Week 5 - STDS and Hormone Therapy Flashcards
Treatment for Chlamydia
First line drug
Dose
Route
Frequency
First line drug: Doxycycline
Dose:100mg
Route: PO
Frequency: BID for 7 days
Treatment for Uncomplicated gonococcal urethritis
First line drug
Dose
Route
Frequency
First line drug: Ceftriaxone
Dose: 500mg
Route: IM
Frequency: single dose
Treatment for Bacterial Vaginosis
First line drug
Dose
Route
Frequency
First line drug: Metronidazole
Dose: 500mg
Route: PO
Frequency: BID for 7 days
Treatment for Herpes Simplex Virus
First line drug
Dose
Route
Frequency
First line drug: Acyclovir
Dose: 400mg
Route: PO
Frequency: TID for 7 days
Treatment for Pelvic Inflammatory Disease
First line drug
Dose
Route
Frequency
500mg IM Ceftriaxone in a single dose +
First line drug: Doxycyline / Metroniazole
Dose: 100mg / 500mg
Route: PO
Frequency: BID for 14 days
Treatment for Syphilis
First line drug
Dose
Route
Frequency
First line drug: Benzathine penicillin G
Dose: 2.4 million units
Route: IM
Frequency: single dose
What are the side effects of Doxazosin?
- Hypotension
- Dizziness
- Fainting
- Somnolence
- Nasal congestion
What patient teaching is needed for Dutasteride?
This drug has a very long half life about 5 weeks so effects may take that long to begin
How do you know when Terazosin is working?
Used to treat BPH.
Patients will begin to feel improvement of symptoms in about two weeks
Symptoms include: difficulty urinating (hesitation, dribbling, weak stream, and incomplete bladder emptying), painful urination, and urinary frequency and urgency
When would oral estrogen therapy be used?
Used to treat loss of estrogen in menopause. It is the most commonly prescribed replacement therapy due to its convenience.
When would transdermal estrogen therapy be used?
Transdermal estrogen therapy includes emulsion, gel or spray.
Used when:
- Liver is bypassed so less total dose needed
- Less N/V
- Blood levels fluctuate less
- Lower risk for DVT, PE, stroke
When would intravaginal estrogen therapy be used?
Insert is used for local effects –> vulval and vaginal atrophy associated with menopause
Ring is used for systemic effects –> control of hot flashes, night sweats, vulval and vaginal atrophy
When would parenteral (IV/IM) estrogen therapy be used?
Used for acute, emergency control of heavy uterine bleeding
When is it safe to prescribe progesterone (AKA: progestin)?
- Amenorrhea
- Dysfunctional uterine bleeding
- Endometrial hyperplasias
- PMS symptoms
When is it NOT safe to prescribe progesterone (AKA: progestin)?
- Individuals who are not able to stick to the strict schedule of taking these at the same time everyday
- Patients with breast cancer or cancer of the reproductive organs
- Undiagnosed vaginal bleeding
- Hepatic disease
- Cerebrovascular disease, CAD, Stroke, HLD, HTN, MI, obesity, thromboembolic disease, thromboembolism, thrombophlebitis, smoking, dementia
What are the side effects of progestin only oral contraceptives?
- breakthrough bleeding
- spotting
- amenorrhea
- inconsistent cycle length
- variations in the volume and duration of monthly flow
What are the benefits of prescribing medroxyprogesterone acetate?
o One injection
o Lasts up to 3 months
o No increased risk for cervical, ovarian or breast cancer
o Reduced risk of endometrial cancer
Used as HRT for loss of estrogen in menopause
What patient education is needed when prescribing topical testosterone?
- Wash hands after every application
- Cover application site with clothing after gel has tried
- Wash application site before anticipated contact with others
- Warn women/children to avoid contact with user’s skin and wash if accidental contact with application site occurs
What patient teaching is needed when prescribing androgens?
Tell female patients about the signs of virilization (deepening voice, acne, changes in body/facial hair, menstrual irregularities)
Advise of liver dysfunction and signs
o Yellow tint to eyes/skin
o Fatigue
o Loss of appetite
o Nausea
o Dark colored urine
o Light colored stools
* Swelling of extremities or unusual weight gain (water/salt retention)
When is androgen therapy appropriate vs. not needed related to puberty?
- Not needed if puberty fails to occur by age 15, usually familial delay.
- Used when psychologic pressures of delayed maturation are causing a boy significant distress – then a limited course of androgen therapy is indicated
- Used in true hypogonadism and treated with long-term replacement therapy
What are some common side effects of testosterone therapy?
- Acne
- Possible male-pattern hair loss
- Polycythemia
- Hypercholesterolemia
- Liver impairment
- Thromboembolic disorders with increased risk of myocardial infarction and stroke
- Endometrial cancer in patients who have not had a hysterectomy
What are the benefits of transurethral Alprostadil for erectile dysfunction?
Errection develops quickly 5-10 minutes and lasts 30-60 minutes
What are the benefits of intracavernous Alprostadil for erectile dysfunction?
- Lasts for intercourse but not more than an hour
- Not painful
- Can use multiple times per week, 1x in 24 hours
How does carbamazepine (inducer) impact oral contraceptives and what symptoms may be associated with that?
It is an inducer and increases metabolism of the contraceptive causing reduced levels in the blood
- Symptoms include
* Breakthrough bleeding/spotting
- Need to increase the estrogen dose of OC
- Combine OC with second form of birth control
- Switch to alternative birth control
- How might this affect which OCP is prescribed?
* High estrogen OCs are reserved for women taking CYP450 inducers
* May result in provider choosing an IUD which is not affected by enzyme inducing drugs
What are the benefits of Etonogestrel subdermal implant (Nexplanon)?
- Most effective reversible contraceptive
- Lasts for 3 years
- Can be used while breastfeeding (after 21st post partum day)
- Only adverse effect is abnormal bleeding
- Can easily be reversed with removal
