Nurs 605 Module 13

Question 1

Treatment regimens of choice for STIs

Answer 1

azithromycin 1g
doxycycline 100mg x 7 days
cefixime 800mg
ceftriazone 250mg x 1 dose 
flagyl 500mg BID x 7 days
pen G -syphilis

Question 2

Discuss the advatages of certain drug regimes for STIs over others

Answer 2

shorter courses=greater compliance

penicillin allergies- alternatives are available, can take cefixime and ceftriazone

Question 3

Describe the use of combined estrogen and progesterone contraceptives (COC)

Answer 3

pregnancy prevention
monophasic, triphasic
triphasic-changes in progestin levels

Question 4

Which generation of progesterone shoe less androgenic effects?

Answer 4

3rd gen progesterones (norgestimate, desogstrel)

drosperidone

Question 5

Describe the use of progesteone only contraceptis

Answer 5

pills- take a same time every day, back up need if missed dose >3 hours
IUD, depot shot
>35 years of age who smoke
can't tolerate estrogen 
migraine/neuro symptoms
breastfeeding mothers

Question 6

Describe the adverse effects of COC

Answer 6

• Major adverse effects: MI, stroke, thrombosis, HTN
• ACHES
• BTB, nausea, vomiting, bloating, breast tenderness, mood changes
• With drospirinone:
• Hyperkalemia in conditions or meds that may cause this: ie) ACEi, ARBS, CKD

Question 7

Describe the adverse effects of POC

Answer 7

• POC: irregular bleeding
• Depot: irregular bleeding, amennorhea with long term use, breast tenderness, mood changes
• IUD: spotting, expulsion, amennorhea with long term use

Question 8

Explain why smoking is a risk for use of combined hormonal contraceptives and at what age this risk outweighs the benefit to their use.

Answer 8

• Smoking increases risk of CV related events in COC
• > 35 years of age = greater risk
• Migraine with aura + smoker + >35 years of age = further increased risk of MI/stroke/CV related events

Question 9

Discuss the risk of VTE in contraception

Answer 9

• VTE
• Increased dose and continuous use of COC may increase risk of VTE
• 3rd generation progestin may also increase risk of VTE
• Further risk associated if patient obese
• <35 years, non smoker, active shows very little risk fo VTE

Question 10

Discuss the risk of MI in contraception users

Answer 10

• MI
• Continuous long term use, can increase risk of MI but overall low
• Non smoking, younger women show less risk of MI

Question 11

Describe the risk of stroke in contrception

Answer 11

May increase with continuous use
• May increase with higher doses of estrogen
• Smoking, HTN increase risk of stroke
• Migraine with aura= increaser risk of stroke

Question 12

What are some medications that can interfere with hormonal contrapcetion

Answer 12

•	CYP 450 inducing medications 
•	Rifampicin, firabutin
•	Carbamazepine
•	Phenytoin
•	St. johns wort 
ARVs

Question 13

Explain the return of fertility after stopping a hormonal contraceptive and the use of contraception in the nursing mother.

Answer 13

• Return of fertility is highly unpredictable
• Ovulation and pregnancy can occur within 6 weeks of giving birth
• Breastfeeding is not shown to protect against pregnancy
• Contraception:
• Use of barriers, spermicides
• Progestin only contraceptive should be offered
• Low risk of thrombosis
• Neutral in breast milk
• IUD insertion as long as the patient is not pregnant

Question 14

What are some common clinical manifestations of a woman going through menopause?

Answer 14

vasomotor-hot flashes, night sweats
urogenital-atophry, dryness, UTI, low libido
mental health-anxiety, depression, headaches

Question 15

Discuss the non pharmacological options for menopausal women

Answer 15

cooling techniques, lifestyle modifications
CBT
weight loss
exercise
dietary changes

Question 16

Discuss estrogen and progesterone use in the menopausal woman

Answer 16

estrogen only-for those with a hysterectomy
ee/progestin- intact uterus only
decreased vasomotor symptoms with good effect, effect seen within 4 weeks of initiation

Question 17

When can women begin using hormonal therapy?

Answer 17

must be post menopause

<60 years of age, and <10 years of menopause

Question 18

What is the alternative hormon medication for those who cannot tolerate estrogen in menopausal women?

Answer 18

oral megstrrol acetate

Question 19

What is the use of antidepressants in menopause?

Answer 19

shows some effect towards vasomotor symptoms
can also be an alternative in those who cannot tolerate estrogen
venlafaxine and escitaloproam are first link in those who experience mood plus heavy vasomotor symptoms

Question 20

How do we manage vaginal symptoms in the menopausal woman?

Answer 20

• Intravaginal estrogen- reduce symptoms of vaginal atrophy; decreases risk of increased UTIs

Question 21

What are the contraindications for use of hormon therapy in menopausal women?

Answer 21

• Estrogen
• Unidentified bleeding
• Active liver disease
• Active clotting disease
• Known carcinoma of breasts or other estrogen dependent tumours
• Pregnancy
• Progesterone
• Undiagnosed bleeding
• Known carcinoma of breast
• pregnancy

Question 22

When can we offer COC in women nearing the age of menopause?

Answer 22

perimenopausal women only, not post menopause

Question 23

Which patients are candidates for erectile dysfunction treatments?

Answer 23

irreversible factors -structural, neurological
low CV risk-asymptomatic, stable angina, controlled a fib
safe to assume sexual activty
no nitrates of alpha blockers in the future!

Question 24

Why are PDE 5 inhibitors first line in those with ED?

Answer 24

• PDE 5 inhibitors first line
• Sildenafil, tadalafil (Viagra, Cialis)
• Safe, efficacious, oral administration
• Partial arousal, works with those with mental sexual arousal as well

Question 25

What are the contraindications in use of PDE 5 drugs in erectile dysfunction

Answer 25

• Concurrent use of nitrates
• Symptomatic hypotension
• Priaprism
• Alpha blockers-use caution

Question 26

What are the non hormonal options for women with menopause?

Answer 26

clonidine

gabapentin