AANP-FNP Exam

Hegar's sign - Softening of lower uterine segment Chadwick's sign - Bluish color of cervix and vagina at 6-8 weeks Goodell's sign - Softening of cervix at 4+ weeks Lipids in chronic inactivity - Low HDL Lipids in under- or untreated hypothyroidism - Elevated total cholesterol, TG, and LDL Lipids in chronic renal insufficiency - Elevated total cholesterol and TG Lipids in alcohol abuse - Elevated TG, HDL, and LDL Vaccines with live attenuated viruses - MMR, varicella, flu-mist(intranasal), Zostavax Drugs of choice for abdominal infection - Beta lactams + metronidazole (most common); fluoroquinolones Drugs of choice for urinary tract infection - Fluoroquinolones (except moxi), TMP-SMX, fluconazole, b-lactams, nitrofurantoin, fosfomycin if pt has many allergies Drugs of choice for pulmonary infections - Macrolides, resp fluoroquinolones, b-lactams, doxycycline (MRSA, atypical coverage) Drugs of choice for skin and soft tissue infections - MRSA: TMP-SMZ, doxycycline, clindamycin; b-lactams Drugs of choice for MRSA - Vancomycin, daptomycin , linezolid, TMP-SMZ, doxycycline, ceftaroline Macrolide drugs - Erythromycin, clarithromycin, azithromycin Macrolide AEs - GI, QT prolongation Tetracycline uses - MRSA, rocky mtn spotted fever, atypicals (mycoplasma pneumonia, chlamydia), spirochetes (Lyme), i Tetracycline AEs - GI, teeth, hepatic dysfunction, photosensitivity Fluoroquinolone drugs - Ciprofloxacin, levofloxacin, moxifloxacin Fluoroquinolone uses - UTI (cipro or levo), atypicals (mycoplasma, legionella) Fluoroquinolones and dairy or vitamins - Take 2 hrs before or 4 hours after (decrease concentrations) Metronidazole (Flagyl) uses - C. Diff, vaginitis Metronidazole AEs - GI, peripheral neuropathy, disulfiram reaction Nitrofurantoin uses - UTI -not pyelonephritis due to no systemic absorption Nitrofurantoin AEs, contraindications - Pulmonary fibrosis, contraindicated in CrCl <60 (excludes many elderly) Aminoglycoside drugs - Gentamycin, tobramycin Aminoglycoside uses - Atypical coverage, resistant infections, tobramycin for CF only Aminoglycoside AEs - Ototoxicity (irreversible), nephrotoxicity (reversible) Aminoglycoside monitoring - Renal dose adjust, hearing test, drug level monitoring Antifungals (azoles) - Fluconazole, itraconazole Itraconazole interactions - Acid suppressive therapies Fluconazole dose adjust - Renal Antifungal AEs - GI, QTc prolongation (fluconazole) Antifungal drug interactions - QT prolongation meds, warfarin Anti-infectives not for pregnant - Tetracyclines, TMP-SMZ TMP-SMZ coverage - G+, G-, MRSA, Protozoa (toxoplasma gondii), fungus (pneumocystis jirovecii), poor anaerobic activity TMP-SMZ AEs - Sulfa allergy, photosensitivity, hematologic (anemia, leukopenia, thrombocytopenia) TMP-SMZ on renal function - Dose adjust in renal impairment, false elevation in serum Cr TMP-SMZ drug interactions - Warfarin Gram + only coverage - Clindamycin, linezolid, vancomycin, daptomycin Gram - only - Monobactams (aztreonam), penicillin VK