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MEDICINE BLUE BOOK

Sixth Edition

Editors

Willie T. Ong, M.D.

Anna Liza R. Ong, M.D.

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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 ... 1995 Second Edition ... 1997 Third Edition ………... 1999 Fourth Edition ………. 2001 Fifth Edition ……… 2003 Sixth Edition ……… 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 willietong@netasia.net

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Table of Contents

Abbreviations viii Contributing Authors x Preface xi

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

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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

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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 154 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

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Approach to Weakness 168

9. Toxicology . . . Kenneth Hartigan-Go, M.D.

Poisoning and Drug Overdose: General Guidelines 169 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

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

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12. Preventive Medicine & Adult Immunizations

Willie T. Ong, M.D., Cecilia S. Montalban, M.D. 199

13. Final Pointers 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

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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

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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.

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Abbreviations

☺ Cheaper drug option

+ Add or with

 With or without

ABG Arterial blood gas

Ac Ante-cibum; before meals Ad lib Ad libitum; as much as

desired

AF Atrial fibrillation

AHA American Heart Association AMI Acute myocardial infarction Amp Ampule(s)

AOG Age of gestation ARF Acute renal failure

ARDS Acute respiratory distress syndrome

ASA Aspirin or Acetylsalicylic acid

ASAP As soon as possible

ATS American Thoracic Society BID Twice-a-day

BM Bowel movement

BP Blood pressure bpm Beats per minute BRP Bathroom privileges BUN Blood urea nitrogen

BW Body weight

C & S Culture and sensitivity

Ca Calcium

CAD Coronary artery disease Cap Capsule(s)

CAPD Chronic ambulatory peritoneal dialysis CBC Complete blood count CBG Capillary blood glucose CBR Complete bed rest CHF Congestive heart failure Conc Concentration

COPD Chronic obstructive pulmonary disease CPR Cardio-pulmonary

resuscitation

CRF Chronic renal failure CRI Chronic renal insufficiency CSA Chronic stable angina CVA Cerebrovascular accident

CVP Central venous pressure CXR Chest X-ray

d Day

DAT Diet as tolerated

DBP Diastolic blood pressure DDx Differential diagnosis DIC Disseminated intravascular

coagulation

DKA Diabetic ketoacidosis DM Diabetes mellitus DOC Drug of choice DTR Deep tendon reflexes

Dx Diagnosis

DVT Deep venous thrombosis ECG or EKG Electrocardiogram EF Ejection fraction e.g. For example EMD Electromechanical

dissociation ET Endotracheal tube FBS Fasting blood sugar g or gm Gram(s)

GS Gram stain

gtts Macrodrops H+ Hydrogen ions HBT Hepatobiliary tract HCO3 Bicarbonate ions

HD Hemodialysis

HDL High density lipoprotein HGT Hemoglucotest

HONC Hyperosmolar non-ketotic coma

HPN Hypertension

HR Heart rate

hr Hour

HS At night

IBW Ideal body weight IE Infective endocarditis IHD Ischemic heart disease I and O Input and output IM Intramuscular

IU International units

IV Intravenous

IVP Intravenous push

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K Potassium

Kg Kilogram

L or l Liter(s)

LDL Low density lipoprotein lpm Liters per minute (Oxygen) LV Left ventricle LVH Left ventricular hypertrophy mcg microgram Mg Magnesium MI Myocardial infarction Min Minute(s) Mil Million MR Mitral regurgitation MRI Magnetic resonance

imaging MS Mitral stenosis MVP Mitral valve prolapse

Na Sodium

NGT Nasogastric tube NH4 Ammonium ions NSS Normal saline solution NYHA New York Heart

Association

OD Once-a-day

OGTT Oral glucose tolerance test OHA Oral hypoglycemic agents PAC Premature atrial

contraction

Pc Post-cibum; after meals PD Peritoneal dialysis PE Physical examination PEFR Peak expiratory flow rate Pen Penicillin

PFT Pulmonary function test PO Per orem; oral route PPI Permanent pacemaker

Insertion

PPI Proton pump inhibitor PRN As needed Pt. or Pts. Patient(s) PT Prothrombin time PTT Partial thromboplastin time PTU Propylthiouracil PVC Premature ventricular contraction q every

QID Four times-a-day

RAIU Radioactive iodine uptake RF Rheumatic fever

RHD Rheumatic heart disease RR Respiratory rate

RV Right ventricle

SBP Systolic blood pressure SGOT Serum glutamic-oxaloacetic

transaminase

SGPT Serum glutamic-pyruvic transaminase

SL Sublingual; under the tongue Sn Sensitivity Sp Specificity SC Subcutaneous STAT Immediately Supp Suppository Susp Suspension SVT Supraventricular tachycardia Syr Syrup Tab Tablet(s) TC Total cholesterol TET Treadmill exercise test TG Triglyceride

TID Three times-a-day TMP-SMZ Trimethoprim-

Sulfamethoxazole

TPAG Total protein and albumin Tsp Teaspoon(s)

2-D Echo Two-dimensional echocardiography

Tx Treatment

u Units

ugtt or ugtts Microdrop (s) UO Urine output UTZ Ultrasound VS Vital signs w/ With w/o Without WPW Wolff-Parkinson-White syndrome Wt Weight

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References

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