GP DRUGS GUIDE
!!DISCLAIMER: this document does not include
most contraindications/interactions for most drugs
as these informations are meant to be researched
by the practicing GP.
!!! This document is not intended to be sold
Assembled by: DR.Nouraldeen Alzorgan
Analgesics/Antipyretics
Drug Adult Paediatric
Paracetamol 500mg tabs 1-2*3-4 Suspension
<5Y 125mg/5ml (weight/2)
1*4
>5Y 250mg/5ml (weight/4)
Perfalgan iv 1g/100ml 1*4
(max 4g) Suppositories
<1Y 125mg supp every 8H
>1Y 250mg supp every 8H
Perfalgan
<10kg 0,75ml/kg
>10kg 1,5ml/kg
>50kg 1g
NSAIDS Brufen Brufen 1-2 years
200-400mg tabs every 8H Suspension 100mh/5ml
Celecoxib - Celebrex : 200mg (weight*0.375) 1*3
tabs(1x1 or 1x2)
Diclofenac inj 75mg/3ml
**NSAIDS>>>check for: asthma, peptic ulcer, kidney disease, pregnancy and HTN
Antihistamines
Drug Adult Paediatric
Demitidine (Fenistil) 1mg tab every 4-6H 1mg/1ml drops
Sedative effects 1drop/kg every 4-6H
Cetrizine (Cerin) 10mg tab 1*1 1mg/1ml syrup
Sedative effects 1-2Y: 0.125mg/kg 1*2
2-6Y: 2.5mg 1*1
6-12: 5mg 1*1
Levocetrizine (Layal) >12Y 5mg tab 1*1 at night 2.5mg/5ml syrup
Less sedative 6months-5Y 1.25-2.5mg
1*1 at night
6-11Y 2.5mg 1*1 at night
Loratadine (Claritine) >30 kg 10mh tab 1*1 5mg/5ml syrup
Non-drowsy 1-2Y 2.5 mg 1*1
2-12Y <30 kg 5mg 1*1
_Systems:
1) ENT:
A) Tonsillitis: apply CENTOR criteria
+Amoxicillin (Amoxil):
Adult 250-500mg tabs 1*3*10-14
Children: 250mg/5ml suspension (weight/3)ml 1*4*10
In case of penicillin allergy:
Azythromycin (zomax):
Adult: 250mg tabs 2*1 on day 1 then 1*1*4
Children: 200mg/5ml suspension (weight/4)ml 1*1*5
+++ Antipyretic
B) Acute Sinusitis:
+Amoxicillin+clav (Amoclan)
Adult 1g tabs 1*2*10 Children: 312mg/5ml suspension (weight/3)ml 1*3*10
In case of penicillin allergy:
>>Cefuroxime (zinnat)
Adult: 250mg tabs 1*2*10 Children: 250mg/5ml suspension (weight*0.15)ml 1*2*10
>> OR Azythromycin (zomax):
Adult: 250mg tabs 2*1 on day 1 then 1*1*4
Children: 200mg/5ml suspension (weight/4)ml 1*1*5
++Otrivin: >12Y 0.1% drops 2-3 drops in each nostril up to 3 times daily
6-12Y 0.05% drops 2-3 drops in each nostril up to 3 times daily
6months-6Y: 0.05% drops 1 drop in each nostril up to 3 times daily
((Otrivin is used for 5 days Max, switch to isotonic NACL nasal spray
(Apisal 7.4mg/ml): 1 puff 4-6 times daily
+++Antipyretic
C) Allergic Rhinitis:
+Antihistamine ++ Otrivin for 5 days then switch to Apisal
D) Common cold:
+supportive care: rest and warm fluids
+Panadol sinus or Banda zokam 2*3
+ Otrivin for 5 days then switch to Apisal
E) Acute Otitis Media:
+Amoxicillin+clav (Amoclan)
Adult 1g tabs 1*2*10 Children: 90mg/kg/day PO devided q12H for 10 days
In case of penicillin allergy:
Azythromycin (zomax):
Adult: 500mg tabs 1*1*3 Children: 10mg/kg/day on day 1 then 5mg/kg/day 1*1*4
+++Antipyretic
F) Acute Labyrinthits:
symptoms of AOM + vertigo, tinnitus, nausea and hearing loss
Treatment: same as AOM + : Ofloxacin 0.3% (Oflox) ear drops: 1-2 drops 4 times for
7 days
G) Otitis Externa:
Simple: Ofloxacin 0.3% (Oflox) ear drops: 1 drop 1-2 times for 7 days
>> If the infection has spread beyond the ear canal:
Ciprofloxacin (Ciprolon) 500mg tab 1*2*7-14 CI in patients<18Y (refer to specialist)
+++Analgesic
H) External auditory canal Furuncle:
+Amoxicillin+clav (Amoclan) Adult: 1g tab 1*2*5,,, Children: 312mg/5ml suspension
(weight/3)ml 1*3*5
In case of allergy:
Cefuroxime (Zinnat): Adult: 250mg tabs 1*2*10 Children: 250mg/5ml suspension
(weight*0.15)ml 1*2*10
++Analgesic
I) Fungal otomycosis:
+Adult: Clotrimazol 1% (Otozol) 1*2*7
+++Analgesic
J) Croup/laryngitis:
+Nebulizer: 1ml of epinephrine in 2 ml saline
+Dexamethasone 0.5mg/kg IM single dose
+Observe
K) Ear wash:
+Before Ear wash: Dewax ear drops 1*2*4
CI: in vegetable foreign bodies, perforated tympanic membrane, otitis externa,
fungal infection.
L) Oral thrush:
Miconazole (Mycoheal) oral gel 1*3
M) Aphthous ulcer (canker sore):
OralMedic or AftaMed
N) Menier's disease:
Betahistine (Betaserc) 8mg tabs 1*3 then refer to ENT specialist
O) Tinnitus:
Exclude: otitis externa, otitis media, ear wax, HTN>>> any persistent unilateral
tinnitus>>refer to ENT to Rule out Acoustic Neuroma
P) Epistaxis: in bilateral cases>> order: CBC, LFT, Coagulation profile
+Leaning Forward and nasal compression for 10-15 minutes without interruption
>If this fails: pack the nose with cotton soaked in a mixture of 2% Lidocain and
1:1000 Epinephrine, put 1-2 cottons in the bleeding nostril, If this fails Refer to ENT
2) Ophthalmology:
A) Allergic conjunctivitis:
+Refresh tears drops: 1drop * 4
+ Olopatadine eye drops: (CI <3Y) 1 drop * 4
+Oral antihistamine
B) Viral conjunctivitis:
+Refresh tears drops: 1drop * 4
+ Ophtazoline eye drops: 1 drop * 4*7
+/- topical antibiotics to prevent secondary bacterial infection: Tobramycin (Tobrex)
eye drops: 1*4*7
C) Bacterial conjunctivitis
Tobramycin (Tobrex) eye drops: 1*4*7 or Tobramycin (Tobracin) eye ointment 1*2*7
D) Episcleritis:
+Refresh tears drops: 1drop * 4
+Tobramycin (Tobrex) eye drops: 1*4*7
+Analgesic
E) Blepharitis:
+Refresh tears drops: 1drop * 4
+Tobramycin (Tobrex) eye drops: 1*4*7
F) Sty:
+Warm compresses
++Tobramycin (Tobrex) eye drops: 1*4*7
+ Adult: Amoxicillin+clav (Amoclan) 1g tab 1*2*7 Children: 312mg/5ml suspension
(weight/3)ml 1*3*7
In case of allergy:
Cefuroxime (Zinnat): Adult: 250mg tabs 1*2*7 Children: 250mg/5ml suspension
(weight*0.15)ml 1*2*7
G) Chalazion: Refer to specialist
3) Dermatology:
A) Chicken pox:
+Antihistamine: Levocetrizine
++Paracetamol
++Calamine lotion 1*2
Adult and severe cases>> Refer to specialist
B) Herpes zoster (Shingles):
Adult:
+Acyclovir (Zovirax) 800mg tabs 1*5*10
+Analgesic: Brufen
>>If act fails: Refer to specialist
C) Napkin Rash:
+Change the type of the diaper
++ Beatzol G cream (Betamethasone, Miconazole, gentamycin) 1*2 daily
D) Pityriasis Alba:
+Panthophil cream 3-4 times a day
+ Hydrocort 1% 1*2*7
E) Pityriasis Rosea:
+Calamine lotion twice daily
+Antihistamine: Levocetrizine
+ Hydrocort 1% 1*2*7
F) Lice:
+Para-plus spray: spray on dry hair and leave it for 10 minutes then rinse with water
+use fine-tooth comb to remove lice
G) Scabies:
+Benzyl Benzoate 25% lotion
Apply on the entire body except the head and neck for 2 consecutive nights for 12
hours each night and repeat application 7 days later
+Antihistamine: Levocetrizine
+Amoxicillin+clav (Amoclan)
Adult 1g tabs 1*2*10 Children: 312mg/5ml suspension (weight/3)ml 1*3*10
In case of penicillin allergy:
Cefuroxime (zinnat)
Adult: 250mg tabs 1*2*10 Children: 250mg/5ml suspension (weight*0.15)ml 1*2*10
H) Warts:
+Cornex gel
Soak the area in warm water for 2-3 minutes then dry it, then apply 1-2 drops of the
gel to the top of the wart
>>For genital warts: Podofilox 1*2*3 ( not indicated for anal warts)
I) Tinea cruris:
+Ketoconazole (Nizoral) cream: 1*2*2-4 weeks
+Antihistamine: Loratadine
>>If failed use systemic antifungal: Adult: Itraconazole (itrazol) 100mg tab 1*1*15
J) Tinea pedis:
+Terbinafine (Lamisil) cream: 1*2*7-14 days
>>If failed use systemic antifungal: Adult: Fluconazole (Diflucan) 150mg capsules: 1
capsule weekly for 4-6 weeks
K) Tenia corporis:
+Ketoconazole (Nizoral) cream: 1*2*2-4 weeks
>>If failed use systemic antifungal: Adult: Fluconazole (Diflucan) 150mg capsules: 1
capsule weekly for 2-4 weeks
L) Tenia barbae:
+Miconazole (mycoheal) cream: 1*3*7 days
>>If failed use systemic antifungal: Adult: Fluconazole (Diflucan) 150mg capsules: 1
capsule weekly for 2-4 weeks
M) Onychomycosis:
+Econazole cream 1*2*2-4weeks
>>If failed use systemic antifungal: Adult: Fluconazole (Diflucan) 150mg capsules: 1
capsule weekly until the infected nail is replaced
N) Impetigo/Ecthyma:
+Fucidin cream 1*2*7
>>If failed use systemic antibiotics:
Cefuroxime (Zinnat): Adult: 250mg tabs 1*2*10 Children: 250mg/5ml suspension
(weight*0.15)ml 1*2*10
O) Intertrigo:
+Fucidin cream 1*2*7
+Azonit-D cream (Antifungal+steroid): 1*2*7
+Analgesic: Brufen
P) Urticaria:
+Betaval cream 1*2*7
+Antihistamine: Fensitil
+ Calamine lotion 1*2*7
If symptoms get worse at (at night or in general): >>
Adult: Prednisolone 5mg tabs 4*2*2 and Refer to the ER (especially if patient
develops angio-edema or SOB)
Then 3*2*2 then 2*2*2 the 1*2*2
Q) Hand-foot-mouth disease/Measles/Rubella/Roseola:
+Antihistamine: Finistil
+Paracetamol
R) Cellulitis:
+Amoxicillin+clav (Amoclan)
Adult 1g tabs 1*2*10 In case of penicillin allergy: Cefuroxime (zinnat)
Adult: 250mg tabs 1*2*10
+Serodase 5mg tab 1*3
+Analgesic: Paracetamol
If child, severe or systemic response (ex: fever) Refer to specialist
Could be confused with DVT>>> CBC, CRP, D-dimer
4) Pulmonology:
Cough meds (personal belief): only for dry cough
Prospan: <1Y 2.5ml 1*2,, 1-5Y: 2.5ml 1*3,, 5-12Y: 5ml 1*2,, >12Y 5ml 1*3
A) Bronchiolitis:
Mild attack without respiratory distress: supportive care: Saline nasal wash and
Paracetamol
Signs of respiratory distress a trial of Salbutamol (Ventolin) 5mg/1ml solution: 0.5ml
in 2ml N/S nebulizer +/- steroids (controversial)
>>Criteria for hospitalisation: extreme tachypnea, Apnea, cyanosis, hypoxia,
dehydration
b) Bronchitis:
Mild attack without respiratory distress: supportive care: warm fluids +
Paracetamole
C) Pneumonia:
Apply CURB65 criteria: c: confusion, U: urea>7 mmol/L (or BUN>30), Respiratory
rate>30, BP<90/60, Age>65
GP treats cases with a score of 0-1 (outpatient):
No comorbidities AND no antibiotic use in the last 3 months:
Adult: Azythromycin (zomax): 500mg tabs 1*1*3 or Clarithromycin (Klacid): 500mg
tabs 1*2*5
Comorbidities OR antibiotic use in the last 3 months:
Levofloxacin (Avoxin) : 750mg tabs 1*1*5 OR 500mg tabs 1*1*10
For Children it's better to refer them to a specialist but Amoxicillin 100mg/kg/day
divided into 2-3 doses daily for 7-10 days or Azythromycin (zomax) 200mg/5ml
suspension (weight/4)ml 1*1*5 could be used ( asses the severity and look for
indications for hospitalisation)
+Antipyretic
D) Asthma:
For maintenance therapy>>> Refer to specialist
Asthma exacerbation: GP only treats mild-moderate attacks
Step one: 1) Salbutamol (Ventolin) 5mg/1ml solution for nebulizer: can be repeated
up to 3 doses every 20 minutes
(Adult): 1ml in 2ml N/S (6-12Y): 1ml in 2ml N/S (<6Y): 0.5ml in 2ml N/S
2) Early steroids: Hydrocortisone IV dose: (<6 months): 25mg, (6moths-6Y): 50mg,
(6Y-12Y): 100mg, (>12Y): 200mg
3) O2 therapy: if the patient is hypoxemic or acutely unwell: 15L/min via non-
rebreathable mask spo2 target: 94-98%
Step two: Ipratropium (Atrovent) 250mcg/2ml solution for nebulizer: : can be
repeated up to 3 doses every 20 minutes
(Adult): 2ml in 2ml N/S (6-12Y): 2ml in 2ml N/S (<6Y): 1ml in 2ml N/S
Step three: Magnesium Sulfate IV: Adult 1.2-2g, Children: 40mg/kg
In 100ml N/S over 30 minutes
E) COPD:
For maintenance therapy>>> Refer to specialist
COPD exacerbation:
O2 therapy:
-Spo2 target 88-92%, either via nasal cannula (flow rate 0.5-2L/minute) or Venturi
mask (24%) until ABG is available
-If no CO2 retention increase the Spo2 target to 94-98%
Bronchodilators: with back to back nebulizer
Salbutamol (Ventolin) 5mg/1ml and: Ipratropium (Atrovent) 250mcg/2ml solutions
for nebulizer:
Ventolin: 1ml + 2ml N/S + Atrovent: 1ml + 2ml N/S
Steroids: give Prednisolone 40mg daily for 5 days
Antibiotics: only if there is purulent sputum: Amoxicillin+clav (Amoclan) 1g tabs
1*2*7 or Azythromycin (Zomax) 500mg tabs 1*1*3
Mucolytic: Mucosolvan 30mg tabs 1*3
5) Gastroenterology:
Symptomatic relief:
**Constipation: Glycerin suppositories: Adult 2.5g sup 1*1,, children: 1.5 supp 1*1
Or Bisocody (Dulcolax) >12Y: 5mg tabs 1*1-2
**Gases: simethicone (Deflat): Adult: 120mg tabs 1*4
Children: 40mg/ml drops: <2Y: 10 drops 1*4,,, >2Y: 20 drops 1*4
**Abdominal cramps: : Hyoscine butylbromide (Spasmopan) 10mg tabs: Adult>12Y:
2tabs 4 times daily, 6-12Y: 1 tab 3 times daily
Prifinium bromide (Riabal) 7.5mg/5ml syrup: <1 Month: 1mlx3, <1Year: 2ML x 3,
1-2Year: 5ML X3, 2-6 Year: 5-10MLx 3
**Poor appetite in kids: Kid appetite 200 ml / 5jd : small spoon daily in the morning
A) Gastroenteritis:
Asses dehydration:
>>Mild-Moderate and patient tolerates oral intake: supportive treatment:
++Fluids: ORS sachets
++Antidiarrheal (might delay recovery):
Loperamide HCL (Imodium) 2mg capsule (CI<12Y): 2 cap initially followed by 1 cap
after each loose stool, max daily dose 12mg (6 caps)
OR Diosmectite (Smecta) 3mg sachets: <1Y: 1 sachet in 50ml of water
1-2Y: 1-2 sachets per day, >2Y: 2-3 sachets per day
++Antiemetic: Metoclopramide (clopram): Adult: 10mg tabs 1*3 Children: (CI<1Y):
5mg/5ml syrup: 0.1-0.15ml/kg up to 3 times daily (max: 0.5ml/kg/24H)
OR Dompridone: (Motilat) (CI<12Y and <35kg): 10mg tabs 1*3
++Antispasmodic: Hyoscine butylbromide (Spasmopan) 10mg tabs: Adult>12Y: 2tabs
4 times daily, 6-12Y: 1 tab 3 times daily
Prifinium bromide (Riabal) 7.5mg/5ml syrup: <1 Month: 1mlx3, <1Year: 2ML x 3,
1-2Year: 5ML X3, 2-6 Year: 5-10MLx 3
>>>Mild-Moderate and patient can't tolerate oral intake:
++IV fluids: N/S (used mainly to deliver drugs and not so much as a dehydration
treatment)
++ Metoclopramide (clopram): Adult: 10mg/2ml ampule up to 3 times daily
Children: 1-18 years: 0.1mg/kg up to 3 times daily
++++Antispasmodic: Hyoscine butylbromide (Spasmopan): 20mg/1ml ampule (not
recommended for children) can be repeated once after 30 minutes if required
+++then treat as patients who tolerate oral intake
!!! In children: Moderate dehydration can also be treated with IV fluids by
calculating the Deficit and Maintenance fluid volume:
Calculate the Deficit: weight in grams*dehydration in %/100
Give half the deficit over 8 hours then the other half over 16 hours
Calculate the Maintenance fluid volume using the 100/50/20 rule (100ml/kg for the
first 10kg+50ml/kg for the second 10kg+20ml/kg for the remaining weight) and give
it over 24 hours
>>>Severe dehydration:
++Fluids:
Adult: 500ml of N/S as an IV bolus over 20 minutes, can be repeated once AND refer
to the ER
Children: give initial bolus of 20ml/kg of N/S over 20 minutes, can be repeated up to
3 times AND refer to the ER
Antibiotics are indicated if: prolonged fever, RBC or WBC in the stool, presence of
other infection foci:
Adult >12y: Sulfamethoxazole/trimethoprim (Septrin D.S) tabs 1*2*5 (CI in G6PD
deficiency) or Ceftraixone injection 1*1*3
<12Y: trimethoprim/sulfamethoxazole (balkatrin) suspension: (weghit/4) ml 1*2*5
CI: in G6PD deficiency
B) GERD: <60Y and without alarm signs
++Life style modification
++ PPI trial: Lansoprazole 30mg capsules (Lanzotec) 1*1 for 4 weeks
C) H.Pylori: presents with chronic epigastric pain +/- diarrhea:
<60Y and without alarm signs: stool analysis and look for H.Pylori Antigen
++Clarithromycin (Klacid) 500mg tabs 1x2 for 2 weeks
++ amoxicillin (Panamox) 1g tabs 1x2 for 2 weeks
++ Lansoprazole 30mg capsules (Lanzotec) (1x2) for 6 weeks
* Quadrable: add metronidazole 500 (Flagyl) (1x2)
D) Amebiasis/ Giardiasis:
Metronidazole (Flagyl): Adult 500mg tabs: 1x3
Child syrup: 125mg/ 5ml or 200mg/ 5ml *Dose (mg) = 10 x weight by 3 example: 20
kg child: 20 x 10 = 200mg>>>5ml (200mg) x 3
For 7-10 days
E) Irritable bowel syndrome (IBS): (IBS + malabsorption/malnutrition is
not IBS)
Symptomatic treatment:
Constipation: Glycerin 2.5g supp 1x1 or Dulcolax 5mg tab 1x1 (AS needed not every
day)
Severe diarrhea: Imodium 2mg cap after a loose bowel action
Abdominal pain: Buscopan 10mg ta1x3
Abdominal distension: Deflat 120mg tab 1x4
F) Hemorrhoids: (1st and 2nd degree):
+life style modification
+Sitz bath: fill a large plastic basin (or bathtub) with warm water (10cm deep) and sit
in it for 15-20 minutes
+Tribenoside+Lidocaine (Procto-Glyvenol) suppositories: 1*1 OR New healer cream
(1x2)
+Daflon 500mg tabs 1*3 (CI in kidney disease, severe diarrhea, allergy,
hypercalcemia)
G) Anal fissure:
+Life style modification
+Bisacody (Dulcolax) 5mg tabs 1*2*7 max
+Xylocaine 2% gel 1*2
+Nitroglycerin (Nitrus) ointment 1*2
+ Sitz bath: fill a large plastic basin (or bathtub) with warm water (10cm deep) and sit
in it for 15-20 minutes
H) Heliminths:
Mebendazole (Bendazole , Vermox)
Pinworm : 1 tablet (100mg) & can be repeated after 2 weeks
Whipworm & Roundworm & Hookworm : 100mg tablet X 3 or one 500mg daily for 3
days, the course can be repeated after 2 weeks
I) Biliary colic: in any abdominal pain: rule out acute surgical abdomen first
Adult:
+Normal saline
+ Hyoscine butylbromide (Spasmopan) 20mg ampule
+Metoclopramide (clopram) 10 mg ampule
+Analgesic: Votrex IM if contraindicated, give Paracetamol 1g IV If severe pain:
pethidine (50-100mg) IM then refer to surgery
J) Acute epigastric pain: Rule out acute surgical abdomen first, patient <60Y
and no alarm symptoms: test and treat approach for H.Pylori
>60Y or alarm symptoms: refer for endoscopy
Patient presents with history of peptic ulcer disease, GERD, non-ulcer dyspepsia
(unknown cause)
Emergency management: Adult:
+Normal saline
+ Hyoscine butylbromide (Spasmopan) 20mg ampule
+ PPI IV Esomeprazole 40mg ampule
+ Metoclopramide (clopram) 10mg ampule
+paracetamol 1g IV
+Home treatment: Lansoprazole 30mg capsules (Lanzotec) 1*1 for 4 weeks
6) Urology:
A) UTI:
**MEN: Nitrofurantoin (Furolin) 100mg capsules 1*2*7
OR SULFAMETHOXAZOLE-TRIMETHOPRIM (Balkatrine) 800/160mg tabs 2*2*7
(interacts with ACEI/ARBs, warfarin)
If prostatitis is suspected refer to ER urologist
**Women: non-pregnant: Nitrofurantoin (Furolin) 100mg capsules 1*2*5
OR SULFAMETHOXAZOLE-TRIMETHOPRIM (Balkatrine) 800/160mg tabs 1*2*7
(interacts with ACEI/ARBs, warfarin)
**Women: Pregnant: Cefuroxime (Zinnat) 500mg tabs 1*2*5
**Pediatric: Cefixime (Suprax) 100mg/5ml suspension: (weight*0.4)ml 1*1*7
Or Cephalexin (Keflex): 125mg/5ml suspension: (weight*0.665)ml 1*3*7
++Brufen
B) Renal colic:
Adult:
+Fluid: normal saline 200ml
++ Hyoscine butylbromide (Spasmopan) 20mg ampule
+Metoclopramide (clopram)
+ IM Delofenac 75mg/3ml
In severe pain give Morphin Then refer to a urologist
C) Acute urine Retention:
Urgent urethral catheterization (insert folly's catheter)
Avoid rapid evacuation that may cause hematuria (clamping should be done every
500 mL of urine output for 10 minutes)
Refer to the urologist to diagnose the cause of urine retention
D) Gonorrhoea/Chlamydia STI:
Single Ceftriaxone 500mg IM injection + 1g Azythromycin (2 tabs of Zomax 500mg
tabs taken together as a single dose)
7) Neurology:
A) Headache:
+Analgesic: Perfelgan 1g/100ml IV
+Metoclopramide (Clopram) 10mg ampule IV
Home treatment: Antiemetic: Metoclopramide (clopram) 10mg tab 1X3
Paracetamol (Panadol) 500mg tab 2x3
B) Febrile convulsions:
**Verify the absence of intracranial or metabolic causes
Age group 6-60 months
---There is evidence of extracranial infection
Management: During the convulsions: Valium 1ml/10 kg slowly IV or IM
OR Sodium valproate (Depakine 200mg/ml) solution rectally • Dose: 1ml of diluted
depakine solution to each kg given rectally
Each Iml depakine diluted with 7ml normal saline
****Example: Child Wight = 8 kg
1 mL depakine + 7 ml normal saline = 8 ml
Give 8 ml of 8 ml
After seizure: Paracetamol <1 Year: 125 mg suppositories every 8 hours
1 Year: 250mg suppositories every 8 hours
C) Bell's palsy:
Steroid:
Adults: Prednisone 5mg tab 6x1x10 (no need or tapering in the short course of
steroids) Children: Predone 15mg/5ml syrup (w/2)ml 1x3x7-10days
Refresh tears eye drops: 4-6 times daily
D) Motion sickness : * Navidoxine , Vominore (meclozine + vit. B6)
E)Coma cocktail “DONT”:
D : Dextrose 100 ml ( the cause may be hypoglycemia )
O : Oxygen ( the cause may be hypoxemia )
N : Naloxone 1 mg , IM ( the cause may be opioid toxicity)
T : Thiamine 100 mg , diluted in 100ml of N/S and given over 30 minutes ( the cause
may be alcohol toxicity )
8) Muscular/Articular:
A) Muscle spasms:
Adults:
- Paracetamol and orphenadrine citrate (Myogesic) tabs 2*2
- Voltaren Gel/ Locagel: 1*2-4
>>for severe muscle spasms:
Dexa + Declofinac IM
Muscle relaxant for 5 days
B) Gout:
--Acute Gout attack:
First line: NSAID: Indomethacin (indomin) 50mg capsule1x3 daily
Second line: Colchicine: 1.2 mg initially, then 0.6 mg one hour later, then 0.6mg once
or twice daily until acute flare resolves
Third line: Steroid: Prednisone 40 mg for four 14 days (no need for tapering in the
short courses) (If NSAIDS are ineffective or contraindicated)
**Uric acid levels are normal in up to 63% of the cases during the attacks>>
recheck uric acid levels 2-3 weeks after the flare resolves
--Chronic Gout:
Allopurinol (Zyloric) 300mg tabs 1*1
The indications for uric acid lowering agents: 1) 2 or more attacks in the past year
2) The presence of tophi 3) Renal disease 4) Uric acid renal stones 5) Patients on
diuretics
Instructions about Allopurinol according to recent guidelines: In the case of acute
gouty arthritis, if the patient is already on allopurinol, do not stop it. However, if the
patient is not on allopurinol, start it 2 weeks after the acute attack.
c) Ankle sprain:
Follow the 'RICE' method to relieve pain and reduce swelling.
R: Rest the injured area.
I: Ice application on the area for 20 minutes
C: Compress the area with a bandage (but if the pain gets worse, loosen the
bandage). E: Elevate the limb.
Analgesic: paracetamol or Brufen
D) Raynaud phenomenon:
+Avoid cold exposure
+Amlodipine (Amlocard) Adult: 5mg tabs 1*1
8) Anaphylaxis:
Emergency management:
•Adrenalin intramuscular injection
• Intravenous nermel-saline
• Intravenous Hydrocortisone
Adrenalin 1:1000 IM Hydrocortisone IV
<6months: 0.15ml <6months: 25mg
>6months: 0.3ml 6months-6years: 50mg
Adults: 0.5ml 6-12years: 100mg
**can be repeated after 5min if needed >12years: 200mg
+Respiratory support in chest tightness and wheezes:
O2 administration (by simple mask)
Ventolin nebulizer 1 ml + 2 ml normal saline
Pulmicort nebulizer 1 ml + 2 ml normal saline
GIT support in nausea vomiting and abdominal cramps:
For.vomiting: Adult: clopram 10ma ampule IM/IV Child: dexamethasone IM/IV
For abdominal cramps: Adult: buscopan 20mg ampule IM. IV Child>6year buscopan
0.5 mg/kg IM, IV
Skin support in pruritis, rash:
Antihistamine: Avil 10mg/ml ampule Adult 10-20mg slowly IV/IM • Child 5mg slowly
IV/IM Observation for 6 hours
Home treatment:
Antihistamine: Aeriallerg 2.: ml 212-year-old 5mg tab 1x1 1-5 years 0.5 mg/ml syrup
(1.25 mg orally once a day) 6-11 months 0.5 mg/ml syrup (1mg orally once a day) 2
ml
9) Wounds, Burns and Animal Bites
A) Wounds:
1) Washing and cleansing:
Remove foreign bodies and cut the ischemic edges, evacuate hematoma if present
Clean wound (saline, then betadine, then saline)
2) Infiltrate anesthesia:
The maximum dose:
Maximum Allowed Dose of Local Anaesthetic mg/kg
DRUG Without Adrenaline With Adrenaline
Lidocaine 3mg/kg 7mg/kg
What is the % (Concentration)?
Maximum Allowed Dose of Local Anaesthetic =
(Maximum Allowed Dose of Local Anaesthetic mg/kg * patient weight) / (%*10)
Example: What is the Maximum Allowed Dose of Lidocaine 1% without Adrenaline to
be infiltrated for a wound in an 80 Kg Patient?
(3*80)/(1*10)=24ml
OR to make it easier most available vials are Lidocaine 2% 50ml vials, max in adults is
15ml
Note: may cause CNS toxicity from the intravascular injection (circumoral anesthesia
-drowsiness -visual disturbance-tinnitus-coma)
3) Stitching Dressing:
4) Antibiotic: Fucidin cream, Sterile dressing, Plaster, Crepe bandage
5) Tetanus prophylaxis according to vaccine status
6) Home management: Antibiotic: Amoxicillin+clav (Amoclan)
Adult 1g tabs 1*2*7 Children: 312mg/5ml suspension (weight/3)ml 1*3*7
In case of penicillin allergy:
>>Cefuroxime (zinnat)
Adult: 250mg tabs 1*2*10 Children: 250mg/5ml suspension (weight*0.15)ml 1*2*10
Analgesic: Brufen
For scar: Contratubex after 1 week of the injury
B) Burns: GP deals with 1st and 2nd degree burns only
Cool affected area as soon as possible (within 3 hours from the time of burn) for 20
minutes with cool running water or with normal saline
wash: Saline-betadine-saline
Dressing:
Silver sulphadiazine ointment
Vaseline gauze
Tetanus prophylaxis according to vaccine status
Home treatment: Antibiotic: : Amoxicillin+clav (Amoclan)
Adult 1g tabs 1*2*7 Children: 312mg/5ml suspension (weight/3)ml 1*3*7
In case of penicillin allergy:
>>Cefuroxime (zinnat)
Adult: 250mg tabs 1*2*10 Children: 250mg/5ml suspension (weight*0.15)ml 1*2*10
Burn cream: Mebo 30g cream 3-4 times daily • Analgesic: Brufen
Change dressing 3-4 times daily
C) Animal bites:
Management:
Inspection: Wounds are thoroughly examined for debris
Irrigation: Irrigate the wound to clean it properly: Saline-betadine 2 minute -saline
Debridement: (under local anesthetic) Animal bites can result in skin tears that can't
be repaired, remove dead or infected skin and tissue that can't be repaired
Closure: Puncture wounds aren't usually closed with stitches.
Tetanus prophylaxis according to vaccine status
Dressing
Rabies vaccine: Anti-rabies serum is given in 6 doses at: (0, 3, 7, 14, 30 and 90 days)
Administrated intramuscularly, Adult in the deltoid area (arm), Children:
anterolateral aspect of the thigh
Infiltrate human rabies immunoglobulin around the site of the bite
Antibiotics:
Amoxicillin+clav (Amoclan)
Adult 1g tabs 1*2*7 Children: 312mg/5ml suspension (weight/3)ml 1*3*7
In case of penicillin allergy:
>>Cefuroxime (zinnat)
Adult: 250mg tabs 1*2*10 Children: 250mg/5ml suspension (weight*0.15)ml 1*2*10
10) Supplements:
A) Vitamin D:
*always should be taken after a big fatty meal
Pediatric: Dedrogyl, Hi-dee
Each 1 drop = 400 microgram
Prophylactic: 1 drop daily
Deficiency: <1moth: 2 drops daily,, 1month-1year: 3-13 drops daily
>1year: 13 drops if def.
Adult: (Hi Dee/ biodal) capsules (2000 IU, 5000 IU, 10,000 IU, and 50,000 IU)
Doses: Adult: 50, 000 IU Once weakly for (8-12) weeks then 2000 IU daily for (3-6)
months.
During pregnancy: 2000 IU daily
B) Iron:
Adult: Oral:
1) Feroglobin: iron + other supplements 1*1 for three months
2) Veltifer or BT pharma iron oral liquid: 1*1 for three months
3) Fortiferrum sachets: 1*1 for three months
Adult IV: HB target: <35kg: 13g/dl,,, >35kg: 15g/dl
Iron needed = Body weight (kg) * 2.3 * (HB target-current HB) + 500
Ex: patient 70kg, current HB: 9> needed iron= 70*2.3*(15-9)+500= 1400mg
Each IV ampule (first 2 drugs) contains 100mg
1) Venofer: each 2 ampules raise HB by 1 g/dl
one ampule taken every other day in 500 NS for 45 minutes
2)Ferromax: each 2 ampules raises HB by 1 g/dl
one ampule taken every other day in 500 NS for 45 minutes
2 ampules can be taken together
3) Ferinject / 125 jd : 5ml or 10ml , both 500 concentration taken in 500 NS for 75
minutes Once every 6 months
Pediatric:
1) Drops: (Ironorm drops, Irofix drops): <1 year: 5 drops daily, 1-2 years: 10 drops daily
2) Syrup: (Irona, Feroglobin, Irofix) 3 – 6 years old: 2.5 ml daily, 6 - 13 years: 5 ml daily
C) B12: Adult:
IM 1000mcg injections:
>>B12 deficiency with Anemia AND/OR neurological symptoms:
1 injection daily for one week (1*1*7)
Then 1 injection per week for 4 weeks
Then 1 injection per month for 4 months
>>B12 deficiency without Anemia and without neurological symptoms:
1 injection per week for 4 weeks
Then 1 injection per month for 4 months
OR if severely low: 1 injection every 3 days for 1 month
Then 1 injection per week for 2 months
Then 1 injection per month for 2 months
D) Folic acid (B9): Adult:
Prophylaxis or for pregnancy: 0.4 mg = 400 microgram:
- 4-5 mg : in case of deficiency , for 4 months
***When the patient has b12 & folic acid deficiency give first b12 2 days before
starting folic acid.
11) Cardiovascular:
A) HTN:
<55Y or with DM2 or Microabluminuria: start with ACEI/ARBs, >55: start with CCB
1) Angiotensin-Converting Enzyme Inhibitors (ACEI):
Captopril tablets: 25mg, 50mg (Capoten): The starting dose is 12.5-25 ma twice a
day. If required gradually increase this dose to 100 mg-150 mg a day
Enalapril tablets: 5mg, 10mg. 20 mg (Ace Press) The recommended starting dose is
from 5mg to 20mg taken once a day. The long-term dose is 20 mg taken once daily
[The maximal long-term dose is 40 mg once a day
Lisinopril tablets: 5mg, 10mg, 20mg (Linopril): The recommended starting dose is 10
mg daily although. Slowly increase this to a dose that best controls blood pressure.
The recommended maintenance dose is 20 mg once daily. The maximum dose is 80
mg once daily.
Ramipril tablets: 2.5 mg. 5mg, 10mg (Triprel) The usual starting dose is 1.25 mg or2.5
mg once daily. - Adjust the dose until the blood pressure is controlled. - The
maximum dose is 10 mg once daily.
2) Angiotensin receptors blockers (ARBS):
Candesartan tablet: 4mg, 8mg, 16mg (Andesart) The recommended dose of 8 mg
once a day Increase the dose to16-32 mg once a day depending on blood pressure
response.
Valsartan tablet: 40 mg, 80mg, 160mg, 320mg (valsart) the usual dose is 80 mg daily.
A higher dose may be required (e.g. 160 mg or 320 mg) Maximum of 320 mg per day
3) Calcium channel blockers (CCB):
Dihydropyridine: Amlodipine tablet, capsules 2.5 mg, 5mg, 10mg (Amlocard,
amlodar) initially, one 5mg tablet once a day. you may increase the dose to 10mg
once a day.
4) Selective beta-blockers:
Bisoprolol tablet 2.5mg, 5mg, 10 mg (concor): Start the treatment with the lowest
possible dose (5mg). Monitor closely at the start of treatment for bradycardia
Increase your dose to obtain the best possible dosage the maximum recommended
dose is 20 mg once per day.
Metoprolol tablet 50 mg, 100 mg (Betaloc ZOK) • Initially 50mg then the dose may
be increased by 50mg increments mg daily in single or divided doses. The maximum
dose should not exceed 400 mg/day.
*** Hypertensive urgency:
It is defined as the presence of severe HTN (> 180/110 mmHg) without target organ
damage Presentation: Headache, anxiety, shortness of breathing, or epistaxis
Management: Reassurance Give Captopril (capoten) tab 25mg, can be repeated
every 15 minutes for up to 3 doses.
The target is to reduce the blood pressure by 20/10 mmHg then follow up as
outpatient in the next 24 hours to fully control the blood pressure
>> Note: Furosemide (Lasix) can lead to significant volume depletion and should be
used only if there is associated volume overload a in the case of Pulmonary Edema
and acute heart failure (for Hypertensive emergency in the ER)
12) Endocrinology:
-DM2:
A) Metformin (Metforal) 500mg, 850mg tabs: Dose: Adults start with 500 mg or 850
mg Metformin Tablets two or three times a day with or after a meal. The maximum
daily dose is 2000 mg taken as 3 divided doses. If reduced kidney function, The
maximum dose is 1000 mg daily, given as 2 divided doses. The renal function should
be closely monitored (every 3-6 months)
B) Sulphonylurea: Can cause weight gain, best for non-obese Diabetics Can cause
hypoglycemia
Glimepiride (Amaryl) 1mg/2mg/3mg/4mg/6mg tabs: the starting dose is one 1mg
tablet once a day, If necessary, may increase the dose after each 1-2 weeks of
treatment The maximum recommended dose is 6 mg Glimepiride tablet per day Just
before or with the first main meal of the day (usually breakfast)
Gliclazide (Diamicron) 30mg tabs: the recommended daily dose is one to four tablets
(maximum 120 mg) in a single intake at breakfast time
C) Dipeptidyl peptidase-4 (DPP4) inhibitors:
Linagliptin (Trajenta) 5mg tabs: the recommended dose is one 5mg tab once daily
**Management of DM2 during Ramadan: Divide the medications doses into 1/3 at
SAHOUR and 2/3 at IFTAR.
>>Hypoglycemia: If the patient is conscious and can protect airways: oral glucose
If unconscious→ I.V dextrose
Glucagon can be used (CI in case the patients is on Sulphonylurea or history of
vigorous exercise)
Treatment of the underlying cause
IV Dextrose dose: 0.25 g/kg (2.5 ml/kg of 10% dextrose or 1 ml/kg of 25% dextrose)
Reassess the patient after dextrose administration.
>>Diabetic keto-acidosis (DKA) and Hyperosmolar Hyperglycemic syndrome (HHS):
HANG FLUIDS AND SEND TO THE ER
