Just another ER Doc
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Just another ER Doc
Fluconazole is a convenient one-time oral treatment for vaginal yeast infections, providing quick and effective relief. It’s easy to use compared to creams or suppositories. However, it is not recommended during pregnancy, as oral fluconazole may pose risks to the fetus.
Butoconazole is a prescription antifungal that effectively treats vaginal yeast infections with a convenient single-dose cream formulation. It provides high cure rates and rapid symptom relief and considered safe during pregnancy.
Tioconazole is an effective over-the-counter treatment for vaginal yeast infections, typically used as a single-dose ointment. It provides convenient relief for uncomplicated infections. However, evidence for its safety in pregnancy is more limited compared to other topical antifungals like clotrimazole or miconazole.
Terconazole is a prescription antifungal that effectively treats vaginal yeast infections. It is available as a cream or suppository and provides reliable relief from itching and discharge and safe for pregnancy.
Miconazole is an effective over-the-counter treatment for vaginal yeast infections. It is available as creams or suppositories and is considered safe for use during pregnancy.
Clotrimazole is an effective over-the-counter antifungal treatment for vaginal yeast infections. It is available as a vaginal cream or tablet and is considered safe for use during pregnancy, especially for uncomplicated infections. Most women experience symptom relief within a few days of treatment.
Aducanumab's FDA approval remains highly controversial due to uncertain clinical benefit despite reducing amyloid plaques. Because of safety concerns and limited evidence, it is reserved for very select patients and is generally available only in the context of a clinical trial setting.
Donanemab has demonstrated a ~30% slowing of cognitive and functional decline in patients with early Alzheimer’s disease, particularly those with low to medium tau pathology. Like other drugs in its class, it carries risks of amyloid-related imaging abnormalities (ARIA), including brain swelling and microhemorrhages, requiring regular MRI monitoring. Its use is best reserved for carefully selected patients with confirmed amyloid pathology, balancing modest clinical benefits against potential safety concerns.
Lecanemab has been shown to slow cognitive and functional decline by about 25–30% in early Alzheimer’s disease, offering meaningful though modest clinical benefit. However, treatment carries notable risks, including amyloid-related imaging abnormalities such as brain swelling and microhemorrhages, which require careful monitoring with MRI. Its use should be reserved for appropriately selected patients with confirmed amyloid pathology, weighing the potential benefits against safety concerns.
Using donepezil and memantine in combination provides greater benefit than either drug alone for patients with moderate to severe Alzheimer’s disease. Studies show the combination can lead to slower decline in cognition, daily functioning, and behavior, offering improved overall clinical outcomes compared to monotherapy. The complementary mechanisms—donepezil enhancing cholinergic signaling and memantine reducing glutamate-related excitotoxicity—work together to provide broader symptom control.
Galantamine is another first-line treatment for Alzheimer’s disease, indicated specifically for mild to moderate stages. It is sometimes favored for its additional action on nicotinic receptors that may support cognition, but it requires careful titration to minimize side effects.
Memantine is a first-line drug for moderate to severe Alzheimer’s disease, often used alone or in combination with an acetylcholinesterase inhibitor. It works by blocking NMDA glutamate receptors, which helps reduce excitotoxicity and may protect brain cells. Clinical benefits are modest but include stabilization or slowing of decline in cognition, daily functioning, and behavioral symptoms, with generally good tolerability.
Rivastigmine is also a first-line option for Alzheimer’s disease, chosen when patients have swallowing difficulties or cannot tolerate oral medications, since it is available as a transdermal patch, though GI side effects are more common with the oral form.
Donepezil is a first-line drug for Alzheimer’s disease, often selected because it is dosed once daily, has a straightforward titration, and is generally well tolerated with fewer gastrointestinal side effects.
I find that if I can correct a significant nasal deviation immediately after the injury, it can sometimes improve both cosmetic and functional outcomes while also reducing the likelihood of needing future correction.
For clavicle fractures that do not require surgery, a sling has the best evidence for effective treatment. It provides comfort, reduces movement at the fracture site, and supports proper healing. Most patients recover well with sling use, followed by gradual rehabilitation.
Early, intensive ABA-based therapy (20–40 hours per week) is first-line and has the strongest evidence for improving language, cognition, and adaptive skills. The American Academy of Pediatrics recommends behavioral and educational interventions as the primary treatment for autism spectrum disorder, with medications reserved for specific symptoms or comorbidities.
In the emergency room, acute psychosis with severe agitation is often managed with rapid-acting medications to ensure safety and stabilization. A common approach is giving an antipsychotic, sometimes combined with a benzodiazepine such as lorazepam (Ativan), to quickly calm the patient and reduce agitation. This allows further evaluation and initiation of longer-term treatment once the immediate crisis is controlled.
Loperamide can reduce diarrhea in gastroenteritis, but I’m cautious about using it unless there is low suspicion for a bacterial cause. In cases with fever, bloody stools, or suspected infections like E. coli or C. difficile, it can actually make things worse by trapping the bacteria or toxins. For mild, non-bloody diarrhea in otherwise healthy adults, it may provide short-term relief.
Prochlorperazine is a backup option for treating nausea and vomiting in gastroenteritis when ondansetron (Zofran) is not effective or available. It can help with symptoms but carries a higher risk of side effects like drowsiness or movement-related problems.
IV hydration is used in severe gastroenteritis when dehydration is significant and oral fluids aren’t enough. It restores fluids and electrolytes more quickly than drinking alone, helping patients feel better faster and relieving symptoms like dizziness, weakness, and low blood pressure.
Metoclopramide (Reglan) is a backup option for treating nausea and vomiting from gastroenteritis when ondansetron (Zofran) is not available or suitable. It is less effective and less well tolerated but can still provide relief, especially by promoting stomach emptying. An added benefit is that it is considered Category B in pregnancy, making it a reasonable alternative for pregnant patients.
Zofran (ondansetron) is the preferred medication for nausea and vomiting caused by gastroenteritis. It works quickly, is well tolerated, and helps patients keep fluids down to prevent dehydration. Compared to other antiemetics, it has fewer side effects and stronger evidence supporting its use.
The BRAT diet is not specifically recommended by the Infectious Diseases Society of America, but it can provide a gentle starting point for people recovering from vomiting. Its bland foods are less likely to trigger nausea, making it helpful for patients who are hesitant to eat. However, it should be used only until patients can advance their diet to include more balanced nutrition for full recovery.
A blood transfusion is used for anemia when hemoglobin levels are very low or symptoms are severe, such as chest pain, shortness of breath, or dizziness. It works quickly by providing healthy donor red blood cells, improving oxygen delivery and relieving symptoms. Transfusions are effective for urgent situations but are not a long-term solution.
Darbepoetin alfa is used for anemia because it stimulates the bone marrow to produce more red blood cells, similar to epoetin alfa, but with a longer half-life. This means it can be given less frequently, which is more convenient for patients. It is commonly used in anemia from chronic kidney disease or chemotherapy to reduce the need for blood transfusions.
Epoetin alfa is a medication that helps the bone marrow make more red blood cells. It is mainly used for anemia caused by chronic kidney disease or by chemotherapy when the body cannot produce enough natural erythropoietin. It reduces the need for blood transfusions but must be carefully monitored due to risks like high blood pressure or blood clots.
Folic acid helps treat anemia when the cause is folate deficiency. It works by supporting the body’s ability to make healthy red blood cells, which can improve energy and reduce fatigue. Treatment is usually simple with daily oral supplements and often leads to quick improvement in symptoms.
Vitamin B12 supplementation will improve anemia if the cause is a true B12 deficiency. It helps the body make healthy red blood cells and can also prevent nerve damage linked to low B12. Treatment may be given as pills or injections, depending on how well the body absorbs it.
Iron supplementation is a basic and widely used treatment for anemia caused by iron deficiency. It works by replenishing the body’s iron stores, which are needed for the bone marrow to make more red blood cells. Many forms are available over the counter, making it easy to access. While effective, improvement takes time since the body must build new red cells, and side effects like constipation or stomach upset can occur.
Enoxaparin (Lovenox) is an appropriate treatment for DVT and is given as an injection, usually twice a day. It is effective but because it is a twce daily injection, it is commonly used as a bridging therapy to transition patients to an oral anticoagulant.
While naloxone (Narcan) reverses the effects of opioids, CPR is what keeps the body alive until the medication takes effect. Chest compressions maintain blood flow if the heart has stopped, and rescue breaths provide oxygen if the person is not breathing. Together, these measures bridge the gap and sustain life until naloxone can fully restore normal breathing and circulation.
Naloxone is the best and most effective treatment for opioid overdose because it rapidly reverses life-threatening effects like slowed or stopped breathing. In some cases, especially with potent opioids such as fentanyl, multiple doses may be required to keep the overdose reversed until emergency care is provided. It is safe, fast-acting, and can be life-saving when used promptly.
Tenecteplase is a clot-busting medication sometimes used in severe pulmonary embolism. It is given as a single IV bolus, making it faster and easier to administer than alteplase. Because it carries a significant bleeding risk, it is reserved for life-threatening PE cases with hemodynamic instability.
Enoxaparin (Lovenox) is an appropriate treatment for pulmonary embolism and is given as an injection, usually twice a day. It is effective and commonly used as a bridging therapy to transition patients to an oral anticoagulant.
Warfarin is an older treatment option for pulmonary embolism that has largely been replaced by factor Xa inhibitors such as apixaban and rivaroxaban. While effective, it is challenging to use because the dose must be carefully titrated to keep blood levels in the right range, and this is easily affected by certain foods, medications, and even illness. Frequent blood tests (INR checks) are required to make sure it is working safely. For these reasons, newer anticoagulants are generally preferred, though warfarin is still used in select cases.
Thrombectomy is a procedure used to remove blood clots in the lungs for patients with pulmonary embolism with with significant risk factors such as severe right heart strain, worsening instability, or a large clot burden.. Because it is invasive, it is generally recommended after thrombolysis has failed, but it may also be considered when clot-busting drugs are contraindicated—for example, in patients with a history of recent major surgery, active bleeding, prior hemorrhagic stroke, or very high bleeding risk. The decision depends on the patient’s situation and whether the hospital has the expertise and resources to safely perform the procedure.
Alteplase is a clot-busting drug used for very serious cases of pulmonary embolism (PE). It is mainly given when large clots block blood flow to major parts of the lungs or when the PE causes life-threatening problems, like dangerously low blood pressure that can’t be maintained without support. In these situations, alteplase can quickly break down the clot and restore circulation. Because it carries a high risk of severe bleeding, doctors reserve it only for patients who are unstable and at risk of dying without urgent treatment.
Eliquis (apixaban) is recommended as a first-line treatment for pulmonary embolism because it offers strong protection against recurrent blood clots with a lower risk of major bleeding compared to rivaroxaban. It is often the preferred DOAC, especially in patients with moderate kidney problems, due to its lower renal clearance.
Heparin is recommended in pulmonary embolism (PE) when immediate anticoagulation is required, including cases with confirmed PE or high clinical suspicion, even before diagnostic confirmation if the risk is high. Heparin is preferred in patients with severe renal impairment (CrCl <30 mL/min), high bleeding risk, clinical instability, or when rapid reversal is needed—for example, before procedures, during thrombolysis, or when aggressive interventions are planned. Its short half-life and ability to be quickly reversed make it especially valuable in these settings.
Physical therapy may benefit some people with Long COVID, but it needs to be carefully tailored to each patient’s tolerance. Studies show that structured rehab programs with breathing exercises, gentle strengthening, and gradual activity can improve fatigue, breathlessness, and quality of life. However, patients with post-exertional symptom exacerbation (PESE) require a cautious, pacing-first approach to avoid worsening their symptoms. When individualized, physical therapy can support recovery and help patients safely return to daily activities.
Energy pacing is one of the main strategies for managing Long COVID, though it does not treat the underlying illness. Similar to its use in ME/CFS, pacing helps patients balance activity and rest to avoid post-exertional crashes, where symptoms worsen after doing too much. This approach often involves breaking tasks into smaller steps, planning rest breaks, and respecting personal limits. While its benefits are modest, pacing is one of the more consistent ways to reduce flare-ups and maintain daily function.
Coumadin is one of the older options for treating DVT, but it can be challenging to manage because blood levels must be checked regularly to ensure it is therapeutic. Patients often need bridging with Lovenox until the INR reaches the target range, which makes it less convenient than newer agents.
Apixaban is my preferred choice for DVT because it offers strong efficacy with a lower bleeding risk compared to older options. The main drawback is the twice-daily dosing, which can be less convenient for some patients.
IVC filters are reserved for patients with DVT who cannot take anticoagulation or continue to have clots despite treatment. They can help prevent pulmonary embolism, but they do not treat the clot itself and are not ideal due to long-term risks.
Apixaban is often preferred in atrial fibrillation because it provides the same stroke prevention as other DOACs while showing a lower risk of major bleeding. This balance of safety and efficacy makes it a common first choice for long-term anticoagulation.
I reserve synchronized cardioversion for patients with atrial fibrillation who are unstable or cannot be adequately rate controlled with medications. It is important to be aware of the risk of embolic stroke, so I only use it when the onset of atrial fibrillation is clearly known or when an ultrasound confirms there is no atrial clot.
Lopressor is equally recommended for rate control in atrial fibrillation, but I’ve had less success with it compared to calcium channel blockers. I generally use it if the patient is already on a beta blocker.
Diltiazem is effective for rate control in atrial fibrillation, and anecdotally I’ve seen better responses with it compared to other medication options. I tend to select it when the patient is already on a calcium channel blocker.
Synchronized cardioversion is reserved for PSVT patients who are unstable or do not respond to medication therapy. It delivers a timed electrical shock to quickly restore normal rhythm and is highly effective in urgent situations.
Metoprolol IV is an alternative to diltiazem for treating PSVT, helping to slow AV node conduction and restore normal rhythm. I usually select it based on the patient’s prior experience or if they are already on a beta blocker.
Diltiazem IV is one of the treatment options for PSVT if adenosine does not work. It slows conduction through the AV node and can help restore normal rhythm, though it must be used carefully in patients with low blood pressure. I generally choose this if the patient is already on a calcium channel blocker.
Vagal maneuvers can sometimes stop PSVT episodes at home by slowing the heart’s rhythm. If they don’t work or symptoms persist, patients usually need to come to the ER for further treatment.
Adenosine is a first-line treatment for stopping PSVT, given as a rapid IV push to reset the heart’s rhythm. If the initial dose does not work, a larger dose may be needed. It is very effective, though patients may briefly feel flushing or chest pressure.
Metoprolol is a beta-blocker given early in myocardial infarction to slow the heart rate, lower blood pressure, and reduce the heart’s oxygen demand. Randomized controlled trials have shown that it can shrink infarct size, improve heart function, and reduce mortality and reinfarction risk. It’s considered a standard treatment alongside reperfusion and other therapies.
Nitroglycerin is commonly used in myocardial infarction to relax and widen blood vessels, which lowers blood pressure and reduces the heart’s workload. It also improves blood flow to the heart muscle and helps relieve chest pain. While it provides symptom relief, it does not reduce mortality and is used alongside other proven therapies.
Heparin is one of the main medications used to prevent new clots from forming and to stop existing ones from getting bigger. It is often given during percutaneous coronary intervention (PCI) to keep the artery open and reduce the risk of complications. Its fast onset of action and effectiveness make it a standard part of heart attack treatment protocols.
Percutaneous coronary intervention (PCI) is the main treatment for a heart attack if it can be done quickly. It allows doctors to see exactly where the artery is blocked and place a small stent to restore blood flow. In some people, however—such as those with severe or multiple blockages in the main heart artery, a coronary artery bypass surgery (CABG) may be a better option.
Aspirin is one of the most important first-line treatments for myocardial infarction because it works quickly to inhibit platelet aggregation and limit clot growth. It has one of the fastest onset of benefits and provides the largest impact on reducing mortality . Its simplicity, low cost, and strong evidence base make it a cornerstone of acute heart attack management. and prevention.
Tranexamic acid (TXA) can be safely combined with oxymetazoline, to help control nosebleeds. The oxymetazoline works by constricting blood vessels, while TXA helps stabilize the clot, and together they may improve bleeding control.
Atorvastatin is one of the first-line treatments for preventing another stroke after an ischemic CVA. It lowers cholesterol, stabilizes artery plaques, and reduces the risk of future strokes and heart attacks. Because of its proven benefit, it is commonly prescribed long-term for secondary prevention.
Carotid endarterectomy is most effective for preventing recurrent stroke in patients with symptomatic high-grade carotid stenosis (70–99%). It may also be considered in select patients with moderate stenosis (50–69%), depending on individual risk factors and surgical candidacy. For those with less than 50% stenosis, the risks of surgery outweigh the potential benefits, and medical management is preferred.
Dual antiplatelet therapy (DAPT), usually aspirin plus clopidogrel, is a viable option for minor ischemic stroke or high-risk TIA to lower early recurrence risk. Because of the balance between benefit and bleeding risk, I typically prescribe DAPT with neurology guidance and for a limited short-term course before transitioning to single antiplatelet therapy.
Ticagrelor is an antiplatelet agent that can be considered in stroke care, but I generally defer to neurology on when to use it. It is usually reserved for patients who have an intolerance to aspirin and/or Plavix (clopidogrel) or in select cases where short-term dual therapy is recommended after a minor stroke or high-risk TIA. While effective, its higher bleeding risk and less common use in long-term prevention make specialist guidance important.
Plavix is an effective antiplatelet option for secondary prevention after ischemic stroke. While it can be used as an alternative to aspirin or in short-term dual therapy, I often defer to neurology on the timing and selection of Plavix, as these decisions depend on stroke type, patient risk factors, and bleeding considerations.
Aspirin is the baseline antiplatelet therapy for ischemic stroke, with extensive evidence supporting its effectiveness in reducing recurrent events. It has been well studied over decades and consistently shown to improve outcomes in secondary prevention. In addition, aspirin is widely available and inexpensive, making it a reliable and accessible cornerstone of stroke care.
Mechanical thrombectomy is an effective treatment for acute ischemic stroke due to large-vessel occlusion, with a broader treatment window of up to 16–24 hours in selected patients. Its limitation is that it requires specialized resources and expertise, so availability depends on the hospital. When accessible and used appropriately, it can greatly improve outcomes by restoring blood flow and reducing long-term disability.
Tenecteplase (TNKase) is a thrombolytic now FDA-approved for acute ischemic stroke and offers the advantage of a single IV bolus dose instead of an infusion. I am careful to confirm patients meet full eligibility criteria and are within the treatment time window, as the main risk remains intracranial hemorrhage. When used appropriately, it provides outcomes comparable to alteplase with simpler administration.
Alteplase (tPA) is a clot-dissolving medication used for acute ischemic stroke that can significantly improve outcomes if given promptly. I am very careful to ensure patients meet the full eligibility criteria, especially the time window of symptom onset, because the risk of serious bleeding, including intracranial hemorrhage, is substantial. Strict patient selection is essential to maximize benefit while minimizing harm.
While the Rhino Rocket can be effective for controlling epistaxis, I do have concerns about patient comfort during its use. The device is initially rigid for placement, which can cause discomfort for patients. Only after it absorbs moisture does it soften and expand to tamponade the bleeding. This makes it reliable but less comfortable compared to balloon devices like the Rapid Rhino.
Rapid Rhino is my preferred nasal tampon when manual pressure, topical medication, and cautery fail to control epistaxis. I prefer it because it is inflatable, which allows me to titrate the pressure to achieve effective hemostasis while minimizing patient discomfort.
If direct pressure and oxymetazoline fail to control the epistaxis, my next step is cauterization with silver nitrate. After applying a topical anesthetic, I identify the bleeding vessel and carefully use silver nitrate to seal it. This approach is effective for localized anterior bleeds and provides a more definitive solution.
Oxymetazoline is my second-line treatment for epistaxis after direct pressure. It works as a topical vasoconstrictor to shrink the nasal blood vessels and often helps stop bleeding when pressure alone is not enough. I usually combine it with lidocaine to provide anesthesia so that If the bleeding continues I proceed to cauterization with silver nitrate to directly seal the bleeding vessel.
Direct pressure is first line treatment for epistaxis and will stop most nosebleeds. The soft part of the nose should be pinched continuously for 10–15 minutes, which allows clotting to occur. If the bleeding recurs, the maneuver can be repeated. Persistent or heavy bleeding lasting longer than 20-30 minutes should prompt medical evaluation for further treatment.
Meropenem is selected for aspiration pneumonia when very broad coverage is needed, including resistant gram-negative organisms and anaerobes. It is particularly valuable in critically ill patients or when complications such as abscess, empyema, or necrotizing infection are suspected. Compared with imipenem, meropenem has a lower risk of seizures, making it safer in patients with renal impairment or CNS disease.
Zosyn (piperacillin-tazobactam) is often chosen for aspiration pneumonia because it provides broad coverage against gram-negative, gram-positive, and anaerobic organisms. It is especially useful in hospitalized or critically ill patients, or when there is concern for complications like abscess, empyema, or necrotizing infection.
Levofloxacin is a respiratory fluoroquinolone that can be used in aspiration pneumonia, particularly as an alternative for patients with penicillin allergy. It provides broad coverage against typical and atypical pathogens seen in community-acquired pneumonia, making it a reasonable choice when the distinction between aspiration and standard community acquired pneumonia is unclear.
Ampicillin-sulbactam (Unasyn) is a first-line IV antibiotic for aspiration pneumonia because it covers gram-positive, gram-negative, and anaerobic bacteria. It is especially useful in hospitalized patients, with the option to switch to oral amoxicillin-clavulanate (Augmentin) once stable.
While incision and drainage is the standard treatment for abscesses, I often add antibiotics to reduce cellulitis and prevent recurrence. Bactrim is particularly useful because it covers MRSA and can be an alternative for early abscesses or in patients who decline I&D.
Incision and drainage is considered the first-line treatment for abscesses, as it provides the quickest resolution of infection and symptoms. By releasing the collection of pus, patients often experience rapid relief of pain and swelling. Antibiotics alone are usually insufficient because they cannot penetrate the walled-off cavity effectively.
Condoms can lower the risk of syphilis by blocking contact with infected secretions, but they are less protective than for other STIs since sores may occur outside the covered area.
Condoms are recommended for preventing chlamydia because they act as a barrier to infected genital secretions during sex. When used correctly and consistently, they significantly reduce the risk of transmission, though they are not 100% effective.
Condoms are strongly recommended for gonorrhea prevention because they provide a reliable barrier to infected secretions during sexual activity. While not perfect, they significantly lower transmission risk when used consistently and correctly
Doxycycline is an alternative option for syphilis in patients who cannot receive penicillin. The typical regimen is 100 mg orally twice daily for 14 days in early syphilis, and 28 days for late latent disease. While generally effective, it is considered less reliable than benzathine penicillin G, and it cannot be used during pregnancy because it does not prevent congenital syphilis. Since it requires a prolonged oral course, patient adherence is also a concern, so it is reserved for those with true penicillin allergy who cannot undergo desensitization.
Benzathine penicillin G is the gold standard treatment for syphilis due to its proven effectiveness and ability to provide long-lasting blood levels that eradicate Treponema pallidum. For primary, secondary, or early latent syphilis, the recommended regimen is a single intramuscular injection of 2.4 million units. For late latent syphilis or syphilis of unknown duration, the regimen is 2.4 million units IM once weekly for three consecutive weeks. In neurosyphilis or ocular syphilis, intravenous aqueous penicillin is required instead. It is also the only therapy shown to reliably prevent congenital syphilis during pregnancy, making it essential in obstetric care.
Ceftriaxone can be considered a backup option for syphilis, but the supporting data are limited compared to penicillin. It may be used in cases of severe penicillin allergy, particularly when doxycycline is not suitable or when treating neurosyphilis or ocular disease.
Azithromycin was a regimen I used to prescribe for chlamydia because of the convenience of a single oral dose and good patient tolerance. However, due to evidence of decreased effectiveness, it is now my second-line option, reserved for patients with allergies or compliance concerns that prevent use of doxycycline.
Doxycycline is preferred for treating chlamydia because it is more effective, particularly for rectal and pharyngeal infections. However, it requires a 7-day course of twice-daily oral antibiotics, which can make compliance more challenging compared to a single-dose regimen. Despite this, its higher cure rates make it the first-line choice in most patients.
Cefixime is an oral option for gonorrhea, which can be convenient compared to an injection, but I use it less often because of its lower efficacy. It does not achieve as high or sustained drug levels as ceftriaxone, making it less reliable, especially for pharyngeal infections. Because of these concerns, it is considered only an alternative when ceftriaxone is not available.
Gentamicin plus azithromycin is an alternative regimen for gonorrhea, reserved for situations where ceftriaxone cannot be used, such as severe allergy. While it can be effective, especially for urogenital infections, it has lower efficacy than ceftriaxone and is less reliable for pharyngeal disease. Because of these limitations and higher rates of gastrointestinal side effects from high-dose azithromycin, it is not a first-line option and should only be used when ceftriaxone is contraindicated.
Ceftriaxone is generally preferred for treating gonorrhea because it is given as a single injection, eliminating concerns about patient adherence to oral regimens. It also achieves higher and more reliable cure rates across genital, rectal, and pharyngeal infections compared to alternatives. This makes it the most effective and convenient first-line option in current guidelines.
Alirocumab (Praluent) is a PCSK9 inhibitor that can lower LDL cholesterol by 50–60% and has proven benefit in reducing cardiovascular events. I consider it for patients with familial hypercholesterolemia or established ASCVD whose LDL remains above goal despite maximally tolerated statins and ezetimibe. Because it is costly and requires injections, I reserve it as a third-line option when aggressive cholesterol lowering is still needed.
Ezetimibe (Zetia) is a useful add-on therapy for patients whose LDL remains above goal despite maximally tolerated statins. It works by blocking cholesterol absorption in the gut, lowering LDL by about 15–25% with very few side effects. It is used when additional LDL reduction is needed but the patient cannot tolerate higher statin doses or requires a non-statin option.
Rosuvastatin (Crestor) is my choice when stronger LDL reduction is needed or if atorvastatin isn’t tolerated. Its higher potency, longer half-life, and fewer drug interactions make it especially useful in high-risk patients.
Atorvastatin (Lipitor) is often my first choice for elevated cholesterol because it reliably lowers LDL and has strong evidence for reducing heart attack and stroke risk. It is well-studied, available as a low-cost generic, and offers flexible dosing for both moderate- and high-intensity therapy. For most patients at increased cardiovascular risk, it provides the best balance of potency, safety, and accessibility.
The foundation of cholesterol management is making healthy lifestyle changes. Lifestyle changes like diet, exercise, weight management, and avoiding tobacco or excess alcohol are the most effective and proven ways to naturally improve cholesterol and lower heart risk. However, many people find these changes difficult to maintain consistently, which is why cholesterol-lowering medications are often needed as an additional tool.
Metoprolol is a beta-1 selective blocker that lowers blood pressure by reducing heart rate and cardiac output. I usually don’t choose it as first-line for uncomplicated hypertension, but it becomes a strong option when patients also have coronary artery disease, prior MI, heart failure, or arrhythmias where rate control is beneficial. Overall, I consider it more of a second-line or adjunctive agent unless those comorbidities are present.
Loperamide can be used symptomatically during opioid withdrawal to manage diarrhea, which is common and can lead to dehydration. It doesn’t treat cravings or other withdrawal symptoms, but it provides important comfort and stability.
Zofran is used symptomatically during opioid withdrawal to control nausea and vomiting. It doesn’t address cravings or the main withdrawal process, but it can make patients more comfortable and prevent dehydration.
Suboxone is a common first-line treatment for opioid withdrawal that reduces cravings and symptoms while lowering the risk of misuse. It can usually be started in an outpatient or ER setting once withdrawal has begun, to avoid precipitated withdrawal. I would use it for patients with moderate to severe opioid dependence who want a safer, flexible option for both detox and long-term maintenance.
Methadone is very effective for easing opioid withdrawal and cravings, with long-lasting effects that keep symptoms under control. As an ER doctor, I’m cautious about starting it because of its higher overdose risk and the fact that it requires specialized clinics for ongoing use. It’s best considered for patients needing structured, long-term maintenance rather than short-term emergency treatment.
Buprenorphine is a partial opioid agonist that helps ease withdrawal symptoms and reduce cravings while lowering the risk of misuse or overdose compared to full opioids. It is often considered for people with moderate to severe opioid dependence who want a safer long-term maintenance option or a bridge during detox. Suboxone (buprenorphine with naloxone) is the most common form, usually started once withdrawal has begun to avoid precipitated withdrawal.
A two-piece inflatable penile prosthesis provides erections by transferring fluid from a small reservoir in the scrotum into cylinders in the penis. It is often selected for men who want a more natural appearance than a malleable implant but need a simpler surgery that avoids placing an abdominal reservoir. This makes it especially useful for those with prior pelvic surgery or higher surgical risk.
A malleable penile prosthesis uses bendable rods that keep the penis firm but positionable, making it a simple, reliable option for erectile dysfunction. It is often chosen because the surgery is less complex, there are no mechanical parts to fail, and it is easy to use for men with limited hand dexterity. The main drawback is that the penis remains semi-rigid at all times, which can affect concealment and natural appearance.
The three-piece inflatable penile prosthesis is often preferred because it provides the most natural erections and flaccidity, offering better concealability and high satisfaction for patients and partners. It is considered the gold standard for surgical ED treatment. However, it does involve a more complex surgery, carries risks of infection or mechanical failure over time, and is generally more expensive than malleable or two-piece options.
Trimix is a compounded injection for erectile dysfunction that is prescribed when men do not respond to PDE-5 inhibitors or Bimix, since adding alprostadil increases potency. While highly effective, it requires careful supervision because of risks like penile pain, priapism (prolonged erections), and scarring.
Bimix is usually prescribed when PDE-5 inhibitors fail and for men who experience penile pain with alprostadil, since it does not contain that drug. It can be highly effective, but because it is compounded and not FDA-approved as a standard product, careful dosing and follow-up are required.
Alprostadil is a prostaglandin E1 therapy for erectile dysfunction, available as an injection (Caverject, Edex) or urethral suppository (MUSE). It produces erections independent of sexual stimulation and is often prescribed when oral PDE-5 inhibitors are ineffective or contraindicated. It can be very effective, but penile pain and the invasive delivery methods may limit its use.
Avanafil (Stendra) is a newer PDE-5 inhibitor for erectile dysfunction that is known for its fast onset of action, sometimes working in as little as 15 minutes. Its effects last about 4–6 hours, and it has fewer interactions with food and alcohol than older agents. It may be prescribed for men who value rapid, on-demand use or who did not tolerate other PDE-5 inhibitors well.
Vardenafil (Levitra, Staxyn) is a PDE-5 inhibitor used for erectile dysfunction that works similarly to sildenafil but may be slightly more potent in some men. It is taken about 30–60 minutes before sexual activity and lasts around 4–6 hours. It may be prescribed when sildenafil is ineffective or not well tolerated, offering another short-acting option with a reliable safety profile.
Tadalafil (Cialis) is an effective treatment for erectile dysfunction that lasts up to 36 hours, earning it the nickname “the weekend pill.” It can be prescribed as needed or as a daily low dose, making it a good option for men who prefer more spontaneity or who also have urinary symptoms from benign prostatic hyperplasia (BPH). It is often chosen when patients want longer duration or more flexible dosing than sildenafil.
Sildenafil is generally considered the first-line treatment for erectile dysfunction. It was the first oral PDE-5 inhibitor approved and has been available the longest, giving it a well-established track record of safety and effectiveness. With the availability of low-cost generics, it is often the most affordable option compared to newer agents. Its efficacy, tolerability, and accessibility make it the starting choice for many patients and physicians, though other PDE-5 inhibitors may be preferred depending on individual response, side effects, or desired duration of action.
Phenobarbital can be used in severe alcohol withdrawal, particularly when seizures are present or hard to control. Its long half-life provides steady protection against recurrent withdrawal seizures, but close monitoring is required due to the risk of oversedation or breathing problems.
Versed (midazolam) is often used in severe alcohol withdrawal, especially when seizures occur. Its rapid onset makes it highly effective for quickly calming agitation and stopping seizures. Due to its short duration, it is typically followed by longer-acting benzodiazepines to maintain control. Overall, Versed is best suited for acute stabilization, with other agents providing ongoing management.
The banana bag is a standard ER treatment for patients in alcohol withdrawal, especially those who are vomiting, confused, or unable to take medications by mouth. It provides thiamine, folate, multivitamins, and fluids to prevent serious complications like Wernicke’s encephalopathy and correct common deficiencies. However, if a patient is stable, not vomiting, and mentally clear, I usually skip the IV and give the pill equivalents with oral fluids instead. This approach is easier, just as effective in those cases, and avoids unnecessary IV use.
Chlordiazepoxide (Librium) works well as an outpatient option after withdrawal is stabilized in the ER. Its long half-life gives steady coverage and allows for a taper at home, reducing rebound symptoms.
Ativan (lorazepam) is a good option for alcohol withdrawal when there’s concern about advanced liver disease or changes in mental status. Because it has a shorter half-life than Valium, it doesn’t build up as much in the body, which lowers the risk of oversedation or confusion. It still does a solid job of easing anxiety, tremors, and preventing seizures, but often needs to be given more frequently. Overall, it’s a safer choice for medically fragile patients where longer-acting medications could cause problems.
Valium (diazepam) is often preferred in alcohol withdrawal because its long half-life allows for smoother coverage — I can load up a patient in the ER and sometimes carry them through the withdrawal period without frequent redosing. This makes it convenient in acute settings and reduces the risk of breakthrough seizures or agitation. However, caution is needed in patients with advanced liver disease, since impaired metabolism can lead to accumulation and oversedation. In those cases, shorter-acting benzodiazepines like lorazepam are often safer.
Lidocaine provides fast and effective relief from the pain, burning, and itching associated with hemorrhoids. It works by numbing the area, making it easier to sit, walk, or go to the bathroom during flare-ups. However, it does not reduce swelling or heal the hemorrhoids themselves, so it's best used for short-term symptom management alongside other treatments.
Preparation H is a good first-line therapy for relieving the symptoms of hemorrhoids, such as itching, burning, and swelling. It offers quick, over-the-counter relief and is available in multiple formulations to suit individual needs. While it doesn’t treat the underlying cause, it can significantly improve comfort during flare-ups.
Colace helps ease bowel movements and reduces the discomfort from hemorrhoids. It doesn't treat the hemorrhoids directly, but makes going to the bathroom less painful.
Topical Zovirax is convenient and well-tolerated for mild cold sores, but I prefer prescribing oral antivirals like acyclovir or valacyclovir for greater effectiveness in reducing symptom severity and duration.
Acyclovir can be an important treatment option for varicella (chickenpox) in patients at increased risk of complications. For individuals over 12 years old, those with chronic skin or lung conditions, on long-term salicylate therapy, or taking corticosteroids, oral acyclovir may help reduce the severity and duration of illness when started early. In more serious cases—such as varicella pneumonia, encephalitis, or in immunocompromised patients—intravenous acyclovir is the treatment of choice. While not routinely used in healthy children with mild disease, acyclovir is a valuable tool in preventing complications in higher-risk groups.
Hydroxychloroquine is a first-line, long-term treatment for chronic SLE and is recommended for nearly all patients. It helps reduce disease activity, prevent flares, and protect against long-term complications.
Prednisone is my first-line treatment for managing lupus flares because it works quickly to reduce inflammation and symptoms. However, it's not ideal for long-term use due to its side effects. As the disease stabilizes, the patient should be transitioned to steroid sparing medication.
I often recommend it before considering surgery, especially if symptoms are intermittent and not severely limiting.
Surgical release is a highly effective treatment for trigger finger, especially when other therapies like splinting or steroid injections have failed.
Corticosteroids can help speed up healing and reduce pain in acute herpes zoster when used with antivirals. However, they don't prevent postherpetic neuralgia and come with potential risks, so I use them selectively. The decision to prescribe them should always weigh the short-term benefits against the risk of side effects.
I often recommend calamine lotion as a gentle, supportive option for poison ivy. It doesn’t stop the rash itself but can help calm the itch, especially in mild cases or when used alongside stronger treatments.
I tend to prescribe Benadryl as another tool for managing itching from poison ivy, even though the evidence doesn’t strongly support its effectiveness. While it may not significantly reduce pruritus, it can help some patients sleep through the discomfort. I use it more as a supportive option rather than a primary treatment.
Famciclovir is another effective antiviral I sometimes use for cold sores—its single-dose option is convenient. It works similarly to Valtrex and is a good alternative if other treatments aren't ideal.
Abreva can help speed up recovery if applied early, and I use it alongside Valtrex or other antivirals for extra support. It’s a convenient, over-the-counter option that adds a layer of defense during outbreaks.
Acyclovir works similarly to Valtrex (valacyclovir) in treating HSV-1, but it requires more frequent dosing, which can make it less convenient. However, it's often more affordable and still effective when taken as prescribed. It's a good option for those looking for a lower-cost treatment.
Valacyclovir is my first-line treatment for cold sores—it works quickly when taken at the first sign of symptoms. I also use it as a preventive option to reduce the frequency of future outbreaks.
Benlysta (belimumab) is used for moderate to severe lupus when standard treatments aren’t enough, especially in autoantibody-positive patients. It helps reduce flares, lower steroid use, and is approved for lupus nephritis as an add-on therapy. It’s generally well tolerated and given by IV or subcutaneous injection.
Azathioprine is a second-line immunosuppressive therapy for lupus, often used when corticosteroids or hydroxychloroquine alone are not sufficient. It is particularly helpful as a steroid-sparing agent and is commonly used for moderate disease or maintenance after lupus nephritis. It is chosen for its relatively mild side effect profile, oral dosing, and safety in pregnancy, making it a good option for long-term immune control. It’s often preferred when mycophenolate or cyclophosphamide are not tolerated or contraindicated.
Shingrix is a highly effective shingles vaccine, reducing the risk of herpes zoster and postherpetic neuralgia by over 90%. It is recommended for adults 50 and older, with a strong safety profile despite some short-term side effects like injection site pain and fatigue. Its long-lasting protection makes it the preferred vaccine for shingles prevention.
Famciclovir is comparable to valacyclovir in effectiveness for treating shingles, helping to reduce rash duration and the risk of postherpetic neuralgia. It may have a slightly better side effect profile, with fewer reports of gastrointestinal symptoms. However, valacyclovir is often preferred due to better insurance coverage and simpler dosing, making it more widely used in clinical practice.
Acyclovir is a first-line antiviral option for shingles, especially when cost is a concern. It effectively reduces rash duration and complications like postherpetic neuralgia. However, it requires more frequent dosing (800 mg five times daily) compared to alternatives like valacyclovir, which may affect adherence.
Valacyclovir is a first-line antiviral treatment for herpes zoster, recommended for reducing rash duration, pain severity, and risk of postherpetic neuralgia. It is best initiated within 72 hours of rash onset and is generally well tolerated. Its convenient dosing and effectiveness make it a preferred option over acyclovir in many cases.
Splinting is a conservative and effective first-line treatment for a partial A1 pulley injury. By limiting MCP joint flexion, it reduces strain on the injured pulley while allowing safe tendon gliding. It’s especially useful in early healing and for preventing symptom recurrence during activity.
Corticosteroid injection is an effective, minimally invasive treatment for trigger finger, especially when splinting or physical therapy hasn't worked. It offers fast relief by reducing inflammation at the A1 pulley and is often successful after just one dose. Consider it when symptoms persist or interfere with daily activities, particularly in non-diabetic patients.
Splinting is considered a first-line therapy for trigger finger, especially in mild to moderate cases. It helps reduce tendon irritation by limiting movement and allowing inflammation to subside. Nighttime use is often effective, and many patients see symptom improvement within a few weeks. It's a non-invasive, low-risk option before considering steroid injections or surgery.
Leuprolide is a preferred ADT option due to its proven effectiveness, widespread availability, and multiple dosing schedules (e.g., monthly, every 3, 4, or 6 months). It is usually administered for 4–6 months alongside radiation in this setting, and while effective, it can cause side effects like hot flashes, fatigue, loss of libido, and metabolic changes.
EBRT is a strong, non-surgical option for unfavorable intermediate-risk prostate cancer, offering excellent cancer control when combined with short-term androgen deprivation therapy. It’s ideal for patients who prefer to avoid surgery or have other health conditions that make surgery risky. Though treatment spans several weeks, it is well-tolerated and avoids the risks of incontinence and surgical complications.
Radical prostatectomy provides strong long-term cancer control and allows for accurate staging. It’s often chosen by patients who want curative treatment, though it carries risks like urinary incontinence and erectile dysfunction and may be followed by radiation if adverse features are found postoperatively.
Brachytherapy is a strong option for favorable intermediate-risk prostate cancer because it delivers high-dose, targeted radiation in a one-time, minimally invasive procedure. It offers excellent cancer control with fewer bowel side effects and is ideal for patients with smaller prostates and minimal urinary symptoms who prefer to avoid surgery.
EBRT is a strong non-surgical option for favorable intermediate-risk prostate cancer, especially for patients who prefer to avoid surgery or have other health concerns. It is well tolerated but may cause side effects such as urinary urgency, bowel changes, and gradual decline in erectile function.
Radical prostatectomy is a curative, first-line option for favorable intermediate-risk prostate cancer, particularly for patients who want definitive treatment and are good surgical candidates. It provides excellent cancer control and staging information but comes with potential side effects like urinary incontinence and erectile dysfunction, which should be considered in decision-making.
Active surveillance may be chosen for favorable intermediate-risk prostate cancer to avoid the side effects of surgery or radiation while closely monitoring for progression. It is especially appropriate for older patients, those with other health conditions, or men who prefer a less aggressive approach. While there is a slightly higher risk of progression compared to low-risk disease, many men can safely delay treatment for years with careful follow-up.
EBRT is a non-surgical option that offers similar cancer control to radical prostatectomy but with fewer risks of urinary incontinence and a less invasive recovery. It's often preferred by older patients or those who wish to avoid surgery and its potential complications.
Radical prostatectomy may be chosen for low-risk prostate cancer in younger, healthy men who prefer definitive treatment or feel anxious about active surveillance. It eliminates the cancer but comes with risks like urinary incontinence and erectile dysfunction, which must be weighed against the low likelihood of progression.
Active surveillance is preferred for low-risk prostate cancer because the annual risk of progression is low (about 5–10% per year), and the likelihood of metastasis or prostate cancer-specific mortality is extremely low over long-term follow-up.
Dupixent is an add-on biologic therapy for moderate to severe asthma with an eosinophilic phenotype or oral steroid dependence. It helps reduce exacerbations and steroid use in patients who are not well-controlled on traditional inhalers. Dupixent is typically used when step 4 or 5 of the asthma treatment algorithm is reached.
Medrol Dosepak is a convenient, pre-packaged oral steroid taper that helps patients gradually reduce their corticosteroid dose over several days. It's commonly used in asthma exacerbations when a controlled steroid taper is needed to prevent rebound symptoms. The built-in schedule improves adherence and reduces confusion around dosing.
Prednisone is reserved for short-term use in moderate to severe asthma exacerbations or uncontrolled asthma. It provides rapid symptom relief but are not first-line maintenance therapy due to their systemic side effect profile.
Atrovent is used as an adjunctive bronchodilator in acute asthma exacerbations, particularly in the emergency department alongside albuterol. It is not a first-line maintenance therapy for asthma but can be beneficial for patients who have intolerances to beta-agonists or need additional relief during severe attacks.
Fluticasone furoate is a once-daily inhaled corticosteroid that provides effective asthma control and may require lower doses than older ICS options like fluticasone propionate. While it typically retails at a higher price, manufacturer discount programs may significantly reduce out-of-pocket costs for eligible patients.
Budesonide is a reliable inhaled corticosteroid for controlling persistent asthma, often preferred for its availability in nebulized form and lower risk of throat irritation. Compared to fluticasone, it has a slightly faster onset and may be better tolerated in some patients, though both are similarly effective.
Levalbuterol has similar effectiveness to albuterol but is typically reserved for patients who experience side effects like tachycardia or jitteriness from albuterol. Due to its higher cost, it’s not usually used as a first-line option unless better tolerated.
Symbicort is often selected as a first-line therapy for moderate to severe asthma because it combines daily inflammation control with rapid symptom relief, thanks to its fast-acting formoterol component. Its ability to be used both as maintenance and as-needed therapy (SMART approach) offers greater flexibility and may reduce the risk of exacerbations.
Digoxin is used as an add-on therapy in CHF patients with persistent symptoms or concurrent atrial fibrillation. While it doesn't reduce mortality, it can improve symptoms and reduce hospitalizations, but requires careful monitoring due to its narrow safety margin.
Albuterol is a first-line bronchodilator for COPD and provides rapid relief of symptoms by relaxing airway muscles. In cases of mild COPD with infrequent symptoms, it may be sufficient as the sole treatment.
Tiotropium, a long-acting muscarinic antagonist, is recommended by GOLD guidelines as a first-line maintenance therapy for patients with moderate to severe COPD. It can be used alone or combined with a LABA or ICS, depending on disease severity and exacerbation risk.
Aclidinium/Formoterol is a LAMA/LABA combination used as maintenance therapy for patients with moderate to severe COPD who need dual bronchodilation. It is recommended for those with persistent symptoms or frequent exacerbations despite monotherapy. A generic version is available in the U.S., offering a more affordable option for long-term treatment.
Trelegy Ellipta is a convenient and effective once-daily triple therapy for COPD, combining a LAMA, LABA, and ICS in a single inhaler. It’s ideal for patients with ongoing symptoms or frequent exacerbations despite dual therapy. However, it is not yet available in a generic form, which may affect affordability for some patients.
Fluticasone propionate can be added to existing LABA/LAMA therapy to create a triple therapy regimen for COPD, especially in patients with frequent exacerbations. This approach offers flexibility and may be more cost-effective, as generic versions of fluticasone are available. It’s a practical alternative for patients who need triple therapy but are looking to reduce medication costs.
Oxygen therapy is beneficial for COPD patients with severe hypoxemia (SpO₂ ≤88%), improving survival and quality of life. For those with moderate hypoxemia (PaO₂ 55–60 mm Hg or SpO₂ 88–92%), studies like the LOTT trial show no clear long-term mortality benefit. However, short-term use during acute illness or exacerbations may still provide symptomatic relief and clinical benefit.
Lung Volume Reduction Surgery (LVRS) is a more drastic treatment option for patients with severe, upper-lobe–predominant emphysema and significant symptoms despite maximal medical therapy.
Annual vaccination is a simple and effective way to protect lung function and prevent flare-ups.
Metformin is an affordable, first-line treatment for type 2 diabetes that effectively lowers blood sugar with a low risk of hypoglycemia. It may also promote weight loss and offer cardiovascular benefits, though side effects like nausea, diarrhea, and rare lactic acidosis can occur.
GLP-1 receptor agonists like liraglutide have become increasingly prominent in type 2 diabetes treatment because they lower blood sugar while promoting significant weight loss. Liraglutide, a daily injection, offers strong evidence for both weight loss and cardiovascular protection, making it a preferred option for patients with obesity or high cardiovascular risk. As a result, it is now often integrated earlier into diabetes treatment regimens.
Sugary beverages, especially those with high-fructose corn syrup, raise uric acid levels by increasing purine metabolism, contributing to hyperuricemia and gout flares. Studies show a strong association, with a 35% higher risk of hyperuricemia among high consumers. While the exact benefit of eliminating these drinks isn't precisely quantified, reducing intake is recommended to help lower uric acid and prevent gout attacks.
Avoiding red meat can help reduce uric acid levels and lower the risk of gout flares, as it is high in purines that contribute to hyperuricemia. However, clinical trials have shown only modest benefits from dietary changes alone, with urate reductions generally less than 1 mg/dL. Thus, limiting red meat should be part of a broader gout management strategy that includes lifestyle changes and medication when needed.
Weight loss is the traditional first-line treatment for type 2 diabetes, as it can significantly improve blood sugar control and even lead to remission. However, achieving and maintaining weight loss is often challenging in practice due to the difficulty of sustaining long-term lifestyle changes. As a result, many patients eventually require medication alongside lifestyle efforts.
In the ER, dihydroergotamine (DHE) is used for acute treatment of severe or refractory migraines, especially when triptans fail. It provides relief by constricting blood vessels and reducing neuroinflammation, but is avoided in patients with cardiovascular risk.
Betamethasone is a strong prescription corticosteroid that's more potent than over-the-counter hydrocortisone. It's highly effective at reducing inflammation, redness, and itching during eczema flares. However, due to its strength, it should be used short-term and only on affected areas, as long-term use can lead to side effects like skin thinning. It's best reserved for more severe or stubborn eczema that doesn't respond to milder treatments.
Vtama is a non-steroidal, prescription cream for eczema that reduces inflammation by targeting the aryl hydrocarbon receptor (AhR). It's safe for use on sensitive areas like the face and has no restrictions on duration or body surface area. Clinical trials show strong results for itch and skin clearance by 8 weeks.
Allegra (fexofenadine) is an over-the-counter, non-drowsy antihistamine that can help relieve itching associated with eczema, particularly when allergies are a contributing factor. While it doesn't address the underlying inflammation of eczema, studies have shown that adding fexofenadine to topical corticosteroids can significantly reduce pruritus in atopic dermatitis patients . Allegra is generally well-tolerated, but it's important to take it with water, as fruit juices can decrease its absorption.
Flonase can help reduce cough caused by post-nasal drip by relieving nasal inflammation and mucus drainage.
Allopurinol is considered first-line therapy for long-term management of gout by lowering uric acid levels and preventing flares. However, I’ve had a family member who developed Stevens-Johnson syndrome from this medication, so I’m cautious about its risks despite its effectiveness.
Colchicine is a first-line treatment for acute gout flares, especially when started within the first 24 hours of symptoms. It helps reduce inflammation and pain, though gastrointestinal side effects like diarrhea are common.
Indomethacin is often my go-to for acute gout flares, largely due to medical tradition and its strong track record in crystal-induced arthritis. That said, other NSAIDs like naproxen or ibuprofen are generally just as effective. I continue to prescribe indomethacin in many cases, but I’m mindful of its higher risk of side effects, including GI irritation, CNS effects, and kidney strain. Safer alternatives may be preferred depending on the patient's overall health.
Staying well-hydrated helps lower uric acid levels and can reduce the frequency of gout attacks. Drinking plenty of water supports kidney function and promotes the excretion of uric acid. It’s a simple but effective lifestyle measure in managing gout.
Reducing or discontinuing alcohol intake can lead to modest decreases in serum uric acid levels, particularly in individuals with hyperuricemia. Episodic drinking significantly increases the risk of recurrent gout attacks, prompting clinical guidelines to recommend limiting alcohol as part of gout management.
Semaglutide is a once-weekly GLP-1 receptor agonist that lowers blood sugar, promotes weight loss, and reduces cardiovascular risk in type 2 diabetes. Its strong efficacy and convenience make it a preferred option, especially for patients with obesity or heart disease risk.
Dulaglutide is a once-weekly GLP-1 receptor agonist that lowers blood sugar, supports weight loss, and provides cardiovascular protection in type 2 diabetes. It is often chosen over other GLP-1s for its simple, easy-to-use pen and minimal dose adjustments, making it ideal for patients who prefer convenience.
The Epley maneuver is a highly effective, first-line treatment for benign paroxysmal positional vertigo (BPPV). It works by repositioning dislodged inner ear crystals to relieve dizziness and vertigo. Most patients experience significant improvement after just one or two treatments.
I use prednisone when NSAIDs or colchicine are contraindicated or poorly tolerated. It is often used in patients with kidney disease, gastrointestinal issues, or those who cannot take other anti-inflammatory medications. However, it is not used for long-term urate-lowering therapy.
Deep nasal suction for RSV can offer noticeable relief in select severe cases, particularly in infants struggling with significant nasal congestion and respiratory distress. While the broader research does not show consistent, significant benefits across all populations, it does suggest that certain subgroups may experience improvements without adverse physiologic effects. Despite being more invasive than standard suctioning, it remains a reasonable option in targeted situations where other measures fall short.
Dextromethorphan is a common first-line OTC therapy for symptomatic relief of dry, non-productive cough in acute bronchitis. It helps suppress the cough reflex, providing short-term relief, particularly useful for improving sleep and comfort. While it doesn't treat the underlying cause, it can ease symptoms during the recovery period.
Honey is a natural first-line option for symptomatic relief of cough in bronchitis, particularly in children over age one and adults. It soothes the throat and may reduce cough frequency and severity, especially at night. While it doesn’t treat the underlying infection, it is a safe and inexpensive remedy for mild cases.
Guaifenesin is a commonly used first-line therapy for bronchitis to help loosen and clear mucus from the airways. It made coughing more productive and reduced chest congestion, making it easier to breathe. While the effect is mild, it can be a helpful addition to supportive care.
Some patients strongly believe that promethazine with codeine is the only thing that truly helps their bronchitis-related cough. While I acknowledge it can be effective for severe symptoms, I’m generally reluctant to prescribe it due to the risk of opioid dependence, sedation, and respiratory depression. I reserve it for select cases where other treatments have failed and the benefit clearly outweighs the risk.
Benzonatate is an effective option for treating dry, irritating coughs by numbing the cough reflex at its source. It is a non-narcotic alternative to other cough suppressants, providing relief with minimal central nervous system effects. Proper use is essential to avoid potential side effects. Always follow the prescribing physician’s directions.
I’ll consider prescribing azithromycin for bronchitis if the patient is very symptomatic and I’m concerned about a possible bacterial component. It’s also appropriate in patients with risk factors like COPD or a significant smoking history. While not routinely needed, it can be helpful in select high-risk cases.
Doxycycline is a good substitute for azithromycin when there's concern for a bacterial component in bronchitis, especially since it also covers atypical pathogens. I’ll consider it in patients with COPD, prolonged symptoms, or when azithromycin isn’t a good option. It’s generally well tolerated and effective in the right clinical context.
The DASH diet is a highly effective first-line therapy for managing hypertension through nutrition. By emphasizing fruits, vegetables, whole grains, and low sodium intake, it helps lower blood pressure naturally without medication. It’s a sustainable, evidence-based approach recommended in most clinical guidelines.
Hydrochlorothiazide (HCTZ) is included as a first-line option in most hypertension treatment algorithms, particularly in patients without compelling comorbidities. HCTZ is often used as monotherapy for stage 1 hypertension or in combination with other agents for better blood pressure control. It's especially favored in older adults and Black patients due to its effectiveness in salt-sensitive hypertension.
Pegloticase is a third-line treatment for chronic, refractory gout, used when standard urate-lowering therapies like allopurinol or febuxostat fail or are not tolerated. It is highly effective but can cause serious side effects such as infusion reactions and anaphylaxis, requiring close monitoring and premedication. The treatment is expensive, with costs exceeding $30,000 per month, though financial assistance programs may help offset the price for eligible patients.
Probenecid is effective for lowering uric acid in under-excreters but is considered a second-line agent after xanthine oxidase inhibitors like allopurinol or febuxostat. It's mainly used when first-line therapies are contraindicated or not tolerated.
Cranberry juice is a low-cost option that may help prevent recurrent urinary tract infections by reducing bacterial adherence in the urinary tract. However, it does not treat active UTIs and should not be used as a substitute for antibiotics. Its benefits are mostly seen in prevention, particularly with regular use of unsweetened juice or concentrated supplements. While not guaranteed to work for everyone, it’s a safe and inexpensive addition to a broader prevention plan.
The Semont maneuver is an alternative to the Epley maneuver for treating BPPV and can be especially helpful for patients who need a faster, more forceful repositioning of inner ear crystals. While the Epley maneuver moves the head slowly through a series of positions, the Semont maneuver uses rapid side-to-side movements to dislodge the crystals. The Semont maneuver is a viable and effective option for treating BPPV, with comparable short-term efficacy to the Epley maneuver, though the Epley maneuver may have better long-term outcomes.
Meclizine is considered first-line for symptomatic relief of dizziness and nausea in BPPV. While it does not correct the underlying cause, it helps manage symptoms during acute episodes. It is best used short-term alongside repositioning maneuvers for definitive treatment.
The Lempert maneuver, also known as the barbecue roll, is a highly effective treatment for horizontal canal BPPV. It works by slowly rotating the patient 360 degrees to move displaced crystals out of the horizontal semicircular canal. Compared to other maneuvers, it is specifically more effective for horizontal BPPV, helping to relieve symptoms quickly in many patients.
Diazepam can be used for patients with severe BPPV symptoms who do not improve with repositioning maneuvers and first-line medications like meclizine. It helps control intense vertigo and anxiety by calming the vestibular system, providing short-term relief. However, it is generally reserved for difficult cases due to the risk of sedation, falls, and dependence with prolonged use.
Physical therapy is one of the first-line treatments for rotator cuff injuries, helping to reduce pain, improve strength, and restore shoulder function. It focuses on gradually rebuilding stability and flexibility, allowing many patients to recover without the need for surgery. Early and consistent therapy is key to achieving the best outcomes.
Ibuprofen is considered first-line therapy for managing pain and inflammation in rotator cuff injuries. It helps reduce swelling, ease discomfort, and support participation in physical therapy. While it does not heal the injury itself, it plays an important role in early symptom control and overall recovery.
Ice is considered first-line treatment for a rotator cuff injury during the first 48 to 72 hours. It helps reduce swelling, numb pain, and limit inflammation early in the healing process. Regular ice application can make recovery more comfortable and support better outcomes when combined with other treatments.
PRP therapy for rotator cuff injuries is considered experimental, with mixed evidence regarding its long-term effectiveness. However, it offers a less invasive option compared to surgery and may provide pain relief and promote healing in select patients. It is often considered when conservative treatments have failed but before moving to surgical intervention.
Arthroscopic rotator cuff repair is a minimally invasive procedure used to reattach torn rotator cuff tendons to the bone and is typically considered after failure of conservative treatments like physical therapy, medications, and activity modification. . It fits into the treatment regimen for patients with full-thickness tears, large partial tears, or persistent symptoms that significantly limit function despite non-surgical management. This approach offers less pain, smaller scars, and quicker initial recovery compared to open surgery.
Benzoyl peroxide is considered a first-line topical therapy for mild bacterial folliculitis, particularly when caused by Staphylococcus aureus. It is often used alone for initial treatment or in combination with topical or oral antibiotics in more persistent cases. Its broad antibacterial activity and low risk of bacterial resistance make it a useful early option, especially for superficial, non-severe folliculitis.
Clindamycin is effective for folliculitis and offers coverage against MRSA, making it useful for resistant infections. However, it carries a higher risk of side effects, including potential C. difficile infection.
Doxycycline is a good option for covering MRSA-related folliculitis due to its effectiveness against resistant Staphylococcus aureus and its added anti-inflammatory benefits. To ensure broader bacterial coverage, I often pair it with another antibiotic like cephalexin , which targets non-MRSA pathogens.
Lisinopril is used as a first-line treatment for hypertension, especially in patients with compelling indications such as diabetes, chronic kidney disease (CKD) with proteinuria, or heart failure with reduced ejection fraction (HFrEF). It’s also suitable for younger, non-Black patients without contraindications. Its benefits include not only lowering blood pressure but also protecting the kidneys and heart. However, it should be avoided in pregnancy and used cautiously in patients with bilateral renal artery stenosis or a history of angioedema.
Albuterol is a helpful first-line therapy for bronchitis when bronchospasm is present. I typically use it if the patient has a history of asthma, reactive airway disease, or demonstrates improvement with a test dose in the emergency department. It works quickly to relieve wheezing and shortness of breath, and can significantly improve comfort and airflow in the right patients. While not needed for all cases, it's an effective option when bronchospasm is contributing to symptoms.
Cyclobenzaprine is used off-label for fibromyalgia to improve sleep quality and reduce muscle tension, particularly in patients with prominent sleep disturbances. While not a first-line treatment, it can be a helpful adjunct for nighttime symptom relief. Its benefits are mainly due to its sedating and muscle-relaxing effects.
Milnacipran is a first-line pharmacologic treatment for fibromyalgia, particularly effective in reducing pain and fatigue. As an SNRI, it modulates pain processing in the central nervous system and is typically used when non-drug therapies are insufficient. Approved specifically for fibromyalgia, milnacipran may be more energizing than other SNRIs, making it a good option for patients with prominent fatigue but without major mood symptoms.
Pregabalin (Lyrica) is an FDA-approved, first-line treatment for fibromyalgia that helps reduce nerve-related pain and improve sleep quality. It is especially useful for patients with prominent neuropathic symptoms, though side effects like dizziness and weight gain can limit its use. It’s typically considered when non-pharmacologic strategies or other medications are not sufficient.
Duloxetine is a first-line pharmacologic treatment for fibromyalgia, particularly effective for patients with both pain and mood symptoms. As an SNRI, it helps reduce central pain sensitization and has shown benefit in improving function and quality of life. It’s commonly used when non-drug approaches like exercise or CBT are not enough.
CBT is effective in improving quality of life, physical functioning, and mood in fibromyalgia patients, with robust evidence supporting its use from multiple high-quality studies and clinical guidelines.
Aerobic exercise is effective in reducing pain and improving quality of life in fibromyalgia patients, with optimal benefits achieved at 90 minutes per week. This intervention is well-supported by systematic reviews and meta-analyses, as well as clinical practice guidelines.
Benadryl can help relieve some of the dizziness and nausea from BPPV, especially if you don’t have access to other treatments. It may take the edge off symptoms, but it doesn’t fix the underlying problem. Be aware it can make you quite drowsy, which might affect your balance even more. Still, it’s a reasonable option if nothing else is available.
Bazedoxifene combined with conjugated estrogens is a non-progestin option for treating menopausal symptoms in women with a uterus, offering relief from hot flashes while protecting the endometrium. It is a useful alternative for those who cannot tolerate progestins, but carries a risk of blood clots. It is contraindicated in women with a history of venous thromboembolism, stroke, or estrogen-sensitive cancers.
Estrogen and progestin (combined oral contraceptives) are prescribed for women with moderate to severe or hormonally driven acne, especially when topical treatments are insufficient or acne flares with menstrual cycles. They carry risks such as blood clots, stroke, and hypertension—particularly in smokers or women over 35—and should be used with caution in those with cardiovascular risk factors.
Human regular insulin is an effective mealtime insulin option for patients with type 2 diabetes who require tighter glucose control. I typically use it when oral medications and basal insulin are insufficient, especially in resource-limited settings where cost is a concern. Although it works well, it requires dosing 30 minutes before meals and has a higher risk of hypoglycemia compared to rapid-acting insulin analogs.
Human regular insulin is a short-acting insulin used in type 1 diabetes to manage blood sugar around meals. It fits into a basal-bolus regimen as the bolus (mealtime) insulin, though it requires careful timing—typically 30 minutes before eating—due to its slower onset compared to rapid-acting insulins. It’s a reliable option, especially when cost is a concern, but less convenient than newer analogs.
Clonidine is used for hypertension primarily in cases of resistant high blood pressure or for short-term outpatient control when rapid lowering is needed. It’s not a first-line choice due to side effects and risk of rebound hypertension, but it is effective when other options have failed.
Prednisolone 1% eye drops are a first-line treatment for iritis, helping to quickly reduce inflammation and prevent complications. They're effective but require close follow-up due to potential side effects like elevated intraocular pressure or cataract formation.
Atropine is a supportive, first-line adjunct treatment for iritis used to dilate the pupil, relieve pain from ciliary spasm, and prevent iris-lens adhesions (posterior synechiae). It is typically used alongside corticosteroid drops like prednisolone to manage inflammation and reduce complications. Though effective, it can cause blurred vision and light sensitivity.
Sacubitril/Valsartan is a first-line therapy for heart failure with reduced ejection fraction, offering improved survival and reduced hospitalizations compared to ACE inhibitors. It is generally well tolerated but requires monitoring for hypotension, kidney function, and potassium levels.
Hydralazine is typically used after labetalol or other beta-blockers in preeclampsia to manage severe hypertension while minimizing the risk of reflex tachycardia. It serves as a second-line agent when additional blood pressure control is needed.
Labetalol is a first-line treatment for managing hypertension in preeclampsia due to its safety and effectiveness in pregnancy. It’s commonly used for both acute and ongoing blood pressure control.
Delivery is the only definitive treatment for preeclampsia, as the condition typically resolves after the placenta is removed. However, the decision to deliver must carefully balance the risks of worsening maternal disease with the potential long-term complications of prematurity for the baby.
Topical roflumilast is a non-steroidal PDE4 inhibitor approved for mild-to-moderate eczema and fits into the treatment algorithm as an alternative to topical corticosteroids or calcineurin inhibitors. It is particularly useful for patients who need long-term topical control or who experience side effects from steroids. For patients already on a systemic biologic, roflumilast may be used as an adjunct or alternative topical option to demonstrate adequate topical therapy when seeking insurance approval.
Cochlear implants can be effective in reducing tinnitus in patients with severe sensorineural hearing loss, often providing partial or complete relief by restoring auditory input and promoting neural reorganization. They are not approved solely for tinnitus treatment but may offer significant benefit when hearing loss is also present.
Sertraline may be considered for patients with tinnitus who also have comorbid anxiety or depression, as it can help reduce emotional distress and improve coping.
Research on sound generators for tinnitus shows mixed results, with modest improvements in perceived tinnitus distress, particularly when used alongside counseling or cognitive behavioral therapy. They are not proven to reduce the tinnitus sound itself but can help promote habituation and improve quality of life in some patients.
Sublingual nitroglycerin is a fast and readily available option in the ER for managing acute CHF, providing rapid symptom relief while waiting for IV access or for medications like furosemide to take effect. It helps reduce preload and improve breathing within minutes, making it a practical bridge therapy in the early phase of treatment.
Nitroprusside is a potent, titratable IV vasodilator for acute decompensated CHF, providing rapid relief by reducing both preload and afterload. However, because it requires ICU-level monitoring due to risks like hypotension and cyanide toxicity, I often prefer other vasodilators such as IV nitroglycerin. In many cases, patients can be effectively stabilized with alternative medications without needing ICU admission.
Furosemide is one of the first-line treatments in the emergency setting for decompensated CHF, as it rapidly reduces pulmonary congestion and relieves dyspnea. Its diuretic effect typically begins within 5 minutes when given intravenously, making it ideal for acute symptom management.
Magnesium sulfate is the first-line treatment for seizure prevention in severe preeclampsia. It significantly reduces the risk of progression to eclampsia and is closely monitored to avoid toxicity, with deep tendon reflexes serving as an early indicator.
Spironolactone is a potassium-sparing diuretic commonly used for heart failure with reduced ejection fraction (HFrEF), particularly in patients with persistent symptoms despite ACE inhibitors and beta blockers. It has been shown to reduce mortality and hospitalization, but requires monitoring for hyperkalemia and renal function. It is generally low-cost, with generic versions widely available.
Losartan is an effective and well-tolerated treatment for hypertension, often used as a first-line option or as a substitute for ACE inhibitors when patients experience side effects like cough. I commonly prescribe it for patients with hypertension and coexisting diabetes or chronic kidney disease, due to its kidney-protective effects. It’s a good choice for long-term control, with a low risk of side effects and convenient once-daily dosing.
Amlodipine is a well-established first-line treatment for hypertension, particularly effective in older adults and Black patients, where it often outperforms ACE inhibitors. It’s also a good option for patients without compelling comorbidities who need long-term blood pressure control. Its once-daily dosing and low side effect profile make it a convenient and reliable choice.
Dietary modification is a cornerstone of CKD management—reducing sodium, processed foods, and excess animal protein helps minimize kidney stress and slow disease progression. Simply put, less junk in means less damage to the kidneys over time.
Avoiding further kidney damage in CKD involves recognizing and minimizing the use of commonly used nephrotoxic medications, such as NSAIDs, certain antibiotics, and over-the-counter supplements. Even everyday drugs like metformin, PPIs, and gabapentin can accumulate or cause harm if not properly adjusted for kidney function.
Research shows that smoking contributes to the progression of CKD by worsening proteinuria and accelerating loss of kidney function. Quitting smoking can significantly slow disease progression and lower cardiovascular risk.
OnabotulinumtoxinA is effective for chronic migraine and can significantly reduce the number of headache days over time. It is typically used when patients have not responded to or cannot tolerate oral preventive therapies.
Claritin is a popular choice for allergic rhinitis because it provides effective symptom relief with minimal drowsiness, unlike first-generation antihistamines like Benadryl. It’s taken once daily and is well tolerated, making it a convenient, non-sedating option for long-term allergy management. Compared to alternatives like Zyrtec or Allegra, Claritin is less likely to cause fatigue but may have a slightly slower onset.
Dapagliflozin is a first-line treatment for heart failure, recommended alongside standard therapies to reduce hospitalizations and cardiovascular death. It is brand-name only and more expensive than generics, but typically covered by insurance due to its proven benefits.
Cognitive Behavioral Therapy is a first-line treatment for patients with bothersome chronic tinnitus, particularly when accompanied by anxiety, depression, or sleep issues. Strong research, including multiple randomized controlled trials, supports its effectiveness in reducing tinnitus-related distress and improving quality of life, even though it doesn’t reduce the sound itself. It is recommended by clinical guidelines as the most evidence-based behavioral intervention for tinnitus.
Metoprolol succinate is a first-line, guideline-recommended beta-blocker for heart failure with reduced ejection fraction (HFrEF), shown to reduce mortality and hospitalizations. It is generally well tolerated, improves heart function over time, and is available as a low-cost generic, making it an accessible option for long-term management. Only the extended-release (succinate) form is used for CHF.
Research shows SPG blocks can provide rapid relief in acute migraine, particularly with autonomic symptoms like tearing or nasal congestion, and may be effective in status migrainosus. Compared to occipital nerve blocks, SPG blocks are more commonly used for frontotemporal or trigeminal-dominant headaches, while occipital blocks target posterior or cervicogenic components. Choice depends on headache location and symptom profile.
Occipital nerve blocks are considered a second-line or adjunctive therapy for migraines, particularly effective in patients with frequent or treatment-resistant headaches. Multiple studies, including meta-analyses, show they significantly reduce migraine frequency and intensity with a favorable safety profile. Relief can begin within 30 minutes and last from days to weeks.
Rizatriptan is a first-line treatment for acute migraine due to its fast onset of action, often providing relief within an hour. It’s a preferred option for patients needing quick symptom control, especially when taken early in the attack.
Water intake is an important factor in managing chronic kidney disease, but there’s no one-size-fits-all recommendation. It should be personalized based on kidney function, symptoms, and other health conditions—and always discussed with a physician.
Carvedilol is not usually a first-line treatment for uncomplicated hypertension but is highly valuable in patients with heart failure, post-MI, or other forms of cardiovascular disease. Its combined beta- and alpha-blocking effects help lower blood pressure while also improving heart function. Carvedilol is typically used when when hypertension coexists with reduced ejection fraction or other cardiac indications.
Methyldopa is a safe, well-established antihypertensive used primarily for chronic hypertension during pregnancy. Due to its slow onset and modest potency, it is not suitable for acute blood pressure control in severe preeclampsia. It is generally reserved for long-term outpatient use rather than inpatient or emergency settings.
Cognitive Behavioral Therapy is considered first-line therapy for most anxiety disorders, including generalized anxiety, social anxiety, and panic disorder. It is highly effective, often as effective as medication, and can provide long-term relief by addressing the underlying thought and behavior patterns that fuel anxiety.
Fluoxetine may be preferred for anxiety in patients who benefit from its long half-life, which reduces withdrawal risk and allows more flexible dosing. It's also a good option for individuals with coexisting depression or fatigue, as it can have a mildly energizing effect.
Pregabalin is not approved for anxiety in the U.S., but it is approved for generalized anxiety disorder in Europe and is commonly used off-label. It may be a good option for patients who also suffer from neuropathic pain, as it is FDA-approved for conditions like diabetic neuropathy and fibromyalgia. Its quick onset and dual benefit make it a practical choice when treating both anxiety and chronic pain.
Lexapro (escitalopram) is often chosen for anxiety because it’s highly effective, well-tolerated, and has a relatively clean side effect and drug interaction profile. It may cause fewer activating or sedating effects than other SSRIs, making it a balanced option for many patients. Its once-daily dosing and consistent therapeutic response contribute to high patient adherence.
Buspirone is considered a second-line treatment for generalized anxiety disorder (GAD), typically used when patients cannot tolerate or do not respond well to SSRIs or SNRIs. It is non-sedating, non-addictive, and has a lower side effect burden, but its efficacy is generally more modest compared to first-line SSRIs like sertraline or escitalopram. It’s a good option for patients seeking an alternative to antidepressants or those concerned about sexual or cognitive side effects.
IV Depakote (valproate) is used in the emergency setting for acute migraine relief, especially in patients who cannot tolerate oral medications or when nausea/vomiting is present. It often provides pain reduction within 30–60 minutes and is generally well tolerated. Oral valproate (divalproex sodium) is approved for migraine prevention, particularly effective in patients with frequent, severe migraines. It is typically reserved for those who do not respond to first-line preventive agents due to its side effect profile, which includes weight gain, fatigue, tremor, and teratogenicity.
Sertraline is often preferred for anxiety because it has strong evidence across multiple anxiety disorders, including GAD, panic disorder, and social anxiety. It tends to be well-tolerated, with a relatively low risk of sedation or weight gain compared to some other SSRIs.
Estrogen plus progestin therapy is used for menopausal symptom relief in women with an intact uterus, with progestin added to protect against estrogen-induced endometrial hyperplasia. This combination is effective for hot flashes, night sweats, and vaginal dryness, but should be used at the lowest effective dose and shortest duration due to risks like breast cancer, blood clots, and stroke.
Estrogen therapy is a first-line treatment for moderate to severe menopausal symptoms such as hot flashes and vaginal dryness, especially in women without a uterus. It is effective but should be used at the lowest dose for the shortest duration possible due to potential risks, including blood clots, stroke, and breast cancer.
Some patients strongly believe that promethazine with codeine is the only thing that truly helps their cough. While I acknowledge it can be effective for severe symptoms, I’m generally reluctant to prescribe it due to the risk of opioid dependence, sedation, and respiratory depression. I reserve it for select cases where other treatments have failed and the benefit clearly outweighs the risk.
While not a first-line treatment like desmopressin (DDAVP) or factor replacement (e.g., Humate-P), it is effective in mild cases or as adjunctive therapy during procedures or menstruation. Aminocaproic acid is generally well-tolerated and inexpensive, with oral formulations available and often covered by insurance. It provides a cost-effective option for reducing bleeding episodes in appropriate VWD patients.
Lexapro is often chosen over other antidepressants because it has a cleaner side effect profile, fewer drug interactions, and is generally well tolerated. Its high selectivity for serotonin reuptake makes it effective at lower doses with minimal sedation or weight gain. These features make it a strong first-line option for treating depression and anxiety.
Prozac (fluoxetine) is often chosen over other SSRIs because of its long half-life, which reduces the risk of withdrawal symptoms and allows for more flexibility with missed doses. It may also be preferred for patients with low energy or fatigue, as it can be more activating than other SSRIs. Its established track record and broad use in depression, anxiety, and OCD make it a versatile first-line option.
Sertraline (Zoloft) is often preferred over other SSRIs because it has a strong balance of efficacy and tolerability, with a relatively low risk of sedation, weight gain, or severe drug interactions. It is also commonly chosen for patients with comorbid anxiety or PTSD, as it has FDA approval for multiple conditions. Its flexible dosing and safety profile make it a popular first-line antidepressant.
A good broad spectrum antibiotic for moderate to severe bacterial folliculitis, though it doesn't cover MRSA. I'll double cover with something that does cover MRSA like bactrim or doxycyline.
Hyaluronic acid injections are a less invasive option for managing pain and improving function in rotator cuff injuries, particularly in cases of tendinopathy or mild degeneration. There is good evidence supporting their short-term benefits, especially when first-line treatments are not enough. They offer a non-surgical alternative for patients looking to reduce symptoms and maintain activity.
Benzoyl peroxide is a first-line, over-the-counter topical treatment for acne and better for inflammatory acne. It works by killing acne-causing bacteria and reducing inflammation, making it effective for both inflammatory and non-inflammatory acne. Common side effects include dryness or irritation, especially at higher strengths.
Humate-P is often preferred for von Willebrand disease (VWD) because it has a high VWF:FVIII ratio (~2.4:1), allowing effective VWF replacement while minimizing FVIII overload and thrombosis risk. It is FDA-approved specifically for VWD and has extensive clinical use in surgery, major bleeds, and severe disease, including type 2 and type 3 VWD. Compared to other VWF products, Humate-P offers reliable dosing and efficacy, making it a go-to option in situations requiring precise control of bleeding.
Humate-P should be given to patients with VWD who are unresponsive to desmopressin, those with severe types like type 2B or type 3, or in situations requiring surgical preparation, treatment of active bleeding, or trauma. It is also appropriate for prophylaxis in selected high-risk patients or during procedures where bleeding risk is significant.
Alphanate is used less frequently for von Willebrand disease compared to products like Humate-P or Wilate because it has lower and more variable VWF activity, and its VWF:FVIII ratio is generally lower. This means it may require higher dosing or closer monitoring to achieve adequate VWF levels. Additionally, it is not FDA-approved specifically for VWD in the U.S. (only for hemophilia A with VWF activity as a secondary indication), which limits its preferred use in clinical guidelines.
Vonvendi is a recombinant, plasma-free VWF ideal for patients with inhibitors to plasma-derived proteins or when separate FVIII control is needed. It offers flexible, tailored dosing and is often paired with recombinant FVIII for major bleeds or surgery. Guidelines recommend it for situations requiring precise VWF and FVIII management.
Hydrocortisone 1% is a mild, over-the-counter corticosteroid used to treat mild eczema by reducing inflammation, redness, and itching. It’s suitable for short-term use and sensitive areas like the face, but should be used cautiously around the eyes due to the potential risk of side effects such as glaucoma with prolonged use. Avoid long-term or frequent application to prevent skin thinning and other complications.
Ruxolitinib cream is a novel, non-steroidal, and highly targeted option for treating eczema, especially in patients with sensitive areas, steroid intolerance, or partial response to standard therapies. It offers rapid relief and is generally well tolerated when used as directed. However, judicious use is critical due to its potential for systemic effects if overused.
Azelastine hydrochloride 0.05% is a fast-acting and well-tolerated first-line treatment for allergic conjunctivitis. With both antihistamine and mast cell-stabilizing effects, it offers rapid relief from itching, redness, and tearing—often within minutes—and lasts up to 8–10 hours. Safe for adults and children over 3, it’s typically dosed as one drop in each eye twice daily. Mild, transient side effects like taste changes or local irritation may occur.
Desmopressin is first-line therapy for type 1 VWD and some type 2 cases, if the patient is responsive. It requires refrigeration, and among administration routes, IV is most reliable, followed by subcutaneous injection and then nasal spray, which has more variable absorption.
Buspirone is an off-label treatment for central sleep apnea that may help reduce central events by stabilizing respiratory drive through serotonin modulation. It has shown potential in small studies and is generally well-tolerated, making it a possible adjunct option when standard therapies are not effective.
Theophylline is an off-label treatment for central sleep apnea that stimulates respiratory drive and may reduce central events, particularly in heart failure patients. Due to its side effects and narrow therapeutic range, it is typically considered only as an adjunct or when other therapies are not suitable.
An off-label treatment for CSA that is more effective as an adjunct with other treatments.
TPNS represents a significant advancement in the management of central sleep apnea, providing a viable and effective option for patients seeking alternatives to traditional therapies.
Supplemental oxygen is a supportive therapy for central sleep apnea, used when positive airway pressure therapies are ineffective or not tolerated. It can reduce the frequency of central events and improve oxygenation, but does not treat the underlying cause.
Adaptive Servo-Ventilation (ASV) is a next-line therapy for central sleep apnea, used when CPAP or BPAP fail to control symptoms. It provides dynamic, breath-by-breath pressure support to stabilize breathing, but is contraindicated in patients with heart failure and reduced ejection fraction (≤45%).
Bilevel Positive Airway Pressure (BPAP) with backup rate is a next-line therapy for central sleep apnea when CPAP is ineffective, particularly in patients with conditions like opioid-induced CSA or hypoventilation.
CPAP is the first-line therapy for central sleep apnea and can also effectively treat coexisting obstructive sleep apnea. It is often used initially due to its simplicity and broad availability. If central events persist, more advanced therapies may be needed.
Botox is best for treating dynamic wrinkles—the kind that appear from repeated facial movements like frowning, smiling, or squinting. These include forehead lines, frown lines, and crow’s feet around the eyes.Unlike topical treatments (like retinoids) that work on the skin's surface to improve texture and fine lines over time, Botox works below the surface by relaxing the muscles that cause those expression lines.
Tazarotene is a powerful prescription retinoid that works well for reducing fine lines, uneven skin tone, and sun damage, often delivering faster results than tretinoin or adapalene. However, it can cause more irritation, especially in the beginning. It's best suited for experienced users who want stronger results and can handle a more intense treatment.
Adapalene 0.1% is an over-the-counter (OTC) retinoid that’s a great starter option for improving fine lines and rough skin texture. It’s gentle enough for sensitive skin and can be used once daily at night after cleansing.
Tretinoin is the gold standard topical treatment for aging skin. It’s proven to improve fine lines and sun damage and comes in different strengths.
HNS is less invasive than MMA and avoids the tissue removal of UPPP, with fewer long-term complications. It's best suited for patients with moderate to severe OSA who can’t tolerate CPAP and meet specific anatomical criteria.
Maxillomandibular Advancement (MMA) is more effective than UPPP for treating moderate to severe OSA, with greater AHI reduction and higher success rates. Though MMA has more temporary side effects like facial numbness, it results in fewer long-term complications and higher patient satisfaction. It’s often the preferred surgical option when CPAP is not tolerated.
UPPP removes or reshapes soft tissue (e.g., uvula, soft palate, tonsils) to open the airway. It’s less invasive but has variable success rates and is often less effective for moderate to severe OSA.
While weight loss can significantly reduce OSA severity and has been linked to a four-fold increase in the likelihood of remission in some studies, it is not always effective as a standalone treatment for all patients. As such, it should be included as part of a comprehensive treatment plan.
Mandibular Advancement Devices are a good alternative for patients who can't tolerate CPAP. They reposition the lower jaw to keep the airway open and are most effective for mild to moderate OSA. MADs are quieter, more portable, and often better tolerated than CPAP. They can sometimes be combined with CPAP.
Percutaneous Nephrolithotomy is the preferred treatment for large, complex, or staghorn kidney stones that are too big to pass or be treated with less invasive methods like ESWL or URS. It allows direct access to the kidney to break up and remove stones effectively, often in a single procedure. PCNL is typically recommended when other treatments are unlikely to succeed.
Ureteroscopy (URS) is a minimally invasive and effective option for treating kidney or ureteral stones, especially those that are large, stuck, or not suited for other treatments like ESWL. It allows direct removal or laser fragmentation of stones without the need for incisions. URS is often chosen when other methods fail or when quick, precise treatment is needed.
ESWL (Extracorporeal Shock Wave Lithotripsy) is a less invasive and commonly recommended first-line treatment for kidney stones, especially those located in the kidney or upper ureter.
Using a urine strainer is a key step in the treatment of kidney stones. It helps confirm whether the stone has passed, which is important for guiding further care and avoiding unnecessary tests or procedures. Catching the stone also allows for analysis of its type, which can help identify the cause and guide steps to prevent future stones.
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), is effective for managing the acute pain of renal colic. Its anti-inflammatory properties help reduce ureteral spasm and lower pressure in the renal pelvis, providing significant pain relief. It is a first line option for treating kidney stone-related discomfort.
Tamsulosin is a safe and effective medication for helping pass ureteral stones, especially those larger than 5 mm. It works by relaxing the ureter, making it easier for stones to pass. Current urological guidelines support its use as part of medical management for kidney stones.
Drinking enough fluids, especially water, helps prevent stone formation and can also aid in flushing out small stones. Staying well-hydrated is a simple and effective way to support kidney health.
Ear plugs are a simple and effective way to prevent swimmer’s ear, especially in individuals with a history of recurrent infections. By keeping the ear canal dry, they help reduce the risk of irritation and bacterial growth.
Isopropyl alcohol ear drops are effective in preventing otitis externa, particularly in individuals who are frequently exposed to water, such as swimmers. By helping to dry out the ear canal and reduce moisture, they create an environment that's less favorable for bacterial and fungal growth.
Ciprofloxacin is typically reserved for severe otitis externa in conjunction with topical therapy. It is indicated when there is concern for a perforated eardrum, extension of the infection beyond the ear canal, or failure to respond to topical treatment alone.
I reserve the use of a wick for cases of otitis externa where the ear canal is significantly occluded and ear drops can't reach the affected area. In these situations, the wick helps deliver antibiotics deeper into the canal to ensure effective treatment. I find it especially helpful when there's marked swelling and topical therapy alone isn't sufficient without improved access.
Aural toilet can be helpful in otitis externa by clearing debris and improving drop penetration, but in my experience, it's often too painful for patients. I usually start with topical treatments and prefer using a wick to aid delivery, referring to Otolaryngology if debridement is needed.
Acetic acid 2% is considered a first-line treatment for mild otitis externa, especially when symptoms are minimal and there's no significant swelling or discharge. However, I generally opt for antibiotic ear drops as a more definitive treatment,
Ofloxacin may be preferred when the eardrum is perforated or tubes are present, as it is non-ototoxic and safe for the middle ear. It also has a lower risk of allergic reactions compared to neomycin-containing drops and offers the convenience of once-daily dosing, though it may be more expensive.
Although Ciprodex is more expensive than other treatments, it offers key benefits like safe use with a perforated eardrum, reduced dosing frequency, and low allergy risk. These advantages often make it a preferred option for otitis externa, especially when patient comfort and adherence are priorities.
Cortisporin Otic is commonly used as a first-line treatment for bacterial otitis externa, especially in uncomplicated cases. Its combination of broad-spectrum antibiotics (neomycin and polymyxin B) and hydrocortisone makes it effective for reducing both infection and inflammation. It's been in use for decades and is generally inexpensive, especially in its generic form, making it a cost-effective option.
My patients have experienced quick and effective pain relief with Antipyrine and Benzocaine Otic Solution. It's purely for symptomatic relief and does not treat the underlying infection, but can be very helpful in managing discomfort. It should not be used if the eardrum is perforated or if there is drainage from the ear.
Cefdinir is an effective treatment for acute otitis media (AOM), especially against beta-lactamase-producing bacteria. It is recommended by the American Academy of Pediatrics as an alternative initial antibiotic. However, it may be less effective than amoxicillin/clavulanate for treating penicillin-resistant Streptococcus pneumoniae.
Tympanostomy tubes are small tubes placed in the eardrum to drain fluid and prevent ear infections. They’re recommended for children with recurrent otitis media or persistent middle ear fluid that affects hearing. The procedure is quick, and the tubes usually fall out on their own within a year.
Azithromycin is commonly used for the treatment of acute otitis media in patients with a penicillin allergy. It is also appropriate when coverage for atypical bacteria is indicated, particularly in cases with concurrent or suspected respiratory tract infections.
Amoxicillin-clavulanate is indicated for the treatment of acute otitis media in cases where there is failure of initial therapy with amoxicillin alone. According to AAP guidelines, it is the preferred second-line agent when symptoms persist or worsen after 48–72 hours of appropriate first-line treatment.
Amoxicillin is the first-choice antibiotic recommended by the American Academy of Pediatrics for treating otitis media (middle ear infection) caused by bacteria. It’s usually the go-to medicine because it works well, is safe, and is easy for kids to take.
The COVID-19 vaccine remains a key tool in protecting against severe illness, especially for those at higher risk. Over time, the overall severity of COVID-19 has decreased—thanks to widespread vaccination, improved treatments, and the emergence of less harmful variants. However, since protection from the Moderna vaccine typically wanes after about six months, continuing with updated doses becomes a personal risk-benefit decision based on individual health, exposure risk, and evolving public health guidance.
The COVID-19 vaccine remains a key tool in protecting against severe illness, especially for those at higher risk. Over time, the overall severity of COVID-19 has decreased—thanks to widespread vaccination, improved treatments, and the emergence of less harmful variants. However, since protection from the Pfizer vaccine typically wanes after about six months, continuing with updated doses becomes a personal risk-benefit decision based on individual health, exposure risk, and evolving public health guidance.
There is some evidence that vitamin D supplementation may reduce the risk, especially that some studies shot that vitamin D deficiency is associated with increased severity and mortality in COVID-19 patients.
The current consensus in the medical literature, as well as the American College of Physicians advises against the use of hydroxychloroquine for the treatment of COVID-19 because of the lack of benefit and the risk of cardiac toxicity (QT prolongation).
For hospitalized patients requiring oxygen or mechanical ventilation, dexamethasone show a significant reduction in mortality.
Molnupiravir is an oral antiviral for COVID-19, used when Paxlovid isn’t appropriate due to drug interactions or kidney/liver issues. While less effective than Paxlovid, it’s a valuable alternative when other treatments aren’t suitable.
Remdesivir is the first-line antiviral treatment for hospitalized patients with COVID-19 who are not yet on mechanical ventilation. Administered intravenously over 5 days, it works by inhibiting viral replication and has been shown to shorten recovery time in clinical trials. It is most effective when initiated within 7 days of symptom onset. While generally well tolerated, patients may experience side effects such as nausea or elevated liver enzymes.
Paxlovid is an effective treatment for COVID-19 that should be started within 5 days of symptom onset. It helps reduce the risk of severe illness, especially in high-risk patients. Some people may experience a rebound of symptoms after completing the treatment, but it still offers strong protection overall.
First line treatment which can be effective alone or in addition to medical therapy.
RSVpreF vaccine reduces risk of severe RSV significantly in the approved populations.
Nirsevimab reduces the risk of serious RSV illness by about 70–75% during their first RSV season. The protection lasts for around 5 months, which covers the typical RSV season.
While it is the only FDA approved treatment for RSV, its use is limited by its effectiveness, cost and challenges in using.
Laparoscopic sleeve gastrectomy is a powerful tool for long-term weight loss and health improvement. It’s not a quick fix — it works best when combined with lifelong changes in eating, exercise, and follow-up care. Most people who commit to those changes are happy with the results.
Clinical studies have shown that people using semaglutide for weight loss can experience significant weight loss over time. In some studies, participants lost an average of 15-20% of their body weight but can be expensive without insurance.
With daily dosing and 5-10% average weight loss, it is not as effective at semaglutide, but some may prefer with less side effects or better insurance coverage.
This is recommended for severe acne that fails standard oral or topical therapies, it does require laboratory, psychiatric and pregnancy monitoring because of side effects.
Doxycycline is an oral antibiotic commonly prescribed for moderate to severe inflammatory acne (red pimples, pustules, and cystic acne). It works by reducing acne-causing bacteria (Cutibacterium acnes) and inflammation.
Topical clindamycin works for mild to moderate inflammatory acne. It is often combined with benzoyl peroxide or retinoids for better effectiveness and to prevent resistance with results typically visible in 6-8 weeks.
One of the first line for acute pain which can be given IV and IM for patients in the emergency departments.
Loteprednol etabonate ophthalmic suspension 0.5% serves as an effective second-line therapy for allergic conjunctivitis, providing rapid relief with a lower risk of steroid-associated complications compared to traditional corticosteroids, but more expensive.
Debrox is a safe, effective, and easy-to-use option for at-home ear wax removal, especially for mild to moderate buildup.
A bit controversial, and definitely not recommended as a physician, q tips do work in removing superficial ear wax, but not cerumen impaction. Ways to mitigate potential injury is holding the q tip close to the cotton tip to minimize perforation if your arm gets bumped and avoid walking around while cleaning. It is much more advised to use other methods.
Ear irrigation is one of the most effective and reliable methods for removing stubborn ear wax, especially when the buildup is deep in the ear canal, close to the eardrum. One of the biggest advantages of ear irrigation is that it is widely accessible, both as a professional treatment and an at-home solution. Many over-the-counter ear irrigation kits and devices allow users to safely and effectively remove ear wax in the comfort of their own homes, saving time and money on doctor visits.
This should be done by a healthcare profession to avoid injury, and is very effective.
When more conservative treatments have not improved ECU tendonitis.
Consider ESWT for chronic ECU tendonitis (lasting >3 months) that hasn't improved with rest, NSAIDs, or physical therapy. It is ideal for patients seeking a non-invasive alternative to injections or surgery, especially athletes or active individuals who need a quicker recovery with minimal downtime.
Though not part of the standard treatment, an alternative that has been show to be effective in other tendinopathies, and may not be covered by insurance.
An alternative if physical therapy, NSAIDS and RICE do not improve symptoms, but does come with some potential risk.
If ECU tendonitis continues despite RICE and NSAID's.
First line therapy for strains and sprains.
First line therapy for reducing inflammation and pain
Often underused, these will strengthen muscles to speed up recovery.
First line therapy for strain and sprains.
First line therapy to reduce inflammation and pain.
While RFA has shown promising results, there is less data on its effectiveness, and because of the availability of the equipment, familiarty by dermatologists, and costs, it is not considered first line therapy.
This treatment is best for larger or resistant cherry angiomas that do not respond well to other methods like electrocautery or laser therapy. It is minimally invasive, quick, and effective, but other methods may be preferred for smaller lesions due to their faster clearance.
While less costly and more widely available at dermatology clinics, there is a higher risk of scarring when compared to lasers.
Electrocoagulation is a great choice for patients looking for an effective, affordable, and quick way to remove cherry angiomas. It is best for small to medium-sized lesions and is widely available at dermatology clinics.
While less costly and more widely available at dermatology clinics, there is a higher risk of scarring when compared to lasers.
The KTP laser is an excellent option for small to medium-sized cherry angiomas that are bright red and superficial. It offers fast results with minimal discomfort and a low risk of side effects.
The Nd:YAG laser is an excellent choice for cherry angiomas that are larger, deeper, or have not responded to other treatments. It is also a safer option for darker skin tones, as it reduces the risk of pigmentation changes compared to PDL.
Effective treatment that usually resolves after 1-2 sessions.
Singulair is a second-line or add-on therapy for allergic rhinitis. Because of the risk of neuropsychiatric side effects, Singulair should be used with caution, especially in children and teenagers.
Azelastine is ideal for people with moderate to severe allergic rhinitis who need fast and effective relief. It is a good option for those who don’t get enough relief from oral antihistamines or prefer a non-steroid treatment. It can also be used as an add-on therapy for better symptom control.
Works well, but may take a day or 2 to take effect.
Cetirizine (Zyrtec) is a highly effective antihistamine for treating rhinorrhea caused by allergies and a good first line drug. It works within an hour and provides 24-hour relief with minimal drowsiness compared to first-generation antihistamines (e.g., Benadryl).
An adjunct to steroids and bronchodilators, it's help me avoid an admission for borderline asthma patients.
For mild to moderate allergy symptoms, ketotifen is a great OTC, cost-effective option.
Laser Eustachian Tuboplasty (LETP) is a minimally invasive procedure that can help improve chronic Eustachian Tube Dysfunction (ETD) by using a laser to remove obstructions and enhance airflow. It offers a quicker recovery than more invasive surgeries, but its effectiveness may vary depending on the severity of the condition. While it can provide long-term relief, it is typically considered when medications and other treatments, like Balloon Eustachian Tuboplasty (BET), have not been effective.
Myringotomy can provide quick relief from ear pressure and fluid buildup, making it an effective option for Eustachian Tube Dysfunction (ETD). However, it has a longer recovery time compared to other treatments, with mild discomfort lasting a few days and full healing taking several weeks. While it helps alleviate symptoms immediately, follow-up care is essential to monitor for complications like ear drainage or persistent perforation.
Another technique to relieve ETD.
The Valsalva maneuver as a simple first step to clear ear pressure and assess Eustachian tube function. If a patient is unable to successfully equalize pressure using this technique, it serves as a useful clinical indicator of Eustachian Tube Dysfunction (ETD), suggesting obstruction or inflammation that will require further evaluation and treatment.
Balloon Eustachian Tuboplasty (BET) is a minimally invasive procedure with no external incisions or major surgery, offering a lower risk alternative to traditional interventions like ear tube placement. Performed in an outpatient setting, it has a short recovery time, allowing most patients to resume normal activities within 24-48 hours, making it a viable option for chronic or severe ETD when medications or conservative treatments fail.
As adjunct treatment that won’t provide immediate relief but effectively reduces inflammation and nasal congestion, helping improve Eustachian Tube Dysfunction (ETD) over time. Best used consistently, it works to decrease swelling and mucus buildup, making it a valuable option for chronic or allergy-related ETD when combined with other treatments.
A non-sedating antihistamine that effectively reduces mucus production, making it a useful adjunct treatment for Eustachian Tube Dysfunction (ETD) caused by allergies. While it doesn’t provide immediate relief or directly open the Eustachian tubes, it can help prevent congestion-related blockages when used consistently.
Oxymetazoline nasal spray provides quick relief for Eustachian Tube Dysfunction (ETD) by reducing nasal congestion and helping open the Eustachian tubes, making it especially useful for short-term use during colds, allergies, or air travel. However, prolonged use beyond three days can lead to rebound congestion, dryness, nasal irritation, and may not be suitable for individuals with high blood pressure or heart conditions.
An off label treatment that has been shown to be effective, especially if there are contraindications to chlorpromazine.
While not officially indicated for hiccups, Reglan is widely used off-label for this condition, especially when gastrointestinal factors contribute.
Only FDA approved for intractable hiccups, but be aware of side effects.
Quick easy solution that works for many people.
Learned this from an anethesiologist as a treatment for hiccups which works well if you can find the proper point.
Olopatadine is ideal for severe allergic conjunctivitis, offering stronger and longer-lasting relief compared to other options. However, its higher efficacy comes at a greater cost, making it a premium choice for those seeking sustained symptom control.
In summary, measles immunoglobulin is a critical intervention for preventing measles in high-risk individuals following exposure, significantly reducing the risk of disease and its complications but only provides temporary benefit.
The MMR vaccine is one of the best ways to prevent measles and can be given within 72 hours of exposure to reduce the risk of infection. It is a highly effective live attenuated vaccine that protects against measles, mumps, and rubella by stimulating the immune system without causing illness.
Recommended by the American Academy of Pediatrics and WHO.
Ospemifene is a good option for postmenopausal women experiencing vaginal discomfort who prefer an oral, non-topical treatment for relief.
An alternative to hormone therapy for the treatment of hot flashes.
An alternative to hormone therapy for the treatment of hot flashes, night sweats, and mood symptoms associated with menopause.
Vaginal estrogen is a safe and effective option for women seeking relief from genitourinary symptoms of menopause without the risks associated with systemic hormone therapy.
Routine eye patching is no longer recommended for corneal abrasions as it does not improve healing and may increase infection risk. Modern management focuses on lubrication, pain control, and infection prevention.
Erythromycin is commonly used as a prophylactic antibiotic for corneal abrasions to prevent bacterial superinfection. However, its effectiveness in pain relief is limited. The primary role of erythromycin is to prevent infection rather than to provide analgesia.
Ketorolac 0.5% is effective for treating corneal abrasions by providing significant pain relief.
Overall, both topical diclofenac 0.1% and oral NSAIDs are viable options for managing pain in corneal abrasions. The choice between them may depend on patient preference, the need for rapid pain relief, and the consideration of potential side effects. Topical diclofenac 0.1% is particularly beneficial for patients who require immediate pain relief and wish to avoid systemic side effects associated with oral NSAIDs.
Augmentin (amoxicillin/clavulanate) is a reliable first-line treatment for community-acquired pneumonia, offering excellent coverage for typical bacterial pathogens, including beta-lactamase-producing strains. However, in more severe outpatient CAP, I prefer to combine Augmentin with azithromycin to ensure coverage of atypical pathogens l. This combination provides a broader spectrum of activity, improving treatment outcomes while maintaining a well-tolerated regimen.
Levofloxacin is a powerful, broad-spectrum antibiotic that provides excellent coverage for both typical and atypical pathogens in moderate to severe community-acquired pneumonia, making it a reliable option for patients with comorbidities or penicillin allergies. However, given potential side effects which include QT prolongation, tendon toxicity, C Diff. diarrhea, I consider the risk/benefit when prescribing.
Amoxicillin is a highly effective first-line treatment for mild community-acquired pneumonia, but I tend to use this primarily in children, given its lack of atypical bacteria coverage and the need for alternative options in cases of penicillin allergy.
Doxycycline is a reliable and cost-effective option for treating mild to moderate community-acquired pneumonia, offering broad-spectrum coverage against both typical and atypical pathogens. Its low resistance rates and twice-daily oral dosing make it a strong alternative to macrolides, especially in areas with high Streptococcus pneumoniae resistance.
One of those last line therapies to prevent intubation that can help with breathing.
Prednisone is highly effective for severe asthma exacerbations but should be used short-term due to significant side effects.
Singulair is a second-line or add-on therapy for asthma, useful for allergy-triggered asthma and exercise-induced symptoms, but inhaled corticosteroids remain the first-line controller treatment.
Mepolizumab is an add-on treatment for severe eosinophilic asthma, used when high-dose inhaled corticosteroids and other controllers fail to control symptoms. It reduces exacerbations, improves lung function, and may decrease oral steroid dependence by targeting IL-5 to lower eosinophil-driven inflammation.
Adapalene is a topical retinoid that treats acne by speeding up skin cell turnover, unclogging pores, and reducing inflammation. It's better for comedonal acne (blackheads/whiteheads). One of the first line treatments for acne.
Cephalexin is a strong alternative to penicillin for mildly allergic patients, offering similar effectiveness with fewer side effects than macrolides (azithromycin) or clindamycin. However, it’s not safe for severe penicillin allergies and requires multiple daily doses for full effectiveness.
Clindamycin is a good backup option for severe penicillin allergies or recurrent strep, but it’s not the preferred treatment due to its higher side effect risk and potential for antibiotic resistance.
Benzathine penicillin G is the go-to treatment for strep throat if you want a one-and-done solution. A single shot clears up the infection and prevents complications like rheumatic fever, so there’s no need to take pills for 10 days. The downside? The shot hurts, and it’s not an option for people with severe penicillin allergies.
Zithromax (Azithromycin) is an alternative treatment for strep throat, mainly used for patients allergic to penicillin or cephalosporins. While it offers a shorter 5-day course and once-daily dosing, it is less effective than first-line treatments (penicillin, amoxicillin) and has a higher risk of antibiotic resistance. It is useful if another bacterial infection (e.g., pneumonia, sinusitis) is present.
An over the counter treatment that can be an adjunct treatment for dysmenorrhea.
As a resident, I had a neurologist who preferred IV Depakote for migraines and would bolus 1 gram over 15 minutes.Though not a first-line option in all settings, IV Depakote can be particularly useful in patients who cannot tolerate triptans or have contraindications to vasoconstrictive therapies. Given its efficacy and relatively low side effect profile, it remains a valuable tool in migraine management, particularly in hospital and emergency settings.
Prochlorperazine is a highly effective option for acute migraine attacks, especially in emergency settings or when nausea and vomiting are prominent symptoms. I often combine with benadryl to reduce side effects and causing sleepiness.
Sumatriptan is a cornerstone of acute migraine therapy, best taken at onset. Available in oral, nasal, and injectable forms, with subcutaneous injection offering the fastest relief (10-15 min). It reduces headache severity and symptoms like nausea, photophobia, and phonophobia.
Metoclopramide is a first-line treatment for nausea and vomiting, commonly used in migraine management. I often combine it with diphenhydramine to reduce the risk of side effects such as akathisia and to promote drowsiness, which can aid in migraine relief.
Ibuprofen is one of my first-line treatments for mild to moderate migraines. As a widely available NSAID, it helps reduce pain and inflammation, especially when taken early in an attack. A standard dose of 200–400 mg can provide significant relief, sometimes even eliminating the migraine when combined with rest and hydration.
Diclofenac can reduce fever, but it's not the first-line option. While it has antipyretic properties, Acetaminophen and Ibuprofen are safer and more commonly recommended due to Diclofenac’s higher risk of stomach and kidney side effects. It is more potent than Ibuprofen but should only be used for fever if other medications are ineffective or under medical advice.
Like other contraceptives, Depo-Provera is indicated in the management of dysmenorrhea.
For dysmenorrhea not controlled by NSAIDS, combined oral contraceptives work by suppressing ovulation, reducing endometrial thickness and decreasing prostaglandin, confirmed in clinical trials.
Ibuprofen has been shown to be highly effective in treating dysmenorrhea and a first line treatment.
Some studies show that TENS is as effective as NSAIDs (like ibuprofen) for dysmenorrhea without side effects, though there is an inconvenience with using the device.
There is some low quality evidence that regular exercise may reduce the severity of dysmenorrhea, and given the overall benefit of exercise and low risk of adverse events, this modality should be added to other treatments.
Applying a heating pad or warm compress to the lower abdomen can relax muscles and reduce pain as a first line, though effectiveness will vary from person to person.
Not my goto for acute pain treatment, it is effective for neuropathic or chronic pain.
WIth the opioid crisis and potential addiction, there is much more scrutiny in prescribing, but this offers increasing dosages to meet pain needs. I do find oxycodone more effective than hydrocodone and reserve this for failure of hydrocodone. This should not be taken with acetaminophen (Tylenol) because of the potential of overdosing.
WIth the opioid crisis and potential addiction, there is much more scrutiny in prescribing, but I'm not convinced of how effective the codeine is for pain control. I'll prescribe this for patients who prefer this, or who find oxycodone or hydrocodone too strong. This should not be taken with acetaminophen (Tylenol) because of the potential of overdosing.
WIth the opioid crisis and potential addiction, there is much more scrutiny in prescribing, but this offers increasing dosages to meet pain needs. This should not be taken with acetaminophen (Tylenol) because of the potential of overdosing.
Works well and quickly, I usually try this second.
My goto for quick relief, and plus I think they taste better.
Fast acting antacid that neutralizes stomach acid.
Prilosec is an effective treatment for gastritis, GERD, and stomach ulcers by reducing acid production and allowing healing. It works best when taken daily for 4–8 weeks,
A good first line for gastritis, with OTC doses at 10-20mg, and prescription doses at 40mg per day.
Baloxavir marboxil (Xofluza) is an antiviral medication used to treat influenza (flu). It differs from traditional flu antivirals like oseltamivir (Tamiflu) and peramivir (Rapivab) in its unique mechanism of action and single-dose regimen.
Peramivir is an intravenous one time dose antiviral medication used to treat influenza, especially if compliance is an issue.
An inhaled treatment for influenza that works best if taken within 48 hours of symptoms.
Tamiflu (oseltamivir) is an antiviral medication for treating and preventing influenza A and B. It is most effective when started within 48 hours of symptom onset and can reduce flu duration by 1–2 days.
Prednisone can be helpful for inflammatory coughs and It is not a first-line treatment for most coughs.
Overall, honey may be a useful alternative for mild cough relief, especially in children, but it is not more effective than dextromethorphan-based OTC medications. For adults, products like Mucinex DM may offer more consistent relief due to their dual mechanism of action.
Naprosyn is a long-acting NSAID that effectively treats arthritis, muscle pain, migraines, and menstrual cramps. It lasts 8–12 hours, reducing the need for frequent dosing. However, it should be used cautiously in people with stomach, kidney, or heart conditions.
Tylenol is a safe and effective pain reliever for headaches, mild arthritis, menstrual cramps, and fever, but it does not reduce inflammation. It works within an hour and lasts 4–6 hours.
Ibuprofen is an effective pain reliever for muscle aches, arthritis, headaches, and inflammatory conditions. It works within an hour and lasts 6–8 hours. However, it should be used cautiously in people with stomach, kidney, or heart issues.
Phenol is an effective, fast-acting throat anesthetic used in sprays and lozenges to provide temporary relief from pharyngitis symptoms. While it does not treat the underlying cause, it is useful for short-term pain relief.
Honey and tea are effective natural remedies for pharyngitis, offering soothing relief, hydration, and mild antimicrobial effects. While they do not cure infections, they help ease throat discomfort and promote healing.
Benzocaine is an effective, fast-acting numbing agent for sore throats caused by pharyngitis. It is best used for temporary relief but does not treat the underlying infection.
Amoxicillin is the most effective and recommended antibiotic for treating strep throat, providing rapid symptom relief and preventing serious complications.
Pramoxine is a great adjunct treatment for eczema, providing fast-acting itch relief without the risks associated with steroids. It works well alongside moisturizers, barrier creams, and anti-inflammatory treatments, helping to soothe irritation while allowing other therapies to heal the skin.
Prednisone is not a first-line treatment for fever but may be used if the fever is due to an inflammatory or autoimmune condition. It helps by suppressing the immune response and reducing inflammation. Use should be reserved for specific cases under medical guidance.
Incision and drainage is a safe and effective procedure for persistent or severe styes. It provides immediate relief and promotes faster healing. Proper aftercare and eyelid hygiene are essential to prevent recurrence.
Keflex is an effective treatment for severe or complicated styes, especially when the infection spreads or does not improve with standard care.
Not always necessary unless infection worsens or doesn't improve with home care.
The BRAT diet is a short-term, gentle approach to managing diarrhea by providing bland, easily digestible foods that help firm stools and reduce irritation. While effective for mild to moderate cases, hydration is essential, and nutrient-rich foods should be reintroduced after 24–48 hours.
Rice is a well-known home remedy for diarrhea, thanks to its easy digestibility and ability to help firm up stools. As part of the BRAT diet (Bananas, Rice, Applesauce, Toast), plain white rice provides a low-fiber, binding effect that can help reduce stool frequency. It also replenishes lost energy without irritating the gut.
Bismuth subsalicylate is an effective treatment for mild-to-moderate diarrhea, including traveler’s diarrhea and stomach flu. It works by reducing inflammation, killing certain bacteria, and decreasing fluid loss in stools. However, it should not be used in children under 12 or in those with aspirin allergies or bleeding disorders.
Loperamide is an effective treatment for non-infectious diarrhea, such as traveler’s diarrhea or IBS-D. It works within an hour by slowing bowel movements and reducing fluid loss.
Hydration is the first and most crucial treatment for diarrhea. Oral Rehydration Solutions are the best option, followed by clear fluids. Proper hydration can prevent serious complications and support faster recovery.
Intranasal Ipratropium Bromide (Atrovent) is a highly effective treatment for rhinorrhea, particularly in common colds, allergic rhinitis, and non-allergic rhinitis. It reduces nasal secretions without causing drowsiness, making it a useful option when antihistamines or decongestants are not sufficient.
Phenylephrine hydrochloride nasal spray is an effective decongestant that can indirectly help with coughs caused by postnasal drip or throat irritation from mucus.
Works well, but may take a day or 2 to kick in.
Cetirizine (Zyrtec) is a highly effective antihistamine for treating rhinorrhea caused by allergies, but it is less effective for viral infections (common cold). It works within an hour and provides 24-hour relief with minimal drowsiness compared to first-generation antihistamines (e.g., Benadryl).
Pseudoephedrine is an effective decongestant that helps relieve nasal congestion and postnasal drip associated with colds, sinus infections, and allergies. However, it is less effective for watery rhinorrhea caused by allergies and is best used short-term due to potential side effects like increased heart rate and insomnia. Combination therapy with antihistamines is often recommended for allergy-related nasal symptoms.
Make sure you use sterile water. Feels awkward but a good way of clearing out mucus and debris.
Physical cooling methods like cool compresses, lukewarm baths, increased air circulation, and hydration can effectively reduce fever as an adjunct to medicine. I usually add them on when medications are not effective or not an option because of the potential discomfort.
Drink water, broth, or electrolyte solutions to prevent dehydration.
Motrin (Ibuprofen) is a highly effective fever reducer with the added benefit of reducing inflammation .It should always be taken with food to avoid stomach irritation. I alternate ibuprofen with tylenol to help control fevers.
Tylenol (acetaminophen) is a safe and effective fever reducer, commonly used for both adults and children. It works by lowering body temperature without reducing inflammation. Proper dosing is essential to prevent liver toxicity. I alternate this with ibuprofen to treat fever.
Cholecystectomy is the definitive treatment for symptomatic gallstones, preventing future attacks and complications. Laparoscopic surgery is preferred due to its quick recovery, while open surgery is reserved for complex cases. Most patients return to normal life with minimal dietary restrictions after surgery.
First line treatment to reduce hemorrhoids and prevent in the future. Consider fiber supplements like psyllium and methylcellulose.
Hydrocortisone is an effective short-term treatment for relieving hemorrhoid symptoms, including itching, swelling, and pain. However, it should not be used long-term due to potential skin thinning and irritation.
A sitz bath is a simple and effective way to relieve hemorrhoid pain, swelling, and discomfort. Whether using a bathtub or a sitz bath basin, regular soaking (2–3 times daily) can significantly improve symptoms and promote healing.
A saline enema is a fast and effective option for relieving occasional constipation especially in cases of rectal fecal impaction. Because of the discomfort and , I tend to reserve it after oral medications have failed or there is more urgency.
Magnesium citrate is an effective, fast-acting laxative for short-term relief of constipation. However, it should be used sparingly and not as a daily solution. For chronic constipation, consider dietary fiber, hydration, and lifestyle changes, consider other alternatives.
Psyllium is an effective, natural remedy for constipation. Its ability to soften stools, add bulk, and regulate bowel movements makes it a versatile choice.
Zinc is a promising option for reducing the duration and severity of upper respiratory illnesses, particularly when taken as lozenges shortly after symptoms begin. While it may not prevent URIs in the general population, it can enhance recovery and alleviate symptoms.At least in one small study, https://pubmed.ncbi.nlm.nih.gov/8678384/, it has been shown to be effective.
A cheap OTC treatment that has mixed results in clinical studies, but I use it personally when I have an upper respiratory illness. Vitamin C can play a supportive role in managing upper respiratory illnesses by reducing symptom duration and severity, particularly in high-risk groups. However, it is not a guaranteed preventive measure for URIs in the general population. Regular intake of Vitamin C through a balanced diet or moderate supplementation is advisable for overall immune health, with higher doses potentially beneficial during illness.
Flexeril is a useful short-term treatment for back pain associated with muscle spasms. It provides significant relief when used as part of a broader treatment plan that includes physical therapy and other supportive measures. While effective, its sedative effects and potential side effects require caution and adherence to the prescribed regimen.
Oral phenylephrine is a readily available and widely used decongestant for managing nasal congestion during URIs. However, its clinical efficacy is questionable, and it is generally less effective than alternatives like pseudoephedrine. The FDA is reviewing it to potentially remove it from pharmacy shelves.
Phenylephrine hydrochloride nasal spray is an effective decongestant that can indirectly help with coughs caused by postnasal drip or throat irritation from mucus. While it is not a standalone treatment for cough, it can be a helpful part of managing upper respiratory symptoms. Always use as directed and avoid overuse to prevent rebound congestion.
Phenylephrine hydrochloride nasal spray is an effective decongestant that can indirectly help with coughs caused by postnasal drip or throat irritation from mucus. While it is not a standalone treatment for cough, it can be a helpful part of managing upper respiratory symptoms. Always use as directed and avoid overuse to prevent rebound congestion.
Benzonatate is an effective treatment for managing the disruptive coughing that can accompany upper respiratory infections. By targeting the cough reflex at its source, it provides rapid and lasting relief, helping patients rest and recover more comfortably.
Albuterol is an effective treatment for coughs associated with bronchospasm or airway constriction, as seen in asthma and COPD. It provides quick relief by relaxing the airways but is not appropriate for general cough symptoms.
Benzo) is an effective option for treating dry, irritating coughs by numbing the cough reflex at its source. It is a non-narcotic alternative to other cough suppressants, providing relief with minimal central nervous system effects. Proper use is essential to avoid potential side effects. Always follow the prescribing physician’s directions.
OTC treatment that helps reduce secretions to improve coughing.
Oxymetazoline nasal spray is a highly effective short-term treatment for nasal congestion during upper respiratory infections. By reducing swelling and opening nasal airways, it alleviates one of the most bothersome symptoms of a URI. However, its use should be limited to 3 days to prevent rebound congestion. Repeated, long-term chronic use over years could pose unknown harms. When used appropriately alongside other treatments, oxymetazoline can significantly improve comfort and quality of life for individuals suffering from URIs.
Salicylic acid is an excellent, versatile treatment for mild to moderate acne, particularly for those with oily or combination skin. While it may not be sufficient for severe acne or cysts, it is a highly effective preventive and maintenance option when used consistently. Pairing it with benzoyl peroxide, good moisturizer and sunscreen can optimize its benefits and minimize potential irritation.
Lactulose is an effective second-line treatment for constipation, especially for individuals who may not have had success with first-line options like fiber supplements or stool softeners. It works by drawing water into the colon, which softens stool and makes it easier to pass. Although it may take a day or two to work, lactulose is gentle and generally well-tolerated, making it a reliable option when other treatments aren’t enough. However, it can cause mild side effects like bloating and gas, which are usually manageable.
Mupirocin can be an effective treatment for bacterial folliculitis when used appropriately. It provides targeted action against Staphylococcus aureus, including MRSA, making it a useful topical treatment for superficial cases.
In general, I would not use this for nausea, unless it was due to acid reflux - this can help maintain electrolyte balance, though there are other solutions.
Meclizine is an effective option for managing nausea and vomiting, especially related to motion sickness and vertigo. It is generally safe for most people, but side effects like drowsiness and anticholinergic effects should be considered.
DO NOT DRINK - intended for inhalation only. In some trials, it provided some benefit, though not as good as prescribe medications.Inhalation of isopropyl alcohol can be a fast-acting and effective method for temporary relief of nausea and vomiting, especially in acute settings. However, it should be used cautiously and for short periods.
Dexamethasone can be highly effective for specific types of severe or persistent nausea, especially due to chemotherapy. There is some benefit as prophylaxis for postoperative nausea and vomiting.However, due to their potential side effects, they are typically used for short periods and in targeted cases.
Droperidol is a powerful antiemetic often used in clinical settings to manage severe nausea and vomiting, such as those caused by surgery or chemotherapy. While it can be incredibly effective, there are important considerations to keep in mind:. It is especially good for nausea due to marijuana.The BenefitsHighly Effective: Droperidol can provide significant relief from nausea and vomiting, making it a valuable option when other medications fail.Fast-Acting: It is often used in urgent care situations for quick relief.Potential Risks and ConcernsCardiac Risks: Droperidol is known to prolong the QT interval, which can lead to serious arrhythmias like torsades de pointes. Because of this, cardiac monitoring is typically recommended during administration.The Bottom LineDroperidol can be a lifesaver for severe nausea and vomiting, but it must be used with caution. Always consult with a healthcare professional to ensure it’s the right choice for you, especially if you have heart conditions or are taking other medications. Safer alternatives like ondansetron or metoclopramide may be considered for milder cases.
A basic first line medical treatment for constipation, that is over the counter.
Hydrating is beneficial for constipation because water helps soften stool, making it easier to pass. When the body is well-hydrated, the intestines can better absorb water, aiding in smoother digestion and reducing the risk of dry, hard stools that cause constipation. Drinking enough water daily supports regular bowel movements and overall digestive health. One of the first basics for the treatment of constipation
My second line treatment for nausea, because of its side effects, especially extra-pyramidal ones.
My 2nd line treatment for nausea because it has more side effects, especially the potential for extra-pyramidal side effects.
My first line treatment for nausea, especially for undertermined etiology. One of the safest side effect profile with effective treatment.
Mechanistically, it doesn't help with poison ivy itching.
I prefer 5 day high dose (60mg) followed by a taper over a period of 14-21 days.
First line therapy and over the counter.
First line
When eczema continues despite conservative therapy.
While potentially effective, it is not convenient.
First line oral therapy for eczema
CeraVe are formulated with ingredients like ceramides and hyaluronic acid, which help restore and maintain your skin’s protective barrier.
Levaquin is a powerful antibiotic option for treating acute bacterial sinusitis, especially in complicated or severe cases. However, due to its potential for serious side effects, it should be used with caution and only when clearly indicated. It is often reserved for patients who cannot tolerate first-line therapies or who have failed previous treatments.
Doxycycline is an effective and well-tolerated option for treating sinusitis in patients who cannot use first-line antibiotics. It is especially useful for those with penicillin allergies or those at risk for resistant bacterial infections. However, due to its side effect profile, it should be used with caution in specific populations like pregnant women and young children.
Augmentin is a powerful first-line option for treating acute bacterial sinusitis, especially when resistance is a concern or in patients with severe or prolonged symptoms. Its dual action against β-lactamase-producing bacteria makes it a superior choice compared to amoxicillin alone in many cases.
Amoxicillin remains a cornerstone in the treatment of uncomplicated acute bacterial sinusitis, with strong evidence supporting its use in appropriate cases.
Takes longer to take effect but reduces the inflammation in the nose.
Can temporarily relieve nasal decongestion, but you should be careful if you have heart disease or hypertension.
Works well, but do not use for more than 3 days or you can develop dependence.
First line topical treatment. Foam is easier to use but may not be worth the liquid.
Haven't tried it, but recommended in literature.
First line, and reduce recurrence.
Most ingrown toenails I see are infected, so this will treat the infection.
Last line for ingrown toenail as it will solve the problem, but is invasive and take time to heal.
Basic treatment at home to reduce the inflammation.
Great second line treatment, but be aware of cardiac dysrhythmia and tendon rupture potential side effects.
For more severe or uri with systemic symptoms
Numbs the bladder and helps with symptoms, though doesn’t directly treat the infection
First line with potential penicillin allergy reaction
First line, but need aware of sulfa allergiea
First line therapy with low side effect profile
Another good drug for MRSA cellulitis.
Broad spectrum for infections, though it doesn't cover MRSA.
There is evidence of benefit, but it is expensive and takes time.
Reduces oxygen and makes things worse for the patient.
First line treatment
Over the counter option that has variable response among patients.
Benefits will vary among patients.
Good for pain relief, but doesn't reduce inflammation.
First line therapy, but can use other NSAIDs.
First line for long term maintenance for asthma.
First line in weight loss. Works well if you are able to monitor what you are eating to ensure as balanced diet.
First line treatment - Aim for 30 minutes, five to seven days a week. I prefer strength training, but also need to mix with cardio and flexibility.
Great way to cover up without daily work.
A good broad spectrum antibiotic for moderate to severe bacterial folliculitis, though it doesn't cover MRSA.
Works great
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