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2012-11-18 20:05:12
GERD treatment Rx

GERD Treatment
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  1. Acne Rx
    • Topical:  
    • Retinoids -comedolytic
    • Benzoyl peroxide -comedolytic and antibacterial. Gel 2.5-10% bid
    • Topical abx AND Benzoyl peroxide  
    • Clindamycin (Cleocin T, ClindaMax) gel. Apply thin film bid 

    • Systemic: For Moderate-Severe Inflammatory acne 
    • Doxycycline 50-100mg bid x 12-18 week

    • Isotretinoin (Accutane): 0.5-10mg/kg/day x 16-20 weeks
  2. Asthma Rx
    • Control triggers
    • Control contributing conditions (URI, Rhinitis, GERD)

    INTERMITTENT MILD: Albuterol (Proventil-HFA, Ventolin-HFA, ProAir-HFA) 90mcg/puff 2 puffs every 4-6h prn or 10mnts before exercise.

    • PERSISTENT MILD:  Albuterol (Proventil-HFA, Ventolin-HFA, ProAir-HFA) 90mcg/puff 2 puffs every 4-6h prn or 10mnts before exercise
    • Maintenance medication: Mometasone (Nasonex): ONCE-daily dosing. 2 prays (100mcg) in each nostril qd.

    PERSISTENT MODERATE: Combination Inhaled Glucocorticoid/LABA = Budesonide/Formoterol HFA (Symbicort): Reliever and Controller med. 80mcg/4.5mcg 2 puffs bid.   

    PERSISTENT SEVERE: Combination Inhaled Glucocorticoid/LABA = Budesonide/Formoterol HFA (Symbicort): Reliever and Controller med.  160mcg/4.5mcg 2 puffs bid.
  3. CHF Rx
    • Treat underlying condition
    • D/C Tobacco 

    • LOW-Na diet 1-2g daily
    • Water restriction

    Loop Diuretics: Control fluid retention. Furosemide (Lasix). Initial: 20-80mg/dose, repeat if inadequate response in increments of 20-40mg/dose at intervals of 6-8h.  May be titrate up to 600mg/day.  Maintenance dose: once or twice a day

    ACEI: Interfere with RAS. Enalapril (Vasotec) 10-20 bid. Initial: 2.5-5mg/day,   increased if needed at 1-2 week intervals.  range

    BBl: If LV dysfunction. Carvedilol (Coreg) 25mg bid.  Initial: 3.125mg bid for 2 weeks, increase if tolerated to 6.25mg bid. Double dose every 2 weeks until highest dose tolerated. 

    • Main stay drug therapy:  Bronchodilators (beta-agonists, anticholinergics), and inhaled glucocorticoids, given alone or in combination depending upon the severity of disease and response to therapy. 
    • Beta Agonists (SABAs, LABAs)
    • SABAs:
    • Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA, AccuNeb) 2 puffs every 4-6h prn with metered-dose inhaler. 

    • LABAs:
    • Salmeterol (Serevent Diskus)
    • Formoterol (Foradil Aerolizer) 

    • Anticholinergics: 
    • Short-Acting AnticholinergicsIpratropium (Atrovent HFA)
    • Long Acting AnticholinergicTiotropium (Spiriva HandHaler)

    • SABA/Short-Acting Anticholinergic:  
    • Albuterol/Ipratropium (Combivent, Duoneb)

    • Inhaled Corticosteroids
    • Budesonide (Pulminort Flexhaler)
    • Fluticasone (Flovent HFA)
    • LABA/Long-Acting Inhaled Steroids combinations:
    • Fluticanose/Salmeterol (Advair Diskus, Advair HFA)
    • Formoterol/Budesonide (Symbicort) 
  5. Folliculitis Rx
    • MCC = S. aureus (gram +)
    • Long term antibiotic use can bring on gram – strains
    • Superficial infection of hair follicle in epidermis

    • Antibacterial soaps
    • Bleach baths
    • Topical abx: Mupirocin (Bactroban) ointment applied tid

    Systemic: 1st gen cephalosporin (has good skin penetration)
  6. GERD Rx
    Lifestyle modifications: wt loss, avoid bedtime snacks, avoid trigger foods (chocolate, peppermint, coffee, tea, citrus fruit), decrease meal size, elevate head of bed, d/c EtOH, d/c tobacco

    Omeprazole (PPI) 20mg one daily for up to 4 weeks 
  7. Hidradenitis Suppurativa
    • I&D: Large fluctuant cysts
    • Intralesional steroids 
    • Weight loss- reduce friction
    • Long term antibiotics (oral/topical): Tetracycline 250-500mg bid
    • Oral contraceptives for premenstrual flares
    • Isotretinoin (Accutane)-selected cases (early, non-scarring)
    • Laser hair removal may provide benefit
    • Infliximab, Etanercept: Biologics-agents used to attack proinflammatory cytokines TNF
    • Wide surgical excision
  8. HTN Rx
    Lifestyle modifications: wt loss, limit EtOH, regular aerobic exercis, d/c tobacco, low-Na diet, low-fat/chol diet. 

    • STAGE 1 (140-159/90-99)
    • INITIAL Rx: Thiazide diuretic (Hydrochlorothiazide) or BBl
    • Hydrochlorothiazide (Microzide): 12.5-50mg/day
    • or 
    • Atenolol (Tenormin): 25-50mg qd.  May increase to 100mg/day. 

    STAGE 2 (>160/>100): TWO drugs required.
  9. Impetigo Rx
    • Soap and water
    • Warm compresses 

    • Abx should cover Beta-hemolytic Strep and Strep aureus
    • Topical Abx: Mupirocin (Bactrobam) ointment apply tid x 3-5, then re-evaluate. 
    • Systemic Abx: Cephalexin (Keflex).  Child: 25mg/kg/day in 4 divided doses. Adult: 250-1000mg every 6 hours. Maximum 4g/day. 
  10. PNA -CAD PNA EMPIRIC OUTpatient Rx
    • MCC = Strep pneumoniae
    • Others: Mycoplasma pneumoniae, Chlamydophila pneumoniae
    • Less common: Legionella pneumoniae, Haemophilus influenzae

    • HEALTHY, NO use of abx in last 3 months:
    • Macrolide:
    • Azithromycin 500mg x 1d, 250mg x 4d
    • or
    • Clarithromycin 500mg bid x 7d

    • IMMUNOCOMPROMISED, use of abx in last 3 months: Macrolide + Respiratory Fluoroquinolone Macrolide:
    • Azithromycin 500mg x 1d, 250mg x 4d 
    • or
    • Clarithromycin 500mg bid x 7d
    • AND
    • (Resp Fluoroquinolone)  Levofloxacin 750mg po q24 x 5 days 
  11. Rosacea Rx
    Avoid Triggers (EtOH, hot/spicy foods/beverages) 

    • Topical Agents:  
    • Metronidazole (Metrocream or Metrogel) 0.75% bid
    • Noritate cream qd

    • Oral Abx:
    • Tetracycline 250-500 mg po BID
    • Doxycycline 50-100mg BID
    • Minocycline 50-100mg QD-BID

    Isotretinoin (Accutane)

    Rhinophyma- (surgical ablation, electrosurgery, wire-brush)