DOC in Pregnancy-N&V: Diclectin (Vit B6 + doxylamine)-Antihypertension: methyldopa, hydralazine and labetalol-Diabetic Type 1&2 : Insulin-Epilepsy: Carbamazepine-Hyperlipidemia: Cholestyramine-Hyperthyroidism: PTU-UC: 5-ASA or sulphasalazine-Constipation: Psyllium (bulk laxative), stool softner-Stomach Ulcers: Anatacids, H2 Blockers and PPI-Vulvovaginitis Candida: Clotrimazole (except 1st trimester), miconazole or nystatin-Migraine: Acetaminophen, NSAIDs-Depression: Fluoxetine-UTI: Cephalosporins (cephalexin) and nitrofuronation-Acne: erythromycin

OTC and Prescription Drugs for Dermatological Conditions-Head Lice : Permethrin 1% (DOC) or 1% Lindane (shampoo but CI in seizures)-Scabies: Permethrin 5% (DOC A&C > 2 mths old) or Sulphur 6% in petrolatum (DOC preg-nancy, lactation and children under 2 months)-Acne: Benzoyl Peroxide in gel, lotion, metronidazole or Erythromycin/Clindamycin (DOC in pregnancy)-Atopic dermatitis: topica hydrocortisone 5%-Diaper Rash: uncomplicated (zinc oxide, petroleum jelly) and complicated (nystatin or clotrima-zole)

OTC Drugs, Antihistamines, Decongestants, Antitussives and Expectorant-Diphenydramine/dimenhydrinate (DOC for motion sickness)-Meclizine (DOC in pilots and navigator due to long half-life)-salt water gargles and throat lozenges (soothes sore throat)-1st generation antihistamines (relieves rhinorrhea and watery eyes)-topical and oral nasal decongestants -relieves stuffy nose and sinuses-expectorant, guaifensin -treats productive cough with chest congestion-dextromethorphan - to suppress dry unproductive cough-Cold: ASA (CI in infants children and teens due to Reye’s syndrome so give acetaminophen in-stead)-Sinusitis: Amoxicillin (DOC) if allergic Trimethoprim/Sulfmethoxazole (TMP/SMX)-Bacterial Pharyngitis: Penicillin V if allergic erythromycin (adults) and erythromycin estate (chil-dren)

OTC Drugs for Nausea, Vomiting, Constipation, Diarrhea and Hemorrhoids-Pregnancy N&V: dimenhydrinate or pyridoxine (Vit B6) - OTC if not then Dicletin-OINV: Metoclopramide (DOC)-PCNV: acute emitogenic (DOC ondansetron + dexamethasone), high emitogenic (DOC dexam-ethasone) and ancticipatory N&V (DOC lorazepam)-Diarrhea: ORS (DOC for children with acute diarrhea) and Loperamide (DOC in pregnancy)-Cholestyramine - bile acid induced diarrhea-Codeine - dont respond to non prescription meds-Clondine - diarrhea associated with opioid withdrawal and diabetic neuropathy

-Octreotide - for chemotherapy induced and AIDS associated diarrhea-Traveller’s Diarrhea: Ciprofloxacin (DOC) alternative azithromycin, cefixime-Lactulose (osmotic laxative): DOC for hepatic encephalopathies since absorbs ammonia-Senna (stimulant laxative): DOC for opiods induced constipation-Pregnancy: bulk forming agents (DOC) (bran, psyllium, methycellulose), stool softener, osmotic or Mg laxatives-Breastfeeding: bulk forming, and osmotic laxatives (1st line) or Mg sulfate, cascara and seena (2nd line)-Elderly: Lactulose or glycerin supplements then bulk laxatives

Analgesics and Topical Pain Relievers-Mild Migraine Attacks: ASA (not enteric coated), Ibuprofen-Moderate Migraine Attacks: NSAIDS (ibuprofen, naproxen, mefenemic acid) and 5HT1b/d agonists (sumatriptan, rizatriptain), zolmitriptan, naratriptan)-Severe Migraine Attacks: Chlorpromazine, dexamethasone, metoclopramide, sumatriptan-avoid amitriptyline and nortriptyline if have migraines and BPH-Migraine prophylaxis: amitriptyline, propranolol, verapamil, nortriptyline-if no relief with triptan do not use second time

Asthma and COPD-short acting beta 2 agonists to relieve symptoms: salbutamol, terbutaline and alternative is ipra-tropium bromide (anticholinergic) if susceptible to tremors or tachycardia-long acting beta 2 agonists for maintenance therapy and exercise induced asthma and used if taking corticosteroids (fluticasone)-Montelukast and Zafirlukast for asthma maintenance and ASA induced asthma-DOC for COPD is ipratropium bromide -sequence of asthma therapy: SABA prn then ICS then LABA than LTRA then PO CTS then IV CTS

Smoking Cessation-Bupropion (DOC) used with or without NRT and can smoke for first two weeks-Nicotine inhaler CI if allergic to nicotine or menthol -Nicotine patch or gum stop smoking completely-Verenciline (Champix) - CI in pregnancy, breastfeeding and children and DI insulin, NRT, war-farin, theophylline

Insomnia-OTC Diphenhyramine, Valerian, Melatonin-Short acting Benzos : Triazolam, midazolam-Intermediate acting Benzos: Oxazepam, temazepam, lorazepam-Long acting Benzos: Diazepam, clonazepam, flurazepam

Eating Disorders-Anorexia Nervosa: DOC is domperidone, metoclopramide-Bulimia Nervosa: DOC is SSRI and venlafaxine

GERD, Ulcers, IBD, IBS-GERD: mild use antacids, alignates or H2RA (cimetidine, ranitidine, famotidine or nizatidine) and for severe use PPI-Peptic Ulcers

- eradicate H.pylori need triple therapy: clarithromycin + omeprazole + amoxicillin/metronidazole or quadruple therapy: tetracycline + metronidazole + bismuth subsalicyclate + omeprazole-to neutralize use antacids-to reduce gastric secretion use H2RA or PPI-IBD (UC and Crohn’s Disease): UC for mild to moderate is 5-ASA (DOC) and severe is oral prednisone. Crohn’s D for mild to moderate is oral budosenide and severe is IV steroid-IBS: Cholestryramine (bile salts malabsorption), Lactulose (constipation), Magnesium hydrox-ide (heartburn), Loperamide (diarrhea), Dicyclomine (has anticholinergic side effects)

Thyroid Disorders-Hypothyroidism (hashimoto disease): Levothyroxin (1.6ug/kg/day in adults but 12.5 to 25ug/day in patients with coronary artery disease or elderly). DI with Fe, Ca, cholestryamine, colestipol, sucralfate-Hypothyroidism (grave’s disease): Methimazole and PTU (DOC in pregnant and lactation women)-IV sodium iodide: thyroid storm-Lugol’s solution: thyroid storm and prior to thyroidectomy-sodium iodide: CI in pregnancy and patients with significant ophthalmopathy -atenolol, metoprolol, propranolol use as adjunct with Grave’s Disease or toxic nodules-dexamthasone as adjunct for thyroid storm and hydrocortisone as adjunct for myxedema coma

Gynaecological and Genitourinary Conditions-Dysmenorrhea: mefenemic acid or diclofenac (DOC)-Endometriosis: for pain with NSAIDs, OCs, P only OCs, androgen agonist (Danazole) and GnRH analogs. For fertility clomiphene-Erectile dysfunction: PDE5 Inhibitors: CI in nitrates and for tafalafil CI in severe hepatic impaire-ment-BPH: finasteride and dutasteride-Urinary Incontinence: DOC is anticholinergics, oxybutynin-Euresis in children: DOC is antidiuretic hormone derivatives desmopressin (DDAVP)

Osteoarthritis, RA and Gout Arthritis, Osteoporosis-OA: Acetaminophen (DOC) and ASA/NSAIDs/Ibuprofen (2nd line)-RA: Methotrexate (DOC) but avoid in patients with hep B, hep C, renal insufficiency or lung dis-ease and use Leflunomide as alternative (CI in pregnancy), NSAIDs-prednisone/triamcinolone safest therapy during pregnancy and lactation-Infliximab used with methotrexate for UC and RA-Acute gout attack: NSAIDs like indomethacin (1st line), colchicines (if NSAIDS CI) and corticos-teroids (if colchicine is CI). Colchicine is CI in severe renal disease (CrCl<50ml/min)-OP: Bisphosphonates (Aldendronate, Risdronate, zolendranoic acid ) is DOC but CI in patients with severe renal disease (CrCl<35mL/min). Raloxifeine is CI in patients with history of DVT/PE, MI or stroke and pregnant women.

Hypertension-Patient with chronic kidney disease with proteinuria give ACEI or an ARB with/without a diuretic-Patient with stable angina give BB-Patient with CAD give ACEI or an ARB-Patient with diabetes give ACEI or an ARB-Patient with a history of stroke give ACEI and a thiazide diuretic-Patient with a recent heart attack or heart failure give ACEI or ARB along with BB

-no other medical conditions for mild-moderate BP give thiazides, BB, ACEI, ARBs or long act-ing CCBs -if have high BP use combo therapy-DOC in uncomplicated hypertension age over 65 years old is thiazide diuretics-DOC in uncomplicated hypertension age less than 65 years old is BB-DOC in pregnancy is methyldopa-DOC for hypertensive crisis is sodium nitroprusside and hydralazine-DOC for Reynaud phenomenon is Felodipine

Coronary Artery Diseases-NSTEMI: Antiplatelets (ASA or/and clopidogrel and GPIs are used) -treatment MONA therapy: morphine then oxygen then nitrates then ASA-STEMI: Thrombolytics (Alteplase DOC) or angioplasty-DOC for stable angina is BBStroke-DOC is antiplatelets (ASA, clopidogrel, ticlopidine, warfarin) but dont give in AF patients. Use ASA first then clopidrogel Use warfarin for patients with AF. -newer oral anticoagulants: Dabigatran, Rivaroxaban and Apixaban require no INR monitoringCHF-DOC is ACEI, furosemide and digoxin

Antiarrhythmic Drugs-Class 1a (quinidine, procainamide, disopyramide) drugs are Na+ channel blocker slows phase 0 depolarization-Class 1b (lidocaine, mexiletine, tocainide) drugs that are Na+ channel blocker shortens phase 3 repolarization-Class 1c (Flecainide, Propafenone) drugs that are Na+ channel blocker significantly slow phase 0 depolarization-Class II (esmolol, propranolol, timolol, atenolol, metoprolol, nadolol) decrease phase 4 depolar-ization-Class III (amiodarone) K+ channel blocker prolong phase 3 repolarization-Class IV (verapamil, diltiazem) Ca2+ channel shortens action potential

Peripheral Vascular Disorders-DVT: LMWH (enoxaparin, dalteparin, tinzaparin, nadroprain) approved for prophylaxis and treatment of DVT. Heparin (UFH) is prophylaxis only and DOC during pregnancy. Start with war-farin with sc LMWH or iv UHF.-Reynaud’s Phenomenon: CCBs (nifedipine, felodipine, amlodipine) DOC.

Anxiety Disorders-Anxiety Disorders: Benzodiazepines-Panic Disorders: Paroxetine, Serttraline, Venlafaxine (SSRIs)-Social Anxiety Disorder: Paroxetine, Venlafaxine-Obsessive Compulsive Disorder: Fluvoxamine, Fluoxetine, Paroxetine (but not CR), Sertraline-Generalized Anxiety Disorder: Paroxetine, Venlafaxine, Buspirone (5HT1a agonist)-Post traumatic stress disorder: Paroxetine

Depression-DOC to treat depression and insomnia is Trazodone-DOC for depression and smoking cessation is Bupropion-DOC for depression and sexual dysfunction are Moclobemide, Mirtazepine and Bupropion

-DOC for depression with diabetes is SSRI avoid TCAs and MAOI due to weight gain-DOC for bipolar disorders and manic depression is Lithium-DOC for depression and ADHD is atomoxetine

Anit Psychotic Drugs-1st generation (haloperidol, loxapine, chlorpromazine, thioridazine) is effective in positive schiz-ophrenic symptoms.-2nd generation (clozapine, risperidone, olanzapine, quetiapine) is effective in negative schizo-phrenic symptoms-Risperidone works for both positive and negative symptoms-DOC for acute agitation in seniors is Quetiapine-2nd generation increase risk of diabetes and lipids except Risperidone-if experience EPS (P - parkinson’s symptoms, A - akthisia, T - tremors, T - tardivve dyskinesia_ use SGA as first line. -if have severe case of psychosis or bipolar disorder add mood stablizers (valproic acid, carba-mazepine)

Dementia - use reversible acetylcholinesterase inhibitor-DOC for Alzhemier’s dementia is Donepezil (selective)-DOC for Lewy body dementia is Rivastigmine (inhbits non specific butyrylcholinesterase and reversible Acetylcholinesterase or centrally selective arylcarbamate AchEI)-DOC for patients with dementia associated with Parkinson’s disease is Rivastigmine-Effective in Alzheimer’s and vascular dementia is Galanthamine (selective, competitive, re-versible acetylcholinesterase inhibitor and also enhances the action of acetylcholine on nicotinic receptors)

Epilepsy-Drugs with least DI with OCs are gabapentin and valproic acid-DOC for trigeminal neuralgia, partial seizures, and tonic clonic seizures is carbamazepine-DOC for trigeminal neuralgia and diabetic neuropathy is gabapentin-Phenobarbital, Primidone (barbiturates) used for generalized seizures-Valproic Acid, Divalproex is DOC for mixed primary generalized seizeures- Simple Partial Seizures: (1st-4th) Carbamazepine, phenytoin, primidone and gabapentin- Complex Partial Seizures (1st-4th) Carbamazepine, phenytoin, phenobarbital, valproic acid-DOC for absence seizures or petit mal seizures is Ethosuccimide

Anti-Parkinson’s Drug-DOC is Levodopa (L - doc, E- empty stomach, V- V&N, O-orthostatic hypotension, D-dyskine-sia/domeperidone for N&V, P-protein diet interactions so avoid, A - avoid Vit B6 supplements)

Antimicrobials-B-lactamase inhibitors for broad spectrum gram +ve and -ve-Penicillins or all beta lactams are not effective for mycoplasma bacteria-DOC for pharyngitis, cellulites is Cephalexin Oral-DOC for MRSA Vancomycin and alternate drug for treating superinfection (Superbug) by Clostridum difficle in patients with P.colitis. Vancomycin active against Staphylococcus, Strepto-coccus and Clostridium sp. (gram +ve bacteria)-Macrolides alternative in patients allergic to penicillins. Erythromycin is DOC for Mycoplasma infection. Azithromycin is more active against gram -ve H.influenza than erythromycin. Clar-ithromycin is effective for H.pylori

-DOC for CAP without RF is Doxycycline-DOC for traveler diarrhea is Ciprofloxacin-Clindamycin for gram +ve anaerobic bacteria Bacteroid fragilis (abdominal infection)-DOC for CAP is Amoxicillin/Clavulanate-DOC for UTI is Ciprofloxacin-Protozoans (Giardia, Entamoeba, Trichomonas) and anaerobes such as Bacteroides, C. diffi-cile, C. vaginalis for Metronidazole.-DOC for P. carinii pneumonia (PCP) is Cotrimoxazole