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
pregnancy, 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
clotrimazole)
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 Reyes syndrome so give acetaminophen
instead)
-Sinusitis: Amoxicillin (DOC) if allergic Trimethoprim/Sulfmethoxazole (TMP/SMX)
-Bacterial Pharyngitis: Penicillin V if allergic erythromycin (adults) and erythromycin estate
(children)

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
dexamethasone) 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
-Travellers 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
ipratropium 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,
warfarin, 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 Crohns Disease): UC for mild to moderate is 5-ASA (DOC) and severe is oral
prednisone. Crohns D for mild to moderate is oral budosenide and severe is IV steroid
-IBS: Cholestryramine (bile salts malabsorption), Lactulose (constipation), Magnesium
hydroxide (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 (graves disease): Methimazole and PTU (DOC in pregnant and lactation
women)
-IV sodium iodide: thyroid storm
-Lugols solution: thyroid storm and prior to thyroidectomy
-sodium iodide: CI in pregnancy and patients with significant ophthalmopathy
-atenolol, metoprolol, propranolol use as adjunct with Graves 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
impairement
-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
disease 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
corticosteroids (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
acting 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 BB

Stroke
-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 monitoring
CHF
-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
depolarization
-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
warfarin with sc LMWH or iv UHF.
-Reynauds 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
schizophrenic symptoms.
-2nd generation (clozapine, risperidone, olanzapine, quetiapine) is effective in negative
schizophrenic 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 - parkinsons 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,
carbamazepine)
Dementia
- use reversible acetylcholinesterase inhibitor
-DOC for Alzhemiers 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 Parkinsons disease is Rivastigmine
-Effective in Alzheimers and vascular dementia is Galanthamine (selective, competitive,
reversible 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-Parkinsons Drug
-DOC is Levodopa (L - doc, E- empty stomach, V- V&N, O-orthostatic hypotension, Ddyskinesia/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,
Streptococcus 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.
Clarithromycin 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.
difficile, C. vaginalis for Metronidazole.
-DOC for P. carinii pneumonia (PCP) is Cotrimoxazole