Notes

Antidepressants

TCA Drugs Amitriptyline Nortriptyline Imipramine Clomipramine Desipramine Doxepin Side effects ↑↓BP Dry mouth Constipation Confusion Arrhythmias Sexual ↑Weight GI Arrhythmia antidote → Na bicarbonate MAOI Drugs Phenelzine Isocarboxazid Tranylcypromine Side effects Tyramine foods → Hypertension crisis Red wine Aged cheese Chocolate White wine and processed cheese are SAFE SSRI Drugs...

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Gastriesophageal Reflux Disease

GERD Etiology Inappropriate relaxation of LES Worsened by Nicotine Alcohol Caffeine Chocolate Peppermint Late-night meals Obesity Scleroderma Gasteroparesis Hiatal hernia Presentation Heartburn Epigastric burning pain 30-90m after meals Radiate → Up into chest Worsened by → Reclining Improved by → Sitting, standing, antacids Sore throat → Water brash Bad metallic...

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Anxiety Disorders

Generalized Anxiety Disorder Treatment SSRI Fluoxetin Paroxetine Sertraline Citalopram Venlafaxine Buspirone Psychotherapy, Behavioral therapy Panic Disorder Treatment SSRIs Fluoxetine Paroxetine Sertraline Benzodiazepines Alprazolam Clonazepam Lorazepam Behavioral/Individual therapy → In conjunction With Agoraphobia → Add CBT Panic attack → First choice → Benzodiazepines → Alprazolam Phobias → Treatment → Behavioral modification, Relaxation techniques Stage fright → Atenolol,...

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Psychotic Disorders

Brief Psychotic Disorder → 1d-1m Schizophreniform Disorder → 1m-6m Schizophrenia → >6m Treatment Hospitalize First line → Atypical antipsychotics Risperidone Olanzapine Quetiapine Ziprasidone Aripiprazole Paliperidone Asenapine Iloperidone Lurasidone Emergency → IM short-acting meds Olanzapine Ziprasidone Haloperidol → More side effects Non-compiance → Long-acting Risperidone Paliperidone Haloperidol → More side effect Fluphenazine → More side effect No response to...

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Mood Disorders

Major Depressive Disorder (MDD) Presentation Depressed mood or anhedonia ≥2w ≥5 SIG E CAPS Sleep Interest Guilt Energy Concentration Appetite Psychomotor → Slow moving Suicidality Treatment First line → SSRIs Fluoxetine Paroxetine Sertraline Citalopram Escitalopram Fluvoxamine After 4w No effect → Switch to another SSRI Some improvement → ↑ Dose...

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Childhood Disorders

Intellectual Disability Disorder Autism Spectrum Disorders ADHD Treatment First line → Methylphenidate, Dextroamphetamine Side effects Insomnia ↓Appetite GI disturbance ↑Anxiety Headache Non stimulants Less side effects, Non-addictive, Best for adults/addiction propensity Atomoxetine → If they really push you against stimulants NRIs Alpha-2 agonists Clonidine Guanfacine Behavioral Disorders Oppositional Defiant Disorder Conduct...

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Eating Disorders

Anorexia Nervosa Presentation Distorted body perception BMI <18.5 <5th percentile Induced vomiting Parotid hypertrophy Pharyngeal erythema Tooth decay Knuckles bruises (Russel sign) Amenorrhea Lanugo → Thin, brown body hair Bradycardia ↓BP ↓WBC Complications Arrhythmia Refeeding syndrome Suicide Treatment BMI <16 → Hospitalize Best initial → CBT Alternate → SSRI/SNRI...

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Sleep Disorders

Narcolepsy Presentation Sleep attacks Forced naps during the day ≥3 per week At least 3 months Cataplexy Hypnogogic/hypnopompic hallucinations Sleep paralysis Diagnosis ↓ CSF Hypocretin-1 ↓ REM Treatment Modafinil Methylphenidate Dextroamphetamine Gamma-hydroxybutirate (GHB) at bedtime Obstructive Sleep Apnea CPAP Central Sleep Apnea Thin person Cheyne-Stokes respirations Bipap Insomnia Diphenhydramine...

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HIV

Transmission Blood Sexual Vertical Presentation Acute Retroviral Syndrome Mono-like → days to weeks post exposure Fever LAD Rash → Maculopapular Pharyngitis Diarrhea N/V ↓Weight Headache Latent Phase Asymptomatic AIDS Night sweats ↓Weight Thrush Recurrent infections Opportunistic infections CD4 <500 Bacterial infection Tuberculosis HSV VZV Vaginal candidiasis Hairy leukoplakia (EBV)...

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Blistering Disease

Pemphigus Vulgaris Etiology Autoimmune → Antibodies split the dermis → Desmosome Drugs ACE inhibitors Penicillamine Phenobarbital Penicillin Presentation 30-50y Bullae that easily rupture (thin walled) Mouth involved Fluid loss Infection Life-threatening Nikolsky sign → Skin debudes by mild pressure Diagnosis Clinical Most accurate → Biopsy → Ab on immunofluorescence Treatment Systemic prednisone Wean...

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Papulosquamous Disease

Seborrheic Dermatitis Etiology Autoimmune against fungus (Maelezzi sp.) Skin hypersensitivity to dermatophytes AIDS Parkinson Also caused by Cradle cap in infants Presentation Rash, scales, flakes Wherever there is hair No hair, no rash Treatment Selenium Shampoo Zinc pyrithione Shampoo Topical steroids Hydrocortisone Alclomethasone Antifungals Ketoconazole Psoriasis Presentation Silvery scaly...

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Eczematous Rashes

Atopic Dermatitis (Eczema) Etiology Mast cell overactivity Mixture of type 1 and 4 hypersensitivity Presentation History of Asthma Allergic rhinitis Family history of atopy Onset <5y Pruritus Scratching → Scaly rough skin (Lichenification) Eosinophilia ↑IgE Complications Staph infection → Impetigo Cephalexin Mupirocin Retapamulin HSV infection → Eczema Herpeticum IV acyclovir → Treat infants...

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