Acute: Treat with NSAIDS, APAP, 5-HT receptor antagonists (triptans). Prophylaxis: Avoid precipitants, TCAs, propranolol, topiramate, verapamil, valproic acid, NSAIDs, Botox, Magnesium, Vitamin B12, CoQ10, feverfew Migraine: If they are recurrent, interfere with daily activities or patient prefers prophylactic therapy, prophylaxis should be considered. Use lowest effective dose, give 2 – 3-month trial, consider a choice that also […]
Guideline Materials and Tips
Kidney Stones
There are four types of kidney stones: Calcium oxalate stones Thiazide reduces urinary calcium excretion Uric acid stones Potassium citrate – stones formed because of low urinary pH Cysteine stones – Tiopronin after dietary intervention Struvite This type of stone is found mostly in women with urinary tract infections.
Acute Kidney Injury
Fast Facts: Normal BUN: SCR = 10-15:1 = ATN (intrinsic acute kidney injury) Cellular Debris usually seen. Elevated BUN (20:1) or Urinary sodium < 20 or low Fractional Excretion of Sodium = pre-renal RIFLE Stratification of injury: Considered kidney injury when SCr increases 2 times baseline Failure when SCr increases 3 times baseline Risk of injury […]
Chronic Kidney Disease
KDOQI Staging Stage GFR Stage 0 >=90 with risks (diabetes, HTN, history) Stage 1 >=90 w/damage Stage 2 60-89 w/damage Stage 3 30-59 w/damage Stage 4 15-29 w/damage Stage 5 <15 KDIGO Staging: All in damaged kidneys. Stage GFR G1 >=91 G2 >=60-89 G3a 45-59 G3b 30-44 G4 15-29 G5 <15 Albuminuria: ACR A1 <30 A2 […]
Menopause
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 […]