Steph Marie @steffiemarie on GrepMed

Fatigue and IBD Algorithm • 40-50% patients have fatigue despite clinical remission • Risk factors: BMI, Depression, sleep disturbance, Female, Thiopurine, MTX?, Anemia • Prevalence Crohn's > UC Anemia and IBD Pearls: • IDA and active IBD: IV Fe > PO FE • Fe Carboxymaltose & Fe Sucrose > alt. IV FE formulations • If persistent macrocytosis after d/c IMM → consider NRH & Heme eval. re: BMBx • Supplement folate if on MTX or SSZ • Check Soluble Transferrin Receptor (sTfR) to differentiate IDA vs. ACD • Monitor & correct B12 (B12, MMA) for ileal Crohn's/resection/restricted diet/deficiency symptoms even if wnl B12 Patient Experience • 2/3 endorse persistent fatigue despite disease control • 1/3 have fatigue w/ active IBD and/or stress • Pts report dehydration as a factor • ~50% report no improvement despite attempted therapies • ~20% w/ improved fatigue after correction of lab abn./other causes • ~30% note improvement w/ mental health/Lifestyle/diet modifications Algorithm by Dr. Waseem Ahmed @Waseem_AhmedMD #Fatigue #IBD #Algorithm #diagnosis #management

Mild-to-Moderate Ulcerative Colitis - Management Algorithm Curcumin: • Natural phytochemical from turmeric • 2g/day divided in 2-3 doses: ↑ induction & maintenance rates with 5ASA vs placebo • Potential GI SE, liver injury, inhibit platelet aggregation Probiotics: • VSL#3/Visbiome, Megaspore, E. coli Nissle • VSL#3: ↑ clinical response & remission with 5ASA vs placebo • RD consult re: diet rich in pre/probiotics Budesonide and UC: • Budesonide-MMX PO (delayed, extended release): controlled delivery to the colon • Budesonide Foam PR, Enema PR • Caution with long-term dosing given risk for steroid AEs; consider decreased dosing if liver disease • 5-ASA = Budesonide to induce remission Patient Experience • >50% combination PO/PR 5-ASA therapy most effective • PO 5-ASA more tolerated than PR 5-ASA • Ostomy pts: poor release in extended-release 5-ASA formulations • Difficult to retain enemas if severe rectal inflammation, elderly ; consider suppository or foam formulations • Some notice change in efficacy when switching 5-ASA brands Algorithm by Dr. Waseem Ahmed @Waseem_AhmedMD #Ulcerative #Colitis #UC #Management #Mild #Moderate #Algorithm #treatment #IBD

Community-acquired pneumonia #management #algorithm #treatment

Intern Pocket Cards - Pharmacologic Pain Management Options Anti-inflammatory: • Acetaminophen (24 hours: < 3-4g in healthy adults, <3g in CKD, <2g in liver disease or cirrhosis) • Oral NSAIDs or IV ketorolac (avoid NSAIDs if CKD or >2 of the following risk factors: history of GI ulcer, age >60, on steroids, on ASA/anticoagulation) • Opioid: Hydrocodone, morphine, oxycodone, hydromorphone, fentanyl, tramadol, codeine • Topical: Lidocaine patch, menthol cream, lidocaine/prilocaine cream, capsaicin cream • Neuropathic agents: Gabapentin, pregabalin, SNRIs, TCAs • Anti-spasmodic: Baclofen, cyclobenzaprine, tizanidine Opioid Equianalgesia Conversion Table: • Morphine 10 IV, 25 PO • Hydromorphone 2 IV, 5 PO • Oxycodone 20 PO • Hydrocodone 25 PO • Codeine 100 IV, 200 PO • Fentanyl 0.15 IV • Tramadol 100 IV, 120 PO Dr. Satya Patel @SatyaPatelMD Full Inpatient Pocket Cards Collection: https://bit.ly/pocketcardset #Pain #Opioid #Conversion #Table #Ladder #medications #pharmacology #agents #internship #guide #comparison

Intern Pocket Cards - Inpatient Bowel Regimen Guide Osmotic agents (draws water into bowel, thereby loosening stool and promoting evacuation): • Polyethylene glycol - Nausea, bloating, cramping • Lactulose, Sorbitol - Abdominal bloating, flatulence • Glycerin - Rectal irritation • Magnesium sulfate PO, Magnesium citrate - Watery stools and urgency Stimulant laxatives: • Bisacodyl - Rectal irritation • Senna - Melanosis coli Bulk-forming laxatives (fiber absorbs excess water and stimulates elimination): • Psyllium - Impaction above strictures, fluid overload, gas, and bloating Rectal distension: • Tap water enema - Discomfort during procedure Notice that docusate is not on here as it is a #TWDFNR Dr. Satya Patel @SatyaPatelMD Full Inpatient Pocket Cards Collection: https://bit.ly/pocketcardset #Bowel #Regimen #Guide #Inpatient #medications #constipation #pharmacology #table #agents #internship #comparison

Intern Pocket Cards - Inpatient Blood Pressure Management Guide ß-blockers: • Metoprolol, Carvedilol, Labetalol • Bradycardia, heart block, ADHF, COPD exacerbation ACEl/ARBs: • Captopril, Enalaprilat (IV), Lisinopril, Valsartan • AKI, hyperkalemia, angioedema Alpha-2 agonists: • Clonidine • Severe bradycardia Nitrates: • Isosorbide dinitrate • Severe AS, PDE inhibitor use Calcium Channel Blockers (CCBs): • Nifedipine ER, Diltiazem, Amlodipine • HFrEF, For non-dihydropyridines: Bradycardia, heart block Diuretics: • Chlorthalidone, Hydrochlorothiazide, Spironolactone • AKI, hypovolemia, difficulty with transferring to urinate Vasodilators: • Hydralazine • Can develop severe reflex tachycardia due to the unpredictable drop in SBP Non-selective alpha-blockers: • Phentolamine • Can develop severe reflex tachycardia due to the unpredictable drop in SBP Partial D1 agonists • Fenoldopam • Glaucoma Dr. Satya Patel @SatyaPatelMD Full Inpatient Pocket Cards Collection: https://bit.ly/pocketcardset #HTN #hypertension #BloodPressure #medications #Inpatient #pharmacology #table #agents #internship #comparison

Pharmacologic treatment algorithms by Global Initiative for Chronic Obstructive Lung Disease grade. Highlighted boxes and arrows indicate preferred treatment pathways. In patients with a major discrepancy between the perceived level of symptoms and severity of airflow limitation, further evaluation is warranted. LAMA: long-acting muscarinic antagonist; LABA: long-acting β2-agonist; ICS: inhaled corticosteroid; FEV1: forced expiratory volume in 1 s. #Management #Pulmonary #COPD #GOLD2017 #LAMA #LABA #ICS #Guidelines

GOLD2017 - The refined ABCD assessment tool. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; GOLD: Global Initiative for Chronic Obstructive Lung Disease; mMRC: modified Medical Research Council; CAT: COPD Assessment Test. #Diagnosis #Pulmonary #COPD #GOLD2017 #Staging #Grading #Classification #FEV1FVC #mMRC

Medical Treatment Algorithm for Chronic Obstructive Pulmonary Disease Initial medical treatment of chronic obstructive pulmonary disease (COPD) is guided by severity of obstruction, symptom burden, and exacerbation risk with escalation in therapy targeted to control persistent symptoms or further exacerbations. Exacerbation severity is differentiated by the location of treatment, with moderate exacerbations treated in the outpatient setting with oral corticosteroids, antibiotics, or both and severe exacerbations requiring hospitalization or emergency department care. Additional therapies such as azithromycin and roflumilast can be considered for select patients who continue to experience exacerbations despite optimal inhaled therapy. Further therapies such as azithromycin and roflumilast can be considered in select patients with persistent exacerbations despite maximal inhaled therapy. BMI indicates body mass index, calculated as weight in kilograms divided by height in meters squared; CAT, COPD assessment test; FEV1, forced expiratory volume in the first second of expiration; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; SABA, short-acting β2-agonist; SAMA, short-acting muscarinic antagonist. #COPD #Treatment #Algorithm #Management #Pulmonary #LABA #LAMA #SABA #SAMA #ICS #Pharmacology

Asthma Medications and Mechanism of Action #Asthma #Medications #Drugs #Pulmonary #Pharmacology #Management #Treatment