pharm exam 4

appropriate use of contraceptives: what should you check before prescribing contraceptives

Patient needs a recent Pap smear, negative pregnancy test, STD testing and gynecologic exam is preferred

how do IUDs and IUS work

they create a spermicidal intrauterine environment

What acronym do we use in patient education for patients starting contraceptives?

ACHES

What does ACHES stand for

Abdominal pain, Chest pain, Headaches, Eye problems, Severe leg pain

Patient reports fevers greater than 100.4 and flank pain, what possible diagnosis is this?

pyelonephritis

what are symptoms of a UTI

burning/stinging with urination, urinary frequency, lower abdominal pain, cloudy urine, strong odor

what is the treatment for a UTI in pregnancy

Amoxicillin

Cephalexin (Keflex), nitrofurantoin (Macrobid) during 1st and 2nd trimester

which patients with a UTI are uncomplicated

premenopausal, sexually active, not pregnant and has not had a UTI recently

What is the 1st and 2nd line treatment for uncomplicated UTI’s

1st = bactrim (trimethoprim-sulfamethoxazole) for 3 days or nitrofurantoin for 7 days

2nd= 7 days of bactrim, copra, levofloxacin, ofloxacin

What patients with a UTI would be considered complicated?

men, pregnant women, postmenopausal, urinary structural defects, neurologic lesions, or a catheter. having a UTI for greater than 7 days

what is 1st and 2nd line treatment for complicated UTIs?

1st= C&S appropriate oral therapy for 10-14 days (usually ciprofloxacin, levofloxacin, enoxacin, norfloxacin, ofloxacin, TMP-SMZ/Bactrim, cefpodoxime

2nd= oral therapy for 2-6 weeks

what is 3rd line treatment for complicated UTIs? 

hospitalization for IV antibiotics, usually rocephin ceftriaxone 

What are causes of uncomplicated UTIs?

poor hygiene, wiping back to front, not urinating after sex, using saliva as lubricant

What are diagnostic criteria for Diabetes?

HbA1C >6.5,

fasting glucose >80-130 and

glucose 2 hours after meals >180

What is the first line therapy for type 2 diabetes

metformin

when initiating metformin what should you educate the patient about

this medication will cause  gastrointestinal side effects such as nausea, diarrhea, and abdominal discomfort. take it with meals to minimize these effects.

your patient is about to start metformin and you want to reduce the side effect of diarrhea

titrate the dose

your patient has CKD and diabetes, metformin has not achieved the goal A1C, what medication should you consider starting

SGLT2(-flozin): farxiga(dapagliflozin) and Jardiance (empagliflozin)

diabetic patient has ASCVD and is obese, what diabetic medication should you start

GLP-1 receptor agonist (-tide): semaglutide(Ozempic) or liraglutide(Trulicity).

diabetic patient with Heart Failure start 

SGLT2 inhibitor: empagliflozin(Jardiance) or dapagliflozin(farxiga)

Diabetic patient with ASCVD and normal BMI

SGLT2 inhibitor: empagliflozin(Jardiance) or dapagliflozin(farxiga)

diabetic patient with obesity

GLP-1 receptor agonist (-tide): semaglutide(Ozempic) or liraglutide(Trulicity).

DPP-4 inhibitors(-gliptin) are used when

patients have type 2 diabetes and are either unable to achieve glycemic control with metformin or have contraindications to metformin.

Your patient is on metformin and A1C is still elevated and diabetes is not under control, what should you add before considering insulin

GLP1 receptor agonist such as semaglutide or liraglutide. Ozempic trulicity

you need to start insulin for your diabetic patient, what type of insulin should you start with

basal insulin (Levemir, Lantus) given @ bedtime

thiazolidinediones like Avandia is used to

improve insulin sensitivity and glycemic control in patients with type 2 diabetes.

sulfonylureas like glyburide are used to

stimulate insulin secretion from the pancreas to lower blood glucose levels in patients with type 2 diabetes.

the following are risk factors for what? hyperparathyroidism, post menupausal women, age >70, excessive smoking, alcohol and caffeine intake, petite stature, low body weight, sedentary lifestyle, low calcium intake 

osteoporosis

postmenopausal osteoporosis is what type

type 1

type 1 osteoporosis occurs in postmenopausal women, what are the most common types of fractures for this group?

fractures of vertebrae, distal femur, and tooth loss

type 2 osteoporosis is known as senile and occurs in men and women >70, what are the most common types of fractures for this group?

hip, pelvic and vertebral

type 3 osteoporosis is known as secondary osteoporosis, what causes it?

steroid use and hyperparathyroidism

when should screening for osteoporosis occur?

Screening for osteoporosis should occur in women aged 65 and older and in men aged 70 and older, as well as in younger individuals >50 with risk factors such as family history, low body weight, or prior fractures.

what screening methods are used for osteoporosis

dual-energy X-ray absorptiometry (DXA) for measuring bone mineral density, along with clinical risk assessment tools such as FRAX.

What are side effects of bisphosphanates

They may include gastrointestinal issues, flu-like symptoms, osteonecrosis of the jaw, and atypical femur fractures.

patients taking bisphosphanates should be educated to 

sit upright for 30 minutes after taking, they can cause reflux, GERD. 

bisphosphanates are used to treat osteoporosis, what are some examples?

alendronate (fosamax)

risedronate (actonel)

ibandronate (bonita)

zoledronic acid (reclast)

how do bisphosphanates work

They inhibit osteoclast-mediated bone resorption, leading to increased bone density.

what are non pharmacological therapies to help with osteoporosis? 

Dietary changes, weight-bearing exercises, fall prevention measures.

what is the most common cause of hypothyroidism

iodine deficiency is the most common cause globally. Other causes include autoimmune diseases like Hashimoto's thyroiditis.

how do you diagnose hypothyroidism

An elevated TSH level with low T4 indicates hypothyroidism.

how do you diagnose hyperthyroidism

An elevated T4 level with low TSH indicates hyperthyroidism.

what is the most common cause of hyperthyroidism

Graves' disease is the most common cause of hyperthyroidism. Other causes include toxic nodular goiter and thyroiditis.

1st line therapy for hypothyroidism is

levothyroxine replacement therapy.

1st and 2nd line therapy for hyperthyroidism is

1st=radioactive iodine

2nd= antithyroid drugs like methimazole and propylthiouracil.

which medication for hypethyroidism can be safely used for a pregnant patient with graves disease?

propylthiouracil (PTU)

how should a provider monitor drug therapy for hypothyroidism 

by regularly checking TSH levels to ensure they are within the target range, typically every 6 to 8 weeks after starting or adjusting therapy. TSH low = too much medication. TSH high = too little medication

hyperparathyroidism can do what to calcium levels

cause elevated calcium levels in the blood, hypercalcemia.

what drugs can cause weight gain

type 2 diabetic medications: insulin, sulfonylureas (glitinides, thiozolidinediones)

HTN medications: beta blockers (metoprolol)

Antidepressants: amitriptyline, clozepam, olanzapine, quetiapine, risperidone

chronic inflammatory/rheumatic arthritis: corticosteroids

Contraindications to weight loss medications include

history of anorexia, severe depression, smokers, pregnancy or breast feeding, or cardiovascular disease.

GLP1: CI in bowel obstruction, can cause gastroporesis, pancreatitis, increase risk of medullary thyroid cancer

orlistat is a weight loss medication. Education includes

causes oily diarrhea,

maintain a low-fat diet to minimize gastrointestinal side effects and avoid potential malabsorption of nutrients.

diagnosis of obesity

BMI 

<18.5 underweight

18.5-24.9 normal

25-29.9 overweight

30-34.9 obesity class 1

35-39.9 obesity class 2

>40 obesity class 3

non pharmacological treatment of obesity

diet, exercise, calorie deficit, behavior therapy

chlamydia causative agent

chlamydia trachomatis

s/s of chlamydia

more than ½ of infected patients have no clinical s/s. Women experience vaginal discharge, pelvic inflammatory disease, urethral syndrome or urethritis, ectopic pregnancy, infertility, endometriosis, edema and friability.

men may experience clear discharge and dysuria

Treatment of chamydia

Azithromycin (Zithromax) 2G 1x dose. abstain from sex for 7 days after completion and test for reinfection after 3 months.

causative agent of gonorrhea is

Neisseria gonorrhoeae

signs and symptoms of gonorrhea

can include painful urination, pus-like discharge, bleeding between periods, and pelvic pain in females.

in males pain in testicles

what is the treatment for gonorrhea

IM Ceftriaxone or Azithromycin, often in combination, is the recommended treatment for gonorrhea.

what is the causative agent of syphilis 

Treponema pallidum

what are primary signs and symptoms of syphillis

ulcer or chancre at the infection site that erupts 3 weeks after exposure

what are secondary s/s of syphillis

low grade fever, malaise, sore throat, hoarseness, headache, anorexia, rash, mucocutaneous lesions, alopecia, and adenopathy may occur weeks to months after the initial chancre heals.

what are tertiary s/s of syphillis

cardiac, neurological, ophthalmic, auditory or gummatous lesions that can develop years after initial infection and may lead to severe complications.

Causative agent of genital herpes 

herpes simplex virus (HSV), specifically HSV-2, although HSV-1 can also cause genital infections.

how is herpes transmitted

skin to skin contact through sex, kissing or vaginal birth

treatment for herpes

antiviral medications: acyclovir, famciclovir, or valacyclovir

treatment for herpes eradicates the disease: true or false

false, antivirals reduce outbreaks but does not eradicate the disease

what causes bacterial vaginosis

an imbalance of bacteria in the vagina, often triggered by sexual activity or douching.

signs and symptoms of bacterial vaginosis include

thin, grayish-white discharge, fishy odor, itching, and irritation.

treatment for bacterial vaginosis includes

metronidazole (flagyl) vaginal cream or oral pill, clindamycin cream or oral pill, and probiotics.

candidiasis is caused by

an overgrowth of Candida albicans yeast, often due to antibiotic use, diabetes, or a weakened immune system.

signs and symptoms of candidiasis include

itching, burning, thick white discharge, and inflammation.

treatment for candidiasis includes

topical anti fungal -AZOLES like fluconazole (Diflucan) and clotrimazole. or oral fluconazole taken in one dose, takes a few days to work

What are 1st and 2nd line treatments for erectile dysfunction

1st line treatments include oral medications like PDE5 inhibitors (sildenafil, verdenafil, avanaail, tadalafil) viagra

2nd line treatments require referral to urologist for possible vacuum erection devices or penile injections.

side effects/ contraindications of PDE5 used to treat erectile dysfunction

CI in patients taking nitrates, causes a severe drop in BP, hearing issues, blue visual discoloration.

Pt. cannot have a CT scan if they haven taken this within 24 hrs

erection lasting more than 4 hrs requires ER visit

BPH definition and diagnostic criteria

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly causes urinary symptoms in older men. Diagnostic criteria include assessment of prostate size and evaluation of urinary flow rates and symptoms.

PSA levels of what indicate BPH

Typically levels above 4 ng/mL

PSA levels of what indicate prostate cancer

Typically levels above 10 ng/mL

AUA scoring for BPH stands for

American Urological Association scoring

Patients with AUA score of 7 or less would indicate what as far as treatment 

Treatment is not indicated, watchful waiting

Patients with AUA score greater than 7 means

Start treatment. Treatment includes alpha adrenergic blockers (-SIN) terazosin, tamsulosin (Flomax) or 5 alpha reductase inhibitor (-ide) finasteride

in patients with BPH and difficulty urinating, the provider can prescribe what as first line treatment 

medications such as alpha blockers (tamsulosin- Flomax) or 5-alpha reductase inhibitors (finasteride) to alleviate symptoms.

alpha blockers end in what

-sin

ex: tamsulosin

5-alpha reductase inhibitors end in what

-ide 

ex: finasteride

what is second line treatment for BPH

combination therapy with alpha blockers and 5-alpha reductase inhibitors, or phosphodiesterase-5 inhibitors such as tadalafil.

what OTC medication helps with BPH

phenylephrine or saw palmetto may provide symptom relief

Action of alpha-blockers in treatment os LUTS (lower urinary tract symptoms)

Alpha-blockers relax the smooth muscles in the bladder neck and prostate, improving urine flow and reducing symptoms associated with LUTS.

antimuscarinic drugs do what

Antimuscarinic drugs reduce bladder contractions, helping to decrease urgency and frequency of urination in patients with overactive bladder.

examples of antimuscarinic drugs include

oxybutynin and tolterodine

What symptoms reported are used to diagnose overactive bladder

urgency (voiding 8 or more times in 24 hours, with nocturia causing awakening to urinate 2 or more times a night)

Before diagnosing overactive bladder, the provider should rule out

UTI, uncontrolled diabetes, STD

1st line behavior treatment and 1st line pharmacologic therapy for overactive bladder includes

behavior= don’t drink water before bed, empty bladder before bed, 

pharmacologic =  antimuscarinic (oxybutynin or tolterodine, trospium) or an anticholinergic medication

Menopause symptoms include

hot flashes, night sweats, mood changes, and vaginal dryness.

the provider would prescribe what as first line for menopause symptoms

hormone replacement therapy (HRT) or estrogen therapy.

Hormone replacement therapy helps

relieve vasomotor symptoms (hot flashes, night sweats, temperature dysregulation), improves genitourinary symptoms (vaginal dryness, pain with intercourse, recurrent UTIs, urgency or discomfort), prevents bone loss (slows bone loss after menopause and reduces risk of fractures), improves sleep and mood symptoms (insomnia, irritability, mood swings).

Hormone replacement therapy should not be used in patients with 

stents and previous clots

side effects of hormone replacement therapy includes

bleeding, clots, DVT. Educate ACHES (same as for pts on contraceptives). Patient must have recent mammogram and Pap smear