Blue Book in Medicine

MEDICINE BLUE BOOK Sixth Edition

Editors Willie T. Ong, M.D. Anna Liza R. Ong, M.D.

Notice: The authors and publisher of this volume have taken care to ensure the accuracy of drug dosages and that these are compatible with the accepted standards of treatment at the time of publication. However, as new data becomes available, there may be changes in treatment and drug use. Therefore, the reader is advised to consult the package insert before using any therapeutic agent. The authors and publisher disclaim responsibility for adverse effects resulting from omissions or undetected errors.

Copyright 2004 by Willie T. Ong, M.D. and Anna Liza R. Ong, M.D. Philippine Copyright No. A-2001-1096 ISBN 971-91562-6-0 Published by: Anna Liza R. Ong, M.D. First Edition ........................ Second Edition .................... Third Edition ……………... Fourth Edition ……………. Fifth Edition ……………… Sixth Edition ………………

1995 1997 1999 2001 2003 2005

Technical Assistants: Grace Villablanca Layout Artist: Victor Santos Printed by: Cacho Hermanos, Inc. Pines Corner Union Streets Mandaluyong City Also by Drs. Willie T. Ong and Anna Liza R. Ong: Cardiology Blue Book, Third edition Altapresyon at Tamang Pangangalaga sa Inyong Puso Legacy of Medicine: Interviews with Distinguished Filipino Internists Ideals and Inspirations for Doctors For comments, orders and suggestions, kindly call telephone number 831-9842 (Nita) or e-mail at [email protected]

Table of Contents Abbreviations viii Contributing Authors Preface xi

x

1. Cardiology . . . . . . . . Willie T. Ong, M.D. Advanced Cardiac Life Support 1 Acute Myocardial Infarction 4 Thrombolytic Therapy in MI 7 Unstable Angina 8 Congestive Heart Failure 9 Hypertensive Emergency 11 Supraventricular Tachycardia 12 Atrial Fibrillation 13 Premature Ventricular Contractions & Ventricular Tachycardia 14 Premature Atrial Contractions 16 Infective Endocarditis (Treatment) 17 Infective Endocarditis (Prophylaxis) 19 Acute Rheumatic Fever Treatment & Prophylaxis 20 Cardio-Pulmonary Clearance 22 Dyslipidemia with Lipid Lowering Drugs 24 Indications for Permanent Pacemaker Insertion 26 Hypertension 27 List of Antihypertensives & Cardiac Drugs 29 Low Molecular Weight Heparins for DVT & Unstable Angina 33 The Cardiac Patient with Other Medical Disorders 34 2. Pulmonology . . . . . . . . Camilo C. Roa, Jr., M.D. Bronchial Asthma 35 Drugs Used to Treat Asthma 36 Management of Chronic Asthma 39 Management of Acute Exacerbations of Asthma: Home Treatment 41 Management of Acute Exacerbations of Asthma: Hospital Treatment 42 Chronic Obstructive Pulmonary Disease 45 Tuberculosis 46 Antituberculosis Drug List 51 Pulmonary Embolism 53 Hemoptysis 54 Pleural Effusion and Thoracentesis 55 Anaphylaxis 56 Pneumothorax 57 Pneumonia 58

3. Gastroenterology . . . . . . . . Virgilio P. Banez, M.D. Peptic Ulcer Disease & Acute Gastritis 61 Upper and Lower GI Bleeding 63 Antiulcer Drugs 64 Hepatic Encephalopathy & Liver Cirrhosis 66 Abdominal Paracentesis 67 Viral Hepatitis 68 Acute Cholecystitis 70 Bacterial Cholangitis and Biliary Sepsis 71 Acute Pancreatitis 72 Acute Diarrhea with Mild Dehydration 74 Cholera with Severe Dehydration 75 Acute Intestinal Obstruction 76 4. Infectious Diseases . . . . . . . . Cecilia S. Montalban, M.D. Clinically Useful Antibiotics 77 Antibiotic Drug List 81 Systemic Viral Infection 86 Acute Tonsillopharyngitis 86 Dengue Hemorrhagic Fever 87 Typhoid Fever 88 Malaria 89 Prevention of Malaria in Travellers 90 Leptospirosis 91 Schistosomiasis 92 Sepsis and Septic Shock 92 Lower Urinary Tract Infection 94 Pyelonephritis 94 Cellulitis 95 Meningitis and Encephalitis 96 Tetanus 98 Osteomyelitis 99 Peritonitis 100 Diverticulitis 101 Pelvic Inflammatory Disease 102 Pneumonia 102 Infective Endocarditis 102 Mumps 103 Varicella Zoster 103 Empirical Antimicrobials for Out-Patient Adults 104 Initial Antimicrobials for Acutely Ill Adults 106 Drug of Choice for Microbial Pathogens 108

5. Nephrology . . . . . . Elizabeth S. Montemayor, M.D. Acute Renal Failure 112 Strategy for Removing Excess Fluid 115 Chronic Renal Failure 116 Hypokalemia 118 Hyperkalemia 120 Hypocalcemia 122 Hypercalcemia 123 Hyponatremia 124 Hypomagnesemia 126 Hypermagnesemia 126 Nephrolithiasis 127 Dialysis 128 Dosage Adjustment of Drugs in Renal Failure 130 6. Endocrinology . . . . . . . . Ruby T. Go, M.D. Approach to Type II Diabetes Mellitus 135 Diabetic Ketoacidosis / Hyperosmolar Coma 140 Thyroid Storm 141 Hyperthyroidism 143 Hypothyroidism 144 Adrenal Insufficiency 145 7. Rheumatology . . . . . . . . Clemente M. Amante, M.D. Osteoarthritis 147 Gouty Arthritis 148 Rheumatoid Arthritis 150 Systemic Lupus Erythematosus 152 8. Neurology . . . . . . Carlos L. Chua, M.D. Cerebral Infarction vs. Hemorrhage Guide Intracerebral Hemorrhage 155 Subarachnoid Hemorrhage 156 Cerebral Thrombosis 157 Cerebral Embolism 157 Transient Ischemic Attack 158 Stroke In Evolution 158 Stroke in the Young 158 Seizures and Epilepsy 159 Brain Abscess 163 Myasthenia Gravis 164 Parkinson's Disease 165 Alcohol Withdrawal 167

154

Approach to Weakness

168

9. Toxicology . . . . . . Kenneth Hartigan-Go, M.D. Poisoning and Drug Overdose: General Guidelines Acid Ingestion 173 Alkaline Ingestion 173 Amphetamine / Metamphetamines 173 Anticoagulants 174 Diazepam 174 Digitalis / Digoxin 175 Ethanol 175 Hydrocarbon / Kerosene 176 Isoniazid 176 Narcotics 177 Organophosphates 178 Paracetamol 179 Phenothiazines / Neuroleptics 181 Salicylate / Aspirin 182 Tricyclic Anti-Depressants 183

169

10. Nutrition . . . . . . Nutritionist-Dietitians' Association of the Philippines Recommended Diet by Organ System 184 Diet Modifications and Food List 184 High Fiber Diet 184 Low Calorie Diet 185 High Calorie Diet 186 High Protein Diet 186 Low Protein Diet 186 Low Fat / Low Cholesterol Diet 187 Low Carbohydrate Diet 187 Low Sodium Diet 188 Low Potassium Diet 188 Low Uric Acid / Low Purine Diet 189 Nutritional Management of Diabetics and Renal Patients 189

11. The Pregnant Patient with Medical Problems Camilo C. Roa, Jr., M.D., Ruby T. Go, M.D., Willie T. Ong, M.D. Pregnancy and Hypertension 192 Pregnancy and Cardiac Disease 194 Pregnancy and Asthma 194 Pregnancy and Thyroid Disease 195 Pregnancy and Diabetes 196 Drugs Used in Pregnancy 197

12. Preventive Medicine & Adult Immunizations Willie T. Ong, M.D., Cecilia S. Montalban, M.D. 13. Final Pointers

199

206

Appendices 207 All About Drips 207 Additional Drug Lists: Pain Relievers / Laxatives / Antidiarrheals / Antiflatulents / Antipyretics / Hypnotics and Sedatives 211 Intravenous Fluids 214 Formulas 214 References 216

Contributing Authors Clemente M. Amante, MD, FPCP, FPRA Professor of Medicine, Section of Rheumatology, UP-PGH

Virgilio P. Banez, MD, FPCP, FPSG, FPSDE Clinical Associate Professor of Medicine, Section of Gastroenterology, UP-PGH

Carlos L. Chua, MD, FPNA Associate Professor of Medicine, Section of Neurology, UP-PGH

Kenneth Hartigan-Go, MD, FPCP, FPSECP, FPSCOT Associate Professor, Department of Pharmacology, UP College of Medicine Clinical Associate Professor of Medicine, Section of Toxicology, UP-PGH

Ruby T. Go, MD Clinical Associate Professor of Medicine, Section of Endocrinology, UP-PGH

Cecilia S. Montalban, MD, FPCP, MSCTM Associate Professor of Medicine, Section of Infectious Diseases, UP-PGH

Elizabeth S. Montemayor, MD, FPCP, FPSN Associate Professor, Department of Physiology, UP College of Medicine Clinical Associate Professor of Medicine, Section of Nephrology, UP-PGH

Willie T. Ong, MD, MPH, FPCP, FPCC Cardiologist, Manila Doctors Hospital and Makati Medical Center

Camilo C. Roa, Jr., MD, FPCP, FPCCP Professor, Department of Physiology, UP College of Medicine Clinical Associate Professor of Medicine, Section of Pulmonary Medicine, UP-PGH

Preface to the Sixth Edition The year 2005 marks the 10-year anniversary of the publication of the Medicine Blue Book. I wrote the draft during my internship and completed the book during my first year of residency at Manila Doctors Hospital. Even then, my utmost desire in sharing this book is to assist the many struggling doctors and nurses in our different training institutions. I had seen how hard and how unrewarding medical training can be. I hope the Blue Book can be your friend and companion at some point in your career. One of the biggest problems afflicting our country right now is the high cost of healthcare. To address this, the Blue Book contains several unique features: (1) cost-effective drug options are listed whenever possible and noted with a smile “☺” icon, (2) priority laboratory exams to request are highlighted in bold, (3) the treatment regimens are generally listed according to importance, which means that crucial treatment strategies are listed first and supportive treatments are listed last, (4) the dosages of drugs have been adjusted for the average Asian patient, and (5) only those tests and drugs available in our local setting are included. This edition presents major revisions and updates in all chapters. The latest guidelines (local ones if available) have been utilized. Again, my profuse thanks to Dr. Clemente Amante, Dr. Virgilio Banez, Dr. Carlos Chua, Dr. Kenneth Hartigan-Go, Dr. Ruby Go, Dr. Cecilia Montalban, Dr. Elizabeth Montemayor and Dr. Camilo Roa Jr. for their selfless and untiring efforts in updating the text. I am also greatly indebted to several people in my medical education: Dr. Romeo P. Ariniego, Medical Director at De La Salle University Medical Center; Dr. Nelson S. Abelardo, past Chair of the Department of Internal Medicine at Manila Doctors Hospital; and Dr. Rody G. Sy, former Head of the Section of Cardiology at UP-Philippine General Hospital. Finally, I would like to thank my parents, Mr. Ong Yong and Mrs. Juanita Tan Ong, for their wholehearted support in this endeavour. And to my wife, Anna Liza, for all her hard work in publishing this book. Above all, I humbly thank the Lord God for His guidance and inspiration. I can accomplish nothing without Him but "I can do everything in Christ who strengthens me." Thank you for reading and may God bless us always. Willie T. Ong

☺ +  ABG Ac Ad lib AF AHA AMI Amp AOG ARF ARDS ASA ASAP ATS BID BM BP bpm BRP BUN BW C&S Ca CAD Cap CAPD CBC CBG CBR CHF Conc COPD CPR CRF CRI CSA CVA

Abbreviations CVP Cheaper drug option CXR Add or with d With or without DAT Arterial blood gas DBP Ante-cibum; before meals Ad libitum; as much as DDx DIC desired Atrial fibrillation American Heart Association DKA Acute myocardial infarction DM DOC Ampule(s) DTR Age of gestation Dx Acute renal failure Acute respiratory distress DVT ECG or EKG syndrome Aspirin or Acetylsalicylic EF e.g. acid EMD As soon as possible American Thoracic Society ET Twice-a-day FBS Bowel movement g or gm Blood pressure GS Beats per minute gtts Bathroom privileges H+ Blood urea nitrogen HBT Body weight HCO3 Culture and sensitivity HD Calcium HDL Coronary artery disease HGT Capsule(s) HONC Chronic ambulatory peritoneal dialysis HPN Complete blood count HR Capillary blood glucose hr Complete bed rest HS Congestive heart failure IBW Concentration IE Chronic obstructive IHD pulmonary disease I and O Cardio-pulmonary IM resuscitation IU Chronic renal failure Chronic renal insufficiency IV IVP Chronic stable angina J Cerebrovascular accident

Central venous pressure Chest X-ray Day Diet as tolerated Diastolic blood pressure Differential diagnosis Disseminated intravascular coagulation Diabetic ketoacidosis Diabetes mellitus Drug of choice Deep tendon reflexes Diagnosis Deep venous thrombosis Electrocardiogram Ejection fraction For example Electromechanical dissociation Endotracheal tube Fasting blood sugar Gram(s) Gram stain Macrodrops Hydrogen ions Hepatobiliary tract Bicarbonate ions Hemodialysis High density lipoprotein Hemoglucotest Hyperosmolar non-ketotic coma Hypertension Heart rate Hour At night Ideal body weight Infective endocarditis Ischemic heart disease Input and output Intramuscular International units Intravenous Intravenous push Joules

K Kg L or l LDL lpm LV LVH mcg Mg MI Min Mil MR MRI MS MVP Na NGT NH4 NSS NYHA OD OGTT OHA PAC Pc PD PE PEFR Pen PFT PO PPI PPI PRN Pt. or Pts. PT PTT PTU PVC

Potassium Kilogram Liter(s) Low density lipoprotein Liters per minute (Oxygen) Left ventricle Left ventricular hypertrophy microgram Magnesium Myocardial infarction Minute(s) Million Mitral regurgitation Magnetic resonance imaging Mitral stenosis Mitral valve prolapse Sodium Nasogastric tube Ammonium ions Normal saline solution New York Heart Association Once-a-day Oral glucose tolerance test Oral hypoglycemic agents Premature atrial contraction Post-cibum; after meals Peritoneal dialysis Physical examination Peak expiratory flow rate Penicillin Pulmonary function test Per orem; oral route Permanent pacemaker Insertion Proton pump inhibitor As needed Patient(s) Prothrombin time Partial thromboplastin time Propylthiouracil Premature ventricular

q QID RAIU RF RHD RR RV SBP SGOT SGPT SL Sn Sp SC STAT Supp Susp SVT Syr Tab TC TET TG TID TMP-SMZ TPAG Tsp 2-D Echo Tx u ugtt or ugtts UO UTZ VS w/ w/o WPW Wt

contraction every Four times-a-day Radioactive iodine uptake Rheumatic fever Rheumatic heart disease Respiratory rate Right ventricle Systolic blood pressure Serum glutamic-oxaloacetic transaminase Serum glutamic-pyruvic transaminase Sublingual; under the tongue Sensitivity Specificity Subcutaneous Immediately Suppository Suspension Supraventricular tachycardia Syrup Tablet(s) Total cholesterol Treadmill exercise test Triglyceride Three times-a-day TrimethoprimSulfamethoxazole Total protein and albumin Teaspoon(s) Two-dimensional echocardiography Treatment Units Microdrop (s) Urine output Ultrasound Vital signs With Without Wolff-Parkinson-White syndrome Weight