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Cardiovascular

Abdominal pain in kids

Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB)

Acanthosis Nigricans

Actinic Cheilitis

Acute Kidney Injury (AKI)

Acute Swollen Joint with Fever

Acute Vision Loss

Acute and Progressive Vision Loss

Adjustment Disorder and Anxiety

Adjustment Disorder with Depressed Mood

Age related macular degeneration

Alcohol Cessation

Allergic rhinitis

Angular Cheilitis

Ankylosing Spondylitis (AS)

Anorexia Nervosa

Anticholinergics and TCAs

Antidepressants

Antimetabolite drugs

Antiphospholipid syndrome

Anxiety Disorders

Aortic Dissection

Atrial Fibrillation

Behavioural / learning disorders

Behavioural disturbances

Bell’s palsy and Ramsey Hunt syndrome

Beta-Human Chorionic Gonadotropin (β-hCG)

Biologic agents

Bipolar Disorder

Bleeding disorders

Bronchiectasis (Updated)

CA-125 (Cancer Antigen 125)

CVD Risk Assessment

Calluses and Corns

Candida (Candidiasis as an STI)

Carpal tunnel syndrome and de quervains tenosynovitis

Cervical spondylosis

Chickenpox (Varicella)

Chronic Cough in Children

Chronic Fatigue Syndrome (CFS)

Chronic Kidney Disease (CKD)

Chronic Rhinosinusitis

Chronic Stridor

Clavicular fracture

Colorectal Cancer Screening Recommendations

Congestive Cardiac Failure

Connective Tissue Diseases

Contact Dermatitis

Cutaneous Drug Eruptions

Dacrocystitis, dacyrostenosis, dacyrocystocoele

Deep Vein Thrombosis (DVT)

Depression and Delirium

Dermal melanocystosis (mongolian spot)

Developmental Dysplasia of the Hip (DDH)

Diabetes Insipidus (DI) vs Primary Polydipsia

Diabetic Neuropathy

Dizziness / syncope

Duchenne muscular dystrophy

Dupuytrens / trigger finger

Dyspnoea (Shortness of Breath)

Smoking Cessation

When to Start Pharmacotherapy

Indications for pharmacotherapy (any of the following):
- Smoking within 30 min of waking (best indicator)
- 10 cigarettes/day
- Withdrawal symptoms during prior quit attempts
- Comorbid mental health conditions

Questions to Assess Willingness to Quit

Have you considered quitting?
Are you ready to quit now?
What were your experiences with previous quit attempts?
What barriers prevent you from quitting?
What are your triggers or high-risk situations?

Non-Pharmacological Strategies

Plan Quit Date: Agree on a specific day to quit
Smoking Cessation Support: Refer to a program (e.g., Quitline)
Craving Management:
- 4 D’s: Delay, Distract, Deep breathing, Drink water
- Physical activity to reduce cravings
Motivational Interviewing: Explore and resolve ambivalence
Follow-Up: Arrange review within 1 week
Education: Provide written materials on quitting strategies

Smoking Cessation: Varenicline

Mechanism of Action: Nicotine partial agonist

Dosing Schedule

Day 1–3: 0.5 mg OD
Day 4–7: 0.5 mg BD
Week 2–12: 1 mg BD
Set quit date after 1st week of therapy

Adverse Effects

Nausea (most common)
Abnormal dreams
Mood changes: depression, irritability, suicidality (monitor closely in psychiatric history)
Caution: History of seizures or cardiovascular disease

Contraindications

Severe renal impairment
Pregnancy, breastfeeding, adolescence
Concurrent use with specific medications (check interactions)

Precautions

Monitor:
- Psychiatric illness (close supervision)
- Cardiovascular events (e.g., angina)
- Hepatic impairment (assess LFTs if indicated)

Counselling

Explain common side effects (e.g., nausea, abnormal dreams)
Adherence to dosing improves outcomes
Cravings may increase after cessation; support is crucial
Combine with nicotine replacement therapy (if suitable) for better success
PBS subsidy requires enrolment in a cessation program
Regular follow-up to assess progress, provide behavioural support

Outcome

Doubles chances of long-term cessation with proper adherence and support.

Smoking Cessation

When to Start Pharmacotherapy

Indications

Smoking within 30 minutes of waking (strongest indicator of dependence)
≥10 cigarettes/day
Withdrawal symptoms during prior quit attempts
Comorbid mental health conditions (e.g. depression, anxiety, psychosis)

Questions to Assess Willingness to Quit

Have you considered quitting?
Are you ready to quit now?
What were your experiences with previous quit attempts?
What barriers prevent you from quitting?
What are your triggers or high-risk situations?

Non-Pharmacological Strategies

Plan a Quit Date: Agree on a specific day to stop entirely.
Smoking Cessation Support: Refer to counselling or a quit program (e.g., Quitline).
Craving Management:
- The “4 D’s”: Delay, Distract, Deep breathing, Drink water
- Incorporate physical activity to curb cravings
Motivational Interviewing: Explore ambivalence, enhance motivation.
Follow-Up: Arrange review within 1 week of quit attempt.
Education: Provide written material on quitting strategies.

Smoking Cessation: Varenicline

Mechanism of Action

Nicotine partial agonist: Reduces withdrawal and blocks reward from smoking.

Dosing Schedule

Day 1–3: 0.5 mg once daily
Day 4–7: 0.5 mg twice daily
Week 2–12: 1 mg twice daily
Set quit date after first week of therapy

Adverse Effects

Nausea (most common), abnormal dreams
Mood changes: depression, irritability, rare suicidality → monitor closely in psychiatric history
Caution in patients with seizure history or CVD

Contraindications

Severe renal impairment
Pregnancy, breastfeeding, adolescence
Check for drug interactions

Precautions

Monitor psychiatric illness (close supervision)
Cardiovascular events (e.g. angina)
Consider hepatic impairment if indicated

Counselling

Explain common side effects (nausea, dreams)
Emphasise adherence for best outcome
Cravings may intensify initially; adequate support crucial
Can combine with nicotine replacement (if appropriate) for better success
PBS subsidy often requires enrolment in a cessation support program
Schedule regular follow-ups for behavioural support

Outcome

Doubles chances of long-term cessation with proper adherence and psychosocial support

Additional Notes

Max Alcohol: 2 drinks/day recommended while quitting.
Notify Employer if needed for workplace adjustments.
Encourage optimised sleep, stress management, and identify triggers (e.g., coffee, driving, boredom).
Consider other pharmacotherapies (nicotine replacement therapy, bupropion) if varenicline is unsuitable.

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