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NR 566 Final Exam-with 100% verified solutions-2023-2024 Doxazosin side effects (due to alpha 1 receptor being blocked) - dizziness/syncope, headache, first-dose orthostatic hypotension, drowsiness, nasal congestion Dutasteride (finasteride) patient teaching - benefits take months to develop, must continue taking med even if improvement not rapidly seen may lower ejaculatory volume & libido How to know Terazosin is working? - improved symptoms of dysuria, urgency, urinary tract infections, hesitancy etc. When is it safe and not safe to prescribe Progesterone (Progestin)? - if woman has had a hysterectomy/pregnant side effects of progestin-only oral contraceptives? - more likely to cause irregular/inconsistent bleeding, must be taken at same time every day to be effective Benefits of prescribing medroxyprogesterone acetate - doesn't cause thromboembolic disorders, headaches, nausea, or most of the other adverse effects associated with combo OCs. does not decrease milk supply during lactation Testosterone replacement therapy routes: - treatment that involves administering testosterone supplements through pills, injections, or skin patches testosterone patch patient teaching: - ○ good hand washing is required after application ○ cover application site with clothing after medication has dried ○ wash the application site before skin-to-skin contact with another person ■ females and children may experience negative effects from exposure to testosterone ■ if cross contamination occurs, wash the affected area with soap and water to prevent absorption When is androgen therapy appropriate vs. not needed related to puberty? - Short term: The psychological pressures of delayed sexual maturation are causing a boy significant distress. Long term: if delayed puberty related to true hypogonadism testosterone replacement therapy side effects? - Hot flashes, bone fractures, decreased libido, insulin resistance, erectile dysfunction, gynecomastia, acne, HTN, sterility, hepatotoxicity, mood swings/ aggression. Alprostadil: benefits of various routes? (for ED) - injection: can be done by patient or in ER setting; rapidly leads to erection, painless intraurethral pellet insertion: can be done by patient, erection occurs within 5-10 mins, minimal side effects How does carbamazepine impact oral contraceptives and what symptoms may be associated with that? - accelerates OC metabolism, reducing OC effect can lead to abnormal bleeding, return of menstrual symptoms, and of course pregnancy! what can the provider do is carbamazepine effecting patient's OC? - 1. Increase the estrogen dosage of the OC. 2. Combine the OC with a second form of birth control. 3. Switch to an alternative form of birth control. Benefits of Etonogestrel subdermal implant (Nexplanon)? - it is one of the most effective forms of contraception, long-term option (contraception up to 5 years), reversible by removing rod Papaverine plus phentolamine patient education: - do not inject more than once in a 24 hr period, notify provider of erection duration and efficacy, do not take other ED meds with this medication, needle/injection teaching, do not change the dose yourself, seek medical attention if erection is >3 hrs Chlamydia first line drug/dose/route/frequency - Azithromycin 1000 mg PO once OR Doxycycline 100 mg PO BID × 7 days Uncomplicated gonococcal urethritis first line drug/dose/route/frequency - Ceftriaxone 250-500mg IM once Bacterial Vaginosis first line drug/dose/route/frequency - 500 mg Metronidazole PO BID x 7 days Herpes Simplex Virus first line drug/dose/route/frequency - Acyclovir 400 mg PO TID x 7-10 days Trichomoniasis first line drug/dose/route/frequency - women: 500 mg Metronidazole PO BID x 7 days men: 2 g Metronidazole PO once Syphilis first line drug/dose/route/frequency - Penicillin G IV (dose depends on the patient) SNRIs- Buspirone (Buspar) Approach when first anti-depression drug doesn't seem to be working? - wait at least 4 weeks minimum before increasing/changing dose. 1st increase dose, then change drug within same class, then switch to new class, then start second med How long should it take antidepressants to work? - 4-8 weeks Suicide risk associated with antidepressants: - increased risk of suicide in those taking antidepressants, especially in children and young adults never to be stopped abruptly (increases risk) First-line treatment options for sleep disturbance? - Benzodiazepines: Triazolam Benzodiazepine-Like Drugs: Zolpidem (Ambien), Zaleplon (sonata), eszopiclone (Lunesta) Melatonin Receptor Agonist: Melatonin, Ramelteon (Rozerem) Orexin Receptor Agonist: Suvorexant (Belsomra) Therapeutic drug level of lithium: - 0.6-0.8 mEq/L Lithium drug-drug interactions - •Thiazides-Diuretics- lithium toxicity •NSAIDS- higher plasma lithium levels •Haloperidol-encephalopathic syndrome (weakness, tremors, confusion, lethargy) -Carbamazepine •anti-acids-decreases effectiveness of lithium *** Common adverse reactions of 1st generation antipsychotics - extrapyramidal symptoms: Parkinsonism, akathisia, dystonia (all manageable w/ anticholinergics), Tardive Dyskinesia (no treatment) dry mouth, constipation (anticholinergic effects) pt teaching regarding first gen. antipsychotics: - inform provider immediately about any signs/symptoms of tardive dyskinesia/adverse effects sunscreen use s/s of toxicity Drug-Drug Interactions of SSRIs - +MAOIs- can cause serotonin syndrome Fluoxetine- not to be taken w/ warfarin or lithium Baseline data needed to prescribe SSRIs/SNRIs: - Na levels in pt on diuretics Common adverse effects of SSRIs: - sexual dysfunction, n/v, agitation, insomnia, weight gain Ways to manage SSRI adverse effects? - sexual dysfunction: add Bupropion, drug holidays weight gain: diet, lifestyle changes n/v: take with food Baseline data needed to prescribe Tricyclic Antidepressants (TCAs)? - EKG especially in those w/ dysrhythmias or 40+ years old Patient education needed for TCAs - Educate patients regarding orthostatic hypotension and anticholinergic effects, including dry mouth, blurred vision, constipation, and urinary hesitancy. Baseline data needed to prescribe MAOIs: - baseline BP Patient education for MAOIs: - Educate patients on foods containing tyramine (DO NOT EAT THESE) and to report signs of hypertensive crisis (nausea, vomiting, profuse sweating, severe headache) immediately. What foods contain tyramine? - Avocados, aged meats, bean curd, bananas, cold cuts/sausages, cured fish, cheese, yeast, beers, protein supplements, soups, shrimp, soy sauce, chocolate, caffeine Symptoms of serotonin withdrawal: - dizziness, headache, nausea, sensory disturbances, tremor, anxiety, and dysphoria