breast
 Mammography - >40 Q1-2yr, >50 QYr, until life expectancy is <5-10yr
o Cervical
 Pap – 21yo, QYr until 30, then Q2-3yr, until 65 or 70 and 10 years and 3
normal paps
o Colon
 Colonoscopy - >50yo, Q10yr
 Sigmoid - >50, Q5yr
o Prostate
 No recommendation
 Osteoporosis
o DEXA at 65yo (or 60 with RFs)
 HTN – 18yo
 HLD
o Men - 35yo
o Women - 45yo
o With RFs - 20yo
 DM
 STDs
o In sexually active m/f
 Anemia
o Jaundice – hemolytic
o Splenomegaly – Thallassemia
o TIBC – Fe deficiency
o Methylmelonic Acid – B12 deficiency
 Drug Fever – commonly caused by heparin, amphotericin, -lactams, and sulfas
 Pyelonephritis  ABX tx (tmp-smx, ceftriaxone, amp/gent)  Respiratory distress
o This is ARDS 2/2 release of endotoxin
o Tx: O2 and watch for fluid overload
 Amenorrhea w/u
o Preg Test
o TSH and PRL
o LH/FSH
o Progestin challenge
 DA decreases PRL
 PRL decreases GnRH and FSH
 TRH stimulates PRL and decreases GnRH and FSH
  Breast Mass warning signs
o Calcifications, irregular borders, increased density, heterogenous density, skin
thickening
 Safe Rx in preg
o Hypercoag - Heparin
o Migraines – amitryptyline
o HTN – labetalol
o Hypothyroid – levothyroxine (increased demand during preg)
o Herpes – acyclovir
 Post partum bleed
o Oxytosin  PGF2  Misoprostal (rectal)  Methylergonovine (do not use in
HTN patients)
 TORCH
o Toxo – calcifications in BG, microceph, chorioretinitis
o HSV - seizures
o Rubella – blueberry muffin spots, HSM
o CMV – periventricular calcifications, microceph, chorioretinitis
o HIV

Vaccinations
 Birth – Hep B
 2 Months – Hib, DTaP, RV, PCV, IPV
 4 Months – Hib, DTaP, RV, PCV, IPV
 6 Months – Hib, DTaP, RV, PCV, Flu #1
o No Polio
 12 Months – MMR, VZV, Hep B #2, Flu #2, Hep A #1
 18-24 Months – Hep B and Hep A
 4-6 years – MMR
 11-12 years – TdaP booster (then Q10yr), MCV
 16 years – MCV booster
 HPV – 9 to 26 years