First Line Treatment (NAPLEX REVIEW) Test
100% Correct Answers
Diabetes - ANSWER-T1D: insulin
T2D: metformin
ASCVD or CKD risk: SGLT2 (-) or GLP-1 agonist
HF risk: SGLT2 (-)
wt loss: SGLT2 (-), GLP-1 agonist
cost: SU, TZDs
hypoglyemia risk: avoid insulin and SU together
DKA and HHS - ANSWER-1. fluids: NaCl first, then switch to D5W1/2NS when BG <
200
2. regular insulin (0.1u/kg)
3. prevent hypokalemia (monitor potassium)
4. treat acidosis (pH < 6.5) with sodium bicarb
Hypothyroidism - ANSWER-1st line: levothyroxine (1.6mcg/kg--using IBW)
alternatives: liothyrinine, armour thyroid
if low salt intake: consume food with iodine (dairy, seasfood, meat, bread) or take
multivitamin with iodine
Hyperthyroidism - ANSWER-1st line: meds (PTU--preferred in in 1st trimester if
pregnant, methimazole--preferred in 2nd and 3rd trimester if pregnant), radioactive
iodine (destroy parts of the gland--take with potassium iodine to prevent cancer) or
surgery
beta-blockers for symptom control
Thyroid Storm (decompensated hyperthyroidism) - ANSWER-1st line: PTU
alternatives: inorganic iodine therapy (SSKI drops), beta blockers (propanolol), steroids
(dexamethasone), APAP or other supportive therapy to help cool down temp
Rhuematoid arthritis (RA) - ANSWER-non drug: PT, rest, exercise, diet/weight control,
surgery (joint replacement)
drug: 1. DMARDs--traditional/non-biologic or biologics (TNF inhibitor or non-TNF
inhibitor), 2. steroids (used to bridge till DMARD takes effect), 3. NSAIDs
options: MTX (1st line) +/- steroid or 2 DMARDS (biologic + non-biologic or 2 non
biologic)
Lupus - ANSWER-non drug: rest, exercise, sun protection, quit smoking
drug:
mild-NSAIDS + PPI (reduce GI risk)
,mod-sev (1 or more immunosuppresants): steroids, hydroxychloroquine,
cyclophosphamide, azathioprine, mycophenalate, cyclosporine, anifirolumab
(saphnelo), belimumab (benlysta)
multiple sclerosis - ANSWER-1.steroids--exacerbations (IV methylprednisolone 3-7
days)
2. disease modifying therapies (1st line)
3. supportive therapy: (anticholinergics--incontinence, laxatives--constipation,
loperamide--diarrhea, skeletal muscle relaxants or analgesics--muscle spasms and
pain, propanaolol--tremors, SNRI--neuropathic pain, modanafil--fatigue, stimulants--
ADHD, scopalamine or meclizine--dizziness, donepezil--cognitive function, PDE-5 (-)---
ED)
Raynauds - ANSWER-calcium channel blocker (nifedipine)
alternatives: iloprost, topical NTG, PDE-5 (-)
celiac disease - ANSWER-avoid gluten (avoid starch products--corn, potato, tapioca,
wheat, etc.)
myasthenia gravis - ANSWER-1st line: cholinesterase inhibitors (pyridostigmine)--stop
ACh breackdown to reduce muscle weakness
alternatives/add ons: steroids, azathiprone, IVIG (severe), efgartigimod (vyvgart)
sjogrens syndrome - ANSWER-dry eyes: artificial tears (OTC: systane, refresh, RX:
restasis, lifiegrast (xiidra))
dry mouth: (OTC: sugar free chewing gum/lozenge, antimicrobial mouthwash, salivary
substitutes, RX: oral muscurinic agonists--pilocarpine, cevimeline)
psoriasis - ANSWER-non drug: oatmeal bath, UV light exposure--reduces scaling and
inflammation, photochemotherapy/laser light therapy
drug (1st line): topical meds (steroids, vitamin D analog (calcipotriene), anthralin,
retnoids, salicylic acid, coal tar, moisturizers
2nd line: topical calineurin (-): protopic, elidel
severe: MTX, cyclosporine, hydroxyurea, entarecept, humira, infliximab, etc.)
pulmonary arterial hypertension - ANSWER--treat underlying causes (toxin, drug or
disease associated)
-CTEPH (chronic thromboembolism pulmonary HTN): warfarain
-non drug: sodium restriction, avoid NSAIDs, vaccinations (flu, pneumonia), avoid high
altitudes (causes hypoxia--trigger), oxygen
-drug (responders): calcium channel blockers (nifedepine, diltiazem, amlodopine)
-drug (non-responders/responders that failed CCB therapy)
pulmonary fibrosis - ANSWER-chronic oxygen supplementation, pirfenidone (esbriet),
nintedanib (ofev)---both drugs slow rate of lung function decline
, Asthma - ANSWER-ICS or ICS/LABA (formoterol)
COPD - ANSWER-Bronchodiolators
Class A: SABA or SAMA PRN, LABA or LAMA
Class B: LAMA or LABA
Class C: LAMA
Class D: LAMA, LAMA/LABA, or ICS/LABA (eos > 300)
Exacerbation: SABA + oral steroid
Tabacco cessation - ANSWER-non drug: counseling
drug: NRT (patch, gum, lozenge, inhaler, spray), bupropion, varenicline
Hyperlipidemia - ANSWER-Statins
add on: ezetimibe or pcsk9 (-)
Hypertension - ANSWER-ACE/ARB, thiazides, DHP calcium channel blockers
others: beta blockers, clonidine, guanfacine, hydralazine, methyldopa, alpha blockers
stable ischemic heart disease (chest pain/angina) - ANSWER-antiplatelets: aspirin,
clopidogrel, both (stent only)
antianginalls: nitrates, beta blockers, CCBs
acute coranary syndromes - ANSWER-PCI (revascularization procedure--preferred for
STEMI)
if not possible with 120 min, give fibrinolytic within 30 min of hospital arrival
1st line drugs: morphine sulfate, oxygen, nitrate, aspirin (MONA)
next: anticoags, clopidogrel, beta blockers, ACE inhibitors
Heart Failure - ANSWER-1st: ACE/ARB/ARNI + beta blocker + loop diuretic
add on: spironolactone, then SGLT2, hydralazine, ivandrabine
last line: digoxin, vericiguat
Arrthymias - ANSWER-Rate: Class 2 or 4 (beta blockers and non-DHP CCBs)
Rhythm: cardiversion-Class 1 or 3 (Na and K blockers) + anticogualant for stroke
prohylaxis (3 weeks before, 4 weeks after)
Ischemic Stroke (acute) - ANSWER-remove clot w/ stent or dissolve clot with IV
fibronlytics (alteplase), aspirin and/or clopidogrel or ticagrelor within 24-48 hrs and
continued for 21-90 days
administer alteplase:
-30 min of STEMI
-3 hours of symptom onset
-60 min of hospital arrival
Ischemic Stroke (chronic prohpylaxis) - ANSWER-noncardioembolic: antiplatlet
monotherapy (aspirin or clopidogrel)
