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Guide to private practice in medicine-note 1

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Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have …

Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have been used by many seniors but need to be careful revision before prescribing. Hope to update once I go through them completely.

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  • 1. Guide to private practice- note 1 Simple way of private practice There are several illnesses that can be easily treated and cured. But most cases relive spontaneous. About 30 cases can identify and can be treated. Allergies Ear infection Cough and cold UTI Eye & Ear drops Asthma Vaginal discharge Painful menstruation Motion sickness Warm treatment Contraceptives Sinusitis Toothache in child Dermatology (pitriasis) Rhinitis Hypertension Appetite inducers (LOA) Numbness of distal limb Oral thrush Diarrhea Abdominal pain & discomfort Gastritis Migraine Viteligo Constipation Vertigo Warts plantar Anemia Acne Wounds Allergies skin  Hydrocortisone cream (tropical)  Betnovate cream  Betnovate-N-combination with antibiotics- Oozing  Betnovate-C_ only steroid –none oozing  Betnil-N  Dexaquin cream/ointment –use in eczema-Infantile eczema Oral treatment 1. Prednisolone 10mg stat+tds (initially up to 10-20mg daily. Acute attack of asthma30- 40mgdaily.) 2. Promethazine HCL (phenagan) IM stas 20mg bd / 25 mg noct / 10-12mg tds (1tab=10mg)
  • 2. 3. *Child<2yr phenagan is not recommended* 4. 2-5yr 5-15mg give as divided doses. 5. 5-20yr 10-15mg bd 6. Piriton (chlophenamine)2tab stat/then nocte+1/2 mane (1tab =2/4/mg ) 7. Ketotifen also can can beused 1-2mg bd>2yrs 8. Drug allergy: hydrocortisone IV+ piriton/phenagan IM stat or prednisolsne 5 tab +piriton2tab Paracetamol doses o <3month 60mg (1/2tsp)6 hrly (10-15mg /kg bodyweight) o 3-12 month 60mg-120mg6hrly (1/2 -1tsp) o 1-5yr 120-250mg 6hrly (1-2tsp) o 6-12 yr 250-500mg 6hrly o >12yr 500-1000mg 6hrly(1-2tab) o >15yr 2 tab *5ml =125mg* If jaundice reduce dose Urinary tract infection a. Nalidixic acid 500mg- 1000mg 6hrly / child 40mg/kg/day b. Vit C1-2 tab tds. c. Frusemide 20-40mg mane d. Probenthine 1tab tds 15mg =1tab e. PCM 2tab sos Other antibiotics a. Nitrofurantion 50-100mg 6hrly or tds b. Norfloxacin 400mg bd c. Ciprofloxacin 250mg bd or 500mg bd Investigation should be done a. *UFR for protein b. *USS abdomen for <5yr child c. *Urine culture /ABST
  • 3. Vaginal discharge If suspected Candidasis 1. Itraconazole 200mg bd for 1day 2. Nystatin vaginal pessary 3. Candid vaginal tablet v1/v2/v3/v6 4. Metranidazole 1tds or metragel local application can be used. 5. Clotrimazole 500mg vaginal tab stat If gonorrheal infection is suspected pencillin500mg 1tds1day. Vitamin 1. VitA,D.E(cod live oil)5ml nocte 2. Vit E evit, evion 200mg , 400mg or tocovt 1tab nocte 3. Polyboin (vit B Complex) syrup 2tsp or 1 tab noct 4. Neuroboin (vitB complex) 1 tab nocte 5. Becsules (vit B with vit C) syrup 2-3tsp or 1cap nocte 6. Neurofle 7. Iburol syrup 8. Vit B12 IM 9. Multi vitamin (multi sanostol) adult3-4 tsp Warm infection 1. Combantrin-  6/12-2yr 1tab (1/2tsp) nocte or combantrin mixture 1tsp mane.  2-9 yr 2tab (1tsp)nocteor combantrin mixture 2tsp mane.  9-13yr 3tab (1,1/2 tsp) nocte or combantrin mixture 3 tsp mane. 2. Mebendazolle-1 tab bd for 3days (threadworm,roundworm, whipworm,hookworm) 3. Albendazole (Zentel )(Albex) adult or >12yr (200mg =1tab )400mg single daily dose (threadworm ,roundworm,whipworm,hookworm) Toothache for children 5-14yr
  • 4. 1. Diclofenac Na 25mg tdsfor 3days 2. Metranidazole 1tds for 3days 3. Amoxicillin 250mg tds for 3days 4. Aludrox1tds Vomiting a. Maxolone (metaclopramide HCL) Adult >15yr 10mg tds, Child  14-9yr 5mg tds,  9-5yr 2.5mg tds,  5-3yr 2mg bd-tds,  1yr 1mg bd (Vomiting, flatulence, heartbum,reflux) a. Motilium(domperidone)adult>15yr10mg tds  Child 5mg/kgbody wt (vomiting, flatulence,heart burn,reflux,digestive disrters) a. Phenergan (promethecine HCL 10mg tab) adult 20mg /nocte ror bd or 10-20mg tds  (Vomiting due to post –op&pregnancy, mortion sickness 1tab before journary) Children is not recommended a. Prochloperazine (stametil) adult 1-2tab (5-10mg)3-5time/day(sever nausea,vomiting, vertigo,- labyrinthin 1tab tds Oral thrush  Nistatin orals suspension  Datarin cream Helicobacter pylori infection (eradication)  Omeprozole 20mg bd  Clarithromycine 500mg bd  Tinidazole 500mg bd  Lansoprozole 30mg bd
  • 5.  Ranitidine 300mg nocte  Metronidazole 400mg bd Anemia 1 Fe SO4 1tab nocte for >7 days 2 Folic acid 1tab bd 3 Vit C1tab tds i. Multi vit 1tab bd ii. Appetite inducer, 1. Cytecxin 1tsp tds 1. Peritol syrup 1tsp 2. Aperiton 2tsp tds 3. Lysatone 1tsp tds 4. Nutroplex 2tsp daily Constipation for adult Bisacodyl tab (SPMC) 5-10mg nocte (5mg tab) Dulcolax 2 tab nocte for 3 days (Suppository –aduit 10mg, children 5mg) 1. For chronic constipation dulcolax 1tab nocte 4days/ lactulose 15 ml nocte sos 2. For pregnant mother fybogel 1packet 24 hrs after delivery fybogel packet 24 hrs Constipation with nausea, vomiting & headache may be typhoid fever *SAT Ix con be done Can be treat with 1. Domperidon (motilium) 10mg bd 3days 2. Metanidazole 3. Dulcolax Ear infection
  • 6. Examine ear properly If wax waxsole not >2night 1. Gentamycine ear drop bd 2. Penicillin250mg 6hrly 3. Diclofenac Na 4. Diazepam 5mg nocte 5. PCM 2tab tds Eye drops & ear drops 1. Gentamycine eye &ear drops 2. Sofiamicine eye & ear drops 3. Dexona eye & ear drops 4. Betanasol eye &ear drops 5. Tobralex eye &ear drops 6. Ciplox eye &ear drops 7. Garamycine eye &ear drops 8. Chloranpenicol/spersanicol for pain Painful menstruation/sever clotted bleeding 1. Ponstant (mefanamic acid)500mg tds 2. Tranexamic acid 500mg bd *Severe abdominal pain with menstruation can treat with above drugs and if no response USS should be done. & should refer to VOG may be chocolate cysts Postcoital contraception 1. Postinor -2 1tab 12hr apart 2tab only should be used within 72hr OCP 3tab stat Should do pregnancy test *pregnancy test –ve but no menstruation give
  • 7. 2. Premalute-N10mg nocte 14 days or 10mg tds 5days menstruation begin after 2 days of treatment *pregnancy test+ve wanted chid give a. Folate 1tab nocte b. Vit Cbd c. Fersolate 1tab nocte d. Calcium tab mane *unwanted child <10week of POA Gynacoside 2tab stat & premalute N10mg nocte 3days. If not abortion occur patient should be referrel center ***Abortion is illegal in some countries. Contraceptive pills (overl & trinordiol 28 tab, Nordett& minnler 21 tab) Dermatologycal treatment Betnovate cream N or C (if viral, acne, rosea, Supricort cream apply bd Inflammational dermatitis Eczema-infantile, atopic, discoid Psoriasis Lichen simplacs/planuas S. dermatitis Heat bum Becnovate cream can be used in above infection Bactroban ointment applies bd for 10 days. Fucidin cream apply bd or tds Metrogyl gel apply bd Soframycine cream (burn,scalds,wound,cut,ulcers,otitis externa,eczema) Foban cream apply bd Scabies Scoboma (lindain1%benzocain 2%lindans) apply in body.
  • 8. Tetmosoluse as soap when bath and wash Fungle infection (taenea infectin, pityriasis versicolor, yeast) Candid (clotrimazole)apply bd for 2-4 week Candiplas (micnazole) apply bd/tds for1-2 weeks. Mycrol cream (ketocanozole 2% onse –bd for 2-3 week Grisefulvin (fungal, grisvin- FP, (syntofulvin) 125mg-500mg adult 500mg-1000mg/daily (Tania infection, candidal infection)  Children *>23kg 125-250mg bd *14-23kg 62.5-125mg bd  Infants *5mg /kg body wt/bd o Nizoral shampoo o Beterdine shampoo o Selsun shampoo o 10% cetrimide shampoo Loss of appetite For childrenperitol syrup dosage 1tsp 30min before meal For adult cytexin syrup 1tsp before meal This syrup can be used 2times per day Diarrhoea for adult Probenthinebuscopan (10mg tab) 20mg 6hrly (children 6-12 yr 10mg tds Loparamine (lomutil) 2tab stat Furoxone 1/2tab <1 yr 1. Tab for child (5mg /kg/body wt 2. Tab for adult (10mg 6hrly) Flagel 400mg tds
  • 9. Domperidon 1tab bd Oral rehydration should be introduce Migraine attacks  Brufen 200mg to 400mg or flunarizine (sibelium) 5mg 1-2tab nocte  Maxalon or domperidone 1bd  Propanalol 20mg bd  Artane 1tds  Migranil 1tab stat or sos Other prophylactic drugs for migraine attacks o Amitryptiline 50mg nocte o Propanalol 40mg bd or tds o Nifidipine Vetigo (vestibular neuritis) Stametil 1 tds for 5days or betasera (betahistine di HCL 8mg)1-2 tab tds PCM 2tab 6hrly Piriton 1 nocte Dexa 1tds 3days Olternative drug for stemitil /cinnaracine 25mg tds5days /silium 5mg per day Treatment for acne Erytop 3% cream apply bd Tetracycline cream L.A Doxycycline 100mg 1 nocte 2 week Folic acid 1bd 3 days Other cream Retin-A cream apply bd Albiotin cream
  • 10. Cough and Cold For adult PCM 2tab tds Brufen 1tds /1bd Dexamethazone 1tds Piriton 1tab nocte /1/2tab mane <4mg> Cimitidine 200mg if mild heart burn If severe heart burn 400mg bd If no gastritis other plasibo bco 1tds or VIT-C1 tds  Antibiotics if sputem suspected- Amoxillin 250mg qds 3days If rhonchi is found should add dexa/ salbutamol or Deriphylin salbutamol 2mg tds/Deriphylin 1tab tds. Cough syrup Dry cough –cough syrup corex- D Benadryl junior 6y- 12y 1tsp tds. 1-6y1/2 tsp tds Avil expectorant Cerycough Rasindal expect Ascoril expectorant (no piriton) Actifan expec…. Actipass expec.. Piriton expec… Dosages  Adult 10ml tds  Children 5-10ml  <6yr 5ml tds *if baby is <9month do not give cough syrup Cetricine 5mg bd given Allergic rhinitis Decongestant decon 1-2 drops tds Epherdrine 1-2 drops Nasivin
  • 11. If patient has cought add  PCM/Brufen 4000mg bd or tds  Digin /alludrox 2tds  Dicolofenic Na 50mg tds/ 25mg tds  Piriton /vit C/bco 1tds/dexa 1tds Cough and cold in small children <1yr 3 days can be prescribed Piriton syrup <6month 1/2tsp tds>1yr 1tsp bd PCM syrup <6month 1/2tsp tds>1yr 1tsp tds Ventolin (salbutamole) <6month 1/2tsp tds> 1yr 1tsp tds Antibiotic syrup 1. –Erythromycin 125mg (1tsp) tds *1yr to 5yr 1tab tds 2. _Cephelexin syrup decacep/ sprideex/ selecxin/ceporex*<1yr 125mg bd 3. _Amoxycillin- decamox/blumox/moxarin/amoxil Asthma 1. –Asses to severity, if patient difficult to speech it should nebulizer. 2. Nebulize with Salbutamol 1ml and water 1ml (children Sal- 5mg and water 1.5ml) 3. Hydrocortisone IV 200mg given 4. –Prednisolone 60mg /Salbutomole 4mg start Continue 1. –Salbutamol 2mg tds or bd 2. –Prednisolone 2 tab/10mg tds 3days /then 5mg tds 2 days 3. –Deriphyline 1tab bd 3days also given Patient suffer from fever should add Antibiotics Amoxicillin 250mg 6hrly, Amoxi Type>see later pages Antibiotics
  • 12. 1. –Amoxycillin types 1. Decamox for adults 250mg cap /500mg tds 2days 4Rs /7.5Rs for 2. Blue mox 125mg tab for child<5yrs 3. Amoxil 250/5000mg tds 10Rs for cap 4. Amoxil tab 125mg 6hrly 5. Axilsy/250/500mg 3.50Rs 2. –Cloxacillin 500mg 3. Cephalexin 1. Blucep 125mg/500mg tab 5Rs for 1 tab 2. Decacef 250mg /500mg cap 3. Sporidex sy/tab 10Rs for 1 cap 1. –Ciprofloxacin, 250mg/maximal daily dosage- 1mg 2. –Co-trimoxol bactrim for children 1 tab bd/5-10Rs 3. –Augmentin,IV 4. –Nitrofurantoin 50/100tds/for prophylaxis50mg nocte1/52 5. _Doxacyclin 100mg nocte 1/52 for prophylaxis 6. _Erythromycin 250/500mg Antibiotics syrup 1. Amoxicillin syrup 1 tsp bd/tds 1tsp=125mg o Decamox syrup o Amoxil 2. Cephlexin syrup o Decacef o Blucef 3. Clocxacillin syrup
  • 13. 4. Erythromycin syrup 5. Bactrm syrup Antibiotics dosage 1-2month 1/5tsp tds 4-5 days 2-4 month ¼ tsp tds 4-5 days 6-10 month ½ tsp tds 4-5 days 11>month 1tsp tds 6-7 days Sinusitis 1. Amoxicillin 500mg tds for 3days 2. Piriton 1 tab bd or stemiz (astemizole) 10mg nocte 3. Vit C1tab tds 4. Brufan /PCM 2tab tds with steaming 3-4 times per day Rhinitis Astemizole (stemiz) 1tab daily for 1-2 weeks Citrizine 10mg 1tab daily for weeks. Less than 12yrs not recommended. Motion sickness 1. Scopdem- hyocin butyl bromide.300mg 30min before travel and continue 6hrly 3 doses adequate 4-5 yr 75 150mg 10yr 150-300 mg 2. Promethaazine HCL (phenergan) 1 tab 30min before journe 3. Avomine 1tab 30 min before journey Hypertention 1. If Systlic BP 140Hgmm diastolic bp 100Hgmm Not treat give dieatary 2. Systolic Bp>160Hgmm diastolic Bp> 100Hgmm start Rx 3. Diastolic>100Hgmm mild HCT (50mg- 100mg ) 25mg mane max 100mg Lasix (frusimide ) 40mg mane with KCI
  • 14.  If lasix with captopril no need KCI Moderate Propanalol 40mg (B blocker) 20mg tds. Max40mg tds Atenalol 50mg daily or mane or nocte Captopril 12.5mg or 25mg start 6.25 bd After 1 week 12.5mg. then after 1 week25mg bd. (postural hypertention can occur therefore at bed time )  Immediately hypertention reduce by  ISD (1sosorbide dinitrote 10mg & 20mg ) 10mg tds.  GTN 2.6mg (0.1mg,0.5mg)  Anticoagulant aspirin 100mg or 300mg 150mg nocte. Risk factor investigation 1. Lipid profile 2. ECG 3. Blood urea 4. Serum Electrolytes 5. Serum Creaternine 6. Chest X ray If cholesterol high Dietary high fibre diet. Reduce fatty acid Drug lovastatin 10mg or 20mg 20mg nocte. Lipid profile Favorable Standed risk Risk Indication Total cholesterol <200mg /dI 200-260mg/dI >260mg/dI 6mmmoI/I HDL >55mg/dI 35-55mg/dI <35mg/dI 0.9mmoI/I LDL >150mg/dI 150-100mg/dI >190mg/dI 4.2mmoI/I Total TG >250mg/dI 2.8mmoI/I Gastritis
  • 15. 1. Famtidine 20mg or 40mg nocte 2. Ranitidine 150mg bd 3. Cimitidine 400mg bd 4. Audrox 2tab tds 5. Omeprazole 20mg bd Diabetes mellitus Randum fasting OGTT 2hr sample diabetes >200mg/dI or >11.1mmoI/I >126mg/dIor>7mmoI/dI >200mg/dlor>11.1mmoI/dI Impaired glu tolerance 140-200mg/dI7,8- 11.1mmoI/I 110-126mg/dI6.1- 7mmoI/I 140-200mg/dI7.8- 11.1mmI/I Nomal (exclude DM) <110mg/di,6.1mmoI/I <140mg?dI<7.8mmoI/dI Fasting glucose 110-130mg/dI dietary advice:low glucse 140mg /dI dietary+drugs Metformin HCI (Diamin -500mg, glycomet-850mg) 250or 500/bd (For Obase because liver glycogenlysis sugar reduce for fat people) Glibenclamide (betanase, dianil, Diabetnil) 5mg initilly2,5mg mane. (Insulin release for Thin people) >200mg/dI dietary+drug Metformin HCI 500mg mane. After 1 week 500mg/dI. 2weeks 500mg tds. Glibenclamide (dianil) 2.5mg mane. After 1week 2,5mg bd.2week after 2.5mg tds Diabetes ketoacidosis give Insulin IV. Diabetic investigation Urine 1. Redusing substance3(benadict) 2. Glucose (Glu oxidase) Diasyix ,clinistix 3. Macroalbbunaemea Blood 1. Random Blood Glucose (RBS) 2. Fasting Blood glucose (FBS)
  • 16. 3. Post prandial blood Glucose (PPBG) 4. Oral Glucose Tolerance test (OGTT) 5. Glycosylated Hb 6. Glycosylated Albumine (Fructosamine) Suppositories 1. Motilium: a. Adults- 60 mg bd b. Child > 6 yrs 30 mg paed supposit bd c. Infant< 2 yrs 10 mg infant supposits bd 2. Ducolax : a. 01. Adult -10 mg a. 02.Child – 5 mg 3. Diclofenac Na: 12.3 mg or 25 mg 50 mg 100 mg