menotropin, follitropin or clomiphene to induce follicular maturation
Which medication is a dopamine agonist used to correct amenorrhea and infertility d/t high prolactin?
Which of these instructions should a nurse give a patient who is to start taking clomiphene [Clomid]? "Have intercourse every other day for 5 to 10 days after the last dose of this medication."
When evaluating the effects of leuprolide [Lupron] in a patient who has endometriosis, a nurse should monitor the laboratory results for which hormone or hormones?
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
he nurse is aware that goserelin [Zoladex] has several uses, including which? (Select all that apply.)
Dysfunctional uterine bleeding Correct
Prostate cancer Correct
Prinicipal inidication for androgens?
Hormone therapy has 3 indications
-mod to severe vasomotor symptoms
-mod to severe vulvar and vag atrophy
-prevention of osteoporosis
Which 2 antidepressants are being used to treat hot flashes?
Admin of estrogen patch? cream? gel? spray? ring?
abdomen or trunk
top of both thighs or back of both calves
after showering, one arm from shoulder to wrist
inner forearm; dry for 2 minutes
leave in place for 3 mos
During the follicular phase of the menstrual cycle, estrogen has which effects on the female reproductive organs?
Proliferation of the endometrium
What is the primary difference between the selective estrogen receptor modulators tamoxifen and raloxifene?
Raloxifene does not increase the risk for uterine cancer.
Progestins may be used to treat which conditions?
Endometrial hyperplasia Correct
Dysfunctional uterine bleeding Correct
Which 2 progestins have the greatest risk for thrombosis?
Risk factors that increase risk of thromboembolism: 3
hx of thromboembolism
hx of thrombophilias
OCs should be DC'd when before surgery?
Which meds REDUCE the effects of OCs?
St john's wort
Which meds need be increased when used with OCs?
IUDs should only be used by who?
monogamous women with low risk of STD
Mifepristone (Mifeprex) is used for what?
abortion; it blocks receptors for progesterone and glucocorticoids
can be given within 7 wks of conception
A patient who takes an angiotensin-converting enzyme (ACE) medication is scheduled to begin taking the Yaz oral contraceptive (OC). Which laboratory results should the nurse monitor during the first cycle of use?
A nurse obtains a health history from a patient who is scheduled to take a combination OC. Which factor in the patient's history should the nurse recognize as a contraindication to this treatment?
he nurse is aware that which 28-day regimen is least likely to simulate ovarian production of estrogens and progestins?
What is the main diff between NRTIs and NNRTIs?
NNRTIs cause DIRECT inhibition of reverse transcriptase
given in active form
Efavirenze (Sustiva) AE 4
AEs of protease inhibitors (5)
fat redistribution (pseudo-Cushing's)
reduced bone mineral density
Scultpra is used to
restore or correct loss of facial fat in people with HIV
Tesamorelin (Egrifta) is used for
reducing excess visceral abdominal fat of HIV pts
Most common AE of Lopinavir/Ritonavir (Kaletra)
A cardiac AE of Lopinavir/Ritonavir (Kaletra) is
prolonged PR and QT interval
Oral solutions of Lopinavir/Ritonavir (Kaletra) should not be given to
pts taking disulfiram and metronadizole
Enfuvirtide (Fuzeon) is a? MOA? admin?
HIV fusion inhibitor
blocks the entry of HIV into CD4 cells
given subQ BID
Maraviroc (Selzentry) is a? MOA? use of drug is low bc?
blocks viral entry
dosing is complex; adjusted based on other drugs; expensive testing prior to therapy
What are the lab tests performed in HIV therapy?
CD4 T-cell count
HIV drug resistance
HLA-B 5701 (for Abacavir)
CCR5 tropism (for Maraviroc)
Postexposure prophylaxis (PEP) should be initiated
ASAP; within 1-2 hrs; no later than 72 hours
When should antiretroviral be given when a mother is infected with HIV; which med?
during gestation and labor
to infant up to 6 wks postpartum
Drug of choice for pneumocystis pneumonia
What 4 meds are used to tx CMV in HIV pts
Med used for meningitis in HIV pt
amphotericin B w/ flucytosine
maintenance: oral fluconazole
med used to tx HSV in HIV pts
tx of chlamydia for adults and adolescents
single 1 gm azithromycin
100 mg doxycycline BID x 7 days
tx of chlamydia for pregnant women
single 1 gm of azithromycin
500 mg og amoxicillin TID x 7 days
tx of urethral, cervical, and rectal gonorrhea
ceftriaxone 250 mg IM x 1
azithromycin 1 gm PO or doxycycline 100 mg PO BID x 7 days
tx of PID
cefoxitin or cefotetan with doxycycline
tx of syphillis
If pt is allergic to PCN, syphyllis can be tx with?
doxycycline or tetracycline
bacterial vaginosis is tx with?
nonpregnant: flagyl PO or flagyl/clindamycin cream
pregnant: clindamycin or flagyl PO only
tx for trichomoniasis
tx of genital herpes 3; MOA; admin
these meds only reduce symptoms and shorten the duration of pain and viral shredding
every day or only when symptoms occur
A patient who has HIV and is taking the nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) zidovudine [Retrovir] reports vomiting, abdominal pain, fatigue, and hyperventilation. Which laboratory result is the priority for the nurse to evaluate?
arterial blood lactate
A patient has been prescribed efavirenz [Sustiva]. The nurse should instruct the patient to use which administration approach to minimize central nervous system (CNS) adverse effects?
Which is the most common bacterial sexually transmitted disease (STD) in the United States, for which the Centers for Disease Control and Prevention (CDC) has recommended annual screening in certain populations?
A nurse instills 1% silver nitrate topically into the eyes of a neonate on delivery to prevent conjunctivitis caused by what?
How does sildenafil work?
inhibits PDE5, which preserves cGMP levels in penis
Palonosetron compared to other serotonin antagonists
has longer half life
effected against both acute and delayed emesis
Which 2 glucocorticoids are used to suppress CINV?
IV, short term, intermittent
Aprepitant (Emend) is approved for? MOA? instruction?
preventing postop N/V and CINV
it blocks neurokinin1-type receptors
must be combined with other antiemetics (ie glucocorticoid, serotonin antagonist)
Fosapretitant (Emend) is? indication?
prodrug convert to aprepitant in the body
indicated only for CINV
Which benzo is used in combination with other antiemetics? benefits? (4)
suppression of anticipatory emesis
production of anterograde amnesia
Dopamine antagonist (phenothiazine) MOA; SE? (4)
block dopamine2 receptors
Promethazine can cause
Promethazine is CI in
children < 2 yrs
Which route is preferred for promethazine?
IV route: 25mg/mL rate of 25mg/min
Butyrophenones drugs used for anti NV? MOA? SE?
block dopamine2 receptors
EPS, sedation, hypotension, QT prolongation
Which 2 cannbinoids are used to prevent CINV?
considered 2nd line d/t potential for abuse
Dronabinol is also used to
increase appetite in pts with AIDS
CI for pts w/ psych issues
Dronabinol is classified as
Schedule III d/t its slow onset and no interest in streets
Regimens for CINV
High risk: aprepitant + dexamethasone + ondansetron
Moderate: dexamethasone + palonosetron
First-line therapy for NV in pregnancy
doxylamine + vit B6 (pyridoxine)
trade name: Dicletin, Diclegis
start with 2 tabs at bedtime
Most effective drug for motion sickness; SE? (3)
dry mouth, blurred vision, drowsiness
Most effective antidiarrheal agents (5)
dcrease intestinal motility
allow more time for absorption of fluid and electrolytes
Opioids used for diarrhea
difenoxin (+ atropine)
Infectious diarrhea is
usually self-limiting and requires no treatment
tx for infectious diarrhea
cipro or norfloxacin
children and pregnant women: azithromycin
Prohyplaxis vaccine for diarrhea
nonspecific drugs for IBS include
IBS-specific drugs include
Alosetron is indicated
ONLY for women with IBS-D lasting 6 mos
selectively blocks 5HT receptors
improvement should be seen in 4 weeks
Alosetron should be discontinued when
constipation occurs and ischemic colitis
Tegaserod is CI
in women with known CV disease
2 IBD are
Crohn's and ulcerative colitis
5 drugs for IBDs are
these drugs are NOT curative
Sulfasalazine is indicated for; AE?
IBD (mild to mod) and RA
hematologic disorders (CBC needed)
Indications for Mesalamine, olsalazine, balasalazide
mesalamine: mild to mod IBD
olsalazine: maintenance therapy of ulcerative colitis
balsalazide: mild to mod active ulcerative colitis
immunosuppressants used for IBD and crohn's
azathioprine & mercaptopurine
used for LONG term therapy
Immunomodulators used for IBD and crohn's
infliximab (remicade) TNF inhib
adalimumab (humira) TNF inhib
natalizumab (tysabri) interfere with alpha4 integrin
Infliximabd (remicade) AE
infection (TB, opportunistic)
Abx (Flagyl and Cipro) are only effective against
it is not helpful in ulcerative colitis
Reglan has 2 actions
increase upper GI motility
AE: sedation, diarrhea, tardive dyskinesia
CI: GI obstruction, perforation, hemorrhage
Pralifermin is indicated for
oral mucositis of pts with hematologic malignancies
AE: rashe, erythema, edema, discoloration of tongue
should be stopped 24 hrs before chemo and should not resume until after 24 hours
A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer?
The nurse is reviewing the prescriber's orders and notes that omeprazole [Prilosec] has been ordered for a patient admitted with acute coronary syndrome (ACS). The nurse should be concerned if this medication is combined with which medication noted on the patient's record?
An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication?
A nurse is planning care for a patient undergoing chemotherapy. The care plan includes medications to reduce chemotherapy-induced nausea and vomiting (CINV). Which regimen should the nurse recognize as effective?
aprepitant & zofran
A nurse teaches a patient who has ulcerative colitis about the side effects of the treatment medication, sulfasalazine [Azulfidine]. Which statement by the patient would indicate understanding of the information?
report any fatigue or sore throat
Laxatives arre contraindicated in pts with
abd pain, nausea, cramps
symptoms of appendecitis
fecal impaction or obstructions of bowel d/t risk of perforation
4 classifications of laxatives based on MOA
classification of laxatives based on therapeutic effect
Group I: within 2-6 hours; watery stool
Group II: intermediate; 6-12 hours; semifluid
Group III: slow 1-3 days; soft but formed
Metamucil; methylcellulose (bulk-forming agent) should be taken
with full glass of H2) to prevent esophageal obstruction
Colace is a ? MOA?
lowers surface tension; inhibit fluid absorption
example of stimulant laxatives?
bisacodyl: group II
senna: group II
castor oil: group I
stimulant laxatives are indicated only for
opioid induced constipation
constipation d/t slow intestinal transit
castor oil is indicated for rapid and thorough evacuation of bowels (prep for procedures)
Osmotic laxative (mg salts) are CI in
pts with kidney disease
sodium phos is a? CI?
HF, HTN, edema
what are the fat-soluble vits?
A D E K
what is the first indication of vit A deficiency?
Vit A deficiency can lead to
xeropthalmia and keratomalacia
Vit A toxicity is referred to as? it can lead to?
Vit A (retinol) therapeutic use?
vit a deficiency
What is the UL of vit A?
classic effects of vit d deficiency
Vit E helps
protect against peroxidation of lipids
High-dose vit E increases risk of
doses above 200 IU/day should be avoided
Vit K is required
for synthesis of clotting factors and prothrombin
Vit K deficiency can cause
bleeding tendencies and spontaneous hemorrhage
In order to prevent neonatal hemorrhage,
Vit K (.5-1 mg) is given after delivery
Ther uses for Vit K
bleeding caused by Vit K deficiency
control of hemorrhage causes by warfarin
Vit C deficiency leads to
scurvy: faulty bone and tooth devt; loosening of teethc; gingivitis; poor wound healing; heamorrhage
the UL for vit C is
niacin deficiency is called
pellagra "rough skin"
riboflavin (B2) deficiency results in
thiamine (b1) deficiency has two forms
wet beriberi (primary symptom is leg edema
dry beriberi (neuro and motor deficits)
Pyridoxine (B6) deficiency results from
inborn errors of metabolism
Pyridoxine UL is
Which vit B interferes with levodopa?
folic acid deficiency results in
neural tube defects
recommendation to ensure sufficient folate
all women capable of being pregnant should take 400-800 mcg of folic acid each day
orlistat is used to? MOA? AE? CI? DI?
promote and maintain weight loss
acts in GI tract to reduce absorption of fat by inhibiting gastric and pancreatic lipase