NP Practice - the whole thing

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NP Practice - the whole thing by Mind Map: NP Practice - the whole thing


1.1. Tinea

1.2. Dermatitis

1.3. Parasites

1.4. HSV

1.5. Acne

1.6. Miscellaneous Skin Drugs

1.6.1. Keratolytic Drugs Retinoic Acid - Vit A acid - Derivatives Tretinoin Antineoplastic Agents Trichloroacetic Acid

1.6.2. Benzoyl Peroxide

1.6.3. Topical Steroids Hydrocortisone 0.5 - 1% - low potency Hydrocortisone valerate 0.2% - intermediate potency Betamethasone Diproprionate 0.5% - high potency

1.6.4. Hydroxyzine

2. Cardiovascular

2.1. HTN

2.1.1. HTN Guidlines Primary HTN treat to <140/90 diabetic treat to <130/80 80yr+ treat carefully SBP 150 is ok

2.1.2. hepatojugular reflux sign

2.2. Dyslipidemia

2.3. CV Disease

2.4. PVD

2.4.1. Peripheral Vascular Tests Allens Test occlude both ulnar and radial arteries till hand goes white Pallor Leg Raise Test raise both legs to 60deg x 1 minute Trendelenberg Test lay supine, raise legs to 90 deg for to empty venous system

2.5. Cardiovascular drug classes

2.5.1. Diuretics Thiazide Diuretics Loop Diuretics Potassium Sparing Diuretics

2.5.2. Vasodilators Renin Angiotensin System Blockers ACE inhibitors Angiotensin Receptor Blockers

2.5.3. Antiplatelet Drugs ASA Clopidogrel

2.5.4. antithrombotic Warfarin - Coumadin Dabigatran

2.5.5. Cardioinhibitory Drugs Alpha bockers Clonidine Methydopa Calcium Channel Blockers Dihydropyridine CCB - for HTN not ischemic disease Non-Dihydropyridine CCB Beta Blockers Cardioselective Beta Blockers non-cardioselective Beta Blocker

3. Mental Health

3.1. Anxiety

3.1.1. anxiety Pharm First line SNRI SSRI second line/ adjunct TCA Benzodiazepines MOAI

3.2. Depression

3.2.1. Depression Pharm SSRIs Citalopram SNRIs venlafaxine single vs Dual action TCAs 2nd line amatriptyline MAOIs - 3rd line phenelzine meclobemide atypical antidepressants bupropion Trazodone which are safer citalopram for SSRIs Bupropion for atypicals and TCAs venlafaxine for SNRIs because it has been around longer NO MAOs, too many DDI and small therapeutic window. which are less sedating most of the SSRIs, SNRIs and bupropion SIGECAPS - for depression Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicide DIG FAST - for mania Distractable

3.3. Suicide

3.3.1. SADPERSONS sex (male) age (>60yrs)

3.4. Pharmacologics

3.4.1. Psychiatric disorders Bipolar Depression Mood Stabilizers Bipolar I - manic Bipolar II - depression with no full mania Bipolar not otherwise specified Depression SSRIs SNRIs single vs Dual action TCAs 2nd line MAOIs - 3rd line atypical antidepressants which are safer which are less sedating anxiety First line second line/ adjunct what drugs are worse to overdose on? TCAs because of narrow therapuetic window what drugs are worse to withdraw from? Benzodiazepines SNRIs ETOH antipsychotics First Generation second generation / atypical ADHD methylphenidate

3.5. Sleep Disturbances

3.5.1. BC Guidline on insomnia/hypersomnia/parsomnias Sleep Hygiene/diary handout

3.6. Addictions

3.6.1. Alcohol Abuse BC Guidlines

4. GU

4.1. STI

4.1.1. STIs Common STIs with genital ulcers Syphilis Lymphogranuloma venereum (LGV) Herpes Genital Warts Human Papiloma Virus (HPV) Tx Algorithm for Vaginitis/cervicitis common STI causing Vaginal Discharge for men Common STI causing urethritis and cervicitis Pelvic Inflammatory Disease

4.2. Urinary Conditions

4.2.1. UTI complcated uncomplicated first line second line Pyelonephritits

4.2.2. BPH Alpha1 adrenergic blockers "...osins" 5 - alpha reductase inhibitors Finasteride best for treating large prostates targeted effect to prostate so, low side effects and DDI blocks testosterone conversion to dihydrotestosterone --> less stimulation, prostate shrinks Phosphodiesterase Inhibitors Tadalafil

4.2.3. urinary incontinence Incontinence in Children

4.2.4. erectile dysfunction Phosphdiesterase inhibitors Sildenafil

5. Renal

5.1. Chronic Kidney Disease

5.1.1. CKD BC Guidlines

6. OB/Gyn/sexuality

6.1. OB / GYN

6.1.1. Contraceptives Combined hormonal contraceptives (COCs) ring Evra patch

6.1.2. Menopause HRT Estrogen Progesterone

6.1.3. Primary amenorrhea

6.1.4. Polycystic ovarian syndrome

6.1.5. endometriosis

6.2. Menstruation and Related Problems

6.2.1. Dysmenorrhea NSAIDs

6.2.2. Amenorrhea

6.2.3. oligomenorrhoea

6.2.4. polymenorrhea

6.2.5. hypomenorrhea

6.2.6. Menorrhagia

6.2.7. metrorrhagia

6.2.8. menometrorrhagia

6.2.9. intermenstrual bleeding

6.3. Sexuality

6.3.1. Sexual History 5 P's

7. GI

7.1. GI

7.1.1. Acute Abdomen

7.1.2. Diarrhea Osmotic Secretion Inflammation Motility Anal Sphincter Control

7.1.3. Dyspepsia and peptic ulcers

7.1.4. Appendicitis Mcburney's point tenderness RLQ (over appendix) Rovsig's sign Press deeply in LLQ and quickly release psoas sign Flexion of Psoas muscle obturator sign stretch the obturator muscle

7.1.5. Cholecystitis Murphy's Sign hook left thumb under right costal margin (where gall bladder is Risk for Cholecystitis ABCDEF

7.1.6. Ascites Fluid wave test assess shifting dullness to percussion

7.2. GERD

7.2.1. GERD Treatment lifestyle mods PPI x 4-8 weeks Chronic if still symptomatic R/O H. Pylori infection

7.3. esophagitis

7.4. Abd Pain


7.5. Dyspepsia

7.5.1. Peptic Ulcer Disease H. Pylori testing/treatment Chronic Dyspepsia triple therapy qudruple therapy must stop ABX 4 weeks, bismuth 2 weeks, PPI and H2 blockers 1 week before Urea Breath Test

7.6. IBD

7.6.1. Crohns Disease

7.6.2. Ulcerative Colitis

7.7. N&V

7.7.1. N&V in Pregnancy

7.8. constipation

7.8.1. non pharm measures increase dietary fibre bulk forming agents Psylium

7.8.2. reduce and treat causal factors

7.8.3. watch for constipating med

7.9. Diarrhea

7.9.1. acute Diarrhea - ? why Infectious Diarrhea? antibiotic associated diarrhea? Metronizadole Vancomycin Viral? Bacterial? O&P?

7.10. antacids

7.10.1. magnesium and aluminum hydroxide

7.11. H2 antagonists

7.11.1. Ranitidine

7.12. PPIs

7.12.1. omeprazole


8.1. Allergies

8.2. Pharyngitis

8.3. Otitis

8.3.1. Otitis Externa OE Staph Aureus & Psuedomonas most common tender tragus and auricle erythema & edema in external canal Malignant Otitis Externa Most common in older pts management gently remove debri from canal

8.3.2. Otitis Media OM

8.4. Rhinitis

8.4.1. Rhinitis Allergic Rhinitis Infectious Rhinitis Nonallergic/noninfectious Rhinitis Occupational Rhinitis Drug induced Rhinitis Hormonal Rhinitis Rhinitis if the elderly (senile) NARES (nonallergic rhinitis with nasal eosinophilia syndrome smoking rhinitis Idiopathic rhinitis (IR)

9. Respiratory

9.1. Asthma

9.1.1. Asthma BC guidlines Summary

9.2. Pneumonia

9.2.1. 60-80% caused by Strep pneumoniae atypical pneumonia caused by other organisms like influenza, mycoplasma, chlamydia young adults more succeptible to atypical pneumonia

9.2.2. LRT infection

9.3. Chronic Cough

9.4. COPD

9.4.1. mild/moderate COPD

9.4.2. Bronchitis Viruses most common cause influenza A&B, parainfluenza, RSV, carona, adenovirus usually resolves in <6wks in healthy cough with normal VS and absence of other resp findings of consolidation are very suggestive consider CAP and pertussis treatment rest

10. Neuro

10.1. parkinsons disease

10.1.1. levodopa/carbodopa

10.1.2. NMDA receptor blocker amantadine

10.1.3. COMT blocker entacapone

10.1.4. MAOIs Selegiline

10.2. Headache

10.2.1. Migraine abortive agents sumatriptan ergotamines what not to use with peds Metoclopramide suppressive/prophylactic agents CCBs TCAs BBs what to avoid in peds analgesics NSAIDs acetaminaphen

10.3. Dizziness

10.4. Bells Palsy

10.4.1. cause of 50% of unilateral LMN facial paralysis some correlation with HSV often triggered by something - often URTI

10.4.2. Sparing Forehead muscles suggests UMN lesion instead of Bells Palsy (LMN) quick onset 2-5 days compared to other etiologies post auricular pain

10.4.3. Treatment protection of the unclosing eye patch at night better prognosis if not full paralysis 80-85% recover in 6 months High dose steroids for a week then tapper antivirals

10.5. Trigeminal Neuralgia

10.5.1. 2 types of TN TN1/ Primary Classic most caused by vascular compression TN2/ Secondary - trigeminal neuropathy

10.5.2. Diagnosed mainly on clinical presentation and lack of other cause immediate referral if ophthalmic involvement Usually unilateral

10.5.3. Treatment First Line - Anticonvulsants Carbamazepine

10.5.4. Often a symptom of MS Treatment with some success using Misoprostol (NSAID)

10.6. Crancial Nerves

10.6.1. Oh Oh Oh, Tiny Tits Are Fun And Give Virgins Awkward Hips Oh-1 Olfactory Oh-2 Optic Oh-3 oculomotor Tiny-4 Trochlear Tits-5 Trigeminal Are-6 Abductens Fun-7 Facial And-8 Auditory Give-9 glossopharyngeal Virgins-10 Vagus Awkward-11 Accessory (spinal accessory) Hips-12 Hypoglosal

10.6.2. Sensory Nerve

10.6.3. Motor Nerve

10.6.4. Sensory Nerves, Motor Nerves or Both Some Say Marry Money, But My Brother Says Big Brains Matter Most

10.7. Dementia

10.7.1. primary treatment

10.7.2. non pharm treatment

10.7.3. cholinesterase inhibitors Donepezil Galantamine

10.7.4. NMDA receptor blockers mementine

10.8. siezures

10.8.1. non-pharm treatment avoid ETOH, Stimulants, stress get enough sleep yoga

10.8.2. pharm depends on type of seizure phenytoin carbamazepine valproic acid phenobarbitol

10.9. Comparing MS, ALS and Musculo dystrophy

10.10. Temporal/Giant Cell Arteritis

11. Hematologic

11.1. Anemia

11.1.1. Anemias Iron Deficiency Anemia patient teaching Megaloblastic Anemias Folate deficient B12 deficient sickle cell anemia

12. Endocrine

12.1. DM

12.1.1. Diabetes Type I Type II what HBA1C do you start treatment? Biguanides Sulfonylurea Insulins bolus/prandial basal premixed acarbose pioglitazone

12.2. Thyroid Disease

12.2.1. Thyroid Thyroid no screening asymptomatic pts Hypothyroid levothyroxine hyperthyroid

12.3. Obesity

12.3.1. BC Guidline

13. Infectious Disease

13.1. Pharmacology of ID

13.1.1. Infectious Diseases Antiviral Drugs Acyclovir Anti parasitic drugs Permethrin Antifungals Clotrimazole - Canesten Ketoconazole fluconazole Mechanisms for antibiotic resistance Antibiotic Toxicities Interactions with warfarin Allergic Reactions Atypical Bacteria and their diseases Antibiotics for Atypical Bacteria Infections Respiratory Infections Skin Infections Eye Infections Ear infections Nasal Infections Throat infections Eye infections Anaerobic Bacteria Mechanisms of Antibiotics add these to the map: Gentamicin (opthalmic anti-­infective) Timolol (beta blocker antiglaucoma agent) Ciprofloxacin otic solution (otic anti-­infective) Benzocaine antipyrine-­glycerine (otic analgesic) Acetic acid otic solutions Loratadine (2nd generation antihistamine) Chlorpheneramine Diphenhydramine Pseudoephedrine (decongestant, look also at phenylephrine) Codeine phosphate (antitussive) Guaifenesin (expectorant) Intranasal steroids (Fluticosone and betamethasone) Cromolyn (mast cell stabilizer) Ketotifen (opthalmic antihistamine + mast cell stabilizer) Ketorolac (ophthalmic NSAID) Highly Resistant Gram Neg Bacteria Antibiotics for highly resistant Gram Neg Bacteria Oral Antibiotics against CA - MRSA Preferred Antibiotic for serious Gram + Infections Antibiotic Classes Miscellaneous Antibiotics macrolides penicillins cephalosporins flouroquinolones sulpha Tetracyclines aminoglycosides Metronidazole Infectious Disease Common Etiologies

13.2. Immunization

13.2.1. Which are live attenuated vaccines?

13.2.2. Basic immunization schedule first year of life

13.2.3. Schedule and reccomendations MMR Hep A Hep B Varicella HPV tetanus influenza antivirals

13.3. HIV

13.3.1. drugs in pregnancy?

13.3.2. Protease Inhibitors (PI) ritonavir

13.3.3. nucleoside Reverse transcriptase inhibitor (NRTI) 1st Generation zodovudine / AZT NON-nucleoside REverse Transcriptase Inhibitors (NNRTI)

14. Reumatologic/MSK

14.1. Musculoskeletal Complaints

14.1.1. Shoulder Exam Standing Inspect Active ROM strength Reflexes palpation Sulcus sign neer's test - of impingement of supraspinadous tendon hawkins test - of impingement of supraspinadous tendon acromioclavicular compression test test biceps tendon / yurgasons test adson's test for thoracic outlet syndrome apprehension test

14.1.2. Foot exam Inspect inspect from back - look for how many toes you can see. more than 2 is getting too many halux valgus Mortons neuroma achiles tendon rupture thompson's test Palpation for tenderness (most important) 2nd metatarsal most common for stress # Plantar Fasciatis chronic heel pain syndrome Midfoot - Lisfranc's Joint Ottawa Ankle Rules Passive ROM

14.1.3. Joint above/joint below valgus force - applied to lateral side of joint leading to ie: genu Valgum [knock-kneed] distal part angled out) Varus force - force applied to medial side of joint (leading to ie: genu VARum[ bow legged] distal part angled in)

14.1.4. Elbow exam inspect "carrying angle (greater than women" active ROM palpation lateral epicondylitis "tennis elbow"

14.1.5. Knee ottawa knee rules

14.2. Sprains

14.3. Strains

14.4. Osteoporosis

14.4.1. full BC Guidline

14.5. Musckuloskeletal Treatment

14.5.1. Back pain acute chronic analgesics narcotics NSAIDs Acetaminophen muscle relaxants non-pharm treatment

14.5.2. Osteoperosis anti catabolic agents - Bisphosphonates 1st line alendronate

14.5.3. Rheumatoid Arthritis non biologic DMARDs hydroxychloroquine only for mild RA

14.5.4. Gout Acute colchicine NSAIDs glucocorticoids chronic allopurinol

14.5.5. fibromyalgia TCAs TCA type muscle relaxant Cyclobenzaprine Amitriptyline

14.5.6. Polymyalgia Rheumatica 1st line high dose corticosteroid

14.6. SEADS

14.6.1. swelling

14.6.2. erythema/echymosis

14.6.3. atrophy/asymetry

14.6.4. deformity

14.6.5. skin changes

14.7. Arthritis & Joint Pain

14.7.1. Infectious Arthritis

14.7.2. Systemic Rheumatic Disease Rheumatoid Arthritis Myopathy Polymyositis Dermatomyositis Connective Tissue Diseases Systemic Lupus Erythmatosis sjogrens disease scleroderma

14.7.3. Spondyloarthropathies

14.7.4. Crystal Induced Arthropathy

14.7.5. Degenerative

14.7.6. Vasculitis

14.7.7. Endocrine

14.7.8. Neoplasia

14.8. Vitamin D

14.8.1. Patient Handout

15. PAIN

15.1. Acute Pain

15.2. Chronic Non Cancer Pain

15.3. Cancer Pain

15.4. Pain

15.4.1. narcotics codeine tramadol

15.4.2. NSAIDs ketorolac

15.4.3. Acetaminophen

15.4.4. GABA gabapentin

15.4.5. Chronic pain

15.4.6. acute pain

16. Oncology

16.1. Oncology Pharm

16.1.1. methotrexate

16.1.2. warfarin

16.1.3. tamoxifen

16.2. Breast CA

16.2.1. BC Guidlines

16.3. Colorectal CA

16.3.1. BC Guidlines Colorectal CA

16.4. Palliative Care

16.4.1. BC Guidline Paliative


17.1. 2 min to write reminders in booklet

17.1.1. 2 min to read instructions 10 min for test Evaluation To do for all scenarios








18.7. Not safe in pregnancy

18.8. probably not safe in pregnancy

18.9. probably safe in pregnancy

19. Diagnostic Testing

19.1. Diagnostic Testing

19.1.1. Laboratory BC Medical Services Plan Payment Schedule

19.1.2. Medical Imaging X- rays ultrasound CT Miscellaneous

19.1.3. Objectives of Diagnostic Tests facilitate diagnosis in a sick pt give prognostic info for pt with a disease screen for sub clinical symptoms in pt with enough risk factors monitor therapy

19.1.4. Questions to ask about each test Why am I considering this test? What question is this test meant to answer? can this test answer my question? do benefits of testing outweigh risks? does the benefit outweigh the cost?

19.1.5. How to decide to use a test? PRE TEST PROBABILITY Liklihood Ratios (LR) CLINICAL DECISION RULES (CDR) help set Pre test probabilities for various problems and provide screening tests Examples According to Bayesian principles, the pretest odds of disease multiplied by the likelihood ratio gives the post-test odds of disease

19.1.6. Diagnostic and Procedural Codes (ICD9)

20. Pediatrics

20.1. Piaget's stages of Development

20.2. Erickson

21. Geriatrics

21.1. Frailty

21.1.1. Full BC Guidline Frailty