The 2·3 Pattern of Smoking Cessation

• Onset of withdrawal is 2-3 hours after last cigarette

• Peak withdrawal is at 2-3 days

• Expect improvement of withdrawal symptoms at 2-3 weeks

• Resolution of withdrawal at 2-3 months

• Highest relapse rate within 2-3 months

Androgen replacement therapy

Indications:
hypogonadism(=impaired production or function of gametes or sex hormones or both

Contraindications:
1. prostate cancer
2. breast cancer
3. hematocrit >52%
4. congestive heart failure (CHF)

Types:
1. oral
-testosterone undeconate
-more negative effect on liver

2. muscular
-mixture of testosterone esters
-testosterone isobutyrate
-testosterone undeconate
-once every 2-3 weeks

3. buccal
-mouth patch/mucoadhesive polymer with testosterone

4. transdermal
patch(andropatch)
-testosterone patches are worn either on the body or on the scrotum
-body patch application is rotated between the buttocks, arms, back or abdomen
-applied once a day
gel(testogel)
-testosterone gels that are applied daily to the shoulders, upper arms, or abdomen.

5. implantation of testosterone capsule
-about 6 months

Monitor/follow:
1. Prostate-Specific Antigen (PSA)
2. Digital rectal examination (DRE)
3. lipid
4. liver function test (LFT)
5. hematocrit

Adverse effects:
1. benign prostatic hyperplasia (BPH)
2. prostate cancer
3. gynecomastia
4. fluid retention--> worsen hypertension and heart failure
5. liver damage
6. headache
7. polycythemia--> myocardial infarction, stroke, clot development
8. sleep apnea

4 cardiovascular drugs which are used for more than 50 years

1. Aspirin
-antiplatlet

2. Warfarin
-vitamin K antagonist

3. Digoxin
-cardiac glycosides

4. Spironolactone
-aldosterone antagonist

Needlestick Injury and Infection

Risk of Developing Infection from a Hollow Needle Puncture

Hepatitis B Virus (HBV) 30%
Hepatitis C Virus (HCV) 3%
HIV 0.3%

Gastric Ulcer vs Duodenal Ulcer

Gastric Ulcer

-more frequent in older patient, male:female 1:1
-epigastric pain
-food intake exacerbates pain
-patient tends not to eat --> weight loss
-risk of cancer (always perform biopsy!!)

Duodenal Ulcer

-more frequent in younger patient, male:female 3:1
-pain in right umbilical area(duodenal area)
-vomiting tend to relieve pain
-pain more frequent during hunger/night time/early morning
-food intake relieves pain
-patient tends to eat more --> no weight loss or weight gain
-lower risk of cancer
-bleeding more frequent (more ulcers)

Drug treatment for tuberculosis

Rifampin is the drug of choice for treatment; in most cases, the treatment duration is at least 18 months without rifampin

Ethambutol (EMB) is used to prevent rifampin resistance if the organism is resistant to isoniazid (INH); EMB can be discontinued as soon as the organism is found to be susceptible to rifampin and INH.

Pyrazinamide is used for the first 2 months of treatment to decrease the treatment duration from 9 months to 6 months if the organism is susceptible to rifampin and INH

Urine alkalinisation

1. Salicylate poisoning
- recommended in all symptomatic patients with regard of hypokalemia (common in salicylate poisoning)
- Diamox should NEVER be used as for acidemia and subsequent increased toxicity
- Urinary alkalinization by PO NaHCO3 enhances the elimination of weak acids: salicylates, phenobarbital, chlorpropamide, chlorophenoxy herbicides, formic acid, and methotrexate

2. Pure uric acid stones
- dissolved with oral alkalinization, K citrate, Na bicarbonate --> urinary pH 6.5-7

3. Rhabdomyolysis
- IV bicarbonate

4. Hemoglobinuria (heatstroke)