OPHTHA

● Candida endophthalmitis: Fluconazole or voriconazole

OB
● Clindamycin + Gentamicin: postpartum endometritis
○ Clindamycin vs aerobic gram pos + penicillin-resistant anaerobes (B. fragilis)
○ Gentamicin vs gram neg s
○ Alternative: Ampicillin-sulbactam
● Ampicillin + Gentamicin: intrapartum intraamniotic infection
● Cefoxitin/Ceftriaxone + Doxycycline: PID
○ Ceftriaxone + Azithromycin: pregnant or breastfeeding with PID
● Tranexamic acid: PPH
○ MoA: antifibrinolytic, inhibits plasmin formation/plasminogen cleavage →
prevents fibrin degradation and clot dissolution
● PCC: increases vitamin K-dependent coagulation factor levels
● Misoprostol: induces prostaglandin-mediated smooth muscle contraction, slow onset
● Oxytocin: increases intracellular calcium levels in myometrium, rapid onset
● Desmopressin: promotes endothelial release of vWF
● Tricholoroacetic acid: condyloma acuminata

⬇️ ⬆️
● Bromocriptine: dopamine receptor agonist
● Clomiphene: depletion of hypothalamic estrogen receptors ( estrogen, FSH LH,

⬇️ ⬇️ ⬆️
stimulating ovulation)
● Letrozole: inhibits aromatase → ovarian estradiol production ( estrogen, FSH
LH, stimulating ovulation)
○ Also inhibits aromatase in adipose tissue
● PPROM <34 weeks: ampicillin + azithromycin, corticosteroids
○ Ampicillin: GBS, aerobic gram-negative bacilli, anaerobes
○ Azithromycin: Ureaplasma
● Methotrexate: folic acid antagonist (inhibits DHFR)
○ Contraindications: hepatic or renal disease, PUD, immunodeficiency, active
pulmonary disease, breastfeeding
● Mifepristone: progesterone antagonist
● Misoprostol: prostaglandin E1 agonist → stimulates uterine contractions
● Amoxicillin or cephalexin: asymptomatic GBS bacteriuria
● Fentanyl: short-acting opioid analgesic for pain management during short procedures
○ AE: respiratory depression and hypotension
● Propofol: rapid-onset sedation and amnesia
○ AE: deep sedation, respiratory depression, loss of airway reflexes, hypotension
● Rocuronium and succinylcholine: NMBs in RSI

⭐
○ Complete paralysis, loss of upper airway tone, cessation of all respiratory effort
● Active TB: 3-drug therapy (HRE) for 2 months then HR for 7 months + pyridoxine
○ Pyrazinamide: not administered due to uncertain teratogenic properties
● Lyme disease: amoxicillin or cefuroxime for 14-21 days (NOT doxycycline)

PSYCH
● Tourette syndrome
○ Antidopaminergic agents
■ Tetrabenazine (dopamine depleter)
■ Antipsychotics (receptor blocker): 2nd gen preferred
○ Alpha-2 adrenergic receptor agonists (clonidine, guanfacine)
● Alcohol withdrawal
○ Benzodiazepines
■ Lorazepam: safe in px with liver disease
■ Chlordiazepoxide
● Catatonia
○ BZD (lorazepam)
○ ECT
● Breastfeeding and depression: sertraline and paroxetine
● Pediatric MDD: fluoxetine are first-line
● Insomnia: cognitive-behavioral therapy is treatment of choice
● Mirtazapine: no sexual dysfunction but AE include appetite, weight gain, sedation
● Bupropion: no weight gain or sexual side effects
● SSRI-related sexual dysfunction
○ SSRI responders: adjunctive therapy with sildenafil or bupropion
○ Modest benefit only: switch to non-SSRI antidepressant
● Severe manic episode may require combination therapy (lithium or valproate plus
antipsychotic)
● Escitalopram: less medication interactions among SSRIs, may be used for geriatric
patients with many medications

PULMO
● Racemic epinephrine: for upper airway swelling (eg, larynx) in croup and angioedema
● Magnesium sulfate: smooth muscle relaxant, bronchodilator response is NOT immediate

INFECTIOUS DISEASE
● Antifungals
○ Amphotericin B: binds to ergosterol → generating pores in the cell membrane
that lyse the cell
○ Echinocandin: inhibit beta-D-glucan synthesis →impaired cross-linking in cell
wall
○ Azole: block enzyme lanosterol 14-alpha-demethylase which converts lanosterol
to ergosterol
● Shigella gastroenteritis alone: ceftriaxone
● Vibrio vulnificus: IV ceftriaxone + doxycycline
● Post Exposure HIV prophylaxis: tenofovir-emtricitabine with raltegravir
● Preemptive therapy for Salmonella infection: TMP-SMX, Ciprofloxacin, Ceftriaxone
○ Children <12 mos of age, immunocompromised adults (at least 50 with known
ASCVD)
● PID: cefoxitin + doxycycline
● Cryptococcal meningitis
○ Induction: amphotericin B and flucytosine for ≥2 weeks (until symptoms abate
and CSF is sterilized)
○ Consolidation: high-dose oral fluconazole for 8 weeks
○ Maintenance: lower-dose oral fluconazole for ≥1 year to prevent recurrence
● Human bites: amoxicillin-clavulanate or ampicillin-sulbactam if parenteral therapy is
needed
● Diphtheria: erythromycin or PenG
● Latent TB: patients who take warfarin, OCP, antiepileptics, methadone → may choose
isoniazid over rifamycin (due to the latter’s interference with metabolism)
● Vancomycin indications in CAP
○ Septic shock + respiratory failure
○ Imaging findings consistent with MRSA (multilobar pneumonia with cavitation)
○ High likelihood of colonization (eg, chronic HD, HF, history of MRSA colonization)
● Mucormycosis: IV liposomal amphotericin B
● Necrotizing fasciitis: Pip-tazo or carbapenem + vancomycin + clindamycin

⭐
● Cystic fibrosis acute pulmonary exacerbation: vancomycin (MRSA) + 2-drug coverage

⭐
against Pseudomonas (cefepime/ceftazidime + amikacin/tobramycin)
● CRBSI empiric therapy: vancomycin + cefepime (or gentamicin)
● TSS: vancomycin + clindamycin + cefepime (alternative for cefepime: PipTazo or
Carbapenem)
● Bacterial meningitis: vancomycin + ceftriaxone/cefotaxime except
○ <1 month (B-E-L): Ampicillin + gentamicin OR ampicillin + cefotaxime
○ >50 years: vancomycin + ceftriaxone/cefotaxime + ampicillin (for Listeria
coverage)
○ Also add dexamethasone prior to or with first dose of empiric antibiotics to
reduce sequelae and death linked to potential S. pneumoniae infection
● Viral meningoencephalitis: empiric acyclovir until HSV is exclude
● HIV-associated dyslipidemia: rosuvastatin or atorvastatin or pravastatin
● AOM
○ Uncomplicated: 10 day course of high-dose amoxicillin
○ Repeat infection within a month of initial treatment: amoxiclav
● Chronic bacterial prostatitis: 6 weeks fluoroquinolone (eg, ciprofloxacin) or TMP-SMX
● Ecthyma gangrenosum: IV beta-lactam (eg, pip-tazo) and aminoglycoside (eg,
gentamicin)
● Ascariasis: single dose of albendazole
● Giardiasis
○ Tinidazole or nitazoxanide
○ Metronidazole (children)
○ Pregnancy (first trimester): paromomycin
●
⭐
Streptococcal pharyngitis: 10-day course of penicillin (or amoxicillin) to prevent
rheumatic fever

ENDO
● Pioglitazone: improves insulin sensitivity by stimulating PPAR-y; increases renal sodium
reabsorption and fluid retention → symptomatic HF
● Diabetic neuropathy: duloxetine (SNRI), pregabalin, TCA
○ Others: gabapentin, lamotrigine, carbamazepine, capsaicin, topical lidocaine
GI
● Fluoroquinolones: SBP prophylaxis
● Octreotide, midodrine: hepatorenal syndrome

RHEUMA
● Losartan: mild uricosuric effect, for gout and hypertension

NEURO
● Spinal epidural abscess: vancomycin + ceftriaxone
● Cluster headache
○ Abortive: 100% oxygen
○ Preventive: verapamil, lithium, topiramate
● Carbidopa: blocks DOPA decarboxylase, prevents conversion of levodopa to dopamine
in liver and peripheral blood
● Selegiline: MAO-B inhibitor, prevents breakdown of dopamine in CNS
● Entacapone/Tolcapone: COMT INH, prevents breakdown of levodopa in periphery
○ Tolcapone: crosses BBB

MISC
● Herbal supplements
○ Ginkgo biloba (and ginseng)
■ Use: memory booster, intermittent claudication, Alzheimer
■ AE: bleeding
○ Hepatotoxicity
■ Comfrey
■ Ephedra
■ Jin bu huan
■ Kava kava
■ Black cohosh
○ Aconite: AE fatal Arrhythmia
○ Saw palmetto
■ Use: BPH
○ Kava kava
■ Use: anxiety and insomnia
■ AE: hepatotoxicity
○
● SJS as AE
○ Antibiotics: sulfonamides, aminopenicillins, quinolone, cephalosporin
○ Anticonvulsant: lamotrigine, phenytoin, carbamazepine
● Restless leg syndrome
○ Iron supplementation: all patients with evidence of iron deficiency or even
low-normal serum ferritin (≤75 ng/mL)
○ Mild intermittent: carbidopa-levodopa prn (regular use causes paradoxical
worsening)
○ Frequent/daily: gabapentin, pregabalin
●