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Chlamydia treatment Azithromycin, 1 g PO once or Doxycycline, 100 mg PO 2 times\/day \u00d7 7 days
Uncomplicated gonococcal urethritis treatment intramuscular ceftriaxone dose of 250 mg IM once,PLUS Azithromycin, 1 gram PO once.
Bacterial Vaginosis treatment Metronidazole 500mg PO BID x 7 days OR Metronidazole gel (0.75%), 1 full applicator (5 grams) intravaginally once a day x 5 days OR Clindamycin cream (2%), 1 full applicator (5 grams) intravaginally at bedtime x 7 days.
Herpes Simplex Virus treatment Recommended RegimensAcyclovir 400 mg PO three times a day for 7-10 days (or longer). ORAcyclovir 200mg PO 5 times a day x 7-10 days (or longer). ORFamciclovir 250 mg PO three times a day for 7-10 days (or longer). ORValacyclovir 1 g PO twice a day for 7-10 days (or longer).
Trichomoniasis treatment Metronidazole 2 grams PO once OR Tinidazole, 2 grams PO once.
Syphilis treatment Adults: Benzathine penicillin G, 2.4 million units IM once.Children: Benzathine penicillin G, 50,000 units\/kg IM once (up to a max of 2.4 million units).
Doxazosin (Cardura) alpha-1 adrenergic blockerCauses receptors in blood vessels to relax. Immediate release forms of this drug are used for hypertension and BPH. Extended release (Cardura XL) is approved for management of BPH only. Preferred for men with relatively small prostates (dynamic obstruction)
Doxazosin side effects (due to alpha 1 receptor being blocked) profound hypotensiondizziness\/syncope, headache, first-dose orthostatic hypotension, drowsiness, nasal congestion
Dutasteride aka Avodart is a 5-a-Reductase Inhibitor. Used in the treatment of BPH and are appropriate for men with very large prostates (mechanical obstruction). helps reduce size of prostate.
Dutasteride patient teaching Anticipate symptom improvement after 6-12 months.reduces ejaculate volume and libido in some men and causes a decline in PSA in all men cannot donate blood while taking this medication for at least 6 months (long half life) teratogenic, absorbed through skin (pregnant women should not even touch it)
Terazosin aka (Hytrin) How to know it’s working is a a1-Adrenergic antagonist. Symptomatic improvement & increased urinary flow develop rapidly. To maintain benefits, they must be taken lifelong.
Various routes of administration of estrogen transdermal Transdermal estradiol is available in 4 formulations: 1- Emulsion (Estrasorb): Applied once daily to the top of both thighs & the back of both calves.2- Spray (Evamist): Applied once daily to the forearm3- Gels (Estrogel, Elestrin, Divigel): Applied once daily to one arm, from the shoulder to the wrist or to the thigh (Divigel). 4- Patches (Alora, Climara, Estraderm, Menostar, Vivelle-Dot): Applied to the skin of the trunk (but not the breast)
transdermal has four advantages: 1-The total estrogen is greatly reduced2-There is less nausea and vomiting3-Blood levels of estrogen fluctuate less4-There is lower risk for DVT, PE, and stroke
Intravaginal: Estrogens for intravaginal are available as inserts, creams, & vaginal rings. All are used primarily for the treatment of vulval & vaginal atrophy associated with menopause. NOTE: Femring is also used for systematic effects to control hot flashes & night sweats.
Systemic estrogen options:Oral: Owing to convenience, the oral route is used more than any other. The most active estrogenic compound\u2014estradiol\u2014is available alone & in combination with progestins.
Parenteral: Although estrogens are formulated for IV & IM administration use of these routes is rare. IV administration is generally limited to acute, emergency control of heavy uterine bleeding.
\u2022By blocking estrogen receptors tamoxifen protects against ? .) Protection against osteoporosis maintenance of the urogenital tract, reduction of LDL cholesterol while avoiding its drawbacks (promotion of breast cancer, uterine cancer, and thromboembolism.) \u2022Hormone replacement therapy increases risk for <\/em><\/strong><\/em><\/strong>? Endometrial cancer, thromboembolism, stroke. (BLACK BOX WARNINGS)
\u2022HRT in women >65 years old increases the risk for _<\/em><\/strong>? Dementia
\u2022What surgical history is a contraindication to progestin use? Hysterectomy
Which of the following statements by a breastfeeding mother would indicate understanding of estrogen use? Select all that apply \u2022It may affect my baby’s growth and development\u2022It may affect the quality and quantity of my breastmilk\u2022f I choose to take estrogen, it is absolutely contraindicated if I get pregnant again.
Hormone Replacement Therapy\u2022Selective Estrogen Receptor Modulators: Tamoxifen, Toremifene, Raloxifene, Bazedoxifene\u2022 Which meds do not pose risk for uterine cancer? 1.Raloxifene-no risk uterine cancer
\u2022Bazedoxifene is recommended for prevention of what in postmenopausal women with a uterus? 1.Osteoporosis
\u2022.) What is the FDA approved med for prevention of vasomotor symptoms and osteoporosis in postmenopausal women with a uterus? 1.Duavee (conjugated estrogens\/bazedoxifine). Common vasomotor symptoms: Hot flashes and drenching sweat.**To keep risk low, HT should be used in LOWEST dosage and for SHORTEST time needed (often <5 years) to accomplish treatment goals. Long-term HRT should be avoided as most risks outweigh benefits.
\u2022What are some non-contraception uses for progestin? 1.Uses: Menopausal hormone therapy, dysfunctional uterine bleeding, amenorrhea, endometrial hyperplasia (potentially pre-cancerous condition) and carcinoma, support early pregnancy in women with corpus luteum deficiency syndrome and those undergoing in vitro fertilization
\u2022What is the only approved indication for long-term progestin use? Long-term progestin use only approved indication is protection against endometrial cancer.
\u2022When are progestins contraindicated? Progestins are contraindicated in the presence of undiagnosed abnormal vaginal bleeding.Relative contraindications include active thrombophlebitis or history of thromboembolic disorders, active liver disease, and carcinoma of the breast. Progestins should not be prescribed in women who have undergone hysterectomy.
\u2022What are some side effects of progestins? Side effects may include higher risk for irregular bleeding than estrogens due to the effects on the endometrium; including breakthrough bleeding, spotting, amenorrhea, inconsistent cycle length, variations in volume and duration of monthly flow.20% of patients experience breast tenderness, headache, abdominal discomfort, arthralgias, and depression
Benefits of prescribing medroxyprogesterone acetate (Depo-Provera) is a Long-acting contraceptive. It is given by injection IM or sub-Q. It protects against pregnancy for 3 months or longer by inhibiting the secretion of gonadotropins. The drug thereby inhibits follicular maturation and ovulation, thickens the cervical mucus, and causes thinning of the endometrium, making implantation unlikely. When injections are discontinued, return of fertility is delayed by an average of 9 months. Use of a long-term method can confer more reliable protection.Reduces risk of endometrial cancer
Testosterone therapy Patient teaching in general and consider teaching specific to different routesTopical testosterone: To minimize the risk for accidental skin-to-skin transfer, advise users of testosterone gel or testosterone topical solution to:Wash their hands after every applicationCover the application site with clothing after the gels has driedWash the application site before anticipated contact with another personAlso, warn women & children to avoid contact with the user’s skin where testosterone was applied & advise them to wash contaminated skin if accidental contact with an application site should occur.
Black Box Warning: Testosterone therapy Secondary exposure to testosterone gel on uncovered skin and to testosterone gel on unwashed clothing has resulted in virilization in children
Oral testosterone: fluoxymesterone & methyltestosterone are the only 2 androgens approved for oral therapy. Despite the cost & ease of administration, they are not first-line agents. The androgenic effects of oral androgens are erratic & pose a risk for hepatotoxicity; therefore, they should not be used long term.
Transdermal patches\/gel: testosterone: Applied once daily to the upper arm, thigh, back, or abdomen. Can be transferred to others by skin-to-skin contact. Wash hands with soap & water after every application, cover the application site with clothing once the gel has dried, wash the application site before skin-to-skin contact with another person, women & children should avoid skin-to-skin contact with application sites on gel users & wash contaminated skin immediately if accidental contact with gel application site occurs.
Transdermal topical solution: Axiron -testosterone Dosing is done by pumping liquid onto an applicator & then applying the liquid to clean, dry, intact skin of the underarm at the same time every morning. Patients should not swim or bathe for 2 hours after application. If underarm deodorant\/antiperspirant is used, it should be applied before applying the testosterone to avoid contaminating the product.
Transdermal nasal gel: Natesto -testosterone Pump should be primed before use & excess gel should be removed. Blow nose before administration. Insert pump into nostril with the tip aimed toward the lateral nostril wall. Depress pump slowly until it stops. As the tip is withdrawn, it should be wiped against the lateral nostril to ensure that any remaining gel is distributed to the nostril. After administration in both nostrils, the nose should be lightly messaged below the nasal bridge. The patient should avoid blowing or sniffing for at least 1 hour after administration.
Implantable pellets: Testopel – testosterone Implantable pellets: Testopel – implanted subdermally in the hip area or abdominal wall lateral to the umbilicus.
Buccal tablets: Stirant – testosterone Buccal tablets: Stirant – tablets are applied to the gum area just above the incisor tooth & are designed to stay in place until removed. To ensure good adhesion, tablets should be held in place (with a finger over the lip) for 30 seconds.
Intramuscular esters: testosterone enanthate (Delatestryl) – IM injection.
When is androgen therapy appropriate vs. not needed related to puberty? in some boys, puberty fails to occur at the usual age (before 15 years old). Most often, this failure reflects a familial pattern of delayed puberty & does not indicate pathology. Puberty can be expected to occur spontaneously but later than usual. Hence treatment is not an absolute necessity. However, some providers will prescribe a limited course of androgen therapy off label is the psychologic pressure of delayed sexual maturation are causing a boy significant distress. In these cases, a limited course of androgen therapy is indicted. Both fluoxymesterone (Androxy, Halotestin) & methyltestosteone (Methitest) are approved for this purpose. If delayed puberty is the result of true hypogonadism, long-term replacement therapy is indicated.
Common side effects of androgen therapy Hot flashes, bone fractures, decreased libido, insulin resistance, erectile dysfunction, gynecomastia, acne, HTN, sterility, hepatotoxicity, mood swings\/ aggression.tell female patients about virilization (deepening of the voice, acne, changes in body & facial hair, male pattern baldness, menstrual irregularities, increased libido, clitoral enlargement). Masculinization can occur if taken by children (e.g., sports performance enhancement). Boys may experience growth of pubic hair, penile enlargement, increased frequency of erections, and even priapism (persistent erection). If the patient can become pregnant, emphasize the need for consistent use of reliable contraception. Hypercholesterolemia, thromboembolic disorders with increased risk of MI, stroke, DVT, and PE.
Alprostadil is a nonoral drug for erectile dysfunction (ED) that can be given either by injection into the penis or by insertion into the urethra. Because of this inconvenient method of dosing, this drug is a second-line agent for ED.
Alprostadil is a nonoral drug for erectile dysfunction (ED) Benefits of various routes Transurethral: Alprostadil pellets (Muse) the only ED drug that is approved for twice-daily use, is inserted into the urethra. Erection develops 5 to 10 minutes after insertion and lasts 30-60 minutes. The objective is to employ the smallest dose required to produce an erection sufficient for intercourse.Intracavernous:Alprostadil (Caverjet, Caverjet Impulse, Edex) is also available in a form for direct injection into the corpous cavernosum. The response is rapid and relatively painless. The objective is sufficient to produce erection but does not last more than 1 hour. Do Not use more than once in 24 hours.
ContraceptionHow does carbamazepine impact oral contraceptives and what symptoms may be associated with that? Carbamazepine is a CYP450 INDUCER and thereby REDUCES oral contraceptive effects. Women taking OCs in combination with inducers including carbamazepine, phenytoin, rifampin, alcohol, and sulfonylureas should be alert for indications of reduced blood levels, such as breakthrough bleeding or spotting. If these signs appear, it may be necessary to either:Increase the estrogen dosage of the OCCombine the OC with a second form of birth control (condom, etc.)Switch to an alternative form of birth control
How might this affect which OCP is prescribed? OCs can DECREASE the benefits of warfarin & hypoglycemic agents by increasing clotting factors, OCs can decrease the effectiveness of warfarin, an anticoagulant. By increasing levels of glucose, OCs can counteract the benefits of insulin & other hypoglycemic agents used in diabetics. Accordingly, when combined with OCs, warfarin & hypoglycemic agents may require INCREASED dosage. OCs can impair hepatic metabolism of several agents, including theophylline, tricyclic antidepressants, diazepam & chlordiazepoxide. Because of reduced clearance, these drugs may accumulate to toxic levels. If signs of toxicity appear, the dosages of these drugs should be reduced.
Benefits of Etonogestrel subdermal implant [Nexplanon] * The most effective method and form of contraception available. Etonogestrel rod is implanted subdermally in the groove between the biceps and triceps in the nondominant arm. Diffuses slowly and continuously, providing blood levels sufficient for contraception for 3 years, after which the rod is removed. While currently FDA approved for 3 years, recent studies have shown that Nexplanon continues to be effective for up to 5 years post insertion.
Papaverine plus phentolamine (a vasodilator & a-adrenergic blocking agent) Erection develops within 10 min and lasts 2-4 hours. Priapism (prolonged erection) can occur (about 10% of people) Adverse effects include orthostatic hypotension with dizziness, transient paresthesia’s, ecchymosis, and difficulty in achieving orgasm or ejaculationNot approved by FDA,
What is abortive therapy and when is it used Given at the first sign of a headache before GI symptoms arrive.used to eliminate headache pain and suppress associated nausea and vomiting. Treatment should commence at the earliest sign of an attack. Medication should be limited to 1-2 times a week.
first time abortive migraine treatment Triptans
First-line treatment for migraine prevention Beta-blockers (propranolol and metoprolol most effective)
First-line treatment for acute, mild to moderate migraine without nausea or vomiting NSAID (e.g., aspirin or naproxen)
How to know someone would be appropriate for preventative therapy indicative for patients who have frequent attacks (three or more a month), attacks that are especially severe, or attacks that do not respond adequately to abortive agents.
Examples of opioid analgesics reserved for severe migraines that don’t respond to first-line medications butorphanol nasal spray
TriptansKnow mechanism of action for sumatriptan relieves migraines. elevated levels of CGRP; activate 5-HT receptors – can abort an ongoing attack.decreases the release of inflammatory neuropeptides thereby diminishing perivascular inflammation. Both actions (vasoconstriction and decreased perivascular inflammation) and help relieve migraine pain.
Know contraindications for triptans contraindicated for patients with a history of ischemic heart disease, myocardial infarction (MI), uncontrolled HTN, or other heart disease.first dose of triptans should be under direct supervision in case of any unknown cardiac disease.
The first dose of any triptan should be: should be under direct supervision in case of any unknown underlying cardiac disease
Alzheimer’s RivastigminePatient teaching PD using caution in patients with peptic ulcer disease, bradycardia, sick sinus syndrome, urinary obstruction and lung disease.
Donepezil- AriceptWhen would it be appropriate to increase the dose? Patients are stabilized on the initial dosage for 1-3 months before an increase in dosage should be attempted.
Cholinesterase inhibitors A class of drugs to treat people with dementia that help increase levels of acetylcholine in the brain. (Rivastigmine, Donepezil)
Cholinesterase inhibitors Side effects GI symptoms (nausea, vomiting, dyspepsia, diarrhea), weight loss, dizziness, headache, bradycardia, fainting, and falls
When on medications for Alzheimer’s Disease (AD) and symptoms increase it is better to increase the AD medication than to add things like herbal medications, vitamins, or NSAIDs
Parkinson DiseasePramipexoleMost common adverse effect when used alone: nausea, dizziness, daytime somnolence, insomnia, constipation, weakness and hallucinations.when combined with levodopa: orthostatic hypotension & dyskinesia
When is Pramipexole (Mirapex) used? monotherapy in early PD can produce significant improvement in motor performance. Combined w\/ levodopa in advanced PD, it can reduce fluctuations in motor control & may permit a reduction in levodopa dosage.
COMT inhibitors EntacaponeTolcaponeCatechol-O-Methyltransferase Inhibitors
When to use\/prescribe COMT inhibitors Entacapone: inhibits the metabolism of levodopa in the intestine & peripheral tissues while tolcapone metabolizes levodopa in the peripheric inhibitors are beneficial for patients who experience a wearing off of the effects of Levodopa\/Carbidopa (it prolongs the availability of levodopa)Indicated only for use with levodopa. It inhibits the metabolism of levodopa in the intestine and peripheral tissues. Entacapone inhibits COMPT which prolongs the plasma half-life of levodopa and thereby prolongs the time that levodopa is available to the brain
What are sleep attacks associated with related to PD treatment? overwhelming & Irresistible sleepiness that comes on without warning. (sleep attacks should not be equated with the normal sleepiness that occurs with dopaminergic agents)
medications that cause sleep attacks pramipexole, ropinirole, rotigotine & apomorphine
Bromocriptine side effects & management the most common dose-limiting effects are psychological reactions (Confusion, nightmares, agitation, hallucinations, paranoid delusions). Therefore if present, dosage needs to be decreased.Nausea can be helped with taking food.Can cause dyskinesia and postural hypotension. Rarely, bromocriptine causes retroperitoneal fibrosis, pulmonary infiltrates a Raynaud-like phenomenon, and erythromelalgia (vasodilation in the feet and sometimes hands, resulting in swelling, redness, warmth, and burning pain)
Use of levodopa\/carbidopa in treatment\/diagnosis Levodopa is the most effective drug for PD. At the beginning of treatment about 75% of patients experience a 50% reduction in symptom severity. Levodopa is so effective, in fact, that if a diagnosis of PD should be questioned if the patient fails to respond.Most effective therapy for PD, levodopa is always given in combination with carbidopa now (improves effectiveness and reduces some side effects like N\/V)
Seizure Disorders PhenytoinCommon side effects and associated patient teaching Anticonvulsanttherapeutic levels (10-20 ug\/mL), sedation and other CNS effects are mild. At plasma levels of 20+ toxicity can occur. Nystagmus (Continuous back-and-forth movements of the eyes) is relatively common. Other manifestations of excessive dosage include sedation, ataxia (staggering gait), diplopia (double vision) and cognitive impairment.(SJS and toxic epidermal necrolysis), DRESS
gingival hyperplasia Phenytoin over formation of gum tissueassociated with phenytoin. Patient teaching is good oral hygiene, including dental flossing and gum massage can reduce the risk of developing side effect
Use with oral contraceptives and associated patient teaching Phenytoin Use with oral contraceptives and associated patient teaching Decreases effectiveness of oral contraceptives, increase dose of oral contraceptive and\/or use additional contraception
Monitoring antiepileptics drugs for effectiveness (major convulsive disorders) plasma levels, serves as an aid for dosage adjustments, patient adherence, determining the cause of lost seizure control, and identifying causes of toxicity, especially in patients taking more than one drug.Over period of time Very often, patients must try several drugs before a regimen that is both effective and well tolerated can be established. Initial treatment should be done with just one antiseizure drug. If this drug fails, it should be discontinued and a different antiseizure drug should be tried. If this second drug fails, two options are open: (1) treatment with a third antiseizure drug alone or (2) treatment with a combination of antiseizure drugs. Use lowest yet effective dosage possible
which anticonvulsant would be given for someone with epilepsy needing adjunctive therapy for partial seizures with or without secondary generalization Gabapentin.only FDA-approved use in epilepsy is adjunctive therapy of partial seizures
absence seizures if seizure activity stops then dosing is appropriate. If some improvement or no change in seizure activity then dosing change or change of medication may be necessary
Morbilliform & Phenytoin rarely developed rash. Seen with genetic mutation known as Hyman leukocyte antigen (HLA) – B*1502. Therefore this medication should not be given to patients with this mutation.
Nural tube defects increase folic acid before conception and throughout pregnancy if patient is on antiseizure drugs.Ergotamine & triptans
Ergotamine & triptans should not be given together b\/c of prolonged vasospastic reaction could occur.
Dementia ( memantine)(Drug Class: N-Methyl-D-Aspartate Receptor Antagonist) What to do when someone has an elevated creatinine clearance Dose adjustment is needed when CrCl is less than 30 mL\/min
panic disorder treatment first line of treatment SSRIs fluoxetine( prozac) paroxetine ( paxil) and sertraline ( Zoloft)
Performance Anxiety FBe familiar with drug class and examples Beta blockers help prevent performance anxiety (low dosePropranolol)
Social Anxiety Disorder First-line treatment options as noted in course textbook SSRI ( Paroxetine- plaxil , Sertraline- zoloft)
General Anxiety DisorderFirst-line treatment options as noted in course textbook: SSRI and SNRIs four drugs only SSRI (paraoxetine- plaxil and escitalopram- lexapro) SNRI (venlafaxine – effexor and duloxetine- cymbalta )
DepressionTreatment options first choice SSRIS , SNRIs, bupropion and mirtazapine
Depressionapproach when first drug doesn’t seem to be working How long should it take to work? SSRIs takes 1-3 weeks for initial response and can take up to 12 weeks for max response.Therapeutic trial should not be considered a failure until a drug has been taken for at least 1 month without success.
BLACK BOX WARNING FOR ANTI-DEPRESSANTS: especially early on, the risk for suicide may actually increase. Concerns about antidepressant-indued suicide apply mainly to children,adolescents, and adults younger than 25.
Sleep disturbance First-line treatment options as noted in course textbook Be familiar with drug class and examples Drug Class: Benzodiazepines, along with newer benzodiazepinereceptor agonists are first line for anxiety\/insomniaExamples: estazolam, flurazepam (Dalmane), temazepam(Restoril), quazepam (Doral), and triazolam (Halcion)
Which sleep med would help patients fall asleep if they don’t have trouble staying asleep? Zolpidem (ambien), Zapelon (sonata), Ramelteon (Rozerem), Triazolam (Halcion)
Lithium Therapeutic drug level 0.6-1.2 mEq\/L
Lithium drug-drug interactions ACE\/ARBsthiazidesNSAIDs SRIstriptans linezolidother serotonergic drugs VerapamildiltiazemphenytoinCBZ
First generation antipsychotics (FGA)Common adverse reactions the first wave of antipsychotic medicationsedation common early in treatment but will subside within a week or so Menstrual irregularities, gynecomastia (breast growth), galactorrhea, sexual dysfunction = also common Less common but more serious = extrapyramidal symptoms (acutedystonia, parkinsonism, akathisia, tardive dyskinesia)
First generation antipsychotics (FGA) Patient teaching Patients should be informed about signs of hypotension(lightheadedness, dizziness) and advised to sit or lie down if these occur. In addition, patients should be informed that hypotension can be minimized by moving slowly when assuming an erect posture. Patients should be warned against participating in hazardous activities (e.g.,driving) until sedative effects diminish.Wear sunscreen, increased sensitivity to sun Handling drug can cause dermatitisBlack Box warning:Not approved for treating dementia-related psychosis, FGAs can double the rate of mortality from heart-related events or from infection. Examples: Chlorpromazine (a low-potency agent)Haloperidol (a high-potency agent)
Selective Serotonin Reuptake Inhibitors (SSRIs) a group of second-generation antidepressant drugs that increase serotonin activity specifically, without affecting other neurotransmittersCitalopram (Celexa), Escitalopram (Lexapro, Cipralex ), Fluoxetine(Prozac), Paroxetine (Paxil), Sertraline (Zoloft
Selective Serotonin Reuptake Inhibitors (SSRIs) Drug-Drug Interactions MAOIs (contraindicated), TCA and lithium (caution needed), NSAIDS, warfarin, and other drugs that impact
Selective Serotonin Reuptake Inhibitors (SSRIs) baseline Serum sodium should be checked in older adults and patients on diuretic therapy. (same as SNRI
Common adverse effects SSRIs nausea, agitationinsomia dry mouthsexual dysfunctionweight gainserotonin syndromewithdrawal syndrome
SSRIs Strategies to minimize adverse effects Educate patients that abrupt cessation of these drugs is notrecommended. Patients should also report thoughts of suicide or selfharm immediately
Serotonin\/Norepinephrine Reuptake Inhibitors (SNRI)Examples Venlafaxine (Effexor XL), Duloxetine (Cymbalta)
Baseline data needed to prescribe- (SNRI)Examples Serum sodium should be checked in older adults and patients on diuretic therapy. (same as SSRI)
Tricyclic antidepressants (TCA)Baseline data needed to prescribe ECG should be checked, especially in patients with known dysrhythmias or patients older than 40 years of age.
Strategies to minimize adverse effects SNRIs Educate patients that abrupt cessation of these drugs is notrecommended. Patients should also report thoughts of suicide or selfharm immediately.
Patient education needed TCA Patients should be informed that they can minimize orthostatichypotension by moving slowly when assuming an upright posture. Inaddition, patients should be instructed to sit or lie down if symptoms(dizziness, lightheadedness) occur.
Monoamine oxidase inhibitors (MAOI)Baseline data needed to prescribe Baseline blood pressure should be obtained.
Patient education needed (MAOI) Patients should be informed about the symptoms of hypertensive crisis (headache, tachycardia, palpitations, nausea, vomiting, sweating) and instructed to seek immediate medical attention if these develop.
Dietary restrictions for MAOIs In addition to tyramine foods (all cheese, protein supplements, avocados, figs, bananas, sausages, smoked meats), several other dietaryconstituents (e.g., caffeine, phenylethylamine) can precipitatehypertension in patients taking MAOIs. Patients should be instructed to avoid them.
Examples drugs from the following drug classes Benzodiazepines: Alprazolam (xanax) Chlordiazepoxide (Librium) Clonazepam (klonopin) Clorazepate (Tranxene-T)Diazepam (valium)EstazolamFlurazepam Lorazepam (Ativan)Midazolam (versed) Oxazepam Temazepam (Restoril) Triazolam (Halcion)
Benzodiazepine-like drugs Zolpidem (ambien), zaleplon (sonata), eszopiclone (Lunesta)
Melatonin receptor agonist Ramelteon (Rozerem)
Symptoms of serotonin withdrawal dizziness, headache, nausea, sensory disturbances, tremor, anxiety, dysphoria
When switching from MAOI to Prozac, wait 2 weeks
When switching from fluoxetine (Prozac) to MAOI wait 5-6 weeks
Kava Kava contraindicated in those with hepatotoxicity
Ginkgo biloba: stomach upset, headache, dizziness, vertigo, possible seizures and fatalities if you eat the seeds
St. John’s wort: insomnia, vivid dreams, restlessness, anxiety, agitation, irritability, abdominal pain, dry mouth, headache
Ginger root: CNS depression, cardiac dysrhythmias, GI side effects can also occur at high dosages
Echinacea A patient with what type of condition should not take echinacea? Immunocompromised patients including those with HIV, RA, SLE, can also compromise drug therapy of TB and cancer (immunosuppressant drugs)
FlaxseedPatient education about administration\/consumption: can reduce absorption of conventional meds so it should be taken 1 hour before or 2 hours after these drugs
Therapeutic effectCoenzyme Q-10 \u2022 Patients with heart failure who took CoQ-10 had improved cardiac function. \u2022 Patients who took CoQ-10 after cardiac surgery had faster recovery. \u2022 CoQ-10 may improve sperm count and semen quality; however, further studies are needed to identify an improvement in conception.antioxidant, gives energy boost, do not use in conjunction with warfarin though
Feverfew migrainesMigraine prophylaxis, seasonal allergies, asthma, Rheumatoid arthritis, Psoriasis (primarily for migraines though)
Laws related to CAM, know what they do Dietary Supplement Health and Education Act (DSHEA) of 1994: categorizes herbal supplements, vitamins, minerals as dietarysupplements rather than as drugs. (exempts them from FDA scrutiny and approval before marketing)
Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006: mandates the reporting of serious adverse events for nonprescription drugs and dietary supplements. The following should be reported:deaths, hospitalizations, life-threatening experiences, persistent orsignificant disabilities and birth defects.
Current Good Manufacturing Practices (CGMP) ruling of 2007: Addressed these issues: no assurance that dietary supplements contain what the label proclaims, the package may contain ingredients that are not listed or it may lackingredients listed<\/p>\n","protected":false},"excerpt":{"rendered":"Final Exam: NR566\/ NR 566 (Latest 2024\/ 2025 Update) Advanced Pharmacology for Care of the Family Exam Review| Questions and Verified Answers| 100% Correct |Grade A \u2013 Chamberlain Final Exam: NR566\/ NR 566 (Latest 2024\/2025 Update) Advanced Pharmacology forCare of the Family Exam Review| Questionsand Verified Answers| 100% Correct |GradeA \u2013 ChamberlainQ: Various routes of […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-131883","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131883","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=131883"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131883\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=131883"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=131883"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=131883"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}