Exam 3 from topical outline Flashcards
Alpha adrenergic antagonists for BPH
-zosin
Recommended for use in men with smaller prostate glands, younger men, and when rapid effect is needed
MOA: functional antihypertensive, relaxes smooth muscle of prostate and bladder neck without interfering with bladder contractility
SE: headache, dizziness, asthenia, drowsiness, retrograde ejaculation, orthostatic hypotension, fluid retention
SE minimized by given at nighttime
Alpha adrenergic antagonists have potential effects on
GFR, renal perfusion, heart rate, fluid retention, may increase CO (preventing HF)
How long can effects take with alpha adrenergic antagonists
May take weeks to months or up to 2 years
5-alpha-reductase inhibitors for BPH
Finasteride + Dutasteride
Inhibits androgen transformation from steroid precurors (testosterone to DHT), decreases prostate volume, prevents progression of disease
SE: impotence, decreased libido, smaller ejaculate, orthostatic hypotension, priapism, prostate cancer risk, gynecomastia
May take 6 months for effects
CI for 5-alpha reductase inhibitors
Pregnancy (can not even touch), sensitivity to sulfa
First line treatment for BPH
Limit fluid intake after dinner
Avoid decongestants
Massage prostate after intercourse
Void frequently
Second line treatment for BPH
Alpha adrenergic antagonist first, addition of 5-alpha reductase inhibitor for more severe symptoms
Risk factors for UTI
Concentrated urine, high urine pH, glucose in urine, pregnancy, diaphragm and spermicide use, estrogen deficiency, constipation, inefficient bladder training,
Cultures for UTI
Do not need to be performed if criteria for uncomplicated UTI is met
Post treatment cultures for UTI
Only needed if symptoms recur within 2 weeks
Normal length of treatment for UTI
Uncomplicated usually 1-3 days
5-7 days if Nitrofurantoin
Recurrent UTI
3+ recurrences annually
Post-coital use of antibiotic prophylaxis
Continuous antibiotic prophylaxis in single bedtime dose (bactrim, trimethoprim, norfloxacin,, nitrofurantoin)
Urinary analgesics
Methenamine, phenazopyridine, flavoxate
Used for symptomatic relief of pain
Don’t use more than 2 days
First line antibiotic for UTI
Bactrim; avoid in patients treated within 6 months due to resistance
Nitrofurantoin–7 day course with little resistance
Fosfomycin–powder dissolved in water, one time dosing
second line antibiotic for UTI
Fluoroquinolones
Geriatrics and UTI
Usually asymptomatic–may just have change in mentation
Post-menopausal more prone due to low estrogen
E. Coli and enterobacter usual organisms
Nitrofurantoin not recommended
Pregnancy and UTI
Amoxicillin first line entire pregnancy
Nitrofurantoin can be used first and second trimester
Cephalexin can be used
Sulfonamides first and second trimester
Urine cultured 1 week after treatment and then every 4-6 weeks
Treat regardless of symptoms
1st line agents for children with UTI
Augmentin, cephalexin, cefpodoxime, bactrim
UTI that does not resolve or recurs within a week after treatment requires
C&S and treatment with fluroquinolone for 7 days
Acute prostatitis s/s
painful ejaculation, pain in rectal or perineal areas
Dx acute prostatitis
third and fourth urine secretion specimens in 4 serial urine sample
Organisms usually G-
Treatment of prostatitis lasts
4-6 weeks or up to 12 weeks due to poor penetration of antibiotics in prostate tissue
1st line antibiotic for prostatitis
Fluoroquinolones
Increase levels of theophylline and warfarin
Monitor creatinine clearance
2nd line antibiotic for prostatitis
Bactrim
Drug-drug interactions with phenytoin, oral hypoglycemics, warfarin
Major systemic regulators of osteoporosis
PTH, calcitriol, growth hormone, glucocorticoids, thyroid hormones, sex hormones
T score signalling osteopenia
-1 to -2.5 SD below mean
T score signalling osteoporosis
more than -2.5 SD below mean
Ca and vitamin D supplementation recommendation
1000-1200mg Ca
800-1000 IU Vitamin D
1st line tx for osteoporosis
Raloxifene
Raloxifene
Selective estrogen receptor modulator
Mimics effects of estrogen on bones without replicating stimulating effects of estrogen on breasts and uterus; decreases bone resorption and bone turnover; decreased cholesterol and LDL
CI: pregnancy, lactation, history of thrombo embolic events
D/C 72 hours before prolonged immobilization
SE: hot flashes, GI distress, flu like symptoms, leg cramps, DVT, arthralgias
Biphosphanates
Prevention and tx of osteoporosis
-dronate
Deposits in bone at sites of mineralization and in resorption lacunae; increases bone density
Bone turnover rates increase to previous levels after 6-9 months
CI: history of esophagus problems, gastritis, PUD
SE: GI disturbance, esophagitis, diarrhea, abdominal pain
Progestin only pill is good for
high blood pressure, smoking >35 years, lactation
Progestin only pill MOA
Does not consistently suppress LH and FSH; primary effect is through changing endometrial and cervical mucus environments
No placebo week
0.35mg norethindrone and 0.075mg norgestrel
Depo-provera
Suppresses ovulation and affects cervical mucus
Dosed every 13 weeks
Give within 5 days of menses
Can be used in lactation
Safe for hx of CV disease, stroke, thromboembolism, PVD
SE: unpredictable bleeding >7 days, decreased serum estradiol (can cause bone loss)
Effect of estrogen in hormonal replacement therapy
Decreases frequency of night sweats and wakefulness, reduces hot flashes, minimizes VMS and GU symptoms, assists in temperature control
Progestin role in hormonal replacement therapy
Decreases risk of endometrial cancer but may increase risk of breast cancer
Limit hormonal replacement therapy to
3-5 years
Hormonal replacement therapy CI in
breast CA, endometrial CA, endometrial hyperplasia, hypertension, acute liver disease, active thromboembolic disease, pregnancy, smoking, intermittent porphyria
SE hormonal replacement therapy
Intolerance to contact lenses, headache, gallbladder disease, increase in triglycerides, N/V, abdominal cramps, increased BP. thromboembolic disease, edema, breast CA, breast tenderness, breakthrough bleeding
Anticholinergic that does not cross BBB
Tropsium
MOA anticholinergics for OAB
Antagonizes parasympathetic muscarinic receptors in the bladder; reduces frequency and contraction intensity, increases bladder contractions, delays initial urge to void
Usually see a response after 2 weeks
SE anticholinergics
Xerostomia, constipation, urinary retention
Oxybutynin
Antimuscarinic and antispasmodic and local anesthestic
Causes CNS adverse effects
Extensive first pass metabolism
CI: urinary retention and glaucoma
Mirabegron
Beta adrenoreceptor agonist
Increases bladder capacity and decreases frequency of urination without affecting urination pressure or residual volume
Causes smooth muscle relaxation
Does not have anticholinergic effects
Therapeutic response within 8 weeks
Can cause QT prolongation in large doses and high blood pressure
Mirena
Releases 20ug/d of lNG
Approved for 5 years of use
No estrogen
Can be helpful for dysmenorrhea, menorrhagia, anemia
Check string after every menstrual period
Trichomonas
Profuse, frothy, yellow vaginal discharge, vaginal and vulvar irritation, dysuria, dyspareunia or post-coital bleeding
Can be dx by pap smear or wet mount
BV due to candidiasis
Fishy odor, yellow or gray discharge, vaginal irritation
DX requires: vaginal pH greater than 4.5, positive amine or whiff test, more than 20% positive clue cells, gray discharge
Partial seizures
Simple Focal seizures typically result in no alteration in consciousness
Complex seizures may have loss of consciousness and automatisms
Generalized seizures
Include both hemispheres of brain, result in early loss of consciousness
Status epilepticus
Seizure activity >30 minutes or 2 or more sequential seizures without recovery between them
Hydantoins
Phenytoin + Fosphenytoin
First line agents for seizures
Increases efflux and decreases influx of sodium ions across all cell membranes
Inhibits calcium uptake in presynaptic terminals
May cause CV events (hypotension and arrhythmia) with rapid IV admin
SE: gingival hyperplasia, hirsutism, coarsening of facial features, rash, ataxia, altered coordination, nystagmus, confusion, peripheral neuropathy
Potent CYP450 inducer
Carbamazepine
Similar MOA as hydantoins
Depresses activity in thalamus and decreases summation of temporal stimulation
CI: allergy to TCA, bone marrow suppression, recent use of MAOI, concurrent use of NNRTI
SE: pruritus, rash, constipation, N/V, ataxia, dizziness, somnolence, blurred vision, urinary retention, xerostomia, hyponatremia
S/S gonorrhea
Purulent or mucopurulent cervical discharge, dysuria, bleeding, menorrhagia, pelvic discomfort
treatment of gonorrhea
single dose of IM ceftriaxone + single dose of azithromycin OR doxycycline for 7 days
s/s chlamydia
vaginal discharge, mucopurulent cervicitis with edema and friability, urethral syndrome or urethritis, pID, ectopic pregnancy, infertility, endometriosis
DOC for chlamydia
azithromycin/erythromycin, doxycycline and ofloxacin are DOC
Tx of chlamydia in pregnant women
azithromycin single dose or amoxicillin 3x a day for 7 days
First line therapy for OA
Acetaminophen
Acetaminophen for OA
Decreases prostaglandin synthesis; has analgesic and antipyretic effects but no anti-inflammatory
Must be taken regularly to be effective
Can experience pain relief in 1 week
Can increase INR in patient taking warfarin
second line therapy for OA
NSAIDs
NSAIDs for OA
Inhibits conversion of arachidonic acid to prostaglandin, prostacyclin, and thromboxanes; inhibits both COX 1 and COX 2
CI: allergy to aspirin, alcohol dependence, pregnancy, sulfa allergy
SE: visual changes, weight gain, headache, dizziness, nervousness, photosensitivity, weakness, tinnitus, easy bruising/bleeding, fluid retention, GI ulcers, GI bleeding
Celcoxib
Selective NSAID for COX 2–less GI events but increased risk of CV events
DMARDs
Used early to treat RA to decrease inflammation
Initiate within 3 months of symptoms
Methotrexate
DMARD for RA
Best for patients with morning stiffness and synovitis
Folic acid antagonist; affects leukocyte suppression; decreases inflammation
May take 3-8 weeks before improvement occurs
When tx stops, exacerbation occurs in 2 weeks
CI: pregnancy and breastfeeding, leukopenia, AIDS, renal impairment, liver disease
Baseline labs needed for methotrexate
Chest X Ray, all labs, CBC (monitor every 4 weeks)
Sulfasalazine
DMARD for RA
Best for patients with significant synovitis but no poor prognostic factors
May see effects in 1-4 months
CI: Sulfa allergy, pregnancy, GU, GI obstruction
Hydroxychloroquine
Antimalarial DMARD for RA
Has a tolerable adverse effect profile
Can not limit progression of RA–Use with methotrexate
Elevates cellualr pH which changes antigen degeneration
Effects within 2-6 months of therapy
CI: pre-existing retinal field changes
Leflunomide
DAMRD for RA
Retards erosions and joint space narrowing
Competitive inhibitor of dihydrofolate reductase
Similar to methotrexate
Benefits seen within 4 weeks to 3 months
CI: pregnancy (within 2 years)
1st line therapy for chronic gout
Xanthine oxidase inhibitors
Xanthine oxidase inhibitors
Allopurinol + Febuxostat
Decreases uric acid levels within 2 weeks
Draw serum uric acid levels every 2-5 weeks during titration
SE: rash, arthralgias, GI complications
ACEI, diuretics may increase levels of allopurinol
Probenicid
Use if XAOI not tolerated
Increases excretion of uric acid in proximal convoluted tubule
May take 6 months for effect
Do not give in acute attack
NSAIDs for gout
good for acute attacks
Naprexen, indomethacin, sulindac
Continue for 24 hours after attack
Corticosteroids for gout
Good for acute attack
Can give intra-articular dose if only 2 joints
Colchicine
Inhibits activation, degranulation, and migration of neutrophils to area of gout attack; can exhibit pain relief in 18-24 hours
SE: diarrhea
Cyclobenzaprine
muscle relaxant used for acute low back pain
SE: drowsiness and dizziness
Benefit seen in first few days
Risk for abuse
