MEDICINE BLUE BOOK

Sixth Edition

Editors

Willie T. Ong, M.D.

Anna Liza R. Ong, M.D.

Notice: The authors and publisher of this volume have taken care to ensure the accuracy

of drug dosages and that these are compatible with the accepted standards of treatment at

the time of publication. However, as new data becomes available, there may be changes in

treatment and drug use. Therefore, the reader is advised to consult the package insert

before using any therapeutic agent. The authors and publisher disclaim responsibility for

adverse effects resulting from omissions or undetected errors.

Copyright 2004 by Willie T. Ong, M.D. and Anna Liza R. Ong, M.D.

Philippine Copyright No. A-2001-1096

ISBN 971-91562-6-0

Published by: Anna Liza R. Ong, M.D.

First Edition ........................ 1995

Second Edition .................... 1997

Third Edition ……………... 1999

Fourth Edition ……………. 2001

Fifth Edition ……………… 2003

Sixth Edition ……………… 2005

Technical Assistants: Grace Villablanca

Layout Artist: Victor Santos

Printed by:

Cacho Hermanos, Inc.

Pines Corner Union Streets

Mandaluyong City

Also by Drs. Willie T. Ong and Anna Liza R. Ong:

Cardiology Blue Book, Third edition

Altapresyon at Tamang Pangangalaga sa Inyong Puso

Legacy of Medicine: Interviews with Distinguished Filipino Internists

Ideals and Inspirations for Doctors

For comments, orders and suggestions, kindly call telephone number 831-9842 (Nita) or

e-mail at willietong@netasia.net

Table of Contents

Abbreviations viii

Contributing Authors x

Preface xi

1. Cardiology . . . . . . . . Willie T. Ong, M.D.

Advanced Cardiac Life Support 1

Acute Myocardial Infarction 4

Thrombolytic Therapy in MI 7

Unstable Angina 8

Congestive Heart Failure 9

Hypertensive Emergency 11

Supraventricular Tachycardia 12

Atrial Fibrillation 13

Premature Ventricular Contractions & Ventricular Tachycardia 14

Premature Atrial Contractions 16

Infective Endocarditis (Treatment) 17

Infective Endocarditis (Prophylaxis) 19

Acute Rheumatic Fever Treatment & Prophylaxis 20

Cardio-Pulmonary Clearance 22

Dyslipidemia with Lipid Lowering Drugs 24

Indications for Permanent Pacemaker Insertion 26

Hypertension 27

List of Antihypertensives & Cardiac Drugs 29

Low Molecular Weight Heparins for DVT & Unstable Angina 33

The Cardiac Patient with Other Medical Disorders 34

2. Pulmonology . . . . . . . . Camilo C. Roa, Jr., M.D.

Bronchial Asthma 35

Drugs Used to Treat Asthma 36

Management of Chronic Asthma 39

Management of Acute Exacerbations of Asthma: Home Treatment 41

Management of Acute Exacerbations of Asthma: Hospital Treatment 42

Chronic Obstructive Pulmonary Disease 45

Tuberculosis 46

Antituberculosis Drug List 51

Pulmonary Embolism 53

Hemoptysis 54

Pleural Effusion and Thoracentesis 55

Anaphylaxis 56

Pneumothorax 57

Pneumonia 58

3. Gastroenterology . . . . . . . . Virgilio P. Banez, M.D.

Peptic Ulcer Disease & Acute Gastritis 61

Upper and Lower GI Bleeding 63

Antiulcer Drugs 64

Hepatic Encephalopathy & Liver Cirrhosis 66

Abdominal Paracentesis 67

Viral Hepatitis 68

Acute Cholecystitis 70

Bacterial Cholangitis and Biliary Sepsis 71

Acute Pancreatitis 72

Acute Diarrhea with Mild Dehydration 74

Cholera with Severe Dehydration 75

Acute Intestinal Obstruction 76

4. Infectious Diseases . . . . . . . . Cecilia S. Montalban, M.D.

Clinically Useful Antibiotics 77

Antibiotic Drug List 81

Systemic Viral Infection 86

Acute Tonsillopharyngitis 86

Dengue Hemorrhagic Fever 87

Typhoid Fever 88

Malaria 89

Prevention of Malaria in Travellers 90

Leptospirosis 91

Schistosomiasis 92

Sepsis and Septic Shock 92

Lower Urinary Tract Infection 94

Pyelonephritis 94

Cellulitis 95

Meningitis and Encephalitis 96

Tetanus 98

Osteomyelitis 99

Peritonitis 100

Diverticulitis 101

Pelvic Inflammatory Disease 102

Pneumonia 102

Infective Endocarditis 102

Mumps 103

Varicella Zoster 103

Empirical Antimicrobials for Out-Patient Adults 104

Initial Antimicrobials for Acutely Ill Adults 106

Drug of Choice for Microbial Pathogens 108

5. Nephrology . . . . . . Elizabeth S. Montemayor, M.D.

Acute Renal Failure 112

Strategy for Removing Excess Fluid 115

Chronic Renal Failure 116

Hypokalemia 118

Hyperkalemia 120

Hypocalcemia 122

Hypercalcemia 123

Hyponatremia 124

Hypomagnesemia 126

Hypermagnesemia 126

Nephrolithiasis 127

Dialysis 128

Dosage Adjustment of Drugs in Renal Failure 130

6. Endocrinology . . . . . . . . Ruby T. Go, M.D.

Approach to Type II Diabetes Mellitus 135

Diabetic Ketoacidosis / Hyperosmolar Coma 140

Thyroid Storm 141

Hyperthyroidism 143

Hypothyroidism 144

Adrenal Insufficiency 145

7. Rheumatology . . . . . . . . Clemente M. Amante, M.D.

Osteoarthritis 147

Gouty Arthritis 148

Rheumatoid Arthritis 150

Systemic Lupus Erythematosus 152

8. Neurology . . . . . . Carlos L. Chua, M.D.

Cerebral Infarction vs. Hemorrhage Guide 154

Intracerebral Hemorrhage 155

Subarachnoid Hemorrhage 156

Cerebral Thrombosis 157

Cerebral Embolism 157

Transient Ischemic Attack 158

Stroke In Evolution 158

Stroke in the Young 158

Seizures and Epilepsy 159

Brain Abscess 163

Myasthenia Gravis 164

Parkinson's Disease 165

Alcohol Withdrawal 167

Approach to Weakness 168

9. Toxicology . . . . . . Kenneth Hartigan-Go, M.D.

Poisoning and Drug Overdose: General Guidelines 169

Acid Ingestion 173

Alkaline Ingestion 173

Amphetamine / Metamphetamines 173

Anticoagulants 174

Diazepam 174

Digitalis / Digoxin 175

Ethanol 175

Hydrocarbon / Kerosene 176

Isoniazid 176

Narcotics 177

Organophosphates 178

Paracetamol 179

Phenothiazines / Neuroleptics 181

Salicylate / Aspirin 182

Tricyclic Anti-Depressants 183

10. Nutrition . . . . . . Nutritionist-Dietitians' Association of the Philippines

Recommended Diet by Organ System 184

Diet Modifications and Food List 184

High Fiber Diet 184

Low Calorie Diet 185

High Calorie Diet 186

High Protein Diet 186

Low Protein Diet 186

Low Fat / Low Cholesterol Diet 187

Low Carbohydrate Diet 187

Low Sodium Diet 188

Low Potassium Diet 188

Low Uric Acid / Low Purine Diet 189

Nutritional Management of Diabetics and Renal Patients 189

11. The Pregnant Patient with Medical Problems

Camilo C. Roa, Jr., M.D., Ruby T. Go, M.D., Willie T. Ong, M.D.

Pregnancy and Hypertension 192

Pregnancy and Cardiac Disease 194

Pregnancy and Asthma 194

Pregnancy and Thyroid Disease 195

Pregnancy and Diabetes 196

Drugs Used in Pregnancy 197

12. Preventive Medicine & Adult Immunizations

Willie T. Ong, M.D., Cecilia S. Montalban, M.D. 199

13. Final Pointers 206

Appendices 207

All About Drips 207

Additional Drug Lists: Pain Relievers / Laxatives / Antidiarrheals /

Antiflatulents / Antipyretics / Hypnotics and Sedatives 211

Intravenous Fluids 214

Formulas 214

References 216

Contributing Authors

Clemente M. Amante, MD, FPCP, FPRA Professor of Medicine, Section of Rheumatology, UP-PGH

Virgilio P. Banez, MD, FPCP, FPSG, FPSDE

Clinical Associate Professor of Medicine, Section of Gastroenterology, UP-PGH

Carlos L. Chua, MD, FPNA

Associate Professor of Medicine, Section of Neurology, UP-PGH

Kenneth Hartigan-Go, MD, FPCP, FPSECP, FPSCOT

Associate Professor, Department of Pharmacology, UP College of Medicine

Clinical Associate Professor of Medicine, Section of Toxicology, UP-PGH

Ruby T. Go, MD Clinical Associate Professor of Medicine, Section of Endocrinology, UP-PGH

Cecilia S. Montalban, MD, FPCP, MSCTM Associate Professor of Medicine, Section of Infectious Diseases, UP-PGH

Elizabeth S. Montemayor, MD, FPCP, FPSN Associate Professor, Department of Physiology, UP College of Medicine

Clinical Associate Professor of Medicine, Section of Nephrology, UP-PGH

Willie T. Ong, MD, MPH, FPCP, FPCC Cardiologist, Manila Doctors Hospital and Makati Medical Center

Camilo C. Roa, Jr., MD, FPCP, FPCCP

Professor, Department of Physiology, UP College of Medicine

Clinical Associate Professor of Medicine, Section of Pulmonary Medicine, UP-PGH

Preface to the Sixth Edition

The year 2005 marks the 10-year anniversary of the publication of the

Medicine Blue Book. I wrote the draft during my internship and completed the

book during my first year of residency at Manila Doctors Hospital. Even then, my

utmost desire in sharing this book is to assist the many struggling doctors and

nurses in our different training institutions. I had seen how hard and how

unrewarding medical training can be. I hope the Blue Book can be your friend and

companion at some point in your career.

One of the biggest problems afflicting our country right now is the high

cost of healthcare. To address this, the Blue Book contains several unique

features: (1) cost-effective drug options are listed whenever possible and noted

with a smile “☺” icon, (2) priority laboratory exams to request are highlighted in

bold, (3) the treatment regimens are generally listed according to importance,

which means that crucial treatment strategies are listed first and supportive

treatments are listed last, (4) the dosages of drugs have been adjusted for the

average Asian patient, and (5) only those tests and drugs available in our local

setting are included.

This edition presents major revisions and updates in all chapters. The latest

guidelines (local ones if available) have been utilized. Again, my profuse thanks to

Dr. Clemente Amante, Dr. Virgilio Banez, Dr. Carlos Chua, Dr. Kenneth

Hartigan-Go, Dr. Ruby Go, Dr. Cecilia Montalban, Dr. Elizabeth Montemayor and

Dr. Camilo Roa Jr. for their selfless and untiring efforts in updating the text.

I am also greatly indebted to several people in my medical education: Dr.

Romeo P. Ariniego, Medical Director at De La Salle University Medical Center;

Dr. Nelson S. Abelardo, past Chair of the Department of Internal Medicine at

Manila Doctors Hospital; and Dr. Rody G. Sy, former Head of the Section of

Cardiology at UP-Philippine General Hospital.

Finally, I would like to thank my parents, Mr. Ong Yong and Mrs. Juanita

Tan Ong, for their wholehearted support in this endeavour. And to my wife, Anna

Liza, for all her hard work in publishing this book. Above all, I humbly thank the

Lord God for His guidance and inspiration. I can accomplish nothing without Him

but "I can do everything in Christ who strengthens me."

Thank you for reading and may God bless us always.

Willie T. Ong

Abbreviations

☺ Cheaper drug option

+ Add or with

With or without

ABG Arterial blood gas

Ac Ante-cibum; before meals

Ad lib Ad libitum; as much as

desired

AF Atrial fibrillation

AHA American Heart Association

AMI Acute myocardial infarction

Amp Ampule(s)

AOG Age of gestation

ARF Acute renal failure

ARDS Acute respiratory distress

syndrome

ASA Aspirin or Acetylsalicylic

acid

ASAP As soon as possible

ATS American Thoracic Society

BID Twice-a-day

BM Bowel movement

BP Blood pressure

bpm Beats per minute

BRP Bathroom privileges

BUN Blood urea nitrogen

BW Body weight

C & S Culture and sensitivity

Ca Calcium

CAD Coronary artery disease

Cap Capsule(s)

CAPD Chronic ambulatory

peritoneal dialysis

CBC Complete blood count

CBG Capillary blood glucose

CBR Complete bed rest

CHF Congestive heart failure

Conc Concentration

COPD Chronic obstructive

pulmonary disease

CPR Cardio-pulmonary

resuscitation

CRF Chronic renal failure

CRI Chronic renal insufficiency

CSA Chronic stable angina

CVA Cerebrovascular accident

CVP Central venous pressure

CXR Chest X-ray

d Day

DAT Diet as tolerated

DBP Diastolic blood pressure

DDx Differential diagnosis

DIC Disseminated intravascular

coagulation

DKA Diabetic ketoacidosis

DM Diabetes mellitus

DOC Drug of choice

DTR Deep tendon reflexes

Dx Diagnosis

DVT Deep venous thrombosis

ECG or EKG Electrocardiogram

EF Ejection fraction

e.g. For example

EMD Electromechanical

dissociation

ET Endotracheal tube

FBS Fasting blood sugar

g or gm Gram(s)

GS Gram stain

gtts Macrodrops

H+

Hydrogen ions

HBT Hepatobiliary tract

HCO3 Bicarbonate ions

HD Hemodialysis

HDL High density lipoprotein

HGT Hemoglucotest

HONC Hyperosmolar non-ketotic

coma

HPN Hypertension

HR Heart rate

hr Hour

HS At night

IBW Ideal body weight

IE Infective endocarditis

IHD Ischemic heart disease

I and O Input and output

IM Intramuscular

IU International units

IV Intravenous

IVP Intravenous push

J Joules

K Potassium

Kg Kilogram

L or l Liter(s)

LDL Low density lipoprotein

lpm Liters per minute (Oxygen)

LV Left ventricle

LVH Left ventricular

hypertrophy

mcg microgram

Mg Magnesium

MI Myocardial infarction

Min Minute(s)

Mil Million

MR Mitral regurgitation

MRI Magnetic resonance

imaging

MS Mitral stenosis

MVP Mitral valve prolapse

Na Sodium

NGT Nasogastric tube

NH4 Ammonium ions

NSS Normal saline solution

NYHA New York Heart

Association

OD Once-a-day

OGTT Oral glucose tolerance test

OHA Oral hypoglycemic agents

PAC Premature atrial

contraction

Pc Post-cibum; after meals

PD Peritoneal dialysis

PE Physical examination

PEFR Peak expiratory flow rate

Pen Penicillin

PFT Pulmonary function test

PO Per orem; oral route

PPI Permanent pacemaker

Insertion

PPI Proton pump inhibitor

PRN As needed

Pt. or Pts. Patient(s)

PT Prothrombin time

PTT Partial thromboplastin

time

PTU Propylthiouracil

PVC Premature ventricular

contraction

q every

QID Four times-a-day

RAIU Radioactive iodine uptake

RF Rheumatic fever

RHD Rheumatic heart disease

RR Respiratory rate

RV Right ventricle

SBP Systolic blood pressure

SGOT Serum glutamic-oxaloacetic

transaminase

SGPT Serum glutamic-pyruvic

transaminase

SL Sublingual; under the

tongue

Sn Sensitivity

Sp Specificity

SC Subcutaneous

STAT Immediately

Supp Suppository

Susp Suspension

SVT Supraventricular

tachycardia

Syr Syrup

Tab Tablet(s)

TC Total cholesterol

TET Treadmill exercise test

TG Triglyceride

TID Three times-a-day

TMP-SMZ Trimethoprim-

Sulfamethoxazole

TPAG Total protein and albumin

Tsp Teaspoon(s)

2-D Echo Two-dimensional

echocardiography

Tx Treatment

u Units

ugtt or ugtts Microdrop (s)

UO Urine output

UTZ Ultrasound

VS Vital signs

w/ With

w/o Without

WPW Wolff-Parkinson-White

syndrome

Wt Weight