If exposed to Hep B

If exposed to HIV
If exposed to Hep A
If exposed to meningococciemia
If exposed to pertussis
Ginko biloba
St. johns wort
Child Abuse fractures

Child abuse bruises (suspicious)

Child abuse burns

Physical abuse testing

Tx for child abuse

*If not immunized, start Hepatitis

immunoglobulin vaccination ASAP
within 7 days and then repeat in 1
month
HIV ppx asap
Hep A immunoglobulin prophylaxis
in 2 weeks
Rifampin, ceftriaxone, or cipro if
contact c respiratory secretions
(ppx)
Erythromycin or Bactrim ppx
Does not work for alzheimers
Decreases HIV med levels
*BAD = Bucket handle or corner fx
of the metaphysis; rib, scapular,
sternal, spinous process fractures
*OK = clavicle, long bone, linear
skull
*Bruising on ears, trunk, face, and
neck (if you dont cruise, you
dont bruise in toddlers)
*Worry about bruising from pulling
on ears (pinna)
*Document or photograph bite
marks
*water/soup should splash (run of
water marks) ok
*But well-demarcated burn
marks/small circular burns
WORRY
*Bruising: CBC, PT/PTT
*Skeletal survey < 2 years
*CLASSIC HEAD CT (if subdural
hematoma and > 1 month, retinal
hemorrhages eye exam or optho
consult)
*potential urine tox if suspicious of
poison
*care of presenting injury, look for
other injury (potential c-spine
precautions)
*Document/photograph well
*Call CPS and law enforcement
*Dont send home c abusive
family

Normal Breast cancer screening

High risk breast cancer screening

Colon Cancer screening

Prostate Cancer screening

Vaccine risks (general)

MMR risks
DTaP risks
HPV risks
Meningococcal
DTaP schedule
MMR schedule
HiB (H. influenza type b) schedule

*Self breast exam starting in 20s

*Breast exam every 3 years if 2030
*Breast exam by health
professional if 40
*Women 40 should have annual
mammogram
*High Risk: (Known BRCA1 or
BRCA2 mutation; 1st degree
relative c BRCA1 or 2 gene)
External beam radiation therapy
to breast between ages 10-30;
annual mammogram and MRI
*Begin screening at 50 years;
(40-45 if AA)
Options for detecting CA or
polyps:
- Flex sig q 5 years
- Colonoscopy q 10 years
- Double contrast barium
enema q 5 years
- CT (virtual) colonoscopy q 5
years
Screening options for early
detection of CA (follow c
colonoscopy if +)
- Fecal occult blood test q
year
- Fecal immunochemical test
q year
- Stool DNA (new test)
*Start DISCUSSION @ 50 years or
45 (if AA) or 40 (if family hx)
*Screening test: PSA DRE
Can cause local pain, tenderness,
erythema, fever, allergic reactions
Joint pain, delayed fever
Can rarely cause seizure, crying
HA, fainting
GBS infection
2, 4, 6, 12 months and a booster
at 4-6
At 1 year and a booster at 4-6
years
2, 4, 6, and 12-15 months

Hep B (HBV) schedule

Polio schedule (enterovirus)
Pneumococcus schedule
HAV (hepatitis A) schedule (hep A
can cause liver failure)
Varicella schedule

Influenza vaccine schedule

Meningococcemia vaccine
schedule (sepsis, meningitis)
(MCV4)

HPV vaccine schedule

Rotavirus

Adult vaccine schedule

Unvaccinated Adults

(uncommon over 5 so no boosters

needed over age 5; dont need
vaccine if never had if over age 5)
Birth, 1-4 months, 6-18 months (3
doses)
2, 4, 6-18 months , 5-6 years
2, 4, 6, and 12-15 months
12-23 months (2 months, 6
months apart during this
timeframe); also give to anyone in
communities with outbreaks
*12-15 months and 4-6 years (2
doses)
*If > 13 years (2 doses, 1 month
apart)
*Given to ALL CHILDREN
*Nasal spray is live and
recommended in kids 5+
*First time vaccine if under 9
years; give second dose 1 month
later
*Polysaccharide at 2-10 years to
high risk; ASPLENIC patients
*Conjugate, adolescents 11-12
years, college students, military
*MCV4 booster now recommended
at age 16
*3 doses (first at 11-12 years,
given 2 months later and then at 6
months later)
*Causes diarrhea
*Oral vaccine at 2, 4, 6 months
and first dose MUST BE BETWEEN
6-12 MONTHS!
*Varicella: 2 doses 8 weeks apart,
avoid within 1 month of pregnancy
or immune deficiency
*MMR 2 doses, 4 weeks apart
*TdaP/Td q 10 years
*Influenza
*Age > 50 herpes zoster
*Age > 65 pneumococcus (or
high risk c chronic illness!)
*Hep A 2 doses, 6 months apart
for some travelers, drug users,

Cardiogenic shock

Distributive shock

Obstructive shock
Toxin or Metabolic Shock

Vasopressors

Types of ADRs

men who have sex with men

*HPV women up to 26
*Hib- adults c splenectomy,
leukemia, HIV
*Meningococcemia- college,
military
*Hep B- 3 doses (2nd dose at 4
weeks, 3rd dose 8 weeks apart) for
people c occupational or
behavioral exposure
*Yellow fever vaccine for South
America or sub-saharan Africa
travel
*c/b CHF, Acute MI, Valvular
disease (ex acute valvular
rupture)
*Tx: directed at etiology: CHF
(nitroglycerin, BiPAP); acute
valvular rupture (OR to repair)
*Septic shock
*loss of tone vasodilation
hypoperfusion
*Tx: IVF (normal saline),
vasopressors, antibiotics if septic
*Pulmonary embolism,
pneumothorax
Tx: reverse cause
*Ex: hyperkalemia, beta blocker
poisoning, cyanide poisoning
*Directed therapy if possible
*Supportive care
*Norepinephrine/Levaphed
(directly stimulates alpha and beta
1 receptors)
*Phenylephrine (directly
stimulates alpha receptors)
*Dopamine (indirectly releases NE
from nerve storage; varying
efects based on dosage)
-Low dose (2-5 mcg/kg/min)
dopamine receptor
- Moderate dose (5-10
mcg/kg/min) beta receptor
-High dose (10-20 mcg/kg/min)
alpha-receptor

Pharmacokinetic: Absorption
Pharmacokinetic: Distribution
Pharmacokinetic: Metabolism
Pharmacokinetic: Excretion
Pharmacodynamic: Exaggerated
Response
Pharmacokinetic: Competitive
Hypersensitivity Reactions: ACID

Category X Teratogenic Drugs

Analgesics
Acetaminophen

NSAIDs

Salicylates

Decreased (ex: transit time,

chelators- bind up metals such as
mylanta, anticholinergics)
Distribution- displace plasma
proteins (so important things cant
be bound)
Ex: CYP450 (enzyme system in
liver that is afected by multiple
meds)
Decreased renal function
Exaggerated response (ex: Benzos
and ethanol)
Ex: beta blockers and albuterol
(both trying to cause
bronchodilation)
*Type 1: Anaphylaxis: PCN, bee
stings
*Type 2: Cytotoxic: destroys cells;
heparin induced
thrombocytopenia (HIT)
*Type 3: Immune complex
mediated (serum sickness to antivenom)
*Type 4: Delayed (ex: poison ivy,
PPD)
*Warfarin, Retin-A, Thalidomide
(for leprosy)
MOA: Inhibits PG synthesis
Ind: Analgesia, Antipyretic
ADR: Well-tolerated; analgesic;
nephropathy
Toxicity: Hepatotoxic (can cause
liver failure!)
Agents: Tylenol, Vicodin, Percocet
MOA: COX inhibition (decrease PG)
Ind: Analgesia, antipyretic, antiinflammatory
ADR: GI upset, PUD, Prolonged
bleeding time, Nephropathy,
Allergic rxn, asthma
Toxicity:
Agents: Ibuprofen, Naproxen,
Toradol
MOA: COX inhibition (decrease PG)

Ind: Analgesia, antipyretic, antiinflammatory, ACS,

cerebroprotective (helps protect
against stroke), Kawasaki
ADR: GI upset, PUD, prolonged
bleeding time, Nephropathy,
Allergic rxn, asthma, REYES
SYNDROME (with kids!)
Toxicity:
Agents: Ibuprofen, Naproxen,
Toradol
MOA: Various receptors
Ind: Analgesia, antitussive,
adjunct to anesthesia
ADR/Toxicity: Decreased
respirations, coma, death
Reversal agent: NALOXONE
(narcan)
Agents: Morphine, Codeine,
Methadone

Opiods

Diabetes Meds
Insulin

Sulfonylurea

Biguanide
(Metformin/Glucophage)

MOA: Exogenous protein mimics

endogenous
Ind: DM, Hyperkalemia
ADR: Hypoglycemia,
lidodystrophy, allergic reaction
Toxicity: Hypoglycemia
Reversal agents: GLUCAGON,
DEXTROSE
MOA: Stimulate B cell insulin
release from pancreatic islet cells
(increases insulin sensitivity over
time)
Ind: DM II
ADR: Hypoglycemia,
disulfiram/antabuse-like
(hypersensitivity to EtOH)
Toxicity: Hypoglycemia
(prolonged)
Tx for hypoglycemia/prlonged:
D50W, glucagon, octeotride
Agents: Glyburide
MOA: Decreases hepatic glucose
pdn; inhibits gluconeogenesis;
converts intestinal glucose to
LACTIC ACID

Glitinides

Thiozolindineodiones (glitazones)

Glucosidase inhibitor

GI Agents
H-2 Antagonists

PPIs

Ind: DM II
ADR: LACTIC ACIDOSIS
Toxicity: Check serum Cr before
giving Metformin (if elevated, do
NOT give)
MOA: AA derivative similar to
sulfonyruea
Ind:
ADR: Hypoglycemia
Toxicity:
Agents: Prandin (repaglinide)
MOA: Insulin sensitizer in muscle
and liver; decreased hepatic
glucose pdn
Ind: DM II
ADR/Toxicity: HEPATOTOXIC;
CARDIOTOXIC
Agents: Actos (pioglitazone
hydrochloride), Avandia
(rosiglitazone maleate)
MOA: Inhibit intestinal alpha
glucosidases
Ind:
ADR: GI upset
Toxicity:
Agents: Acarbose
MOA: Inhibit histamine stimulation
of gastric acid
Ind: PUD, GERD, Zollinger-Ellison
Syndrome, Antihistamine
ADR: Cimetidine (anti-androgen),
gynecomastia, galactorrhea
DDIs: Cimetidine inhibits CYP450
Agents: rantidine (Zantac),
famotidine (Pepcid), cimetidine
(Tagamet)
MOA: Inhibit proton pump on
gastric parietal cell (final common
pathway)
Ind: GERD, PUD, ZES, H. pylori
ADR: RARE, associated c gastric
cancer from achlorhydria
Agents: Omeprazole (Prilosec),
lansoprazole (prevacid),

Antacids

Bismuth Subsalicylate

Antiemetics
Phenothiazines

5HT-3 antagonists

Hyperlipidemia
HMG-reductase inhibitors (statins)

Pantoprazole (protonix)
MOA: Weak bases: neutralize,
inhibit pepsin
Ind: GERD, PUD (duodenal)
ADR: Aluminum causes
constipation, magnesium causes
diarrhea
Toxicity: Milk-alkali syndrome
Agents: Mylanta, Maalox
MOA: Antimicrobial, inhibits Pepsin
release; increase mucus secretion
Ind: GERD, constipation, H. pylori
ADR: Black stool (not melena!),
Salicylism (rare), Bismuth toxicity
DDIs:
Agents: Pepto bismol
MOA: Block dopamine receptors
Indications: N/V, previously used
for antipsychotics, intractable
hiccums)
ADR: Sedation, dystonia,
Parkinson, local tissue injury
(parenteral)
Toxicity: TCA-like, Seizure, Vtach,
Hypotension
Agents: Prochlorperzine
(Compazine), Promethazine
(Phenergan), Chlorpromzine
(Thorazine)
MOA: Block 5HT3 receptors
Ind: N/V
ADR: Well tolerated!
Toxicity:
Agents: Odansetron (Zofran)
MOA: blocks cholesterol synthesis
in liver
Indications: hypercholesterolemia,
post MI
ADR: myopathy,
RHABDOMYOLYSIS (INCREASED
C NICOTINIC AGENTS AND
FIBRATES!)
Agents: Atorvastatin (Lipitor)

Nicotinic Acid (nicotinic acid,

Vitamin B3)

MOA: decreases VLDL, decreases

TG, also decreases cholesterol and
increases HDL
ADR: FLUSHING (give ASA to
prevent), palpitations, hepatotixic
(sustained release)
Agents: niacin, NicoBID

Fibrates

Bile Acid Sequestrants

Ezetimibe

Asthma/COPD Meds
Beta2- Agonists

Anticholinergics

Steroids

MOA: stimulate B2 receptors in

bronchial tree, smooth muscle
relaxation
Ind: Asthma, COPD,
bronchospasm, hyperK, uterine
contractions
ADR: Tachy, palpitations, jittery,
hypoK
Agents: Albuterol, Salmeterol
MOA: counteracts vagal mediated
bronchoconstriction
Ind: Asthma, COPD
ADR: dry mouth, tachy
Agents: ipratropium (atrovent)
MOA: complex
Ind: anti-inflammatory,

immune suppressant
ADR: moon face, buffalo
hump, striae, hyperglycemia,
fluid retention, infection, PUD,
cataracts, psychosis, adrenal
suppression
Agents: Prednisone,
methylpresnisolone,
dexamethasone (parenteral,
inhaled, PO)

Cardivascular agents
Beta Blockers

CCBs

MOA: Prevent catecholamine

stimulation at endogenous B
receptors
Indications: HTN, angina,
dysrhythmia, MI, glaucoma,
Thyrotoxicosis, performance
anxiety
ADR: Hypotension, bradycardia,
heart block, bronchospasm (even
cardioselective ones if high
enough dose), hypoglycemia
Toxicity: Severe, treat c
GLUCAGON
MOA: Block intracellular Ca influx
Ind: HTN, angina, dysrhythmias,
SAH, migraine, Raynauds,
Prinzmetal
ADR: Hypotension, bradycardia,
constipation
Toxicity: Severe, treat c calcium,

ACE-Is/ARBs

Alpha 2 agonists

Alpha 1 Antagonists

glucagon
Agents: Verapamil, diltiazem,
nifedipine
MOA: ACE-S inhibit angiotensin I to
II conversion; ARBs block
angiotensin receptor
ADRs: Cough, angioedema,
hyperkalemia
Toxicity: Lithium (ACE-Is renal
blood flow so excretion of other
agents), c NSAIDs cause
hyperkalemia
Agents: Captopril, enalapril,
losartin
MOA: Presynaptic stimulation
inhibits release of catecholamines
Ind: HTN, glaucoma, withdrawal
syndromes (ex: opiate withdrawal)
ADR/Toxicity: Hypotension,
bradycardia, sedation, coma,
opiod-like, respiratory depression
Agents: Clonidine, exymetalozine
(afrin)
MOA: Block postsynaptic alpha 1
stimulation
Ind: HTN, BPH
ADR: FIRST DOSE SYCOPE (take
at night the first time), orthostatic
hypotension
Agents: Terazosin, Prazosin

Diuretics
Thiazides

Loop diuretics

MOA: Inhibits Na/Cl resorption in

distal tuble ( H2O exretion)
Ind: HTN, edematous states
ADR: hypoK, increased uric acid,
hyperglycemia, decreased calcium
excretion
Agents: HCTZ
MOA: Inhibit Na/K/Cl resorption in
loop
Ind: HTN, edema, hyperkalemia,
hyperCalcemia
ADR: hypokalemia, ototoxicity,
hypoCalcemia
Agents: furosemide (Lasix),

Cardiac glycosides

Nitrates

bumetanide (bumex)
MOA: Block Na/K ATP-ase pump;
increase vagal tone
Ind: AFib, CHF
ADR/Toxicity: VT, PVCs, Brady, GI
upset, CNS, blue-green visual
change
Agents: Digoxin, digitoxin
MOA: Increase NO, vascular
smooth muscle relaxation
Indications: Angina, MI, CHF
ADR: HA, Hypotension,
tachycardia, methemoglobinemia
DDIs: PHOSPHODIESTERASE
INHIBITORS (EX: SILDENAFIL),
hypotension
Agents: paste, IV, Sublingual

Antiacoagulation
Warfarin

Heparin

Vitamin K dependent clotting

factors
Antibiotics
PCN (beta lactam)
Cephalosporins (beta lactam)
Vancomycin (non beta lactam)

MOA: prevents vitamin K

conversion back to active form,
inhibits VII, IX, X, II
Ind: DVT, PE, CVA prophyalxis
ADR: bleeding, skin necrosis,
purple toe syndrome,
teratogenic (use Heparin c
pregnant women)
DDIs: MANY!
MOA: unfractionated binds to
antithrombin III and also inhibits
Xa; fractionated low MWH inhibits
Xa only
*Ind: DVT, PE, ACS, use over
warfarin in pregnancy
*ADR: bleeding, hypersensitivity,
thrombocytopenia (HIT)
Reversal Agent for Heparin OD:
Protamine
SNoTT- Seven, Nine, Ten, Two
Inhibit cell wall synthesis
Inhibit cell wall synthesis; more
resistant to beta lactamase
Inhibit cell wall synthesis (diferent
mechanism)

Sulfa
TMP (trimethoprim)
Quinolones
Tetracycline and aminoglycosides

Macrolide
Antidepressants
Tricyclic Antidepressants (TCAs)

SSRIs

MAOIs

MOA: structurally similar to PABA,

needed for folate synthesis
ADR: sulfa allergy;
MOA: Inhibits folate
dihydroreductase (FDHR)
MOA: Inhibit DNA gyrase of
bacteria, cannot make nucleic acid
MOA: bind to 30S ribosomal
subunit, non-functioning protein
Tetracycline ADR: teeth staining,
no children < 8 or pregnancy
Aminoglycoside ADR: Ototoxic
and nephrotoxic
MOA: bind to 50s subunit, inhibit
translocation downstream
MOA: Inhibit reuptake of NE, 5HT,
DA
Ind: Depression, neuropathic pain
ADR: Dry mouth, urinary
retention, blurred vision, sedation,
orthostatic hypotension
DDIs: SEROTONIN SYNDROME!
Toxicity: Seizure, hypotension,
VTach, and fatal dysrhythmias
Agents:
MOA: Inhibit 5HT (Serotonin)
reuptake
Ind: Depression, OCD, PMS
ADR: Well tolerated, loss of libido
Agents: Fluoxetine, Paroxetine
MOA: Prevent breakdown of NE,
5HT, DA
Ind: Severe depression
ADR: Tyramine reaction (HTN
crisis with aged cheese, wine)
Agents: Phenylzine,
Tranlycypromine

Sedative Hypnotics
Benzos

MOA: GABA agonist (decreases

neuronal excitability)
Ind: Anxiolytic, hypnotic, seizure,
EtOH withdrawal, performance
anxiety, procedure sedation,
induction

Barbiturates

ADR: sedation, ataxia, dizziness,

amnesia
Reversal Agent: FLUMAZENIL
(careful, flumazenil can
precipitate withdrawal)
Agents: diazepam, lorazepam
MOA: similar to benzos, GABA
agonist
Indications: antesthesia, seizures,
formerly anxiolytic, and hypnotic
ADR: hypotension, bradycardia,
decreased respiration rate
Agents: Phenobarbital,
pentobarbital

Drugs of Abuse
Cocaine

Amphetamine

Heroin

MOA: inhibit neuronal uptake of

catecholamines: Na channel
blockade (anesthetic)
Ind: local anesthetic, hemostasis
Toxicity: HTN, hyperthermia,
rhabdomyolysis, MI, seizures,
VTach (Tx c benzos, cooling,
nitrates/nitroprusside, CCB)
CI: AVOID BETA BLOCKERS!
MOA: Cause catecholamine
release
Ind: ADHD, weight loss (PHEN
PHEN Phenomenon)
Toxicity: HTN, tachycardia,
hyperthermia, intracranial
hemorrhage, rhabdomyolysis (Tx
same and c cocaine)
Diacetylmorphine, opiod (see
opiods)