Things to remember

• amiodarone
• griseofulvin
• NSAIDs
• phenothiazines (chlorpromazine, pimozide, clozapine, promethazine, etc. - 'z-drugs')
• methoxsalen (for psoriasis)
• quinolones (ciprofloxacin, moxifloxacin, norfloxacin, ofloxacin)
• retinoids (acitretin, adapalene, isotretinoin, tazarotene, tretinoin)
• SJW
• tetracyclines (doxycycline, minocycline, tetracycline) thiazides (rare)

• triclosan
• coal tar derivatives
• fragrances
• methoxsalen
• retinoids (adalaplene, isotretinoin, tazarotene, tretinoin)
• sulfonamides

gliclazide and glipizide

• wt gain
• anaemia
• oedema
• heart failure
• CV ischaemic events (possibly)
• C/I with insulin - inc risk of HF
• C/I - T1DM, ketoacidosis, Insulin tx, HF (except pioglitazone in class 1)
• Rosiglitazone - increases in HDL and LDL cholesterol
• Pioglitazone - myalgia

• EtOH - decreases blood glucose, may mask warning signs of hypos, avoid binging, eat something when you drink
• friends and family to know sx and tx of hypos
• inject s/c into abdomen OR thigh/upper arm/buttock
• SA - 30 mins before meals
• ultra-short acting - immediately before meals
• resuspend cloudy insulin (long-acting - humulin, isophane, protaphane) gently rotate vials/cartridges of cloudy insulin
• sulphonylureas - often stopped/reduced once tx est'd, metformin/pioglitazone may be continued - rosiglitazone C/I

• DPP-4 inhibitor
• MOA: inc conc of incretin hormones (e.g. GLP-1) - increases G-dependent I secretion, reduces glucagon production
• Precaution - tx with ACE-i - inc risk of angiodema
• Sfx: hypos, infections, headaches, constipation (infreq)

• Swallow whole before meals or chew with first mouthfuls of food
• give glucose but not sucrose (cane sugar) for hypos
• flatulence, diarrhoea, abdominal pain and distension common ADRs

• GLP-1 analogue: up insulin, down glucagon (enhances glucose-dependent insulin secretion and suppresses inappropriate glucagon secretion), delays gastric emptying = reduced G absorption rate and decreases appetite
• inject 60 mins before main meals at least 6 hrs apart - BD dosing
• slow stomach emptying - may affect other meds, ensure ABx given at least 1 hr before/4 hrs after exanitide

• empty stomach, pref before breakfast
• tell if sx of hyperthyroidism occur - palpitations, excitability, insomnia, flushing, sweating, weight loss

inhibit osteoclasts (decrease bone resorption)

• common: n, v, d, headache, hypocalcaemia, muscoloskeletal pain
• rare: osteonecrosis of the jaw (risk higher w/ infusion)
• concomitant use of NSAIDs increases irisk of oesophageal adverse effects

• cholecalciferol - slow onset (4-8 weeks), long duration of action (8-16 weeks)
• calcitriol - rapid onset (1-3 days), short duration of action (<1 week), active, higher risk of hypercalcaemia

• SERM
• oestrogen agonist effects on bone
• antagonistic effects on other oestrogen-receptive tissue, e.g. breast and endometrium
• prevention and tx of post-menopausal OP, Primary prevention of BREAST CANCER in high-risk post-menopausal women
• Precautions: VTE hx/risk, CAD
• C/I in pregnancy - cat X
• common ADR: hot flushes (may also aggravate), sweating, leg cramps, p oedema, sleep disorders
• ensure adequate intake of Ca and Vit D

• give in 2 doses - 2/3 mane, 1/3 evening
• usual contraindications do not apply
• increase in therapy required during illness and stress --> mild infection = 2-3X dose, serious infection/sx --< IV

• write date you open - 28/7
• wash your hands, then sit or lie down
• tilt head back and look up and gently pull down lower lid to create pouch
• 1 dop into pouch - close eyes and gently press against inner corner of eye (over tear duct) for at least 3 mins
• avoid letting top of dropper touch your eyes, skin or other surface
• another drop - allow 5 mins
• clean tissue to mop up excess
• get someone to help/mirror/eye dropper
• try storing in fridge - know when drop in eye
• contact lenses - wait at least 15 mins after before inserting

• squeeze small amount (1cm) along pouch then blink several times to spread the ointment
• if using drops, use oinment last

• clear away debris and mucus with NS before using medication if possible
• no improvement in 2 days - refer/r/v diagnosis
• contact lenses should not be worn for 24 hrs after infection resolved

• regular use of artificial tears
• cool compresses
• hygeine - avoid sharing facial towels, touching face, etc
• infection until redness and weeping resolves - no antivirals

• Seborrhoeic dermatitis of lid margin - greasy, easily removed scales on lid margin
• warm compress (face cloth in warm water - apply for 5-10 mins BD)
• scrub lids BD - 1:10 baby soap:water

• 1: PG analogues
• 2: BBs
• 3: CA-i's

• BBs (e.g. timolol) --> D-BD
• PG analogues (e.g. latanoprost) --> D (nocte)
• Carbonic Anhydrase-i's (dorzolamide) --> BD-TDS
• A2 agonist (e.g. brimonidine) --> BD-TDS

• use generally C/I in CAL - betaxolol cardioselective and preferred
• consider systemic effects - C/I in bradyarrhythmia, AV block
• oral BBs lower IOP - consider alternate class as may be more effective and lower risk of adverse fx
• avoid tx with verapamil --> profound bradycardia
• ADR: stinging on instillation, bradycardia
• timolol - non-selective, fewer local fx
• betaxolol - selective for B1, stinging

• evening for optimal effect
• structurally different - consider another drug in this class if response to one is poor
• paradoxical increase in pressure if 2 PG analogues used together - avoid combination

• allergy to sulphonamides - risk of allergy
• common ADR: occular irritation, foreign body sensation bitter taste
• avoid driving if you exp blurred vision

• NS BD
• artificial teas - 4-8 times daily
• cold water compresses as required

• topical drugs:
• ketorolac (acular) - 2-4 wks only - 1 QID
• levocabastine (livostin) - 1 BD
• ketotifen (zaditen) - 1 BD
• olopatadine (patanol) - 1 BD
• azelastine (Eyezep) - 1 BD
• recurrent disease - cromoglycate

• azelasatine (eyezep)
• levocabastine (livostin) - may cause drowsiness
• ketotifen
• olopatadine
• ketotifen (zaditen) and olopatadine (patanol) also have mast-cell stabilising effects

• mast cell stabiliser
• may take 3-6 weeks to reach full effect - i.e. delayed onset of action, 2-4 weeks for noticeable effect
• start tx 1 month before hayfever season or use oral/topical antihistamines until it takes effect

• anticholinergics
• diuretics
• OCP

• preservative containing:
• infrequent use - inexpensive product
• frequent use - product with less irritant preservative, e.g. polytears, genteal
• preservative free:
• non-irritant, but more expensive (bulky single dose)
• useful for use >4-6/day, contact lens wearers, allergy to preservative
• single vials can be used more than once, but discarded in 24 hrs
• ointments/gels: use at bedtime

pantop 40mg = omeprazole/esomeprazole/rabeprazole 20mg = lansoprazole 30mg

• most common during first trimester
• ensure ADEQUATE HYDRATION
• ginger (up to 1g D) or pyridoxine (vitamin B6 - 25-50mg TDS PRN)
• if these are ineffective, consider: doxylamine, metoclopramide, promethazine or prochlorperazine
• prochlorperazine suppositories if n+v severe

• domperidone, droperidol, haloperidol, metoclopramide, prochlorperazine
• EPSE (usually acute dystonic reactions*) due to central dopaminergic activity may occur - more common in elderly and <20yrs
• EPSE rare with domperidone - does not X BBB*mainly muscle spasms of face, neck, back and limbs
• domperidone and metoclopramide - widely used, additional prokinetic activity (good for n/v due to gastroparesis)
• prochlorperazine - PREVENT n+v
• droperidol - PONV

• drink water - enough to satisfy thirst and keep urine light-coloured (unless restricted by Dr)
• exercise - develop abdominal muscles
• increase fibre intake - grains, fruits, vegetables; 25-30g D recommended in adults, increase intake gradually to avoid bloating
• use toilet after meals - gastrocolic relfex maximal - 'gut is most active'
• do no resist urge to go

• bulking agents: 2-3 days
• osmotic laxatives:
• glycerol, lactulose, sorbitol - oral 1-3 days, rectal: 5-30 mins;
• polyethylene glycol (Glycoprep, movicol)- oral - 0.5-3 hrs for bowel preparation, 1-4 days for constipation
• saline laxatives (epsom salts, microlax, fleet, picolax, picoprep)
• stool softeners: oral - 1-3 days, rectal: 5-20 mins
• stimulant laxatives: oral - 6-12 hrs, rectal - 5-60 mins

• dietary and lifestyle changes preferred
• bulking agents to supplement fibre intake
• docusate, lactulose, sorbitol safe
• occasional doses polyethylene glycol (e.g. movicol) ok if resistant to the above
• stimulant laxatives - avoid

• 1: ORS
• antidiarrhoeals not recommended - do not reduce fluid and electrolyte loss, may delay expulsion of organisms, may cause ADRs

• --> diarrhoea
• 1: bulking agents usu useful
• if diarrhoea persists - add opiod antidiarrhoeal, e.g. loperamide

• 1: norfloxacin
• 2: azithromycin (suitable in pregnancy and children)

• advise on avoiding/treating infection
• treat symptomatically if mild - ORS - tx for 1-3 days
• seek medical advice if, e.g. bloody diarrhoea, fever
• loperamide may be useful in adults

• 1: tinidazole - as a single 2g (4 X 500mg) dose, give as divided doses in pregnancy
• 2: metronidazole - for 3-7 days, use in children
• adult - 2g once D for 3 days, or 400mg TDS for 7 days if tx fails, children, pregnancy and breastfeeding
• do not tx asymptomatic carriers unless they handle food
• take with food

• depends on goal - remission or induction + other factors:
• 5-aminosalicylates - induce remission in mild-mod disease
• corticosteroids - induce remission (usu 7-14 days), then wean
• Azathioprine + mercaptopurine - induce and MAINTAIN remission, have corticosteroid sparing effect, onset may be up to 3 MONTHS - use adjuvant in interim, no direct comparisons - if not responsive to one, try the other
• MTX - induce remission, prevent relapse - mainly used in pts refractory to/intolerant of AZA and mercaptopurine
• TNF-A antagonists (infliximab, adalidumab) - unresponsive mod-severe disease
• antibacterials (metronidazole/ciprofloxacin) - for perianal fistulae
• other: antidiarrhoeals, cholestyramine (+ im B12) = may reduce diarrhoea

• 5-ASAs - induce and MAINTAIN remission in mild-mod disease, combination of rectal and oral synergistic; for distal colitis - choose rectal mesalazine
• corticosteroids - induce remission in severe/refractory acute disease (7-14/7)
• azatioprine + mercaptopurine - limited ev in UC, used for maintaining remission and corticosteroid-sparing effects, onset may be 3/12
• cyclosporin: iv, rapid onset (usu 1 week) for severe, unresponse disease, once in remission, use other agents for maintenance
• Infliximab - induce and MAINTAIN remission in unresponsive, mod-sev disease
• antidiarrhoeals (eg. loperamide, codeine) - CONTRAINDICATED (risk of toxic megacolon)
• Antispasmodics - not recommended

• look for aggravating factors - constipation, diuretics, anticholinergics, sedating drugs
• reduce caffeine and EtOH intake
• bladder training
• reduce fluid intake at night

• selective A-blockers - 48 hrs to effect
• 5-A- reductase inhibitors - reduce prostate size, may take 6 months before sx improve (12-18 months for full effect)
• both inc urinary flow rate
• combination - when prostate large and rapid relief required, selective alpha blocker can be stopped at 6-12 months in mst pts

nitrofurantoin - penetrates prostatic tissue poorly

• 1: lifestyle (regular exercise + other - wt loss, physical activity, devices - walking stick)
• 1: regular paracetamol
• 2: topical NSAID, capsaicin, rubefacient + reg paracetamol
• 3: PRN NSAID (e.g. 30-60 mins b4 painful activity), intra-articular steroids, hyalans
• 4: higher NSAID dose
• 5: opiods, orthopaedic r/v
• NB: many pts on LT NSAIDs can be switched to paracetamol w/out inc in sx

• analgesic, antipyretic, anti-inflammatory
• inhibit PG synthesis via COX-inhibition
• - COX-1 inhibition = impaired gastric cytoprotection and antiplatelet effects
• - COX-2 inhibition = anti-inflammatory and analgesic activity
• - reduction in GFR and renal blood flow occurs through both COX-1 and COX-2 inhibition
• little-no effect on COX-1 inhibitors at therapeutic doses of COX-2-i's

• no rationale for >1
• maximal effect in 2 weeks. no response = switch after 3 weeks
• monitor FBC, Cr, LFTs
• lowest effective dose for shortest possible time

• ensure all pts receieve pneumococcal and annual influenza vaccinations
• withdrawal in apparent remission --> relapse

• disease suppression: antirheumatic agent + analgesic, corticosteroid (low dose pred) or NSAID
• mild-disease activity: sulfasalazine or hydroxychloroquine (sulfasalazine acts sooner and more effective)
• mod-severe disease: low-dose MTX (1st line), other immunosuppresants; leflunomide or cytokine modulators (biological agents, e.g. rituximab) when antirheumatics/immunosuppresants (inc MTX) inappropriate/ineffective
• combination often needed to slow progression of jt damage (e.g. rituximab + MTX)

• use insect repellants
• wear protective clothing
• take medications regularly/at right time
• See Dr if fever develops w/in 12 months of possible exposure

• 1: systemic corticosteroids
• 2: colchicine
• avoid NSAIDS - risk of bleeding

• bursitis/tendonitis:
• rest injury - by avoiding painful activities, not immobilisation
• passive motion exercises
• local heat/ice packs
• analgesics - reduce pain, aid mobilisation - paracetamaol and NSAIDs have similar efficacy
• also consider topical NSAIDs and rubefacients
• strains + sprains:
• RICE for first 2 days
• early mobilisation and recovery - use analgesics
• topical NSAIDs or rubefacients

no evidence for its efficacy in this condition

• apply BD - QID PRN for up to 14 days, r/v use after this
• rub product in completely as may stain clothing and temporarily discolour skin
• photosensitivity

• lack of sleep
• stress
• alcohol withdrawal
• ilicit drugs
• changes in medication/non-compliance

CBZ, PHY, oxCBZ, barbiturates, topiramate

reduce efficacy of oral contraceptives - consider medroxyprogetserone depot or copper IUD if possible, or high-dose COC if not.

• TDM - th range = 4--12mg/L
• take with food
• drowsiness and blurred vision at start of tx
• increase fx of EtOH
• CYP3A4 inducer
• refer if: rash, sore throat, fever, mouth ulcers, bruising, bleeding
• do not stop taking suddenly
• increase dose slowly - autoinduction
• monitor for skin reactions - SJS, toxic epidermal necrolysis
• BMD monitoring - vit D + cal if needed

• atropine
• belladona alkaloids (atropine, hyoscine)
• benzhexol
• benztropine
• darifenacin
• glycopyrrolate
• hyoscine
• iptratropium
• oxybutynin
• solifenacin
• tiotropium
• tropicamide

• 1: simple analgesic - paracetamol (less effective), aspirin, NSAID
• 2: if ineffective (e.g. for 3 attacks/severe): triptan, ergot alkaloid at onset of attack
• antiemetic for n+v (metoclopramide/domperidone)
• avoid opiods - may aggravate sx, dependence, little evidence

• 5HT1 agonists
• relief w/in 30-60 mins (longer with naratriptan)
• aid associated sx (n, v, photophobia, phonophobia)
• 1/3 may have recurrence of headache - give 2nd dose
• most effective when taken when headached BEGINNING TO DEVELOP, not earlier (during aura) or later (when headache severe)
• sumatripatn most studied

• limited by ADRs - peripheral vasoconstriction
• taken at onset of attack
• do NOT take with triptan
• lack of ev re dose
• rectal/sc/im

• 1: BBs (propranolol, metoprolol, atenolol), amitriptyline
• 2: valproate, topiramate
• 3: methysergide, pizotifen - but limited by ADRs

treatment of acute attacks still needed - may take 1-3 months for full effect

• antiplatelet - asprin, clopidogrel, dipyridamole with aspirin (headache + BD dosing affect compliance, but more effect than aspirin alone)
• warfarin in AF
• antihypertensives
• statins
• carotid sx (high risk pts)

• - most ppl can be maintained w/ 10mg escitalopram, 20mg citalopram, paroxetine, fluoxetine, 50mg sertraline, 50-100mg fluvoxamine
• - doses may be higher in the tx of OCD and eating disorders (vs. if for depression or anxiety)
• - withdraw gradually - 50% weekly
• - fluoxetine has an active metabolite and long half life = long wash over
• - lower seizure threshold
• - increase bleeding risk - consider PPI
• indications: depression, OCD. PTSD, PMS

• sedation
• anticholinergic
• orthostatic hypotension

• PD - risk of aggravation
• epilepsy - lowers seizure threshold
• respiratory failure - resp dep
• hyperthyroidism - risk of acute dystonia
• QT prolongation
• shock - hypotension
• glaucoma, urinary retention - anticholinergic fx (esp chlorpromazine, clozapine, olanzapine)
• elderly - higher risk of orthostatic hypotension, confusion, anticholinergic fx, acute EPSE
• ADRs traditionally reported with older agents, less common/severe with newer ones

• sedation, EPSE*, orthostatic hypotension, blurred vision, constipation, anticholinergic fx, wt gain, hyperprolactinaemia (--> womanising fx)
• metabolic fx: inc BSL, wt gain, dyslipidaemia, inc risk of T2DM
• EPSE - dystonia (spasms) - have benztropine on hand, akathisia (feeling of motor restlessness), parkinsonism (tremor, rigidity, bradycardia - tardive), tardive dyskinesea (involuntary movements after M-LT tx)

low potency - more sedating, low EPSE, more othostatic and anticholinergic fx

• low potency = chlorpromazine
• high potency = haloperidol

atypical APs generally have lower incidence of EPSE

electrolytes, LFTs, blood picture

• 1: psychostimulants - dexamphetamine, methylphenidate (give more than once d, except low doses or CR methylphenidate)
• 2: atamoxetine (risk of suicidal thoughts/beh)
• 3: TCAs, clinidine (A-adrenergic, sedative properties)
• SSRIs not indicated

• alters HR
• constricts coronary blood vessels - IHD + thromboembolism
• benefis of stopping smoking: red MI risk and premature death

• behavioural techniques to aid and encourage cessation (e.g. avoiding triggers)
• refer to quitline (13 QUIT)
• nutritional advice (e.g. fruit for snacks)
• exercise program - help avoid wt gain
• NB: withdrawal effect = hunger

• bupropion (Zyban) - X2 quit rate; inhibits NA and dopamine uptake - prec with schizo and dep; insomnia (40%) and seizures
• NRT - X2 quit rate
• varenicline (Champix) - >2X quit rate; partial agonist at nicotine Rs, reduces withdrawal and pleasurable effects of smoking; nausea (30%) - may req dose red, apparent withdrawal and return to smoking on tx cessation

• GORD - inc gastric acid
• arrhythmia - exacerbation
• HF, pulmonary oedema - red clearance = red dose
• thyroid dysfn - hyperT = inc CL, hypoT = dec CL - adjust dose
• smoking - inc CL
• epilepsy - dec seizure threshold
• B2 ag = inc risk hypoK
• TOXICITY: common - GORD, insomnia, palpitations; rare - seizures