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Quiz 7
GI/GU/Reproductive Study guide
| Question | Answer |
|---|---|
| Antacid mechanism: | direct buffering of stomach acid |
| Alginates | create a layer of foam, (example Gaviscon) |
| Antacid dosing | variable but generally qid prn |
| Adverse effects of Ca and Al antacids | constipation |
| Adverse effects of magnesium antacids | diarrhea |
| Adverse effects of electrolyte imbalance in renal impairment | cognitive problems (aluminum and magnesium toxicity), osteomalacia, and tetany (hypercalcemia) |
| Drug interactions for antacids | Quinolone/tetracycline antibiotics (separate by 2 hours), phenytoin, levothyroxine, iron supplements |
| H2 Antagonists | famotidine (Pepcid) nizatidine (Axid) ranitidine (Zantac) cimetidine (Tagamet) |
| H2 antagonist mechanism | block histamine H2 receptors on gastric parietal cells, decrease secretion of stomach acid |
| Famotidine dosing | GERD 10-40 mg bid PUD 20-40mg qd |
| Nizatidine dosing | GERD 75-100 mg bid PUD 150 mg qd- bid (300mg qd) |
| Ranitidine dosing | GERD 75-300 mg bid (300 mg qd) PUD 150 mg qd bid |
| Cimetidine dosing | GERD 200-800 mg bid (400 mg qid) PUD 400 mg qd-bid |
| Adverse effects of H2 Antagonists | headache, dizziness, diarrhea/constipation, cognitive impairment/agitation |
| H2 antagonist drug interactions | Ketoconazole/itraconazole (antifungals), calcium/iron, CYP1A2 and 2C9/19 substrates (Tagamet specifically, will affect theophylline and warfarin), CYP3A4 and 2D6 (cimetidine specifically) substrates with narrow therapeutic index |
| Cimetidine is the most potent enzyme inhibitor of the H2 antagonists T/F | True- Famotidine least likely for drug interactions. |
| Off label use for Cimetidine | Treatment of warts |
| Proton Pump Inhibitors (PPIs) | omeperazole (Prilosec) lansoprazole (Prevacid) pantoprazole (Protonix) rabeprazole (Aciphex) esomeprazole (Nexium) |
| PPI Mechanism | Irreversibly inhibits H/K ATPase (aka proton pump) Decreases production of stomach acid |
| PPI dosing for GERD | usually once a day dosing is sufficient, may do twice a day dosing for nocturnal symptoms (severe cases only) |
| PPI dosing for PUD induced by H pylori | Use twice day dosing because it enhances benefit of antibiotic |
| PPI adverse effects | diarrhea/constipation, nausea/abdominal pain, pernicious anemia (low B12), and gastric carcinoma |
| PPI drug interactions | Ketoconazole/itraconazole, calcium/Iron, CYP2C19 substrates (warfarin) |
| PPI onset | 12-24 hours |
| Prokinetics (improve motility) | Metoclopramide (Reglan), Erythromycin, Bethanechol |
| Prokinetic Mechanism | Metoclopramide- dopamine antagonist centrally, potentiates Ach peripherally Erythromycin- Motilin receptor agonist Bethanechol- Ach agonist |
| Prokinetic dosing | Before meals and hs |
| Adverse effects-Reglan | Sedation, confusion, fatigue, nausea/vomiting, abdominal pain, diarrhea, extrapyramidal sx., pseudoparkinsonism, akathesia, increased prolactin (gynecomastia, impotence, breast enlargement, galactorhea), and neuroleptic malignant syndrome |
| Erythromycin adverse effects | nausea/vomiting, abdominal pain, diarrhea (C-diff), rashes, urticaria, QT prolongation, drug resistance |
| Bethaechol adverse effects | Cholinergic (hypersecretion, sweating bronchoconstriction, orthostasis, etc.) Contraindicated in asthmatics |
| Metoclopramide drug interactions | Dopamine agonists/antagonists, anticholinergics, CNS depressants |
| Erythromycin drug interactions | CYP3A4 substrates, anything with QT prolongation, anything with narrow drug range, such as: theophylline, warfarin, digoxin, lithium... |
| Bethanechol drug interactions | anticholinergics, cholinesterase inhibitors (example: Aricept) |
| Why would you choose prokinetics | All are reserved for symptomatic failure of acid-suppressing therapy. Reglan is generally chosen first, fewer GI side effects |
| Antibiotic combos for H pylori infection 3 drug regimin | Clarithromycin, Amoxicillin, Lansoprazole (PrevPac) X 7-14 days Substitute metronidazole for PCN allergy |
| H pylori 4 drug regimen | Metronidazole, tetracycline, bismuth, PPI X 10-14 days |
| Sequential therapy for H pylori | Amoxicillin, PPI X 5days, then Clarithromycin (Biaxin), tinidazole, PPI X 5days (Reserve quinolones (levofloxacin) to avoid resistance) |
| Sucralfate (Carafate) mechanism | reacts with stomach acid to form adherent paste, preferentially binds to damaged tissue (liquid bandaid) |
| Sucralfate dosing | 1 g ac, hs; 1 g bid for maintenance |
| Carafate adverse effects | Constipation, aluminum toxicity in severe renal patients, hypophosphatemia |
| Carafate drug interactions | Similar to aluminum antacids, acid suppressants |
| Loperamide (Imodium) mechanism | Inhibits peristalsis, opiate agonist, anticholinergic antagonist |
| Loperamide dosage | may be used if afebrile and lacking bloody stools, 4 mg initially, then 2 mg after each loose stool, not to exceed 8-16 mg/day. Use less than 48-72 hours |
| Loperamide adverse reactions | constipation, dizziness, drowsiness, fatigue (not recommended for children less than 2-6) |
| Bismuth Subsalicylate (Pepto) mechanism | decreased prostaglandin production, mucosal protection |
| Pepto uses | Can reduce number of stools by 50%, travelers diarrhea prevention |
| Pepto dosage | 524 mg every 30 to 60 minutes not to exceed 8 doses |
| Pepto adverse reactions | Caution in pregnancy and nursing, constipation, black tongue or stool (harmless) |
| Pepto interactions | Salicylates *adverse effects increased, Reye's syndrome, not recommended under age 12 |
| Diphenoxylate/Atropine | Lomitil |
| Lomotil Mechanism | Inhibits peristalsis, opiate agonist, anticholinergic only to limit abuse. |
| Lomotil dosage | 5mg 3-4 times daily, reduce and/or discontinue ASAP, not recommended in children less than 2 |
| Lomotil (diphenoxylate) adverse reactions | nausea, constipation, dizziness, drowsiness, anticholinergic effects |
| Lomotil (diphenoxylate) drug interactions | CNS depressants, anticholinergics, MAOIs |
| First line agent for diarrhea | Loperamide Imodium |
| Fiber intake should be | 20-30 grams/day |
| Bulk-forming fibers drug interactions | Digoxin, warfarin |
| Emollients (stool softeners) | Docusate salts |
| Docusate mechanism | anionic surfactant, allows easier penetration of water into the stool |
| Docusate uses | best for prevention, effect takes 1-3 days, used often in pregnancy and postpartum, post-cardiac surgery |
| Docusate dosing | 50-250mg daily |
| Docusate interactions | mineral oil |
| Mineral oil (lubricant) mechanism | softens fecal content by coating, inhibits colonic resorption of water |
| Mineral oil uses | fecal impaction (onset 6-8 hours) |
| Mineral oil dosing | 15-45 ml |
| Mineral oil drug reactions | Inflammatory reaction in intestines, liver and spleen, can be aspirated, not usually recommended |
| Mineral oil drug interactions | fat soluble vitamins |
| Hyperosmotic/Saline Choices | OTC- glycerin suppository, sorbitol oral, mag salts, Na Phosphate oral Rx- Sorbitol, Lactulose, Polyethylene glycol |
| Bedwetting is defined at what age | Age 5 years and beyond |
| Imipramine | Tofranil Tricyclic antidepressant |
| Tofranil (imipramine) | First drug used to treat bedwetting, relaxes bladder muscle and may lighten sleep, success 10-50%, maximal effects achieved in a few days, relapse rate high when discontinued. |
| Tofranil (imipramine) considerations | used in children over 6, only available in capsule or tablet form, inexpensive |
| Tofranil (imipramine) dosage | 7-8 years (25 mg given one hour before bed 9 years and older (50 mg-75mg one hour before bed) |
| Imipramine side effects | anxiety, irritability, insomnia, loss of appetite, tachycardia, blurred vision, dry mouth, constipation, weight gain, hypotension |
| Imipramine major danger | accidental overdose (irreversible heart block) adult should administer and be kept out of child's reach |
| Desmopressin (DDAVP) | Synthetic vasopressin- reduces urine production |
| DDAVP indication | children 6 years and older with primary nocturnal enuresis. |
| DDAVP nasal spray | banned in 2007- deaths due to hyponatremia |
| DDAVP response rate | high (70-90%) good for episodic use such as summer camp, expensive and relapse rate is 95% |
| DDAVP dosage | start with dose of .2mg and titrate up to a max of .6mg, titrate until child completely dry at night. Parent should not titrate until speaks to provider. Duration of medication is controversial but 6 months to 4-8 weeks. |
| DDAVP adverse effects | headaches, facial flushing, nausea, hyponatremia |
| Stress incontinence first line treatment | alpha adrenergic agonists |
| Stress incontinence second line treatment | estrogen in postmenopaussal women- alone or together with alpha adrenergic agonists |
| Stress incontinence | Cymbalta (duloxetine) |
| Urge incontinence first line treatment | anticholinergics |
| Urge inontinence second line treatment | estrogen in postmenopausal women |
| Mixed incontinence treatment | agent that treats the predominant symptom |
| overflow incontinence treatment | drugs are not indicated- surgery is indicated |
| antimuscarinics are also called: | anticholinergics |
| Muscarinic action | decrrease heart rate and force of contraction, constricts airways, dilates blood vessels, increase activity of he stomach, intestines, bladder, salivary, lacrimal, and sweat glands. |
| urge incontinence treated with | muscarinic antagonists |
| Muscarinic antagonists adverse reactions (think of atropine) | cognitive impairment, tachycardia, pupil dilation, blurred vision, restlessness, mouth dryness, urinary retention, increased salivary and respiratory secretions and perspiration |
| First Generation Muscarinic antagonists | Oxybutynin (Ditropan, Ditropan XL) Tolterodine (Detrol, Detrol LA) |
| Second Generation Muscarinic antagonists | Darifenacin (Enablix) Solifenacin (Vesicare) Trospium (Sanctura) |
| Oxybutynin (Ditropan) | first drug of choice available in short release, extended release and transdermal patch |
| Ditropan indications | improves total bladder capacity, neuropathic voiding dysfnction, and bladder filling pressure/ uaed to depress uninhibited detrusor contractions in patients with and without neurogenic bladder dysfunction. |
| Tolterodine (Detrol/Detrol LA)indications | overactive bladder symptoms of urinary frequency or urge incontinence, as effective as oxybutynin |
| Detrol dosing | twice daily dosing, fewer problems with dry mouth |
| Solifenacin (Vesicare) indications | overactive bladder with symptoms of urinary incontinence |
| Vesicare adverse effects | QT interval prolongation in patients on medications who also have this property |
| Darifenacin (Enablix) indications | treatment of overactive bladder with symptoms of urinary incontinence, urgency, and frequency |
| Trospium chloride (Sanctura) indications | management of overactive bladder and urge incontinence, has fewer cognitive effects |
| Tricyclic antidepressants | effective for urge and mixed incontinence, increases urethral outlet resistance by adrenergic simulation of smooth muscle of the bladder neck and proximal urethra, assist urine storage by decreasing bladder contractility. |
| Tricyclic antidepressant drug of choice | Imipramine (Tofranil) sedating effects, take at night |
| Tofranil contraindications | may not use within 14 days of MAOI, death may occur |
| Tricyclic antidepressant adverse, effects: | orthostatic hypotension, cardiac conduction abnormalities, dizziness, confusion, potentially life-threatening overdose. limit to individuals who have one or more medical indications |
| alpha adrenergic agonists for stress incontinence | 1. bind with a receptor and initiate the same activity produced by endogenous substance 2. receptors regulate sympathetic innervation of the neck of the bladder 3. contract the smooth muscles of the GU tract |
| Alpha adrenergic agonist example | pseudophedrine (Sudafed) |
| Sudafed dosage | 15-30 mg TID only modestly effective |
| Sudafed contraindications | Severe HTN, coronary artery disease, use with caution in HTN, DM, BPH, hyperthyroidis, increased intraocular pressure. |
| Alpha adrenergic agonists adverse effects | hypertension, nausea, insomnia, rash, itching, headache, anxiety, and dizziness |
| Estrogen for stress incontinence | adjunct therapy in stress incontinence and urethral underactivity |
| estrogen actions | increases urethral vascularity and tone, enhances alpha adrenergic responsiveness of urethral muscle in postmenopausal women |
| Estrogen usage | use only topical products, best justified if woman also has urethritis or vaginitis |
| Serotonin- Norepinephrine Reuptake Inhibitor SNRI- Duloxietine | Cymbalta |
| Cymbalta used for | stress incontinence |
| Cymbalta approved for | depression and diabetic neuropathy, currently off-label for stress incontinence |
| Cymbalta action on urinary system | increases urethral and external urethral sphincter muscle tone during storage phase |
| Cymbalta precautions | avoid with severe renal or hepatic impairment, avoid in pregnant or breastfeeding, discontinue gradually, avoid in all patients who have taken MAO inhibitors within 14 days |
| Cymbalta adverse effects (CNS) | suicidal thoughts, anxiety, agitation, aggressiveness, engaging in unusual or dangerous activities |
| Cymbalta adverse effects (Serotonin syndrome) rare | Confusion, hallucinations, agitation, tachycardia, BP changes, arrhythmias, nausea, vomiting, diarrhea, overactive reflexes, fever, sweating, shivering, shakiness, seizures, coma |
| Cymbalta most common side effects | nausea, vomiting, decreased appetite, drowsiness, headaches, dry mouth, diziness, insomnia, constipation or diarrhea, fatigue and weakness, cough, sore throat, or runny nose, sweating, decreased libido and other sexual adverse effects. |
| Vascular causes of Erectile dysfunction | compromise of vascular flow such as HTN, PVD, arteriosclerosis |
| Neurologic causes of ED | impaired nerve conduction to the bain or to penis |
| Hormonal causes of ED | sub-physiologic levels of testosterone |
| Psychogenic causes of ED | depression, performance anxiety, sedation, alzheimer's disease, hypothyroidism, mental disorders |
| Social causes of ED | cigarette smoking, excessive alcohol intake because excessive alcohol intake can lead to (androgen deficiency, peripheral neuropathy, chronic liver disease) |
| anticholinergics that cause ED | antihistamines, tricyclic antidepressants |
| Dopamine agonists that cause ED | Reglan |
| Beta blockers that cause ED | atenolol, metoprolol |
| centrally acting agents that cause ED | clonidine, methyldopa |
| Other drugs that cause ED | Digoin, peripherally acting sympatholytics (rarely ued) spironolactone (Aldactone) |
| Thiazide diuretics that cause ED | HCTZ, chlorthalidone |
| Selective norepinephrine reuptake inhibitors that cause ED | Cymbalta, Effexor |
| Antipsychotics that cause ED | Thorazine, Prolixin, Haldol |
| Anticonvulsants that cause ED | Dilantin Tegretol, and Lithium Carbonate |
| Other drugs that can cause ED | Proscar, Avodart, alcohol, cimetidine (Tagamet), Opioids, Hormones, corticosteroids, estrogens, and anti-androgens |
| First line therapy for ED | Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) |
| PDE-5 inhibitor mechanism | Nitric oxide is released during sexual stimulation, this enhances ability to produce cGMP, cGMP dilates vessels and enhances arterial flow to the corpora cavernosa and enhaces blood filling of cavernosal sinuses |
| Patient education on PDE-5 inhibitor | take Viagra on an empty stomach at least 2 hours before meals, avoid fatty meals before taking Viagra or Levitra, try the drug 5-8 times before declaring failure. |
| Vardenafil (Levitra, sidenafil (Viagra) pharmacokinetics | 1 hour onset of action short duration of action (4-5 hours) oral absorption delayed if taken within 2 hours of a fatty meal avoid alcohol due to orthostatic hypotension |
| Tadalafil (Cialis) pharacokinetics | 2 hour onset of action,, prolonged duration of action up to 36 hours, food does not affect rate of absorption |
| PDE-5 Inhibitor dosing | Take no more than is prescribed, take only once per day |
| PDE-5 Inhibitor dosing special considerations | elderly patients, hepatic dysfunction, renal dysfunction, P450 3A4 inhibitors such as cimetidine, erythromycin, clarithromycin and ketoconazole |
| PDE-5 Inhibitor adverse effects | (In order of frequency) headache, flushing, flu-like symptoms, dyspepsia, myalgia, abnormal vision, back pain, ischemic optic neuropathy (Lead to permanent vision loss) |
| Priapism | Erection lasting longer than 4 hours (rare) associated with excessive doses or concomitant therapy |
| Vardenafil (Levitra) and sidenafil (Viagra) hypotension | -decrease systolic 8-10 mm Hg and diastolic 5-6 mm Hg. -Starts 1 hour after dose -Lasts 4 hours -May cause clinical hypotensive problems in patients on multiple antihypertensives or nitrates. |
| Vardenafil (Levitra) and sidenafil (Viagra) temporary vision changes | -Sensitivity to light -Blurred vision -Loss of blue-green color discrimination |
| Tadalafil (Cialis) adverse effects | Lower back and limb pain- dose related |
| PDE-5 Inhibitor drug interactions | Nitrates May cause severe hypotension Withhold for 24 hrs after sildenafil or vardenafil and for 48 hrs after tadalafil |
| PDE-5 inhibitor and treatment of angina | use non-nitrate containing agents such as calcium channel blockers, beta blocker, or morphine |
| May prescribe PDE-5 inhibitors to: | 1. symptomatic CV disease with less than 3 CV risk factors 2. Well controlled HTN 3. Mild, stable angina 4. Mild heart failure (Class 1) 5. Mild valvular heart disease 6. MI greater than 6 weeks ago |
| Diagnose low testosterone level by | monitor first morning serum testosterone |
| Adverse effects of low testosterone | Na retention and weight gain, exacerbation of HTN and heart failure, lipid profile changes |
| BPH | benign prostatic hyperplasia |
| Prostate gland anatomy | normal adult prostate- size of walnut, surrounds neck of bladder and urethra |
| Prostate function | Secrete seminal fluid |
| Prostate enlargement affects | half of men in their 60s and as many as 90% in their 70s and 80s. |
| As BPH worsens: | the bladder wall becomes thicker and irritable, begins to contract even when it contains small amounts of urine, causing more frequent urination, eventually weakens and loses the ability to empty causing urinary retention. |
| AUA Symptom Score for BPH | Score 1-7 mild score 8-19 moderate score 20-35 severe |
| AUA recommends that the symptom scale be used: | at initial assessment and then to follow the course of illness and therapy along with PSA levels |
| Substances that exacerbate BPH | Alcohol, coffee, high intake of butter and margarine |
| Substances that improve BPH | Green tea, soy and high intakes of fruits |
| Medications that exacerbate BPH | Decongestants, Antihistamines, diuretics, and antidepressants |
| Alpha adrenergic antagonists pharmacology | antagonists stop or slow down the natural alpha adrenergic fight or flight reactions; constrict the blood vessels in the skin, digestive tract, and urinary tract; dec. activity of the stomach & intestines; & contract the smooth muscle in genital& urinary |
| Alpha Adrenergic Antagonists include | terazosin (Hytrin) doxazosin (Cardura) prazosin (Minipress) tamsulosin (Flomax) (These are functional anti-hypertensives) |
| Alpha Adrenergic antagonist adverse effects | orthostatic hypotenion, syncope, dizziness, should begin with a low dose and increase incrementally. |
| Side effects of Flomax | tiredness, asthenia, ejaculatory dysfunction, flu-like symptoms, and nasal congestion |
| Dosage of Alpha Adrenergic antagonist | one tablet qhs |
| 5 (alpha) reductase inhibitors mechanism of action | -testosterone is converted to DHT, which stimulates prostate growth -converion is facilitated by 5 alpha reductase -agents that suppress androgen action will induce prostate atrophy -reduction in volume and sx may not be for 12 months |
| 5 alpha reductase inhibitors | finesteride (Proscar) dutasteride (Avodart) flutamide (Eulexin) leuprolide (Lupron) |
| finasteride (Proscar) mechanism | halts disease progression, decreases the size, increases urine flow in most patients, reduces risk for acute urinary retention and surgery, recommended for long term therapy |
| finasteride (Proscar) adverse effects | does not affect libido or spermatogenesis |
| dutasteride (Avadart) has same indication and effects as Proscar: adverse effects | impotence, decreased libido, ejaculation disorders, gynecomastia |
| flutamide (Eulexin) inhibits binding of androgen to its receptors: adverse effects | nipple tenderness, decreased libido, diarrhea **use in patients unable to tolerate finasteride** |
| leuprolide (Lupron) adverse effects | hot flashes, loss of potency **Reserved for patients with prostate cancer** |
| In the treatment of BPH what is the first line of choice drugs: | Alpha adrenergic agonists, they are faster and more effective than a 5 alpha reductase inhibitor, more effective in reducing lower urinary tract sx., no effect on PSA, associated with less sexual dysfunction. |
| Which drug therapy is best for significantly enlarged prostate and people that cannot tolerate the cardiovascular side effects of alpha adrenergic antagonists | 5 alpha reductase inhibitors |
| Combination therapy good first choice for: | patients with an enlarged prostate greater than 40 grams and an elevated PSA greater than or equal to 1.4 ng/mL |
| Monitoring patients with BPH and medications | -monitor BP during the first 2 wks of tx. -attend to subjective complaints of sexual dysfunction (biggest reason for non-compliance) -evaluate success of therapy by the reduction of symptoms |
| Main cause of UTI in children | E-coli causes 85% of UTIs in children |
| Infants younger than 3 months with a UTI | Refer for admission for parenteral antibiotics |
| First line antibiotics for 1st UTI in children | Suprax 16mg/kg/day Day 1 BID, thereafter once daily |
| Cephalexin (Keflex) | 25-100mg/kg/day low cost QID dosing |
| Sulfamethoxazole/Trimethoprim (Bactrim, Septra) | 6-10mg/kg/day moderate cost BID dosing Use with caution in jaundiced infant (will refer anyway) |
| Amoxicillin is no longer recommended for UTI because | increased incidence of resistance to E coli |
| Second line treatment of UTI in children less than 12 | Nitrofurantoin (Macrodantin) Ciprofloxin (Cipro) |
| Nitrofurantoin (Macrodantin) | 5-7mg/kg/day unpleasant taste low cost may be useful in older children |
| Ciprofloxin (Cipro) | 20-30mg/kg/day approved as 2nd line for complicated UTI in children greater than 1 year High cost Causes antibiotic resistance Black box warning: high risk of tendinitis and tendon rupture. |
| Treatment of UTI in pregnancy After C & S | First line (5 to 14 days)- Nitrofurantoin, cephalosporin Other drugs- sulfonamides (avoid in mothers with G6PD deficiency, avoid in late pregnancy (neonatal hyperbilirubinemia) **PCN no longer best choice due to E coli resistance** |
| Guidelines for treating uncomplicated UTI in non-pregnant women | First line TMP-SMX DS (Bactrim, Septra) Trimethoprim Fluoroquinolone (Cipro) Macrodantin or Macrobid Fosfomycin tromethamine (Monural) |
| Bactrim, Septra | BID for 3 days- check for sulfa allergy |
| Trimethoprim | BID for 3 days- give this with sulfa allergy |
| Cipro (fluoroquinolone) | BID for 3 days |
| Macrodantin or Macrobid | 7 days |
| Fosfomycin tromethamine (Monural) | single dose |
| Because of resistance do not use: | 1st generation cephalosporin and amoxicillin |
| Once daily treatment for frequent UTIs | nitrofurantoin, norfloxacin, ciprofloxacin, trimethoprim TMP-SMX DS (Bactrim/Septra) |
| How often do you re-evaluate the need to continue daily antibiotics in frequent UTI patients | after 6-12 months |
| Pyridium | Use with antibiotic to relieve discomfort NO benefit after 2 days Pregnancy category B |
| Pyridium dosage | 200mg TID after meals Makes urine orange or red and may stain fabric May stain contact lenses |
| Acute bacterial prostatitis outpatient therapy | all therapy is BIDD X 4 weeks |
| First line treatment for prostatitis | Ciprofloxacin (Cipro) Ofloxacin (Floxin) |
| Treatment for prostatitis if allergic to quinolones | TMP-SMX DS or TMP (Bactrim or Septra) |
| First line treatment for chronic prostatitis | TMP-SMX other drugs used to treat: Norfloxacin Carbenicillin (Geocillin) Ofloxacin (Floxin) Minocycline Cephalexin |
| Acute epididymitis | If caused by GC or chlamydia, follow CDC recommendations. If allergic to cephalosporins or tetracyclines: use ofloxacin or levofloxacin |
| Acute epididymitis- Ofloxacin | BID for 10 days |
| Acute epididymitis- levofloxacin | daily for 10 days |
| Timeline of Menstrual cycle | Day 1-28 |
| Day 1 | Menstruation begins |
| Day 3-5 | FSH rises, initiating follicle growth |
| Day 6-7 | LH begins to rise, estrogen follows suit, endometrium begins to thicken |
| Day 10-12 | Estrogen peaks |
| Day 13-14 | FSH, LH spike (pre-ovulatory surge) |
| Day 14 | Ovulation |
| Day 15-16 | Estrogen and progesterone rise |
| Day 21-22 | Corpus luteum begins to degenerate, estrogen peaks and begins rapid fall, progesterone begins slow fall |
| Day 27-28 | Endometrium begins to degenerate |
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