Introduction

Thank you for getting the Locum Quick Guide.

This eBook is designed to help you make quick, safe, and

confident clinical decisions, especially in busy or high-
pressure settings.

While every effort has been made to align with standard

clinical practice, please note that certain recommendations
may vary depending on individual clinic policies and patient
factors.

Use this as your fast reference companion — practical,

simplified, and tailored for real-world locum work.

Wishing you all the best in your locum journey.

May your efforts bring relief and healing to many.

InshaAllah.

“Beautiful Patience”
[12:18]

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This eBook is intended for personal reference only. No part of this

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Educational reference for healthcare professionals only — not a
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Unauthorized sharing, resale, or modification is strictly prohibited.

2
 Table of Content
FBC, CKD Stages, Respiratory, Heart Rate 4

Syrup Medications Fast Dose Calculation 5

Peadiatrics Symptoms & Doses 7

Adult Symptoms & Medications 9

Adult Medication Bundle 12

Adult Antibiotics 15

Dermatology Management 16

Nebulization 23

Suture to Open (STO) & Size 24

Referral 25

Hypertension 27

Diabetes Mellitus 28

Target Control for DM, Hypertension, Dyslipidemia 31

Procedures 32

Injections 36

Antenatal Commons 37

Neonatal Jaundice 38

Clinic Issues 41

Ramadan Fasting Dose Adjustment 45

3
Immunization Schedule 46
 FBC, CKD Stages, Respiratory, Heart Rate

Blood Parameter Hb HCT TWC Plt

<3 months 13.0 - 20.0 42 - 66 5 - 21

<6 months 9.5 - 14.5 31 - 41 6 - 18

<6 years 10.5 - 14.0 33 - 42 6 - 15 150 - 450

(Lower in
<12 years 11.0 - 16.0 34 - 40 4.5 - 13.5 children)

Male Adult 14.0 - 18.0 42 - 52 5 - 10

Female Adult 12.0 - 16.0 37 - 47 5 - 10

Age Respiratory

<2 months <60

CKD Stages eGFR

<1 year <50

I > 90
<5 years <40

II < 90
<8 years <30

III A < 60
Adult <20

III B < 45

IV < 30 Age Heart Rate

V < 15 <1 year <160

<2 years <120

<8 years <110

Adult <100

4
 Syrup Medications Fast Dose Calculation

Syrup Medications Fast Dose Calculation (mL)

Paracetamol (15mg/kg) (250mg/5ml) weight (kg) x 0.3 (QID)

Cetirizine (0.25mg/kg) (5mg/5ml) 0.25 OD

Bromhexine (0.3mg/kg) (4mg/5ml) 0.375 TDS

Carbocisteine (10mg/kg) (100mg/5ml) 0.5 TDS

Augmentin (15mg/kg) (228mg/5ml) 0.328 BD

Augmentin (15mg/kg) (312.5mg/5ml) 0.24 BD

Augmentin (15mg/kg) (457mg/5ml) 0.164 BD

Azithromycin (10mg/kg) (200mg/5ml) 0.25 OD

Azithromycin (15mg/kg) (200mg/5ml) 0.375 OD

Amoxicillin (15mg/kg) (250mg/5ml) 0.3 TDS

Amoxicillin (25mg/kg) (250mg/5ml) 0.5 BD

Domperidone (0.25mg/kg) (5mg/5ml) 0.25 TDS

Gravol (1mg/kg) (15mg/5ml) 0.33 TDS

Promethazine (0.2mg/kg) (5mg/5ml) 0.2 TDS

Colimix (0.5mg/kg) (5mg/5ml) 0.5 TDS

Benadryl (1mg/kg) (14mg/5ml) 0.35 TDS

Piriton (0.1mg/kg) (4mg/5ml) 0.125 TDS

5
 Syrup Medications Fast Dose Calculation

Syrup Medications Fast Dose Calculation (mL)

Prednisolone (0.16mg/kg) (2.5mg/5ml) 0.33 TDS

Prednisolone (0.16mg/kg) (3mg/5ml) 0.27 TDS

Dexamethasone (0.03mg/kg) (0.5mg/5ml) 0.33 TDS

Salbutamol (0.1mg/kg) (2mg/5ml) 0.25 TDS

Metronidazole (7.5mg/kg) (200mg/5ml) 0.1875 TDS

Erythromycin (20mg/kg) (200mg/5ml) 0.5 BD

Cefaclor (15mg/kg) (250mg/5ml) 0.3 TDS

Cloxacillin (15mg/kg) (250mg/5ml) 0.3 QID

Acyclovir (mg/kg) (200mg/5ml) 0.5 QID

Cephalexin (25mg/kg) (250mg/5ml) 0.5 BD

Lactulose (0.5mL/kg) 0.5 BD

Buscopan/Hyoscine (0.5mg/kg) (5mg/5ml) 0.5 TDS

Ibuprofen (5mg/kg) (100mg/5ml) 0.25 TDS

MMT (40mg/kg) (500mg/5ml) 0.4 TDS

Maxolon (0.1mg/kg) (5mg/5ml) 0.1 TDS

Desloratadine (0.1mg/kg) (2.5mg/5ml) 0.2 OD

⚡️ Get All The Doses in 1 Second with SetelDoc Dose Calculator

6
 Peadiatrics Symptoms & Doses

Symptom Doses

If <1 month old, refer TRO neonatal sepsis

Syrup Paracetamol 10-15mg/kg QID (>2mo)
Fever
Supp PCM 30mg/kg (use with lubricant)
Prolonged fever DDX: leptospirosis, malaria, Kawasaki

Syrup Carbocisteine 10mg/kg TDS

Or Syrup Benadryl 1mg/kg TDS (avoid during asthma attack)
Cough Or Syrup Bromhexine 0.3mg/kg TDS
Or Syrup Promethazine 0.2mg/kg TDS
Or Syrup Paedicof 5mL TDS (2-5yo); 10mL TDS (>5yo)

Syrup Cetirizine 0.25mg/kg OD

Runny Nose / Or Syrup Promethazine 0.3mg/kg TDS
Nasal Congestion Or Syrup Desloratadine 0.1mg/kg OD (non-drowsy)
Or Syrup Piriton 0.1mg/kg TDS

Syrup Gravol 1mg/kg TDS

Or Syrup Promethazine 0.2mg/kg TDS
Or Syrup Maxolon 0.1mg/kg TDS (Caution: EPS -
ExtraPyramidal Symptoms)
Vomiting
Or Syrup Domperidone 0.25mg/kg TDS
ORS: 10ml/kg; give small frequent sips even if the child
vomits, continue slowly
Advice: reduce sugary drinks, take soup or porridge

Hidrasec 1 sachet TDS (>3mo)

Or Syrup Kaolin 15mL TDS (>6yo)
Or Smecta 1 sachet BD/TDS
Loose Stool
ORS: 10ml/kg; give small frequent sips even if the child
vomits, continue slowly
Advice: reduce sugary drinks, take soup or porridge

Syrup MMT 5-10ml TDS (gastritis)

Syrup Colimix 0.5mg/kg TDS (>6mo)
Abdominal pain
For infant colic, flatulence, discomfort
Syrup Buscopan 0.5mg/kg TDS (cramp) (>6yo)

All doses are for >2yo unless stated otherwise.

7
 Peadiatrics Symptoms & Doses

Symptom Doses

Nebulization (refer nebulization table)

Prednisolone 0.5-1mg/kg OD or Dexa 0.1mg/kg OD for 5 days
Syrup Salbutamol 0.1mg/kg TDS
Shortness of MDI Salbutamol 2p 4 hourly is more preferable
breath (SOB) Montelukast
12mo-5yo: 4mg ON (oral granules)
6-14yo: 5mg ON
>14yo: 10mg ON

Prednisolone 0.5-1mg/kg OD or Dexa 0.1mg/kg OD for 3 days

Urticaria Syrup antihistamine (refer runny nose box above)
Calamine lotion LA TDS

Syrup Paracetamol 10-15mg/kg QID (>2mo)

Pain Supp PCM 30mg/kg (use with lubricant)
Or Syrup Ibuprofen 5mg/kg TDS (avoid in fever)

Syrup lactulose 0.5mL/kg BD

Constipation
Ravin enema I/I PRN

Syrup antihistamine
Aqueous cream LA QID then steroid cream
Hydrocortisone cream LA BD (for face)
Mometasone LA OD or Betamethasone cream LA BD (for
Eczema
body & cannot be applied on face)
Prednisolone 0.5-1mg/kg OD or Dexa 0.1mg/kg OD for 3 days
(if severe)
For antibiotic if secondary infection due to scratching

Minimum criteria: Temperature of 38°C + Cough

Doses (5 days) (More effective if started <48H of fever onset)
<9 months old: 3mg/kg BD
9-11 months old: 3.5mg/kg BD
1-12 years old:
Influenza
≤15 kg: 30mg BD
>15-23kg: 45mg BD
>23-40kg: 60mg BD
>40 kg: 75mg BD
Refer if SOB or dehydration or altered conscious level

8
 Adult Symptoms & Medications

Symptoms Management

Paracetamol 1g QID
AVOID NSAID: risk of bleeding
Fever
Alternative: Orphenadrine or tramadol
Prolonged fever DDX: leptospirosis, malaria, Kawasaki

Productive cough
Syrup Benadryl 10ml TDS
Bromhexine 8mg TDS
Dry cough
Copastin 10mg TDS
Cough
Syrup Sedilix 10ml TDS (contains antihistamine)
Syrup Cough-en 10ml TDS (contains antihistamine)
Chronic (>2weeks)
CXR, Pulmonary Tuberculosis workup, sputum C&S at KK
Consider ACE-i induced cough if on perindopril / enalapril

Loratadine 10mg OD (non-drowsy)

Clarinase I/I BD (non-drowsy)
Cetirizine 10mg OD (drowsy)
Runny nose / Piriton 4mg TDS (drowsy)
nasal Actifed I/I TDS (drowsy)
congestion Saline nasal spray (<2 years old)
Oxynase 2p BD (don’t use >2weeks to avoid rebound congestion)
Montelukast 10mg ON
⚠️ Refer ENT if worsening rhinitis

Lozenges
Throat spray 3 hourly
Sore throat Thymol gargle TDS
⚠️ Refer ENT if peritonsillar abscess or tonsillitis ≥7 episodes in 1
year

Pain management
Migraine
Caffox II/II STAT then I/I every 30minutes (max: 6 tabs/day)
Headache Sumatriptan 50–100mg (may repeat after 2H, max 200mg/day)
Prevention: Propranolol 40–80mg BD (contraindicated in
asthma and COPD patients)
⚠️Always Check BP. If neurological signs → urgent referral

9
 Adult Symptoms & Medications
Symptoms Management

Stemetil 5mg TDS

Betaserc 16mg BD
Dizziness
Cinnarizine 25mg TDS
🧠 Check hydration, check BP, ear complaint, vision, anemia

NSAID
Ibuprofen 400mg TDS (headache, dental, fever)
Ponstan 500mg TDS (menstrual pain)
Voltaren 50mg TDS (joint pain)
Naproxen 550mg BD (headache, menstrual, joint pain)
Celebrex 200mg OD/BD (joint pain)
Arcoxia 90mg/120mg OD (joint pain)
Safer alternative for gastritis & CKD
Pain
Tramadol 50mg TDS (opiod)
Orphenadrine I/I TDS (muscle pain)
Topical cream such as Flanil, voren gel

🧠 Always combine with PCM for maximum effect

🧠 Analgesic Tolerance: Painkiller overuse causing less pain relief
even with the same dose. Gradual taper prevents rebound pain.
🧠 Add MMT / pantoprazole for patient with gastritis
Maxolon 10mg TDS (may cause EPS if <19 years old)
Domperidone 10mg TDS
Stemetil 5mg TDS
Veloxin I/I PRN (pregnant)
Vomit Charcoal II/II TDS (absorbs toxin)
ORS (oral rehydration salts)
⚠️ Always ask LMP for female
⚠️ Refer ED if post head trauma vomiting
⚠️ Possible bowel obstruction if cannot pass flatus

Charcoal II/II TDS (absorbs toxin)

Loperamide 2mg TDS
Lomotil II/II TDS
Smecta (diosmectite) sachet TDS (>2years old)
Loose Stool
Hidrasec 1 sachet TDS (>3months)
ORS
⚠️ Bloody diarrhoea → rule out dysentery (stool c&s) - refer
hospital

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 Adult Symptoms & Medications

Symptoms Management

Epigastric pain or gastritis

MMT 15ml or II/II TDS
Pantoprazole 40mg OD
Abdominal Omeprazole 20-40mg OD/BD
Pain / Esomeprazole (nexium) 20-40mg OD
Gastritis / Abdominal cramp
GERD Buscopan II/II TDS

⚠️ Remember to rule out appendicitis & UTI

⚠️ Refer for scope if worsening
Lactulose 15ml BD
Bisacodyl 5–10mg OD
Ravin enema I/I PRN
Constipation

🧠 Ask for change of bowel habit

⚠️ Vomiting & NO flatus: Possible bowel obstruction
Impacted ear wax / cerumen
Cerumol 5 drops for 15 minutes TDS
Soluwax 10 drops for 5 minutes for 2 consecutive nights
Infection
CMC ear drop 2-3 drops TDS
Ear
Pocin H 3 drops TDS
Candid ear drop (fungal infection)

⚠️ Post-auricular tenderness: Mastoiditis

⚠️ Unilateral hearing loss, foul smell: Cholesteatoma

🧠 Refer specialist for non resolving symptoms

⚡️ Try SetelDoc Glossary for faster & detailed drug explanations especially
in havoc situation

11
 Adult Medication Bundle

Diagnosis Management

PCM 1g QID
Loratadine / Cetirizine 10mg OD / Piriton 4mg TDS
URTI Benadryl 10ml TDS
Lozenges or throat spray or gargle
Antibiotic if indicated

Maxolon 10mg TDS / Domperidone 10mg TDS

Charcoal II/II TDS
Lomotil II/II TDS
AGE
ORS
Smecta TDS
⚠️ Avoid drip in children or pregnant mother

Minimum criteria: Temperature of 38°C + Cough

Tamiflu 75mg BD for 5 days (More effective if started <48hours
Influenza from fever onset)
Symptomatic treatment
Refer if SOB or dehydration or altered conscious level

If normal ECG despite typical chest pain symptoms, refer ED for

serial ECG
Chest pain
Atypical chest pain: GERD, herpes zoster, pulmonary embolism,
aortic dissection, rib fracture, pneumonia, severe anemia

Pain management, good posture, physiotherapy

Back pain
⚠️ Red flags: bowel or urinary incontinence / numbness / weakness

Loratadine / Cetirizine 10mg OD and Piriton 4mg ON

Prednisolone 30mg OD or Dexa 0.75mg BD for 3-5 days (if severe)
Aqueous cream LA QID then steroid cream
Hydrocortisone cream LA BD (for face)
Eczema
Mometasone LA OD or Betamethasone cream LA BD (for body
and cannot be applied on face)
IM Hydrocortisone 200mg or IM Dexa 8mg and IM Piriton 10mg
(Piriton: drowsy. Only inject corticosteroid if driving)

⚠️ FBC must be done on day 3 of fever to rule out dengue fever

12
 Adult Medication Bundle

Diagnosis Management

Pain management
Cephalexin 500mg BD 5 days (QID if pregnant)
Or Cefuroxime 500mg BD 5 days
UTI
Ural TDS
If stone is suspected: Rowatinex II/II TDS for 1 week
⚠️ Repeat UFEME after antibiotic completion. Preferably, urine c&s

Colchicine 1mg STAT, 0.5mg (after 30min), then TDS after 12H
Pain management
Gout For uric acid test and Allopurinol if frequent gout attacks
Avoid ikan bilis, sardine, mackerel, shellfish, red meats, soup,
budu, tempoyak, tapai, sweet drinks, alcohol.

Loratadine / Cetirizine 10mg OD and Piriton 4mg ON

Prednisolone 30mg OD or Dexa 0.75mg BD for 3-5 days (if
severe)
Urticaria
IM Hydrocortisone 200mg or IM Dexa 8mg and IM Piriton 10mg
(Piriton: drowsy. Only inject corticosteroid if driving)
Calamine lotion LA BD

Neb Salbutamol 1:3 (up to 2 times)

IM Dexa 8mg or Hydrocortisone 200mg if indicated
Prednisone 30mg OD or Dexa 0.75mg BD for 5 days
Asthma MDI Budesonide 2p BD or Seretide accuhaler 1p BD + MDI
Salbutamol 2p PRN
Montelukast 10mg ON
Symptomatic treatment

Neb Salbutamol 1:3 or Combivent 2 (up to 2 times)

IM Dexa 8mg or Hydrocortisone 200mg if indicated
COPD Prednisone 30mg OD or Dexa 0.75mg BD for 5 days
MDI Berodual 2p BD/TDS + MDI Salbutamol 2p PRN
Symptomatic treatment

13
 Adult Medication Bundle

Diagnosis Management

Topical: Miconazole / Clotrimazole cream LA TDS

Symptomatic: Loratadine / Cetirizine 10mg OD + Piriton 4mg ON
Oral antifungal (Choose one) (if topical does not work)
Fluconazole 150mg-300mg per WEEK for 2-4weeks
Tinea
Itraconazole 200mg OD for 1 week
Terbinafine 250mg OD for 1-2 weeks
Griseofulvin 500mg-1000mg OD for 2-4 weeks
Avoid moisture or sharing personal items, change clothes daily

Ponstan 500mg TDS

Dysmenorrhea
Buscopan II/II TDS for abdominal cramp

For Incision & Drainage if fluctuant

Pain management
Abscess
Cloxacillin 500mg QID or Augmentin 625mg TDS
CMC ointment / mupirocin / fusidic acid LA TDS

Pain management
Prolase II/II TDS
Soft Tissue Voren gel LA BD
Injury Avoid heat cream or hot compress. Hot compress after 2 weeks
RICE therapy (Rest, Ice, Compress, Elevate)
X-ray if worsening

14
 Adult Antibiotics

Diagnosis Antibiotic Selection

Amoxicillin 500mg TDS

Tonsillitis / Pharyngitis
Erythromycin (EES) 800mg BD

Amoxicillin 500mg TDS

Rhinosinusitis Augmentin 625mg TDS
Doxycycline 100mg BD

Amoxicillin 500mg TDS

Acute Otitis Media Augmentin 625mg TDS
Erythromycin (EES) 800mg BD

Amoxicillin 500mg TDS

Pneumonia Augmentin 625mg TDS
Doxycycline 100mg BD

Cephalexin 1g BD
Amoxicillin 500mg TDS
Abscess / Cellulitis /
Cloxacillin 500mg QID
Impetigo
Augmentin 625mg TDS
Erythromycin (EES) 800mg BD

Cephalexin 500mg BD
Urinary Tract Infection
Augmentin 625mg TDS (3-5 days)
(UTI) (Non pregnancy)
Cefuroxime 500mg BD (3-5 days)

Cephalexin 500mg QID

UTI in Pregnancy
Augmentin 625mg TDS
(Asymptomatic)
Cefuroxime 500mg BD (safer than Augmentin in pregnancy)

Cephalexin 500mg QID

UTI in Pregnancy
Augmentin 625mg TDS
(Symptomatic)
Cefuroxime 500mg BD (safer than Augmentin in pregnancy)

Most cases do not require antibiotic

AGE Metronidazole 400-800mg TDS (greasy, foul-smell stool)
Refer hospital if bloody diarrhea for workup

15
Notes: Based on National Antibiotic Guideline (NAG) 2024 and antibiotic availability in
most GP settings
 Common Dermatology Management

Diagnosis Management

Features
Sudden onset of localized or generalized itchy,
erythematous raised wheals (hives)
Appears and disappears within 24 hours (no lasting marks)
Angioedema: swelling of lips, eyelids, face, hands, or genitals
may occur with or without hives
Management
Loratadine / Cetirizine 10mg OD and Piriton 4mg ON
Prednisolone 30mg OD or Dexamethasone 0.75mg BD for 3-
5 days (if severe)
IM Hydrocortisone 200mg or IM Dexa 8mg and IM Piriton
10mg (Piriton: drowsy. Only inject corticosteroid if driving)
Calamine lotion LA BD

Features
Itchy skin (pruritus is essential)
Red, inflamed patches, ill-defined edges
Acute: red, weepy, sometimes crusted
Chronic: thickened (lichenification), dry, scaly
Distribution
Infants: cheeks, scalp, trunk, extensor limbs
Adults: flexors (elbows, knees), hands, wrists, neck
Management
Loratadine / Cetirizine 10mg OD + Piriton 4mg ON
Prednisolone 30mg OD or Dexa 0.75mg BD for 3-5 days (if
severe)
Aqueous cream LA QID then steroid cream
Hydrocortisone cream LA BD (for face)
Mometasone LA OD or Betamethasone cream LA BD (for
body and cannot be applied on face)
IM Hydrocortisone 200mg or IM Dexa 8mg and IM Piriton
10mg (Piriton: drowsy. Only inject corticosteroid if driving)

16
 Common Dermatology Management

Diagnosis Management

Features
Annular (ring), scaly, pruritic lesion with active, raised well-
defined border and central clearing
Management
Topical: Miconazole / clotrimazole cream LA TDS
Loratadine / Cetirizine 10mg OD + Piriton 4mg ON
Oral antifungal (Choose one) (if topical failed)
Fluconazole 150mg-300mg per WEEK for 2-4weeks
Itraconazole 200mg OD for 1 week
Terbinafine 250mg OD for 1-2 weeks
Griseofulvin 500mg-1000mg OD for 2-4 weeks
🧠 Avoid topical steroid - worsens fungal infection (tinea
incognito)

Features
Well-demarcated erythematous plaques with silvery scales
on extensor surfaces
Nail involvement is a useful clue (pitts, onycholysis,
subungual hyperkeratosis, discoloration, dystrophy)
Mild: BSA < 10% ; Moderate: BSA 10-30% ; Severe: BSA >30%
Management
Mild: Topical steroid, moisturizer & antihistamine
Moderate - Severe: Refer for phototherapy, bio treatment

Features
Ill-defined erythematous patches or thin plaques with
greasy, yellowish scales
Distributions: scalp, face, ears
Causes: Malassezia yeast overgrowth & increased sebaceous
activity
Management
Scalp: antifungal shampoo (ketoconazole, selenium sulfide)
± mild topical steroid
Seborrheic Face/body: low-potency steroid or miconazole or
dermatitis ketoconazole cream
Maintenance: antifungal shampoo weekly, avoid harsh soaps

17
 Common Dermatology Management

Diagnosis Management

Features
Intensely itchy rash, worse at night, burrows with vesicle or
papule at one end, multiple family members affected
Reddish nodules on scrotum, axilla, or groin
Distribution: involves thin skin areas — finger webs, wrists,
axillae, waist, genitalia

Management
Permethrin 5%: Apply neck down for 8-12H ON. Repeat after
1 week (suitable for pregnancy)
Benzyl benzoate: Apply neck down ON for 3 days
Children: 12.5%
Adult: 25%
Crotamiton 10%: Apply 24H for 5-7 days
Antihistamine
EES 800mg BD for 5 days if secondary infection
Treat close contact with medications
Wash clothes and bedding at 50°C or seal in plastic bag for 1
Scabies
week to suffocate mites

Features
Chronic inflammatory disorder of the pilosebaceous unit
Common Sites: Face, chest, back, shoulders
Types of Lesions:
Non-inflammatory: Comedones (open = blackheads,
closed = whiteheads)
Inflammatory: Papules, pustules, nodules, cysts
Mild / moderate: Predominantly comedones / papules /
Acne - comedones pustules
Severe: Nodules & cysts

Management
Low glycemic diet
Mild – topical benzoyl peroxide / topical retinoid / topical
antibiotic
Moderate – combine topical + oral antibiotic
Severe – refer dermatology
Acne - pustules,
nodules, cysts

18
 Common Dermatology Management

Diagnosis Management

Features
Superficial bacterial skin infection, highly contagious
Common in children
Often follows minor trauma, insect bite, or eczema
Types
Non-bullous (common type):
Small vesicles → pustules → honey-colored crusts
Usually on face, especially around mouth & nose
Bullous:
Large flaccid bullae with clear/yellow fluid
Management
Mild / localized:
Topical antibiotic (e.g. mupirocin or fusidic acid)
Extensive / recurrent:
Oral antibiotic (e.g. cloxacillin or amoxicillin-clavulanate)
Supportive:
Gentle cleansing, avoid scratching, good hygiene
Avoid sharing towels or close contact

Features
Highly contagious, spread by respiratory droplets
Incubation: around 10 days
⚠️ GET IMMUNIZATION HISTORY
Clinical Stages
1. Prodromal (Catarrhal) Phase
Fever + 3C: Cough, Coryza (runny nose), Conjunctivitis
May have Koplik spots (tiny white spots on buccal
mucosa - pathognomonic)
2. Exanthem (Rash) Phase (NO VESICLES)
Maculopapular rash starts behind ears → face → trunk →
limbs
Rash becomes confluent, then fades in same order
Measles 3. Recovery Phase
Rash fades → brownish discoloration & fine desquamation
Management
Notify
Supportive care: hydration, antipyretics, nutrition
Isolate for at least 4 days after rash onset

19
 Common Dermatology Management

Diagnosis Management

Features
AKA chicken pox. Caused by Varicella-Zoster Virus (VZV)
Highly contagious - airborne
Incubation: 10–21 days
More severe in adult
Prodrome: Mild fever, malaise, loss of appetite
Rash:
Centripetal distribution (trunk > limbs)
Lesions at different stages: macules → papules → vesicles
→ pustules → crusts
“Dew drop on rose petal” appearance (clear vesicle on
erythematous base)
Varicella Management
Supportive: rest, fluids, antipyretics (avoid aspirin → Reye’s
syndrome)
Antiviral (acyclovir) if:
Immunocompromised / pregnant / adult / severe case
Isolate until all lesions crusted

Features
Caused by Coxsackievirus A16 or Enterovirus 71
Common in children <10 years
Spread by fecal-oral, respiratory droplets, or contact with
blister fluid
Clinical Features
Prodrome: Low-grade fever, sore throat, poor appetite
Oral lesions: Vesicles/ulcers
Skin lesions: Vesicles / papules on hands, feet, buttocks,
sometimes knees/elbows. May be tender
Herpangina = mouth only (posterior oropharynx)
HFMD Usually self-limiting (7–10 days)
Management
Notify
Supportive: Rest, fluids, soft diet, antipyretics
Maintain good oral hygiene
Isolation: Avoid daycare/school until fever and mouth ulcers
resolve

20
 Common Dermatology Management

Diagnosis Management

Features
Reactivation of latent Varicella-Zoster Virus (VZV) in dorsal
root ganglia
Usually occurs in older adults or immunocompromised
Clinical Features
Prodrome: Pain, burning, tingling, or itching along affected
dermatome (1–3 days before rash)
Rash:
Erythematous macules → grouped vesicles → pustules →
crusts
Unilateral, dermatomal distribution, not crossing midline
Herpes zoster
Common sites: thoracic, lumbar, or trigeminal regions
Complications
Postherpetic neuralgia (persistent pain >1 month)
Ophthalmic zoster → corneal ulcer, vision loss
Ramsay Hunt syndrome (facial palsy + ear vesicles)
Management
Antiviral (within 72 hours of rash): Acyclovir
Paracetamol, NSAIDs, or gabapentin (neuropathic pain)

Features
Superficial (epidermis or dermis): impetigo, folliculitis,
erysipelas
Deep (subcutaneous tissue, fascia, or muscle): cellulitis,
abscess, necrotizing fasciitis
Management
Impetigo: Refer above
Erysipelas (“butterfly-shaped” facial rash & more superficial
than cellulitis): Amoxicillin
Cellulitis (poorly demarcated erythema, warmth, tender,
swelling): Cephalexin / Cloxacillin / Amoxicillin / Augmentin
Abscess / Furuncle / Carbuncle (tender, fluctuant): Incision
and drainage (I&D) ± antibiotics
Necrotizing Fasciitis (rapidly spread, black discoloration,
crepitus): Refer.

(Around hair follicle)

Necrotizing Fasciitis

21
 Common Dermatology Management

Diagnosis Management

Features
Caused by Herpes Simplex Virus (HSV)
HSV-1: Commonly oral / facial infections
HSV-2: Commonly genital infections
Transmitted via contact with infected secretions or lesions
May become latent in sensory ganglia → recurrent episodes
Common Presentations
Herpes labialis (cold sores): Lips, perioral area
Genital herpes: Painful grouped vesicles / ulcers on genitalia
Herpetic whitlow: Vesicular lesion on finger
Herpes keratitis: Dendritic corneal ulcer
Eczema herpeticum: Widespread HSV in atopic dermatitis
patients
Management
Antiviral: Acyclovir / Valacyclovir / Famciclovir
Analgesia and local hygiene
For recurrent cases: consider suppressive antiviral therapy
Herpes Simplex Avoid contact during active lesions (especially neonatal risk)

Features
Caused by Monkeypox virus (Orthopoxvirus family)
Transmitted via lesions, body fluids
Incubation: 6–13 days (up to 21 days)
Clinical Features
Prodrome: Fever, chills, headache, myalgia,
lymphadenopathy (distinctive feature vs smallpox)
Rash starts within 1–3 days after fever
Progression: Macules → papules → vesicles → pustules →
scabs
Lesions are well-circumscribed, deep-seated, often in
same stage of evolution within one area
Distribution: Face, palms, soles, genitalia, trunk
Monkeypox
May be painful or itchy
Duration: 2–4 weeks
Management
Notify
Isolation until all scabs have fallen off
Supportive care: Hydration, nutrition, pain relief, antipyretics
Antiviral (if severe/immunocompromised): Tecovirimat

22
 Nebulization

Age Salbutamol Saline

<2
0.5ml 3.5ml
years

>2
1ml 3ml
years

Age Combivent Saline

<5 years 1ml 3ml

>5 years 2ml 2ml

>12
1 vial -
years

Age Pulmicort Saline

<2
1 vial -
years

>2
2 vial -
years

23
 Suture To Open (STO) & Size

Location Suture Size Removal

Face 6-0 3-5 days

Scalp 4-0 7-10 days

Upper Extremity 4-0 7-10 days

Trunk 4-0 10-14 days

Lower Extremity 4-0 10-14 days

Hand or Feet 4-0 10-14 days

Palms or Soles 4-0 10-14 days

24
 Referral

System Diagnosis

Dengue with red flags

TRO Leptospirosis
Infection
Sepsis
AGE with moderate to severe dehydration

Acute Coronary Syndrome (ACS)

Decompensated heart failure (CCF)
Hypertensive urgency / emergency
Cardiology Arrhythmias (AF, VT, WPW)
Cardiac tamponade
Syncope with red flags
Cardiogenic shock

Severe asthma / COPD / pneumonia

Pleural effusion
Respiratory Hemoptysis
Pulmonary embolism
Pneumothorax

Fever <1 month old (neonatal sepsis)

Severe neonatal jaundice
Pediatrics Weight loss > 10% from birth weight
Poor oral intake
Intussusception

Diabetic ketoacidosis (DKA)

Endocrine / Hyperosmolar hyperglycemic state (HHS)
Metabolic Severe hypoglycemia
Thyroid storm

Stroke / Transient Ischemic Attack (TIA)

Status epilepticus
Neurology
Headache with red flags
Meningitis / encephalitis

Suicidal ideation/attempt
Psychiatry Severe depression or psychosis 25
Delirium
 Referral

System Diagnosis

Ectopic pregnancy
Miscarriage
OBGYN
Antepartum hemorrhage (previa/abruption)
Severe pre-eclampsia / eclampsia

Head trauma with red flags

Acute abdomen (appendicitis / post trauma)
Gallstone complications
Surgical Intestinal obstruction
Irreducible hernia
Testicular torsion
Hematemesis melena

Fractures
Dislocations
Orthopedics
Septic arthritis
Back pain with red flags

Sudden vision loss

Acute glaucoma
Retinal detachment
Chemical eye injury
Ophthalmology
Foreign body
Ocular trauma
Endophthalmitis
Orbital cellulitis

Acute Kidney Injury (AKI)

Urosepsis / acute pyelonephritis
Renal Nephrotic syndrome
Gross hematuria
Acute urinary retention

Sudden hearing loss

Cholesteatoma
ENT Severe epistaxis
Foreign body
Mastoiditis
26
 Hypertension

CLINICAL PRACTICE GUIDELINES - MANAGEMENT OF HYPERTENSION, 5TH EDITION (2018)

27
 Diabetes Mellitus

CLINICAL PRACTICE GUIDELINES - MANAGEMENT OF T2DM, 6TH EDITION (2020)

28
 Diabetes Mellitus

CLINICAL PRACTICE GUIDELINES - MANAGEMENT OF T2DM, 6TH EDITION (2020)

29
 Diabetes Mellitus

CLINICAL PRACTICE GUIDELINES - MANAGEMENT OF T2DM, 6TH EDITION (2020)

30
DM, Hypertension, Dyslipidemia Target Control

Parameter Diabetes Dyslipidemia

Finger prick Fasting ≥5.6

≥5.2
(Screening) Random ≥7.8

Venous blood
FBS: ≥7.0
Lab Diagnosis RBS: ≥11.1
IFG: 6.1-6.9 Venous blood
IFG: Impaired Fasting IGT: 7.8-11.0 TC > 5.2
Glucose
Low HDL
IGT: Impaired
Glucose Tolerance HbA1c TG > 1.7
Normal: <5.6%
Pre-DM: 5.6-6.2%
DM: ≥6.3%

Target Control Diabetes Hypertension

BP <130/80 (if high risk) <140/90

LDL <2.6
<3.0 (without other
(≥50% reduction from High risk (IHD/CKD): <1.8
baseline) comorbids)
Very high risk: <1.4

TG <1.7

HDL Males: >1.0 | Females: >1.3

HbA1c ≤6.5%

Fasting: 4.0 - 7.0

Glucose level
Random: 4.0 - 8.5

18.5-22.9 kg/m² (Overweight: BMI>23; Obese: BMI>25)

BMI
10% weight loss in 6 months if overweight/obese

Exercise 150 minutes/week or 30 minutes/day

31
 Procedures

Procedure Management

1. Clean: Wear gloves. Irrigate wound with normal saline (avoid

harsh antiseptics unless infected).
2. Assess: Check wound depth, edges, discharge, signs of infection.
3. Apply:
a. Use non-adherent dressing (paraffin/bactigras) for
fresh/clean wounds.
Wound b. Use absorbent dressing (gauze+povidone) for dirty wounds.
Dressing c. Dry or necrotic wound = Dermasyn
d. Secure with tape/crepe bandage, not too tight.
4. Change:
a. Daily for infected/oozing wounds.
b. Every 2–3 days for clean wounds (or earlier if soaked/loose).
5. Advise patient: Keep dressing dry, return if pain, swelling,
redness, pus, fever. Healthy diet & reduce sugar intake.

1. Use for: Small, clean, straight, superficial, low-tension cuts

2. Avoid in: Dirty, deep, bleeding, jagged, joints, mucosal or hairy
areas
3. Steps: Clean → dry → approximate edges → apply thin glue layer
Glue Stitch over the wound (not inside wound) → hold 30–60 sec → repeat 2-
3 layers if needed
4. Aftercare: Keep dry 24 hrs, glue peels off in ~1 week
⚠️Cover critical areas such as eyes, ears, mouth with gauze to
prevent chemical injury

1. Wound Toilet
a. Irrigate with normal saline
b. Remove dirt, clots, dead tissue
c. Use dilute antiseptic only if grossly contaminated
d. IM ATT 0.5mL STAT
2. Choose correct suture:
a. Face → 5/0 or 6/0 nylon, remove 5 days
b. Scalp/limb → 3/0–4/0 nylon, remove 7–10 days
Toilet & Suture c. Trunk → 3/0 nylon, remove 10–14 days
3. Refer:
a. Deep wounds → tendon, nerve, vessel, joint, bone involved
b. Complex sites → eyelid, lip crossing vermilion border, ear,
nose, hand/foot with functional risk
c. Contaminated / dirty wounds
Rule:
Simple + clean → T&S 32
Complex / contaminated / risky → Refer
 Procedures
Procedure Management

Indications
Visible & superficial FB (skin, conjunctiva, ear, nose)
Patient symptomatic (pain, discomfort, obstruction)
Contraindications / Refer if
Deeply embedded FB
In/near vital structures (eye globe, vessels, tendons, joints)
Suspicion of multiple fragments (e.g. glass, metal)
Failed attempt or poor visualization
Uncooperative child requiring sedation
Foreign Body Technique (General)
Removal 1. Explain, consent, and ensure good lighting.
2. PPE: gloves, eye shield if needed.
3. Use appropriate tool: forceps, needle, curette, irrigation.
4. Stabilize surrounding tissue.
5. Remove FB gently, avoid crushing/breaking.
6. Irrigate wound if needed.
7. Check for residual FB.
Aftercare
Tetanus prophylaxis if indicated.
Topical / oral antibiotics for contaminated wounds.

Common Indications
Dating scan (1st trimester)
Viability check (heartbeat, number of fetuses)
Growth & wellbeing (fundal height mismatch, reduced
movement)
Placenta localization (previa suspicion, bleeding)
Amniotic fluid assessment
Key Parameters
1st trimester: Crown-rump length (CRL) for dating
2nd/3rd trimester: Biparietal diameter (BPD), Head
circumference (HC), Abdominal circumference (AC), Femur
Scan
length (FL)
Fetal heartbeat (normal 110–160 bpm)
Amniotic fluid (AFI or single deepest pocket)
Placenta position (avoid calling previa <28 weeks unless
covering os)
Refer:
No heartbeat when expected
Growth restriction / macrosomia suspicion
Oligohydramnios / polyhydramnios
Placenta previa covering os after 28 weeks 33
Congenital anomaly suspected
 Procedures

Procedure Management

Indications
Chemical injury (acid/alkali splash) – immediate, continuous
irrigation
Foreign body removal (dust, sand, debris)
Infective/irritative conjunctivitis (to relieve symptoms)
Contraindications
Penetrating eye injury
Globe rupture suspected (e.g. teardrop pupil, extrusion of
contents)
Large corneal laceration
Technique
Eye Irrigation
1. Wash hands, wear gloves.
2. Seat/lie patient, support head.
3. Use 0.9% saline (copious volume).
4. Hold lids open, direct stream from inner canthus → outward.
5. Continue until pH neutral (for chemicals, usually ≥30 minutes).
6. Evert eyelids & sweep fornices for debris.
Aftercare
7. Check vision, cornea, conjunctiva.
8. Refer urgently if chemical burn, persistent FB sensation, corneal
opacity, or vision loss.
9. Apply CMC ointment to reduce dryness and pain

Indications
Symptomatic cerumen impaction (hearing loss, pain, itch,
tinnitus)
Removal of small non-organic foreign body (if safe)
Contraindications
Perforated tympanic membrane, ear infection, history of ear
surgery
Ear Irrigation
Technique
1. Use body-temperature water (to avoid vertigo).
2. Seat patient upright, protect clothing with towel.
3. Pull pinna upward & backward (adults).
4. Direct jet towards postero-superior canal wall, never at TM.
5. Use branula tip for better targeted irrigation (remove needle)
6. Stop if patient has pain, dizziness, nausea.

34
 Procedures

Procedure Management

Intramuscular (IM) is easier and safer. Intravenous (IV) injection

can cause vasovagal syncope
Pantoprazole cannot be given IM
For antibiotic, combine with lignocaine 1-2mL. Etc: 8mL
Rocephine + 2mL Lignocaine
1. Prep: Confirm drug, dose, site, allergies. Clean hands + site.
2. Needle: Choose correct size (IM: 21–23G, SC: 25–27G).
3. Patient: Relaxed, comfortable, explain briefly.
4. IM (e.g. deltoid, gluteal, thigh):
Injection a. Stretch skin. Insert at 90°, steady and quick.
b. Aspirate only if protocol requires.
c. Inject slowly, withdraw swiftly, apply pressure.
5. SC (e.g. insulin, heparin):
a. Pinch skin, insert at 45° (thin) or 90° (normal).
b. Inject steadily, don’t rub after anticoagulants.
6. IV (e.g. pantoprazole)
a. Check: Right drug, dilution, allergies.
b. Cannula: Confirm patency, flush first.
c. Inject: Clean port → aspirate → inject slowly → flush.

1. Prep: Good lighting, support arm, use butterfly, warm compress,

calm patient, well hydrated
2. Trick: Choose best vein first, try hand veins if needed
Blood taking 3. Attempts: According to patient tolerance
4. If fail: Return another day (well hydrated) OR refer to
hospital/lab
🧠
5. Safety: Lie patient flat if faint-prone

1. Check: Right fluid, rate, indication, allergies.

2. Set up: Use aseptic technique, make sure no air bubbles.
3. Cannula: Ensure patent IV access before connecting.
IV Drip
4. Rate: Usually 30–35 ml/kg/day (adjust if cardiac/renal issues).
5. Avoid drip in children and pregnant mother. If they need drip, it
means they need referral unlike adult patients.

35
 Injections

Name Content Indication Dose

Diclofenac sodium
Voren Pain IM 50-75mg STAT
(25mg/ml)

Tramadol Pain
Tramadol IM 50-100mg STAT
(50mg/ml) Safer for CKD

<12yo: 4mg/kg (max

Hydrocortisone Allergic reaction
Zycort 100mg)
(100mg/vial) AEBA/COPD
Adult: 200mg STAT

Dexamethasone Allergic reaction

Penatone IM 8mg STAT
(4mg/ml) AEBA/COPD

Triamcinolone Allergic reaction

Shincort IM 40mg STAT
acetonide (40mg/ml) Arthritis

Chlorpheniramine <50kg: 0.2mg/kg (max

Pirimat maleate (piriton) Allergic reaction 40mg/day)
(10mg/ml) Adult: 10mg STAT

Pantoprazole
Pantoprazole Gastritis IV 40mg STAT
(40mg/vial)

Abdominal pain
Buscopan Hyoscine (20mg/ml) IM 20mg STAT
/ cramp

Gastril Ranitidine (25mg/ml) Gastritis IM 50mg STAT

<7yo: Not required if

Tetanus complete
ATT Tetanus toxoid
protection immunization
≥7yo: IM 0.5mL STAT

Prochlorperazine Dizziness
Stemetil IM 12.5mg STAT
mesylate (12.5mg/ml) Vomt

Metoclopramide
Pulin Vomit IM 10mg STAT
(5mg/ml)

36
 Antenatal Commons
Weeks Purpose of Scan

<14 Dating. Repeat in 2 weeks for USOD.

20 Fetal growth and abnormality.

28 Placenta localization and AFI.

32 Growth, AFI, EFW (for complicated patient or history of LBW).

36 Head presentation, EFW, AFI.

Weeks Parameters Acceptable Discrepancy to Use LMP

<9 CRL < 5 days

<14 CRL < 7 days

<16 BPD, HC, AC, FL < 7 days

<22 BPD, HC, AC, FL < 10 days

<28 BPD, HC, AC, FL < 14 days

≥28 BPD, HC, AC, FL < 21 days

Diagnosis Notes Management

MGTT For HbA1c

GDM FBS: ≥5.1 Refer dietician
2H post prandial: ≥7.8 BSP target: 5.3/6.7/6.7/6.7

Cephalexin 500mg QID 5 days

If abnormal UFEME, treat
UTI Repeat UFEME post antibiotic
even if asymptomatic
Urine C&S

Hb <11.0
Ferrous fumarate 200/400mg
Repeat FBC 2 weeks
Zincofer 1/1 OD
Anemia Iron study, FBP, ferritin. Hb
Iberet 1/1 OD 37
analysis if suspected
Maltofer 1/1 OD
Thalassemia
 Neonatal Jaundice

Medium Risk NNJ

Low Risk NNJ High Risk NNJ
≥38W with risk or
Hours ≥38W & well 35-37W6D & well
35-37W6D & well
of life

PL ET PL ET PL ET

<48 154 325 120 291 86 257

<72 205 376 171 325 137 291

<96 257 410 205 359 171 316

<120 291 428 239 385 188 325

>5days 308 428 257 385 205 325

Common Risks
Try SetelDoc NNJ Calculator for Free!

G6PD deficiency
Mother with O blood or Rhesus negative
Cephalhaematoma or bruises
Sepsis

Parameter Normal

Weight Less than 10% of birth weight

Urine output 5 - 6 wet nappies in 24 hours

Number of feeds 24 hours At least 8 - 12 feeds

Frequency of stools 2 in 24 hours; not pale

Length of feed 5 - 40 minutes

Alertness and tone Alert & good tone

Sucking pattern during feeds Rapid to slow sucks

38
Extended TSB Table

39
Extended TSB Table

40
 Clinic Issues

Issue Management

Some staff may ask you to add unnecessary medicines

Demanding Politely decline: “I follow MOH guidelines.”
staff Stay calm and confident — avoid arguments
Document if staff insist on inappropriate requests

Avoid RM30/hour unless it’s an overnight or low-load shift

RM40/hour is still acceptable for normal sessions
Low rate
RM50–60/hour is reasonable for busy clinics
Always clarify rate and payment method before confirming

Comply only if it doesn’t breach medicolegal safety

Bossy boss Politely remind staff to follow your treatment plan
Keep short notes to protect yourself in case of dispute

Politely remind staff or boss for pending payments

Keep proof of attendance (photo of logbook or WhatsApp
Late payment
message)
Avoid returning to clinics with repeated delays

If procedure may do more harm than good, explain risks and

Sterilization refer to hospital
concern Only proceed if instruments are properly sterilized
Document patient refusal of referral

Ask staff early about clinic’s standard workflow (MC issue,

Unclear SOP / referral, medical report)
workflow Observe how previous cases were managed
When unsure, document your clinical decision clearly

Check drug stock before starting consultation (especially

Medication antibiotics, nebulizers, or creams)
stock issue If unavailable, write the name for patient to buy outside
Record in notes to avoid misunderstanding

41
 Common Questions

Symptoms Common Questions

Demam sejak bila?

Ada mandi sungai / aktiviti tanah / hutan?
Ada batuk, sakit tekak, atau ruam?
Fever
Pernah digigit nyamuk / kutu?
Ada sakit kepala, muntah, cirit-birit atau sakit badan?
Ada ahli keluarga / rakan serumah juga demam?

Batuk sejak bila?

Ada kahak? Kalau ada, warna apa?
Cough Ada sesak nafas, sakit dada atau bunyi wheezing?
Pernah ada asma / merokok / kerja pendedahan habuk?
Ada demam atau sakit tekak sekali?

Sejak bila?
Ada bersin-bersin waktu pagi / gatal hidung / mata?
Runny nose /
Ada demam, sakit tekak atau batuk?
nasal
Ada keluar lendir pekat atau kuning hijau?
congestion
Ada sakit muka / dahi (petanda sinusitis)?
Sejak bila simptom ini bermula?

Sejak bila?
Sakit di bahagian mana?
Jenis sakit: tajam, berdenyut, atau mencucuk?
Abdominal
Ada muntah, cirit-birit, atau sembelit?
pain
Ada kencing kerap / sakit bila kencing?
Bagi wanita: ada lewat haid atau keputihan?
Masih boleh buang angin?

Sejak bila?
Ada demam sebelum ruam keluar?
Rash Ada gatal atau sakit bila sentuh?
Ada ubat / makanan baru-baru ini?
Ada ahli keluarga lain juga kena?

42
 How to Handle Difficult Patient?

Situation How to Handle

Acknowledge their request but explain medical reasoning ("I

understand why you want this, but based on guidelines, it's not
Demanding
necessary.")
Offer alternative options that align with best practices

Ask open-ended questions ("What’s stopping you from taking

the medication?")
Non-Compliant Address fears or misconceptions
Use motivational interviewing ("What are your health goals?
Let’s find a way to get there together.")

Reassure them with clear, simple explanations

Anxious Use a calm and reassuring tone
Offer relaxation techniques or refer to counseling

Stay calm and do not argue

Set firm boundaries ("I want to help you, but we need to
Aggressive
communicate respectfully.")
If threatening, involve security or a supervisor

Politely redirect: "I want to make sure we address your main

concern today. What’s the most important issue for you?"
Talkative
Summarize their points quickly and guide them back to the
medical issue

Acknowledge and offer to check reliable sources

Rare Medical
"That's a great question. Let me double-check the latest
Question
guidelines for you."

Confirm and cross-check references

Unfamiliar
"I’m not familiar with that specific medication, but let me review
medication
the latest data before I advise you."

43
 How to Handle Difficult Patient?

Type How to Handle

Diagnosis you Be honest and suggest further evaluation

are unsure "Medicine evolves, and I want to give you the best care. I’ll
about consult a specialist to ensure accuracy."

Show openness but prioritize evidence-based care

Alternative
"I appreciate your curiosity. Let’s review the research together
treatments
and see if it's a safe option for you."

Unsatisfied Reassure and suggest a second opinion

with your "Your concerns are important. If you’d like, I can refer you to a
response specialist for a more in-depth discussion."

44
 Ramadan Fasting Dose Adjustment

Medicine Dose Adjustment

Metformin No adjustment

Suhoor: ½ morning dose

Gliclazide
Iftar: Evening dose

Gliclazide MR Take the same dose during iftar

OD: Take the same dose during iftar

Vildagliptin
BD: No adjustment

Saxagliptin Take the same dose during iftar

Empagliflozin Take the same dose during iftar

Before bed: Same dose

Basal Insulin (Insulatard /
↓ 20% dose if hypoglycemia
Glargine / Levemir)

Pre-mixed Insulin (Mixtard Suhoor: ↓ 50% evening dose

/ Novomix) Iftar: Morning dose

Suhoor: ↓ 50% evening dose

Actrapid Afternoon: Omit
Iftar: Morning dose

General Rules
Continue usual medications
Shift to once daily at iftar if possible
Antihypertensive For BD regimens, split between Iftar & Suhoor
Encourage hydration during non-fasting hours
Monitor BP regularly (especially elderly, CKD,
diuretic users)

45
Immunization Schedule

46
 References
1. Frank Shann
2. MIMS
3. Malaysia Clinical Practice Guidelines
4. MyFormulary
5. National Antimicrobial Guideline (NAG) 2024
6. Common Clinical Problems in Primary Care
7. Oxford Handbook of General Practice
8. NICE Guidelines (UK)
9. CDC
10. Fitzpatrick’s Color Atlas and Synopsis of Clinical
Dermatology
11. Rook’s Textbook of Dermatology
12. Andrew’s Diseases of the Skin

47