Ch. 34, 56, 57 & 58 Quiz Flashcards
Name and upper UTI and tell how it is usually gotten.
Acute Pyelonephritis - usually develops from a lower UTI
What are some s/s of an upper UTI?
Chills, fever, flank pain, painful urination, urgency, frequency, pyuria
Name 3 lower UTIs.
Acute cystitis, urethritis, and prostatitis
What organisms usually cause a lower UTI?
E. coli, Staph, Klebsiella, Pseudomonas
What are some s/s of a lower UTI?
Pain and burning on urination, frequency, urgency, foul smelling
What is a combo drug often used to treat UTIs and what is the purpose of using it?
Trimethoprim-sulfamethoxazole (Bactrim). Used to prevent trimethoprim resistant organisms b/c single agent treatment can lead to drug resistance.
Name the 5 classes of drugs used to fight UTIs.
Urinary Anti-infectives, Sulfanomides, Fluoroquinolones, Penicillins, and 3rd-generation Cephalosporins
What anti-infective treats UTIs?
Nitrofurantoin (Furadantin, Macrodantin)
What Sulfanomides are used to treat UTIs?
Trimethoprim-sulphamethazole (Bactrim)
What Fuoroquinolones are used to treat UTIs?
Nalidaxic acid (Neg-Gam), ciprofloxacin (Cipro)
What Penicillins are used to treat UTIs?
Amoxicillin/clavulanic acid (Augmentin)
What 3rd-generation Cephalosporins are used to treat UTIs?
Cefixime (Maxipime)
How does Nitrofurantoin work?
Treats gram+ and gram- and inhibits bacterial enzymes and metabolism
What are the side effects of Nitrofurantoin?
Rust or brown colored urine, N/V, rash, pruruitis, dizziness, HA, drowsiness
What would some adverse reactions to Nitrofurantoin be?
Superinfection, peripheral neuropathy, hepatotoxicity, Stevens-Johnson syndrome, and blood dyscrasias
What are some nursing interventions when administering Nitrofurantoin?
Take with food to decrease GI distress, Shake liquid suspension well, rinse mouth after taking drug, avoid antacids (2hrs before and after), Increase fluid intake, consume cranberry juice, plums, proteins, vitamin C
What food should not be eaten when taking Nitrofurantoin and why?
Grapefruit b/c it hinders absorption
What antiseptic/antiinfective is effective against Pseudomonas and E. coli?
Methenamine hippurate (Hiprex)
When is Methenamine hippurate (Hiprex) bactericidal?
When urine is acidic.
What other class of drug should NOT be taken with Methenamine hippurate (Hiprex) and why?
Sulfonamides b/c they may cause crystalluria
What client teaching is appropriate with Methenamine hippurate (Hiprex)?
Consume acidic foods and fluids; Vitamin C produces an acid-ash diet (meat, fish, eggs, and cereals), which enhances the function of this medication
What does Methenamine hippurate (Hiprex) treat?
Treats chronic UITS
What is a urinary analgesic used to treat the symptoms of a UTI?
Phenazopyridine (Pyridium)…doesn’t actually treat the UTI, it treats the symptoms
What does Phenazopyridine (Pyridium) relieve?
N/V and diarrhea (should report if severe b/c may become dehydrated); Red-orange urine: this is an expected SE (most common)
What are some adverse reactions to Phenazopyridine (Pyridium)?
Blood dyscrasia, nephrotoxicity, hepatotoxicity
Name a urinary stimulant.
Bthanechol (Urecholine)
What does Bethanechol (Urecholine) treat and how?
Treats hypotonic bladder by increasing bladder tone of detrusor muscle
What are some contraindications of using Behtanechol (Urecholine)?
Peptic ulcer, COPD (may cause bronchodilation)
What are some SE/adverse reactions of Bethanechol (Urecholine)?
GI distress, dizziness, fainting
Name a urinary Antispasmodic.
Oxybutynin (Ditropan)
How does Oxybutynin (Ditropan) work?
Direct action on smooth muscles to relieve spasms
What are some SE/adverse reactions of Oxybutynin (Ditropan)?
Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation (has similar effects as anticholinergics)
When should Oxybutynin (Ditropan) be avoided?
Avoid in narrow-angle glaucoma, cardiac, renal, hepatic, prostate problems, urinary and GI obstructions
Name an Antimuscarinic and what it does?
Tolterodine tartrate (Detrol). It blocks parasympathetic nerve impulses to control overactive bladder
What are the side effects of Tolterodine tartrate (Detrol)?
Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation (may also cause urinary retention which needs to be reported)
What are some contraindications for Tolterodine tartrate (Detrol)?
To be avoided if client has narrow-angle glaucoma or cardiac, renal, hepatic, prostate problems
What does the client need to be taught when taking Tolterodine tartrate (Detrol)?
Teach the client to palpate their bladder and report if there is tenderness or pain
A client with a lower UTI has been prescribed nitrofurantoin (Mcrodantin). What side effects/adverse reactions would the nurse teach the client to expect? A.) Irritability; B.) Anxiety; C.) Crystalluria; D.) Brown, discolored urine
D.) Brown, discolored urine. Nitrofurantoin may cause a rust or brown discoloration of urine. Drowsiness, not irritability and anxiety, is a side effect. Nitrofurantoin does not cause crystalluria as methenamine or sulfa preparations do
A client entering the medical clinic has been dx with an overactive bladder. Which medication would the nurse expect to be ordered? A.) Ciprofloxacin (Cipro); B.) Oxybutynin (Ditropan); C.) Bethanechol (Urecholine); D.) Tolterodine tartrate (Detrol)
D.) Tolterodine tartrate (Detrol). Tolterodine tartrate is an antimuscarinic that controls an overactive bladder. Ciprofloxacin is a fluroquinolone antibiotic, oxybutynin relieves urinary spasms, and bethanechol is a urinary stimulant
Why are most oral contraceptives commonly used?
Most commonly used for pregnancy prevention, endometriosis, dysmenorrhea
What is the method of action of estrogen products?
Prevents formation of dominant estrogen-producing follicle so estrogen levels remain constant and ovulation is inhibited
What are the 3 types of estrogen/progestin combinations?
Monophasic (fixed E:P ratio throughout cycle), Biphasic (estrogen fixed, progestin varies), and Triphasic (low doses of both with minimal side effects)
What was the first chewable oral contraceptives?
Femcon FE
What was the first continuous dose oral contraceptive?
Lybrel
What is Loestrin 24 Fe?
First 24 days of active hormones and 4 days Fe (iron)
Which oral contraceptive combines ethinylestradiol with progestin drospirenone?
Yaz (combo with diuretic) - fewer side effects than ones in the past
Name 3 progestin-only oral contracetives.
Ovrette, Ortho Micronor, and Nor-QD
What is the action of progestin-only oral contraceptives?
Alters cervical mucus (thickens it to slow sperm passage). Alters endometrium to inhibit implantation
What does a client do if they miss a dose of progestin-only contraceptive?
Take tablet as soon as realize and back up contraception for 48 hrs
What are the guidelines for missed doses of oral contraceptives?
1 tab = take tab as soon as realized, take the next pill as scheduled; 2 tabs = take 2 tabs for 2 days with next tablet as scheduled, use a backup method of contraception for the rest of the cycle; 3 tabs = discontinue the present pack and allow for withdrawal bleeding. Start a new package of tabs 7 days after the last tab was taken. Use another form of contraception until tabs have been taken for 7 consecutive days
What is spotting/bleeding between periods called?
Breakthrough bleeding
What are some side effects due to estrogen EXCESS?
N/V, dizziness, fluid retention, bloating, breast enlargement, leg cramps, decreased tearing and visual changes, HA, hypertension
What are some side effects due to estrogen DEFICIENCY?
Nervousness, dyspareunia (pain in the labia, vagina, or pelvis during or after sexual intercourse), vaginal bleeding, oligomenorrhea (scanty or infrequent menstrual flow)
What are some contraindications for contraceptive use?
Pregnancy, venous thrombosis, vascular disease, liver disease, breast cancer, smoking > 15 per day if over 35
What is dyspareunia?
Pain in the labia, vagina, or pelvis during or after sexual intercourse
What are some side effects due to EXCESS progestin?
Increased appetite, weight gain, decreased breast size. Oily skin and scalp, acne, excess hair growth, depression. Vaginitis from yeast, amenorrhea after cessation of use
What are some side effects from progestin DEFICIENCY?
Dysmenorrhea (painful menstrual cramps), bleeding late in cycle, heavy flow with clots, amenorrhea (absence of menstrual bleeding)
What drugs do oral contraceptives decrease the effectiveness of?
Oral anticoagulants and oral hypoglycemics (Monitor PT/INR & blood glucose)
What effect does an oral contraceptive have on PT/INR levels?
It decreases them
What might you have to do when taking an oral contraceptive with anticoagulants?
Increase the dose of anticoagulant meds
What does an oral contraceptive do to a client’s blood glucose?
Increases it
When do you ABSOLUTELY not take oral contraceptives?
Pregnancy (#1), breastfeeding, hypertension (If monitoring pre-hypertension, may be put on it after assessing other risk factors), heavy smoking habit, multiple risk factors
What is the #1 side effect in oral contraceptives?
DVT (Deep Vein Thrombosis)
What are some cautions against using oral contraceptives?
Undiagnosed genital bleeding, postpartum less than 21 days, hyperlipidemia
What are you at risk for if you smoke while taking an oral contraceptive?
Cardiovascular disease
What client teaching is necessary with oral contraceptives?
Take at same time each day, Managing missed doses, Monitor for skin reactions with use of patches, Notify MD for menstrual changes (dysmenorrhea, amenorrhea, breakthrough bleeding), smoking increases risk of CV complications
What alternate method of birth control is a IM injection every 3 months?
Depo-Provera
What are the side effects of Depo-Provera?
Breast tenderness, depression, irregular spotting, some bone density loss, and slowed return to fertility (also causes weight gain and fluid retention)
What is the first weekly form of birth control?
Ortho Evra - Patch (need to monitor for skin reactions)
What is Implanon?
Birth control implant under the skin of your arm
What is Nuvaring?
Flexible plastic vaginal ring that releases a low dose of progestin and estrogen over 3 weeks
What is a female condom?
A barrier contraceptive that decreases the risk of STIs and unintended pregnancies
Name an IUD?
Mirena - inserted into the uterus
What is the function of Mirena?
After placement in the uterus it thickens the cervical mucosa
How long can the IUD Mirena last?
Can last for 5 years
What is Mirena used for?
Used for barrier contraceptive and heavy menstrual flow
How long has emergency contraception been available?
Available for more than 25 years
What are EC pills called?
Morning after pills
What is the Yuzpe regimen?
By combining pills in a specific order, the estrogen and progestrin in those pills work to prevent an unplanned pregnancy before it starts. Most effective when used whithin 72 hrs after having unprotected sex
What is a copper IUD used for?
Can be inserted up to 5 days after unprotected sex to prevent pregnancy
How affective is emergency contraception?
Approx. 80-90% effective if taken correctly
What does the acronym ACHES stand for?
A = Abdominal pain (severe); C = Chest pain or SOB (PE that’s caused by DVT); H = Headaches that are severe; dizziness, weakness, numbness, speech difficulties; E = Eye disorders including blurring or loss of vision; S = Severe leg pain or swelling in the calf or thigh (DVT s/s)
Why is the acronym ACHES used?
It is used for dangerous side effects that must be reported to a health care provider
What is endometriosis?
Occurs when cells from the lining (endometrium) of the uterus grow in other areas of the body
What pharmacologic agents are used to treat symptoms of endometriosis?
Danazol and Leupride acetate
What is the function of Danazol?
To reduce heavy bleeding and decrease breast pain in fibrocystic breast disease and decrease the amount of hormones made by the ovaries (which make endometriosis worse)
What is the function of Leupride acetate?
Used for no more than 6 months. It suppresses estrogen so menopausal symptoms commonly appear but will disappear within 3-5 months
What else is Leupride acetate used for besides endometriosis?
Also used for prostate CA, relief from fibroids, and fertility
What are the symptoms of menopause?
Lighter menstrual flow, hot flashes, vaginal dryness
What are the treatments for menopause?
Hormone replacement therapy and estrogen replacement therapy
Why is hormone replacement therapy done?
For relief of symptoms such as vaginal dryness, hot flashes, sleep disorders
When is progestin/estrogen replacement therapy done?
Progestin is used if uterus is still present - The progestin prevents endometrial hyperplasia that can lead to CA. Estrogen is used for pts that have had a hysterectomy
How is hormone replacement therapy done?
At lowest dose and shortest duration possible (usually less than 5 years)
What are the selected agents used for hormone replacement therapy?
Provera, Estraderm transdermal system, Climara Pro, Vaginal cream, Estring, Femring, Estrogel, and Estrasorb
How long should contraception be used after menopause?
Contraception should be used until 1 year after cessation of spontaneous menstruation
How are the symptoms of menopause managed?
Increase calcium in diet, weight-bearing exercises such as walking, avoid caffeine and ETOH consumption in excess (occasional use is OK), avoid red meats and excess sugar, use water-soluble lubricant for vaginal dryness, stay hydrated and layer clothing to treat hot flashes
What is an Estradiol transdermal system?
Menostar patch. One time a wk patch used for prevention of postmenopausal osteoporosis. Estrogen patch - lowest transdermal dose available
What is alendronate (Fosamax)?
A bisphosphonate used to treat osteopenia and osteoporosis
How is alendronate (Fosamax) administered?
Daily or weekly dosing. Take with full glass (8oz) water before first food of the day and remain upright for at least 30 minutes (eliminates GI upset b/c of acidity)
What kind of hormone replacement therapy is Provera?
Oral progestin hormone for prevention of endometrial hyperplasia
What kind of hormone replacement therapy is Estraderm Transdermal System and Climara Pro?
Transdermal estrogen system is a skin patch that is applied to intact skin in the prescribed dose, changed 2x week or weekly depending on the product
What kind of hormone replacement therapy is vaginal creams?
Treatment of vaginal atrophy, which causes painful intercourse and urinary difficulties
What kind of hormone replacement is Estring?
An elastomer ring that provides a consistent low dose of estrogen, inserted into the vagina for 3 months
What kind of hormone replacement therapy is Femring?
Contains estrogen in a soft, flexible silicone ring for treatment of menopausal symptoms, inserted into the upper vagina for 3 months
What kind of hormone replacement therapy is Estrogel?
Thin film (delivered via a pump daily) applied to one arm from the shoulder to wrist for treatment of moderate to severe vasomotor symptoms
What kind of hormone replacement therapy is Estrasorb?
A lotion that is applied to legs for relief of vasomotor symptoms?
Which agents to treat menopause can be applied to the skin?
Estrogel and Estrasorb
What are the medications used to treat/prevent osteoporosis pre/during/post menopause?
Estradiol transdermal system (Menostar), Alendronate (Fosamax), Ibandronate sodium (Actonel), Raloxifene (Evista), and Teriparatide (Forteo)
Which osteoporosis medication is taken monthly for menopause?
Ibandronate sodium (Boniva) 1x/month. Take with a full glass (8oz) water before first food for the day and remain upright for at least 30 minutes. Used to treat and prevent postmenopausal osteoporosis
Why is Risedronate (Actonel) taken for in menopause?
It is used to treat and prevent postmenopausal osteoporosis
Why is Raloxifene (Evista) taken during menopause and what are you at a high risk for while on this med?
Taken to increase bone mineral density, decrease bone turnover, and decrease vertebral fractures. High risk for DVTs
What is Teriparatide (Forteo) used for and how is it administered?
Used to treat postmenopausal osteoporosis. Parathyroid hormone taken subQ daily.
Considering common concerns of teenage girls, which of these oral contraceptive benefits does the nurse realize would be most likely to motivate use? A.) Protection against breast disease; B.) Dysmenorrhea relief; C.) Reduction in iron deficiency anemia; D.) Decreased risk of endometrial cancer
B.) Dysmenorrhea
A client is taking Tri-Levlen and reports the most troubling side effect to be depression. The client has also experienced weight gain. The nurse knows that these are usually associated with… A.) estrogen deficiency; B.) progestin deficiency; C.) excess progestin; D.) excess of estrogen
C.) excess progestin
What is the main androgen and how is it best administered?
Main androgen is testosterone and is well absorbed by IM injections
When is testosterone treatment indicated?
Hypogonadism (resulting in lowered testosterone, infertility, lack of hair growth, decreased libido, and erectile dysfunction) and Constitutional growth delay (Androgen deficiency can cause a deficiency in growth hormone)
What other drugs does androgen therapy interact with?
Anticoagulants (warfarin), barbiturates, phenytoin, corticosteroids (decreases the effects of androgen therapy)
What lab interactions do androgens effect?
Decreases blood glucose in diabetics; increases cholesterol, thyroid, liver function, hematocrit; Increases PT/INR
What are some common side effects of androgens?
Abdominal pain, nausea, diarrhea, increases salivation
What are some adverse reactions to androgen therapy?
Masculinization, urinary urgency, gynecomastia (development of breast tissue in men), priapism (painful erection that lasts a while), allergic reaction, habituation (decreased response after repeated doses), depression
What are some contraindications for androgen use?
Pregnancy, Nephrosis or nephrotic phase of nephritis, hypercalcemia, pituitary insufficiency, hepatic dysfunction, BPH, prostate cancer
What are some cautions against androgen usage?
Hypertension, Hypercholesterolemia, CAD, gynecomastia, renal disease, seizure disorder
Should oral androgens be taken with or without food?
With food to decrease gastric distress
What is an anabolic steroid?
Synthetic derivatives of testosterone
Why were anabolic steroids developed?
Maximize anabolic effects of androgens. Minimize their androgenic effects
How do you prevent kidney stones?
Drink 2-3L of water a day
Name some antiandrogens?
GnRH, Ketoconazole, Cyproterone acetate, Flutamide, and Finasteride
What does GnRH stand for?
Gonadotropin-releasing hormone
What does GnRH do?
Inhibits testosterone synthesis
What does Ketoconazole (Nizoral) do?
Anti-fungal that inhibits testosterone synthesis and is used for treatment of prostate cancer
What is Cyproterone acetate and what does it do?
It is an androgen antagonist (blocks the action of testosterone). It also suppresses LH and FSH secretion and has progestational qualities
What does Flutamide (Eulexin) do?
It is used with estrogen to treat prostate cancer and prevents stimulation of cancer cells by the androgens
What is the suffix -azole used for?
Anti-fungal agents
What does Finasteride (Proscar) do?
Treats male pattern baldness and BPH
What type of drug enhances blood flow to the penis and facilitates erections?
Phosphodiesterase inhibitors
What are some phosphodiesterase inhibitors?
Sildenafil citrate (Viagra), Vardenafil (Levitra), Tadalafil (Cialis), Apomorphine (Uprima), and Phentolamine (Vasomax)
What are the major side effects of phosphodiesterase inhibitors?
HA (most common), dyspepsia, nasal congestion, and nasopharyngitis
What contraindications are there for phosphodiesterase inhibitors?
If taking nitrates b/c it can cause significant drop in BP (nitrates are vasodilators that open up the blood vessels)
What is an adverse reaction of phosphodiesterase inhibitors?
Priapism = abnormal, painful, and continuous erection of the penis
What is the only natural product that works for sexual performance?
Yohimbine
What does Yohimbine do?
It is an alpha-adrenergic antagonist that affects both the central and peripheral nervous system; causes an increase in peripheral blood flow which increases BP
Where does Yohimbine come from?
The bark of the African yohimbe tree
What are the side effects of Yohimbine?
HA, dizziness, HTN
When is Yohimbine contraindicated?
If heart disease is present
What types of drugs are used to treat BPH?
5-alpha reductase inhibitors and alpha-adrenergic blocking agents
What are the 5-alpha reductase inhibitors?
Finasteride (Proscar) and Dutasteride (Avodart, Duagen)
What are the alpha-adrenergic blocking agents?
Tamsulosin (Flomax), Doxazosin (Cardura), Terazosin (Hytrin), and Alfuzosin (Uroxatrel) - All of these end in the suffix -sin
What is a common side effect of an androgen shot?
Abdominal pain and hives at the injection site
What is a common side effect of alph-adrenergic blockers?
Orthostatic hypotension, dizziness, and fatigue
The nurse teaches a client that sildenafil is contraindicated for clients taking which category of medications? A.) Sulfonylureas; B.) Beta blockers; C.) Nitrates; D.) Proton pump inhibitors
C.) Nitrates
What is the difference between primary and secondary infertility?
Primary infertility is when they have never conceived or carried to term and secondary infertility is when they have conceived and carried to term, but unable to conceive again
What 3 drugs are used to stimulate ovulation and what are their side effects?
Clomiphene citrate (Clomid): fatigue, dizziness, N/V, HA, fluid retention & depression; Bromocriptine mesylate (Parlodel): suppress prolactin (which stimulates milk production) which in high levels can cause infertility; Recombinant FSH, recombinant LH, and recobinant hCG: ovarian hyperstimulation which increases risk of multiple births
What mimics natural GnRH release?
Pulsatile exogenous GnRH (IV admin in pulses vs. continuous infusions to mimic natural response)
What type of therapy is pulsatile exogenous GnRH used for?
Hypothyroidism, Hyperthyroidism, Adrenal dysfunction, endometriosis, and inadequate luteal-phase progesterone output
What is done for inadequate luteal-phase progesterone output?
Progesterone IM or intravaginally
What is the treatment for gonorrhea?
Ceftriaxone or cefixime and azithromycin or doxycycline (when treating gonorrhea client should be concurrently be treated for chlamydia)
What is the suffix used for bacterial STI medications?
-mycin
What is the suffix used for viral STI medications?
-vir
Which STIs are bacterial infections?
Chancroid, Chlamydia, Gonorrhea, Granuloma inguinale, Lymphogranuloma venereum, Nongonococcal urethritis, Pelvic Inflammatory Disease (PID), Syphiis, and Trichomoniasis
Which STIs are viral infections?
Genital warts (HPV), Hepatitis A, B, & C, Genital herpes simplex, and Molluscum contagiosum
Which STIs can be either bacterial or viral infections?
Acute urethral syndrome, Epididymitis, Mucopurulent cervicitis, and Proctitis
