Archive

Anxiety disorders

1. Treatment

    1. Tab paroxetine 20mg #60 qd

    2. Tab lorazepam 1mg #60 tds or bid

        1. or tab alprazolam 1mg #60 bid

Anorexia

1. mostly a side effect of drug or as a result of a disease

2. Use

    1. Syrup Zinc gluconate 1cc/kg/day

    2. Syrup multivitamin

Ankle sprain

1. take x-rays in

    1. can not walk >4 steps

    2. tenderness in 6 cm of medial and lateral malleolus

    3. tenderness on base of 5th metatarsus

    4. Use AP, Lateral, Mortise view

2. Treatment

    1. no Fx:

        1. 3 month of rubber band

        2. use NSAIDs

    2. No response to conservative treatment

        1. possibility of soft tissue injury

        2. refer to orthopedics

        3. almost always refer knee sprains

Animal Bites

1. Order:

    1. Vaccine TD 0.5 cc IM

    2.  or Vaccine DT 0.5 cc IM

    3. Amp TIG (tetabulin) (250u/ml) 3000-6000 unit IM

2. Vaccination:

    1. no prior vaccination

        1. 0-3-7-10 days IM

        2. 0-3-7 days intra dermal (2 injection each time in different limbs)

    2. prophylaxis

        1. 0-7 days IM or ID

    3. >3 months from prior dosage:

        1. 0-3 days IM

3. TIG:

    1. 20 unit/kg in 7 days from the time of bite

    2. injection only around the wound

4. Antibiotics:

    1. Cap co-amoxiclav 625mg tds #15

    2. Cap cefalexin 500mg qid #20

    3. cap cloxacillin 500mg qid #20

5. Next visit: 24-48 hours later

Angular cheilitis, Geographic tongue

1. cheilitis

    1. Cream miconazole bid #1

    2. Oint betamethasone 0.1% bid #1

    3. Vit A-D

    4. Iron supplement

    5. Vit B complex supplement

2. G. tongue

    1. mouthwash

    2. Gel fluocinonide 0.05% bid #1

Allergic rhinitis

1. Treatment: Antihistamine + Corticosteroids

    1. Tab loratadine 10 mg qd #10

    2. Spray Nasal fluticasone qd #1

2. Finest approach

    1. if mild symptoms:

        1. tab loratadine 10 mg qd #20 or Syrup 5mg/ml

        2. or tab cetirizine 10 mg qd #20 or syrup 5mg/ml

        3. or tab fexofenadine 60 mg bid #40

        4. or Tab chlorpheniramine 4 mg qid #30 or syrup 2mg/ml

        5. or Tab diphenhydramine 25 mg qid #30 or syrup 12.5 mg/ml

    2. If more severe symptom:

        1. Spray nasal fluticasone bid #1

            1. or spray nasal fluticasone 2 puff qd

            2. spray Mometasone 2 puff qd

        2. syrup loratadine 5-10 cc #1 qd

    3. for pregnant pt

        1. spray nasal cromolyn  qid #1

        2. spray mometasone 2 puff qd #1

    4. if not responded to antihistamine and corticosteroids

        1. tab montelukast 10 mg qd #30

        2. spray nasal fluticasone bid #1

Allergic conjunctivitis

1. Usually bilaterally affected

2. Treatment:

    1. Tab hydroxyzine 10mg #10 bid

        1. or tab cetirizine 10mg bid

        2. or tab loratadine 10mg bid

    2. Shampoo baby #1 tds

    3. Drop opht ketotifen #1 tds

    4. drop tear opht artificial 0.5% #1 qid

    5. Cold compress

    6. Only in severe cases

        1. Drop opht betamethasone #1 tds

Acute Sinusitis

1. DDx:

    1. Bacterial: >10 days last, >39 C fever, Relapse after temporary healing

    2. Viral

2. Imaging

    1. Water X-ray

    2. Coronal PNS CT scan without contrast

3. Treatment for children

    1. Syrup amoxicillin 250mg/4cc #1 2*w/3 cc tds (90mg/kg/day)

        1. or cap amoxicillin 500 mg tds #28

        2. or Tab co-amoxiclav 625mg tds #28 (45mg/kg/day)

        3. or syrup farmentin 643 w/3 bid #1

    2. Susp acetaminophen 120mg/5cc #1 qid w/2cc (10mg/kg)

        1. or tab acetaminophen 325mg qid #30

    3. Nasal drop NaCl 0.65% #1

        1. or serum N/S for irrigation

    4. Nasal drop pseudoephedrine #1 2drops for 3-5days

        1. do not prescribe for bacterial forms

    5. Elixir diphenhydramine tds #1

4. Ab therapy for adults

    1. cap amoxicillin 1gr q8h

        1. or tab co-amoxiclav 625 tds

    2. for hypersensitivity

        1. tab azithromycin 250 mg

Acute bacterial prostatitis

1. Symptoms:

    1. urinary symptoms

    2. perineal pain

    3. myalgia

2. Treatment:

    1. Tab SMP-TMX 800-160mg bid for 6 weeks

        1. or tab ciprofloxacin 500mg bid

        2. or tab levofloxacin 500mg qd

    2. in high risk for gonorrhea

        1. Amp ceftriaxone 250mg IM

        2. Tab doxycycline 100mg bid for 1m

    3. for fever:

        1. Tab acetaminophen 500mg qid

    4. for pain:

        1. Tab ibuprofen 400mg tds