NR 566 Final Study Guide

Chlamydia (Among Adolescents and Adults) Treatment - Doxycycline 100 mg Orally BID for 7 day **Alternative therapy: - Azithromycin 1g Orally in a single dose - Levofloxacin 500 mg orally daily for 7 days Uncomplicated gonococcal urethritis Treatment - Chlamydial infection is excluded: Ceftriaxone 500 mg IM single dose If Chlamydial infection has not been excluded: - Ceftriaxone 500 mg IM single dose - Doxycycline 100 mg Orally BID for 7 day **Alternative therapy: -Gentamicin 240 mg IM in a single dose + Azithromycin 2 g orally in a single dose - Cefixime 800 mg orally in a single dose Bacterial Vaginosis Treatment - - Metronidazole 500 mg orally BID for 7 days - Metronidazole gel 0.75% one full applicator intravaginal, once a day for 5 days - Clindamycin vaginal cream 2% one full applicator intravaginal, at bedtime for 7 days Herpes Simplex Virus (First Clinical Episode) Treatment - - Acyclovir 400 mg orally TID for 7-10 days - Famciclovir 250 mg orally TID for 7-10 days - Valacyclovir 1 g orally twice a day for 7-10 days Pelvic Inflammatory Disease (PID) (IM or Oral Regimens) Treatment - - Ceftriaxone 500 mg IM in a single dose + Doxycycline 100 mg orally BID for 14 days + Metronidazole 500 mg orally BID of 14 days - Cefoxitin 2g IM in a single dose + Probenecid 1g orally in a single dose + Doxycycline 100 mg orally BID for 14 days + Metronidazole 500 mg orally BID for 14 days - Other parenteral third generation Cephalosporin (Ceftizoxime or Cefotaxime) + Doxycycline 100 mg orally BID for 14 days + Metronidazole 500 mg orally BID for 14 days Syphilis Treatment - Benzathine Penicillin G 2.4 million units IM in a single dose Doxazosin side effects (due to alpha 1 receptor being blocked) - dizziness/syncope, headache, first-dose orthostatic hypotension, drowsiness, nasal congestion Dutasteride (Avodart) patient teaching - benefits take months to develop, must continue taking med even if improvement not rapidly seen may lower ejaculatory volume & libido Should not be handled by pregnant women as the medication is teratogenic How to know Terazosin is working? - improved symptoms of dysuria, urgency, urinary tract infections, hesitancy etc. Improvement should occur rapidly Oral Estrogen - Most convenient and used most often. Transdermal Estrogen - Total dose of estrogen is greatly reduced. Less nausea and vomiting, blood levels of estrogen fluctuate less. Lower risk for DVT, PE, and stroke. Intravaginal Estrogen - Used for local effects. Primarily treatment of vulval and vaginal atrophy associated with menopause. Femring (vaginal ring) - used for systemic effects (controlling hot flashes and night sweats), as well as local effects (vulval and vaginal atrophy) Parenteral Estrogen - Limited to acute, emergency control of heavy uterine bleeding When is it safe to prescribe Progesterone (Progestin)? - Safe: Menopausal hormone therapy, dysfunctional uterine bleeding, amenorrhea, endometrial Hyperplasia and carcinoma, In Vitro Fertilization When is it not safe to prescribe Progesterone (Progestin)? - Not safe: Undiagnosed abnormal vaginal bleeding, active thrombophlebitis, history of thromboembolic disorders, active liver disease and carcinoma of the breast Side effects of progestin-only oral contraceptives? - more likely to cause irregular/inconsistent bleeding, must be taken at same time every day to be effective Less Effective **Little to no effect on milk production Benefits of prescribing medroxyprogesterone acetate (Depo-Provera) - doesn't cause thromboembolic disorders, headaches, nausea, or most of the other adverse effects associated with combo OCs. does not decrease milk supply during lactation Protects against pregnancy for 3 months or longer Testosterone replacement therapy routes: - treatment that involves administering testosterone supplements through pills, injections, or skin patches testosterone patch patient teaching: - ○ good hand washing is required after application ○ cover application site with clothing after medication has dried ○ wash the application site before skin-to-skin contact with another person ■ females and children may experience negative effects from exposure to testosterone ■ if cross contamination occurs, wash the affected area with soap and water to prevent absorption When is androgen therapy appropriate vs. not needed related to puberty? - Short term: The psychological pressures of delayed sexual maturation are causing a boy significant distress. Long term: if delayed puberty related to true hypogonadism testosterone replacement therapy side effects? - Hot flashes, bone fractures, decreased libido, insulin resistance, erectile dysfunction, gynecomastia, acne, HTN, sterility, hepatotoxicity, mood swings/ aggression. Alprostadil: benefits of various routes? (for ED) - Transurethral - inserted into the urethra - Can be used twice daily - Erection develops 5 to 10 minutes after drug insertion and lasts 30 to 60 minutes Intracavernous - direct injection into the corpus cavernosum. - Used no more than 3 times a week and no more than once every 24 hours. - Response is rapid and the injections are relatively painless How does carbamazepine impact oral contraceptives and what symptoms may be associated with that? - accelerates OC metabolism, reducing OC effect can lead to abnormal bleeding, return of menstrual symptoms, and of course pregnancy! what can the provider do is carbamazepine effecting patient's OC? - 1. Increase the estrogen dosage of the OC. 2. Combine the OC with a second form of birth control. 3. Switch to an alternative form of birth control. Benefits of Etonogestrel subdermal implant (Nexplanon)? - it is one of the most effective forms of contraception, long-term option (contraception up to 5 years), reversible by removing rod - Safe during breastfeeding after the 21st day postpartum Papaverine plus phentolamine patient education: - do not inject more than once in a 24 hr period, notify provider of erection duration and efficacy, do not take other ED meds with this medication, needle/injection teaching, do not change the dose yourself, seek medical attention if erection is 3 hrs Adverse effects associated with Pramipexole - nausea, dizziness, daytime somnolence, insomnia, constipation, weakness, and hallucinations. Impulse control disorder can occur (excessive gambling, spending etc.) Sleep attacks (overwhelming and irresistible sleepiness that comes on without warning) When is Pramipexole best used in treating Parkinson's? - - Used alone in the early stages of PD - Produces significant improvement in motor performance - Combined with Levodopa in advance stages of PD - Reduce fluctuations in motor control when are COMT inhibitors indicated? (I.e. Entacapone) - If patient experiences "off" phases with their medication therapy (return of symptoms for random periods of time) extends the half-life of Levadopa What are sleep attacks associated with Parkinsons treatment? - overwhelming/irresistible sleepiness that comes on without warning How to manage side effects of Bromocriptine (dopamine agonist): - **Adverse effects are dose dependent - Take with food to decrease GI upset - start with lowest effective dose and gradually increase - screen for hx of compulsion/sleep disturbance what seizure meds reduce OC efficacy? - carbamazepine, eslicarbazepine, lamotrigine, oxcarbazepine, phenytoin, phenobarbital, rufinamide, topiramate Phenytoin side effects - drowsiness, ataxia nystagmus blurred vision lethargy GI upset suicidal behavior/cognitive decline patient teaching with Phenytoin - strict adherence to medication is important due to its narrow therapeutic range patient teaching regarding anti-seizure meds and OC/pregnancy: - effectiveness of OC may be decreased by many anti-seizure meds, if pregnancy is unwanted the pt should consider adding or increasing contraception. lowest dose/lowest number of meds used during pregnancy tends to be most safe. Risk vs benefit! Folic acid is essential How to monitor antiepileptic drugs for effectiveness? - Monitoring plasma drug levels and absence of seizures during trial period while finding right medication. Patient should not drive during this time Which anticonvulsant would be given for someone with epilepsy needing adjunctive therapy for partial seizures with or without secondary generalization? - Gabapentin What is abortive migraine therapy and when is it used - analgesics (NSAID and opioid) and migraine specific meds (Triptans and Ergot alkaloids) used to treat migraine pain and associated symptoms used at 1st sign of attack First-line treatment for migraine prevention? - Beta Blockers: Metoprolol or Propranolol First-line treatment for acute, mild to moderate migraine without nausea or vomiting? - NSAID: Naproxen or aspirin How to know someone would be appropriate for preventative migraine therapy? - Indicated for patients who have frequent attacks (3+ a month), severe attacks, or attacks that do not respond adequately to abortive therapy Opioid analgesic reserved for severe migraines that don't respond to first-line medications? - Butorphanol nasal spray; one spray each nostril every 60 minutes prn mechanism of action for sumatriptan: - suppresses the release of CGRP from trigeminal neurons