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 ........................
Second Edition ....................
Third Edition ...
Fourth Edition .
Fifth Edition
Sixth Edition

1995
1997
1999
2001
2003
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
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

ABG

Abbreviations
Ac
Cheaper drug option
Ad lib
Add or with
With or without
AF
Arterial blood gas

Ante-cibum; before meals

Ad libitum; as
much as desired
Atrial fibrillation

AHA
Association
AMI
infarction
Amp
AOG
ARF
ARDS
ASA
ASAP
ATS
Society
BID
BM
BP
bpm
BRP
BUN
BW
C&S
Ca
CAD
Cap
CAPD
CBC
CBG
CBR
CHF
Conc
COPD
CPR
CRF
CRI
insufficiency
CSA
CVA
CVP
CXR
d
DAT
DBP

American
Acute

Heart
myocardial

Ampule(s)
Age of gestation
Acute renal failure
Acute respiratory
distress syndrome
Aspirin
or
Acetylsalicylic acid
As soon as possible
American
Thoracic
Twice-a-day
Bowel movement
Blood pressure
Beats per minute
Bathroom privileges
Blood urea nitrogen
Body weight
Culture and sensitivity
Calcium
Coronary artery disease
Capsule(s)
Chronic ambulatory
peritoneal dialysis
Complete blood count
Capillary blood glucose
Complete bed rest
Congestive heart failure
Concentration
Chronic
obstructive
pulmonary disease
Cardio-pulmonary
resuscitation
Chronic renal failure
Chronic
renal
Chronic stable angina
Cerebrovascular accident
Central venous pressure
Chest X-ray
Day
Diet as tolerated
Diastolic blood pressure

DDx
DIC

Differential diagnosis
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
mcg
Mg
MI
Min
Mil
MR
MRI
MS
MVP
Na
NGT
NH4
NSS
NYHA
OD
OGTT
OHA
PAC
Pc
PD
PE
PEFR
Pen
PFT
PO
PPI
PPI
PRN
Pt. or Pts.
PT
PTT
PTU
PVC
q
QID

Left ventricular
hypertrophy
microgram
Magnesium
Myocardial infarction
Minute(s)
Million
Mitral regurgitation
Magnetic resonance
imaging
Mitral stenosis
Mitral valve prolapse
Sodium
Nasogastric tube
Ammonium ions
Normal saline solution
New York Heart
Association
Once-a-day
Oral glucose tolerance test
Oral hypoglycemic agents
Premature atrial
contraction
Post-cibum; after meals
Peritoneal dialysis
Physical examination
Peak expiratory flow rate
Penicillin
Pulmonary function test
Per orem; oral route
Permanent
pacemaker
Insertion
Proton pump inhibitor
As needed
Patient(s)
Prothrombin time
Partial thromboplastin
time
Propylthiouracil
Premature ventricular
contraction
every
Four times-a-day

RAIU
RF
RHD
RR
RV
SBP
SGOT
oxaloacetic
SGPT
SL
Sn
Sp
SC
STAT
Supp
Susp
SVT
Syr
Tab
TC
TET
TG
TID
TMP-SMZ
TPAG
Tsp
2-D Echo
Tx
u
ugtt or ugtts
UO
UTZ
VS
w/
w/o
WPW
Wt

Radioactive iodine uptake

Rheumatic fever
Rheumatic heart disease
Respiratory rate
Right ventricle
Systolic blood pressure
Serum
glutamictransaminase
Serum glutamic-pyruvic
transaminase
Sublingual; under the
tongue
Sensitivity
Specificity
Subcutaneous
Immediately
Suppository
Suspension
Supraventricular
tachycardia
Syrup
Tablet(s)
Total cholesterol
Treadmill exercise test
Triglyceride
Three times-a-day
TrimethoprimSulfamethoxazole
Total protein and albumin
Teaspoon(s)
Two-dimensional
echocardiography
Treatment
Units
Microdrop (s)
Urine output
Ultrasound
Vital signs
With
Without
Wolff-ParkinsonWhite syndrome
Weight