💊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.

Commonly Prescribed Medications

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Dentowesome 2020📝

References: 2020 firstaidforfree.com

🤒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

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

ASTHMA

Mild intermittent

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

Alternative drugs/Treatments

💊 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)

Alternative drugs/Treatments

💊 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)

Alternative drugs/Treatments

💊 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

Alternative drugs/Treatments

💊 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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Dr. Mehnaz Memon🖊

References: Davidson’s Principles and Practice of Medicine Textbook

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References:

Davidson’s Principles and Practice of Medicine Textbook

Careful examination of the oral cavity mayreveal findings indicative of an underlyingsystemic condition, and allow for early diagnosisand treatment. Examination should includeevaluation for mucosal changes, periodontalinflammation and bleeding, and general

condition of the teeth.