NR 566 SIMPLIFIED FAST- TRACK MEDICAL CASES AND ACCURATE RESPONSES

NR 566 SIMPLIFIED FAST- TRACK MEDICAL CASES AND ACCURATE RESPONSES Chlamydia treatment first line drug, dose, route and frequency - Answer Doxycycline 100 mg PO BID x 7 days or Azithromycin 1000 mg po once Uncomplicated gonorrhea urethritis treatment - Answer ceftriaxone 500 mg IM single dose with or without doxycycline 100 mg 2x days for days Bacterial Vagionosis 1st line Treatment - Answer Non pregnant metronidazole 500 mg 2xdays for 7 days pregnant - vaginal metronidazole 2% for 7 days clindamycin 1% for 7 days HSV (herpes simplex virus) 12st line treatment - Answer 1 Clinical episode: Acyclovir 400 mg 3x days for 7-10 days 2 Clinical episode: Acyclovir 800 mg 2x days for 5 days Trichomoniasis treatment - Answer Metronidazole (Flagyl) 500 mg 2x day for 7 days (WOMEN) single dose of 2 grams for MEN MEN or Women tinidazole 2g single doxazosin (BPH treatment) (a1 blocker) side effect - Answer side effect hypotension, dizziness, nasal congestions Dutasteride (Avodart) BPH treatment (5a reductase inhibitors) patient teaching - Answer benefits take months to develop, must continue taking med even if improvement not readily seen may lower ejaculatory volume and libido Terazosin (Hytrin) how to know is working - Answer improve symptom of dysuria, urgency, UTI, hesitancy Penicillins MOA - Answer inhibit cell wall synthesis; bactericidal ruptures cell by poking holes in wall Penicillins and cephalosporins - Answer If allergic to one allergic to the other Narrow spectrum penicillinase sensitive - Answer Penicillin G Penicillin V Narrow spectrum penicillin resistant - Answer Nafcillin Oxacillin Dlcloxacillin Broad spectrum penicillin - Answer Amoxicillin Ampicillin Extended spectrum penicillins - Answer Piperacillin Amoxicillin is safe in what? - Answer Breastfeeding, safe in children and infants, pregnant women in 1st trimester older adults adjust for renal Ampicillin - Answer A penicillin that is effective against gram-negative and gram-positive bacteria What are the four groups of penicillin - Answer Narrow spectrum penicillinase resistant, narrow spectrum penicillin resistant, broad spectrum penicillin, extended spectrum penicillin Betalactamase with penicillin - Answer Has minimal toxicity if adverse rxn due to the pcn Penicillin Baseline Data - Answer Culture Penicillin monitoring - Answer Resolution of infection. Signs/symptoms of allergic reaction. Renal function Penicillin contraindications/precautions - Answer client with history of allergic reaction to penicillins, cephalosporins, or imipenem use caution with kidney dysfunction, lactating mothers Penicillin adverse effects - Answer Can do skin test to check for true allergy Aminoglycosides MOA - Answer inhibit bacterial protein synthesis Aminoglycosides - Answer Gentamicin Tobramycin Amikacin Aminoglycosides used against what type of bacteria? - Answer Aeorobic gram negative Aminoglycosides therapeutic uses - Answer Parenteral: gentamicin, tobramycin, amikan Topical: Eye infection gentamicin, neomycin Ears: Neomycin Aminoglycosides baseline data - Answer Blood/urine culture Aminoglycosides Monitoring - Answer Drug levels, renal function, urine output, hearing tests Aminoglycosides adverse effects - Answer Ototoxicity, balance issues, possible permanent deafness in older adults w/ hearing impairment, nephrotoxicity, neuromuscular blockade, hypersensitivity (rash, urticaria). Aminoglycosides black box warning - Answer Neurotoxicity may manifest as ototoxicity and produce a loss of hearing or balance, which may become permanent with continued use. *Tinnitus, vertigo, and persistent headaches are early signs of ototoxicity.* The risk of neurologic effects is higher in patients with impaired renal function. Other signs of neurotoxicity include paresthesias, muscle twitching, and seizures. Concurrent use with other neurotoxic drugs should be avoided. Aminoglycosides monitoring drug levels - Answer Once daily doses: only trough level 1 hour before next dose Peak levels: 30 min after IV/IM Divided doses: trough level just before next dose Aminoglycosides safe for use in - Answer Children/Adolescents Aminoglycosides contraindication - Answer Harm fetus, crosses placenta use in caution with renal impairment with older adults can increase interval dosage to reduce risk of renal damage Cephalosporins - Answer inhibit cell wall synthesis, bacteriacidal, low toxicity Cephalosporins baseline data - Answer Culture and sensitivity Cephalosporins monitoring - Answer None Cephalosporins adverse effects - Answer Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema, causes CDiff Cephalosporins contraindications - Answer Allergies to cephalosporins or penicillin, hepatic or renal impairment Cephalosporin use in infants - Answer 3rd gen ok Can use commonly in children Ok to use in breastfeeding Cephalosporins black box warning - Answer Telvacin not to be used in pregnancy Carbapenems - Answer Imipenem Meropenem Ertapenem Doripenem Carbapenems MOA - Answer Bind to penicillin-binding proteins and inhibit peptidoglycan synthesis and cell wall formation Bactericidal broad spectrum used in mixed infections Carbapenems adverse effects - Answer Diarrhea, nausea, rashes, thrombophlebitis at injection sites. Carbapenems contraindications - Answer Known allergy to any of the carbapenms or betalactams; seizure disorders, meningitis, pregnancy and lactation use of valproate Carbapenems Dosing considerations - Answer Adjust dose for renal impairment Vanomycin - Answer Only drug available to treat MRSA infections and CDiff does not interact with PCN Vancomycin baseline data - Answer Culture and Sensitivity Vancomycin MOA - Answer Blocks cell wall synthesis by sequestration Vancomycin monitoring parameters - Answer Vanco levels with IV peak/troughs Vancomycin Precautions - Answer Renal insufficiency (reduce dosage) Impaired hearing Colitis When patient develops CDiff they should - Answer Immediately stop the antibiotic they are on and take either metronizadole or vancomycin sulfamethoxazole/trimethoprim - Answer Bactrim most common treatment for UTI sulfamethoxazole/trimethoprim MOA - Answer Sequential blockade of folic acid synthesis sulfamethoxazole/trimethoprim uses - Answer -UTI -otitis media -bronchitis -pneumonia -pneumocystis jirovecii sulfamethoxazole/trimethoprim adverse effects - Answer Diarrhea, nausea/vomiting, rash, skin photosensitivity sulfamethoxazole/trimethoprim - Answer Bactrim Sulfamides MOA - Answer Inhibit synthesis if tetrahydrofolate Sulfamides baseline data - Answer UA with culture and sensitivity, CBC w/ WBC, Renal Function Sulfamides monitoring - Answer CBC, CD4+ Sulfamides use - Answer *UTIs*, AIDS, pneumonia, MRSA sulfamides adverse effects - Answer Hypersensitivity rxn, blood dyscarias, kernictus in newborns Sulfamides never give too - Answer Nursing mothers, pregnant in 1st trimester and after 32 weeks, infants younger than 2 months Sulfamides renal dosage - Answer Creatinine 15-30 decrease dose by 50% Creatinine lower than 15 stop immediately Sulfamide patient teaching - Answer Complete course, take with 8-10 glasses of water to prevent crystaluria, avoid exposure to sun/tanning beds, watch for hypersensitivity syndrome (rash) Sulfamides in newborns - Answer Causes kernictus which is the build up of bilirubin in the brain dies irreversible damage Sulfamides can cause what in older adults - Answer Neutropenia and Steven Johnson syndrome Trimethoprim - Answer -Inhibits bacterial dihydrofolate reductase. Bacteriostatic. used commonly in UTI in combination with sulfamexazole Trimethoprim adverse effects - Answer megaloblastic anemia, leukopenia, granulocytopenia, hyperkalemia Trimethoprim monitoring - Answer Check potassium 4 days after start Trimethoprim: Patient Teaching - Answer - instruct patient to take medication and to finish medication completely as directed, even if feeling better advise patient to notify health care professional if skin rash, sore throat, fever, mouth sores, or unusual bleeding or bruising occurs Leucovorin (folinic acid) may be administered if folic acid deficiency occurs instruct patient to notify health care professional if symptoms do not improve Trimethoprim contraindications - Answer pregnancy and lactation Folate deficiency (alcoholism) in renal dysfunction reduce dosage Trimethoprim while taking ARBS/ACE - Answer Increase risk of hyperkalemia Tetracycline - Answer Do not give with milk products, do not give to pregnant women or children before age 8 or damage to tooth enamel occurs Tetracycline MOA - Answer inhibit protein synthesis (bacteriostatic) Tetracycline adverse effects - Answer GI irritation, effects on bone and teeth, superinfection, hepatotoxicity, renal toxicity, photosensitivity Tetracycline first -line for moderate to severe acne, rosacea - Answer if not better after 2-3 month of topical benzamycin, Retin-A use tetracycline used for - Answer BROAD SPECTRUM low dose therapy used to tx: ACNE, STD's, respiratory infections, UTI's H.pylori Tetracycline drug interactions - Answer -Calcium, iron, zinc, aluminum, magnesium and antacids (avoid dairy products) -Decrease effectiveness of oral contraceptives -Increase warfarin effects -Barbiturates -Carbamazepine -Phenytoin -Isotretinoin interacts with digoxin Macrolides - Answer Erythromycin Macrolides MOA - Answer Inhibit protein synthesis by blocking translocation ("macroslides"); bind to the 23S rRNA of the 50S ribosomal subunit. Bacteriostatic. In high doses can be bacterialcidal Macrolides toxicity - Answer Prolonged QT interval, GI discomfort, acute cholestatic hepatitis Macrolides increase risk for sudden death in which drugs - Answer CYP3A4 5x risk with varapamil, ketoconazole, CCB, HIV, Nefazodone) Macrolides Antagonists - Answer Clindamycin and chloramephil Lincosamides (Clindamycin) - Answer Used for *serious infections such as sepsis (blood infection) and bone Clindamycin side/adverse effects - Answer C diff Clindamycin indications - Answer Treatment of serious infections caused by susceptible strains of bacteria, including some anaerobes; useful in septicemia and chronic bone and joint infections. Clindamycin mechanism of action - Answer Bacteriostatic. Inhibit protein synthesis by blocking translocation via 50S subunit. Progesterone (progestin) When is day not safe to prescribe - Answer if women has had a hysterectomy/pregnant Which of the following symptoms are typical GERD symptoms? Epigastric pain and belching Cough and hoarseness Chest pain and globus (lump in the throat) Heart burn and regurgitation - Answer Heart burn and regurgitation are typical symptoms of GERD. Which of the following symptoms are considered atypical for GERD? Nausea Bloating Chest pain Belching - Answer Chest pain The bacteria that is associated with GERD is: Pseudomonas Staph aureus E. Coli H. pylori - Answer h. pylori _________is a risk factor for the development of GERD. - Answer obesity Obesity exerts pressure on the lower esophageal sphincter which causes the up-flow of acid from the stomach into the esophagus. A 50-year-old is diagnosed with gastroesophageal reflux disease. This condition is caused by: Sympathetic nerve stimulation. Fibrosis of the lower third of the esophagus. Loss of muscle tone at the lower esophageal sphincter. Reverse peristalsis of the stomach. - Answer The disease is due to the loss of muscle tone at the lower esophageal sphincter. Which of the following is an "alarm" finding in a person with GERD symptoms? Hypotension. Abdominal pain. Weight gain. Iron-deficiency anemia - Answer Iron-deficiency anemia is an alarm system that can indicate bleeding. The gold standard for the treatment of GERD is: Calcium carbonate. Proton-pump inhibitors (PPIs). Antacids. H2 antagonists. - Answer PPI A 37-year -old female complains of a 7-month history of intermittent heart burn that occurs after eating tomatoes. She denies any weight loss. On exam, the NP identifies epigastric tenderness. As first line therapy for this patient, the NP should advise the patient to: Take an antacid prior to eating. Use a prokinetic agent. Avoid trigger foods. Drink addition fluids with food intake. - Answer Prior to starting medications, avoiding trigger foods can be tried since a specific food, tomatoes were identified, and the patient reports no alarm symptoms. The NP provides education to a patient with a new diagnosis of GERD. Which statement below would indicate that the patient needs further teaching? "I will eat small meals throughout day instead of 3 large ones." "I will not eat just before bedtime." "After I eat, I will recline to help decrease the pressure on the lower esophageal sphincter (LES)." "I will drink ginger tea instead of mint tea." - Answer Reclining will exacerbate GERD symptoms. Select the symptoms below which indicate that the patient may have GERD (Select all that apply): Dysphagia Rebound tenderness Fever Odynophagia Globus Sour taste in mouth - Answer GERD symptoms can include: Sour taste in mouth Odynophagia Dysphagia Globus Side effect of progestin oral contraceptives - Answer it can cause irregular/ inconsistent bleeding, must be take at same time very day to be effective Medroxyprogesterone Acetate benefits - Answer doesn't cause thromboembolic disorder, headache, nausea or most of the other adverse effects associated with combo OCs. testosterone replacement therapy routes - Answer administering testosterone supplement through, pill, injections, and patches. Testosterone patch patient teaching - Answer wash hands after applying cover application site with clothing after the drug had dried wash the application site before skin-to-skin contact another person Androgen therapy appropriate vs. not needed related to puberty - Answer Short term: The psychological pressures of delayed sexual maturation are causing a boy significant distress Long term: if delayed puberty related to true hypogonadism Side effect of testosterone replacement therapy - Answer hot flashes, bone fx, decrease libido, insulin resistance, erectile dysfunction, acne, HTN, sterility, aggression, and mood swings. Alprostadil benefits of various routes: for ED - Answer The injection needs to be done by the patient or in ER setting: rapidly leads to erection, painless Intraurethral pellet insertion: can be done by the patient, an erection occurs within 5-10 mins minimal side effects How does carbamazepine impact oral contraceptives and what symptoms may be associated with that? - Answer accelerated OC medication and reducing OC EFFECT How might this affect which OCP is prescribed Carbamazepine - Answer Increase the estrogen dosage of the OC Combine the OC with a second from a birth control Switch to an alternation form of birth control Benefits of Etonogestrel subdermal implant (Nexplanon) - Answer it is one of the most effective forms of contraception, long term option is 5 years, reversible by removing rod can take with women with a hx of thrombosis · Papaverine plus phentolamine Patient Education - Answer Do not inject more than once in a 24 hours period, notify provide if erection duration and efficacy, consult MD before taking new medication, seek medical attention right away if erection is >3 hours Syphilis 1st line treatment - Answer Penicillin G IV