Guide to Commonly Prescribed Medications

💊A proper medication (drug) history is important as part of the patient assessment.

💊In this blog post, we will cover some of the most commonly prescribed medications and their indications/mechanisms of action.


References: 2020 firstaidforfree.com

Malaria (Features of P.falciparum infection)

P.falciparum infection

🤒Clinical Features:

This is the most dangerous of the malarias and patients are either ‘killed or cured’. The onset is often insidious, with malaise, headache and vomiting. Cough and mild diarrhoea are also common. The fever has no particular pattern.

🦗Neurological

  • Coma
  • Hypoglycaemia
  • Seizures
  • Cranial nerve palsies
  • Opisthotonus (a type of abnormal posture where the back becomes extremely arched due to muscle spasms)
Disconjugate gaze due to cranial nerve palsy

🦗Optic fundi

Malaria Retinopathy with Roth’s spots

🦗Respiratory

  • Pulmonary edema
  • Secondary bacterial pneumonia

🦗Cardiovascular

  • Shock
  • Cardiac failure (‘algid malaria’)
  • Dysrhythmias with Quinine

🦗Renal

  • Acute renal failure
  • Severe haemolysis results in haemoglobinuria (black water fever)

🦗Abdomen

  • Hepatic dysfunction & haemolysis lead to Jaundice
  • Tender liver edge with hepatitis
  • Pain in left upper quadrant with splenomegaly

🦗Blood

  • Parasitaemia
  • Anaemia – Normocytic Normochromic
  • Thrombocytopenia
  • Coagulopathy
Ring form in RBC

Dentowesome 2020

@dr.mehnaz🖊


References: Davidson’s Principles and Practice of Medicine Textbook; Image source: ResearchGate, Quizlet

Drugs of choice in respiratory diseases

🔗Refer Asthma First Aid & Prevention tips on Page 2‼️

ASTHMA

Mild intermittent

💊 Short acting β2-agonists (e.g. Salbutamol, Terbutaline) inhalations when needed.

💊 Anticholinergics (e.g. Ipratropium, Tiotropium) inhalations when needed, alone or in addition to beta-2 agonists

💬 Patient is asymptomatic between the dyspnoea episodes, so no daily medication required!

ASTHMA

Mild persistent

💊 Short acting β2-agonists (e.g. Salbutamol, Terbutaline) inhalations ➕ Corticosteroid inhalation (low dose)

💊 Short acting β2-agonists ➕ Mast cell stabilizer or Leukotriene antagonist or Theophylline sustained release

💬 Beta-2 agonist inhalation is needed every day, so once daily corticosteroid inhalation if given for asthma control.

ASTHMA

Moderate persistent

💊 Long acting beta-2 agonists (e.g. Salmeterol, Formeterol) inhalations ➕ Corticosteroid inhalation (low to high dose)

💊 Long acting beta-2 agonist tablets or Theophylline sustained release ➕ Corticosteroid inhalation (medium dose)

💬 The dose of corticosteroid inhalations depends on the severity of symptoms.

ASTHMA

Severe persistent

💊 Long acting beta-2 agonists (e.g. Salmeterol, Formeterol) inhalations ➕ Corticosteroid inhalation (high dose) ➕ Corticosteroid tablets/syrup

💊 Long acting beta-2 agonist tablets or Theophylline sustained release ➕ Corticosteroid inhalation (high dose) ➕ Corticosteroid tablets/syrup

💬 Systemic corticosteroids have significant adverse effects, so after adequate asthma control, are gradually withdrawn.*

ASTHMA

Acute severe asthma

💊 Oxygen 60% ➕ Nebulized beta-2 agonists (e.g. Salbutamol) in high dose ➕ Systemic corticosteroids

💬 An emergency condition, earlier called as status asthmatics. Aminophylline is no longer recommended.

* After adequate control of severe persistent asthma, systemic corticosteroids are withdrawn, and the patient then would be managed as moderate persistent type. This is called "step down" approach of management. In this approach, it is considered better to manage patients assuming in the next higher type and then, after reviewing in 1-6 months, to step-down, instead of "step-up" after failure in asthma control.

Aspirin induced

asthma

💊 Leukotriene antagonists (e.g. Montelukast, Zafirlukast)

Exercise induced

asthma

For Prophylaxis: Mast cell stabilizers or beta-2 agonists or Leukotriene antagonists💊

COPD

  • For smoking cessation: I line: Behaviour therapy; II line: Nicotine replacement therapy; III line: Antidepressants e.g. Bupropion
  • For respiratory infections: Antibiotics
  • For bronchodilatation: I line: Anticholinergics; II line: beta-2 agonists; III line: Theophyline
  • For hypoxemia: I line: Ambulatory oxygen; II line: Long term oxygen therapy

Dry cough

💊 Cough suppressants (e.g. Dextromethorphan) + Treat the cause e.g. post nasal drip by antihistaminics and decongestants.

Productive cough

💊 Expectorants (e.g. Pot iodide) &/or Mucolytics (e.g. Acetylcysteine) ➕ Treat the cause e.g. allergy by antihistaminics and bacterial infection by antibiotics

References: CLASSIFICATION OF DRUGS WITH DRUGS OF CHOICE 3RD EDITION BY VIKAS SETH


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Oral manifestations of systemic diseases – I

Careful examination of the oral cavity may
reveal findings indicative of an underlying
systemic condition, and allow for early diagnosis
and treatment. Examination should include
evaluation for mucosal changes, periodontal
inflammation and bleeding, and general
condition of the teeth.

I.GIT Diseases
• Gastrointestinal diseases refer to diseases involving
the gastrointestinal tract, namely the esophagus,
stomach, small intestine, large intestine and rectum,
and the accessory organs of digestions, the liver,
gallbladder, and pancreas.

Crohn’s disease, also known as Crohn
syndrome and regional enteritis, is a type of
inflammatory bowel disease (IBD).
Ulcerative colitis is a form of inflammatory
bowel disease (IBD) that causes inflammation
and ulcers in the colon.
Gastroesophageal reflux is a chronic symptom
of mucosal damage caused by stomach acid
coming up from the stomach into the
esophagus.
Chronic liver disease in the clinical context is a
disease process of the liver that involves a
process of progressive destruction and
regeneration of the liver parenchyma leading to
fibrosis and cirrhosis.

1. Crohn disease:
– diffuse labial, gingival or mucosal swelling
– „cobblestoning“ of buccal mucosa and
gingiva
– aphtous ulcers
– mucosal tags
– angular cheilitis
– oral granulomas

2.Ulcerative colitis:-
– oral signs are present in periods of
exacerbation of disease
– aphtous ulceration or superficial
hemorrhagic ulcers
– angular stomatitis
– pyostomatitis vegetans, pyostomatitis
gangrenosum.

3.Gastroesophageal reflux:-
– reduction of the pH of the oral cavity below
5,5

– enamel damage
– damage of the dentin – higher sensitivity (to
temperature..), caries

4. Chronic liver diseases:-
– jaundice
– petechiae or gingival bleeding (hemostasis
disorder)

RREFERENCES:-

1.Google -slideshare

2.Davidson-22nd edition