NR 568 Week 8 Final Exam Study Guide (Weeks 5-8), Exercises of Nursing

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Guide

Week 5

- Prevention of osteoporosis with hormone replacement therapy HT reduces postmenopausal bone loss and thereby decreases the risk for osteoporosis and related fractures. The first line of prevention and treatment of osteoporosis is hormone replacement therapy (HRT). All of the approved drugs for the prevention and treatment of osteoporosis act as inhibitors of bone resorption; these drugs include HRT, selective estrogen receptor modulators, calcitonin, and bisphosphonates - When and when not to use progestin for hormone replacement therapy and why You should not use HRT (Estrogen with or without Progestin) for the prevention or treatment of coronary heart disease or stroke. HRT (Estrogen with or without Progestin) is effective for the control of hot flashes, night sweats and vaginal dryness. Local vs. systemic estrogen options and why one would be chosen over the other Prostaglandins I. Prostaglandins, a group of lipids, originate from the fatty acids and act as a middleman. The hormone rushes to the work whenever there is an incident of tissue damage. Hence, the primary attribution of these molecules is to clot blood and form new cells on the wounded site. They do the task by inhibiting the aggregation of the platelet. II. Aside from that, prostaglandins control the inflammation due to injury, blood pressure, and blood flow. Furthermore, the hormone also contributes to uterine contraction during pregnancy labor. Leukotrienes I. Leukotrienes, the inflammatory chemical group, are responsible for your suffering during an allergy attack. These hormones signal the airway muscles to tighten and release excess mucus as soon as you make any contact with an allergen. The leukotrienes also cause lung swelling in asthma and play an inflammatory role in tissue damage or injury. Histamine I. Histamine fights on your behalf against any potential allergy or alien that invades your immunity system. Your while blood cells secrete these compounds whenever under attack. Such inflammatory responses might trigger an allergic reaction in the body, such as itching or sneezing. II. Histamine has some other roles to perform too. The local hormone

Guide contributes in III. Smooth muscle contraction, Blood pressure regulation, Capillary permeability enhancement by blood vessel dilation, Gastric juice secretion, Serotonin

Guide IV. The amino acids are the building blocks of serotonin, the essential neurotransmitter of our body. These local hormones are present in bulk in the digestive system, blood platelet, and central nervous system. V. Serotonin has a noticeable contribution to mood stabilization, sharpening memory, and the cognitive system. But, do you know the lack of this neurotransmitter causes depression and anxiety? Besides lifting your mood, serotonin plays a role in maintaining a healthy sleep pattern and digestion process. The hormone also takes part in blood clotting and boosting the immunity network. Estrogen I. Estrogen, the female hormone, plays the master role in flourishing feminine characteristics. This hormone contributes to, Breast and sexual organ development, Driving sexual desire and gratification, Healthy menstruation cycle, and Body fat distribution II. The estrogen level fluctuates and takes a hit during the menopausal transition. The lack of this hormone leads to hot flashes, night sweats, frequent mood swings, and weight gain. Progesterone I. The ovaries and placenta are the primary manufacturers of progesterone hormones. However, the adrenal gland also has a significant contribution to the production of this hormone. II. Progesterone is considered the secondary female hormone due to its role during pregnancy, conception, and maintaining the menstrual cycle. Hence, the lack of these molecules leads to irregular periods, mood swings, interrupted sleep cycles, anxiety, etc. Androgen I. Androgen, also called the male hormone, is a group of sex hormones that dominates male characteristics. But, surprisingly, women also require a fair share of androgen to balance out their hormones. II. The androgen surge during puberty contributes to the reproductive system development, pubic and facial hair growth, and the deepening of the voice. This hormone also has a significant role in libido and building muscle mass.

Local Hormones Systemic Hormones

Produced from nerves and glands

Originates from one

specific

gland or tissue

Localized work Work throughout the body

Perform tasks like blood clotting, building

immunity, and inflammatory response Carry^ out^ a^ particular^ task

Local hormone therapy includes: cream, rings, and sometimes suppository. It is applied directly to the desired area.

Guide For example, a practitioner delivers a ring or suppository inside the vagina to treat irritation or dryness. Again, creams are widely used for breast enhancement by leveling up localized hormones.

Guide Systemic hormone therapy includes: supplements and pellets. An expert inserts these artificial grains into the bloodstream, which eventually releases the desired hormones. Estrogen hormone therapy is globally popular among women to get relief from menopausal nightmares. o Peri-menopausal estrogen therapy (ET)

- Transdermal estrogen therapy has fewer adverse effects. - Osteoporosis, osteopenia, and hormone replacement therapy (HRT) o Selective estrogen receptor modulator (SERM) ▪ Bazedoxifene - Management of oral contraceptives (OCs) o How to change patient from one combination oral contraceptive to another. o How to initiate treatment (when in the cycle is it best to start- may vary based on the type of contraceptive) o What teaching needs to be done o What baseline data is needed? o Contraindications for OCs **- How to achieve an extended cycle with oral contraceptives

• What behaviors would make one birth control method more effective over** another? o Be able to evaluate a patient scenario and suggest an appropriate birth control method (type of prescribed contraception: OC, long- term methods, IUD, long- acting reversible contraceptives (LARCs), etc. - What effect does CYP450 inhibitors or inducers have on OCs? o Recall examples of CYP450 inhibitors and inducers from NR (Chapter 4 in textbook) o How does this impact prescribing of OCs? **- Benefits and drawbacks of progestin-only contraception
• What are the most effective forms of contraception?
• Testosterone replacement** o Administration o Benefits o Patient Teaching - Treatment of delayed puberty o When is it appropriate to initiate androgen therapy (short course and long-term) - Androgen therapy o Effects ▪ Therapeutic ▪ Adverse o Monitoring Needs o Role of androgens in treating anemia - Preferred administration route of alprostadil and why

Guide

- Treatment of hypogonadism o Benefits o Administration methods for transdermal preparations

Guide ▪ Testosterone gels

- Erectile Dysfunction (ED) o Patient Teaching o Medication Classes used to treat ED ▪ Vasodilators **▪ PGE

• Treatment of BPH** o Know examples of drugs in each major drug class o Adverse effects of common therapies ▪ 5-α-Reductase Inhibitors ▪ α 1 Blockers ▪ Phosphodiesterase-5 Inhibitor ▪ α1a Blocker/5-α-Reductase Inhibitor o Therapeutic Effects ▪ Time to achieve ▪ Patient education/Provider response ▪ Assessment for therapeutic effect - National STI/STD Curriculum o Treatment of STIs/STDs ▪ Chlamydia ▪ Uncomplicated gonococcal urethritis ▪ Bacterial Vaginosis ▪ Herpes Simplex Virus ▪ Trichomoniasis ▪ Syphilis

Week 6

**- PD on exam is Parkinson Disease

• Management of PD** o Early stages o Combination therapy o Medications used to treat “off” times including “wearing off” experiences o Adverse Effects ▪ Pramipexole - Management of seizures o Which medication would be the safest choice for someone on an oral contraceptive? o Purpose and timing of serum drug levels o Patient teaching & Drug Interactions

Guide ▪ Phenytoin

Guide ▪ Lamotrigine ▪ Tegretol

- Management of Migraines o 1 st^ line therapy ▪ Preventative ▪ Abortive o When to use abortive therapy and when to use preventive therapy ▪ Drugs for each ▪ Contraindications for drugs - Sumatriptan o Alternative preventative medication options - Management of Alzheimer’s Disease o Administration Considerations ▪ Memantine ▪ Rivastigmine o Dosing considerations ▪ Donepezil ▪ Memantine ▪ Galantamine o Side Effects ▪ Cholinesterase Inhibitors - Additional Notes o If phenytoin is administered in doses only slightly greater than those needed for therapeutic effects, the liver's capacity to metabolize the drug will be overwhelmed, causing plasma levels of phenytoin to rise dramatically. This unusual relationship between dosage and plasma levels is illustrated in Fig. 21.1A. As you can see, after plasma levels have reached the therapeutic range, small changes in dosage produce large changes in plasma levels. As a result, small increases in dosage can cause toxicity, and small decreases can cause therapeutic failure. This relationship makes it difficult to establish and maintain a dosage that is both safe and effective. For this reason, serum drug levels and trough levels are often used, along with assessments of seizure control, to determine dosage. ▪ Examples: If a patient is taking phenytoin 300mg daily for seizures and their serum concentration is 8mg/L and they experience a considerable increase in seizure activity, their dose would only need to increase to 350mg daily. o When on medications for Alzheimer’s Disease (AD) and symptoms increase, it is better to increase the AD medication than to add things like herbal medications, vitamins, or NSAIDs

Guide 1

Week 7

- Management of Bipolar Disorder (BPD) o Drugs from other classes that can be used to treat BPD o Drug Interactions ▪ Lithium - Monitoring ▪ Anticonvulsants - Lamotrigine - Tegretol - Depakote - Trileptal - Topamax o Monitoring ▪ Lithium - Management of Major Depressive Disorder o Know example drugs ▪ SSRIs o Adverse Effects ▪ Venlafaxine ▪ Monoamine Oxidase Inhibitors o Food & Drug Interactions ▪ Monoamine Oxidase Inhibitors (MAOIs) o Suicide Risks and Considerations ▪ Safety measures o Administration and Cessation of Medication Considerations ▪ Selective serotonin reuptake inhibitors (SSRIs) - What do patients need to know about starting and stopping SSRIs? ▪ MAOIs - What patient type would be appropriate for MAOIs? o Baseline Data Needed to prescribe and strategies to minimize adverse effects for the following: (you will use each option only once on the exam) ▪ SSRI/SNRI ▪ Tricyclic Antidepressants **▪ MAOIs

• Management of Panic Disorder** o Medications used to treat ▪ Exam will note mg in choices but if you know the med, the mg will be irrelevant. ▪ First-generation antipsychotics (FGA) - Adverse Effects - Management of social anxiety disorder (SAD)

Guide 1 o What medications can be used ▪ On a routine basis versus on an as needed basis

- Management of anxiety o Long term treatment options o Recommended duration of treatment - Side effects of both 1 st^ generation and 2 nd^ **generation antipsychotics

• Management of ADHD in Adolescents
• Management of Insomnia** o What type of patient scenario would be appropriate for administration of the following drugs? ▪ Trazodone ▪ Zaleplon ▪ Flurazepam ▪ Zolpidem o Know Examples for the major drug classes ▪ Benzodiazepine ▪ Benzodiazepine-like Drug - Buspirone ▪ Zolpidem ▪ Melatonin Receptor Agonist

Week 8

- For the following herbal medications, you will need to know how they interact with conventional drugs and common problems that can happen with each one. o Kava ▪ Monitoring o Ginkgo biloba o Echinacea ▪ Contraindications o St. John’s wort o Ginger root ▪ Patient Teachings o Flaxseed ▪ Contraindications o Black cohosh

Prescription Writing

Guide 1

- Medications you will need to know for the prescription writing questions include : o Azithromycin o Erythromycin o Tinidazole o Benzathine Penicillin o Acyclovir