NR566 advanced pharmacology for care of the family

1. Explain how hormone replacement therapy is used for prevention of osteoporosis.

Answer. Hormone therapy reduces postmenopausal bone loss decreasing the risk of osteoporosis and related fractures. Regrettably when Hormone therapy stopped, bone mass rapidly decreases by roughly 12%. Hormone therapy must continue all-time to maintain bone health.

2. Which is the most common use of non contraceptive use of estrogens.

Answer. Estrogens is used for Hormone Therapy, HT in postmenopausal women as non contraceptive.

3. Progestin for hormone replacement therapy is used when and why?

Answer. Progestin is used to counterbalance estrogen mediated stimulation of the endometrium which can lead to cancer and end`ometrial hyperplasia.

4. When is use of progestin for hormone replacement therapy not acceptable to use and why?

Answer. Progestins should not be prescribed as hormone replacement therapy for women who have undergone hysterectomy as it risks breast cancer. Hysterectomy is an operation/surgical to remove the uterus.

5. Between local and systemic estrogen which would you choose and why?

Answer. Transdermal formulations have four advantages compared with oral formulations of estrogen.

• Because the liver is bypasses the total dose pf estrogen is greatly used.
• Vomiting and nausea is less.
• Less fructuation of estrogen blood levels. advanced pharmacology for care of the family.
• The risk for DVT, pulmonary embolism and stroke is lower.

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6. Combination OC function/mechanism

Answer. By inhibiting ovulation it reduces fertility.

7. In combination OC (Oral Contraceptives) what is the role of progestin?

Answer. It acts in the pituitary and hypothalamus to suppres the midcycle luteinizing hormone surge which triggers ovulation.

8. In combination OC (Oral Contraceptives) what is the role of estrogen?

Answer. It suppresses release of follicle stimulating hormone from the pituitary inhibiting follicular maturation.

9. State two main categories of OCs. (Oral Contraceptives)

Answer.

• Type one contains an estrogenplus a progestin known as combination OCs.
• The othe type is the one that contains just a progestin known as minipilis or progestin only OCs.

10. Which is the most effective contraception? advanced pharmacology for care of the family.

Answer.

• Etenogestrel subdermal implants or Nexplanon, this is the birth control implant that goes in the arm
• Intramuscular medroxyprogesterone acetate or known as Depo Provera. This is a is a form of birth control by an injection or shot that contains progestin. The injection in either on upper arm or buttock. It works by preventing pregnancy by stopping ovulation by thickening cervical mucus making it hard for sperm to reach and fertilize an egg
• Sterilization Intrauteline Device, IUD. This is a small devicethat is inserted in uterus which thickens cervical mucus and makes it difficult for sperm to enter the cervix or prevent fertilized egg from attaching to uterus wall. This is the most effective birth control methods, long term and reversible.

11. Which method of contraception is mostly choosen by birth control users.

Answer. Sterlization Tubal ligation which is female sterlization and vasectomy which is male sterlization and they are selected by about 19% of birth control users.

12. When choosing birth control method, which factors are considered?

Answer.

• Effectiveness safety personal preference. One should choose birth control methot that requires little effort as that is the most effective since some birth control methods works better than others.
• Is it reversible? One should consider reproductive goals as some permanent control methods are permanent and hence should be considered when one is sure family is complete.
• Side effects: Some contraceptives have side effects mostly hormone based hence should enquire about possible side effects. Some of side effects include, breast tenderness, bleeding, depression, nausea, weight gain, cramping, heavy periods, hair or skin changes, or headaches.
• Lifestle impact
• Relationship status
• Health status
• Safety
• Personal preference. advanced pharmacology for care of the family.

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13. Which drug can be used to prevent and treat thomboembolism?

Answer. Thromboembolism is reduction in blood flow that is caused by an embolism from a blood clot.

• Warfarin is the drug used to treat thromboembolism as it reduces the formation of blood clots.

14. What is the initial dose of warfarin?

Answer. Initial dose should be 10mg unless the patient is older than 75, has cormobidities (This is having multiple medical conditions at the same time), poor nutrition and elevated INR (An INR test measures the time for the blood to clot) off warfarin, elevated liver tests. Afterward to start at 5mg per day.

15. What is Initial treatment of upper or lower extremity DVT

Answer. Short term treatment with SC LMWH, SC foundaparinux or iv/SC Heparin for at leat 5 days and until INR is 2.0 for the last 24 hours.

16. Which is the preffered treatment of DVT?

Answer. For acute DVT, LMWHs are recommended for the treatment while in pregnancy PE Is recommended because of safety, equivalent or superior effectiveness compared with unfractionated heparin.

17. DVT d/t a reversible risk factor is treated for how long?

Answer. Deep vein thrombosis (DVT) is treated for 3 months since it has a low risk of recurrence.

18. When a patient has superficial vein thrombosis in the lower limb that is greater than 5cm, how many days of

of prophylaxis therapy is needed with LMWH or fondaparinux.

Answer. 45 days

19. When a patient has superficial vein thrombosisin lower limb that is greater than 5 cm, which is the preferred drug and dose as per ACCP.

Answer. Fondaparinux (Also Called ARIXTRA) 2.5 mg once daily.

20. For how long does ACPP recomends LMWH for patient with DVT or PE along with cancer?

Answer. First 3-6 months of anticoagulation therapy.

21. Which dose of Apixaban is used to treat DVT and PE?

Answer. 10 mg BID x 7 days and then 5mg BID.

22. To reduce risk of further DVT and PE, which dose of apixaban?

Answer. 2.5 mg BID

23. In pregnancy, what is the use of anticoagulants?

Answer.

• Women with a mechanical  heart valve be treated with one of three regimens.

1. LWMH twice daily during pregnancy.
2. SC heparin every 12 hours; or
3. SX heparin or LMWH until the 13^th week of pregnancy, then warfarin until close to delivery when LMWH or heparin is resumed.

• Warfarin is a known teratogen and may cause fetal hemorrhage, whereas heparin LMWH do not cross the placenta and therefore do not cause teratogenity or fetal bleeding, though bleeding at the uteroplacental junction is possible.
• Women on warfarin who are planning a pregnancy should have frequent pregancy tests and substitution of heparin or LMWH when pregnancy is achieve.
• Should be managed by an anticoagulation specialist and perinatologist.

24. Population needed warfarin starting dose adjustment

Answer.

• Patients weighing more than 80 kgs (176 lbs) should be started on 7.5mg daily
• Normal starting dose is 5mg daily

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25. Who can get tuberculin screening?

Answer.

1. Targeted screening for TB is ussually based on the patient’s presenting with an identified risk factor. In some areas of thecountry, routine TB testing is part of all health maintenance visits because of an increased incidence of TB in the area.
2. Patients identified as being at risk are those with compromised immune systems like HIV Positive or udergoing immunosuppresive therapy or prolonged adrenocorticosteroid therapy., close contacts of patients with newly diagnosed infectious TB, injection drug users known to be HIV seronegative, foreign born persons from high prevalence countries, medically underserved low-income populations, and residents and staff of long-term-care facilities or prisons. All health care providers should be screened routenely.
3. Who can get hep B Vaccine?

• The current recommendations for childhood immunizations include administering the three dose HBV series to new borns or at age 11 to 12 years to children not previously vaccinated. The series can be started at any age, although it is recommended for all ages, although it is recommended that preterm infants be atleast 1 month of age before starting HPV series.
• Vaccination with HBV is recommended for all ages, particulary patients at high risk of contracting hepatitis B. Those at high risk include IV drugs users, infants born to mothers who are HbsAg-positive, hemodialysis patients, sexually active people with multiple partners, incarcerated people, international travellers, household contacts for hepatitis B carriers, and sexual contacts of hepatitis B carriers. Patients who are getting tatoos or who share razors toothbrushes or body piercing jewelry are also at risk of contracting hepatitis B. Health care workers, daycare staff and other people who may have exposur to body fluids also have a greater risk of contracting hepatitis B. Patients with diabetes are at increased risk of contracting hbv and its recommended they reveive HBV series.

27. What is the ultimate goal of therapy for HIV?
28. Reduce HIV associated morbidity and prolong the duration and and quality of survival
29. Restore and preserve immunological function
30. Achieve maximal and durable suppresision of plasma HIV viral load
31. Prevent HIV transmission

• Maxima suppresion goal HIV RNA less than 50 copies/Ml goal

1. Improve quality of life
2. Obtain maximal and durable supression of HIV
3. Prevent vertical HIV transimisson
4. Prolong survival
5. Reduce HIV related morbidity
6. Reduce transmission of HIV
7. Restore and preserve immunological function.
8. Metronidazole education

• When mixed with alcohol, metronidazole has the potential to cause disulfiram like reactions. Alcohol should not be consumed during or for atleast one day following completion of metronidazole therapy.
• The treatment regimen for trichomoniasis include oral metronidazole or tinidazole CDC, 2010. Patients need to be advised to avoid consuming alcohol during treatment with metronidazole.

29. Treatment of primay dsymenorrhea.

• Primary dsymenorrhea is defined as cramping pain in the lower abdomen occuring just before or during menstruation.
• Ibuprofen, diclofenac potassium, ketoprofen, meclo fenamate, mefenamic acid and naproxen are the drugs used for bsymenorrhea.
• NSAIDS are the first line of drugs treatment for women not desiring contraception (Zahradnik et al, 2010) and are particuarly effective if started 2 to 3 days before menses or at the first sign of bleeding.
• OTC NSAIDS have the same active ingredients eg ibuprofen, naproxen sodium, as presciption drugs; however the labelled recommended dose for general discomfort may be subtherapeutic for dsymenorrhea.
• Complementary and alternative medicine (CAMs) shown to improve symptoms of dsymenorrhea include thiamine (Vitamin B1), Magnesium, Vitamin E and omega 3 fatty acids.