1. know INR target for stroke/afib
a. (INR) target of 2.0 to 3.0 for preventing ischemic stroke in atrial fibrillation.
2. who can get hep B vaccine
a. The current recommendations for childhood immunizations include
administering the three-dose HBV series to newborns or at age 11 to 12
years to children not previously vaccinated. The series can be started at any
age, although it is recommended that preterm infants be at least 1 month of
age before starting HPV series
b. Vaccination with HBV is recommended for all ages, particularly patients at
high risk of contracting hepatitis B. Those at high risk include IV drug users,
infants born to mothers who are HbsAg-positive, hemodialysis patients,
sexually active people with multiple partners, incarcerated people,
international travelers, household contacts of hepatitis B carriers, and
sexual contacts of hepatitis B carriers. Patients who are getting tattoos or
who share razors, toothbrushes, or body-piercing jewelry are also at risk of
contracting hepatitis B. Health-care workers, daycare staff, and other people
who may have exposure to body fluids also have a greater risk of contracting
hepatitis B. Patients with diabetes are at increased risk of contracting HBV
and it is recommended they receive the HBV series
2. who can get tuberculin screening
a. Targeted screening for TB is usually based on the patient's presenting with
an identified risk factor. In some areas of the country, routine TB testing is
part of all health maintenance visits because of an increased incidence of TB
in the area.
b. Patients identified as being at risk are those with compromised immune
systems (e.g., HIV-positive or undergoing immunosuppressive therapy or
prolonged adrenocorticosteroid therapy), close contacts of patients with
newly diagnosed infectious TB, injection drug users known to be HIV
seronegative, foreign-born persons from high-prevalence countries,
medically underserved low-income populations, and residents and staff of
long-term-care facilities or prisons. All health-care providers should be
screened routinely.
2. ultimate goal of therapy for HIV
(1) reduce HIV-associated morbidity and prolong the duration and quality of survival
(2) restore and preserve immunological function
(3) achieve maximal and durable suppression of plasma HIV viral load, (4) and prevent HIV
transmission
o maximal suppression goal HIV RNA less than 50 copies/mL goal
• Improve quality of life
• Obtain maximal and durable suppression of HIV
• Prevent vertical HIV transmission
• Prolong survival
• Reduce HIV-related morbidity
• Reduce transmissibility of HIV
• Restore and preserve immunological function
5. t score and what to do
o T scores of less than 2.5 are the major focus of any prefracture treatment.
Those patients with BMD T scores between −1.0 and −2.5 with other
, factors that increase fracture risk to more than 20% in 10 years are also
considered for drug interventions.
o The T-score on your bone density report shows how much your bone mass
differs from the bone mass of an average healthy 30 year old adult. A bone
density test is like any other medical test or measurement. The results for
the entire population will be distributed around an average score (the
mean). A T-score is a standard deviation — a mathematical term that
calculates how much a result varies from the average or mean. The score
that you receive from your bone density (BMD or DXA) test is measured as
a standard deviation from the mean. The manufacturers of the DXA
machines have programmed them to use a formula to compute these
values.
o Most commonly, your BMD test results are compared to the ideal or peak
bone mineral density of a healthy 30-year-old adult, and you are given a T-
score. A score of 0 means your BMD is equal to the norm for a healthy
young adult. Differences between your BMD and that of the healthy young
adult norm are measured in units called standard deviations (SDs). The
more standard deviations below 0, indicated as negative numbers, the
lower your BMD and the higher your risk of fracture.
o As shown in the table below, a T-score between +1 and −1 is considered
normal or healthy. A T-score between −1 and −2.5 indicates that you have
low bone mass, although not low enough to be diagnosed with
osteoporosis. A T-score of −2.5 or lower indicates that you have
osteoporosis. The greater the negative number, the more severe the
osteoporosis.
6. metronidazole education
o When mixed with alcohol, metronidazole has the potential to cause
disulfiram-like reactions. Alcohol should not be consumed during or for at
least 1 day following completion of metronidazole therapy.
o The treatment regimen for trichomoniasis includes oral metronidazole or
tinidazole (CDC, 2010). Patients need to be advised to avoid consuming
alcohol during treatment with metronidazole.
2. treatment for primary dysmenorrhea
o Primary dysmenorrhea is defined as cramping pain in the lower abdomen
occurring just before or during menstruation.
o Ibuprofen, diclofenac potassium, ketoprofen, meclo-fenamate, mefenamic
acid, and naproxen are the drugs used for dysmenorrhea. The best response
occurs if NSAIDS are starting with the onset of menses symptoms
o NSAIDS are the first line of drug treatment for women not desiring
contraception (Zahradnik et al, 2010) and are particularly effective if begun 2
to 3 days before menses or at the first sign of bleeding.
o OTC NSAIDs have the same active ingredients (e.g., ibuprofen, naproxen
sodium) as prescription drugs; however, the labeled recommended dose for
general discomfort may be subtherapeutic for dysmenorrhea.
o Complementary and alternative medicines (CAMs) shown to improve
symptoms of dysmenorrhea include thiamine (vitamin B1), magnesium,
vitamin E, and omega-3 fatty acids
a. (INR) target of 2.0 to 3.0 for preventing ischemic stroke in atrial fibrillation.
2. who can get hep B vaccine
a. The current recommendations for childhood immunizations include
administering the three-dose HBV series to newborns or at age 11 to 12
years to children not previously vaccinated. The series can be started at any
age, although it is recommended that preterm infants be at least 1 month of
age before starting HPV series
b. Vaccination with HBV is recommended for all ages, particularly patients at
high risk of contracting hepatitis B. Those at high risk include IV drug users,
infants born to mothers who are HbsAg-positive, hemodialysis patients,
sexually active people with multiple partners, incarcerated people,
international travelers, household contacts of hepatitis B carriers, and
sexual contacts of hepatitis B carriers. Patients who are getting tattoos or
who share razors, toothbrushes, or body-piercing jewelry are also at risk of
contracting hepatitis B. Health-care workers, daycare staff, and other people
who may have exposure to body fluids also have a greater risk of contracting
hepatitis B. Patients with diabetes are at increased risk of contracting HBV
and it is recommended they receive the HBV series
2. who can get tuberculin screening
a. Targeted screening for TB is usually based on the patient's presenting with
an identified risk factor. In some areas of the country, routine TB testing is
part of all health maintenance visits because of an increased incidence of TB
in the area.
b. Patients identified as being at risk are those with compromised immune
systems (e.g., HIV-positive or undergoing immunosuppressive therapy or
prolonged adrenocorticosteroid therapy), close contacts of patients with
newly diagnosed infectious TB, injection drug users known to be HIV
seronegative, foreign-born persons from high-prevalence countries,
medically underserved low-income populations, and residents and staff of
long-term-care facilities or prisons. All health-care providers should be
screened routinely.
2. ultimate goal of therapy for HIV
(1) reduce HIV-associated morbidity and prolong the duration and quality of survival
(2) restore and preserve immunological function
(3) achieve maximal and durable suppression of plasma HIV viral load, (4) and prevent HIV
transmission
o maximal suppression goal HIV RNA less than 50 copies/mL goal
• Improve quality of life
• Obtain maximal and durable suppression of HIV
• Prevent vertical HIV transmission
• Prolong survival
• Reduce HIV-related morbidity
• Reduce transmissibility of HIV
• Restore and preserve immunological function
5. t score and what to do
o T scores of less than 2.5 are the major focus of any prefracture treatment.
Those patients with BMD T scores between −1.0 and −2.5 with other
, factors that increase fracture risk to more than 20% in 10 years are also
considered for drug interventions.
o The T-score on your bone density report shows how much your bone mass
differs from the bone mass of an average healthy 30 year old adult. A bone
density test is like any other medical test or measurement. The results for
the entire population will be distributed around an average score (the
mean). A T-score is a standard deviation — a mathematical term that
calculates how much a result varies from the average or mean. The score
that you receive from your bone density (BMD or DXA) test is measured as
a standard deviation from the mean. The manufacturers of the DXA
machines have programmed them to use a formula to compute these
values.
o Most commonly, your BMD test results are compared to the ideal or peak
bone mineral density of a healthy 30-year-old adult, and you are given a T-
score. A score of 0 means your BMD is equal to the norm for a healthy
young adult. Differences between your BMD and that of the healthy young
adult norm are measured in units called standard deviations (SDs). The
more standard deviations below 0, indicated as negative numbers, the
lower your BMD and the higher your risk of fracture.
o As shown in the table below, a T-score between +1 and −1 is considered
normal or healthy. A T-score between −1 and −2.5 indicates that you have
low bone mass, although not low enough to be diagnosed with
osteoporosis. A T-score of −2.5 or lower indicates that you have
osteoporosis. The greater the negative number, the more severe the
osteoporosis.
6. metronidazole education
o When mixed with alcohol, metronidazole has the potential to cause
disulfiram-like reactions. Alcohol should not be consumed during or for at
least 1 day following completion of metronidazole therapy.
o The treatment regimen for trichomoniasis includes oral metronidazole or
tinidazole (CDC, 2010). Patients need to be advised to avoid consuming
alcohol during treatment with metronidazole.
2. treatment for primary dysmenorrhea
o Primary dysmenorrhea is defined as cramping pain in the lower abdomen
occurring just before or during menstruation.
o Ibuprofen, diclofenac potassium, ketoprofen, meclo-fenamate, mefenamic
acid, and naproxen are the drugs used for dysmenorrhea. The best response
occurs if NSAIDS are starting with the onset of menses symptoms
o NSAIDS are the first line of drug treatment for women not desiring
contraception (Zahradnik et al, 2010) and are particularly effective if begun 2
to 3 days before menses or at the first sign of bleeding.
o OTC NSAIDs have the same active ingredients (e.g., ibuprofen, naproxen
sodium) as prescription drugs; however, the labeled recommended dose for
general discomfort may be subtherapeutic for dysmenorrhea.
o Complementary and alternative medicines (CAMs) shown to improve
symptoms of dysmenorrhea include thiamine (vitamin B1), magnesium,
vitamin E, and omega-3 fatty acids
