Random but Noteworthy Pharmacotherapeutic Info.
Joined September 2023
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🫁Community-acquired #Pneumonia: #Empiric #Outpatient #Antibiotic Selection
‼️No first-line #Regimen has been clearly shown to be superior to another.
💢Antibiotic selection depends on:
➤ Likelihood of #Antibiotic_Resistance
➤#Comorbidities
➤ Potential #Adverse_Effects
♥️#Hypertension Treatment:
🤰Patients who may become #Pregnant
☝🏽Monotherapy:
💊#CCBs
✔️Preferred: #Nifedipine
🔘Alternative: #Amlodipine
✌🏽Combination therapy:
💊a CCB➕
☑️a #Thiazide-like Diuretic
OR
☑️a certain #Beta_Blocker:
🔘#Labetalol
🔘#Carvedilol
🔘#Metoprolol
#Antihypertensive drug therapy during #pregnancy based on #Queensland Clinical Guideline
#Methyldopa
#Labetalol
#Hydralazine
#Nifedipine
#Prazosin
#Clonidine
#hypertension
♥️#Blood_Pressure Management:
🚫Drug combinations to avoid
❌#ACE_inhibitor ➕ #ARB ⚠️
❌#Direct_Renin_inhibitor (#Aliskiren) ➕ ACE inhibitor or ARB ⚠️
❌#Beta_Blocker ➕ #Diltiazem or #Verapamil ⚠️
❌Alpha-1 Adrenergic Blocker ➕ Clonidine ⚠️
❌Beta-Blocker ➕ #Clonidine ⚠️
🚺#Bacterial_Vaginosis: Male Sex Partner Treatment to Prevent Recurrence
⏳A 7-day #Antibiotic treatment course.
💊Oral #Metronidazole 400 or 500mg, BID
➕
🧴Topical 2% #Clindamycin applied to the penile skin, BID
✅Male treatment should coincide with female partner treatment.
♥️#Hypertensive_Urgency: #Sublingual vs. #Oral Captopril
❌SL #Captopril 25mg produces a greater reduction in #Systolic_Blood_Pressure.
✅Oral captopril is associated with a superior decrease in #Mean_Arterial_Pressure, the primary therapeutic goal in #Emergency_Hypertension.
Hypertensive Urgency = BP ≥180/120 with NO organ damage → Go Slow
Use oral meds: Amlodipine 5–10 mg, Captopril 25 mg oral , Labetalol 100–200 mg.
❌ Avoid S/L Captopril & IV Lasix → they drop BP too fast → stroke / AKI/ MI risk.
Hypertensive Emergency = High BP + organ damage (stroke, MI, pulm edema , aortic Dissection) → Go Fast
Use IV Labetalol / Nicardipine/ Nitroglycerin / Clevidipine
Organ damage with specific choices
1-ACS - Nitroglycerin
2- Ac. Pul edema - Nitroglycerin & loop diuretics
3-Obstructive lung disease- Clevidipine, Nicardipine or Nitroglycerin
4- Aortic Dissection- Labetalol
5- Stroke Labetalol, CCBs
6- Eclampsia- Labetalol
7- AKI .Nicardipine or Clevidipine
8- Pheochromocytoma- Phentolamine
Remember: “Urgency = No Damage → Slow. Emergency = Damage → Fast.”
♥️#Hypertensive_Urgency: Management
😴#Antihypertensive drugs may be given to patients if resting in a quiet room for 30mins is not effective.
📉The shorter-term goal is to reduce the BP to ≤160/100.
‼️#Mean_Arterial_Pressure should not be lowered >30% over the first hours .
💢Main reasons for diluting the #Corticosteroids with #Lidocaine before intra-articular injection:
✅Instant #anesthetic relief confirms accurate injection placement.
✅Lowers risk of steroid-induced tissue atrophy.
✅ Reduces crystal-related irritation and post-injection flare.
💊COCs: Potential Non-Contraceptive BENEFITS
🔻#Dysmenorrhea
🔻#Endometriosis Pelvic Pain
🔻#Menorrhagia
🔻#Ectopic_Pregnancy
🔻#PMS & #PMDD Symptoms
🔻#Benign_Breast_Disease
🔻#Ovarian_Cysts
🔻#Ovarian_Cancer
🔻#Endometrial_Cancer
🔻#Colorectal_Cancer
🔻#Acne
🔻#Hirsutism
💊#Combined_Oral_Contraceptives: Side Effect Comparison of #Ethinyl_Estradiol
🔺 High-dose (≥50 µg):
⬆️#Nausea/#Vomiting
⬆️#Venous_Thromboembolism (#VTE )
🔻 Low-dose (≤35 µg):
⬆️Bleeding Disturbances:
➤#Amenorrhea
➤Irregular, Frequent #Bleeding, or #Spotting
💊#Combined_Oral_Contraceptives: #Obesity
🎬Start with 20–30mcg #Ethinyl_Estradiol (avoid >35mcg due to #VTE risk)
⚖️ Extended-cycle or 24/4 regimens may offer steadier suppression
🤰#Pregnancy risk is only slightly higher at BMI ≥35
🩹adherence is more important than weight
💊#Combined_Oral_Contraceptives: #Menstrual_Suppression Benefits
✅The reduction or elimination of #withdrawal_bleeding has been found helpful for the following condition:
😣#Endometriosis
😖#PMDD
🥸#Hyperandrogenism
😫#Dysmenorrhea
😤#Perimenopause
🌝#Lifestyle needs
💊#ISOTRETINOIN: Lab Monitoring
⤴️#Hypertriglyceridemia:
✓ 300–500 mg/dL:
Lifestyle management
✽ 500–800 mg/dL:
Consider dose reduction or lipid therapy
✗ >800 mg/dL:
Discontinue
⤴️#Liver_Enzyme_Elevations:
✗ Stop Isotretinoin if levels >3× normal.
🤰#Pregnancy testing
💢#Acne_Vulgaris Management: COCs
✅FDA Approved:
EE 20/30/35 +#Norethindrone 1mg
EE 35 +#Norgestimate 180/215/250mcg
EE 20 +#Drospirenone 3mg
❇️Others (Anti-Androgens):
EE 30 + #Drospirenone 3mg
EE 30 + #Dienogest 2mg
EE 30 + #Chlormadinone 2mg
EE 35 + #Cyproterone_Acetate 2mg
📌 Key Points:
☀️#Oral_Antibiotics should be prescribed for the shortest possible period of time (max 3-4 months).
🌟 Concomitant use of a topical #Retinoid & #Benzoyl_Peroxide is recommended to facilitate discontinuation of the antibiotic and to inhibit #Antibiotic_resistance.
💢#Acne_Vulgaris Management: #Oral_Antibiotics
✅Preferred
➤ Tetracyclines:
💊#Tetracycline
💊#Doxycycline
💊#Minocycline
💊#Sarecycline
❇️Alternatives
➤ Macrolides:
💊#Azithromycin
💊#Erythromycin
✳️Others
💊#TMP_SMX
💊#Cephalexin
💊#Amoxicillin
💊#Ciprofloxacin
💢#Acne_Vulgaris Management: #Oral_Antibiotics
✅Preferred
➤ Tetracyclines:
💊#Tetracycline
💊#Doxycycline
💊#Minocycline
💊#Sarecycline
❇️Alternatives
➤ Macrolides:
💊#Azithromycin
💊#Erythromycin
✳️Others
💊#TMP_SMX
💊#Cephalexin
💊#Amoxicillin
💊#Ciprofloxacin
Medications That Could Trigger #Acne:
💊#Hormonal (#Steroids & #OCPs)
💊#Halogens (#iodide & #bromide)
💊#Vitamins (#B2, #B6 and B2
💊#Tuberculostatic (#Isoniazid & #Ethambutol)
💊#Lithium Salts
💊#Antiepileptics (#Phenytoin)
💊#Immunosuppressants (#Cyclosporine & #Azathioprine)
👴🏾👵🏼#Antidepressants with Strong #Anticholinergic_Activity:
❌Potentially Inappropriate Medication Use in #Older_Adults
💊#Amitriptyline
💊 #Amoxapine
💊#Clomipramine
💊#Desipramine
💊#Doxepin (>6 mg/day)
💊#Imipramine
💊#Nortriptyline
💊#Paroxetine
ℹ️#AGS_BEERS_CRITERIA
ALT https://www.deprescribingnetwork.ca/blog/anticholinergic-medications
📉#Glucose-Lowering Interventions: Initial Therapy in #Asymptomatics
🏃♂️#Lifestyle_Modification:
✔️moderate-intensity #Aerobic_Activity at least 150 min per week
💊#Metformin: 500mg once or twice daily
🫰#A1C (%) is expected to decline by 1 to 2 points with each #monotherapy.
ALT https://intermountainhealthcare.org/blogs/8-exercise-ideas-for-seniors-managing-diabetes
💢#BETA_BLOCKADE: Adverse noncardiac effects
🔺#Airways_Resistance
🔺#Peripheral_artery disease
🔺#Facilitation of #Hypoglycemia
🔺#Hyperkalemia
🔺#Depression
🔺#Fatigue
🔺#Sexual_dysfunction
🔺#Lipid_metabolism alteration
🔺#Weight_gain
🔗doi.org/10.1161/HYPERTENSION…
#Betablocker
🫁β-Blockade: #Airways_Resistance
✅Increased airways resistance is less likely to occur with #βblockers with ISA or beta-1 selectivity.
❇️Beta-1 selectivity may diminish at higher doses.
❎All β-blockers should be avoided in patients with severe #bronchospastic_disease.
ALT Beta-1 selectivity is not absolute, however, and may diminish at higher doses. It has also been suggested that combined beta and alpha blockade with labetalol or carvedilol may be better tolerated than nonselective agents in patients with chronic lung disease
🥶#Pica: #Pagophagia
🩸Various forms of may be a clinical manifestation of #Iron_Deficiency, with or without #Anemia.
🧊Craving #ice is particularly common and is often associated with an #iron deficiency.
⚠️It may be present in children with #NonAnemic_Iron_Deficiency.
🩸#Iron_Deficiency: #Older_Adults
⚠️Older adults with iron deficiency #Anemia should take no more than 1 low-dose oral #Iron tablet daily.
✅Low-dose #Oral_Iron_Therapy (<50mg elemental iron/day) is as effective and has fewer #Adverse_Effects than high-dose therapy (150mg/day).
