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Let’s start our USMLE Review with Drugs of Choice from the Gold Standard USMLE Step 2 Audio Review program.
Play USMLE Audio MP3 19 09 Drugs of Choice Chicken Pox Below
What is the virus in chickenpox?
- Varicella zoster.
And while there is no consensus on the need for treatment of Varicella zoster in immunocompetent children or teenagers, treatment is certainly indicated in anyone immunocompromised, pregnant, or suffering from pneumonia.
What is the drug of choice and choice of routes of administration?
- Acyclovir PO or IV.
And the trade name for Acyclovir?
What are the 2 purine analogs used for leukemias, for the chronic granulocytic, the acute lymphocytic, and the acute myelogenous?
- Mercaptopurine and Thioguanine.
What is pseudomotor cerebri?
- Benign intracranial hypertension.
What is the most common symptom from pseudomotor cerebri?
What are 3 other signs, which may be seen depending on the level of intracranial hypertension? Papilledema, diminished visual acuity, and possible diplopia from what?
- From Abducens nerve palsy.
What is the drug of choice for treating pseudomotor cerebri? Acetazolamide with or without what?
Trade name for Acetazolamide?
Trade name for Furosemide?
What class of drug is Acetazolamide/Diamox?
- A carbonic anhydrase inhibitor.
And what class of drug is Furosemide/Lasix?
- A loop diuretic.
If Acetazolamide with or without Furosemide is not adequate, what drug is the alternative of choice for pseudomotor cerebri?
Trade name for Prednisone?
What is the virus in shingles?
- Herpes zoster.
And how is it acquired?
- From residual infection by Varicella zoster in childhood.
In immunocompetent hosts with shingles/herpes zoster, trials have only shown benefit when treatment is started within how many days from the onset of rash?
- Within 3 days.
And what has been the traditional drug of choice for shingles/herpes zoster?
There are 2 other equally acceptable choices now. Which 2 alternative drugs of choice have been demonstrated to shorten time to healing of lesions and reduce post-herpetic neuralgia?
- Famciclovir and Valacyclovir.
And the trade name for Famciclovir?
And the trade name for Valacyclovir?
Now, in immunocompromised hosts, any of these 3 (Acyclovir, Famciclovir, or Valacyclovir) would likely work, but only 1 is FDA approved at this time for immunocompormised host.
What is it, and what is the choice of routes of administration depending upon severity?
- Acyclovir PO or IV.
Trade name again?
Even after recovering from shingles, the patient can have acute attacks of extremely painful post-herpetic neuralgia, following the same unilateral dermatome that the shingle blisters followed.
What is the drug of choice for treating an acute attack of post-herpetic neuralgia?
What class of drugs is the drug class of choice for the chronic management and prophylaxis of post-herpetic neuralgia?
- The tricyclic antidepressants.
And in particular which one?
Now, Amitriptyline may be more effective when it is combined with another class of drug. What other class?
- A Phenothiazine.
What is the trade name of a drug that combines Amitriptyline with a Phenothiazine?
And what are the 2 components of Triavil?
- Amitriptyline and Perphenazine.
Now, what must you, as the physician, monitor the patient closely for if you’re using a tricyclic antidepressant including Amitriptyline?
- The development of tardive dyskinesia.
Now, post-herpetic neuralgia usually subsides within 6 months. For less acute irritation, what topical agent may be effective?
- Capsaicin cream.
And the trade name?
In adult advanced cardiac life support, and the treatment of pulseless electric activity, what must be considered first?
- The possible causes, because you may be able to administer a specific treatment for a specific cause. For example, if the patient is known to have pre-existing hyperkalemia, and goes into pulseless electrical activity, what is the drug of choice? Sodium bicarbonate.
However, if you do not have a specific therapy you can administer for a specific cause, what is the drug of choice for pulseless electrical activity?
If after administering several courses of epinephrine, you have a heartbeat but it is too slow, it is bradycardic, what is the next drug of choice to administer?
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