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 ... 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
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
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 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
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
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
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
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.
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
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