All things med mx

Remipril is for what?

Remipril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and heart failure by relaxing blood vessels, thereby reducing blood pressure.

Atovastatin is for what?

Atovastatin is a statin medication used to lower cholesterol levels and reduce the risk of cardiovascular disease by inhibiting the enzyme HMG-CoA reductase.

Pantoprazole is for what?

Pantoprazole is a proton pump inhibitor (PPI) used to treat gastroesophageal reflux disease (GERD) and other conditions involving excessive stomach acid production.

Dutasteride & tamsulosin is for what?

Dutasteride and tamsulosin are medications used to treat benign prostatic hyperplasia (BPH) by reducing prostate size and improving urine flow.

Hydrocholorothiazide is for what?

Hydrochlorothiazide is a thiazide diuretic used to treat hypertension and edema by promoting fluid excretion through the kidneys.

Hyperkalemia mx

Insulin + glucose , Salbutamol, Diuretics that remove potassium, Calcium gluconate, Sodium Bicarbonate, exchange resins eg: Resonium

Hypercalcaemia mx

IV fluids

Bisphosphonates

Denosumab

Mx for easy bruising

avoidance of medications that impair platelet function:

NO aspirin, clopidogrel, NSAIDs, anticoagulants (warfarin, DOACs), corticosteroids.

Mx for easy bruising/ bleeding in ITP

in Thrombocytopenia treat the underlying cause.

if severe: corticosteroids ± IVIG.

if severe blood loss: plt transfusion

Coagulation factor deficiency in Vit K low? or if low cogulation factors in haemophilia?

1. Replace vit K

2. replace coag factors (VIII or IX)

von Willebrand disease mx?

desmopressin or vWF-containing factor replacement.

STEMI mx

O2

Aspirin

GTN

Morphine

reduce mortality with: BBlockers, Statins, Reperfusion <90min or thrombolysis PCTA angioplasty

Alcohol withdrawl mx?

Initial assessment: ABCD

IV access

monitor vitals,GCS

withdraw score

Give Thiamine + Benzodiazepine eg) Diazepam (according to scale)

correct electrolytes (K+/Mg)

± treat hypoglycaemia

± IV fluids (if dehydrated)

± Metoclopramine (antiemetics for N / V)

Mx for school sores (impetigo) in children?

Clean the lesions gently w/ soap/ water

keep it covered

good hygiene

dont share anything! no towels/ bed/ cloths

treat all affected household contacts

Wash existing cloths/ bed

if Group A strep infection in Impetigo —> IM benzathine benzylpenicillin

If Scabies: Permethrin cream 5% w/ repeat in 7 days or Ivermectin if> 15kg child

Febrile convulsions in a child Mx?

• if simple febrile cause: reassurance

• If seizure >5min : benzodiazepine ASAP

• safety net: to call an ambulance if:

  • seizure lasts >5 minutes

  • it is their first seizure

  • they do not wake/recover afterwards

  • they have difficulty breathing or become blue/pale

  • the seizure is prolonged or they remain significantly drowsy.

initial Ix/mx + actual mx: of heavy menstrual bleeding?

• Assess haemodynamic stability and severity of bleeding.

• Pregnancy test.

• FBC ± ferritin → assess iron-deficiency anaemia.

• Determine likely cause using PALM-COEIN.

• Consider pelvic examination and pelvic US depending on history/examination.

• Treat iron deficiency if present.

Mx:

• IUD (Mirena) → generally most effective medical option.

• Tranexamic acid → reduces menstrual blood loss; taken during menstruation.

• NSAIDs (e.g. mefenamic acid) → reduce bleeding + dysmenorrhoea.

• Combined oral contraceptive pill → regulates/reduces bleeding.

• Progestogen → alternative when oestrogen contraindicated.

• ± hysterectomy or endometrial ablation

Surgical emergency trauma eg: gun shot wound

• A – Airway + C-spine

• B – Breathing: RR, SpO₂, chest examination, oxygen if required.

• C – Circulation: control catastrophic haemorrhage immediately, assess pulse/BP, IV access, bloods, fluids/blood products as appropriate.

• D – Disability: GCS, pupils, BGL.

• E – Exposure: look for other injuries

Mx:

• Apply direct pressure/haemostatic dressing; use a tourniquet

• IV access

• analgesia

• Prevention of infection: tetanus shot prophylaxis + Abs

• urgent surgical assessment and imaging when stable.

How do you manage delirium?

• Identify and treat the underlying cause.

• ABCDE + observations + BGL.

• Correct dehydration/electrolyte abnormalities/hypoxia —> if those are cause

• Review medications.

• Treat any: pain, constipation and urinary retention

• Ensure glasses/hearing aids are available.

• Avoid unnecessary restraints/catheters.

• Maintain sleep–wake cycle, Provide orientation: clock, calendar, familiar people/environment.

manage mild CAP community-acquired pneumonia in a child?

mild:

• Oral antibiotics if bacterial pneumonia suspected.

• Fluids and regular feeding as tolerated.

• Paracetamol/ibuprofen for comfort/fever.

• Safety-netting and review.

manage severe CAP community-acquired pneumonia in a child?

• Admit.

• Oxygen if hypoxaemic.

• IV antibiotics if unable to tolerate oral therapy or significantly unwell.

• IV/NG fluids if required.

• Monitor respiratory status closely.

What important interaction should you remember with digoxin?

Digoxin has a narrow therapeutic index. Check renal function, electrolytes and interacting medications. Toxicity can cause GI symptoms, confusion, visual disturbance and arrhythmias.

How do you manage an uncomplicated, reducible inguinal hernia?

• may not need surgery if no symptoms (aka uncomplicated)

• if symptoms = refer for surgery esp if risk of strangulation

• observe for syx

How do you manage an incarcerated/strangulated hernia?

• Emergency surgical assessment.

• NBM.

• IV access + fluids.

• Analgesia/antiemetics.

• Bloods ± crossmatch.

(strangulation is present if severe pain + irreducable tender lump + red + N/V + ischemic / BO signs)

How do you manage major depression during pregnancy?

• Assess suicide/self-harm risk and symptoms for severity

• Discuss psychological therapy

• For mild depression → psychological interventions may be appropriate initially.

• Moderate–severe depression → psychological therapy + consider antidepressant medication: SSRIs

• Severe depression w/ inability to care for self → urgent psychiatric assessment/admission may be required.

What is the management of faltering growth/ failure to thrive in baby?

• Confirm accurate weight/length/height measurements and plot serially.

• Assess dietary intake and feeding and waste (wet nappies- if malabsorption vs inadequate intake eg) feeding issue)

• Detailed developmental and psychosocial history (inc requirements or different behaviours)

• Examine for systemic disease (IBD/ coeliac / diabetes/ infection)

• Assess parental heights/genetic potential.

• Dietitian/paediatric referral if significant or persistent.

Returned traveller with fever + rash + diarrhoea/vomiting = Malaria vs Dengue vs typhoid treatment?

if Malaria:

• P. falciparum; severe malaria requires urgent IV artesunate

if Dengue:

• supportive care and careful fluid management. Use paracetamol for fever/pain and avoid aspirin/NSAIDs because of bleeding risk.

if typhoid:

• Antibiotics + fluids + electrolytes