Non-Insulin Meds for DM2

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…

    Anticoagulation

    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
  • Onychomycosis

    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
  • Supraventricular Tachycardia Management

    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
  • Botanical Medicine

    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…

    Treatment for Allergic Rhinitis

    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
  • Nausea and Antiemetic Medications

    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
  • Skeletal Muscle Relaxants

    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…

    Why Family Medicine?

    Why Family Medicine? It is a very satisfying field, particularly if you love building relationships with patients and their families. I’ve gotten to treat both parents and their kids. I’ve even got to take care of a pregnant woman, deliver her baby, then take care of both her newborn and herself post-partum. The range of practice is wide, and the…

    End of Intern Year

    So it’s come to this day, the end of internship year. There’s no doubt that there were some rough days and sleepless nights during the past 365 days, but there were also many days when I came home with a smile knowing I did something significant for someone else. As for my co-residents, I have really enjoyed working with them…

    Return to the Caribbean

    The last time I saw the Caribbean was the day I hauled my bags to the airport and flew away from St. Maarten where I had been living for two years for Basic Sciences, to move back to the states to start my clinical rotations. That was in the fall of 2011. It wasn’t until nearly four years later, this…

    COPD and Asthma

    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.…

    Cellulitis

    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…

    Eyelid Swelling

    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…

    Dos and Don’ts for Residency Application and Interview

    It’s that time of the year again… interview season. It didn’t seem that long ago that I was interviewing here and meeting my current colleagues for the first time. Today, I find myself on the other side of the dinner table, interviewing candidates who I will potentially work with next year. I’ve gotten to read many applications, and met many…

    Hobby

    Hey folks, I know I haven’t blogged in a while, but I am still here, surviving my intern year. Residency has been pretty busy thus far, but there hasn’t been a day gone by where I haven’t come home feeling I’ve had a productive day. My intern experience thus far has been pretty inpatient-heavy. I’ve had two months of internal…

    45 Thoughts Running Through My Head During Match Season

    It’s that time of year again, when all medical students who are transitioning into doctors go through a rite of passage called the Match season. I can’t believe it’s been a year already since I went through mine. It hasn’t been that long since I’ve been on this side of the Match, and already,  I will be interviewing applicants like…

    How to Dress for a Residency Interview

    During the residency interview, it’s important to dress to impress. While you can act and speak professionally, wearing jeans or a mini skirt to an interview can ruin the program’s impression of you. For every interview you go to, it’s important to bring two types of outfits:
  • Business Casual – to wear to the dinner with residents the night before interview.
  • Back Burner

    With rounds, daily progress notes, grand rounds, afternoon clinics, day calls, night calls, morning reports, presentations, and teaching sessions, there are several things that had to be put on the back burner these past two months into residency, and blogging happened to be one of them, as you’ve probably noticed from my hiatus. The other is working out and eating…

    Learning Curve

    There’s so much I wanted to write about, like my experience during orientation, my first day of residency, Lyra’s 3rd month “birthday,” my first overnight on-call shift as a resident physician, my first paracentesis, and my struggles finding my way around the hospital system. However, it’s been 4 weeks since I started orientation and 2 weeks since I starting seeing…