NR 508 STUDY GUIDE EXAM OUTLINE
Sexually Transmitted Infections and Vaginitis
Differential diagnosis of vaginal discharge: sex partners, douching, lack of
vaginal lactobacilli
Management of
syphilis: PCN G. IF allergic tx w/ 14 days of doxycycline 100mg BID po or
tetracycle 500mg QID x 14 days.
gonorrhea & chlamydia: Ceftriaxone 250mg IM x 1
Chlamydia: Azithromycin 1g PO x 1 or doxy 100mg BID for 1 wk
PID: Cefoxitin 2g IM x 1 + probenecid 1g PO + doxy 100mg BID po x 14 days
+
Metronidazole po 500mg BID x 14 days IF severe: Admit
bacterial vaginosis: Metronidazole 500mg po BID x 7 days or applicator once
daily x 5 days or Clindamycin cream 2% one applicator bedtime x 7 days IF
pregnant use oral metro
vulvovaginal candidiasis: common w/ antibx/DM/pregnancy. Yeast infection.
Tx: Azole class. Clotrimazole, butaconazole, miconazole. Fluconazole 150mg x
1.
genital warts: podofilox 0.5% solution/gel, cryotherapy, or bicholoracetic acid
trichomonas: Protozoa infection, yellow/green discharge, itchy Tx:
metronidazole 2g po x 1 or 500mg BID po x 7 days AVOID alcohol on ZOLES
bc of disulfiram rxn
, NR 508 STUDY GUIDE EXAM OUTLINE
HSV: simplex 2 genital herpes. Tx: acyclovir 400 mg TID x 7-10 days or
Famciclovir 300mg po TID 7-10 days. Valcyclovir 1g BID 7-10 days.
Episodic tx: acyclovir 400mg TID for 5 days
HPV: Cervical Genotypes 16 & 18
neoplasia. public lice: 1% permethrin
topical
scabies: Permethrin cream, lindane lotion, crotamiton, Ivermectin
Recommended follow-up (test-of-cure) for patients who have chlamydia,
gonorrhea or syphilis
Treating infections during pregnancy – choice of drugs NO DOXY if preg
Chapter 48: Women as Patients
Pharmacokinetic and Pharmacodynamic gender: Women have longer
gastric emptying times which influences absorption. Women have larger %
of body fat then man. Larger dose for lipophilic drugs (valium), smaller for
water-soluble drugs (flagyl). Alcohol absorption higher in women than men.
Hepatic enzyme differences 25% higher in women. Opioids reduce pain
more for women. Warfarin has less benefit to women & more bleeding
episodes. ASA little effect to reduce risk MI but does lower strokes for
women. Antipsychotics have greater improvement sx for women but more
severe reactions.
Puberty: Calcium 1300mg daily, Iron supplements (red meat)
Pregnancy: Drug absorption increases due to increase cardiac output, plasma
volume 50% higher in 3rd trimester. Supplement 30mg of iron
Menopause: Avg age 51 y/o. Loss of estrogen increased chances for CAD,
HTN, CVA Sx: hot flashes/night sweats, vag dryness, mood change,
, NR 508 STUDY GUIDE EXAM OUTLINE
menopausal sx. Minimize hormone replacement therapy due to inc. risk of
breast CA
pregnancy risk categories: Caffiene, Smoking, Alcohol,Avoid herbs in 1st
trimester, avoid extracts & essential oils. Helpful: Ginger for N/V & Horse
chestnut for varicose veins
Management of dysmenorrhea: NSAIDS reduce prostaglandins to
decrease contractions, oral contraceptives
HIV and women: Fastest growing population for HIV. 25% risk to baby if no
therapy given. 2% risk if anti-retrovirals given. Cannot breastfeed.
Chapter 1: The Role of the Advanced Practice Nurse as Prescriber
Roles and responsibilities of APRN prescribers: Collaborate w/ physician on
best drug to give patient, in depth knowledge of drugs, use pharma
protocols, central role in educating nurses & patients on appropriate use of
drugs
Clinical judgement in Prescribing- Is a prescription the right tx? Goals of
therapy, effective drugs for the disease? Monitoring goals met? Cost?
Collaboration with other providers- different perspective on prescribing,
critical for quality patient care
Autonomy and Prescriptive authority- varies state to state. 21 states are
independent prescribing, 26 are autonomous.
Chapter 2: Review of Basic Principles of Pharmacology
Metabolism: Biotransformation/ Chemical change of drug structure
Enhance excretion, inactivate the drug, increase therapeutic action, activate
pro-drug, increase/decrease toxicity
Factors (Age, genetics, pregnancy, liver dz, time of day, environment, diet,
alcohol, drug interactions)
Drug Dose Determined:
, NR 508 STUDY GUIDE EXAM OUTLINE
a) Dose-response relationship
b) Therapeutic index: ratio of lethal dose/therapeutic dose
c) Plasma level profile: Onset of action time
d) Half-life
e) Bioavailability: % of drug absorbed & available. Effected by
incomplete absorption & first-pass metabolism
Tissue Distribution: Fats=lipid-soluble drugs (low blood flow), bone
(tetracycline deposits in bone & teeth), Blood-brain barrier= impenetrable
only lipid-soluble drugs cross (Levadopa), Placental barrier= low molecular
weight drugs pass easier (ethanol)
Receptors: agonist: drug bind to/stimulates cell causing a response
Antagonists: drug binds to/occupies cell without stimulating a
response Potency: lower drug concentration to require response
Efficacy: max effect a drug can produce
Sexually Transmitted Infections and Vaginitis
Differential diagnosis of vaginal discharge: sex partners, douching, lack of
vaginal lactobacilli
Management of
syphilis: PCN G. IF allergic tx w/ 14 days of doxycycline 100mg BID po or
tetracycle 500mg QID x 14 days.
gonorrhea & chlamydia: Ceftriaxone 250mg IM x 1
Chlamydia: Azithromycin 1g PO x 1 or doxy 100mg BID for 1 wk
PID: Cefoxitin 2g IM x 1 + probenecid 1g PO + doxy 100mg BID po x 14 days
+
Metronidazole po 500mg BID x 14 days IF severe: Admit
bacterial vaginosis: Metronidazole 500mg po BID x 7 days or applicator once
daily x 5 days or Clindamycin cream 2% one applicator bedtime x 7 days IF
pregnant use oral metro
vulvovaginal candidiasis: common w/ antibx/DM/pregnancy. Yeast infection.
Tx: Azole class. Clotrimazole, butaconazole, miconazole. Fluconazole 150mg x
1.
genital warts: podofilox 0.5% solution/gel, cryotherapy, or bicholoracetic acid
trichomonas: Protozoa infection, yellow/green discharge, itchy Tx:
metronidazole 2g po x 1 or 500mg BID po x 7 days AVOID alcohol on ZOLES
bc of disulfiram rxn
, NR 508 STUDY GUIDE EXAM OUTLINE
HSV: simplex 2 genital herpes. Tx: acyclovir 400 mg TID x 7-10 days or
Famciclovir 300mg po TID 7-10 days. Valcyclovir 1g BID 7-10 days.
Episodic tx: acyclovir 400mg TID for 5 days
HPV: Cervical Genotypes 16 & 18
neoplasia. public lice: 1% permethrin
topical
scabies: Permethrin cream, lindane lotion, crotamiton, Ivermectin
Recommended follow-up (test-of-cure) for patients who have chlamydia,
gonorrhea or syphilis
Treating infections during pregnancy – choice of drugs NO DOXY if preg
Chapter 48: Women as Patients
Pharmacokinetic and Pharmacodynamic gender: Women have longer
gastric emptying times which influences absorption. Women have larger %
of body fat then man. Larger dose for lipophilic drugs (valium), smaller for
water-soluble drugs (flagyl). Alcohol absorption higher in women than men.
Hepatic enzyme differences 25% higher in women. Opioids reduce pain
more for women. Warfarin has less benefit to women & more bleeding
episodes. ASA little effect to reduce risk MI but does lower strokes for
women. Antipsychotics have greater improvement sx for women but more
severe reactions.
Puberty: Calcium 1300mg daily, Iron supplements (red meat)
Pregnancy: Drug absorption increases due to increase cardiac output, plasma
volume 50% higher in 3rd trimester. Supplement 30mg of iron
Menopause: Avg age 51 y/o. Loss of estrogen increased chances for CAD,
HTN, CVA Sx: hot flashes/night sweats, vag dryness, mood change,
, NR 508 STUDY GUIDE EXAM OUTLINE
menopausal sx. Minimize hormone replacement therapy due to inc. risk of
breast CA
pregnancy risk categories: Caffiene, Smoking, Alcohol,Avoid herbs in 1st
trimester, avoid extracts & essential oils. Helpful: Ginger for N/V & Horse
chestnut for varicose veins
Management of dysmenorrhea: NSAIDS reduce prostaglandins to
decrease contractions, oral contraceptives
HIV and women: Fastest growing population for HIV. 25% risk to baby if no
therapy given. 2% risk if anti-retrovirals given. Cannot breastfeed.
Chapter 1: The Role of the Advanced Practice Nurse as Prescriber
Roles and responsibilities of APRN prescribers: Collaborate w/ physician on
best drug to give patient, in depth knowledge of drugs, use pharma
protocols, central role in educating nurses & patients on appropriate use of
drugs
Clinical judgement in Prescribing- Is a prescription the right tx? Goals of
therapy, effective drugs for the disease? Monitoring goals met? Cost?
Collaboration with other providers- different perspective on prescribing,
critical for quality patient care
Autonomy and Prescriptive authority- varies state to state. 21 states are
independent prescribing, 26 are autonomous.
Chapter 2: Review of Basic Principles of Pharmacology
Metabolism: Biotransformation/ Chemical change of drug structure
Enhance excretion, inactivate the drug, increase therapeutic action, activate
pro-drug, increase/decrease toxicity
Factors (Age, genetics, pregnancy, liver dz, time of day, environment, diet,
alcohol, drug interactions)
Drug Dose Determined:
, NR 508 STUDY GUIDE EXAM OUTLINE
a) Dose-response relationship
b) Therapeutic index: ratio of lethal dose/therapeutic dose
c) Plasma level profile: Onset of action time
d) Half-life
e) Bioavailability: % of drug absorbed & available. Effected by
incomplete absorption & first-pass metabolism
Tissue Distribution: Fats=lipid-soluble drugs (low blood flow), bone
(tetracycline deposits in bone & teeth), Blood-brain barrier= impenetrable
only lipid-soluble drugs cross (Levadopa), Placental barrier= low molecular
weight drugs pass easier (ethanol)
Receptors: agonist: drug bind to/stimulates cell causing a response
Antagonists: drug binds to/occupies cell without stimulating a
response Potency: lower drug concentration to require response
Efficacy: max effect a drug can produce
