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 […]
Guideline Materials and Tips
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, […]
Pharyngitis aka Strep Throat
Caused by strep pyogenes or group A B-hemolytic strep, or viruses (rhinovirus, coronavirus, adenovirus, HSV, parainfluenza) Mononucleosis differential: splenomegaly, cervical adenopathy. A diffuse rash 2-3 days after PCN dose is indicative of mono. If you have to guess a sub for PCN allergic patients in ANYTHING chose a macrolide. Treatment: PCN V or Amoxil for […]
Urinary Incontinence
Causes (DRIP): Drugs, delirium Retention, Restricted mobility Impaction, infection, inflammation Polyuria, prostatitis Treatment: Urge: Anti-muscarinic and anticholinergic: oxybutynin, tolterodine, fesoterodine, trospium, solifenacin, darifenacin B-agonist: mirabegron Stress: alpha-adrenergic agonists: pseudoephedrine, phenylephrine topical estrogens if other signs of estrogen deficiency SSRI/SNRI: only duloxetine Overflow: alpha-adrenergic agonists: alfuzosin, tamsulosin 5-alpha-reductase inhibitors: finasteride, dutasteride Parasympathomimetic: bethanechol Phosphodiesterase inhibitor: tadalafil BPH: Meds that […]
Glaucoma
Angle-closure is a medical emergency: 1 drop of timolol, apraclonidine, pilocarpine stat until ophthalmologist. Open-angle: brinzolamide, dorzolamide (carbonic anhydrase inihibitors) or latanoprost: prostaglandin
Arthritis
Osteoarthritis:Risk factors: age, female sex, obesity, genetics, sports, occupation, injury, acromegaly and other illnesses.Treatment: Lifestyle: weight loss, exercise, PT and surgery Drugs: APAP up to 3g daily NSAIDS if APAP not working. Take ASA at least 30 minutes before NSAID if on ASA. Topical agents, especially for the knee (capsaicin, diclofenac 1% gel) Intraarticular glucocorticoid […]
Inflammatory Bowel Disease
Ulcerative Colitis: Rectum and colonic mucosa involvement, no small intestine involvement, no skip lesions Blood diarrhea, spasm of anal sphincter (Tenesmus), weight loss, fever Staging: Mild < 4 stools a day, no symptoms Mod > 4 stools a day, minimal symptoms Severe > 6 stools a day, temp > 99.5 F, HR > 90, ESR […]
GERD, PUD, Stress Ulcer Prophylaxis
GERD (gastroesophageal reflux disease) Only screen for H. pylori in the case of PUD, history of documented peptic ulcer disease or gastric mucosa-associated lymphoma. No endoscopy needed unless there are alarm symptoms. Lifestyle Modifications: Avoid alcohol, caffeine, chocolate, citrus, garlic, onions and mint Reduce fat Avoid eating 2-3 hours before bedtime Remain upright for 2 hours after […]