Pharm 2 FINAL

interactions with ergot alkaloids, SSRIs, SNRIs, MAOIs may occur​ birth defects are seen in laboratory animals; therefore, this drug class must not be used during pregnancy​

What are the precautions for Triptans?

Take one pill as soon as possible and then continue with the pack. Use an additional form of contraception for 7 days.

What instructions should be given to a patient if one or more OC pills are missed in the first week?

Social anxiety​ Hypersomnolence​

effects of Sertraline (Zoloft)​

GAD, social anxiety, panic and social phobia​

effects of Venlafaxine (Effexor)​

Pelvic inflammatory disease, accessory gland infection, and perihepatitis (Fitz-Hugh-Curtis Syndrome) (Well-described complications of genitourinary infection with Neisseria gonorrhoeae include pelvic inflammatory disease, accessory gland infection, and perihepatitis (Fitz-Hugh-Curtis Syndrome). Acute renal failure, neurologic symptoms, and severe vaginal hemorrhage do not have a clear association with gonococcal infections and an alternative diagnosis should be sought for these symptoms.)

A 22-year-old woman is diagnosed with cervicitis caused by Neisseria gonorrhoeae. What are known potential complications of genitourinary gonococcal infection in women?

Ceftriaxone 500 mg IM in a single dose plus oral doxycycline 100 mg twice daily for 7 days

A 23-year-old woman is diagnosed with gonococcal cervicitis based on purulent discharge and Gram's stain findings. Results for chlamydia are pending. She has an intrauterine device for birth control and a urine pregnancy test in the clinic is negative. Which one of the following regimens is recommended?

Benzathine penicillin G 2.4 million units IM in a single dose

A 24-year-old man presents with a diffuse macular and papular rash on his chest, back, hands and feet. He had 2 new male sexual exposures approximately 6 weeks ago. He now has a positive Venereal Diseases Research Laboratory (VDRL) test with a titer of 1:256. He had a negative syphilis test about 3 months ago. He has no other symptoms and his neurologic examination is normal. He has no known antibiotic allergies. What treatment is indicated?

Tinidazole 2 g orally in a single dose

A 24-year-old woman with vaginal discharge is diagnosed with trichomoniasis. She does not have HIV and she is not pregnant. Which one of the following regimens is considered a recommended treatment?

asthma or COPD​, sick sinus syndrome​, GI Bleeding​, weight < 50 kg​

What are precautions of Revastigmine (Exelon)?

Moist, wart-like papular lesions that develop in 10-20% of patients with secondary syphilis. (Patients with secondary syphilis can have protean manifestations, including condylomata lata. Approximately 10 to 20% of patients with secondary syphilis will develop condylomata lata, which manifests as moist, papular lesions in warm intertriginous areas. These lesions are not the same as human papillomavirus-related condyloma acuminata)

A 22-year-old man is diagnosed with syphilis and condylomata lata. What is condylomata lata?

Without regard to meals (The patient may take the medication without regard to meals. The patient does not need to avoid dairy products, take the pill only in the morning, or take it on an empty stomach.)

A patient comes to the clinic and receives valacyclovir for a herpes-zoster virus. When will the provider instruct the patient to take the medication?

The patch is applied once daily to the back or abdomen. (Testosterone patches are indicated for male hypogonadism. Patches are applied once daily to the upper arm, thigh, back, or abdomen. Evaluation for epiphyseal closure should be done with radiographs every 6 months, not annually. Gynecomastia is a rare, not common, side effect that usually occurs in patients taking androgens in high doses, not to bring testosterone up to normal levels. Testosterone only accelerates the growth of prostate cancer when it occurs; it does not cause it.)

A 14-year-old male patient diagnosed with hypogonadism will begin testosterone patch therapy. What information will the prescriber include when teaching the family about this therapy?

Liver function tests Serum cholesterol (Adverse effects of androgen abuse can cause hepatotoxicity and an elevated serum cholesterol level, with a decrease in HDL cholesterol and an increase in LDL cholesterol. A TSH level is not necessary. A CBC is not indicated. Serum glucose and hemoglobin A1c levels are not indicated.)

A 14-year-old male patient is admitted to the hospital following a football injury. The patient is muscular, has a deep voice, and full beard. Which tests will the provider order in response to these assessment findings? (Select all that apply.

"A limited course of androgen therapy may be prescribed, but it is not necessary." (Although treatment is not required in this patient, the psychological effects of delayed puberty indicate a limited course of androgen therapy. Telling the parents not to worry does not address their concerns. This patient will not be a candidate for long-term androgen replacement therapy. Limited treatment can minimize the risk of epiphyseal closure, especially with close monitoring and radiographs.)

A 14-year-old male patient who has not yet begun puberty reports being bullied at school. The boy's father reports that he and his father also experienced teasing as adolescents because they did not begin puberty until around age 16 years. What will the provider tell the patient and his father when they ask what can be done?

Ceftriaxone 500 mg intramuscularly in a single dose plus oral doxycycline 100 mg twice daily for 7 days (Ceftriaxone 500 mg given as a single intramuscular dose is the recommended treatment for uncomplicated gonococcal infections of the urethra, as occurred in this man. For persons who weigh 150 kg (300 lb) or greater, the dose of ceftriaxone should be increased to 1 gram. If concomitant chlamydia infection can not be ruled out, then oral doxycycline 100 mg twice daily for 7 days should also be administered to treat empirically treat for chlamydia. For pregnant persons, oral azithromycin 1 gram should be used in place of doxycycline to treat chlamydia.)

A 17-year-old male is diagnosed with an uncomplicated gonococcal urethritis based on a Gram's stain of a urethral discharge specimen that shows multiple gram-negative intracellular diplococci. No additional testing is performed. He denies any history of drug allergies. Which one of the following is a preferred regimen for treatment of this patient's urethritis?

Gram-negative diplococci within white blood cells

A 19-year-old man is evaluated in the clinic with a purulent urethral discharge. A Gram's stain is performed on a sample of the discharge. Which one of the following is most consistent with a diagnosis of gonorrhea?

Azithromycin 1 g orally in a single dose

A 19-year-old woman has Chlamydia trachomatis detected on a screening test of a self-collected vaginal swab. She has a pregnancy test, which is negative. Which one of the following medications is recommended for treatment in this case?

Ceftriaxone 500 mg intramuscularly in a single dose (Pregnant persons with uncomplicated gonococcal cervical infection should receive a single dose of ceftriaxone 500 mg IM. If chlamydia infection cannot be excluded then a single azithromycin 1 gram dose taken orally should also be administered. Pregnant persons should not receive doxycycline or a fluoroquinolone, since both have potential for fetal harm and are not recommended for use during pregnancy.)

A 25-year-old pregnant woman is diagnosed with cervicitis at 20 weeks gestation. She reports increased, foul-smelling discharge and dysuria. A sample of the purulent discharge is sent for nucleic acid amplification testing (NAAT) and the test is positive for gonorrhea but negative for chlamydia. She reports no other symptoms and she has no drug allergies. Based on the 2020 updated gonorrhea treatment recommendations from the Centers for Disease Control (CDC), Which one of the following regimens should be given to treat this pregnant woman with cervicitis?

First catch urine nucleic acid amplification test

A 26-year-old male has two new recent sexual partners and presents with urethral discharge. Which one of the following tests is preferred for detecting Chlamydia trachomatis?

Ceftriaxone 250 mg IM in a single dose plus doxycycline 100 mg twice a day for 14 days plus metronidazole 500 mg orally twice a day for 14 days

A 26-year-old woman is diagnosed with pelvic inflammatory disease. She has no antibiotic allergies. The decision is made to treat her as an out-patient. Which one of the following regimens is recommended?

Benzathine penicillin G 2.4 million units IM in a single dose (The recommended therapy for secondary syphilis is benzathine penicillin G, intramuscularly, 2.4 million units in a single dose. Three doses of benzathine penicillin G, spaced 1 week apart is appropriate for late latent therapy. The slow absorption of intramuscular benzathine penicillin G provides systemic levels of penicillin for at least 1 week.)

A 29-year-old man develops a diffuse rash 5 weeks after having sexual contact with a new male partner. Testing for syphilis shows a positive Venereal Diseases Research Lab (VDRL) test of 1:256. He is diagnosed with secondary syphilis. He does not have any antibiotic allergies. What is the recommended treatment for this patient?

Metronidazole 500 mg orally twice a day for 7 days

A 29-year-old woman with a malodorous, homogenous gray vaginal discharge is diagnosed with bacterial vaginosis. She is not pregnant. What is the recommended treatment for this woman?

Clotrimazole 1% cream 5 g applied intravaginally daily for 7 days

A 30-year-old woman is 28 weeks pregnant and presents with severe vulvar itching and burning, along with thick white clumpy vaginal discharge. Which one of the following is a recommended regimen for this woman?

Early latent syphilis (The patient fits the criteria for early latent syphilis because of the positive serologic test for syphilis, lack of current clinical manifestations, and a history of secondary syphilis symptoms within the prior 12 months. At the time she initially developed the rash she had secondary syphilis. Late latent reflects latent syphilis infection of at least 1 year in duration. There is no category of latent syphilis that is referred to as very late latent syphilis.)

A 31-year-old woman had a negative screening syphilis test 9 months ago. Five months ago, she developed a maculopapular rash that resolved on its own; she now has a Rapid Plasma Reagin (RPR) titer of 1:128. How would you classify the current stage of syphilis for this patient?

Aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units IV every 4 hours or continuous infusion, for 10-14 days. (The recommended regimen for neurosyphilis is aqueous crystalline penicillin G 18-24 million units per day, given as 3-4 million units intravenous every 4 hours (or as continuous infusion), for a total of 10 to 14 days. An acceptable alternative regiment is procaine penicillin G 2.4 million units intramuscular once daily with probenecid 500 mg orally four times a day for 10 to 14 days. Benzathine penicillin, 2.4 million units IM once per week for up to 3 weeks, can be considered after completion of the neurosyphilis regimen.)

A 32-year-old HIV-negative man presents is diagnosed with secondary syphilis and neurosyphilis. He does not have any antibiotic allergies Which one of the following regimens would you recommend for treatment?

Valacyclovir 500 mg orally twice a day for 3 days

A 38-year-old man is seen with an episode of recurrent genital herpes. Which one of the following treatment options would be considered a recommended regimen for this man in this situation?

Acyclovir (Genital herpes can be treated with acyclovir, famciclovir, or valacyclovir, which are antiviral medications. Azithromycin, metronidazole, and tinidazole are antibiotics and do not have antiviral effects.)

A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. Which medication will the provider prescribe?

Aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units IV every 4 hours or continuous infusion, for 10-14 days

A 41-year-old man with chronic HIV infection presents with headaches and new hearing loss. He has a serum Venereal Disease Research Laboratory (VDRL) titer of 1:64. A lumbar puncture is performed and shows 32 white blood cells/mm3 and a cerebrospinal VDRL titer of 1:32. He does not have any antibiotic allergies. What treatment is recommended for this man?

Wet mount showing abundant bacterial clumping upon the borders of epithelial cells

A 42-year-old woman is evaluated for a homogeneous milky white vaginal discharge. Which one of the following cluster of findings most strongly suggests a diagnosis of bacterial vaginosis?

A false-negative nontreponemal syphilis test due to extremely high serum antibodies levels in response to infection with Treponema palladium. (The prozone effect occurs when very high serum antibodies supersaturate the antigens used in the nontreponemal assay; if this is suspected the laboratory should be informed and dilution of the sample can typically reveal the true positive test)

A 43-year-old woman has a clinical diagnosis of secondary syphilis but has a negative nontreponemal Rapid Plasma Reagin (RPR) test with a titer of 1:1. A clinician suspects the nontreponemal test is negative due to the "prozone effect". What is the prozone effect?

Transdermal preparations have fewer side effects. (Transdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than do oral preparations. Progesterone is contraindicated in women who have undergone hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiency such as vaginal and vulvar atrophy but this patient has severe vasomotor symptoms. Side effects of ET can be common regardless of age.)

A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the provider. When the patient expresses concerns about adverse effects of ET, what information will the provider share with her?

Child's height and weight (Side effects of methylphenidate include a reduced appetite, and children taking these drugs should be monitored for growth suppression. Baseline height and weight measurements help with this ongoing assessment. The value of an ECG for children has not been proved, except when known heart disease is a factor. Excessive use of stimulants can produce a state of psychosis but is not related to the family history. Renal function tests are not indicated.)

A child will begin taking methylphenidate for attention-deficit/hyperactivity disorder (ADHD). What important baseline information about this patient will the provider obtain before medication administration is started?

"I can continue to use ibuprofen as needed for muscle pain." (Because ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can increase lithium levels as much as 60%, it should not be used by patients taking lithium. Aspirin does not have this effect. Lithium induces polyuria in 50% to 70% of patients, so patients should be advised to drink extra fluids, especially during exercise. Antihistamines have anticholinergic effects, which cause urinary hesitancy; this can be uncomfortable when patients experience the polyuria associated with lithium use. Muscle weakness and tremors can occur with lithium; tremors can be treated with blockers or by altering the lithium regimen.)

A college track star with a history of seasonal allergies is diagnosed with bipolar disorder. After the prescriber teaches the patient about newly ordered lithium, which statement by the patient indicates the need for further teaching?

Trimethobenzamide (Trimethobenzamide can be used as an antiemetic in patients treated with apomorphine. Serotonin receptor agonists (e.g., ondansetron) and dopamine receptor antagonists (e.g., prochlorperazine) cannot be used, because they increase the risk of serious postural hypotension. Levodopa only increases nausea and vomiting.)

A hospitalized patient newly diagnosed with Parkinson disease is prescribed apomorphine but develops medication-related nausea and vomiting. What drug will the provider prescribe to manage these side effects effectively?

Irritability, tremor, and respiratory distress (Use of venlafaxine late in pregnancy can result in a neonatal withdrawal syndrome characterized by irritability, abnormal crying, tremor, respiratory distress, and possibly seizures. Poor appetite and disturbed sleep are not part of this withdrawal syndrome. Serotonin syndrome is not likely. Sustained mydriasis occurs as an adverse effect in patients taking the drug)

A neonate is born to a mother who is prescribed venlafaxine. The provider orders the neonatal unit staff to report any signs of drug withdrawal seen in the infant. The staff will monitor for what signs of withdrawal?

Order liver function studies. (Kava can cause severe liver injury and, in some cases, require liver transplantation. This patient has abdominal pain, which can be the result of liver damage, so liver function tests should be reviewed. Acetylcysteine is the antidote for acetaminophen, not kava. Urinary retention is not anticipated. No abnormalities are anticipated on a CBC.)

A patient admitted to the emergency department with abdominal pain tells the provider he has been taking kava. Which action will the provider take based on this information?

A patient being treated for erectile dysfunction is prescribed sildenafil 50 mg PRN. Which assessment finding would be most concerning to the provider? (All the assessment findings are indicative of potential side effects of sildenafil. However, snoring that has worsened indicates intensification of obstructive sleep apnea, which can lead to airway obstruction. This patient report would be most concerning.)

A patient being treated for erectile dysfunction is prescribed sildenafil 50 mg PRN. Which assessment finding would be most concerning to the provider?

donepezil ​ (Donepezil requires tapering. Rivastigmine and Galantamine do not require tapering.)

A patient diagnosed with Alzheimer's disease has decided to stop treatment. The NP has educated the client that medication discontinuation will result in the return of cognitive symptoms and the medication may not work as well if restarted. The client would still like to stop the medication due to the gastrointestinal side effects. Which of the following medications requires tapering? ​

Order a serum calcium level. (Foscarnet frequently causes hypocalcemia and other electrolyte and mineral imbalances. Paresthesias, numbness in the extremities, and perioral tingling can indicate hypocalcemia, so a calcium level should be drawn. These are not signs of foscarnet overdose. Nephrotoxicity may occur, but these are not signs of renal complications, so a creatinine clearance is not indicated. If nephrotoxicity occurs, prehydration with IV saline is indicated to reduce the risk of renal injury.)

A patient diagnosed with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient's dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour. The patient reports numbness in the extremities and perioral tingling. What action will the provider take?

Ordering tests to reevaluate the patient's diagnosis (Patients beginning therapy with levodopa/carbidopa should expect therapeutic effects to occur after several months of treatment. Levodopa/carbidopa is so effective that a diagnosis of PD should be questioned if the patient fails to respond in this time frame. Adding a dopamine agonist is not indicated. The "on-off" phenomenon occurs when therapeutic effects are present. Increasing the dose of levodopa/carbidopa is not indicated.)

A patient diagnosed with Parkinson disease (PD) begins treatment with levodopa/carbidopa. After several months of therapy, the patient reports no change in symptoms. The provider will implement what action?

Helping to control symptoms during manic episodes (Risperidone is an antipsychotic often used in conjunction with lithium to help manage symptoms during manic episodes, regardless of whether psychotic symptoms occur. Risperidone does not elevate mood and is not used during depressive episodes. It is not used to counter side effects associated with lithium. It does not prevent recurrence of depressive episodes.)

A patient diagnosed with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone in addition to the lithium that the patient is already taking. The prescriber will tell the patient that the risperidone is used to achieve what outcome?

"Do you have any history of alcohol abuse or compulsive behaviors?" (Pramipexole has been associated with impulse control disorders, and this risk increases in patients with a history of alcohol abuse or compulsive behaviors. Pramipexole increases the risk of hypotension and sleep attacks, so a history of hypertension or insomnia would not be cautionary. Unlike with levodopa, the risk of psychoses is not increased.)

A patient has been newly diagnosed with Parkinson disease. Before beginning therapy with pramipexole, the provider will ask the patient which assessment question in order to minimize risk for injury?

Prolonged QT interval (Methadone prolongs the QT interval. It does not prolong the P-R interval, cause a bundle branch block, or produce an elevated ST segment.)

A patient has been taking methadone for 5 months to overcome an opioid addiction. The provider will monitor the patient for which electrocardiographic change?

Fentanyl transdermal patch (Transdermal fentanyl is indicated only for persistent, severe pain in patients already opioid tolerant. Hydrocodone, a combination product, has actions similar to codeine and is not used for severe, chronic pain. Meperidine is not recommended for continued use because of the risk of harm caused by the accumulation of a toxic metabolite. Pentazocine is an agonist-antagonist opioid and is less effective for pain; moreover, when given to a patient who is already opioid tolerant, it can precipitate an acute withdrawal syndrome.)

A patient has been taking oxycodone to manage severe, chronic pain for the last 6 months but now reports that it is no longer effective. The provider will discuss prescribing which medication for the patient?

Cardiac monitoring Intravenous sodium bicarbonate Gastric lavage and activated charcoal (Patients who overdose with a TCA should have cardiac monitoring, because cardiac side effects can occur. Administration of IV sodium bicarbonate is recommended to control dysrhythmias caused by cardiac toxicity. Gastric lavage followed by activated charcoal can reduce absorption of the TCA. Sedative drugs would only increase the sedative effects of the TCA. Procainamide causes cardiac depression and is not recommended to treat TCA dysrhythmias.)

A patient is brought to the emergency department after taking a handful of tricyclic antidepressant (TCA) tablets. What interventions will the provider order? (Select all that apply.)

Buspirone (This patient has symptoms of generalized anxiety disorder (GAD) that are not acute or severe. Buspirone is as effective as benzodiazepines but without causing CNS depression or having the same abuse potential. Symptoms develop slowly, which is acceptable in this case since symptoms are not acute or severe. Alprazolam is a benzodiazepine and would be used in the short term to treat acute, severe anxiety. Amitriptyline is a TCA used to treat panic disorder. Paroxetine is an antidepressant used as a second-line drug for GAD.)

A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the provider order for this patient?

Doxycycline, 100 mg IV twice daily, and cefoxitin, 2 g IV every 6 hours in the hospital (Many experts recommend that all patients with PID receive IV antibiotics in the hospital to minimize the risk of sterility and other complications. Medications used intravenously can be cefoxitin or cefotetan combined with doxycycline; when symptoms resolve, IV therapy may be discontinued but must be followed by PO doxycycline. Outpatient regimens are not recommended. Oral medications are not recommended for initial treatment)

A patient is diagnosed with pelvic inflammatory disease (PID). Which treatment regimen is most appropriate for reducing the risk of sterility in this patient?

Hallucinations (Abrupt discontinuation of baclofen is associated with visual hallucinations, paranoid ideation, and seizures. Adverse effects (not withdrawal effects) of baclofen include weakness, dizziness, fatigue, and drowsiness. Respiratory depression is a result of overdose of baclofen.)

A patient reports stopping baclofen the day before being admitted to the hospital. The provider instructs the hospital staff to monitor the patient for which withdrawal effects?

Institute respiratory support measures. (When benzodiazepines are administered IV, severe effects, including profound hypotension, respiratory arrest, and cardiac arrest, can occur. Respiration should be monitored, and the airway must be managed if necessary. Flumazenil [Romazicon] is a competitive benzodiazepine receptor antagonist and is used to reverse the sedative effects but may not reverse respiratory depression. Gastric lavage would not be effective, because the benzodiazepine has been given IV. Without further indication of the ingestion of other drugs, toxicology testing is not a priority.)

A patient is given intravenous diazepam for seizures. When the seizures stop, the patient is lethargic and confused with a respiratory rate of 10 breaths/minute. The provider will take what action immediately to address the patient's risk for injury?

The patient has a cross-dependence to the benzodiazepine. (Benzodiazepines are given to ease withdrawal from alcohol because of cross-dependence with these drugs and alcohol, enabling the benzodiazepine to suppress withdrawal symptoms. Alcohol and benzodiazepines can potentiate one another. The benzodiazepine does not potentiate withdrawal symptoms)

A patient is prescribed a benzodiazepine for alcohol withdrawal. The provider understands that this drug is effective because of what associated action?

Echinacea (Echinacea stimulates the immune system so it should not be used in patients with autoimmune disease such as RA; it also compromises the effectiveness of immunosuppressive drugs. Black cohosh, feverfew, and glucosamine are not contraindicated in patients with RA)

A patient is prescribed an immunosuppressant for rheumatoid arthritis (RA). The prescriber will caution this patient to avoid which dietary supplement?

"Be sure to take the flaxseed 1 hour before taking your prescribed medicine." (Flaxseed may reduce the absorption of conventional drugs and should be taken 1 hour prior to or 2 hours after taking drugs. Defatted flaxseed is not recommended for patients with hyperlipidemia because it can increase triglyceride levels. It does not help with the absorption of medications. It has shown efficacy in reducing cholesterol and LDL.)

A patient is prescribed medication for hyperlipidemia. The patient asks about using flaxseed supplements to increase fiber. What response will the provider give this patient?

Tardive dyskinesia (Tardive dyskinesia can occur in patients during long-term therapy with FGAs. This patient shows signs of this adverse effect. Acute dystonia is characterized by severe spasm of muscles in the face, tongue, neck, or back, and by opisthotonus. Akathisia is characterized by constant motion. Parkinsonism is characterized by bradykinesia, drooling, tremor, rigidity, and a shuffling gait.)

A patient prescribed a first-generation antipsychotic (FGA) has developed difficulty speaking and chewing and is observed having slow, wormlike movements of the tongue. The provider recognizes these symptoms and begins treatment for which adverse reaction?

Stop taking the SSRI 2 weeks before starting the MAOI. (MAOIs increase 5-HT availability, thus greatly increasing the risk of serotonin syndrome. SSRIs should be withdrawn at least 14 days before an MAOI is started. An SSRI should never be given at the same time as an MAOI. It is not necessary to wait 5 weeks before starting an SSRI.)

A patient prescribed a serotonin reuptake inhibitor (SSRI) for depression several months ago tells the provider that the medication has not helped with symptoms. The provider explains plans to switch to a monoamine oxidase inhibitor (MAOI). What must the provider do to address the patient's risk for injury?

Documenting these findings (It may take up to 1 month for the effects of dutasteride to take effect. The patient should be educated about the time taken for positive effects to be achieved. A urine sample would not be necessary. Doubling the dose is not appropriate because the medication has not had sufficient time to take effect. A prostate examination may be performed, but would not reveal findings related to the use of dutasteride (and was likely done as part of the initial evaluation prior to prescribing the drug).)

A patient prescribed dutasteride 2 weeks ago reports continued urinary hesitancy. Which action by a provider is most appropriate?

Bradycardia (Local anesthetics can cross the placenta, causing bradycardia and central nervous system (CNS) depression in the infant. They do not affect blood glucose. Jitteriness is a sign of CNS excitation, not depression. Increased respirations are not an adverse effect in the newborn.)

A patient receives an epidural anesthetic during labor and delivery. What effect in the newborn in the immediate postpartum period must the provider be prepared to address?

Blood pressure 96/58 (Hypotension, dizziness, and nasal congestion are all adverse effects of doxazosin, an 1-adrenergic antagonist. However, hypotension would be the most concerning because it can lead to inadequate peripheral tissue perfusion. Diminished ejaculate volume is seen with administration of 5--reductase inhibitors, not with doxazosin administration.)

A patient receiving doxazosin presents for a routine evaluation. Which assessment finding related to the medication therapy would be most concerning to the provider?

Transurethral administration has fewer side effects. (Transurethral administration has fewer side effects than intracavernousal administration of alprostadil. Both intracavernousal and transurethral administration lead to increased arterial blood flow to the penis. The dosage of transurethral alprostadil ranges from 125 to 1000 mcg, which is higher than the dose required for intracavernousal administration (5 to 40 mcg). Erection develops 5 to 10 minutes after drug insertion and lasts 30 to 60 minutes)

A patient receiving intracavernousal alprostadil discusses switching to the transurethral administration route. Which information does the provider include as a benefit of changing administration routes?

Ergotism (Ergotism is a serious toxicity caused by acute or chronic overdose of ergotamine. The toxicity results in ischemia, causing the extremities to become cold, pale, and numb. Symptoms associated with ergotamine withdrawal include headache, nausea, vomiting, and restlessness. These are not symptoms of a severe migraine or side effects of sumatriptan.)

A patient reports numbness in the extremities. The assessment history notes that the patient's hands and feet are cool and pale and that the patient has a history of migraine headaches. The provider focuses on further assessing for what likely cause of the symptoms?

"What foods have you eaten in the last 24 hours?" Patients taking a MAOI should be counseled to follow strict dietary restrictions and to avoid all foods containing tyramine. Patients who consume such foods when taking an MAOI experience a hypertensive episode. Antihypertensive medications, given with an MAOI, will result in hypotension. Grapefruit juice does not alter the metabolism of an MAOI. SSRIs and MAOIs, when administered together, cause a serotonin syndrome

A patient taking a monoamine oxidase inhibitor (MAOI) has a blood pressure of 198/102 mm Hg. What assessment question will the provider initially ask this patient?

"Don't take the medication on Friday and Saturday." (Sexual dysfunction may be managed by having the patient take a drug holiday, which involves discontinuing medication on Fridays and Saturdays. Cutting the tablet in half anytime to reduce the dosage is an inappropriate way to manage drug administration effectively. In addition, it does not describe a drug holiday. The patient should not take the drug every other day, nor should it be discontinued for a week at a time, because this would diminish the therapeutic levels of the drug, thereby minimizing the therapeutic effects. In addition, neither of those options describe a drug holiday.)

A patient taking fluoxetine reports decreased sexual interest. The prescriber orders a "drug holiday." What instructions will the provider give the patient to describe a drug holiday?

Its tendency to accelerate the metabolism of some drugs. (St. John's wort has the potential to interact with many drugs through three different mechanisms. One mechanism, induction of P450 enzymes, accelerates the metabolism of many drugs, causing loss of therapeutic effects. St. John's wort reduces the effects of digoxin, because P-glycoprotein transports drugs out of tubular cells of the kidney and into the urine, greatly reducing digoxin levels. St. John's wort does not counteract the beneficial effects of CNS depressants; it can actually intensify the effects of serotonin. St. John's wort is not known to increase the risk of bleeding)

A patient uses St. John's wort in addition to regular prescription drugs. Which effect of this dietary supplement would most concern the provider?

Write an order for serum drug levels (If medication therapy is not effective, it is important to measure serum drug levels of the medication to determine whether therapeutic levels have been reached. Patients should be asked at the beginning of therapy to keep a seizure frequency chart to help deepen their involvement in therapy; asking for historical information is not helpful. Until it is determined that the patient is not complying, the nurse should not reinforce the need to take the medication. Until the drug level is known, increasing the dose is not indicated.)

A patient who has been taking an antiepileptic drug for several weeks reports little change in seizure frequency, what action will the provider take to provide effective care?

Ask the patient to keep a headache diary to help determine possible triggers. (Keeping a headache diary to try to identify triggers to migraines can be helpful when a patient is trying to prevent them and is the first step in managing headaches. Prochlorperazine is an antiemetic and does not prevent or abort migraine headaches. Prophylactic medications such as amitriptyline are used when headaches are more frequent. To prevent medication-overuse headache, abortive medications should not be used more than 1 to 2 days at a time)

A patient who has infrequent migraine headaches wants to prevent them from occurring. What intervention will the provider take?

Suggest nondrug therapies to augment the medication. (Patients with severe depression benefit more from a combination of drug therapy and psychotherapy than from either component alone, so this patient should ask the provider about nondrug therapies. Once a drug has been selected for treatment, it must be used for 4 to 8 weeks before its efficacy can be assessed. Until a drug has been used at least 1 month without success, it should not be considered a failure. Adding a second medication, changing to a different medication, and increasing the dose of this medication should all be reserved until the current drug is deemed to have failed after at least 4 weeks.)

A patient who has major depression with severe symptoms begins taking an antidepressant medication. Three weeks later, the patient reports that the drug is not working. What action will the provider take to address the patient's concerns?

Naratriptan (Naratriptan has effects that persist longer than other triptans, and the 24-hour recurrence rate may be reduced when taking this formulation. Aspirin has a shorter half-life than the triptans.)

A patient who has migraine headaches has been using sumatriptan with good initial results but now reports frequent migraine recurrence 24 hours later. Which medication will the provider order for this patient?

Coronary artery disease (Serotonin receptor agonists can cause vasoconstriction and coronary vasospasm and should not be given to patients with coronary artery disease, current symptoms of angina, or uncontrolled hypertension. There is no contraindication for asthma, diabetes, or renal disease.)

A patient who has recurrent migraine headaches is prescribed sumatriptan. Which condition in this patient's history is of concern to the prescriber?

Reassure the patient that this is normal with this form of contraception. (Patients taking the progestin-only OC may expect irregular bleeding, including spotting and irregular periods. This symptom does not indicate lack of compliance with the regimen. A pregnancy test is not indicated for anticipated irregular menstruation. It is not necessary to use a backup form of contraception.)

A patient who has taken a progestin-only oral contraceptive for 3 months reports mid-cycle spotting and irregular menstrual cycles. What action will the provider take?

Lithium (In almost all cases of mania, divalproex sodium is the drug of choice, except for euphoric mania symptoms. Lithium is used to treat euphoric mania. Olanzapine and risperidone are used to treat other symptoms associated with BPD.)

A patient who is admitted to a hospital for management of first-time symptoms of mania is exhibiting euphoric mania. Which medication will the provider order?

Changing to an oral contraceptive with increased estrogen (Carbamazepine induces hepatic cytochrome P450 enzymes and thus accelerates the metabolism of oral contraceptives. Spotting is a sign of reduced estrogen blood levels; patients experiencing this effect may need an increased estrogen dose. If the dose of OC is not changed, the woman may use condoms along with the OC. Reducing or increasing the dose of carbamazepine may lead to subtherapeutic or toxic doses.)

A patient who prescribed a combination oral contraceptive begins taking carbamazepine. After several weeks, the patient reports that she has begun experiencing spotting during her cycle. What action will the provider discuss with the patient to address this occurrence?

Prescribe progestin-only contraception (Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least 4 weeks prior to surgery. Because they lack estrogen, progestin-only OCs do not cause thromboembolic disorders; therefore, the provider should discuss an alternate method of birth control with the patient or prescribe a progestin-only contraceptive. Estrogen, not progestin, increases the risk of thrombosis; therefore, decreasing progestin is inappropriate. Estrogen-only hormone therapy is for management of menopausal symptoms, not contraception, and it would not address the risk for thrombosis.)

A patient who takes a combination oral contraceptive (OC) shares that she is planning to undergo knee replacement surgery in 1 month. What change in contraceptive management will the provider make for this patient?

Dantrolene Intravenous fluids Intravenous fluids (Neuroleptic malignant syndrome is characterized by "lead pipe" rigidity, sudden high fever, and autonomic instability. Treatment requires supportive measures, drug therapy, and immediate withdrawal of the antipsychotic medication. Dantrolene is used to relax muscles and reduce heat production. Intravenous fluids are used to maintain hydration. Anticholinergic medications and blockers are not helpful.)

A patient who takes haloperidol for schizophrenia is found lying rigid in bed with a temperature of 41.3C. A cardiac monitor shows cardiac dysrhythmias. What interventions will be ordered by the provider as the treatment of this patient? (Select all that apply.)

Prescribe a COMT inhibitor, such as entacapone. (This patient is describing abrupt loss of effect, or the "off" phenomenon, which is treated with entacapone or another COMT inhibitor. Amantadine is used to treat dyskinesias. A direct-acting dopamine agonist is useful for gradual loss of effect, which occurs at the end of the dosing interval as the dose is wearing off. Shortening the dosing interval does not help with abrupt loss of effect.)

A patient who takes levodopa/carbidopa for Parkinson disease reports periods of lost drug effect lasting from minutes to several hours with no relationship to the timing of drug administration. What course of action will the provider take?

Complete blood count with differential Renal function tests Thyroid function tests (Patients taking lithium can develop a mild, reversible leukocytosis, so annual CBC evaluation with differential is recommended. Chronic lithium use is associated with degenerative changes in the kidneys, so renal function should be assessed annually. Lithium can reduce the incorporation of iodine into thyroid hormone and can inhibit thyroid secretion; therefore, thyroid hormone and thyroid-stimulating hormone (TSH) levels should be measured annually. Lithium is affected by sodium levels but not by calcium or potassium levels. Because lithium is excreted by the kidneys, hepatic function tests are not indicated.)

A patient who takes lithium for bipolar disorder is admitted to the hospital. Records show that the patient has not kept the last four appointments for lithium-related laboratory studies. Besides obtaining a lithium level, the provider caring for this patient will order which laboratory tests? (Select all that apply.)

She should consider a different form of birth control while taking phenytoin (Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and because avoiding pregnancy is desirable when taking phenytoin, patients should be advised to increase the dose of oral contraceptives or use an alternative method of birth control. Increasing the patient's dose of phenytoin is not necessary; OCPs do not affect phenytoin levels. Phenytoin is linked to birth defects; OCPs have decreased effectiveness in patients treated with phenytoin, and the patient should be advised to increase the OCP dose or to use an alternative form of birth control. OCPs do not alter the effects of phenytoin.)

A patient who takes phenytoin for seizures asks the provider for a prescription for oral contraceptives. What recommendation will the provider make to help assure the effectiveness of the contraception method?

Zaleplon (Zaleplon [Sonata] works well for people who have trouble falling asleep and, because of its short duration of action, can be taken late at night without causing a hangover or next-day sedation early in the morning. Zolpidem [Ambien] has a longer duration and is a good choice for patients who have difficulty maintaining sleep. Flurazepam has a long duration of action. Trazodone causes daytime grogginess.)

A patient whose job requires often staying up late and then getting up early reports occasional instances of being unable to fall asleep. The provider will prescribe which medication for this patient?

Order intravenous foscarnet every 8 hours for 2 to 3 weeks

A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions. What action will the provider take?

Topiramate (Topiramate can be used for migraine prophylaxis, and its benefits appear equal to those of the first-line blockers. Botulinum toxin can be used for migraine prophylaxis in patients who have 15 or more headaches a month. Meperidine may be used as abortive therapy, not prophylaxis. Timolol is a blocker; this patient has asthma, and because blockers cause bronchoconstriction, these agents are not recommended.)

A patient with a history of asthma experiences three or four migraine headaches each month, uses sumatriptan as an abortive medication but has developed medication-overuse headaches. When asked what can be done to prevent migraines, the provider suggests prescribing which medication?

Increase the lamotrigine dose to 500 mg twice daily (Carbamazepine induces hepatic drug-metabolizing enzymes and can increase the rate at which lamotrigine is metabolized; therefore, the lamotrigine dosage will need to be increased. Reducing the dose of either drug is not indicated. Increasing the dose of carbamazepine may be necessary but only after serum drug levels have been checked.)

A patient with a seizure disorder is admitted to the hospital after an increase in seizure frequency. The prescriber considers adding carbamazepine 100 mg twice daily to the patient's medication regimen, but notes that the patient is already taking lamotrigine 375 mg twice daily. What changes will the prescriber make to the patient's medication regimen?

Five-pound weight gain (Patients receiving testosterone may experience edema secondary to sodium and water retention. Treatment involves discontinuing the drug and giving diuretics if needed. Growth of pubic hair is an expected effect. A rash at the site of transdermal application is a common effect. Acne is an expected effect.)

A provider assesses an adolescent male patient who has been receiving androgen therapy for hypogonadism via a transdermal patch. The patient's last clinic visit was 4 weeks earlier. Which part of the interval history is of greatest concern to the provider

Alprazolam (Xanax) (This patient's symptoms are related to performance only and are not generalized to all social situations. Because this patient must speak in front of an audience only three or four times per year, a PRN medication can be used. Paroxetine is not appropriate for prn use and must be used continuously for at least 1 year. While agonists such as albuterol help asthma symptoms, they can worsen anxiety related to making presentations. While antagonists such as propranolol will decrease anxiety, they may worsen asthma.)

A patient with asthma is having difficulty at work because of anxiety and fear when making presentations at meetings three or four times each year. The patient reports when this occurs, the anxiety can stimulate an asthma attack. The provider will order which medication to be taken as needed?

Levothyroxine therapy (Patients taking lithium may experience reduced incorporation of iodine into the thyroid hormone, resulting in goiter and hypothyroidism. Administration of levothyroxine or withdrawing the lithium will reverse both. Increasing the lithium dose or prescribing propylthiouracil will make this worse. Iodine supplements are not indicated.)

A patient with bipolar disorder who has been taking lithium for several years has developed a goiter. When the serum tests reveal hypothyroidism what will the provider prescribe for this patient?

Baclofen (Baclofen is used to treat muscle spasticity associated with multiple sclerosis, spinal cord injury, and cerebral palsy. It does not reduce muscle strength, so it will not exacerbate this patient's muscle weakness. It can be given intrathecally, via an implantable pump, and therefore is a good choice for patients who cannot take medications by mouth. Dantrolene causes muscle weakness and must be given by mouth or intravenously, so it would not be a good option for this patient. Diazepam is not the first-line drug of choice. Metaxalone is used to treat localized muscle spasms caused by injury and is not used for cerebral palsy.)

A patient with cerebral palsy has severe muscle spasticity and muscle weakness which makes it difficult to take anything by mouth. The provider will prescribe and educate the patient on which medication for home therapy?

Have you missed any doses of baclofen?" (Baclofen does not appear to cause physical dependence, but abrupt discontinuation has been associated with adverse reactions. Abrupt withdrawal of oral baclofen can cause visual hallucinations, paranoid ideation, and seizures and should be considered when a patient develops these symptoms. Seizures are not a symptom of baclofen toxicity.)

A patient with cerebral palsy who has been receiving baclofen for 3 months is admitted to the hospital for evaluation of new-onset seizures. What assessment question will the provider ask to help identify the most likely cause of these seizures?

"When hormone therapy is discontinued, bone loss resumes." (Benefits of HT to prevent osteoporosis are not permanent; bone loss resumes when HT is discontinued. HT does not reverse bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk.)

A patient with osteopenia asks about the benefits of hormone therapy in preventing osteoporosis. Which statement by the provider is correct?

Ginkgo biloba (Ginkgo biloba can suppress platelet aggregation and will increase the risk of bleeding in patients taking antiplatelet medications and anticoagulants. Coenzyme Q-10, Ma huang, and St. John's wort do not have antiplatelet actions.)

A patient with postoperative hemorrhage admits taking, but not reporting, multiple dietary supplements. Which dietary supplement does the provider identify as a likely contributor to the patient's bleeding?

"Ginger root can decrease my risk of bleeding." (Ginger root can increase, not decrease, the risk of bleeding in patients taking other anticoagulant or antiplatelet drugs. In high doses, it can cause GI disturbances. It has been shown to be effective in treating morning sickness. It may affect fetal sex hormones.)

A pregnant patient asks about the risks and benefits of using ginger root to treat morning sickness during pregnancy. After a discussion with the provider, which patient's statement indicates a need for further teaching?

"I should apply the medication to my genitals for best results." (The medication should be applied to the arms, shoulders, and abdomen, not to the genitalia; this statement indicates a need for further teaching. Secondary exposure to testosterone gel can occur with handling unwashed clothing. The patient should be advised to return to the clinic within 2 weeks for blood tests.)

A prescriber is providing education to a patient who is beginning therapy with testosterone gel. Which statement made by the patient demonstrates a need for further teaching?

"I should wash the application site before being intimate with my partner. (Testosterone administered via gels can be transferred to others by skin-to-skin contact; gel users should wash the application site before skin-to-skin contact with another person. The gel should be applied to clean, dry skin on the upper arms, shoulders, or abdomen and should be covered with clothing. Swimming and bathing are allowed 5 to 6 hours after application.)

A prescriber is teaching a male adult patient about the use of testosterone gel. Which statement by the patient indicates an understanding of the teaching?

"Increased salivation and diarrhea are common with this medication." Anticholinergic effects such as dry mouth and constipation are common with FGAs, so this statement indicates a need for further teaching. Neuroendocrine effects, orthostatic hypertension, and sedation can occur with FGAs.

A prescriber provides teaching for a patient about to begin taking a first-generation antipsychotic (FGA) drug. Which statement by the patient indicates a need for further teaching about side effects of these drugs?

"Estrogen therapy is the most effective drug for suppression of menopausal symptoms. (ET is the most effective means to suppress menopausal symptoms. It can prevent osteoporosis, but it carries risks of breast cancer and stroke.)

A prescriber provides teaching to a patient about the risks and benefits of estrogen therapy (ET) in the peri-menopausal period. Which statement by the patient indicates understanding of the teaching?

Has the patient taken ergotamine in the past 24 hours? (Triptans and ergot alkaloids cause vasoconstriction and, if combined, excessive and prolonged vasospasm could result. Sumatriptan should not be used within 24 hours of an ergot derivative. A family history is important, but it is not vital assessment data as it relates to this scenario. Acetaminophen has no drug-to-drug interaction with sumatriptan. Sulfa is not a component of sumatriptan and, therefore, is not relevant.)

A provider considers prescribing sumatriptan for a patient experiencing a migraine headache. Before prescribing this drug, what is the most important information to obtain?

"I should brush and floss my teeth regularly." (Gingival hyperplasia occurs in about 20% of patients who take phenytoin. It can be minimized with good oral hygiene, so patients should be encouraged to brush and floss regularly. Because small fluctuations in phenytoin levels can affect response, maintaining therapeutic levels is not easy. Patients should be cautioned against consuming alcohol while taking phenytoin. Rashes can be serious and should be reported immediately.)

A provider counsels a patient who is prescribed phenytoin for epilepsy. Which statement by the patient indicates understanding of the teaching?

A 55-year-old woman with multiple sclerosis (Dose-related liver damage is the most serious adverse effect of dantrolene and is most common in women older than 35 years. Dantrolene is used to treat spasticity associated with multiple sclerosis, cerebral palsy, and spinal cord injury, so all of these patients would be candidates for this agent. Dantrolene also is used to treat malignant hyperthermia.)

A provider has prescribed dantrolene for the following patients. Which patient will the provider monitor most closely for risk of injury?

"I will apply a thin layer of the medication to only the burned area." (Topical anesthetics can be absorbed in sufficient amounts to cause serious and even life-threatening systemic toxicity, so they should be applied in the smallest amount needed to as small an area as possible. Covering the site increases the skin's temperature, which increases absorption, so this should be avoided. Applying the medication to broken skin increases systemic absorption and should be avoided.)

A provider has prescribed the topical anesthetic lidocaine for a patient who has a second-degree burn on one arm. Which statement by the patient indicates understanding of the teaching regarding this treatment?

A woman with multiple sexual partners (Women at risk for sexually transmitted diseases (STDs) should not use an IUD, because the risk of infection is higher. Women who have multiple sexual partners are especially at risk for STDs. IUDs are appropriate for contraception for the other women described.)

A provider in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception?

A history of hepatitis (Hepatotoxicity is a serious potential problem in a patient receiving tizanidine. Baseline liver enzymes should be obtained before dosing and periodically thereafter. Analgesic anti-inflammatory drugs commonly are used in conjunction with centrally acting muscle relaxants, so using aspirin is not a concern. This drug does not contribute to malignant hyperthermia. Patients should be advised to avoid alcohol when taking this drug, but a history of occasional alcohol use is not a contraindication.)

A provider is considering prescribing tizanidine for patient who is experiencing localized muscle spasms after an injury. What information in the patient's health history will be concerning enough to the provider to warrant selecting a different drug?

"Effectiveness is best if the medication is taken within 7 weeks of conception. (Mifepristone can prevent pregnancy or cause abortion, depending on when it is taken. If mifepristone is taken within 5 days of unprotected intercourse, it will prevent pregnancy; however, the question asks about abortion, not pregnancy prevention. As an abortifacient, it is most effective if it is used within 7 weeks of conception. The timing specified in the other responses occurs prior to conception.)

A provider is discussing various ways to obtain a medical abortion with a patient. Which statement by the patient best demonstrates understanding of mifepristone (RU 486) scheduling?

"Olanzapine causes more metabolic side effects than thioridazine." (Olanzapine is an SGA and, although it has fewer extrapyramidal side effects than the FGA the provider has ordered, it has an increased risk of metabolic side effects, which is contraindicated in patients with diabetes. It is more expensive, but this is not the most important reason for not prescribing it. Thioridazine has more side effects than olanzapine, but the side effects caused by olanzapine are more critical for this patient. Thioridazine does not have a faster onset of action.)

A provider orders thioridazine for a patient with diabetes mellitus who is diagnosed with schizophrenia. The patient requests olanzapine, which the patient has seen advertised on television. Which response will the provider give to address the primary reason the patient is not being prescribed olanzapine?

"If the absolute neutrophil count is less than 3000, the drug will be discontinued permanently." (Clozapine can cause agranulocytosis. If the absolute neutrophil count (ANC) drops below 1000/mcL, the drug must be discontinued permanently. Blood counts must be evaluated weekly, and this evaluation should be continued for several weeks after withdrawal of the drug. Fever, sore throat, and mouth ulcers are symptoms of agranulocytosis and should be reported immediately.)

A provider prescribes clozapine for a patient with schizophrenia who shows suicidal behaviors. After the provider teaches the family about the medication and its side effects, which statement by a family member indicates a need for further teaching about this drug?

I need to put the medication on my thighs and calves." (The top of the thighs and the back of the calves are the preferred sites for application of the transdermal spray. The waistline and abdomen are used for the patches. The gel is applied to arms. Breasts are not used for application of transdermal estrogen.)

A provider prescribes transdermal estrogen spray. Which patient statement demonstrates understanding of the application of this medication?

"I may need to try several drugs before finding one is effective." Even with an accurate diagnosis of seizures, many patients have to try more than one AED to find a drug that is effective and well tolerated. Unless patients are being treated for absence seizures, which occur frequently, monitoring of the clinical outcome is not sufficient for determining effectiveness, because patients with convulsive seizures often have long seizure-free periods. Serious side effects may occur, but withdrawing a drug precipitously can induce seizures. Not all patients have seizure control with therapeutic drug levels, because not all medications work for all patients

A provider provides teaching for a patient with a newly diagnosed partial complex seizure disorder who will begin therapy with an antiepileptic drug (AED). Which statement by the patient indicates to the provider an understanding of the teaching?

Etonogestrel subdermal implant (Etonogestrel subdermal implant [Nexplanon] is an extremely effective method of contraception with a failure rate of 0.05%. Intramuscular medroxyprogesterone acetate [Depo-Provera] has a failure rate of 0.3% (theoretical use) and 3% (actual use). Combined oral contraceptives have a failure rate of 0.3% (theoretical use) and 8% (actual use). Diaphragms with spermicide have a failure rate of 6% (theoretical use) and 16% (actual use).)

A teenager requests the most effective irreversible form of contraception. Which method of contraception will the provider recommend?

Hospitalizing the patient for closer monitoring (Patients with depression sometimes think of suicide, and during treatment with antidepressants, these thoughts often increase for a time. Patients whose risk of suicide is especially high should be hospitalized. All antidepressants carry this risk, so changing medication is not recommended. Discontinuing the medication is not recommended. More frequent clinic visits are recommended for patients with a low to moderate risk of suicide.)

A young adult patient, who has been taking an antidepressant medication for several weeks, reports having increased thoughts of suicide. The patient's history includes an attempted suicide more than once in the past. When questioned the patient identifies a concrete plan for committing suicide. The provider will take what action to best assure the patient's safety?

Reassure the patient that this is a transient, reversible side effect of the medication (Some patients taking sumatriptan experience unpleasant chest symptoms, usually described as "heavy arms" or "chest pressure." These symptoms are transient and are not related to heart disease. Patients experiencing angina-like pain when taking sumatriptan, as a result of coronary vasospasm, should be asked about hypertension or coronary artery disease (CAD); they should not take sumatriptan if they have a history of either of these. The symptoms this patient describes are not characteristics of pregnancy. There is no need to stop taking the medication.)

A young female adult who has recently begun taking sumatriptan reports a sensation of chest pressure, without pain, and arm heaviness. What action will the provider take?

HTN

Discontinue Oral Contraceptives or continue Oral Contraceptives and manage the condition with medications

contraindicated in patients with ischemic heart disease, prior MI, or uncontrolled hypertension

What are the contraindications of Triptans?

agitation headache dry mouth constipation weight loss may cause seizures with high doses

Adverse effects of Norepinephrine Dopamine Reuptake Inhibitor (NDRI)

anorexia diarrhea headache weight gain sexual side effects

Adverse effects of Selective Serotonin Reuptake Inhibitors (SSRIs)

elevated blood pressure sweating anxiety dizziness insomnia constipation

Adverse effects of Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

folic acid (First-trimester exposure to valproic acid has been associated with an increased risk of neural tube defects and other structural abnormalities. This finding led to the recommendation that women on valproic acid should take an increased daily dose of folic acid)

Amy is of child-bearing age; therefore, which nutritional supplement should be encouraged with valproic acid therapy?

"I will take the pill 30 minutes before sex. (Papaverine plus phentolamine is administered as an intracavernousal injection, not as an oral pill. The patient should be educated about the correct route of administration. Desired effect may be achieved quickly with administration. Adverse effects of administration include orthostatic hypotension and fibrotic nodules in the corpus cavernosum from injection. The patient should be educated about these effects and ways to prevent complications, such as rising slowly from a seated position to prevent dizziness.)

After being educated about administration of papaverine plus phentolamine for erectile dysfunction, which statement made by the patient indicates a need for further teaching by the prescriber?

valproic acid (Valproic acid (Depakene, Depakote, Depakote ER, Depakote Sprinkles, Depacon) is the first line of treatment for partial complex seizures and is used widely to treat all major seizure types. In addition to its use in epilepsy, valproic acid is used in the treatment of bipolar disorder and migraine headaches)

After having an EEG. Amaya is diagnosed with partial complex seizure. What is the first line of treatment for this diagnosis?

Discard the inert pills and start a new pack during the honeymoon. (OC users can achieve an extended-cycle schedule by discarding the inert pills and beginning a new pack for up to four cycles. It is not necessary to discontinue OCs. Because this patient has already purchased a 1-year supply, using the 28-day-cycle product as described is more appropriate than purchasing an extended-cycle product that does the same thing. With medroxyprogesterone acetate, episodes of unpredictable bleeding and spotting lasting seven days or longer are common during the first few months of use.)

After purchasing a 1-year supply of 28-day-cycle oral contraceptives, a patient calculates that her period will begin during her upcoming honeymoon. What will the prescriber suggest?

Heart rate and blood pressure checks Tinnitus, vertigo, hearing loss assessments Pulmonary edema Eye examination for visual acuity, assessment of color vision, pupillary response, and fundoscopic exam

After starting therapy with a PDE5 inhibitor, which of the following should be included in a monitoring plan for Joe? Select all that apply.

The combination drug topiramate/phentermine is associated with the greatest amount of weight loss. (The combination drug topiramate/phentermine is associated with the greatest amount of weight loss)

Alexandro is a 38-year-old Hispanic male who presents for assistance losing weight. He claims that he is exercising 30 minutes daily in addition to 1200 calorie diet for the past 6 months. Despite these efforts he has only lost 3 lbs. The medical record reveals his BMI has been consistent at 39 for the past year. He is currently taking no medications, has no other health disorders. He has a family history of Type 2 Diabetes Mellitus, hypothyroidism, fatty liver disease, and hypertension. 1. As the prescriber considers treatment options for Alexandro, they know the following is true:

that while taking medications for weight loss routine monitoring is required (Patients should be advised that routine monitoring is required while taking weight loss medications. Patients should lose at least 4 pounds during the first 4 weeks of drug treatment. If this initial response is absent, patient adherence to the plan should be evaluated and the appropriateness of drug selection considered. For patients who do respond, ongoing assessment must show that (1) the drug is effective at maintaining weight loss and (2) serious adverse effects are absent. Otherwise drug therapy should cease.)

Alexandro should be advised

Amaya is Asian. When considering a change in antiseizure medications, which of the following medications carry a higher risk for Amaya? (Carbamazepine and phenytoin both carry a higher risk for Steven Johnson's Syndrome (SJS) or toxic epidermal necrolysis (TEN) for Asians. Product labeling warns that the risk for developing SJS or TEN is strongly associated with a genetic mutation known as human leukocyte antigen (HLA)-B*1502, which occurs almost exclusively in people of Asian descent. For this reason, phenytoin should not be prescribed for patients known to have this mutation)

Amaya is Asian. When considering a change in antiseizure medications, which of the following medications carry a higher risk for Amaya?

abrupt discontinuation of antiseizure drugs can cause status epilepticus. medication should be withdrawn slowly over a minimum of 6 weeks. (Abrupt discontinuation of antiseizure drugs can lead to status epilepticus; medication should be withdrawn slowly (over 6 weeks to several months). Precautions must be taken to have a sufficient supply of medications. Follow-up care visits scheduled before medication refills may be helpful)

Amaya shares her concern about running out of medication due to a busy life, forgetting to refill her prescription, and not liking the idea of having to take medicine every day for the rest of her life. Which of the following education points will help encourage Amaya to take her medication as prescribed? Select all that apply.

suppression of sodium influx promotion of sodium efflux promotion of potassium efflux blockade of glutamate receptors increase of gamma-aminobutyric acid (GABA) (The mechanisms of action of antiseizure medications include suppression of sodium influx, suppression of calcium influx, promotion of potassium efflux, blockade of glutamate receptors, and an increase of gamma-aminobutyric acid (GABA). Antiseizure drugs are known to suppress the discharge of neurons within a seizure focus and suppress the propagation of seizure activity to other areas of the brain. Recently, it was discovered that nearly all antiseizure drugs act through five basic mechanisms: suppression of sodium influx, suppression of calcium influx, promotion of potassium efflux, blockade of receptors for glutamate, and potentiation or increase of gamma-aminobutyric acid (GABA))

Amy and her parents ask how antiseizure drugs work. Which of the following describes the mechanisms of action of antiseizure medications? Select all that apply.

Nitrates (There is an absolute contraindication for concomitant use of PDE5 inhibitors with any form of nitrates because of the risk of severe hypotension, cardiovascular collapse, and death. Alpha-blockers, beta-blockers, and diuretics as well as many other medications have potential drug interactions and should not be used concomitantly with PDE5 inhibitors, or doses of the PDE5 inhibitor should be dosed down.)

An absolute contraindication exists for concomitant use of PDE5 inhibitors and which of the following drugs?

Medroxyprogesterone acetate (This patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, an IUD is not indicated for her because there is a greater risk for STDs. Tubal ligation carries surgical risks and should not be used by adolescents because it is irreversible. Progestin-only oral contraceptives must be taken at the same time every day; therefore, the issue of adherence remains a concern.)

An adolescent female patient with multiple sexual partners has difficulty adhering to her daily oral contraceptive schedule. Which contraceptive product will the provider recommend?

Ceftriaxone, 250 mg IM once, and azithromycin, 1 g PO once (The only options for treating cervical infection with gonorrhea are cefixime and ceftriaxone. Ceftriaxone is recommended over cefixime because of antibiotic resistance to cefixime. Because a high percentage of patients with gonorrhea also have chlamydial infections, they should be treated with either doxycycline or azithromycin until a chlamydial infection has been ruled out. Azithromycin combined with doxycycline would not treat gonorrhea. Ceftriaxone would treat gonorrhea only. Doxycycline would treat chlamydia only.)

An adolescent patient with mild cervicitis is diagnosed with gonorrhea. The provider will order which treatment regimen?

"My libido may improve. (Treatment with androgen replacement therapy in patients with testicular failure helps to restore libido. A side effect of androgens is premature epiphyseal closure; this is not a concern in adults, so radiographs to evaluate this are not indicated. Androgens do not restore fertility. Hair loss won't decrease and it may increase.)

An adult male patient will begin androgen therapy for testicular failure. Which statement by the patient indicates understanding of the treatment regimen as provided by the prescriber?

"Testosterone treats anemia by stimulating the synthesis of a renal hormone." (Testosterone can be used to treat refractory anemias in men and women. It works by stimulating the synthesis of erythropoietin, a renal hormone that stimulates the production of red blood cells. Virilization effects can be permanent if the hormone is not withdrawn, so patients developing facial hair and other signs should be told to report this to the provider. Breast enlargement occurs in males taking this drug. Testosterone reduces HDL cholesterol and increases LDL cholesterol.)

An adult patient anemia following cancer chemotherapy will now begin treatment with testosterone. Which statement by the patient indicates understanding of the provider's teaching?

Blood-brain barrier (The blood-brain barrier is not fully developed at birth, making infants much more sensitive to CNS drugs than older children and adults. CNS symptoms may include sedation and drowsiness. The first-pass effect and GI absorption affect metabolism and absorption of drugs, and renal filtration affects elimination of drugs, all of which may alter drug levels.)

An infant is prescribed a central nervous system (CNS) drug. The parents are concerned that the child exhibits unusual drowsiness and sedation. The provider explains these effects based on an understanding of which difference in the physiology of infants and adults?

"The dose can be increased, because the patient has been taking the drug for longer than 3 months." Donepezil is given for mild, moderate, and severe Alzheimer disease (AD), and dosing may be increased, although it must be titrated up slowly. For patients with moderate to severe AD who have taken 10 mg once daily for at least 3 months, the dose can be increased to 23 mg once daily. Donepezil is not given twice daily. Donepezil does not cause hepatotoxicity; hepatotoxicity occurs with tacrine, the first acetylcholinesterase (AChE) inhibitor, which now is rarely used. Dosing is increased after 3 months, not 1 year.

An older adult patient displays confusion, memory loss, and disorientation in familiar surroundings. Although the patient has been taking donepezil 10 mg once daily for 6 months, the symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What response will the prescriber provide to best address the spouse's concerns?

Slowed heart rate Lightheadedness (Cardiovascular effects of cholinesterase inhibitor drugs are uncommon but cause the most concern. Bradycardia and fainting can occur when cholinergic receptors in the heart are activated. Confusion and memory impairment are signs of the disease and are not side effects of the drug. Diarrhea, not constipation, is an expected adverse effect.)

An older adult patient with Alzheimer disease is prescribed a cholinesterase inhibitor drug. When providing medication education to the care giver, the prescriber will prioritize which possible side effects? (Select all that apply.)

35% of isolates were resistant to ciprofloxacin (Ceftriaxone is the preferred agent and widely used to treat gonorrhea. In the United States, rates of resistance to ceftriaxone have remained less than 0.5%. In contrast, fluoroquinolone resistance with Neisseria gonorrhoeae is highly problematic in the United States, with rates of resistance to ciprofloxacin now at approximately 35%.)

Based on 2019 data from the Gonococcal Isolate Surveillance Project (GISP), which one of the following is an accurate estimate of the rate of Neisseria gonorrhoeae antimicrobial resistance?

Persons who are Black (Among race/ethnicity categories in the United States for 2019, Black individuals have the highest gonorrhea rate (581.0 cases per 100,000 population), with the next highest rate in persons who are American Indian/Alaskan Native.)

Based on 2019 surveillance data in the United States, the rates of gonorrhea were highest in which group of persons?

Females aged 15-24 years (Females 15-24 years of age are the age group with the highest rates of C. trachomatis infection. The high rates in this age group, in combination with the significant potential for long-term complications in women from unidentified C. trachomatis infection, underlies the USPSTF and CDC recommendation to perform routine screening in all sexually active females younger than 25 years of age.)

Based on United States STD surveillance data, which age group has the highest rates of infection with Chlamydia trachomatis?

In recent years, more than 10% of gonococcal isolates have been resistant to fluoroquinolones

Based on data from the Gonococcal Isolate Surveillance Project (GISP), which one of the following statements is TRUE?

Rates are higher in Black persons than in White persons, for both males and females

Based on data from the National Health and Nutrition Examination Survey (NHANES) conducted 2007-2010, which one of the following is TRUE regarding the seroprevalence of herpes simplex virus-2 among White and Black individuals?

α1 Blockers

Blockade of α1a receptors relaxes the smooth muscle in the bladder neck, prostate capsule, and prostatic urethra, and thereby decreases dynamic obstruction of the urethra. Benefits develop rapidly.

toxicity may result from acute or chronic overdose and include signs of muscle pain, paresthesia, and cold extremities

What are the precautions for Ergot Alkaloids?

Rates of reported cases are higher in the South than in the Midwest

Which one of the following statements is TRUE regarding the epidemiology of gonorrhea in the United States?

Most cases are polymicrobial

Which one of the following statements is TRUE regarding the microbiology of pelvic inflammatory disease?

screen for patient's personal preference. (To encourage consistent implementation the prescriber should screen for the patient's personal preference)

Casey is a 19-year-old African-American female who presents for contraception start. She is otherwise healthy and takes no medications. She has no known drug allergies. She does not smoke. She has been dating the same man for 2 years. She denies sexual activity now or in the past. Family medical history includes mother with hypertension, migraine headache, and type 2 diabetes mellitus. 1. To encourage consistent implementation the prescriber should

Bupropion hydrochloride ER 150 mg every morning by mouth x 7 days, then increase dose to 300 mg every morning.​ (Unlike SSRIs, Bupropion does not have weight gain as an adverse effect. Because Christina prefers to take one daily dose, use 24 hours extended-release formula. It is recommended to start antidepressant medications at the lowest dose and increase after several days to minimize adverse effects.)

Christina is a 34-year-old who presents to the office with complaints of loss of energy, anxiety, and excessive sleeping. She has no past medical history. She is diagnosed with depression. She is concerned about starting on antidepressants because she has heard they cause weight gain, and she isn't great at remembering to take pills "unless I can take them in the morning". Write a prescription for Christina to treat her depression. ​

donepezil (​​Donepezil is appropriate for Cleo. It is approved by the FDA for the treatment of mild dementia and is not affected by nicotine. Donepezil also treats psychological symptoms of AD such as anxiety, depression, apathy, delusions, and pacing (Stahl, 2015). Rivastigmine and galantamine are not appropriate choices for Cleo. Rivastigmine should be avoided in clients with COPD. Nicotine can also increase clearance of the medication. Galantamine is also FDA indicated for mild to moderate dementia but will not address his anxiety.)

Cleo is a 65-year-old male diagnosed with mild cognitive changes related to Alzheimer's disease. He also has anxiety, COPD, and smokes cigarettes. Which of the following medications is appropriate for Cleo? ​

inhibiting ovulation (Combination oral contraceptives reduce fertility by inhibiting ovulation.)

Combination oral contraceptives reduce fertility by

MAO-B Inhibitors

Combining _______ medications with levodopa in early treatment may delay motor complications.

Estrogen

Contraindicated in the following conditions: abnormal vaginal bleeding of unknown cause breast cancer (except when used as treatment for certain metastatic cancers) deep vein thrombosis (DVTs) or pulmonary embolism (PE) stroke, myocardial infarction, or other arterial thromboembolism within the past year abnormal liver function or disease pregnancy

additional of an aspirin or aspirin-like drug to her current plan. (Adding an aspirin or aspirin-like drug to her current plan may provide relief. Additionally, metoclopramide may be added to aspirin for symptom relief. Opioid analgesics are reserved for headaches that are not relieved with other measures)

Current first-line options for treatment of migraine include

5-α-Reductase Inhibitor (Finasteride) α-Adrenergic Antagonist (Tamsulosin)

Drug therapy is indicated for patients with moderate symptoms of benign prostatic hypertrophy (BPH). Two major drug classes are used to treat BPH.

use of broad-spectrum agents does the most to facilitate emergence of antimicrobial resistance. (The prescriber is aware that all antimicrobial drugs promote the emergence of drug-resistant organisms. Because broad-spectrum antibiotics kill more competing organisms than do narrow-spectrum drugs, broad-spectrum agents do the most to facilitate emergence of resistance. Not only do antibiotics promote emergence of resistant pathogens, they also promote overgrowth of normal flora that possess mechanisms for resistance)

Debra is a 50-year-old Caucasian female who presents with a one-day history of sinus congestion and headache. "It's a sinus infection. It always takes an antibiotic to get rid of it. I'm just trying to get ahead of it. I have new grandbabies. I can't be sick." She has no known drug allergies. She has a history of GERD and her only medication is over-the-counter famotidine 20 mg twice a day. A review of her chart indicates that she received Amoxicillin Clavulanate for similar symptoms of 10-day duration with fever of 101 about 18 months ago. She is currently afebrile, and she denies fever. 1. As the prescriber considers treatment options for Debra they are aware that

Azithromycin (The preferred treatment for C. trachomatis infection during pregnancy is either azithromycin or amoxicillin. Doxycycline can be used for nonpregnant patients. Erythromycin is used for infants. Sulfisoxazole is not recommended for pregnant women near term, because it can cause kernicterus in the infant.)

During a routine screening, an asymptomatic, pregnant patient at 37 weeks' gestation learns that she has an infection caused by Chlamydia trachomatis. The provider will order which drug?

include discussion of the perfect and usual effectiveness of various methods (Education to assist Casey in selecting a method for contraception may include discussion of the perfect and usual effectiveness of various methods)

Education to assist Casey in selecting a method of contraception may

SSRIs, SNRIs, bupropion, mirtazapine. (First-line medications for the treatment of severe depression based on the tolerability and low side effect profile include SSRIs, SNRIs, bupropion, and mirtazapine.)

First-line medication selection, based on tolerability and low side effect profile, for the treatment of severe depression may include

Has never had surgery (In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease risk of MI or DVT)

For which patient situation will a provider select combination estrogen and progestin therapy over estrogen only therapy for management of menopausal symptoms?

Progestin

Goal of hormone therapy: Counteracts endometrial hyperplasia caused by unopposed estrogen during hormone therapy. (Other uses include management of dysfunctional uterine bleeding, amenorrhea, and endometriosis; counters corpus luteum deficiency in pregnancy; reduces risk of preterm birth; supplementation during in vitro fertilization.)

estrogen

Goal of hormone therapy: Manages symptoms and structural changes associated with a decrease in this endogenous hormone. (Other uses include palliation of metastatic breast cancer in selected cases.)

donepezil (Donepezil may be used for symptom management in PD. Dementia occurs in 40% of PD patients. AAN guidelines recommend treatment with two drugs: donepezil and rivastigmine. Both drugs are cholinesterase inhibitors developed for Alzheimer's disease. In patients with PD, these drugs can produce a modest improvement in cognitive function without causing significant worsening of motor symptoms, even though these drugs increase the availability of acetylcholine at central synapses)

Helen and her family have heard of other medications that are used to treat PD and inquire if they may help control Helen's symptoms. Which of the following medications may be used for symptom management in PD?

Medications increase the level of dopamine and decrease the level of acetylcholine in CNS responses can take several months to occur. (The educational point that will help Helen's family understand the pharmacological approach to symptom management in PD is: Medications increase the level of dopamine and decrease the level of acetylcholine in CNS responses can take several months to occur. Given the neurochemical basis of parkinsonism—too little striatal dopamine and too much acetylcholine—the approach to treatment is direct: use drugs that can restore the functional balance between dopamine and acetylcholine. To accomplish this, two types of drugs are used: (1) dopaminergic agents (i.e., drugs that directly or indirectly activate dopamine receptors) and (2) anticholinergic agents)

Helen's family asks why marked symptom improvement is not seen since she was started on three medications for PD at the time of diagnosis. Which of the following education points will help Helen's family understand the pharmacological approach to symptom management in PD?

carbidopa reduces cardiovascular responses to levodopa (The educational point that will help Helen's family understand the desired effects of carbidopa in the combined levodopa/carbidopa therapy is: carbidopa reduces cardiovascular responses to levodopa. By reducing the production of dopamine at the periphery, carbidopa reduces cardiovascular responses to levodopa as well as nausea and vomiting)

Helen's family asks why she is receiving the combination drug, levodopa/carbidopa, and not just levodopa. Which of the following education points will help Helen's family understand the desired effects of carbidopa in the combined levodopa/carbidopa therapy?

luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

High doses of androgens can result in testicular shrinkage, sterility, and gynecomastia due to the suppression of which hormones? ​

Acute is less than or equal to 30 days in duration. (Most experts have defined acute PID as a duration of less than or equal to 30 days. The pathogens associated with acute PID are typically different than those causing chronic PID.)

How is acute PID defined?

During asymptomatic viral shedding

How is most genital HSV-2 transmitted?

20%

How many children and adolescents are impacted by mental health disorders worldwide?

$1 trillion

How much does lost productivity related to anxiety and depression cost the global economy each year?

Schedule an appointment for her to receive the injection in 3 weeks when her period starts. (To ensure that patients are not pregnant when they receive medroxyprogesterone acetate, the first injection should be given during the first 5 days of a normal menstrual period.)

How will the provider initiate contraception with intramuscular medroxyprogesterone acetate

zaleplon (Sonata)

If Norene reports feeling drowsy during the day after taking medication for insomnia, which of the following sedatives has the shortest half-life and may help alleviate this issue?

SSRIs should not be stopped abruptly. Discontinuation can result in rebound anxiety.

Important teaching about SSRIs

1,800,000

In 2019, approximately how many cases of Chlamydia trachomatis infections were reported in the United States?

South (In 2018, the South had the highest rate of infection with N. gonorrhoeae in the United States, with 205.4 cases per 100,000 population. The lowest was in the Northeast (144.4 cases per 100,000 population).

In 2019, which region of the United States had the highest rate of reported gonorrhea (cases per 100,000 population)?

West

In 2019, which region of the United States had the highest rate of reported primary and secondary cases of syphilis in the United States?

5-α-reductase inhibitors, α1 adrenergic blockers, and PD5 inhibitor, tadalafil. (Management of benign prostatic hyperplasia includes 5-α-reductase inhibitors, α1 adrenergic blockers, a PD5 inhibitor, anticholinergics, and botulinum toxin.)

Management of benign prostatic hyperplasia using medication includes

Autoinoculation from an individual's genital infection (In adults, accidental autoinoculation from an individual's genital infection is the most common cause of chlamydial inclusion conjunctivitis; genital-ocular sexual practices are relatively rare and not a common route of inoculation in adults. Congenitally-acquired C. trachomatis conjunctivitis can occur from exposure of the neonate to infected secretions from the mother's genital tract during birth. Trachoma, a follicular conjunctivitis caused by C. trachomatis, can result in blindness, but the C. trachomatis serotypes associated with this infection are rare in the United States)

In adults in the United States, Chlamydia trachomatis conjunctivitis occurs most often as a result of which one of the following:

It has decreased due to increased screening and treatment of gonorrhea and chlamydia. (In the United States, the incidence of PID in both inpatient and office-based settings has decreased in recent years. This has been widely attributed to an increase in effective screening for infection with Neisseria gonorrhoeae and Chlamydia trachomatis in adolescents and young women.)

In the United States, which one of the following is TRUE regarding the incidence of PID?

Perinatal eye infection causing inclusion conjunctivitis (The most common clinical condition caused by chlamydial infection in neonates and infants in the United States is inclusion conjunctivitis (ophthalmia neonatorum). Cases of infant inclusion conjunctivitis are almost always perinatally-acquired infections. In contrast, the trachoma-forming chlamydial serotypes are most often transmitted by flies. Pneumonia and urogenital infections do occur in neonates and infants, but less often than inclusion conjunctivitis.)

In the United States, which one of the following is the most common clinical condition caused by chlamydial infection among neonates (younger than 1 month of age)?

The elementary body

In the life cycle of Chlamydia trachomatis, which particle is considered infectious and first infects the host cell?

Metronidazole 500 mg orally twice a day for 7 days (The 2015 STD Treatment Guidelines recommend any of the following regimens as first-line therapy for bacterial vaginosis in non-pregnant women: (1) metronidazole 500 mg orally twice a day for 7 days, 2) metronidazole gel 0.75%, one full applicator (5 grams) intravaginally once daily for 5 days, or 3) clindamycin cream 2%, one full applicator (5 grams) intravaginally at bedtime for 7 days. Alternative options include oral tinidazole, oral clindamycin, and intravaginal clindamycin ovules. Single-dose metronidazole should not be used to treat bacterial vaginosis.)

In which one of the following groups is screening for bacterial vaginosis indicated?

In an asymptomatic patient with recurrent genital symptoms but negative HSV cultures (Type-specific serologic assays might be useful in patients with recurrent or atypical genital symptoms with negative cultures, a clinical diagnosis of genital herpes without laboratory confirmation, a sex partner with genital herpes, or as part of a comprehensive evaluation for STDs in persons with multiple sex partners, persons with HIV infection, and men who have sex with men (MSM) who have increased risk for HIV acquisition. Routine HSV type-specific serologic testing is not recommended in asymptomatic persons (including during pregnancy), in patients with culture-proven HSV-2, or in cases of early infection since HSV-specific antibodies can take from 2 weeks to 3 months to develop.)

In which one of the following patients would it be reasonable to perform type-specific serologic testing for HSV?

-hypertension -cardiac disease -diabetes -history of cholestatic jaundice of pregnancy -gallbladder disease -uterine leiomyoma -epilepsy -migraine

What are relative contraindications for hormone based contraceptives?

First Day Start (The First Day Start method does not require 7-day use of a backup contraceptive method. With this method, the first pill is taken on the first day of menses. No backup contraceptive method is needed as ovulation is suppressed within the first cycle. With Sunday Start, the first pill is taken on the Sunday following the start of menses. Another form of contraception is required for the first 7 days of the first cycle. With Quick or "Same Day Start: the first pill is taken on the day of the office visit following a negative pregnancy test. Another form of contraception is required for the first 7 days of the first cycle to prevent pregnancy.)

Jessica asks when she should start her OCPs. Which of the following methods does not require 7-day use of a backup contraceptive method?

Increase the estrogen dose in her pills (Increasing the dose of estrogen in the oral contraceptives is the best action for managing Jessica's breakthrough bleeding. Breakthrough bleeding is a result of estrogen deficiency; therefore, the amount of estrogen in Jessica's oral contraceptive pills must be increased.)

Jessica presents to the clinic 3 months after beginning oral contraception. She reports breakthrough bleeding about 10 days into each monthly pill pack of Lo-Estrin contraception. Which of the following is the corrective action for managing Jessica's breakthrough bleeding?

BRCA1 BRCA2 (BRCA 1 and BRCA 2 gene mutations place Jessica at higher risk of breast cancer and contraindicate the use of OCs. Risk is affected by the patient's age, personal risk of cancer, and overall health)

Jessica reported that her mother has a history of breast cancer. Which of the following gene mutations place Jessica at a higher risk of breast cancer and contraindicates the use of oral contraceptives? Select all that apply.

Fluoxetine (Fluoxetine is the best medication choice. Fluoxetine is an SSRI which is one of the recommended medications for GAD. At this time, only three SSRIs—fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)—are approved for this condition. However, the other SSRIs appear just as effective. ​Bupropion is an SNRI. Medications that contain norepinephrine can increase anxiety. Therefore, this medication is not the best choice for Jill.​Alprazolam seems like a good choice because Jill has tried the medication and it works but this is not an appropriate choice. Benzodiazepines should be prescribed only for short-term use. Jill has chronic anxiety, not acute anxiety. ​Buspirone seems like a good choice because this medication targets 5HT1A; however, this medication is used as an adjunct therapy, not monotherapy. Therefore, this medication is not the best choice for Jill.​)

Jill, a 23-year-old graduate student presents with reports of panic attacks and worry "for my whole life." She reports that she can bring them on herself when she worries. This happens almost every day and some days it is so bad she cannot go to work or school. She was offered a few Xanax by a friend and she wants a prescription because "they really help". The NP diagnoses Jill with Generalized Anxiety Disorder (GAD). Which of the following is the best choice to prescribe? ​

Viagra increases and preserves cGMP levels in the penis, thereby making the erection harder and longer lasting. (The PDE5 class has a 10-fold selectivity for the enzyme that produces smooth muscle relaxation in the corpus cavernosum of the penis. As smooth muscles in the corpus cavernosum relax, blood flow into the penis is increased, resulting in an erection.)

Joe is requesting a PDE5 inhibitor. Which of the following best describes the mechanism of action of sildenafil (Viagra)?

fluoxetine​ (Fluoxetine is the best choice given that LC states she forgets to take her medications. Fluoxetine has a 2-3 days half-life, an excellent option for forgetful people. Although sertraline has a long half-life, fluoxetine has the longest half-life and is, therefore, the best option. Escitalopram is a well-tolerated medication and certainly an option. However, fluoxetine has the longest half-life which is best when considering lifestyle considerations for LC. Venlafaxine's active metabolite has a 9-13-hour half-life but is associated with a discontinuation syndrome. Clients can feel uncomfortable with the first missed dose. Therefore, this medication is not the best choice given lifestyle considerations for LC.)

LC, a 19-year-old college sophomore presents for evaluation. Her diagnosis is depression. She is very busy with her coursework and sorority activities, reporting she sometimes forgets to take her pills on time.​ Given her lifestyle, which of the following is the best medication choice for LC? ​

can slow the cognitive decline but not reverse it. (The advanced practice prescribed is aware that the current medications for the treatment of Alzheimer's disease can slow the cognitive decline but not reverse it. The medications have statistical significance but limited clinical manifestations)

Lonnie, a 72-year-old Caucasian male, presents for cognitive decline. He is unable to maintain his checkbook. He fails the clock draw test in the office. He has had no recent injuries and takes no medications. He is accompanied by his wife who claims he has always been in good health. A review of his office health record supports this claim. 1. Even as the advanced practice prescriber arranges further diagnostic testing for Alzheimer's disease, they are aware that current medications

α1 Blockers

MAY CAUSE THIS ADVERSE EFFECT: Abnormal ejaculation (ejaculation failure, reduced ejaculate volume, or retrograde ejaculation). Risk of floppy-iris syndrome during cataract surgery.

5-α-Reductase Inhibitor

MAY CAUSE THIS ADVERSE EFFECT: Decreased ejaculate volume and libido. Teratogenic to the male fetus.

Alprazolam #5 tabs PRN (Because MB has anxiety in a specific situation, a benzodiazepine can be prescribed for PRN use. Limiting the number of pills is appropriate to help prevent misuse of the medication. ​Using a daily medication is not necessary since MB does not have chronic anxiety. Therefore, buspirone is not the best choice.​Providing an SSRI PRN is not appropriate as it may take up to 6 weeks for efficacy. Therefore, citalopram is not the best choice.​)

MB is a 55-year-old woman who schedules an appointment a month before a planned vacation to Hawaii. "I've been on a plane once before, and I had a major panic attack. It was terrible". MB is concerned about having another panic attack on the long transpacific flight. MB is in good health and not taking medications. ​ Which of the following is the best choice to prescribe?​

blocks dopamine or NE reuptake has stimulant properties Suppresses appetite

MOA of Norepinephrine Dopamine Reuptake Inhibitor (NDRI)

inhibits reuptake of serotonin

MOA of Selective Serotonin Reuptake Inhibitors (SSRIs)

inhibit 5-HT and norepinephrine reuptake

MOA of Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Male partners should be tested and empirically treated for gonorrhea and chlamydia if they had sexual contact during the 60 days preceding onset of the patient's symptoms. (All male sex partners who have had contact with a woman with PID during the 60 days preceding onset of the woman's symptoms should be examined, tested, and receive presumptive treatment for gonorrhea and chlamydia. If a patient's last sexual intercourse was longer than 60 days before onset of symptoms or diagnosis, the patient's most recent sex partner should be treated.)

Management of sex partners of women with pelvic inflammatory disease (PID) includes which of the following strategies?

moderate

Mimi is presenting with anxiety, agitation, and difficulty recognizing family and familiar people (e.g., church friends). These symptoms are indicative of what stage Alzheimer's disease.

testosterone

What androgen agent is needed for male replacement therapy and hypogonadism?

ramelteon (Rozerem)

Norene reports she has taken melatonin before and asks if there is a medication that would make melatonin work better. Which of the following medication is a melatonin receptor agonist?

ramelteon

Of the major drugs used to treat insomnia, which of the following is not regulated as a controlled substance and is permitted for long-term use?

SSRIs, SNRIs, bupropion, mirtazapine​ (First-line medications for the treatment of severe depression based on the tolerability and low side effect profile include SSRIs, SNRIs, bupropion, and mirtazapine.)

Olivia is a 16-year-old biracial female. She reports feeling down and depressed nearly every day for the past 2 weeks. She has also withdrawn from drama club, an extracurricular activity that she previously enjoyed. She denies any recent losses or being bullied but feels that her ability to concentrate has decreased. Her mother shares that Olivia is spending more time sleeping or napping alone in her room, seems sullen and withdrawn, and irritable when she does interact with family. Olivia's mother notes that Olivia's appetite has declined and that Olivia remarks that she is not hungry with most meals. Olivia's mother tells the provider that Olivia does not seem interested in most of her usual activities or her phone. Olivia comments to the provider that she feels that her family and friends would be better off if she "weren't around." She denies thoughts or plans of hurting herself or others. ​ First-line medication selection, based on tolerability and low side effect profile, for the treatment of severe depression may include:​

sick sinus syndrome​ seizure disorder​

What are Precautions for Donepezil (Aricept)?

Breast cancer

Oral Contraceptives do not cause this condition, but estrogens can promote further development if it is pre-existent.

Benign prostatic hypertrophy (This drug class relaxes bladder smooth muscle and has a second indication for treating benign prostatic enlargement if used daily.)

PDE5 inhibitors have a secondary indication due to smooth muscle relaxation. If used daily, this drug class is indicated for which of the following disorders?

Complete the entire course of treatment unless experiencing an adverse effect. (Patients should be instructed to take their medication for the entire prescribed course, even though symptoms may subside before the full course has been completed.)

Patient education for antimicrobials includes:

Impulse control disorder

Patients should be educated on dopamine dysregulation syndrome (DDS) which can manifest as:

gastrointestinal symptoms (nausea and diarrhea)​ headache​ dizziness​ muscle weakness​

What are the Common Side Effects of Donepezil (Aricept)​?

5-α-Reductase Inhibitor

Reduces dihydrotestosterone production, which shrinks the prostate and reduces the mechanical obstruction of the urethra. May also delay BPH progression. Benefits take months to develop.

Estrogen

Required pt education: Nausea is common early in treatment but diminishes with time. To reduce nausea:avoid cooking odors and warm, stuffy environmentsconsume dry foods and raw fruits and vegetables.use guided imagery with muscle relaxation, yoga, and music therapy Menopausal HT with this hormone alone increases the risk for endometrial carcinoma. adverse effects include abnormal vaginal bleeding, hypertension, benign hepatic adenoma, and reduced glucose tolerance)

Progestin

Required pt education: breakthrough bleeding, spotting, and amenorrhea may occur report abnormal or prolonged vaginal bleeding

PSA at 6 months and periodically thereafter (The anticipated diagnostic testing for 5-α-reductase inhibitor includes a baseline PSA with recheck of PSA at 6 months and periodically thereafter. If the PSA does not decrease at 6 months, the patient should be screened for prostate cancer.)

Robert and the prescriber agree to a trial of a 5-α-reductase inhibitor. The anticipated diagnostic testing following up is

YES

Scott is a 69-year-old with a history of COPD. He complains that he has a hard time falling asleep some nights and has been taking Benadryl 50 mg at bedtime to help him sleep. He complains of dry mouth and dry eyes the mornings after he takes Benadryl, and states sometimes he feels a little confused after waking. He wonders if he should continue taking the Benadryl for sleep. What recommendations would you have for Scott related to sleep?​ Question 1 Should Scott continue using Benadryl? [yes/no]​

Take 1 hour before sexual activity Go to the emergency room for painful erections lasting more than 4 hours Avoid grapefruit juice. Sexual stimulation is required to obtain an erection. (Other important education points include: Take caution in engaging in sexual activity if diagnosed with a pre-existing cardiovascular disease (irrespective of a PDE5 inhibitor. If anginal pain, lightheadedness, or other symptoms occur during sex refrain from sexual activity and report the symptoms to the prescriber. Stop taking PDE5 inhibitors and seek immediate medical attention if a sudden loss of vision occurs in one or both eyes or if hearing loss develops. Avoid nitrates for at least 12 hours after taking avanafil; at least 24 hours after taking sildenafil or vardenafil, and at least 48 hours after taking tadalafil)

Sildenafil (Viagra) is prescribed for Joe as requested. Which of the following education points is important to include? Select all that apply.

Reduced genital sensitivity​ Fatigue​ Reduced libido​

Testosterone therapy can be used to treat which symptoms in post-menopausal women?

Cervical motion tenderness occurring in the absence of any other explanation. (The clinical presentation for PID is highly variable and some women are asymptomatic. The Minimal Clinical Criteria include the following: · Uterine or adnexal tenderness (bilateral or unilateral), · Cervical motion tenderness occurring in the absence of any other explanation, or · Acute adnexal tenderness, which may be the most sensitive sign of upper genital tract infection.)

The CDC 2015 STD Treatment Guidelines recommend presumptive PID treatment for sexually active young women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more minimum clinical criteria are met. Which one of the following is included under "Minimal Clinical Criteria"?

reduction of prostate size by suppression of DHT over the course of months. (The action of 5-α-reductase inhibitors include reduction of prostate size by suppression of DHT over the course of months.)

The action of 5-α-reductase inhibitors include

vasoconstriction and reduction of perivascular inflammation. (

The action of sumatriptan in headache relief is

prevent the breakdown of acetylcholine by acetylcholinesterase (AChE), increasing the availability of acetylcholine at cholinergic synapses. (The action of the cholinesterase inhibitors is prevention of the breakdown of acetylcholine by acetylcholinesterase (AChE), increasing the availability of acetylcholine at cholinergic synapses thus improving transmission by central cholinergic neurons that have not yet been destroyed.)

The action of the cholinesterase inhibitors is thought to

medication overuse headache. (Daily use of aspirin or aspirin-like medications may result in medication overuse headache.)

The advanced practice prescriber inquires about use of aspirin and aspirin-like medications. If the patient reveals that she uses these medications for headache relief daily, the prescriber should suspect

the exact mechanism of action of most CNS agents for therapeutic results is unknown. (The advanced practice prescriber is cognizant that the exact mechanism of action for most CNS agents is unknown. There is evidence that supports the use of norepinephrine, dopamine, and enkephalins in treatment plans for a variety of disorders. With over 21 neurotransmitters in the CNS system and some evidence of actions that are not explained with the known neurotransmitters, more research is indicated. The CNS system is complex and current technology is not adequate to capture the complexities)

The advanced practice prescriber is cognizant that

gastrointestinal symptoms (nausea, vomiting, diarrhea, anorexia, and weight loss), headache, dizziness​, fatigue​

What are the common SE of Galantamine (Razadyne, Razadyne ER)?

are only indicated for 3 months use. (The drugs diethylpropion and phentermine are only indicated for 3 months use)

The drugs diethylpropion and phentermine

Neisseria gonorrhoeae and Chlamydia trachomatis (The most common pathogens associated with PID are Neisseria gonorrhoeae and Chlamydia trachomatis. Other microbes associated with PID include gram-negative rods, anaerobes, Mycoplasma genitalium, and Ureaplasma urealyticum.)

The most common pathogens associated with PID are?

contraindicated in patients with hepatic or renal impairment, CAD, and PVD

What are the contraindications of Ergot Alkaloids?

Discuss diet modification and exercise. (All PIs can elevate plasma levels of cholesterol and triglycerides. Potential interventions for hyperlipidemia include modified diet, exercise, and lipid-lowering agents. Lovastatin and simvastatin should be avoided, because they can accumulate to dangerous levels. Pancreas is not indicated to lower triglycerides and cholesterol.)

The nurse is caring for a patient who is taking a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. Upon being notified of the test results, what action will the provider take?

Reduce the dose of memantine (Patients with severe renal impairment may require discontinuation, but with a slight elevation, a dosage reduction is indicated. Adding sodium bicarbonate would alkalinize the urine and increase memantine levels, causing toxicity. It is not necessary to discontinue or decrease the dose of the memantine with mild or moderate renal impairment. A serum creatinine level is less sensitive than creatinine clearance for monitoring renal function in older adults and it cannot be used to validate creatinine clearance findings)

The patient who is on memantine therapy has a slight elevation in the creatinine clearance. What action will the provider take in response to this laboratory result?

A vaginal conjugated estrogen

The patient who reports vaginal dryness and pain with intercourse is opposed to using lubricants but is concerned about hormonal adverse effects. Which hormone formulation will the provider choose to decrease systemic estrogen effects

nasal butorphanol spray (The preferred opioid treatment for migraine headache butorphanol nasal spray which is used when other methods have failed)

The preferred opioid treatment for migraine headache is

is guided by symptoms and tolerability of each individual patient. (The prescriber knows that treatment with medication for psychiatric disorders is based on the individual's symptoms and tolerability. Psychiatric disorders have limited diagnostic lab and imaging to guide diagnosis and treatment. Counseling and medication have equal efficacy in the treatment of mild to moderate symptoms but may be more effective when combined)

The prescribe knows that treatment with medication of psychiatric disorders

is guided by symptoms and tolerability of each patient​ (The prescriber knows that treatment with medication for psychiatric disorders is based on the individual's symptoms and tolerability. Psychiatric disorders have limited diagnostic lab and imaging to guide diagnosis and treatment. Counseling and medication have equal efficacy in the treatment of mild to moderate symptoms but may be more effective when combined.)

The prescribe knows that treatment with medication of psychiatric disorders:​

A reduction of the risk of anesthetic toxicity A prolonging of the anesthesic effect (Vasoconstrictors, when combined with local anesthetics, reduce the risk of toxicity and prolong the anesthetic effects. Vasoconstrictors, when combined with local anesthetics, slow down the absorption process. They do not prevent bradycardia or shorten the duration of action.)

The provider has prescribed a vasoconstrictor to be given in combination with a local anesthetic. What is the expected goal for this action? (Select all that apply.)

Reduce the dose of bromocriptine. (Bromocriptine is used to treat levodopa-induced dyskinesias and has dose-dependent psychological side effects. Reducing the dose of this drug can minimize these side effects. Adding an antipsychotic medication is not indicated. Cabergoline is not approved for this use. Reducing the dose of levodopa/carbidopa is not indicated.)

The provider prescribes bromocriptine for a patient who takes levodopa/carbidopa. Afterward, the patient becomes agitated and has frequent nightmares. What action will the provider take to manage the patient's symptoms?

Nervousness and tachycardia (Absorption of the vasoconstrictor can cause systemic effects, including nervousness and tachycardia. Local anesthetics are nonselective modifiers of neuronal function and also can block motor neurons, so it is expected that patients may have difficulty with movement. The sensation of pressure also is affected and is an expected effect. As the local anesthetic wears off, the sensation of the pain will return.)

The provider used lidocaine with epinephrine as a local anesthetic when suturing a laceration on a patient's hand. Following the procedure, which patient symptom causes the most concern?

-thrombophlebitis, thromboembolic disorders, cerebral vascular disease, coronary occlusion, or a past history of these conditions, or a condition that predisposes to these disorders -abnormal liver function -known or suspected breast cancer -undiagnosed abnormal vaginal bleeding -known or suspected pregnancy -smokers older than 35 years

What are absolute contraindications for hormone based contraceptives?

"We only need to change the patch every 2 weeks. (The rivastigmine transdermal patch needs to be changed daily. Sites used should not be reused for 14 days. Transdermal dosing provides lower, steady levels of the drug. Intensity of side effects is lower with the transdermal patch. The old patch must be removed prior to applying the new patch to prevent toxicity)

The spouse of a patient with Alzheimer disease asks the provider for more information about the rivastigmine transdermal patch that is being used. After the discussion with the provider, which statement by the spouse indicates a need for further explanation?

Early or midcycle breakthrough bleeding Increased spotting Hypomenorrhea

These s/s indicate estrogen deficiency

Nausea Breast tenderness Edema Bloating Hypertension Migraine Cervical mucorrhea Polyposis

These s/s indicate excess estrogen

Increased appetite Weight gain Depression Tiredness Fatigue Hypomenorrhea Breast regression Monilial vaginitis Acne, oily scalp Hair loss Hirsutism

These s/s indicate excess progestin

Late breakthrough bleeding Amenorrhea Hypermenorrhea

These s/s indicate progestin deficiency

Cervical motion tenderness or uterine tenderness or adnexal tenderness

To make a presumptive diagnosis of pelvic inflammatory disease in sexually active young women and other women experiencing pelvic or lower abdominal pain, the CDC recommends one or more minimum clinical criteria are present on pelvic examination. What are the three minimum clinical criteria?

Selective serotonin reuptake inhibitors (All three major classes of antidepressants are effective for management of panic disorders, but selective serotonin reuptake inhibitors are first-line drugs. Benzodiazepines are second-line drugs and are rarely used because of their abuse potential. MAOIs are effective but are difficult to use because of their side effects and drug and food interactions. Tricyclic antidepressants are second-line drugs, and their use is recommended only after a trial of at least one SSRI has failed.)

To manage a patient's panic attacks, the provider will first prescribe a drug in which drug class?

gastrointestinal symptoms (anorexia, nausea, vomiting, or diarrhea)​, weakness, dizziness​, tremor​

What are common SE of Revastigmine (Exelon)?

concurrent use with (amantadine, rimantadine, ketamine, or dextromethorphan)​ severe hepatic impairment​ severe renal impairment​

What are precautions of Memantine (Namenda)?

Refer. NPs should not treat any kind of severe or complex mental illness, such as schizophrenia, bipolar disorder, or personality disorder in the primary care setting. These patients should be referred for a psychiatric consultation (physician or psychiatric mental health NP).​

Treat or refer? A 19-year-old presents verbalizing suicidal thoughts. Lately, she has expressed feeling extremely sad. She has difficulty eating and has no enjoyment in her everyday activities. Her mother states that before the onset of these symptoms, the patient exhibited impulsivity including frequent unsafe sexual encounters and recklessness.

Treat. FNPs can diagnose and treat patients with uncomplicated mental illness, such as depression and anxiety, within their scope of practice (SOP).

Treat or refer? A 28-year-old man presents with hypersomnolence and hopelessness. He used to play on his church softball team but has no interest in social activities. ​

Treat. NPs can diagnose and treat patients with uncomplicated mental illness, such as depression and anxiety, within their scope of practice (SOP). ​

Treat or refer? A 35-year-old female patient with difficulty sleeping, intermittent chest tightness, and excessive worrying. She is diagnosed with anxiety.

Refer. NPs should not treat any kind of severe or complex mental illness, such as schizophrenia, bipolar disorder, or personality disorder in the primary care setting. These patients should be referred to a psychiatric consultation (physician or psychiatric mental health NP).​

Treat or refer? A 47-year-old man presents with auditory and visual hallucinations and agitation. He is diagnosed with schizophrenia.

cholinesterase inhibitors (ChEIs) and memantine.

Treatment for AD

Lactation

Use progestin-only contraceptives for these patients

severe hepatic or renal impairment

What Contraindications are for Galantamine (Razadyne, Razadyne ER)?

Methyltestosterone (Android)

What androgen agent is needed for Delayed puberty, Hypogonadism (Male), Replacement therapy (Male)?

Oxandrolone (Oxandrin)

What androgen agent is needed for catabolic states (Cachexia)?

Take one pill as soon as possible and then continue with the active pills in the pack but skip the placebo pills and go straight to a new pack once all the active pills have been taken.

What instructions should be given to a patient if one or two OC pills are missed during the second or third week?

Follow the same instructions given for missing one or two pills but use an additional form of contraception for 7 days

What instructions should be given to a patient if three or more OC pills are missed during the second or third week?

Although the exact mechanism of action is unknown in relieving migraine headaches, the following actions are known to occur: ​ agonist activity at subtypes of serotonin receptors​ blocks inflammation associated with trigeminal vascular system​ promotes constriction to reduce amplitude of pulsation​ depresses the vasomotor center​

What is MOA of Ergotamine?

Decreases the release of inflammatory neuropeptides thereby diminishing perivascular inflammation. Both actions (vasoconstriction and decreased perivascular inflammation) help relieve migraine pain.​

What is MOA of Sumatripan?

reduces blood pressure​

What is the MOA of CBD​

Galantamine (Razadyne, Razadyne ER) acts by elevating acetylcholine (Ach) in the cerebral cortex, modulating the nicotinic Ach receptors to increase Ach release from existing presynaptic nerve terminals. It also increases glutamate and serotonin levels; however, the benefits of this action are unknown at this time

What is the MOA of Galantamine (Razadyne, Razadyne ER)?

suppresses platelet aggregation​

What is the MOA of Gingko biloba

inhibits CYP2D^ and CYP3A4​

What is the MOA of Goldenseal​

stimulates cardiovascular system and CNS​

What is the MOA of Ma huang (ephedra)​

Prevents glutamate, an excitatory neurotransmitter, from binding at the receptor site. NMDA receptors control activity throughout the brain by regulating how much calcium enters the nerve cell. An overproduction of the NMDA receptor and excess glutamate can lead to excessive calcium entering the cell and disrupting information processing. Blocking NMDA receptors protects neurons from the effects of too much glutamate without affecting normal neurotransmission

What is the MOA of Memantine (Namenda)?

Rivastigmine (Exelon) acts centrally for both acetylcholinesterase and butyrylcholinesterase, thereby potentially increasing its efficacy.​

What is the MOA of Revastigmine (Exelon)?

induces CYP3A4​

What is the MOA of St. John's wort​

inhibits centrally active acetylcholinesterase​

What is the MOA of ​Donepezil (Aricept)​?

gastrointestinal symptoms (constipation, diarrhea, and weight gain)​ urinary frequency​ confusion​ dizziness​ headache​ cough​

What is the common SE of Memantine (Namenda)?

metoprolol (Lopressor)​

What is the drug interaction risk of CBD​

warfarin (Coumadin)​

What is the drug interaction risk of Gingko biloba

fentanyl​

What is the drug interaction risk of Goldenseal​

methylphenidate (Ritalin)​

What is the drug interaction risk of Ma huang (ephedra)​

oral contraceptives​

What is the drug interaction risk of St. John's wort​

CBC​ HbA1C (Atypical antipsychotics can cause increased blood glucose and an increased risk of developing DM II. Measure HbA1C every 3 months for 1 year and then annually. Certain medications, such as Clozapine, may cause blood dyscrasias and CBC should be monitored.)

What is the drug treatments and the appropriate related lab tests for Atypical antipsychotic medications?

renal function​ liver function​ CBC​ (Carbamazepine can cause blood dyscrasias, hepatotoxicity, and renal failure. Draw CBC, LFT, and renal function every 3 months for 1 year and then annually. )

What is the drug treatments and the appropriate related lab tests for Carbamazepine?

serum lithium level ​ renal function ​ thyroid function​ (Lithium has a narrow therapeutic index and should be monitored carefully. Serum levels should be evaluated 5 days after any dosage change and regularly at 6-month intervals. Lithium can cause renal and thyroid toxicity. Renal and thyroid function should be evaluated every 6 months. )

What is the drug treatments and the appropriate related lab tests for Lithium?

liver function​ CBC​ (Valproic acid and its derivatives can cause leukopenia, thrombocytopenia, and hepatotoxicity. Monitor CBC and LFTs every 3 months for 1 year and then annually. ​)

What is the drug treatments and the appropriate related lab tests for Valproic acid?

30%

What is the global burden of disease of mental health, neurological, and substance use disorders?

Levodopa

What is the most effective medication for PD?

Bacterial vaginosis (The most likely diagnosis is bacterial vaginosis since all of the Amsel's diagnostic criteria for bacterial vaginosis are present: (1) alkaline pH, (2) presence of clue cells, and (3) positive "whiff test, and (4) homogeneous discharge. The presence of three of the following four criteria provides sufficient evidence for a clinical diagnosis of bacterial vaginosis.)

What is the most likely diagnosis based on the following criteria: (a) pH 5.0; (b) clue cells greater than 20% per high power field, (c) potassium hydroxide (KOH) "whiff test" positive with an fishy odor, and (c) homogenous discharge?

Acidic, between 3.8 and 4.5 (The normal bacterial flora is dominated by Lactobacillus species that convert glycogen to lactic acid, which helps to maintain a normal acidic vaginal pH of 3.8 to 4.5.)

What is the normal vaginal pH in most healthy women?

50-70% (The estimated rate of male-to-female transmission of Neisseria gonorrhoeae is 50-70% per episode of vaginal intercourse. Female-to-male genital transmission is estimated to be about 20% per episode. Rectal intercourse and fellatio have not been quantified but are likely efficient modes of transmission. Cunnilingus appears to carry much lower risk, though transmission can occur.)

What is the rate of male-to-female transmission of Neisseria gonorrhoeae via semen per episode of vaginal intercourse?

Tubal infertility occurs in approximately 8% of women after one episode of PID

What is the risk of developing tubal infertility following pelvic inflammatory disease (PID)?

progestin (Oral contraceptive that contains only progestin 'progestin-only pill' and is taken daily)

What is the the associated drug class with the contraceptive method: "Mini pill"

progestin and estrogen (Oral contraceptive that contains both progestin and estrogen and is taken daily)

What is the the associated drug class with the contraceptive method: Combined oral contraceptives

neither (A dome-shaped silicone cup inserted in the vagina hours before sexual intercourse. A diaphragm does not contain progestin or estrogen.)

What is the the associated drug class with the contraceptive method: Contraceptive diaphragm

progestin (A thin rod that is inserted under the skin of the upper arm which releases progestin; prevents pregnancy for up to 4 years)

What is the the associated drug class with the contraceptive method: Contraceptive implant

progestin (Injection that contains progestin; prevents pregnancy for up to 3 months)

What is the the associated drug class with the contraceptive method: Contraceptive injection

neither (A chemical that kills sperm that does not contain progestin or estrogen.)

What is the the associated drug class with the contraceptive method: Spermicide

progestin and estrogen (Transdermal patch that releases progestin and estrogen; prevents pregnancy for 1 week (patch changed every week with one patch-free month)

What is the the associated drug class with the contraceptive method: Transdermal contraceptive patch

progestin and estrogen (Flexible ring inserted inside the vagina that releases progestin and estrogen; prevents pregnancy for three weeks with one free week.)

What is the the associated drug class with the contraceptive method: Vaginal ring

symptom management (The therapeutic goal for Helen and others with Parkinson's disease is symptom management. The ideal treatment would reverse neuronal degeneration or at least prevent further degeneration and control symptoms. Unfortunately, the ideal treatment does not exist; no drugs prevent neuronal damage or reverse the damage that has occurred. Drugs can only provide symptomatic relief, not cure PD. Furthermore, there is no convincing proof that any current drug can delay disease progression)

What is the therapeutic goal for Helen and others with Parkinson's Disease (PD)?

termination of migraine or cluster headache

What is the therapeutic goal of Ergot Alkaloids?

termination of migraine headache

What is the therapeutic goal of Triptans?

slow her memory loss (Current pharmacologic agents are unable to stop or restore memory or cognitive function. Drugs cannot reverse the pathophysiologic disease process. Therefore, the goal of therapy is to slow Mimi's memory and cognitive decline.)

What is the treatment goal for Mimi?

85% Approximately 85% of persons infected with HSV-2 have not been diagnosed, and the proportion of persons who have knowledge of their HSV-2 status has not changed significantly in recent years.

What percentage of persons infected with HSV-2 are unaware of their serostatus?

NSAID use​, GI bleed​, asthma or COPD​, concurrent use with medications that slow or decrease heart rate​

What precautions are for Galantamine (Razadyne, Razadyne ER)?

"You may experience blurred vision, dry mouth, or constipation." (Cyclobenzaprine has significant anticholinergic effects and patients should be warned about dry mouth, blurred vision, and constipation. Tizanidine, not cyclobenzaprine, can cause hallucinations and psychotic symptoms. Methocarbamol, not cyclobenzaprine, may turn urine brown, black, or green, which is a harmless side effect. Tizanidine and metaxalone, not cyclobenzaprine, can cause liver toxicity and require monitoring.)

When a patient with a lower back injury begins experiencing muscle spasms, the provider orders cyclobenzaprine 10 mg three times a day. What information will the provider include when teaching this patient about this drug?

Change products at the beginning of her next cycle. (When changing one combination OC for another, the change is best made at the beginning of a new cycle. It is not correct to begin taking the new product immediately or to stop the old product 1 week before starting the new product. An alternate means of contraception is unnecessary.)

When changing a patient's combination oral contraceptive (OC) to a different combination product, what advice will the provider give the patient?

memantine (Four drugs are approved for treating AD dementia. Three of the drugs—donepezil, galantamine, and rivastigmine—are cholinesterase inhibitors. The fourth drug—memantine—blocks neuronal receptors for N-methyl-D-aspartate (NMDA). Treatment of dementia with these drugs can yield improvement that is statistically significant but clinically marginal)

Which of the following agent works by blocking the NMDA receptor?

memantine (Memantine is not indicated for mild AD as studies have not demonstrated symptom improvement. It is indicated in patients with mild-moderate AD.)

Which of the following agents has not demonstrated symptom improvement in mild AD?

rivastigmine (Rivastigmine is metabolized by AChE in the brain. The other agents are metabolized by CYP-450 enzymes.)

Which of the following agents is not metabolized by CYP-450 enzymes?

Side effects, potential for worsening mood or suicidal ideation, expected response time to medication. (When initiating medication for the treatment of depression the prescriber provides information about side effects, expected response time and the potential for worsening mood and suicidal ideation. Additional information includes medication dosage and timing, future lab work to monitor for adverse effects of medication and that medication adjustments are performed after at least one month on current dosage.)

When initiating medication for depression the prescriber provides the following education:

Side effects, potential for worsening mood or suicidal ideation, expected response time to medication​ When initiating medication for the treatment of depression the prescriber provides information about side effects, expected response time, and the potential for worsening mood and suicidal ideation. Additional information includes medication dosage and timing, future lab work to monitor for adverse effects of medication, and that medication adjustments are performed after at least one month on the current dosage.)

When initiating medication for depression the prescriber provides the following education: ​

Sleep attacks (A few patients taking pramipexole have experienced sleep attacks, or an overwhelming and irresistible sleepiness that comes on without warning. Dizziness, hallucinations, and dyskinesias are listed as side effects of all dopamine agonists.)

When selecting a dopamine agonist for a patient with Parkinson disease, the provider identifies which side effect associated with pramipexole as being less likely to occur than with other dopamine agonists?

the likely organism, sensitivity of the organism to the drug, host characteristics. (When selecting an antimicrobial agent, the prescriber considers the likely organism, sensitivity of the organism to the drug and host characteristics such as immune system status and location of the infection. The prescriber should follow evidence-based guidelines for appropriate prescribing of antimicrobial agents to reduce risk of emergence of drug-resistant organisms.)

When selecting an antimicrobial agent, the prescriber considers

Oxandrolone has a Black Box Warning, as this agent can cause peliosis hepatitis, a condition in which blood-filled cysts form in the liver, leading to liver failure or intra-abdominal hemorrhage

Which androgen agent has a black box warning?

Decreased urinary hesitation (Terazosin is an 1-adrenergic antagonist. These medications relax the smooth muscles of the bladder neck to improve urinary symptoms experienced with BPH. They do not decrease the size of the prostate. Increased urinary frequency is a sign of worsening BPH, not improvement.)

Which finding indicates that terazosin has been effective for a patient with benign prostatic hypertrophy (BPH)?

Non-pharmacological sleep hygiene techniques should be explored before pharmacological intervention.

Which key educational point should be shared with the older adult (over the age of 65) regarding the use of sleep aids.

Estrogen Frovatriptan Naproxen (Menstrual migraines may be treated with estrogen, some perimenstrual triptans, such as frovatriptan, and Naproxyn. Neither amitriptyline nor ergotamine are used for that purpose.)

Which medications would a provider prescribe to treat menstrually associated migraine? (Select all that apply.

Sertraline 75mg PO daily (Sertraline 75mg PO daily is contraindicated with selegiline. Selegiline should not be combined with selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac). The combination of an MAO-B inhibitor plus an SSRI can cause fatal serotonin syndrome. Accordingly, SSRIs should be withdrawn at least 5 weeks before giving selegiline)

Which of Helen's medications is contraindicated with selegiline?

inability to name familiar objects anxiety difficulty sleeping (Symptoms of Alzheimer's disease include confusion, memory loss, disorientation, feeling lost in a familiar situation, impaired judgment, anxiety, insomnia, and other personality changes. Mimi's symptoms that support a diagnosis include her inability to name familiar objects, anxiety, and difficulty sleeping.)

Which of Mimi's symptoms support a diagnosis of Alzheimer's disease? Select all that apply.

Tadalafil (Cialis (Tadalafil) is the PDE5 inhibitor with the longest half-life of 36 hours. The half-life of Viagra is 4 hours; the half-life of Levitra's is also 4 hours. Doxazosin is an alpha-blocker used for BPH)

Which of the following PDE5 inhibitors has the longest duration of action?

risperidone olanzapine (There is convincing evidence that neuropsychiatric symptoms can be reduced with two atypical antipsychotics: risperidone (Risperdal) and olanzapine (Zyprexa). However, benefits are modest, and these drugs slightly increase mortality, mainly from cardiovascular events and infection. Cholinesterase inhibitors may offer modest help. There is little or no evidence for a benefit from conventional antipsychotics (e.g., haloperidol, chlorpromazine), mood stabilizers (valproate, carbamazepine, lithium), antidepressants, or memantine)

Which of the following antipsychotics has demonstrated a reduction in neuropsychiatric symptoms with their use? Select all that apply.

Melatonin OTC suvorexant (Belsomna)​ limit caffeine intake to early in the day​

Which of the following are other acceptable options for Scott if experiencing SE from Benadryl?

The following statements are true about benzodiazepines: · the prolonged use of benzodiazepines may lead to a tolerance of some effects of the medication but not others · no tolerance is developed for the anxiolytic effects of benzodiazepine. Benzodiazepines can cause physical dependence; therefore, this is a false statement. Benzodiazepines differ in their dependence potential; a tolerance does not occur toward all effects.

Which of the following are true statements about benzodiazepines?

pregnancy test liver function seizure frequency depression screening (Pregnancy tests, liver function tests, seizure frequency assessment, and depression screening are recommended before starting valproic acid. A negative pregnancy test is required as this medication is teratogenic. A baseline assessment of seizure frequency and determination of the type of seizures is also required. A depression screening is also needed before starting seizure medications. Liver function tests are a specific requirement before initiating valproic acid therapy.)

Which of the following baseline data are recommended before starting Amaya on valproic acid? Select all that apply.

the patient's cognitive function the level of disease severity activities of daily living patient's level of behavioral disturbances or quality-of-life

Which of the following clinical and/or laboratory parameters are necessary to evaluate therapeutic effects? Select all that apply.

Hypertension Diabetes Thromboembolism Cerebrovascular or cardiovascular disease Breast cancer Pregnancy

Which of the following conditions are absolute or potential contraindications for prescribing combined oral contraceptives for Jessica? Select all that apply.

Diabetes

Which of the following conditions in Jessica's family history is a relative contraindication for OC use?

chronic obstructive pulmonary disease (COPD) (Acetylcholine inhibitors can lead to an increase in acetylcholine at the synapses in the lungs leading to bronchoconstriction. Therefore, caution is warranted in patients with concomitant asthma or COPD.)

Which of the following conditions or diseases raise concern if acetylcholinesterase inhibitors were used to treat Mimi's AD?

Pregnancy test

Which of the following diagnostic tests is required before prescribing contraceptives for Jessica?

Hirsutism (Hirsutism is treated off-label with 5-α-reductase inhibitors. However, it is not known if 5-α-reductase inhibitors are excreted in breast milk. Women taking these drugs for off-label uses should not breastfeed. PCOS, pre-menstrual syndrome, and premenstrual dysphoric disorder (PMDD) are not treated off-label with 5-α-reductase inhibitors.)

Which of the following disorders is treated off-label with 5-α-reductase inhibitors?

Consider initiating Viagra at a lower dose due to his age of 65 years. (Consider lower dosing when prescribing drugs for erectile dysfunction to adults age 65 and older. Although Joe does have a positive cardiac history, he is not requiring any nitrates; therefore, a trial is indicated if accompanied with thorough patient education about the risks and possible adverse symptoms.)

Which of the following dosing considerations should be made due to Joe's age and cardiac history?

take the medication with low protein food Levodopa is administered orally and undergoes rapid absorption from the small intestine. Food delays absorption by slowing gastric emptying. Furthermore, because neutral amino acids compete with levodopa for intestinal absorption (and for transport across the blood-brain barrier as well), high-protein foods will reduce therapeutic effects (Rosenthal & Burchum, 2021, p. 129). Therefore, taking the medication with low protein foods would help preserve the therapeutic effect.)

Which of the following education points is required to help preserve the therapeutic effects of carbidopa/levodopa therapy?

female gender (Risk factors for Alzheimer's disease (AD) include female gender, previous family history, onset at 65 years or older, lower education, sedentary lifestyle, and smoking. The relevant risk factor for Mimi is her gender. She is not male and does not have a history of diabetes or is a smoker.)

Which of the following is a relevant risk factor for Mimi for Alzheimer's Disease?

Pregnancy (The decision whether to admit a woman to the hospital with acute PID can be difficult. Among the choices listed, only pregnancy is considered one of the CDC criteria for admission)

Which of the following is considered one the criteria for hospitalization in a woman with acute pelvic inflammatory disease?

motor function orthostatic vital signs reports of palpitations (Orthostatic vital signs: reports of palpitations, and motor function assessments are needed to monitor the effects of carbidopa/levodopa therapy. If palpitations are reported or dysrhythmias are suspected, an electrocardiogram (ECG) may be indicated. Motor function tests must be evaluated at each visit and compared with baseline values)

Which of the following is needed to monitor the effects of carbidopa/levodopa therapy? Select all that apply.

1.5 mg twice daily

Which of the following is the appropriate starting dose for oral rivastigmine (Exelon)?

benzodiazepine

Which of the following is the correct drug class for eszopiclone?

potentiates the action of inhibitory neurotransmitter

Which of the following is the correct mechanism of action for benzodiazepine medications?

donepezil monotherapy (For patients diagnosed with moderate AD, the drug of choice is a cholinesterase inhibitor plus consideration of memantine. It is not recommended to combine 2 cholinesterase inhibitors.)

Which of the following is the most appropriate treatment for moderate AD?

Bacterial vaginosis (Bacterial vaginosis is the most common diagnosis among women with symptomatic vaginitis, followed by candidiasis and trichomoniasis. There are several less frequent causes for vaginal discharge and/or irritation, including normal physiologic variation, allergic reactions, atrophic vaginitis, and lichen simplex.)

Which of the following is the most common cause of vaginitis in reproductive-aged women?

trazodone (Desyrel)

Which of the following medications is the best agent for treating an individual with a history of drug abuse and major depressive disorder (MDD)?

Tamsulosin (Tamsulosin and other α blockers are used off-label to treat women with urinary hesitancy and retention associated with bladder outlet obstruction or insufficient contraction of the bladder detrusor muscle. Benefits derive from relaxing the smooth muscle in the bladder neck and urethra. Maximal improvement may take several weeks to develop. Doxazosin, terazosin, and finasteride are not used off-label to treat women with urinary hesitancy and retention associated with bladder outlet obstruction.)

Which of the following medications is used off-label to treat women with urinary hesitancy and retention associated with bladder outlet obstruction?

Migraine headaches (Jessica reports a past medical history of migraine headaches which raises some concerns for starting her on OCPs. The use of OCPs in women with migraine headaches increases the risk of thrombotic stroke. Given the low risk, OCPs are generally considered safe for women with migraine headaches who are younger than 35 years, who do not smoke, are healthy, and whose headaches are not preceded by a visual change or aura. The best course of action is to determine whether Jessica experiences auras with her headaches and discuss the associated risks of OCPs with her before initiating therapy.)

Which of the following past medical history issues raises concern for starting Jessica on oral contraceptive pills (OCPs)?

A backup contraceptive is required when taking antibiotics

Which of the following patient education points should be included when teaching Jessica about oral contraceptive use?

Most men complain of urethral discharge (In contrast to chlamydial urethritis, which is more frequently asymptomatic, most men with urethritis due to Neisseria gonorrhoeae infection complain of urethral discharge and/or urethral discomfort. Epididymitis is a possible complication of genitourinary gonococcal infection, but most men with gonorrhea do not develop epididymitis. Coinfection with Chlamydia trachomatis does not significantly alter the clinical presentation of urethritis caused by N. gonorrhoeae)

Which of the following statements best describes the clinical sign and symptoms of urethritis caused by infection with Neisseria gonorrhoeae in men?

inhibit the breakdown of dopamine by MAO-B inhibitors (Both rasagiline and selegiline are MAO-B inhibitors and work by inhibiting the breakdown of dopamine by MAO-B.)

Which of the following statements best describes the mechanism of action of rasagiline?

Doxazosin and Terazosin (Beers Criteria includes the peripheral α-1 blockers doxazosin and terazosin among its listing of potentially inappropriate medications for patients age 65 and older. Tamsulosin and finasteride are not listed on the Beers Criteria.)

Which of the following α-1 blockers used in the treatment of BPH is listed on the Beers Criteria as a potentially inappropriate medication for patients age 65 and older? Select all that apply.

Premature rupture of membranes and preterm labor (Infection with Trichomonas vaginalis in pregnant women is associated with obstetrical adverse outcomes, including premature rupture of membranes, preterm labor, and preterm birth. Trichomoniasis does not increase the risk of ectopic pregnancy, infertility, or ovarian cancer.)

Which one of the following adverse clinical outcomes is associated with Trichomonas vaginalis infection in women?

Gram-negative diplococcus that preferentially attaches to epithelial cells (Neisseria gonorrhoeae is a gram-negative diplococcus that binds preferentially to mucus-secreting epithelial cells. Although N. gonorrhoeae can bind to other cell types, it utilizes its surface structures to bind to the urogenital epithelial cells.)

Which one of the following best describes Neisseria gonorrhoeae?

A painless, well-circumscribed ulcer that has a clean base and persists for 1 to 6 weeks

Which one of the following best describes a primary syphilis (chancre) lesion?

Asymptomatic (Although men with chlamydia infection may present with inflammatory signs and symptoms, most chlamydial urethral infections are asymptomatic. When discharge is present, it is usually mucopurulent, mucoid, or clear. Some patients will also have dysuria as a possible presentation, but this is less common. Scrotal pain is not commonly found in cases of urethritis but is common in patients who develop epididymitis.)

Which one of the following best describes the most common clinical presentation of chlamydial urethral infection in males?

Asymptomatic, or frothy gray or yellow-green vaginal discharge (Women with vaginitis caused by acute infection with Trichomonas vaginalis characteristically present with a frothy gray or yellow-green vaginal discharge and pruritus. Pelvic examination may show cervical petechiae ("strawberry cervix"). Many women, however, have no symptoms or minimal symptoms with trichomoniasis. Foul, fishy odor is characteristic of bacterial vaginosis whereas dysuria and milky white vaginal discharge best describes the presentation of candidiasis. Mucosal ulcerations generally do not result from any of the organisms that cause vaginitis.)

Which one of the following best describes the signs and symptoms of trichomoniasis in women?

Transmission is most efficient from infected male to susceptible female partner. (The efficiency of sexual transmission is greater from males to females compared with females to males. Analysis of data from a randomized, double-blind, placebo-controlled trial found that on a per sex act basis, the rate of HSV-2 acquisition was nearly 6 times higher for women than for men.)

Which one of the following best describes the transmission efficiency of herpes simplex virus (HSV)?

Overgrowth of Gardnerella vaginalis and Prevotella bivia (Although the etiologic agent in bacterial vaginosis is not known, symptomatic infection is characterized by a relative decrease in lactobacilli and an overgrowth of bacterial vaginosis-associated organisms, which are typically gram-negative rods and cocci. The organisms that appear to play the most significant role in the overgrowth are Gardnerella vaginalis and Prevotella bivia.)

Which one of the following changes in the normal vaginal environment is associated with bacterial vaginosis?

Lesions present, symptoms usually severe, HSV-1 and HSV-2 antibodies not present (In primary HSV-2 infection, lesions and severe systemic symptoms are typically present, and there are no antibodies to either HSV-1 or HSV-2. In nonprimary HSV-2 infection, the patient already has antibodies to HSV-1, which typically mitigate the severity of HSV-2 symptoms. Patients with recurrent symptomatic HSV-2 infection will usually have milder symptoms in the setting of established HSV-2 antibodies.)

Which one of the following combinations of clinical and laboratory findings most accurately describes primary HSV-2 infection?

Candida albicans (Candida albicans is responsible for approximately 85% to 95% of cases of vulvovaginal candidiasis in the United States. Other non-albicans candida species, including C. glabrata, cause the remainder of cases.)

Which one of the following fungal organisms is responsible for most cases of vulvovaginal candidiasis?

Non-Hispanic Black women (The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States is estimated at 3.1%, but rates are at least four times higher among non-Hispanic Black women. In addition, trichomoniasis prevalence increases with age. Trichomoniasis remains uncommon among men who have sex with men.)

Which one of the following groups has the highest rates of diagnosis of trichomoniasis?

Multiple sexual partners (Multiple sexual partners, age younger than 20 years, and current or prior infection with gonorrhea or chlamydia have consistently been demonstrated to be significant risk factors for PID. Other possible risk factors include history of PID, male partners with gonorrhea or chlamydia, current douching, insertion of IUD, bacterial vaginosis, and oral contraceptive use.)

Which one of the following has been identified as a factor associated with development of PID?

Late latent refers to syphilis infection of at least 1 year in duration

Which one of the following is TRUE regarding a definition of latent syphilis?

Asymptomatic (Women with cervical chlamydia infection most often are asymptomatic. When symptoms do appear they are typically non-specific and include vague pelvic discomfort and spotting. Women with chlamydial cervicitis can develop urethritis, pelvic inflammatory disease, and perihepatitis (Fitz-Hugh-Curtis syndrome). Chronic complications include fallopian tube scarring and infertility.)

Which one of the following is TRUE regarding the most common clinical presentation of chlamydial cervicitis in women?

C. trachomatis has a gram-negative-like cell wall (Chlamydia trachomatis has a gram-negative-like cell wall, but is not visible using a standard Gram's stain. This organism is an obligate intracellular pathogen. During the life cycle of C. trachomatis, the elementary body is the infectious form and the reticulate body is the replicative form.)

Which one of the following is TRUE regarding the organism Chlamydia trachomatis?

Women with trichomoniasis are 2 to 3 times more likely to acquire HIV. (Trichomoniasis confers a two- to three-fold risk of acquiring HIV. Among women living with HIV, more than half are coinfected with Trichomonas vaginalis and are at an increased risk for pelvic inflammatory disease and for shedding of HIV in the genital tract. Women with HIV do not have higher risk of recurrent or resistant trichomoniasis, and there are no data to support a higher rate of neonatal trichomoniasis in infants born to women with HIV.)

Which one of the following is TRUE regarding the relationship between trichomoniasis and HIV?

Rates decreased. (During the years 1999 through 2016, the HSV-2 seroprevalence rates steadily declined among persons 14 through 49 years of age in the United States.)

Which one of the following is TRUE regarding trends in HSV-2 seroprevalence rates in the United States from 1999 through 2016?

Azithromycin 1 gram orally in a single dose (The 2015 STD Treatment Guidelines recommend treating urogenital Chlamydia trachomatis infection in adults with either azithromycin 1 gram orally in a single dose or doxycycline 100 mg orally twice a day for 7 days. For rectal chlamydial infections, some experts prefer using doxycycline rather than azithromycin. Erythromycin ethylsuccinate and levofloxacin are considered acceptable alternative agents for the treatment of urogenital C. trachomatis infection.)

Which one of the following is an appropriate first-line therapy for urogenital infection due to Chlamydia trachomatis in an adult?

Follow-up visit and obtain NAAT to evaluate reinfection (at 3 months from initial visit) In most situations involving genitourinary chlamydial infection, patients do not require routine "test-of-cure" after appropriate therapy. Due to high rates of reinfection, patients should have a follow-up visit with additional testing even if asymptomatic; the testing for reinfection as well as additional education and counseling is recommended at 3 months after treatment.

Which one of the following is an appropriate plan regarding follow-up for a 19-year-old woman who is diagnosed with Chlamydia trachomatis cervicitis and treated with a recommended regimen?

Infertility (Even after one episode of PID, a woman has significant risk of developing subsequent complications, including ectopic pregnancy, infertility, and chronic pelvic pain. The risk for development of these complications increases further with multiple episodes of PID)

Which one of the following is considered a known chronic sequela following acute pelvic inflammatory disease (PID) in a young woman?

Tinidazole 2 grams orally in a single dose (The preferred treatment for trichomoniasis is single-dose therapy with either metronidazole (2 grams orally) or tinidazole (2 grams orally). Patients need to be instructed that alcohol consumption should be avoided during treatment with metronidazole or tinidazole. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or tinidazole.)

Which one of the following is considered a preferred regimen for the treatment of trichomoniasis in a 28-year-old woman who is not pregnant and has not antimicrobial allergies?

Routine annual screening for all sexually active females younger than 25 years of age (The CDC recommends routine screening for chlamydial infection every 12 months for all sexually active females under the age of 25. More frequent screening may be considered in higher risk populations. There is no recommendation for routine screening for chlamydial infection in males, although it is reasonable in male populations who have a higher risk of acquiring chlamydial infection.)

Which one of the following is most consistent with current CDC recommendation for screening for chlamydial infection?

Nucleic acid (DNA, RNA) amplification technique on a urine or urethral swab sample (The nucleic acid amplification test (NAAT) has emerged as the preferred method to diagnose chlamydial infection, primarily because of improved sensitivity; this test is FDA approved for use on urine specimens from men and women, urethral swabs in men, and endocervical swabs in women. Cell culture techniques remain an acceptable method for the diagnosis of chlamydial infection, but they are no longer preferred because of the test complexity and lower sensitivity when compared with NAAT.)

Which one of the following is the preferred method to diagnose chlamydial urethritis in men?

Perform annual screening in sexually active females 24 years or younger and in older women who are at increased risk for infection

Which one of the following most accurately describes recommendations for chlamydia screening in asymptomatic females?

Routine screening should be performed at least annually

Which one of the following most accurately describes the recommendation from the Centers for Disease Control and Prevention regarding screening for Neisseria gonorrhoeae in sexually active men who have sex with men?

Oral acyclovir (HSV antiviral therapy for episodic therapy of recurrent HSV includes three preferred oral medications, all with similar efficacy: acyclovir, valacyclovir, and famciclovir. Intravenous acyclovir should be reserved for patients with severe HSV disease or complications requiring hospitalization (e.g. disseminated infection, pneumonitis, or hepatitis) or complications of the central nervous system (e.g. meningitis or encephalitis). Intravenous cidofovir, topical cidofovir, and topical imiquimod have been used to treat acyclovir resistant HSV, but these therapies are not recommended for routine treatment of HSV.)

Which one of the following options is a preferred therapy for both episodic and suppressive treatment of recurrent genital herpes infections?

Herpes simplex virus type 2 (Most cases of recurrent genital and perirectal herpes in the United States are caused by herpes simplex virus type 2 (HSV-2). More recently, however, an increasing proportion of anogenital herpetic infections have been attributed to HSV-1, especially in young women, college students, men who have sex with men, and heterosexual African American men.)

Which one of the following organisms is responsible for most cases of recurrent genital herpes in the United States?

Valacyclovir 500 mg orally once daily taken by the HSV-seropositive partner

Which one of the following regimens has been shown to reduce transmission of HSV in heterosexual HSV-2 discordant heterosexual couples?

Suppressive antiviral therapy with daily valacyclovir decreases the rate of HSV-2 transmission to susceptible heterosexual partners. (Suppressive therapy delays the time to first genital herpes recurrence and reduces the frequency of recurrences by approximately 75% in patients who have frequent recurrences. Furthermore, treatment with valacyclovir 500 mg daily has been shown to decrease the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection. There is no evidence that suppressive therapy leads to antiviral resistance, and all the anti-HSV antiviral agents can be dose-adjusted for patients with renal impairment.)

Which one of the following statements about suppressive antiviral therapy for HSV-2 is TRUE?

Routine screening is not recommended

Which one of the following statements best describes the 2016 U.S. Preventive Task Force Service Recommendation regarding serologic screening for genital herpes infection in asymptomatic adolescents and adults?

Reporting is required in all states (Laws and regulations in all states require reporting of all persons diagnosed with Chlamydia trachomatis infection to public health authorities by clinicians, laboratories, or both.)

Which one of the following statements best describes the reporting requirements for a person diagnosed with Chlamydia trachomatis infection in the United States?

All sex partners during the 60 days preceding the onset of symptoms should be referred for treatment (All sex partners within the 60 days preceding the onset of symptoms or diagnosis of chlamydia should be referred for treatment. Partners with exposure greater than 60 days preceding the onset of symptoms or diagnosis of chlamydia do not need to be routinely screened or treated. Referral and treatment should occur for the most recent partner, even if this contact occurred more than 60 days prior. Similarly, all symptomatic contacts should be referred, regardless of time since diagnosis.)

Which one of the following statements is TRUE for CDC recommendations for the management of sex partners of a patient diagnosed with urogenital chlamydia infection?

Patients should be re-examined within 72 hours after initiation of therapy. (All women who receive treatment for PID should be re-examined within 72 hours after initiation of therapy; this follow-up evaluation should demonstrate substantial clinical improvement. Retesting for chlamydial or gonococcal infection is recommend at 3 to 6 months after treatment. There are no specific recommendations to monitor for long-term sequelae after PID.)

Which one of the following statements is TRUE regarding appropriate follow-up for PID?

Neurosyphilis can occur in patients with secondary, early latent, or late latent syphilis. (Patients can develop syphilis early or late in the course of illness. Early neurosyphilis can develop in patients with secondary syphilis and patients may present with meningitis, cranial neuropathy, and occasionally stroke-like symptoms. Clinical manifestations of late neurosyphilis include general paresis and tabes dorsalis but can present with a wide variety of neurologic symptoms. Ocular involvement can occur in early or late neurosyphilis. Patients can develop neurosyphilis during secondary, early latent, or late latent syphilis.)

Which one of the following statements is TRUE regarding neurosyphilis?

Since 2012, syphilis rate in males has been significantly higher than in females. (Overall, since 2012, cases of primary and secondary syphilis in males have markedly exceeded the number of cases in females. In 2019, males had a 5-fold higher rate of primary and secondary syphilis than females. Overall, nearly 50% of cases of primary and secondary syphilis in males involve men who have sex with men.)

Which one of the following statements is TRUE regarding reported rates of primary and secondary syphilis in the United States?

Treponema pallidum is a motile spirochete bacterium that is approximately 6 to 20 micrometers in length.

Which one of the following statements is TRUE regarding the biology of Treponema pallidum?

Herpes simplex virus type 2 is a DNA virus that causes chronic infection. (Herpes simplex virus (HSV) type 1 and type 2 have a single, linear molecule of double-stranded DNA that encodes approximately 74 genes. Following initial genital infection, HSV is transported from the infected epithelial cells along the peripheral nerve axons to the sacral ganglia and paraspinous ganglia. At this point, HSV establishes chronic infection and enters a latent phase.)

Which one of the following statements is TRUE regarding the organism herpes simplex virus type 2?

The increased risk of PID is primarily confined to the first 3 weeks after insertion of the intrauterine contraceptive device

Which one of the following statements is TRUE regarding the risk pelvic inflammatory disease (PID) associated with use of an intrauterine contraceptive device?

Transmission can occur via sexual contact, from human bites, across the placenta, or through transfusion of blood products. (Treponema pallidum is known to be transmitted via sexual contact, human bites, from mother-to-child across the placenta, or through transfusion of blood products. The transmission of T. pallidum has not been described with respiratory secretions, fomites, or gastrointestinal secretions.)

Which one of the following statements is TRUE regarding transmission of Treponema pallidum?

Active infection with Trichomonas vaginalis confers a two to three-fold risk of acquiring HIV infection.

Which one of the following statements is TRUE regarding trichomoniasis and HIV?

Routine screening is recommended and should be performed at the first prenatal visit; repeat syphilis screening may be indicated in the early third trimester and at delivery. (Routine screening for syphilis in pregnancy is recommended by the CDC and the American College of Obstetrics and Gynecology; the screening for syphilis should be performed at the first prenatal visit. Women who are at high risk for syphilis or live-in areas of high syphilis morbidity should have repeat screening performed at around 28 weeks gestation and again at delivery.)

Which one of the following statements most accurately reflects recommendations for syphilis screening in pregnant women?

Nucleic acid amplification testing (NAAT) (Nucleic acid amplification tests (NAATs) have increasingly become the primary test used to diagnose Neisseria gonorrhoeae genital infections. Multiple studies have shown that NAATs have greater sensitivity for detecting N. gonorrhoeaethan Gram's stain, culture, or DNA probe testing. These tests are FDA-cleared for diagnosis of N. gonorrhoeae in endocervical specimens from women, urethral specimens from men, and urine specimens from men and women. In addition, some laboratories have validated N. gonorrhoeae for use with rectal or oropharyngeal specimens.)

Which one of the following tests has the highest sensitivity for detecting Neisseria gonorrhoeae from a sample of purulent cervical discharge?

Cefoxitin 2 g IV every 6 hours plus Doxycycline 100 mg orally or IV every 12 hours (Prompt and effective therapy is essential to optimize good outcomes for women with PID. Three parenteral regimens are recommended for the treatment of PID: · Cefotetan 2 g IV every 12 hours PLUS Doxycycline 100 mg orally or IV every 12 hours, or · Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours, or · Clindamycin 900 mg IV every 8 hours PLUS Gentamicin loading dose IV or IM (2 mg/kg), followed by a maintenance dose (1.5 mg/kg) every 8 hours. Single daily dosing (3-5 mg/kg) can be substituted.)

Which one of the following treatment regimens is considered a recommended parenteral option for the initial treatment of a woman with pelvic inflammatory disease?

Vulvovaginal candidiasis diagnosed in a 34-year-old woman with diabetes mellitus. (Most women diagnosed with vulvovaginal candidiasis have an uncomplicated course of infection and treatment. Some women, however, have complicated vulvovaginal candidiasis, which is defined as infection that is 1) moderate to severe, 2) associated with pregnancy or other concomitant conditions (i.e., immunosuppression, diabetes mellitus), or 3) recurs more than four times per year in immunocompetent women. Complicated vulvovaginal candidiasis requires further diagnostic testing with culture and may necessitate longer treatment courses or maintenance therapy with antifungal medications.)

Which one of the following women would be considered to have complicated vulvovaginal candidiasis?

Patients who have not responded to SSRIs and TCAs Patients diagnosed with atypical depression Patients with bulimia nervosa (Patients who have not responded to SSRIs or TCAs, patients with atypical depression, and patients with bulimia nervosa are candidates for MAOIs. MAOIs contribute to hypotension and therefore are contraindicated in patients with hypotension. MAOIs are not recommended for the treatment of postpartum depression.)

Which patients will the provider consider as candidates for monoamine oxidase inhibitor (MAOI) therapy? (Select all that apply.)

Signs and symptoms of hyperglycemia (Signs and symptoms of hyperglycemia are important educations points to review with Jessica as she has a family history of diabetes and is taking OCs. OCs can elevate blood glucose levels. This diabetogenic effect is caused by OC progestin)

With Jessica's family history of diabetes, which of the following education points is indicated in the use of OCs?

estrogen

baseline data needed prior to prescribing this medications: heart rate, blood pressure, and weight pregnancy test, thyroid-stimulating hormone (TSH), serum triglyceride (or full lipid panel, if indicated) screening for breast cancer and cardiovascular disease pelvic exam, if indicated

Heart block (When absorbed in a sufficient amount, local anesthetics can affect the heart and blood vessels. These drugs suppress excitability in the myocardium and conduction system and can cause hypotension, bradycardia, heart block, and potentially cardiac arrest. Anaphylaxis would be manifested by hypotension, bronchoconstriction, and edema of the glottis. Central nervous system excitation would be manifested by hyperactivity, restlessness, and anxiety and may be followed by convulsions. No evidence indicates respiratory depression; this patient's respirations are within normal limits.)

Within a few minutes of administration a local anesthetic, the patient has a pulse of 54 beats/minute, respirations of 18 breaths/minute, and a blood pressure of 90/42 mm Hg. The provider should monitor the patient for further signs of what condition?

Progestin

baseline data needed prior to prescribing this medications: heart rate, blood pressure, and weight pregnancy test screening for breast and cardiovascular disease pelvic exam, if indicated

Suicide risk with antidepressant drugs​ Drug-drug interactions​ (Patients with depression may consider or attempt suicide. The risk for suicide may increase at the start of treatment with antidepressants. Antidepressant-induced suicide is more prevalent in children, adolescents, and adults younger than 25 years.​)

black box warning of antidepressants

Stimulant actions​ Suppresses appetite​

effects of Bupropion (Wellbutrin)​

mild antihistamine effects​

effects of Citalopram (Celexa)​

Progestin

contraindicated in undiagnosed abnormal vaginal bleeding relative contraindications include active thrombophlebitis or a history of thromboembolic disorders, active liver disease, and carcinoma of the breast

Can treat pain syndromes from fibromyalgia and neuropathies​

effects of Duloxetine (Cymbalta) ​

Long half-life​ Good for patients who may forget dose ​

effects of Fluoxetine (Prozac)​

Treats anxious depression​ Increased dose for smokers​

effects of Fluvoxamine (Luvox)​

Social anxiety​ insomnia​

effects of Paroxetine (Paxil)​

Bupropion (Wellbutrin)​

examples of Norepinephrine Dopamine Reuptake Inhibitor (NDRI)​

Citalopram (Celexa)​ Escitalopram (Lexapro)​ Fluoxetine (Prozac)​ Paroxetine (Paxil)​ Fluvoxamine (Luvox)​ Sertraline (Zoloft)​

examples of Selective Serotonin Reuptake Inhibitors (SSRIs)​

Venlafaxine (Effexor)​ Desvenlafaxine (Pristiq)​ Duloxetine (Cymbalta) ​

examples of Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)​

migraines

hormone based contraceptive that is safe for use in females younger than 35 years who have this condition and do not smoke, and are healthy, and do not experience an aura

Progestin

monitoring requirements during which hormone therapy: blood pressure assessment for fluid retention, including weight referral for transvaginal ultrasound or hysteroscopy for occurrence of undiagnosed bleeding that continues for 6 months

Estrogen

monitoring requirements during which hormone therapy: blood pressure, and weight serum triglycerides and TSH regular breast and pelvic exams as recommended for age endometrial biopsy for unscheduled bleeding that continues for 6 months

Can be used for perimenopausal vasomotor symptoms. ​

use of Desvenlafaxine (Pristiq)​

Men produce more testosterone which results in higher amounts of erythropoietin and erythrocytes

why do men have higher hematocrit levels than women?

The medication will take several weeks to achieve full effect; therefore, continuing the prescribed dose is recommended.​ (Antidepressant medications generally take 4-6 weeks to achieve symptom relief. Although an additional medication may need to be added or a different medication may need to be prescribed if no improvement is seen, the NP should wait to ensure enough time for the initial prescription to work.)

​Christina calls the office after 2 weeks and complains that she feels "the same" and wants to know if she can have a different prescription to treat her depression. Which of the following statements is an appropriate response to Christina?​