NR509 EXAM

NR566 final exam What is the first line treatment for Chlamydia that only needs to be taken orally once? - ANSWER Azithromycin 1000mg What is the first line treatment for Chlamydia that is taken BID for 7 days? - ANSWER Doxycycline 100mg What is the IM treatment for uncomplicated gonorrhea? - ANSWER Ceftriaxone 500mg IM ceftriaxone can be given with or without this medication to treat gonorrhea. - ANSWER Doxycycline 100mg BID Treatment for bacterial vaginosis in a non pregnant patient. - ANSWER Metronidazole 500mg BID for 7 days What are two treatments for bacterial vaginosis in a pregnant patient. - ANSWER Vaginal metronidazole 2% for 7 days. Clindamycin 1% for 7 days. First line treatment for HSV. - ANSWER Acyclovir 400mg three times a day for 7-10 days. Second line treatment for HSV. - ANSWER Acyclovir 800mg BID for 5 days. Trichomoniasis treatment for women. - ANSWER Metronidazole 500mg BID for 7 days. Tinidazole 2grams single dose. Trichomoniasis treatment for men. - ANSWER Metronidazole 2grams single dose. Tinidazole 2grams single dose. What are doxazosin side effects? - ANSWER hypotension, dizziness, nasal congestion What is doxazosin used to treat? - ANSWER BPH Dutasteride (Avodart) is used to treat what? - ANSWER BPH How long does it take to see effects of Dutasteride (Avodart)? - ANSWER May take months. Patient should continue to take it even if improvement is not seen right away. What are side effects of Dutasteride (Avodart)? - ANSWER May lower ejaculatory volume. May lower libido. How do you know that Terazosin (Hytrin) is working? - ANSWER Symptoms of dysuria, urgency, UTI, and hesitancy improve. When is it not safe to prescribe progesterone? - ANSWER If a patient is pregnant or has had a hysterectomy. Breast cancer. Arterial disease. Previous diagnosis of depression. What are side effects of progestin oral contraceptives? - ANSWER irregular bleeding Patient teaching about progestin oral contraceptives. - ANSWER Must take at the same time every day to be effective. May cause inconsistent bleeding. Benefits of using medroxyprogesterone acetate? (Depo-Provera) - ANSWER Does not cause thrombolytic disorders, headache, nausea, or other adverse effects associated with combo OC's. Testosterone replacement therapy routes. - ANSWER Pill, injection, patch. What are teaching points about testosterone patch? - ANSWER Wash hands after applying Cover site after dried Wash application site before skin to skin contact May cause rash at application site When is androgen therapy appropriate for short term use? - ANSWER Pressure of delayed sexual maturation causes significant distress. When is androgen therapy appropriate for long term use? - ANSWER Delayed puberty related to hypogonadism. Side effects of testosterone replacement therapy. - ANSWER hot flashes, bone fractures, decreased libido, insulin resistance, erectile dysfunction, acne, hypertension, sterility, aggression, mood swings. What is alprostadil used for? - ANSWER erectile dysfunction Routes of administration for alprostadil. - ANSWER Intracavernosal (Immediate erection) Intraurethral pellet (Erection 5-10 mintutes) How does carbamazepine impact OC's? - ANSWER Accelerate the metabolism reducing the effect. How would an OC be prescribed with carbamazepine? - ANSWER Increase the estrogen dose, combine with a second form of birth control, or switch to an alternate birth control. What is carbamazepine used to treat? - ANSWER Seizure disorders What are the benefits of the etonogestrel sub-dermal implant (Nexplanon)? - ANSWER Very effective Long-term option- 5 years Reversible after removed Women with a history of thrombosis can use this What is papaverine/phentolamine used to treat - ANSWER erectile dysfunction What are patient education points for papaverine/phentolamine? - ANSWER Do not inject more than once in 24 hours. Notify of duration and efficacy of erection. Consult physician before taking new medications. Seek medical attention if erection lasts more than 3 hours. What is the first line treatment for syphilis? - ANSWER Penicillin G IV What is Pramipexole (Mirapex)? When is it best prescribed? - ANSWER Dopamine receptor agonist Best when used in the early stages of PD What are adverse effects of pramipexole (mirapex)? - ANSWER nausea, dizziness, daytime sleep attacks(extreme/irresistible urge), insomnia, constipation, weakness, hallucinations, impulse control When to prescribe COMT inhibitors - ANSWER When levodopa is not working long enough and starts to wear off between doses. This medication extends the half-life of levodopa. What seizure medications reduce oral contraceptive efficacy? - ANSWER Carbamazepine Eslicarbazephine Lamotrigine Oxcarbazepine Phenytoin Phenobarbital Rufinamide Topiramate What can patients do to minimize adverse effects of bromocriptine (dopamine agonist)? - ANSWER Take medication with food to decrease GI upset or decrease dose What is levodopa/carbidopa used for? - ANSWER Treatment and replacement of dopamine for PD. Helps improve ADL function. What are adverse effects of levodopa/carbidopa? - ANSWER orthostatic hypotension, psychosis, dyskinesia Phenytoin (Dilantin) common side effects - ANSWER CNS side effects, gingival hyperplasia, leathery skin, GI upset, blurred vision, suicidal behavior, cognitive decline. Ways to prevent gingival hyperplasia when taking phenytoin - ANSWER Good oral hygiene How long should a patient wait before they start driving after being diagnosed with a seizure disorder? - ANSWER 1 year What vitamin should a patient take when on phenytoin besides folic acid? - ANSWER Vitamin D. Phenytoin and contraceptive interaction - ANSWER Makes OC's less effective, should have backup or increase dose. How is phenytoin effectiveness monitored? - ANSWER Serum drug level. Absence of seizures during trial drug period. What anticonvulsant would be given for adjunctive therapy for partial seizures with or without secondary generalization? - ANSWER Lamotrigine What medication (with example) can be used preventatively for migraines? - ANSWER Beta blockers such as metoprolol/propranolol What is abortive therapy? - ANSWER Abortive therapy is aimed at alleviating pain during the aura phase (if present) or soon after the headache has started. What are examples of abortive therapy for migraines? - ANSWER NSAIDS, opioids, triptans, ergot alkaloids What is the first line treatment for acute mid/moderate migraines without vomiting? - ANSWER NSAIDs such as naproxen or ASA When is it appropriate to prescribe a patient preventative therapy for migraines? - ANSWER Frequent attacks 3 or more a month, or attacks that do not respond to abortive therapy, severe migraines. What are examples of opioid analgesics for severe migraines? - ANSWER Butorphanol nasal spray. Spray each nostril Q60 min PRN What is the mechanism of action for sumatriptan? - ANSWER Suppresses release of CGRP from trigeminal neurons. This leads to vasoconstriction and decreased perivascular inflammation to relieve migraine pain. The first dose of triptan should be under medical supervision for what reason? - ANSWER In the case of any unknown underlying cardiac condition. What are contraindications to triptans? - ANSWER Ischemic heart disease HTN CV disease Pregnancy Basilar or hemiplegic migraine can cause cerebral vasoconstriction Use of an ergot alkaline within 24 hours cause prolonged cerebral vasospasm What is rivastigmine (Exelon) used for? - ANSWER Combat symptoms of Alzheimer's disease. Slows progression of disease-not a cure What are patient teachings for rivastigmine (Exelon)? - ANSWER bradycardia, fainting, falls risk, falls-related fractures. What is Donepezil (Aricept) used to treat? - ANSWER Symptoms of Alzheimer's disease When would it be appropriate to increase the patient's dose of Donepezil (Aricept)? - ANSWER When the patient is stable on the initial dose for at least 1-3 months. Cholinesterase inhibitor side effects are usually related to what? - ANSWER Dosing. Dosing should start low and titrate up. Common dose-related side effects of cholinesterase inhibitors - ANSWER Nausea, diarrhea, insomnia. What is most likely happen as a result of the cardiac side effects of cholinesterase inhibitors? - ANSWER Falls due to bradycardia What can be done to prevent weight loss that can be associated with cholinesterase inhibitors? - ANSWER Nutritional shakes, encourage snacks between meals, meet with a dietician. When taking medications for Alzheimer's disease, what medication should be added before herbals, supplements, NSAIDs, - ANSWER Memantine- Dementia medication that decreases abnormal brain activity. What should be considered in the renally impaired when prescribing memantine? - ANSWER Dosage adjustment. Especially in patients with a creatinine clearance of less than 30ml/min. What medication is the first-line treatment for panic disorder? - ANSWER SSRIs What are examples of SSRIs? - ANSWER Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) What is the first line treatment for performance anxiety? - ANSWER Beta blockers such as propranolol (Inderal) What is the first line treatment for general anxiety disorder? - ANSWER SSRIs and SNRIs What are examples of SNRIs used for general anxiety disorder? - ANSWER Venlafaxine (Effexor XR) Duloxetine (Cymbalta) Buspirone What are examples of SSRIs used for general anxiety disorder? - ANSWER Paroxetine (Paxil) Escitalopram (Lexapro) What drugs are used to treat depression? - ANSWER SSRIs SNRIs Bupropion Mirtazapine (atypical antidepressant) How long should a patient be on treatment for depression before switching to a different medication/adding another medication is considered? - ANSWER 4-8 weeks. What should the provider consider if a treatment for depression is not working? - ANSWER Switch to a drug of the same class Switch to a drug of another class Add a drug like an atypical antidepressant When are initial and maximal results seen when a patient is on antidepressants? - ANSWER Initial: 1-3 weeks Maximal: 12 weeks What is a black box warning for all antidepressants? - ANSWER Increased suicide risk What populations are at higher risk for increased suicide risk when starting on antidepressants? - ANSWER Children, adolescents, adults younger than 25 What medication can help a patient fall asleep but does not effect staying asleep? - ANSWER Melatonin What is the first line treatment for sleep disturbances? - ANSWER Benzodiazepine (Triazolam) Benzodiazepine-Like Drugs (Zolpidem ,Zaleplon, eszopiclone) Barbiturate (Secobarbital) Melatonin Receptor Agonist (Ramelteon , melatonin) Orexin Receptor Agonist (Suvorexant) What is the therapeutic range of lithium? - ANSWER 0.6-0.8 mEq/L is ideal level Can be anywhere from 0.4-1.0mEq/L What medications interact with lithium? - ANSWER Diuretics NSAIDs Anticholinergics What is a side effects of first generation antipsychotics? - ANSWER Severe movement disorders known as extrapyramidal symptoms and tardive dyskinesia. What should a patient be educated on when taking a first generation antipsychotic? - ANSWER Hypotension signs and management What drugs interact with SSRIs? - ANSWER MAOIs Antiplatelet (ASA) Anticoagulant (Eliquis, Xeralto) What baseline data is needed in older adults and those on diuretics before starting therapy with an SSRI or SNRI? - ANSWER Sodium levels What is a strategy to minimize adverse effects of SSRIs? - ANSWER Report thoughts of suicide or self harm. Do not abruptly discontinue. What are common adverse effects of SSRIs? - ANSWER Sexual dysfunction weight gain serotonin syndrome What baseline data is needed before starting tricyclic antidepressants? - ANSWER ECG, especially if they are known to have a dysrhythmia or are above the age of 40 What side effect of tricyclic antidepressants should patients be educated on? - ANSWER Hypotension What baseline data is needed before starting an MAOI? - ANSWER BP What can happen to patients when taking MAOIs and what are the symptoms? - ANSWER Hypertensive crisis - headache, tachycardia, palpitations, N/V, sweating. What is the dietary restriction with MAOIs? - ANSWER Tyramine What kinds of foods contain tyramine? - ANSWER Fermented, aged, bean curd, cured meats, protein supplements, chocolate, caffeine, avocado, banana. What are examples of benzodiazepine-like drugs? - ANSWER Zolpidem Zaleplon Eszopicolone (Lunesta) Triazolam is an example of what drug class? - ANSWER Benzodiazepines What are examples of melatonin receptor agonists? - ANSWER Ramelteon (Rozerem) Melatonin What are symptoms of serotonin syndrome? - ANSWER Dizziness, headache, nausea, sensory disturbances, tremor, anxiety, dysphoria. When can symptoms of serotonin syndrome begin and how long can they last? - ANSWER Begin days to weeks. Persist 1-3 weeks. What are adverse effects of Kava? - ANSWER hepatotoxicity, severe liver injury What are adverse effects of ginkgo biloba and how can these be reduced? - ANSWER GI upset, headaches, dizziness Reduce dose = reduced symptoms What kind of precautions do patients need to be on when taking ginkgo biloba? - ANSWER Seizure precautions What are adverse effects of ginger root? - ANSWER CNS depression Cardia dysrhythmias GI disturbances Doses over 5 grams can stimulate the uterus What are adverse effects of St. John's Wort? - ANSWER Allergic skin reactions, especially if patient has allergies to daisies and ragweed. CNS effects (insomnia, vivid dreams, restless, anxiety, agitation) GI effects Phototoxicity in high doses Echinacea is contraindicated in what patient populations? - ANSWER HIV, TB Immunocompromised, Autoimmune disorders What should patients know before taking flax seeds? - ANSWER May reduce absorption of other medications. Take 1 hour before or two hours after other medications. What improvements are seen with coenzyme Q-10 - ANSWER Improve cardiac function and recover May improve sperm count and quality What is feverfew used for? - ANSWER Prophylaxis of migraines 50-300mg twice daily. What is the purpose of the Dietary Supplement Health and Education Act of 1994? - ANSWER Dietary supplements are food supplements and not drugs, therefore they are exempt from the FDA approval process. What is the purpose of the Food, Drug, and Cosmetic Act? - ANSWER Requires drugs, both prescription and OTC, go through rigorous evaluation of safety before receiving FDA approval. What does the Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006 mandate? - ANSWER Reporting of serious adverse effects of nonprescription drugs and dietary supplements. What is the purpose of the Current Good Manufacturing Practices ruling of 2007? - ANSWER Regulates supplement manufacturing and labeling to make sure supplements are free of contaminates and to prevent mislabeling. What is the treatment for PID? - ANSWER Doxycycline 100mg BID for 14 days Must either add one single dose of ceftriaxone 250mg or one IM injection of cefoxitin Should also add flagyl 500mg PO BID for 14 days When is it safe to use progesterone? - ANSWER Menopausal hormone therapy, endometrial cancer and hyperplasia, amenorrhea, dysfunctional uterine bleeding. When are COMPT inhibitors prescribed for PD? - ANSWER When levodopa doses wear off too soon before another dose is due. Extends half-life of levodopa.