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Lila erectile dysfunction causes agent orange buy discount avana 200mg on-line, a 19-year-old college student icd 9 code for erectile dysfunction due to diabetes order 50 mg avana free shipping, comes to the clinic for renewal of her prescription for oral contraceptive pills erectile dysfunction viagra trusted avana 100mg. She has been unable to get to the clinic to have her prescription renewed before today erectile dysfunction lisinopril buy avana 50 mg visa. She remembers having unprotected intercourse 2 days ago, and now she is concerned that she will become pregnant. Which clients would the nurse consider at highest risk for an adverse response to this therapy A 42-year-old who has delivered four healthy children the client who is taking estradiol and drospirenone (Yasmin) informs the nurse that she forgot to take her pills for the past 2 days. The nurse is providing health education about contraceptive methods to a group of young adults. Rank the following contraceptive methods in order of effectiveness from most to least effective: 1. What advice would you give Gina with regard to continuing the oral contraceptives Black cohosh (Cimicifuga racemosa) for menopausal symptoms: A systematic review of its efficacy. Unsafe abortion: Global and regional incidence, trends, consequences, and challenges. How close are we in achieving safe, affordable and reversible male contraceptives Emergency contraception use and counseling after changes in United States prescription status. Fertility after discontinuation of contraception: A comprehensive review of the literature. Describe the roles of the hypothalamus, pituitary, and testes in regulating male reproductive function. Explain the role of androgens in the treatment of male hypogonadism, delayed puberty, and breast cancer. Describe the potential consequences associated with the use of anabolic steroids to enhance athletic performance. Compare and contrast the nonpharmacologic and pharmacologic management of disorders and conditions of the male reproductive system. For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. Apply the nursing process to the care of patients who are receiving pharmacotherapy for disorders and conditions of the male reproductive system. Because hormonal secretion in men is relatively constant throughout the adult life span, the pharmacologic treatment of reproductive disorders in men is less complex and more limited than in women. This chapter examines the drugs used to treat the disorders and conditions of the male reproductive system. Unlike the 28-day cyclic secretion of estrogen and progesterone in women, testosterone secretion is relatively constant in adult men. Beginning in puberty, testosterone production increases rapidly and continues to maintain a high level of production until later adulthood, after which it slowly declines. The relationship among the hypothalamus, pituitary, and the male reproductive hormones is illustrated in Figure 74. These Male reproduction function is controlled by androgens, which are hormones secreted by Leydig cells in the testes. Testosterone, the primary androgen, is responsible for maturation of the male reproductive system and the secondary sex characteristics of men. Androgens are responsible for the development of the male urogenital system in the fetus. After birth the Leydig cells are quiet until activated by the gonadotropins, which are hormones secreted by the pituitary gland. The resulting increased production of testosterone by the testes begins the cascade of changes that accompany the onset of puberty in the male adolescent. The increased testosterone levels are responsible for the process of virilization, or the development of the male sexual characteristics. During the next several years, the testes, scrotum, and penis enlarge until they reach adult proportions. Pubic and axillary hair grows and other body hair becomes more adult-like in nature. The production of sperm that are capable of fertilizing an ovum begins in the seminiferous tubules of the testes. Sebaceous gland activity is stimulated, resulting in an increase in the level of acne. Of particular importance is its ability to build skeletal muscle mass and to stimulate bone growth, which contributes to the differences in muscle strength and body composition between men and women. Androgen secretion is regulated by the same pituitary hormones that control reproductive function in women. Adrenal androgens have a role in the growth of pubic hair and are thought to influence the skeletal growth spurt in adolescents. In adult males, the adrenal androgens have minimal effects due to the comparatively larger amount of testosterone secreted by the testes. Androgens are used to treat testosterone deficiency in men, delayed puberty, oligospermia, hypogonadism, anemia, musclewasting disorders, and certain cancers.

Urban Hispanic households with at least one child of elementary school age or younger were interviewed to determine their health beliefs regarding the cause erectile dysfunction doctors in tulsa purchase 50 mg avana mastercard, prevention erectile dysfunction kansas city order avana discount, and treatment of colds and flu; their knowledge about appropriate antibiotic use; and the influence of different sources for health knowledge erectile dysfunction doctors in pa discount avana 200 mg on line. The nurse researchers found that overall lipo 6 impotence buy 100 mg avana with amex, the families interviewed were aware that viruses were the cause of colds and flu. Only a small percentage believed that "mal de ojo" (evil eye) or "susto" (sudden fright) were causes. While some recognized that viruses were the cause, a large percentage believed that bacteria were also a cause. A majority believed that antibiotics were usually or sometimes needed to treat the infection, even though many recognized and worried about antibiotic resistance. Health care providers such as physicians or nurses had the biggest influence on whether the families would seek vaccination after recommendation. Public service announcements by government or professional agencies, radio or television programs, recommendations of friends or relatives, and articles in newspapers and magazines played a lesser role. A positive finding of the study was the role that health care providers play in the likelihood that recommendations for vaccination and general health care would be followed. Critical Thinking Question What strategies and in what settings could nurses and nursing students use to increase the dissemination of health knowledge to diverse populations Antiviral pharmacotherapy can be extremely challenging due to the rapid mutation rates of viruses, which can quickly render medications ineffective. Also complicating therapy is the intracellular nature of the virus, which makes it difficult for drugs to find their targets without giving excessively high doses that injure normal cells. Antiviral drugs have narrow spectrums of activity, usually limited to one specific virus. For most of the viral pathogens, pharmacologic cures are not possible; thus, antivirals remain the least effective of all the anti-infective classes. Immunosuppression, physical challenge, or emotional stress can promote active replication of the virus and the reappearance of the characteristic lesions. Note that the antiviral drugs used to treat herpesviruses do not cure the patient; the virus remains in patients for the remainder of their life. Topical forms of several antivirals are available for local application to herpes lesions, though they are not as effective as the oral medications. Herpes of the eye is the most common infectious cause of corneal blindness in the United States. Ocular herpes causes a painful, inflamed lesion on the eyelid or surface of the eye. Prompt treatment with antiviral drugs can stop the herpesvirus from multiplying and destroying epithelial cells. Like genital herpes, once patients acquire ocular herpes they often experience recurrences, which may occur years after the initial symptoms. Pharmacotherapy of ocular herpes is through the local application of drops or ointment. The goal of therapy is to prevent permanent visual disability by limiting corneal involvement of the infection. Trifluridine (Viroptic) and idoxuridine (Dendrid, Herplex) are available in ophthalmic formulations. Oral acyclovir is used in situations where topical drops or ointments are contraindicated. Prophylaxis of herpesvirus infection: Due to the expense and potential adverse effects, antiviral agents are not routinely prescribed for prophylaxis. However, patients who experience particularly severe or frequent recurrences (more than six episodes per year) may benefit from low doses of prophylactic antivirals. If drug therapy is initiated within 24 hours after symptoms first appear, the length of the acute episode may be shortened, or even prevented. Because of the severity of neonatal herpes infections, pregnant women with the infection are sometimes treated with antivirals. The most extensive clinical experience during pregnancy has been with acyclovir, which has not been associated with teratogenic effects. The safety and effectiveness of these drugs during pregnancy, however, have not been clearly established. Doses should be lowered in these patients and proper hydration should be implemented to prevent crystalluria. Classification: Therapeutic: Antiviral for herpesviruses Pharmacologic: Nucleoside (deoxyguanosine) analog Therapeutic Effects and Uses: Approved in 1982 as one of the first antiviral medications, the activity of acyclovir is limited to the herpesviruses, for which it is a drug of choice. When given for prophylaxis, it decreases the frequency of herpes recurrences, but it does not cure the patient. Probenecid decreases acyclovir elimination and can lead to toxic levels of the antiviral. Systemic acyclovir may result in additive nephrotoxicity if used with other drugs affecting renal function such as aminoglycosides. Mechanism of Action: Acyclovir is a nucleoside analog that inhibits viral replication by affecting two viral enzymes. First, it enters the host cell where it is activated by a viral enzyme known as thymidine kinase. Patient and Family Education: Start the antiviral therapy as soon as possible after the onset of signs and symptoms for best results. Minor skin irritation, rash, and localized pruritus may occur with the dermatologic formulations. Drugs Similar to Acyclovir (Zovirax) Other antivirals effective for treating herpesvirus infections include cidofovir, docosanol, famciclovir, foscarnet, ganciclovir, penciclovir, trifluridine, valacyclovir, and valganciclovir. It has an extended intracellular half-life that permits once-weekly dosing, versus foscarnet or ganciclovir, which must be infused daily. Common adverse effects include rash, headache, alopecia, chills, anorexia, and anemia.

Howard Young syndrome

Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation 4 Answer: 1 Rationale: the client taking lithium must be conscious of maintaining normal sodium intake impotence causes cures purchase avana 200 mg without a prescription. Because lithium is a salt erectile dysfunction drugs australia purchase generic avana on line, if sodium intake is low the body will replace the sodium with lithium erectile dysfunction treatment herbal discount 50mg avana with visa, leading to lithium toxicity erectile dysfunction medications online order avana in india. The client taking lithium must have regular blood studies and toxicity is a very real concern; hence the necessity for routine blood studies. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation 5 Answer: 3 Rationale: A typical antidepressant such as venlafaxine may take up to 3 weeks or longer to reach full therapeutic effect, so the client must continue taking the medication as ordered so that therapeutic drug levels can be reached and maintained. Cognitive Level: Analyzing; Client Need: Health Promotion and Maintenance; Nursing Process: Evaluation 6 Answer: 2, 3 Rationale: Fluoxetine causes weight loss in some clients, while other clients experience weight gain or fluctuations in weight. A healthy diet and adequate exercise will help maintain normal weight while on this drug. While rare, an increased risk of suicide has been noted in clients up to age 24, and the client should be carefully monitored, especially during the early initiation of therapy. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation 5 Answer: 4 Rationale: One adverse effect of alpha1-adrenergic antagonists is tachycardia. Clients experiencing tachycardia should not receive alpha1-adrenergic antagonists. A pheochromocytoma is a benign tumor of the adrenal medulla that secretes catecholamines. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation 6 Answer: 2, 3, 4 Rationale: Beta-adrenergic blockers can have dramatic metabolic effects that produce an increase in serum triglycerides and hypoglycemia. Additionally, these drugs can affect the sexual function of men by producing a decreased libido. Anorexia and thrombocytopenia are not adverse effects associated with beta-adrenergic antagonists. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation Chapter 22 1 Answer: 3 Rationale: Ataxia, weakness, restlessness, dizziness, and other motor problems can occur with lorazepam. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation 2 Answer: 4 Rationale: Sleeping for 7 h is the desired effect of temazepam. The client will be taking temazepam to assist with insomnia, not to treat anxiety related to everyday stress or to help control panic attacks. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Evaluation 3 Answer: 3 Rationale: this medication must be gradually reduced, not abruptly terminated. Abrupt termination may cause withdrawal symptoms (nausea, vomiting, abdominal cramps, diaphoresis, confusion, tremors, seizures). These are appropriate statements, and indicate that the client understands the teaching. Cognitive Level: Analyzing; Client Need: Health Promotion and Maintenance; Nursing Process: Evaluation 4 Answer: 2 Rationale: Panic disorder is not an appropriate use for phenobarbital. Treatment of status epilepticus, use prior to diagnostic testing, and use prior to receiving general anesthesia are all appropriate for phenobarbital. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Implementation 5 Answer: 3 Rationale: Client safety is the major concern with sedativehypnotics, so prevention of falls is the highest priority. The client may experience urinary incontinence, activity intolerance, or poor nutritional intake related to drug therapy or other reasons. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation 6 Answer: 1 Rationale: Smoking enhances the metabolism of benzodiazepines, so the medication is broken down and removed from the body more quickly if the client is a smoker. Therefore, a smoker may require a Chapter 24 1 Answer: 4 Rationale: Antipsychotic medications treat the symptoms associated with mental illness but do not cure these disorders. These are not symptoms associated with abrupt withdrawal of an antipsychotic medication. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation 1406 Appendix A 2 Answer: 2 Rationale: Acute dystonia, or severe muscle spasms, especially of the back, neck, face, or tongue, may appear within hours or days of the first dose of a phenothiazine and should be reported immediately. The phenothiazine medications usually cause adverse effects even when taken as prescribed. Anorexia or loss of appetite is a common adverse effect, not an expected therapeutic effect. Cognitive Level: Applying; Client Need: Health Promotion and Maintenance; Nursing Process: Evaluation. It suppresses tremor and rigidity by decreasing the excess cholinergic effect associated with dopamine deficiency. Haloperidol and antacids may be given simultaneously; there are no known interactions between these two medications. Taking the drug prn will not reduce symptoms of psychosis because it takes several weeks of regular administration before therapeutic levels are reached. Cognitive Level: Applying; Client Need: Health Promotion and Maintenance; Nursing Process: Implementation 5 Answer: 4 Rationale: the client taking risperidone or any antipsychotic medication should refrain from consuming alcohol. Because there is an increased risk of hyperglycemia or diabetes in clients taking risperidone, alcohol should also be avoided because it may affect blood sugar levels. Weight gain may occur, and obtaining a weekly weight will help the client track any gain. Hypotension is related to adverse reactions the client may experience and must be monitored and reported if it occurs. The medication should be given continuously and not only when the symptoms are present.

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Describe the roles of interferons erectile dysfunction psychological treatment discount avana 100 mg without prescription, interleukins erectile dysfunction depression medication order avana 50 mg on line, and other cytokines in modulating the immune response impotence 22 year old order avana 200 mg otc. Explain how pegylation of the interferon molecule allows for less frequent dosing erectile dysfunction pump implant video order avana in united states online. Explain why therapy with immunosuppressant medications is necessary following organ transplants. Apply the nursing process to care for patients who are receiving immunostimulants and immunosuppressants. A healthy defense system can protect the body from life-threatening infections caused by thousands of different species of organisms often over an entire lifetime. In addition, body defenses can protect against internal invaders such as cancer cells. This chapter examines pharmacotherapy with agents that either stimulate or suppress immune function. Body defenses are composed of a complex system of cells, tissues, and processes designed with a single goal: to protect the body from invasion by foreign substances, or antigens, that may cause harm. Some of these defenses are specific to a single species of microbe, whereas others are nonspecific and provide the same response or protection regardless of the invading pathogen. The student should review the components of body defenses in Chapter 43 before proceeding. Immunomodulator is a general term referring to any drug or therapy that affects body defenses. Two basic types of immunomodulators are used for pharmacotherapy: use of colony-stimulating factors to treat neutropenia was presented in Chapter 42 and the application of vaccines to boost the immune response is presented in Chapter 46. Immunosuppressants are drugs that diminish the ability of the immune system to fight infection and disease. The When challenged by antigens, certain cells of the immune system secrete cytokines, which are substances that help the body mediate and intensify the immune response. A single cytokine can affect multiple target cells, each resulting in a different action. There is also considerable overlap or redundancy among the cytokines in that different cytokines can produce the same biologic actions. In addition to affecting their target cells, cytokines interact with each other by turning the synthesis of other cytokines on or off. Also called biologic response modifiers, some of these agents have been approved to boost specific functions of the immune system. When the virus attempts to attack the protected cell, the pathogen is inactivated. Their actions slow the spread of viral infections, stimulate the activity of existing leukocytes, increase phagocytosis, and enhance the cytotoxic ability of T cells. With prolonged therapy, serious adverse effects such as immunosuppression, hepatotoxicity, and neurotoxicity may be observed. Lifespan and Diversity Considerations: Monitor hepatic function laboratory values and cardiac function more frequently in the older adult because normal age-related physiological changes may increase the risk of adverse effects. Neonates and infants should not receive this drug because it contains benzyl alcohol, which is associated with an increased incidence of neurologic and other serious complications in this age group. If infection occurs during therapy, anti-infectives should be started immediately. Triglycerides should be monitored during therapy because elevated levels have resulted in symptoms of pancreatitis in some patients. Immediately report any signs of depression, such as lethargy, excessive sleeping, or suicidal ideation. Other adverse effects include blood dyscrasias, headache, insomnia, incoordination, hypertension, increased liver enzymes, rash, impotence, peripheral edema, and malaise. The most common adverse effects include flulike symptoms, nausea, vomiting, diarrhea, rash, and elevated hepatic enzymes. The drug is nearly always used in combination with ribavirin because this increases the effectiveness of therapy. Two injections per week for 8 weeks are usually sufficient to cause warts to disappear. Its off-label indications include treatment of hepatitis C, herpes simplex, and other viral infections by the subcutaneous route. This product may contain egg protein and is contraindicated in patients with egg sensitivity. It may be used off-label to treat chronic hepatitis B infections and neoplastic disease. It is usually given in combination with the antiviral ribavirin over a period of 24 to 48 weeks. It is important to note that ribavirin can cause fetal injury and death and is a possible carcinogen. Peak concentrations can be sustained for 48 to 72 hours, which results in greater antiviral activity. It is marketed as oprelvekin (Neumega) for its ability to stimulate platelet production in patients with immunosuppression. Vaccines are types of immunostimulants that have the ability to mobilize the body against specific antigens.

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