Author: Benji Ho

First Line – Start with this.

Biguanide (Metformin)

MOA: inhibits gluconeogenesis

Weight loss, decreased mortality, decreased CV events. Because of this, continue even when insulin-dependent.

AE: GI. Take with meals.

CI in men with Cr >1.5 or women with Cr >1.4, or GFR<30.

Cheapest ($4/month)

Second Line – Add to Metformin if no improvement in A1C in 3 months. Can… Continue reading

Risk Classifications Schemes

Caprini Risk Assessment – estimates venous thromboembolism risk for non-orthopedic surgeries. Low risk use SCDs. Mod risk use meds or SCDs. High risk use meds+SCDs. If risk of bleeding, use SCDs only.

CHADS2 – estimates stroke risk in Afib patients. Easiest one to use. Recommends aspirin, anticoagulant, or both, depending on risk.

CHA2DS2-VASc – a more accurate

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Facts about Onychomycosis

Onychomycosis is very common. 50% of patients older than 70 years old have it.

Onychomycosis is most often caused by dermatophytes of the genus Trichophyton. Non-dermatophyte molds are less common.

Treating onychomycosis is more than just about cosmetics. It can lead to cellulitis in the elderly, and foot ulcers in diabetics.

Onychomycosis is hard to treat, since

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Types of SVT:

AVNRT – caused by a slow and fast pathway in the node, causing reentry.

AVRT – caused by an accessory pathway between the atrium and ventricle, not in the node. If there is delta wave and tachycardia, it is WPW.

Atrial Tachycardia – caused by focal area of automaticity in atrium.

Acute Treatment

Vagal Maneuvers – Valsalva

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Botanical (Herbal) medicine has been used all over the world, and in different ways. In a 2005 CDC survey, 19% of adult Americans take dietary supplements and most use them without medical advice. Because many of your patients may be taking botanicals at home, as a medical practitioner, it is important to at least be familiar with them, and even… Continue reading

When treating allergic rhinitis, you should take into account the severity of symptoms, patient’s age, whether they are pregnant or not, price, and other factors. For asthmatics, allergic rhinitis is especially important to be treated as it can lead to asthma exacerbation. And of course, one should try to avoid known allergens as well. For Mild Intermittent Symptoms:

Second Generation

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Nausea and vomiting happens when the Vomiting Center in the medulla is stimulated by one of three different neurotransmitter pathways:

Visceral Stimulation (of intestines, stomach) – i.e. nausea from gastroenteritis

mediated by dopamine and serotonin

Chemoreceptor Trigger Zone (in medulla oblongata) – i.e. nausea from chemotherapy

mediated by dopamine and serotonin

Vestibular Stimulation (in inner ear) – i.e. nausea from

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Skeletal Muscle Relaxants can be prescribed for musculoskeletal pain only if you find no relief with acetaminophen or NSAIDs. Skeletal muscle relaxants have not been proved to be more effective than acetaminophen or NSAIDS, and because of the side effects and lack of evidence for long-term efficacy, they should only be prescribed if Acetaminophen or NSAIDs have failed, and should… Continue reading

COPD TREATMENT 1. Smoke cess, flu vax
2. SABA or SAC
3. LABA or LAC
4. (LABA or LAC) + ICS
5. (LABA or LAC) + ICS + O2 (if <88) Theophylline isnt that great. SAC = short acting anticholinergic (ipratropium)
LAC = long acting anticholinergic (tiotropium) ASTHMA TREATMENT 1. SABA
2. SABA + ICS (or LTRA, cromolyn, zil)
3.… Continue reading

ERYSIPELAS – caused by strep
1. Penicillin, Amoxicillin, Ampicillin (covers strep specificallly) CELLULITIS – caused by strep and staph
No Abscess or pustular drainage – likely MSSA, MSSE
1. Cephalexin, Dicloxacillin – PO, for minor infxn
2. Oxacillin, Nafcillin, Cefazolin – IV, for more severe infxn
Abscess or purulent drainage present – likely MRSA, MRSE
3. TMP/SMX (Septra), Clindamycin, Doxycycline… Continue reading

Anatomy Zeis gland = sebaceous gland of eyelash (external)
Moll gland = apocrine gland of external eyelid
Meibomian gland = sebaceous gland of internal eyelid Pathology Infxn of Meibomian = internal hordeolum (internal stye)
Infxn of Zeis or Moll = external hordeolum (external stye)
Blocked Meibomian that is not infected (no pain, no erythema) = Chalazion Internal hordeolums can resolve… Continue reading