Menopause is the cessation of menstrual periods for 1 year. The average age for menopause is 52. Estrogen: Estrogen relieves genitourinary atrophy, vasomotor instability, reduces hip and vertebral fractures, relieves hot flashes which decreases insomnia and fatigue, stabilizes mood changes, improves sexual function. Risks: cancer, especially when unopposed, CHD, bloating, headache, breast tenderness, increased blood clotting Women […]
Osteoporosis
All women over 65 and men over 70 should have bone mineral density (BMD) testing. If fractures or risks, test sooner. Initiate therapy if: Hip or spine fracture and BMD T-score -2.5 or below at hip, spine or femoral neck T-score is between -1.0 and -2.5 at femoral neck or spine and the 10-year probability of […]
Contraception and Fertility
Contraception: Management of adverse effects: Bleeding: if early in the cycle, you need higher estrogen component. If late bleeding, you need more progesterone. Nausea: Usually related to estrogen, take at night with food Acne: Usually related to progestin Severe effects: Abdominal pain Chest pain Headaches: could be a stroke or blood clot Eye problems, blurred […]
Otitis Media
Analgesia: APAP, NSAIDS, rarely opioids. Avoid ASA in kids. Antihistamines and decongestants are not usually recommended. Antibiotics only if: Bulging tympanic membrane, perforation or otorrhea Delay unless fever or otalgia > 48-72 hours in kids > 2 years. Not usually for otitis media with effusion, only if greater than 3 months Not for the persistence of […]
General Antibiotic Tips
It’s easier to remember antibiotics that don’t need renal adjustment than antibiotics that do. Certain antibiotics ROMANCCED the kidneys. Rifampin Oxacillin Moxifloxacin Azithromycin Nafcillin Clindamycin Ceftriaxone Erythromycin Doxycycline Antipseudomonals: IV :aminoglycodisdes pip/tazo (Zosyn) ticarcillin/clavulanic acid (Timentin) ceftazidime (Fortaz) cefepine (Maxipime) imipenem/cilastin (Primaxin) meropenem (Merem) doripenem (Dorax) ciprofloxacin (Cipro) colistin (Nebuliner) PO:norfloxacin ofloxinc ciprofloxacin (best) levofloxin Carbapenems […]
Influenza
Influenza mortality is greatest in those over 65 years of age. Flu onset is sudden: high fever, dry cough, headache, muscle aches, exhaustion Type A – causes epidemics every 1-3 years Type B – less likely to mutate than Type A. Epidemics seen every 5 years. Treatment: Mostly supportive care. Adamantanes: amantadine, rimantadine – no […]
Acne
Topical retinoids: adapalene, tazarotene, tretinoin Topical antibiotics: clindamycin, erythromycin Oral antibiotics: doxycycline, erythromycin, minocycline, tetracycline, Bactrim Non-antibiotic treatments: azelaic acid, benzoyl peroxide, dapsone, salicylic acid Accutane REMS program: You can read the whole thing here. Highlights- The goals of the isotretinoin risk evaluation and mitigation strategy are: To prevent fetal exposure to isotretinoin To inform […]
Skin and Soft Tissue Infections
IDSA 2014 Guidelines Source control and debridement are very important in SSTIs. Quick Guide Epidermal/Surface Skin Infections May be Staph (Impetigo & Ecthyma): · Topical: mupirocin (increasing resistance)· MSSA (usually): cephalexin 250 mg PO q6h or 500 mg PO q12h · MRSA suspected (purulence): doxycycline 100 mg PO BID, clindamycin 300 to 450 mg PO q6h, TMP/SMX 1 DS BID · Duration: […]
HIV Infection
They probably won’t ask you to manage an HIV patient’s antiretrovirals, but prophylaxis and medication side effects are fair game. Know that everyone with a diagnosis of HIV should get HAART, which is usually 2 NRTIs and an NNRT or a PI. It’s always at least 3 drugs. You should probably be able to identify […]
Basic Vaccines
Hep A: Travelers, primate workers, healthcare workers, people with clotting disorders, homosexuals, people with liver disease should all get. Killer virus. Given in 2 doses, 6 months apart. Heb B: 3 doses, first administered at birth. Meningococcal: People in close quarters like military barracks or college dorms should get. HPV: All females from age 9-26 hours, […]