Pharm chpts 51, 74,80

what is the prototype drug for BPH

5-alpha reductase inhibitor (finasteride)

sildenafil, tadalafil, vardenafil, and avanafil are all prototype drugs what what class

PDE-5 inhibitors

T/F- nitrofurantoin can turn your pee dark brown

T- but this is ok i guess

what are the recommended drugs fro treating bacterial vaginosis

- oral/vaginal metronidazole - vaginal clindamycin

what are the contraindications for finasteride

- pregnancy (cat X)

in pts with acute cystitis, who qualifies for short course therapy

- women whom are not pregnant with a lower UTI - short course therapy should not be used in men, children, pregnant folk, and upper tract infections

a male pt who takes finasteride states that he wants to donate blood, what do you tell him

- you cannot donate blood since you being on 5ARI can cause teratogen to an unborn child potentially

what are the adverse effects of tamsulosin

- abnormal ejaculation - lesslikely to cause hypotension/fainting/dizziness than non-selective alternatives, but still possible

Knowing that there is no cure for herpes simplex virus, what drugs can be given to help get through episodes

- acyclovir, famciclovir, valacyclovir

in pts taking PDE-5 inhibitors, what drugs should not be taken in combo

- alpha-adrenergicblockers - nitro - nitrates for angina pectoris

what are the two meds recommended for treating uncomplicated chlamydia infections in adults or adolescents (2)

- azithromycin - doxycycline

what are the adverse effects of sildenafil

- hypotension - priapism - nonarteritic ischemic optic neuropathy - sudden hearing loss - N/V/D facial flushing

What is the MOA of nitrofurantoin?

-broad spectrum antibacterial drug (static at low, cidal at high doses) - injures bacteria by damaging DNA

what is the MOA of sildenafil

A PDE-5 inhibitor which decreases cGMP breakdown allowing for a harder longer lasting erection

The nurse is discussing upper and lower UTIs. Which of these conditions can be treated at home? (Select all that apply.) a. Acute cystitis b. Acute urethritis c. Recurrent UTI d. Severe pyelonephritis e. Acute bacterial prostatitis

A, B, C

Which are contraindications for taking sildenafil [Viagra]? (Select all that apply.) a. Patients who are taking nitroglycerin for angina pectoris b. Patients with nonarteritic ischemic optic neuropathy (NAION) in one eye c. Patients with BPH who are taking alpha 1-adrenergic antagonists d. Patients with a blood pressure of 100/60 mm Hg e. Patients with a history of myocardial infarction (MI) in the past 6 months

A, B, C

Which infections may be acquired through nonsexual transmission? (Select all that apply.) a. Chlamydia trachomatis b. Gardnerella vaginalis c. Herpes simplex d. Neisseria gonorrhea e. Treponema pallidum

A, B, C, D, E all of them

Nitrofurantoin [Macrodantin] is prescribed for an adolescent female patient with acute cystitis. What should the nurse include in the teaching for this patient? (Select all that apply.) a. "Make sure you tell your prescriber if you might be pregnant." b. "If you experience any tingling or numbness, stop taking the drug and call the clinic immediately." c. "Headaches and drowsiness can occur and are mild side effects." d. "You should not take sulfonamides while taking this medication." e. "Your urine may have a brown tinge while you are taking this drug."

A, B, C, E

Most UTIs are caused by.....

E. coli

T/F- sildenafil causes an erection

F- it does not cause it directly, it only enhances normal erectile responses

T/F- papaverine plus phentolamine is approved for ED

F- it is not recommended for this use even though its sure to give you a boner

T/F- nitrofurantoin can be used for both upper and lower UTI

F- it is only good for lower

T/F- tamsulosin is a non-selective alpha1 recptor inhibitor

F- it is selective

T/F- PID can easily be treated at home

F- most providers recommend in hospital IV tx for this condition to prevent sterility

T/F- resistance to methenamine is common in treating chronic UTI

F- there is no resistance to this med

A nurse is teaching a patient about the use of sildenafil [Viagra] for erectile dysfunction. Which statement by the patient indicates understanding of the teaching? a. "If my erection lasts longer than 4 hours, I should contact my provider." b. "I should not use nitroglycerin within 12 hours of using sildenafil." c. "I should take this drug about 15 minutes before sexual activity." d. "This drug may cause me to have an erection when I don't want one."

a. "If my erection lasts longer than 4 hours, I should contact my provider."

Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem? a. Elevated blood urea nitrogen and creatinine b. History of reactions to antibiotic agents c. Possibility of pregnancy d. Previous resistance to antiseptic agents

a. Elevated blood urea nitrogen and creatinine (should not be given to pts with hx of renal problems)

A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her? a. "This agent is not effective against infections of the upper urinary tract." b. "This antiseptic agent is safe for use during pregnancy and has no drug resistance." c. "This drug is linked to many serious birth defects and is not recommended during pregnancy." d. "You will need to take this medication with meals to avoid gastric upset."

a. "This agent is not effective against infections of the upper urinary tract."

A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? a. Acyclovir [Zovirax] b. Azithromycin [Zithromax] c. Metronidazole [Flagyl] d. Tinidazole [Tindamax]

a. Acyclovir [Zovirax]

A patient who has erectile dysfunction asks about medications to treat this disorder, but tells the nurse he doesn't want to have to plan sexual activity several hours in advance. Which medication will the nurse expect the provider to order for this patient? a. Avanafil [Stendra] b. Sildenafil [Viagra] c. Tadalafil [Cialis] d. Vardenafil [Levitra]

a. Avanafil [Stendra]

During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug? a. Azithromycin b. Doxycycline c. Erythromycin ethylsuccinate d. Sulfisoxazole

a. Azithromycin

An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge from the penis. The nurse is correct to suspect that the patient has which disorder? a. Gonorrhea b. Herpes simplex c. Nongonococcal urethritis d. Syphilis

a. Gonorrhea

A female patient has come to the STD clinic and has been diagnosed with a Trichomonas vaginalis infection. What education should be provided to this patient? a. Male partners should always be treated, even if they are asymptomatic. b. The applicator for the vaginal gel should be washed after each application. c. The infection is not completely eliminated with the medication. d. The medication should be taken twice daily for 2 weeks.

a. Male partners should always be treated, even if they are asymptomatic.

A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment? a. Uncomplicated lower urinary tract infection treatable with short-course therapy b. Complicated lower urinary tract infection treatable with single-dose therapy c. Uncomplicated upper urinary tract infection requiring 14 days of oral antibiotics d. Complicated upper urinary tract infection requiring parenteral antibiotics

a. Uncomplicated lower urinary tract infection treatable with short-course therapy

A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will: a. begin a 2-week course of antibiotics. b. evaluate for a structural abnormality of the urinary tract. c. initiate long-term prophylaxis with low-dose antibiotics. d. treat the patient with intravenous antibiotics.

a. begin a 2-week course of antibiotics.

A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to: a. begin antibiotic therapy after urine culture and sensitivity results are available. b. give prophylactic antibiotics for 6 weeks after the acute infection has cleared. c. initiate immediate treatment with broad-spectrum antibiotics. d. refer the patient for intravenous antibiotics and hospitalization

a. begin antibiotic therapy after urine culture and sensitivity results are available.

A male patient tells the nurse he awakens once or twice each night to void and has difficulty starting his stream of urine. He describes these symptoms as "annoying." The patient's provider examines him and notes that the prostate is moderately enlarged. The patient is sexually active and tells the nurse that he does not want to take any medication that will interfere with sexual function. The nurse anticipates the provider will order: a. doxazosin [Cardura]. b. finasteride [Proscar]. c. silodosin [Rapaflo]. d. a transurethral prostatectomy.

a. doxazosin [Cardura].

A patient admitted to the hospital is using metronidazole [Flagyl] 0.75% gel. The nurse understands that this agent is used to treat which condition? a. Chlamydia trachomatis b. Gardnerella vaginalis c. Haemophilus ducreyi d. Trichomonas vaginalis

b. Gardnerella vaginalis aka bacterial vaginosis

An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The nurse will expect the provider to order which drug(s)? a. Azithromycin [Zithromax], 1 gm PO once, and doxycycline [Vibramycin], 100 mg PO twice daily for 7 days b. Ceftriaxone [Rocephin], 250 mg IM once, and azithromycin [Zithromax], 1 gm PO once c. Ceftriaxone [Rocephin], 125 mg IM once d. Doxycycline [Vibramycin], 100 mg IV twice daily for 12 days

b. Ceftriaxone [Rocephin], 250 mg IM once, and azithromycin [Zithromax], 1 gm PO once

what is the MOA for tamsulosin

blocks alpha 1 receptors relaxing smooth muscle in the bladder neck, prostate capsule, and prostatic urethra, thereby decreasing dynamic obstruction of the urethra

A healthy male patient who does not have erectile dysfunction asks about medications to improve sexual stamina. What will the nurse tell this patient? a. "Medications for ED can improve the duration of erection in healthy men." b. "Medications for ED can improve the quality of erection in healthy men." c. "Medications for ED have no effect on erections in healthy men." d. "Medications for ED will cause priapism in healthy men."

c. "Medications for ED have no effect on erections in healthy men."

A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient? a. "Make sure you void after intercourse and drink extra fluids to stay well hydrated." b. "We will treat each infection as a separate infection and treat with short-course therapy." c. "You will need to take a low dose of medication for 6 months to prevent infections." d. "You will need to take antibiotics for 4 to 6 weeks each time you have an infection."

c. "You will need to take a low dose of medication for 6 months to prevent infections."

A newborn infant has been given erythromycin ophthalmic ointment as a routine postpartum medication. The infant's mother learns that she has a C. trachomatis infection and asks the nurse if her baby will need to be treated. Which response by the nurse is correct? a. "The erythromycin ointment will prevent your baby from developing conjunctivitis." b. "Without additional treatment, your baby could develop blindness." c. "Your baby will need to be treated with oral erythromycin." d. "Your baby will need to take doxycycline [Vibramycin] for 10 days."

c. "Your baby will need to be treated with oral erythromycin." the eye ointment will cover the conjunctivitis but the kid should be treated for pneumonia too

The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse? a. "Your child may need to be hospitalized for treatment." b. "Your child may need a urine culture before and after treatment." c. "Your child may need tests to assess for urinary tract abnormalities." d. "Your child may need additional medications, such as urinary tract antiseptics."

c. "Your child may need tests to assess for urinary tract abnormalities."

A patient is diagnosed with pelvic inflammatory disease (PID). Which treatment regimen is most appropriate for reducing the risk of sterility in this patient? a. Azithromycin [Zithromax], 1 gm PO once, and cefoxitin, 2 gm IM once in the clinic b. Ceftriaxone [Rocephin], 250 mg IM once, with doxycycline [Vibramycin], 100 mg PO twice daily for 14 days as an outpatient c. Doxycycline [Vibramycin], 100 mg IV twice daily, and cefoxitin, 2 gm IV every 6 hours in the hospital d. Doxycycline [Vibramycin], 100 mg PO twice daily for 14 days, and metronidazole [Flagyl], 500 mg PO twice daily for 14 days in the hospital

c. Doxycycline [Vibramycin], 100 mg IV twice daily, and cefoxitin, 2 gm IV every 6 hours in the hospital

A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a good medication for him to take. Which aspect of this patient's history would be of most concern? a. Benign prostatic hypertrophy b. Mild hypertension c. Occasional use of nitroglycerin d. Taking finasteride

c. Occasional use of nitroglycerin

A patient is admitted to the hospital with fever, headache, malaise, joint pain, and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis? a. Congenital b. Primary c. Secondary d. Tertiary

c. Secondary

A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with: a. cephalexin [Keflex]. b. fosfomycin [Monurol]. c. methenamine [Hiprex]. d. nitrofurantoin [Macrodantin].

c. methenamine [Hiprex].

A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats per minute, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

c. pyelonephritis.

what is the preferred drug from treating gonorrhea

cephalosporins

is sildenafil safe to use in: children, pregnant women, breastfeeding women, older adults

children- tx not indicated in children pregnant women- Cat B, but not indicated for women either breastfeeding- not indicated for women older adults: consider lower doses after age 65

is tamsulosin safe to use in: children, pregnant women, breastfeeding women, older adults

children: not approved for this use pregnant: risk Cat B breastfeeding: not recommended older adults: use caution, BEERs list potentially

what is the most commonly reported bacterial STD

chlamydia

what is the MOA of finasteride and what class of med is it

class: 5-alpha reductase inhibitor MOA: inhibits 5-alpha reductase- enzyme needed to convert T into DHT thus... it promotes the regression of prostate epithelial tissue and decreased mechanical obstruction of urethra

Tadalafil [Cialis] was prescribed 4 weeks ago for a patient with erectile dysfunction. The patient also takes prazosin [Minipress] for hypertension. Which statement by the patient best demonstrates understanding of the use of tadalafil [Cialis]? a. "I can take this up to 2 times a day, just before intercourse." b. "I have a little renal trouble, so I should take a higher dose." c. "I should take this medication with food." d. "I should take this medication no more than once a day."

d. "I should take this medication no more than once a day."

A male patient is being treated for benign prostatic hyperplasia (BPH) by another provider but cannot remember which drug he is taking. He comes to the clinic seeking treatment for erectile dysfunction and receives a prescription for sildenafil [Viagra]. What will the nurse teach this patient? a. "Sildenafil is not safe to take in conjunction with finasteride [Proscar]." b. "Sildenafil is safe with any medication for benign prostatic hyperplasia." c. "To be safe, you should have a transurethral resection before starting sildenafil." d. "You should not take sildenafil if you are taking silodosin [Rapaflo]."

d. "You should not take sildenafil if you are taking silodosin [Rapaflo]."

A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective? a. A 14-day course of amoxicillin with clavulanic acid [Augmentin] b. A 7-day course of ciprofloxacin [Cipro] c. A single dose of fosfomycin [Monurol] d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5°F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infection d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication? a. Anorexia, nausea, and vomiting b. Brown-colored urine c. Drowsiness d. Tingling of the fingers

d. Tingling of the fingers (peripheral neuropathy- may not be reversible)

what are the contraindications for nitrofurantoin

pregnant women near term and for infants less than 1 month (risk of hemolytic anemia)

A patient with a history of benign prostatic hyperplasia is admitted to the unit. The patient is taking multiple medications, including terazosin [Hytrin]. During the evening rounds, the patient begins to complain of dizziness and nasal congestion. Upon assessment, the patient is somnolent and has a blood pressure of 101/42 mm Hg. The nurse is correct to suspect: a. priapism. b. sinus infection. c. allergic reaction. d. adverse effects.

d. adverse effects.

An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

d. prostatitis.

what should be avoided in the diet while taking sildenafil

grapefruit juice - also for best absorption one should avoid high fat meals at time of taking med (slows abs)

where is nitrofurantoin the most concentrated

in the urine, does not go into tissues etc

acute uncomplicated pyelonephritis is an infection of the (bladder/urthera/kidneys/ureters)

kidneys

acute cystitis is a (upper/lower) UTI most often seen in _______

lower UTI seen in women of childbearing age

you have a husband who threw a fit and threw his finasteride on the floor and then stomped on them which resulted in pills being crushed. Should his pregnant wife pick them up herself or make him do it

make him do it. Pregnant women handling crushed pills can pose a risk to the fetus

who will benefit the most from using sildenafil for sexual benefits: men with ED, men without ED, women

men with ED - no "additional" benefits have been document in men without ED - not approved for women

what is the MOA and route of admin for papaverine plus phentolamine

route- injected into the corpus cavernosum MOA- produces erections by uincreasing arterial inflow and decreasing venous outflow

what is the MOA and route of administration for alprostadil (prostaglandin E1)

route= insertion into urthera or injection into penis MOA- relaxation of smooth muscle allowing blood in and compression of veins trapping blood and causing an erection

what is the most common cause of STDs in preadolescent children

sexual abuse

what is the prototype drug for alpha adrenergic antagonists

tamsulosin

tamsulosin should be used in pts with (mild/severe) BHP while finasteride should be used in pts with (mild/severe) BHP

tamsulosin= mild finasteride= severe

a (complicated/uncomplicated) UTI occurs in men and women who have a structural or functional abnormality of the urinary tract that predisposes them to developing infection

uncomplicated

nitrofurantoin is indicated for the use of ...

uncomplicated cystitis (lower UTI)

what are the therapeutic uses of the drug methenamine

used in chronic infection of the lower urinary tract

what are the adverse effects of nitrofurantoin

• Nausea, vomiting, diarrhea (most common) -Take with meals/milk to decrease these symptoms • Hemolytic anemia assoc. with G6PD deficiency • peripheral neuropathy, hepatotoxicity, CNS effects

T/F- women are frequently asymptomatic of chlamydia

T- but if left untreated it can lead to symptomatic PID, ectopic pregnancy, and infertility

what is the MOA of methenamine

Methenamine is converted to formaldehyde which denatures bacterial proteins, causing cell death - urine must be acidic (pH5.5 or less)

A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis? a. "C. trachomatis conjunctivitis in newborns can result in blindness." b. "The CDC recommends screening for chlamydial infections in all sexually active men." c. "Treatment for C. trachomatis should be initiated when infections are symptomatic." d. "Women with asymptomatic Chlamydia trachomatis infections can become sterile."

d. "Women with asymptomatic Chlamydia trachomatis infections can become sterile."

. A nurse is obtaining a history from a patient who will receive tadalafil [Cialis] for erectile dysfunction. The patient reports that he expects to have sexual activity three or four times a week. What should the nurse tell the patient? a. Adverse effects of tadalafil resolve more quickly than those of sildenafil. b. There is an increased risk of priapism with frequent sexual activity. c. He should take tadalafil 30 to 60 minutes before sexual activity. d. He should talk to his provider about daily dosing of tadalafil.

d. He should talk to his provider about daily dosing of tadalafil.

T/F- neonate eyes are susceptible to STD eye infections

T- eye drops can be given to prevent this shortly after birth

what is recommended for the tx of PID, mono or combo drug therapy

combo drug therapy- there is no mono drug that can tx this

. A 68-year-old male patient receives a prescription for 25-mg tablets of sildenafil [Viagra] for erectile dysfunction. When he asks the nurse how to take the medication, the nurse will tell him to: a. begin taking one tablet twice daily, 12 hours apart. b. start with one tablet about 1 hour before anticipated sexual activity. c. take 25 to 100 mg per dose 30 minutes to 4 hours before sexual activity. d. take two tablets 1 hour before sexual activity with a high-fat meal.

b. start with one tablet about 1 hour before anticipated sexual activity.

what is an absolute contraindication of sildenafil

contraindicated in men using nitrates

what is the drug of choice for treating trichomoniasis

metronidazole

what is the drug of choice for resolving herpes simplex virus

none- there are no drugs to cure this, only things to help you get through the tough times

what is the prototypedrug for nonoral erectile dysfunction drugs

papaverine/phentolamine alprostadil

what is the drug of choice for syphilis

penicillin G