Dr. Mani shrestha/ Manish

11/03/2026

30 Drug Interactions That Kill Patients in the ER

(life-threatening interactions emergency physicians must recognize immediately)

Hemodynamic collapse

Nitroglycerin + Sildenafil → profound hypotension

Tadalafil + nitrates → cardiovascular collapse

Severe bleeding

Warfarin + Trimethoprim-sulfamethoxazole

Warfarin + Metronidazole

Warfarin + Amiodarone

Warfarin + NSAIDs (e.g., Ibuprofen)

Respiratory depression

Morphine + Diazepam

Oxycodone + benzodiazepines

Opioids + Gabapentin

Serotonin syndrome

Fluoxetine + Tramadol

SSRI + Linezolid

SSRI + Sumatriptan

Phenelzine + SSRIs

Fatal arrhythmias

Azithromycin + Amiodarone

Haloperidol + QT-prolonging drugs

Methadone + macrolides

Rhabdomyolysis

Simvastatin + Clarithromycin

Statins + Cyclosporine

Severe toxicity

Lithium + thiazides

Lithium + Ibuprofen

Digoxin toxicity

Digoxin + Verapamil

Digoxin + Amiodarone

Theophylline toxicity

Theophylline + Ciprofloxacin

Fatal electrolyte disorders

Spironolactone + ACEI/ARB

Hypoglycemia

Insulin + Propranolol

Renal failure

ACEI + NSAID + diuretic (“triple whammy”)

Immunosuppressant toxicity

Tacrolimus + macrolides

CNS toxicity

Carbamazepine + Erythromycin

Metabolic crisis

Metformin + contrast dye (AKI → lactic acidosis)

Fatal sedation

opioids + alcohol

08/03/2026

Symbicort Doses in Asthma
• Combination of ICS (budesonide) + LABA (formoterol).
• Can be used as maintenance + reliever therapy (SMART) because formoterol has rapid onset.

04/03/2026

New TB Guidelines 2025 — quick and easy revision of the updated 4-month regimen.

26/02/2026

26/02/2026

2026 Pulmonary Embolism Clinical Categories
Replaces massive / submassive terminology
Introduces trajectory-based physiology classification
Recognizes shock without hypotension (Category D)
Adds Respiratory modifier (R) for hypoxemia/tachypnea
Supports outpatient PE care for Categories A–B
Encourages PERT activation for Categories C–E

26/02/2026

Spectrum of Smoking-Related Diseases
Smoking affects almost every organ system.
Cessation is the single most effective intervention at all stages; benefits are seen even in advanced disease.
Respiratory and cardiovascular diseases are most common and clinically significant.
Cancer risk is dose-dependent but decreases after cessation over years.
Screening is important in high-risk populations: low-dose CT for lung cancer, ABI for PVD.
Multimodal treatment: lifestyle modification, pharmacotherapy, rehabilitation, and intervention if indicated.

26/02/2026

Atypical Pneumonia
Mycoplasma – Gradual, dry cough, low fever; CNS/skin signs; treat with macrolides.
Chlamydophila – Mild, gradual, dry cough; usually self-limited; macrolides/tetracyclines.
Legionella – Abrupt, high fever, productive cough; GI/CNS involvement; macrolides/fluoroquinolones.
Coxiella (Q fever) – Livestock exposure, moderate fever, dry cough; doxycycline.
Viruses (Influenza, RSV, Adenovirus) – Abrupt, dry cough, systemic symptoms; supportive; antivirals for influenza.
General – Dry cough + interstitial infiltrates suggest atypical; beta-lactams ineffective; extrapulmonary signs help differentiate.

26/02/2026

Bronchodilators & Mucolytics in Acute Respiratory Diseases

15/02/2026