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PP exam 4
Everything that is in red came from test your knowledge!

Patho Risk Factors Causes Other:

Manifestations

Prostate -Bladder Outlet -Caused by the - High fever Prostatitis has

Prostatitis becomes Obstruction growth of -Joint pain manifestations as
swollen, -Diabetes Mellitus bacteria that are -Lower Back pain UTIs
tender and -Suppressed not normally -Pain around base
inflamed Immune System found in prostatic of penis
(Prostate -Urethral fluid.
inflammation) Catheterization Ex. E. Coli.

Inflammation -Sex with a partner -Caused by a -Pain and swelling Complications:

Epididym of the tube at who has an STI bacterial or STI in testicle Abscess formation,
itis the back of the -Sex without a -Can be caused - Groin discharge sepsis or continued
testicle that condom by enlargement from penis or
infection
stores and -Hx of prostate or of the prostate swollen lymph
carries UTI gland. nodes in the groin
sperms. -Uncircumcised - Frequent urge to
Treatment:antibioti
penis urinate or
-Medical frequent urination cs for infection.
procedures that -Painful Analgesics, ice and
affect the urinary ejaculation scrotal elevation for
tract (Foley comfort.
catheter) Diagnosed by
culture by urethral
swab.

Teaching:
Swelling and pain
will take several
weeks to months.

Benign -Age- Westernized unknown Frequency, Complications:

Prostatic associated countries (US, urgency, UTI, Bladder
Hypertro prostate gland UDK, Canada), retention, diff stones, bladder
phy enlargement
black and white starting urine, damage, kidney
that can cause
race, family hx, weak stream, damage
urination
overweight with dribbling,
difficulty
more fat on nocturia,
-Urinary stomach bladder Treatment:
system may be distension, Alpha-Adrenergic
weak. Can lead overflow blockers (Prazosin
to infection, incontinence, ED and tamsulosin),
bladder Antiandrogens
stones, and (Finasteride
reduced kidney (proscar), Surgical-
function.
transurethral
needle
ablation(TUNA)
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[laser treatment],
Transurethral
resection of
prostate (TURP).

Diagnosis: Digital
rectal examination
(DRE) and
measurement of
prostate specific
antigen (PSA) [it
will be elveated],
transrectal
ultrasound (TRUS)
to check bladder
and prostate
volume and
residual urine.

Teaching:
Men over 40 should
have annual DREs.

Erectile Multifactorial Smoking, Some meds Psychological Complications:

Dysfunct overweight, and dz’s. screening will be Heart attacks and
ion inactive lifestyle, Diabetes. Meds performed for death.
age, alcohol, such as younger men or
drug use, stress antidepressants any age who can
and anxiety (loses sexual achieve but not Treatment:
desire, loses maintain Pharmacological-
hormone erection. phosphodiesterase
function), type 5 inhibitors
penila dz or (PDE5i) such as
trauma, renal Sildenafil
failure. Alcohol. (Viagara),
vardenafil,
tadalafil, avanafil

Non
Pharmacological-
stop drugs that
cause ED, (cardiac
drugs) and fix
endocrinopathy
related dysfunction
(reduced
testosterone asso
w/ renal failure),
use of vasodilators
and stop smoking.

Side effects
Priapism (painful and
continuous erection),
gynecomastia (mammary
gland enlargement in men),
urinary urgency, halt
spermatogenesis,
oligospermia (low sperm
count)
Who can not use
impotence agents (Viagra,
Cialis) or androgen
therapy
Sexual Transmitted Infections
3
Teaching:
priapism (erection
more than 6 hours)
this is a surgical
emergency that
uses needles to
drain the blood
Androgen Therapy
Drug interactions Indications for Indications for anti-
Women androgen
Increases effect of Pregnancy Do not use in
anticoagulants; combination with herbal
decreases effect with or dietary supplements
barbiturates, such as black cohosh,
phenytoin, chasteberry or DHEA.
phenylbutazone;
antagonizes calcitonin
and parathyroid;
corticosteroids
exacerbate edema.
People with heart problems, priapism (erection more than 6 hours),
pregnant women
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Risk Factors Causes Manifestations Other:

Candidiasis Antibiotics Candida Albicans. Itching and irritation Complications:

*Fungal use (broad), - Antibiotic use Burning especially Causes vaginitis
increased which changes during intercourse or
estrogen pH of vagina, while urinating
levels, pregnancy, Redness and swelling Treatment:
uncontrolled uncontrolled Vaginal pain and Miconazole cream,
diabetes, diabetes, soreness clotrimazole tabs or
impaired impaired immune Vaginal rash cream, nystatin tablets,
immune system Watery vaginal ketoconazole cream, loose
system, discharge cotton clothing
sexual -Taking oral Thick white odor free
activity, contraceptives or vaginal discharge
pregnancy hormone with cottage cheese Teaching:
theraphy which appearance Eat probiotics yogurt,
increases avoid taking baths every
estrogen day, dont wear workout
clothes all day

Chlamydia -Sexually Chlamydia Painful urination Complications:

*Bacterial active before trachomatis Lower abdominal Other STIs, epididymitis,
25 parasite that pain prostate infection,
-multiple sex requires host cell Vaginal discharge in infection to newborns,
partners women infertility, reactive
-unsafe sex Discharge from the arthritis
-history of penis in men
prior STI Painful sexual Teaching: All pregnant
intercourse in women women are screened and
Bleeding between tested.
periods and after sex
in women
Testicular pain in
men Treatment:
Azithromycin 1g as single
Usually dose (GIVE DURING
asymptomatic. PREGNANCY), Doxycycline
100mg bid x7 days ( DO
NOT TAKE DURING
SECOND AND THIRD
TRIMESTER)
Erythromycin 500 mg PO
4x daily for 7 days (LAST
CHOICE), levofloxacin 500
mg PO once for 7 days

Gonorrhea Multiple sex Neisseria Signs: Penile D/C Complications:

*Bacterial partners, gonorrhoeae. Bleed after sex PID, ectopic pregnancy,
diagnosed Aerobic bacteria. infertility, passing from
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with another Symptoms: dysuria, mother to baby during
STI polyuria delivery (Erythromycin is
given to newborns over
(If oral infection= each eye at birth to
sore throat prevent conjunctivitis
resembling strep caused by N.gonorrhoeae)
throat)

Treatment:
ceftriaxone 250mg IM
AND azithromycin 1g PO
single dose. (use of two
drugs improves treatment
and slows development of
drug resistance)

If allergic to
cephalosporins,
Gemifloxacin 320 mg PO
AND azithromycin 2g PO
single dose.

Syphilis Low income, Ulcerative Signs: Rash on hands Complications:

*Bacterial Men seeking infection caused and feet, systemic dz that can be
men. by Treponema lymphadenopathy fatal.
Pallidum. Can pass to infant during
Through sexual Primary: painless pregnancy, if allergic to
contact. Requires sores, asymptomatic, PCN should be given
warm moist allergic skin test and
environment. Secondary syphillis: desensitization and then
skin rash on hands be treated with PCN
and feet (lasts 2
months but is still All stages should be
very contagious), tested for HIV
fever, fatigue,
lymphadenopathy,
spreads through
whole body, Treatment: primary
resolves on its own within
Tertiary syphillis: 1 3-6 weeks.
year after infection, Primary & Secondary=
blind, deaf, large benzathine penicillin IM.
sores inside th ebody
Tertiary= get CSF
analysis first before
treatment to determine
neurologic involvement.

Trichomoni -Multiple sex One-celled Women: Complications:

asis partners protozoan called (symptomatic when men= urethritis,
*Bacterial -A history of Trichomonas vagina ph is epididymitis, prostatitis
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(most other sexually Vaginalis a type disturbed) Pregnancy= membrane
common transmitted of tiny parasite - profuse foul rupture, preterm delivery,
curable dz) infections that burrows smelling yellow delivery of low birth
-A previous under mucosal green vaginal weight infant
episode of lining. Incubation discharge
trichmoniasis period between - genital,
-Having sex exposure and redness,burnin Treatment:
without a infection is g and itching Nitromidazoles such as
condom unknown, but its - pain with Metronidazole (1 dose)
-Having a thought to range urination or and Tinidazole (2 dose)
partner that from 5-28 days. sexual for PO.
is circumsized intercourse
DO NOT DRINK ALCOHOL
Men: (in urethra, WHEN TAKING 24 hrs
rarely cause after metron, 72 hrs after
symptoms) tinid.
- Irritation inside
penis
- Burning with
urination or
after
ejaculation
- Discharge from
the penis

Genital Woman HPV. spread by - Pain or itching. Management of genital

Herpes Multiple sex sexual contact. - Small red herpes is acyclovir,
*Viral partners After the initial bumps or tiny valacyclovir,
infection, the white blisters. famciclovir
virus lies - Ulcers
dormant in your - Scabs
body and can
reactivate several Women: sores on the
times a year. buttocks and thighs,
anus, mouth,
HSV1- causes urethra, vaginal area,
cold sores or external genitals,
fever blisters cervix
around mouth.
Can also spread Men:sore sin penis or
to genitals. scrotum
Recurrences
much less
frequent than
HSV2

HSV2- genital
herpes. Sexual
and skin to skin
contact. Very
common and
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highly
contagious,
whether or not
you have an
open sore.

HPV -Number of Virus enters your -genital warts (flat

*Viral sexual body through cut lesions, small
partners or abrasion. Skin cauliflower-like
-Age to skin contact. bumps)
-Warts mostly - common warts
in children HPV Vaccine (rough,raised bumps
-Weakened prevents cervical on hands, fingers,
immune cancer elbows)
system - plantar warts (hard,
-Aids, HIV, grainy growth that
organ usually appears on
transplant the heels or balls of
-Damaged feet.
skin - flat warts (flat
-Personal topped, slightly
contact raised darker than
-Touching skin)
someone's S&S might worsen
wart without during pregnancy
protection. -
Surfaces
exposed to
HPV

PID Infection with Gonorrhea and Abnormal vaginal Complications:

*Bacterial gonorrhea, chlamydia. discharge infertility , sepsi, and
chlamydia, Pain in the lower death. It is ridiculously
multiple sex Long term abdomen (often a painful.
partners, past complication of mild ache) Can not take meds during
PID, using STI of any kind. Pain in the upper pregnancy, Ectopic
douches, right abdomen pregnancy, salpingitis
sexually Abnormal menstrual (inflammation of fallopian
active less bleeding tubes)
than 25 yo, Fever and chills
having an Painful urination
IUD n&v Treatment:
Painful sex Antibiotics to treat
infection (ceftriaxone,
Diagnosed by: body doxycycline,
temp greater than metrondiazole, cefoxitin,
101, vaginal other third gen
discharge, elevated cephlosporins,
WBD, C reactive
protein and
erythrocyte. Teaching:
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Come back after 3 days to
check for effectiveness of
meds, have partner
tested and treated,

HIV Unprotected body fluids that (2-4 weeks after Complications:

*Viral sex, multiple contain free exposure) Flu like Depletes CD4 T
partners, virions and symptoms such as lymphocytes and ends
sharing infected CD4+ T fever, fatigue, rash, with symptomatic AIDS,
needles cells pharyngitis, Opportunistic infections
lymphadenopathy such as pneumonia,
respiratory or cardiac
failure r/t impaired
breathing, Cachexia
(weakness and wasting)

Treatment:
Antiretroviral (ART) bc it
reduces transmission to
others.
(NRTIs, NNRTIs, PIs,
Fusion (entry) inhibitors,
CCR5 antagonists and
INSTIs.

All pregnant women are

tested 1st visit and 3rd
trimester if at high risk
for HIV.

Other:

Risk Factors Causes Manifestations Other:

Osteoporos Old age, Old bone is being Pain and bone Complications:
is female, family resorbed faster deformity bc of Fractures. Kyphosis
hx, petite than new bone is fracture. caused by vertebral
thin, hx of being made. collapse and diminished
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fracture, height.
asian and Fat or pulmonary
white embolism. Death (20%)
ethnicity, hx
of rheumatoid Treatment:
arthritis, Bisphosphonates
prolong use - Alendronate
of steroids, (Fosamax)
smoking, - Risedronate
alcohol or (Actonel)
soda, low - Ibandronate
calcium and (Boniva)
vitamin D - Zoledronic Acid
(Reclast)
Selective Estrogen
Receptor Modulators
(SERMs)
- Do not take w/ hx
of VTE or
pregnancy

Teaching:
Take the pill with full
glass of water and be
upright 30 min after.
Causes horrible erosive
esophagitis. Will literally
at a hole in the
esophagus

Diet high in calcium,

vitamin D, magnesium.
Weight bearing exercise,
avoid alcohol, tobacco
and glucocorticoids.

Birth Control

Who can not Hx of blood clot, hx of stroke or MI, CAD, known or suspected breast cancer or
take BC endometrial cancer, jaundice during pregnancy or during previous use of the pill,
known or suspected pregnancy, liver tumor, if you plan to have surgery with
prolonged bed rest, smoke and have high BP, have lupus, migraines with aura.
Smoke and over age 35.
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Birth Control Type of S&S Complications Teaching
options hormone

IUD Copper: stops Copper: Heavy Perforation, Copper: lasts up to

uterine bleeding, dysfunctional uterine 10 years
contraction and cramps, and bleeding, PID
stops sperm blood clots in
movement. menstrual flow.
WOMEN WHO HAVE
Levonorgestrel NO HAVE HAD CHILD Levo: Lasts up to 5
(PROGESTIN): YET CAN NOT GET years.
makes mucus Levonorgestrel: THIS String check: Feel for
thicker so Menorrhagia is string from the
sperm can not improved, device, done monthly.
enter dysmenorrhea is
also improved.

Nexplanon Progestin only Irregular Same as Oral Similar to the

Implantable in bleeding, weight contraceptives. Not as injection DEPOT
the arm gain, mood effective in obese PROVERA.
changes, women BMI greater
abdominal pain, than 20.
acne, Lasts 3 years

EE CHC Irritation, breast Less risk than CHC Place on skin of butt,
Transdermal tenderness, pills. stomach upper outer
Patch N/V, cramps, Skin reactions, cramps arm or upper porso.
Ehinyl Estradiol bloating, weight or change in vision or
Place once a week for
and gain, change in inability to wear
Norelgestromin appetite, brown contact lens. Not as 3 weeks in row. 4th
Patch spots, hair loss effective with women week is patch free.
over 198 llbs.

Vaginal discharge,
irritation or infection.

EE CHC (mostly Cramps, Venous Lasts 3 weeks and

Transvaginal progestin) bloating, thromboembolism, remove for 1 week.
Contraception
(CHC)
Vaginal ring

Depo Shot Progestin only Amenorrhea, Decreased bone Lasts 11-13 weeks (3
(Depot weight gain, marrow density months-ish)
Medroxyprogest mood changes, (BMD).
erone Acetate) cramps,
bloating,

Oral Contraceptives Types

Estrogen excess (S&S) Progestin excess (S&S) Combined Hormone

(Common) N&V, bloating,
cramps, breast tenderness,
headache, loss of hair, weight
changes, vaginal itching, changes
in menstrual cycle, freckles or
darkening of facial skin. (Rare)
(Common) changes in vaginal bleeding, (CHC)
dry mouth, frequent urination, loss of Estrogen and
appetite or unusual thirst. (Rare) Blood Progestin. Most
clots, headache, migraine, paralysis, common is Ethinyl
change in speech, coordination or vision, Estradiol (EE).
SOB Inhibits ovulation by
preventing formation
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blood clots that lead to heart of a dominant follicle
attacks, strokes, DVT , PE. so that estrogen
levels do not peak
and cause ovulation

Estrogen deficiency Progestin Deficiency Menstrual

-Vaginal bleeding (breakthrough -Dysmenorrhea, bleeding late in the Disorders
bleeding, especially in 1st few cycle (days 15 to 21), heavy menstrual Amenorrhea-
cycles after starting therapy) that flow with clots, or amenorrhea, absence
lasts several days (usually during of menstruation
Dysmenorrhea-
days 1 to 14) -Changes in laboratory values, including
painful menstruation
-Oligomenorrhea (very scant thyroid and liver function, blood glucose,
periods) especially after long- and triglycerides. Menorrhagia-
term use increase menstruation
-Nervousness, Dyspareunia flow; 80ml per
(painful sexual intercourse) menstruation +
secondary to atrophic vaginitis. increase duration

Metrorrhagia-
bleeding between
menstruation in
premenopausal
women

Polymenorrhea- short
menstrual cycle (<21
days), resulting in
frequent
menstruation

Oligomenorrhea- long
menstrual cycle (>42
days), infrequent
menstruation

Premenstrual
syndrome-
physical/emotional
symptoms not fully
understood
Premenstrual
dysphoric syndrome-
severe PMS (severe
depression, tension,
irritability severe PMS
(severe depression,
tension, irritability)

Complications Teaching Drug Interactions

blood clot risk increase, DVT When miss Anticonvulsants, Anti Tuberculin, Antifungal,
which could cause PE, hormone pill,use another Antibiotics, Barbiturates, Hypnotics and
 12
issues, migraine. And personality form of bc for 7 sedatives, migraine meds (specific drug
changes. Breast cancer risk due days., do not names on on page 769)
to estrogen. 60% of breast smoke bc
cancers are estrogen sensitive increase risk of
cardiovascular
risks. Does not
protect against
STIs.

Drug Antibiotics (use backup method of bc)

Interactions - Rifampin (rifadin) which is used to treat TB
(in depth) - Tetracycline, often used to treat acne
- Ampicillin and Amoxicillin, used to treat bacterial infections such as UTI
- Metronidazole used to treat Trichomoniasis and PID
- Penicillin used to treat syphilis
- Doxycycline used to treat chlamydia and PID
Anti-seizures and migraine medications
- Phenobarbital (Dilantin), used to treat seizures and sometimes insomnia.
- Carbamazepine, used to treat epilepsy, bipolar disorder and someone's
ADHD and schizophrenia
- Hydantoins used to treat seizures
- Succinimides used to treat seizures
Antifungals
- Griseofulvin used to treat ringworm, jock itch, athletes foot

Mnemonic A- abdominal pain

**IF PRESENT C- chest pain/ SOB
STOP BC AND H- headaches (severe)
CONTACT
E- eyes (vision changes)
HCP!!!**
S- severe leg pain

What are the types of birth control?

1. Oral contraceptives
2. Transdermal patches
3. NuvaRing Transvaginal Contraception (Non-biodegradable, transparent, and colorless or
almost colorless)
4. Spermicides
5. Barrier methods
a. Intrauterine contraception
6. Emergency
a. Combined hormone contraceptive pills
b. Plan B
c. ParaGard
7. THE BEST TYPE OF BIRTH CONTROL IS ABSTINENCE

What are the side effects of progestin, estrogen?

1. ↑Excess estrogen↑:
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a. N/V/D,
b. fluid retention, edema, bloating, breast enlargement,
c. breast tenderness, Chloasma (brown patches appear on the face.),
d. leg cramps,
e. decreased tearing, corneal curvature alteration, visual changes,
f. vascular, headache, HTN.
2. ↓Estrogen deficiency↓:
a. Vaginal bleeding (breakthrough bleeding, especially in 1st few cycles after
starting therapy) that lasts several days (usually during days 1 to 14)
b. Oligomenorrhea (very scant periods) especially after long-term use
c. Nervousness, Dyspareunia (painful sexual intercourse) secondary to atrophic
vaginitis.
3. ↑Excess progestin↑:
a. Increased appetite, weight gain, oily skin and scalp, acne,
b. Depression,
c. vulvovaginal candidiasis (vaginitis from the yeast microbe candida),
d. excess hair growth (hirsutism),
e. decreased breast size, and amenorrhea after cessation of use (1% to 2% of
patients)
4. ↓Progestin deficiency↓:
a. Dysmenorrhea, bleeding late in the cycle (days 15 to 21), heavy menstrual flow
with clots, or amenorrhea,
b. Changes in laboratory values, including thyroid and liver function, blood glucose,
and triglycerides.

Who should not take contraceptives/hormones?

1. Pregnant pts
2. Hx of endometrial cancer
3. Personal hx of breast cancer
4. Hx of thromboembolic disorders
5. Acute liver dz or chronic impaired liver function
6. Active gallbladder or pancreatic dz
7. Coronary Artery Disease (CAD)
8. Undiagnosed vaginal bleeding
9. Endometriosis

What drugs interact with birth control?

1. Anticonvulsants, antituberculins, antifungals, antibiotics, barbiturates, hypnotics &
sedatives, migraine drugs,

What class of meds are used to treat osteoporosis?

1. Bisphosphonates
2. Selective Estrogen Receptor Modulators (SERMs) – contraindication is hx/risk for VTE &
pregnancy.
a. SE: nausea, abdominal/stomach pain, difficulty swallowing, esophageal
inflammation, reflux, ulcers. DO NOT take with aspirin, NSAIDS, antacids
3. Prevention –
a. Calcium, Vit. D, Weight bearing exercises.
4. Medications for treatment –
a. Alendronate (Fosamax)
b. Ibandronate sodium (Boniva)
 14
c. Risedronate (Actonel)
d. Reclast
e. Raloxifene (Evista)
f. Teriparatide (Fortéo)
g. Salmon calcitonin (e.g., Fortical, Miacalcin)
h. Denosumab (Prolia)
i. Menostar (estradiol transdermal system)

What are the risk factors for osteoporosis?

1. Bone fractures (hip & vertebral most common)
2. Women greater >50 are at highest risk because loss of estrogen.
3. Old age, female, family hx, petite thin, hx of fractures, Asian and white ethnicity, hx of
rheumatoid arthritis, prolong use of steroids (cause osteoporosis), smoking, ETOH or soda,
low calcium and vitamin D

CH 57:

Who cannot use impotence agents (Viagra, Cialis) or androgen therapy?

1. Pregnant pts
2. Nephrosis or nephrotic phase of nephritis
3. Hypercalcemic pts
4. Pituitary insufficiency
5. Hepatic dysfunction
6. BPH
7. Prostate cancer
8. Hx of myocardial infarction (MI)
9. Men with breast cancer

What are the side effects of androgen therapy?

1. Side effects
a. Pripiasm (painful continuous erection)
b. Gynecomastia (man boobies)
c. Spermatogenesis halted
i. Oligospermia (low sperm count)

2. Adverse effects
a. Hypercalcemia (N/V, Lethargy, decreased muscle tone, polyuria)
b. Virilization (facial hair growth, oily skin, vocal huskiness)
c. Teratogenic effects
d. Hepatic carcinoma

What drugs interact with androgen therapy?

1. Oral anticoagulants, calcitonin, parathyroid hormones, insulin, antidiabetic agents,
corticosteroids, barbiturates, phenytoin, phenylbutazone.

What is the indication for androgen therapy in women?

1. Breast cancer treatment that is not estrogen dependent.

Indications for androgen therapy

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growth delay, endometriosis, refractory anemias, advanced breast cancer in women,
hypogonadism, angioneurotic edema, and tissue wasting associated with severe or chronic
illness.

What are the indications for anti-androgen therapy?

1. Antiandrogens – block synthesis or action of androgens.
2. Treatment of:
a. BPH,
b. Advanced prostatic cancer
c. Endometriosis.
i. Other uses – baldness, acne, hirsutism, virilization (development of male
physical characteristic muscle bulk, body hair, and deep voice in a female),
precocious puberty in boys.
d. DO NOT USE with herbal/supplements (black cohosh, chasteberry, DHEA)