Week 5 - STDS and Hormone Therapy

Question 1

Treatment for Chlamydia

First line drug
Dose
Route
Frequency

Answer 1

First line drug: Doxycycline
Dose:100mg
Route: PO
Frequency: BID for 7 days

Question 2

Treatment for Uncomplicated gonococcal urethritis

First line drug
Dose
Route
Frequency

Answer 2

First line drug: Ceftriaxone
Dose: 500mg
Route: IM
Frequency: single dose

Question 3

Treatment for Bacterial Vaginosis

First line drug
Dose
Route
Frequency

Answer 3

First line drug: Metronidazole
Dose: 500mg
Route: PO
Frequency: BID for 7 days

Question 4

Treatment for Herpes Simplex Virus

First line drug
Dose
Route
Frequency

Answer 4

First line drug: Acyclovir
Dose: 400mg
Route: PO
Frequency: TID for 7 days

Question 5

Treatment for Pelvic Inflammatory Disease

First line drug
Dose
Route
Frequency

Answer 5

500mg IM Ceftriaxone in a single dose +

First line drug: Doxycyline / Metroniazole
Dose: 100mg / 500mg
Route: PO
Frequency: BID for 14 days

Question 6

Treatment for Syphilis

First line drug
Dose
Route
Frequency

Answer 6

First line drug: Benzathine penicillin G
Dose: 2.4 million units
Route: IM
Frequency: single dose

Question 7

What are the side effects of Doxazosin?

Answer 7

• Hypotension
• Dizziness
• Fainting
• Somnolence
• Nasal congestion

Question 8

What patient teaching is needed for Dutasteride?

Answer 8

This drug has a very long half life about 5 weeks so effects may take that long to begin

Question 9

How do you know when Terazosin is working?

Answer 9

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

Question 10

When would oral estrogen therapy be used?

Answer 10

Used to treat loss of estrogen in menopause. It is the most commonly prescribed replacement therapy due to its convenience.

Question 11

When would transdermal estrogen therapy be used?

Answer 11

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

Question 12

When would intravaginal estrogen therapy be used?

Answer 12

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

Question 13

When would parenteral (IV/IM) estrogen therapy be used?

Answer 13

Used for acute, emergency control of heavy uterine bleeding

Question 14

When is it safe to prescribe progesterone (AKA: progestin)?

Answer 14

• Amenorrhea
• Dysfunctional uterine bleeding
• Endometrial hyperplasias
• PMS symptoms

Question 15

When is it NOT safe to prescribe progesterone (AKA: progestin)?

Answer 15

• 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

Question 16

What are the side effects of progestin only oral contraceptives?

Answer 16

• breakthrough bleeding
• spotting
• amenorrhea
• inconsistent cycle length
• variations in the volume and duration of monthly flow

Question 17

What are the benefits of prescribing medroxyprogesterone acetate?

Answer 17

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

Question 18

What patient education is needed when prescribing topical testosterone?

Answer 18

• 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

Question 19

What patient teaching is needed when prescribing androgens?

Answer 19

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)

Question 20

When is androgen therapy appropriate vs. not needed related to puberty?

Answer 20

• 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

Question 21

What are some common side effects of testosterone therapy?

Answer 21

• 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

Question 22

What are the benefits of transurethral Alprostadil for erectile dysfunction?

Answer 22

Errection develops quickly 5-10 minutes and lasts 30-60 minutes

Question 23

What are the benefits of intracavernous Alprostadil for erectile dysfunction?

Answer 23

• Lasts for intercourse but not more than an hour
• Not painful
• Can use multiple times per week, 1x in 24 hours

Question 24

How does carbamazepine (inducer) impact oral contraceptives and what symptoms may be associated with that?

Answer 24

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

Question 25

What are the benefits of Etonogestrel subdermal implant (Nexplanon)?

Answer 25

• 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