Medications EMREE
Scarlet fever
Presents with exudative tonsillitis, cervical lymphadenopathy, a strawberry tongue, flushed
cheeks with perioral pallor, and an erythematous maculopapular rash that appeared one day
after the onset of fever. These findings are characteristic of scarlet fever.
dx : rapid antigen
confirm : throat culture
rx : oral pencillin / azithromycin
UTI
Treatment oral options for UTIs due to ESBLs-E coli include nitrofurantoin, fosfomycin,
pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin
while pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin are treatment oral options for
ESBLs- Klebsiella pneumoniae
Meningitis
bacterial meningitis
treatment
<1 month: ampicillin plus gentamicin
>1 month--> 50 years: vancomycin+cefotaxime/ceftriaxone
>50 years: ampicillin+vancomycin+cefotaxime/ceftriaxone
Pyoderma gangrenosum
Treat with tacrolimus, steroids, or cyclosporine A
Toxoplasmosis
Pyrimethamine PLUS sulfadiazine PLUS leucovorin
Brucellosis
Doxycycline PLUS rifampin
G-ve coccobacilli
GAS (Group A strep, B hemolytic) Strep throat A
Penicillin
OR 1st generation cephalosporins (Cefalexin, Cefazolin)
OR 2nd generation cephalosporins (Cefaclor, Cefoxitin, Cefuroxime, Cefotetan)
Macrolide (patients with penicillin allergy) Azithromycin, clarithromycin, erythromycin
Salmonella
Ciprofloxacin OR Ceftriaxone for adults
Azithromycin for children
Diabetic medication that causes hypoglycemia
Sulfonylureas and meglitinides directly stimulate release of insulin from pancreatic beta cells
and thereby lower blood glucose concentrations. Because they work by stimulating insulin
secretion, they are useful only in patients with some beta cell function. Adverse effects may
include weight gain and hypoglycemia.
Sulfonylurea
First generation
Chlorpropamide
Tolbutamide
Second generation
Glyburide
Glimepiride
Glipizide
Meglitinide
Nateglinide
Repaglinide
Reversal of anticoagulant
Andexanet alfa can rapidly reverse the anticoagulant effect of apixaban and rivaroxaban
Glaucoma
Preferred first-line therapy: topical prostaglandin analogs Latanoprost Travoprost Bimatoprost
Alternative options Topical beta blockers alone and/or alpha-2 agonists
For closed angle glucoma :
◦ Direct parasympathomimetic: pilocarpine
◦ Alpha-2 agonist: apraclonidine
◦ Beta blocker: timolol
• PLUS a systemic carbonic anhydrase inhibitor: Acetazolamide OR
methazolamide
Etanercept
TNF inhibitor
Indications:
Moderate to Severe Rheumatoid Arthritis (RA)
Psoriatic Arthritis
Ankylosing Spondylitis (AS)
Moderately to Severely Active Polyarticular Juvenile Idiopathic Arthritis (JIA)
Mycoplasma (Atypical pneumonia)
A macrolide, doxycycline, fluoroquinolone
Azithromycin, doxycycline, ciprofloxacin
Side effect of ceftriaxone: Diarrhea
Side effect of ethambutol: optic neuritis and color vision disturbances
Endometritis:
Clindamycin and gentamicin
Chronic endometritis can be by doxycycline
Breast Abscess/Mastitis
Antibiotics dicloxacillin / cephalexin
if MRSA = clindamycin / TMP- SMX
+ analgesia + continue breastfeeding
Cat Scratch Disease
Pathogen: Bartonella henselae (gram -ve aerobic bacillus)
Mild-moderate: azithromycin (5 days)
Persistent / disseminated: erythromycin / doxycycline
CNS involvement / endocarditis: rifampicin + (erythromycin / doxycycline)
Genital warts
Podophyllotoxin (also used to treat molluscum contagiosum)
Wernicke
Thiamine (oculomotor, confusion, ataxia) it is reversible.
Give before glucose !!
Decubitus ulcer
Cefotaxime (cephalosporins are the strongest
IBD
Crohn’s:
First line is corticosteroid
Maintenance is biologics like TNF alpha (Infliximab). Then 6MP then 5 ASA (mesalamine)
Sulfasalazine can also be used to induce remission in mild to moderate crohns
Ulcerative colitis:
first line is mesalamine, then you can maybe add corticosteroids.
In moderate to severe: TNF alpha and oral steroids
Acute severe: IV steroids
SBP:
First line: 3rd gen cephalosporin (IV Cefotaxime)
Alternative: Oral ofloxacin
Diarrhea after antibiotics:
Metronidazole
Oral vancomycin
Fidaxomicin
Traveler’s diarrhea:
SEVERE: Ciprofloxacin or rifaximin
MILD: Supportive. Treat the dehydration, bismuth, and loperamide if using abx
Side effect of Quinolone:
G6PD
Myelofibrosis: JAK2 +ve
Ruxolitinib
Polycythemia vera:
Methotrexate / Phlebotomy / Antiplatelet prophylaxis (aspirin) / Cytoreductive therapy
(hydroxyurea / interferon alpha / Ruxolitinib)
AML is a complication of polycythemia vera.
Trigeminal neuralgia
Carbamezapine
Tolosa Hunt syndrome (Down and out, orbital pain, CN3)
Steroids
Giardiasis
Paromycin
Gonorrhea: Ceftriaxone
Chlamydia: Azithromycin
PID: Ciprofloxacin + Doxycycline
Urge incontinence: Oxybutynin
Glaucoma:
OPEN ANGLE: Timolol + Bimatoprost (topical) (to decrease the volume and pressure of the
aqueous humor)
Others 🡪 Laser trabeculoplasty and surgical trabeculotomy
CLOSED ANGLE
Timolol, pilocarpine (cholinergic, induces miosis), and then IV acetazolamide
Surgical iridotomy or iridectomy
Uveitis:
Anterior: Cyclopentate (DILATE) / steroids / analgesia
Intermediate: Steroids
Posterior: Steriods / vitrectomy / cryotherapy / laser coagulation
Febrile neutropenia: Meropenem
Alzheimer’s
Start with rivastigmine/donepezil/galantamine for mild AD
Mod/severe Memantine + Donepezil
Pneumonia in HIV +ve patient = Pneumocystis jiroveci
TMP-SMX
Aspergillus
IV Voriconazole
Alcohol withdrawal
Chlordiazepoxide + thiamine + folic acid + multivitamins
Bacteriodes fragilis
Metronidazole
OR clindamycin
OR extended-spectrum penicillin with penicillinase inhibitor
Empiric antibiotic treatment of uncomplicated lower UTIs
First-line treatment
Nitrofurantoin for 5 days
Trimethoprim/sulfamethoxazole (TMP/SMX) for 3 days
Fosfomycin (single dose
Empiric treatment of complicated lower UTIs include:
Fluoroquinolones PO or IV: e.g., ciprofloxacin or levofloxacin
Beta lactams
Second-generation or third-generation cephalosporins: e.g., ceftriaxone
Extended-spectrum penicillins: e.g., ampicillin/sulbactam
Cystitis
Co-trimoxazole (TMP-SMX) for 3 days
Complicated pyelonephritis Ciprofloxacin 14 days
Uncomplicated pyelonephritis Ciprofloxacin 5-7 days
Random:
Hemophilia, G6PD, Duchenne: x-linked recessive
Cystic fibrosis, Thalassemia: autosomal recessive
Marfan, Von Willebrand: autosomal dominant
Afro American with dyspnea, bilateral interstitial nodules on CXR. Renal biopsy shows
Crescentic glomerulonephritis, Most likely pulmonary biopsy finding:
Non caseating granuloma (sarcoidosis)
ANCA +ve, wegener’s: Polyangiitis granuloma
Alzheimer’s: Tau Protein, amyloid, ApoE
Parkinson’s: Alpha synuclein
WIPE Wiskott Aldrich: Infections + Purpura due to low Platelets + Eczema
Drainage:
Rectal cancer 🡪 para iliac (higher)
Anal cancer 🡪 inguinal (lower)
Oropharyngeal cancer 🡪 Jugulogastric
BB 1st line in AFib avoid in COPD
CCB 2nd line in AFib avoid in DECOMPENSATED HF
SVT 🡪 Adenosine
If SVT with Asthma 🡪 Verapamil cuz adenosine causes bronchoconstriction
Amiodarone: SE is thyrotoxicosis/hyperthyroidism
Furosemide and Thiazide worsen hypokalemia
- Digoxin toxicity is increased with hypokalemia
- Don’t give furosemide and digoxin together
ACEi increase potassium. Don’t give in hyperkalemia peaked T waves
ACEi decrease dyslipidemia
Don’t give mannitol with heart failure. It causes rapid fluid shifts
NSAIDs are contraindicated in HTN Diabetes HF CKD = decreases effect of antihypertensives +
causes water retention
Avoid nonselective betablocker (propranolol) in prinzmetal cuz causes vascoconstriction
Turner syndrome coarc of aorta and biscupid aorta
Avoid thiazide in hypertensive patient, DM, gout: causes hyperglycemia + hyperuricemia +
hypercalcemia
What is the interleukin that increases in parasitic infections?
IL-5 (major effect is eosinophil growth)
What interleukin works as an anti-viral?
IL-6
Vincristine causes SIADH
Dopamine controls prolactin. when dopamine is gone, prolactin runs free
Methyldopa decreases dopamine = increasing prolactin
Methyldopa will cause autoimmune hemolytic anemia but with no bite cells and shistocytosis
and coombs negative
Diabetes insipidus:
Water deprivation test 🡪 works, this is psychogenic DI (aka ADH increases and urine osmolality
decreases)
If didn’t work 🡪 Give ADH.
Worked 🡪 Central DI, give desmopressin
Still did not work 🡪 Nephrogenic DI, give diuretics
Cushing syndrome:
First we do 24 hour cortisol urine test
Then we do low dose dexamethasone test
If it did not suppress the cortisol level, then we have cushding syndrome
Then we check the ACTH level
If it low ACTH that means this is adrenal tumor bc adrenal tumor is releasing cortisol and
negative feedback of ACTH
If it high ACTH, then it could be pituitary (cushing disease) or ectopic ACTH
So we do high dose dexamethasone test
If it suppresses the cortisol, this is pituitary
If it does not suppress then this is naughty ectopic tumor
Addisons disease:
Aldosterone increases Na and excretes K
No aldosterone = hyponatremia (hypotension) and hyperkalemia
Hypotension, NV, fatigue, hyperpigmentation = primary failure aka adrenal gland not producing
Everything except hyperpigmentation = secondary failure aka pituitary
If cortisol is low 🡪 u give ACTH
Adrenal gland (1ary insufficiency) there is enough ACTH but the adrenals are not working so the
cortisol will not increase after ACTH administration (cosyncotropin) Tx is prednisone and
fluticasone (cortico and mineralo)
Pituitary (2ndary insufficiency) there is aslan zero ACTH, so when u give ACTH the cortisol will
increase (only give prednisone)
What is the mechanism of action of glipizide? sulfonurea
It increases insulin secretion from the pancreas
Necrotizing fasciitis: Strep pyogenes
Fascia and fat, more painful, with (?)flu like symptoms
Clostridium myonecrosis/gas gangrene: Clostridium perfringens
Muscle only, less painful, most likely (?)extremities/limb
What is the mechanism of action of omeprazole?
PPI (inhibition of the H+ K+ ATPase system)
What is the mechanism of action of cholera toxin?
Increases intracellular cAMP (stimulates cAMP)
What is the source of GTP energy?
Hydrolysis in the nucleus
What is the rate limiting enzyme for dopa synthesis?
Hydroxylase
Zieve’s syndrome Triad = jaundice + hemolytic anemia + hyperlipidemia
AMA primary biliary, - give ursodeoxycolic acid
SMA autoimmune hepatitis,
pANCA primary sclerosing – ulcerative colitis – beaded appearance, intra and extra hepatic.
Sideroblastic anemia target cells high RDW
Iron deficiency anemia low MCV high TIBC low iron high RDW
Thalassemia trait (if iron is normal) low MCV iron normal target cells (iron could be high due to
blood transfusion or something else)
Leukomoid reaction high LAP
CML Low LAP
CLL smudge cells
Hereditary hemorrhagic Telangiectasia: epistaxis + telangiectasia + AVM
Pre-eclampsia prophylaxis: Low dose Aspirin after 12 weeks
Brandt Andrews: useful in 3rd stage of labor
Byssinosis: Cotton inhalation
DUMBELS: Diarrhea, Urination, Miosis, Excessive lacrimation, Salivation
Treat by Atropine
TCAs are contraindicated in CAD. + can cause cardiac conduction delay and QRS prolongation
Theophylline: Narrow therapeutic margin
Don’t use for asthma
Low citrate = uric acid stone = give potassium citrate
Abx revision
1. Endometritis : clinda + genta
2. SBP: cephalosporin, prophylaxis: flouro
3. Decubuitus ulcer: cephalosporin
4. Bacteroides fragilis: clinda or metro
5. H.pylori: amox + PPI + clarithro or metro
6. PID:
> outpatient: One single dose of IM ceftriaxone and oral therapy with doxycycline
> Inpatient: Clindamycin plus gentamicin *or* Cefoxitin or cefotetan plus doxycycline
7. TB in hepatitis: strepto + ethambutol
8. TB in pregnant active : INH + ethambutol(for 2 months only) + Rifambin
9. Lung aspergillus : Voriconazole
10. Scarlet fever : Oral Pen V = phenoxymethylpenicllin
11. Chlamydia Psitacci : doxy or macrolide
12. H. ducree : azithromycin or ceftriaxone
13. Granuloma inguinale: Azithro
14. febrile neutropenia: Antipsueddomonal beta lactam](eg, cefepime, meropenem,
piperacillin-tazobactam)
15. Nocardia: TMP-SMX
16. Meningitis:
> <1 month: ampicillin PLUS either or both: Gentamicin, Cefotaxime(not ceftriaxone)
> 1 month to 50 years: ceftriaxone + vanco
> above 50 ys : ceftriaxone + vanco + ampicilin
17. Salmonella : flouro
