Anti-psychotics
The current dominant theory suggests that first-generation psychotics, used to treat schizophrenia, work by suppressing symptoms of psychosis by blocking what receptor?
dopamine D2receptors in the mesolimbic area of the brain
When prescribing HRT for females with a uterus, the NP knows the therapy should include what?
Estrogen and progesterone
(Estrogen alone should never be prescribed to females with a uterus bc it will increase the risk of endometrial cancer. In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma.)
For patients who have undergone hysterectomy, progestin is unnecessary; estrogen-only preparations still carry increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but increased risk of stroke and breast cancer with estrogens
What are the benefits associated with male androgen therapy?
improved energy, mood, muscle mass, bone density, and sexual dysfunction
How do alpha-1 adrenergic antagonist help with BPH?
These medications relax the smooth muscles of the bladder neck to improve urinary symptoms experienced with BPH. They do not decrease the size of the prostate. Increased urinary frequency is a sign of worsening BPH, not improvement
What is the recommended treatment for babies born to mothers with a positive Chlamydia infection?
Oral erythromycin
(Infants born to women with cervical C. trachomatis are at risk for conjunctivitis and pneumonia. Topical erythromycin may help prevent conjunctivitis, but it is not completely effective and does not prevent pneumonia; therefore, this infant will need treatment with oral erythromycin. Blindness will not occur as a result of C. trachomatis conjunctivitis.)
(Pregnant females should be treated with azithromycin. Doxycycline is contraindicated in pregnancy)
What is a common cause of fever >102 in pediatrics
UTI
Note that Children with recurrent urinary tract infections should be assessed for underlying urinary tract abnormalities to help determine a possible cause for recurrence.
What are the risk associated with PPI use?
increased infection rate (COP and hospital-acquired pneumonia), fractures, kidney issues, decreased vitamin absorption
All antidepressants carry the risk of worsening of depression symptoms. When should the NP admit a patient to the hospital for depression?
When the patient is at high risk for suicide.
(Patients with depression often think of suicide, and during treatment with antidepressants, these thoughts often increase for a time. Patients whose risk of suicide is high should be hospitalized. All antidepressants carry this risk, so changing medication is not recommended. Discontinuing the medication is not recommended. More frequent clinic visits are recommended for patients with a low to moderate risk of suicide.)
Common side effect of bismuth and senna?
Black stools and discoloration of the tongue are side effects associated with bismuth but are not harmful
Systemic absorption of senna, followed by renal excretion, may impart a harmless yellowish-brown or pink color to the urine.
What side effects are associated with first generation antipsychotics?
Anticholinergic effects, neuroendocrine effects, orthostatic hypotension, sedation, extrapyramidal effects, and prolactin elevation
When should back-up contraception be used when oral contraceptives are in use?
Type of birth control pill use is changed, missed pills, sick or diarrhea, switching contraceptive method
note that progestin-only pills may experience irregular bleeding, including spotting, and irregular periods
What are the risks associated with androgen therapy?
Worsening sleep apnea, acne and skin reactions, stimulating growth of the prostate (BPH) and growth of prostate cancer (if present), gynecomastia, decreased sperm production, stimulation of red blood cell production (placing pt at risk for blood clots), increase in LDL chol.
people who abuse androgens in any form are also at risk for hepatotoxicity
pt on therapy should have cbc, psa, ldl, and total chol checked regularly according to recommendations and no oral androgens are safe as they are high risk for liver damage
What is the most common pathogen for UTI?
e choli
What STI is characterized with painful blisters and sores on the genitals?
Herpes simplex virus
Herpes is spread through viral shedding, which can occur when no blisters are present. Although HSV-1 is primarily oral and HSV-2 is primarily genital, a patient can have HSV-1 or HSV-2 in either location. HSV is treated with acyclovir, famciclovir, or valacyclovir, which are antiviral medications
A UTI that returns after initial treatment should be treated how?
Patients who develop a subsequent urinary tract infection after treatment are treated in a stepwise fashion, beginning with a longer course of antibiotics. The next steps would be to begin a 4- to 6-week course of therapy, followed by a 6-month course of therapy if that is unsuccessful. If urinary tract infections are thought to be caused by other complicating factors, an evaluation for structural abnormalities may be warranted
What is the most common cause of peptic ulcer disease?
Helicobacter pylori and long term NSAID use
(The recommendation for all patients with gastric or duodenal ulcers and documented Helicobacter pylori infection is treatment with antibiotics. Patients on NSAIDS can take a PPI to prevent ulcers)
What is the preferred management for patients on an anti-depressant who report sexual dysfunction?
Sexual dysfunction may be managed by having the patient take a drug holiday, which involves discontinuing medication on Fridays and Saturdays
What is the preferred medication to lower ammonia levels in patients with liver issues?
Lactulose is the only laxative known to lower ammonia levels in patients with portal hypertension and hepatic encephalopathy secondary to liver disease.
Agranulocytosis is a life-threatening side effect of what anti-psychotic medication?
Clozapine
(Clozapine has a black box warning for life-threatening agranulocytosis. This typically is gradual and occurs over the first 6 months. If the total WBC count falls below 3000/mm3 or if the ANC (absolute neutrophil count) falls below 1500/mm3 treatment should be interrupted. When subsequent daily monitoring indicates the counts have risen above these values, clozapine can be resumed. If the total WBC count falls below 2000/mm3 or if the ANC falls below 1000/mm3, clozapine should be permanently discontinued. Blood counts should be monitored for 4 weeks after drug withdrawal. )
True or False
Women with a history of coronary heart disease can never be prescribed any forms of HRT.
False
(Estrogens for intravaginal administration are used for local effects, primarily to treat vulval and vaginal atrophy. Because these preparations bypass the liver, the total dose is reduced and there is a lower risk of systemic effects.)
What class of medications is contraindicated in PDE-5 inhibitors (Tadalafil and Sildenafil)
Nitrate preparations
What are the s/s of prostatitis?
prostatitis, is manifested by high fever, chills, malaise, myalgia, and localized pain, and may also be manifested by dysuria, nocturia, and urinary urgency, frequency, and retention.
What are the long-term risk associated with pelvic inflammatory disease?
Infertility, ectopic pregnancy, and chronic pain
This is related to scarring and adhesions in the reproductive organs.
Many experts recommend that all patients with PID receive IV antibiotics in the hospital to minimize the risk of sterility and other complications. Medications used intravenously can be cefoxitin or cefotetan combined with doxycycline; when symptoms resolve, IV therapy may be discontinued but must be followed by PO doxycycline. Outpatient regimens are not recommended. Oral medications are not recommended for initial treatment
Why are medications like cipro preferred when treating a UTI?
E. coli is a Gram-negative bacterium, and antibiotics are chosen based on the pathogen they target to kill. Cipro targets gram-negative pathogens, making it a good choice for UTI treatment.
What H2 blocker has antiandrogenic effects?
Cimetidine has antiandrogenic effects and can cause decreased libido, impotence, and gynecomastia. These effects are reversible.
What is the general rule regarding changing from MAOIs to SSRIs?
MAOIs increase 5-HT availability, thus greatly increasing the risk of serotonin syndrome. MAOIs should be withdrawn at least 14 days before an SSRI is started. An SSRI should never be given at the same time as an MAOI.
What is the purpose of the main treatments, like sulfasalazine, for inflammatory bowel disease?
reduce inflammation
other meds like infliximab have additional risks, including an increased risk of infection, especially opportunistic infections such as TB. Infusion reactions may occur and include chills, fever, itching, and shortness of breath. The induction regimen is 5 mg/kg infused at 0, 2, and 6 weeks, followed by a maintenance regimen every 8 weeks.)
What side effects are common in second generation antipsychotics?
SGAs are more likely than FGAs to cause agranulocytosis and anticholinergic effects and are metabolized by CYP3A4 enzymes
True or False
Even short-term HRT is beneficial for females with bone loss.
False
(Benefits of HT for patients with osteopenia are not permanent; bone loss resumes when HT is discontinued. HT does not reverse bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk by a small amount)
What education should be provided to med using topical androgen therapy?
It requires careful education regarding application, absorption, potential side effects, and precautions to prevent transference to others. Patients should be instructed on proper application technique, dosage, frequency, and where to apply the medication, as well as when to avoid showering or washing after application
Complications of renal calculi
Patients with renal calculi are more likely to have complicated urinary tract infections that have less predictable microbiologic etiologies. Because the symptoms are mild, it is important first to obtain a culture and sensitivity to assist with antibiotic selection. If symptoms worsen, a broad-spectrum antibiotic may be started until sensitivity information is available. Intravenous antibiotics are indicated for severe pyelonephritis.
What STI medication is associated with a disulfiram-like reaction?
Metronidazole
Peripheral neuropathy is associated with what common UTI medication?
Nitrofurantoin
(Tingling of the fingers can indicate peripheral neuropathy, which can be an irreversible side effect of nitrofurantoin.)
When are laxatives contraindicated?
Laxatives are contraindicated for patients with abdominal pain, nausea, cramps, or other symptoms of abdominal disease or an acute surgical abdomen. Laxatives should not be used in patients with obstruction or impaction. This patient shows signs of abdominal obstruction, and laxatives could cause a bowel perforation secondary to increased peristalsis
What patient education should be included for patients taking a benzodiazepine?
Avoid alcohol
(Patients who mix alcohol or other CNS depressants with benzodiazepines may experience amnesiac events. Furthermore, patients can experience paradoxical effects of benzodiazepines, including insomnia, excitation, euphoria, anxiety, and rage. Anterograde amnesia occurs when patients have impaired recall of events that occur after dosing)
What medication given commonly in GI for nausea is a serotonin receptor antagonist; drugs in this class are the most effective drugs available for suppressing nausea and vomiting associated with anticancer drugs. The drug is even more effective when combined with dexamethasone.
Ondanestron
Know the definition of each:
Acute dystonia, Parkinsonism, Akathisia, and Tardive Dyskinesia
Make sure to know these
What annual screening should be included in patients in HRT?
Mammogram
A male patient on androgen therapy whose PSA doubles (even if still in range) should be treated how?
Refer to urology, Because these meds can cause prostate cancer to grow the general rule is that if the PSA doubles, regardless if it is still in range, to refer to urology for prostate evaluation
What type of patient with a complicated UTI should receive IV antibiotics?
The patient with an indwelling catheter and signs of pyelonephritis shows signs of a complicated UTI, which is best treated with intravenous antibiotics
What STI screenings are recommended in pregnancy?
syphillis, HIV, chlamydia, gonorrhea, and hep B (hep c in high prevalence areas)
Patients with recurrent UTI should receive what therapy?
A patient who has reinfection of urinary tract at a rate of more than three per year, is an indication for long-term prophylaxis. Voiding after intercourse is a good teaching point for sexually active women to prevent urinary infections, but it is not a sufficient preventive measure for recurrent infections.
What is the preferred bowel cleanser in patients with kidney dysfunction?
PEG-ELS solutions provide an isosmotic solution and do not cause dehydration or electrolyte imbalance. They are safe to use in patients with renal impairment or cardiovascular disease.
What class of medications is commonly used to treat BPD and neurological disorders?
Anti-seizure meds (lamictal, depakote, etc)
What is the most effective anti-diarrheal medication?
Opioids
(however, they slow peristalsis, which can delay the transit of the causative organism and prolong infection)