MEN'S AND WOMEN'S HEALTH

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MEN'S AND WOMEN'S HEALTH by Mind Map: MEN'S AND WOMEN'S HEALTH

1. STD TREATMENT

1.1. Gonorrhea

1.1.1. Ceftriaxone 250mg IM

1.1.1.1. AND azithromycin 1g

1.1.1.1.1. OR Doxycycline 100mg BID x 7 days

1.1.1.1.2. COVERS CHLAMYDIA

1.1.2. If cephalosporin allergy

1.1.2.1. gemifloxacin 320mg PO + AZ

1.1.2.2. Gentamycin 240mg IM + AZ

1.1.3. Pharyngeal

1.1.3.1. Ceftriaxone 250mg IM

1.1.3.1.1. AND azithromycin 1g PO

1.1.4. Conjunctivitis

1.1.4.1. ceftriaxone 1g IM

1.1.4.2. AND azithromycin 1g PO

1.1.5. Kids

1.1.5.1. Ceftriaxone 25-50mg/kg IV or IM

1.2. Chlamydia

1.2.1. Azithromycin 1g PO

1.2.2. OR doxycycline 100mg PO BID x 7 days

1.2.3. Alternatives

1.2.3.1. Erythromycin base 500mg PO QID x 7 days

1.2.3.2. OR ofloxacin 300mg PO BID x 7 days

1.2.3.3. OR levofloxacin 500mg PO x 7 days

1.2.4. Pregnancy

1.2.4.1. Azithromycin 1g PO

1.2.5. Infants and kids

1.2.5.1. erythromycin 50mg/kg/day PO x 14 days

1.3. Syphilis

1.3.1. primary, secondary, or early latent <1 year

1.3.1.1. Benzathine PCN G 2.4 million U IM in a single dose

1.3.1.2. If PCN allergy

1.3.1.2.1. Doxycycline 100mg BID x 14 days

1.3.1.2.2. OR tetracycline 500mg QID for 14 days

1.3.1.3. Latent > 1 year or unknown duration

1.3.1.3.1. Benzathine PCN G - 2.4 million U IM in 3 doses eac at 1 week intervals

1.3.1.3.2. PCN allergy

1.3.2. Neurosyphilis

1.3.2.1. PCN G- 18-24 million U per day, administered as 3-4 million U IV every 4 hours or continuous infusion for 10-14 days

1.3.2.2. Procaine PCN G 2.4 million U IM 1x/day PLUS probenecid 500 mg QID both for 10-14 days

1.3.3. Children

1.3.3.1. Primary, secondary or early latent

1.3.3.1.1. Benzathine PCN G- 50,000 units/kg IM in single dose (maximum 2.4 million units)

1.3.3.2. Latent

1.3.3.2.1. Benzathine PCN G- 50,000 units/kg IM for 3 doses at 1 week intervals (max total 7.2 MU)

1.4. Trichomonas

1.4.1. Metronidazole or Tinidazole 2g PO single dose

1.4.1.1. avoid ETOH for 36 hours

1.4.2. OR Metronidazole 500mg BID x 7 days

1.4.3. Failure:

1.4.3.1. Metronidazole or Tinidazole 2g PO x 7 days

1.4.4. Treat partners

1.4.5. Caution with treating in early pregnancy

1.5. Epididymitis

1.5.1. Acute

1.5.1.1. Ceftriaxone - 250mg IM in single dose

1.5.1.1.1. AND Doxy 100mg BID x 10 days

1.5.1.2. Acute + Anal intercourse

1.5.1.2.1. Ceftriaxone 250mg IM single dose

1.5.1.2.2. AND levofloxacin 500mg 1x/day for 10 days OR ofloxacin 300mg PO 2x day for 10 days

1.6. PID

1.6.1. Ceftriaxone 250mg IM

1.6.1.1. AND doxycycline 100mg PO 2x for 14 days

1.6.1.2. WITH OR WITHOUT

1.6.1.2.1. Metronidazole 500mg pO 2x day x 14 days

1.6.2. Cefotetan 2g IV Q12 hrs

1.6.2.1. AND doxyclycline 100mg PO or IV q12 hours

1.6.3. Cefoxitin 2g IV q6 hrs

1.6.3.1. AND doxyclycline 100mg PO or IV q12 hrs

1.7. Vaginosis

1.7.1. Metronidazole gel .75%

1.7.1.1. 1 5g applicator full at bedtime for 4 days

1.7.2. Metronidazole 500mg BID x 7 days

1.7.2.1. CANNOT DRINK WHILE ON ORAL METRONIDAZOLE

1.7.3. Multiple recurrences - metronidazole gel x 6 months

1.7.4. Alternatives

1.7.4.1. Tinidazole 2g PO x 2 days

1.7.4.2. Tinidazole 1g PO 1x day for 5 days

1.7.4.3. Clindamycin 300mg PO 2x day for 7 days

1.8. Chancroid

1.8.1. Azithromycin 1g

1.8.2. OR IM ceftriaxone

1.8.3. OR PO erhythromycin x 7 days

1.9. HSV

1.9.1. higher doses with concurrent HIV

1.9.2. Valcyclovir

1.9.2.1. Best bioavailability

1.9.2.2. less frequent dosing

1.9.2.3. initial:

1.9.2.3.1. 1g BID x 7-10 days

1.9.2.4. Recurrent

1.9.2.4.1. 500mg BID x 3 days

1.9.2.5. Acyclovir

1.9.2.5.1. Cheap

1.9.2.5.2. Short half life

1.9.2.5.3. initial

1.9.2.5.4. Recurrant

1.9.3. Famcyclovir

1.9.3.1. increased bioavailability

1.9.3.2. less frequent dosing

1.9.3.3. initial

1.9.3.3.1. 250mg TID x 7 days

1.9.3.4. Recurrant

1.9.3.4.1. 125mg 2x day x 5 days

1.10. Candidal (Yeast infections)

1.10.1. Fluconazole 150 mg - 1 tablet only

1.10.2. Topical/Intravaginal - butoconazole, clotrimazole, miconazole, nystatin, terconazole

1.10.3. Pregnancy

1.10.3.1. Intravaginal clotrimazole or miconazole x 7 days

1.10.3.2. Women will present with first yeast infection in pregnancy

1.10.4. Recurrance

1.10.4.1. Flucaonazole + 2nd/3rd dose 3 & 6 days later

1.10.4.2. probiotics

1.11. Genital Warts

1.11.1. Aldara cream

1.11.1.1. imiquimod

1.11.1.2. 3.75% - 5% 3x week & wash off 6-10 hours later

1.11.1.3. max 16 weeks

1.11.2. Podofilox

1.11.2.1. .5% gel BID x 3 days

1.11.2.2. discontinue for 4 days & repeat PRN

1.11.2.3. Max 4 treatment cycles

1.12. Lymphogranuloma vereum

1.12.1. Doxycycline 100mg BID x 21 days

1.12.2. OR erythromycin 500mg QID PO for 21 days

1.13. Nongonoccocal Urethritis

1.13.1. Azithromycin 1g PO

1.13.2. OR doxycycline 100mg BID x 7 days

1.13.3. OR erythromycin 500mg QID x 7 days

1.14. Crabs

1.14.1. Permetrhin 1% cream rinse

1.14.2. OR pyrethrins with piperonyl butoxide

1.14.3. OR malation .5% lotion

1.15. Scabies

1.15.1. Permethrin 5% cream

1.15.2. Ivermectin 200mcg/kg PO repeated in 2 weeks

2. MEN

2.1. ERECTILE DYSFUNCTION

2.1.1. AE: HA, dyspepsia, back pain, nasal congenstion, flushing, sudden vision or hearing loss, priapism, HYPOTENSION

2.1.2. PDE5i - inc cGMP, relax smooth muscle

2.1.3. C/I nitroglycerine, severe renal/hepatic impairment

2.1.4. Sildenafil (Viagra)

2.1.4.1. 50mg PO 1 hr before sexual activity

2.1.4.2. Increase to 100mg or reduced to 25mg PRN

2.1.4.2.1. 25mg for hepatic/renal/>65

2.1.4.3. MAX 100mg/day

2.1.4.4. tx ED, pulmonary arterial HTN,

2.1.5. Tadalafil (Cialis)

2.1.5.1. 10mg PO before sexual activity

2.1.5.2. OR 2.5mg/day PO daily dose

2.1.5.3. 5-20mg dose adjustments

2.1.5.3.1. renal/hepatic  do not exceed 5mg/day

2.1.5.4. Tx BPH, pulm art. HTN, ED,

2.1.6. Vardenafil (Levitra)

2.1.6.1. film coated - 10mg PO 1hr before sex

2.1.6.1.1. 5-20mg dose increase/decrease

2.1.6.1.2. decrease dose with azoles/avirs/mycin

2.1.6.2. PO disintegrating - 10mg PO placed on tongue 1 hr before sex

2.1.6.2.1. do not exceed 1 dose/day

2.2. ANDROGEN DEFICIENCY

2.2.1. AE: men with carcinoma of the breast or prostate or women who are or may become pregnant, can cause virilization in females

2.2.2. Methyltestosterone (Android)

2.2.2.1. SYNTHETIC

2.2.2.2. PO 10-50mg/day

2.2.2.3. Buccal 5-25mg/day

2.2.2.3.1. 2x activity of PO

2.2.2.4. tx delayed puberty

2.2.2.5. tx breast cancer that has spread

2.2.2.5.1. PO 50-200mg/day

2.2.3. Fluoxymesterone (Androxy, Japetestom)

2.2.3.1. SYNTHETIC

2.2.3.2. replacement therapy for testosterone deficiency

2.2.3.2.1. 5-20mg PO qD

2.2.3.3. Metastatic Breast CA females

2.2.3.3.1. 10-40mg/day PO x 3 months

2.2.4. Testosterone

2.2.4.1. Tesosterone cypionate (Depo)

2.2.4.1.1. 50-400mg IM q 2-4 weeks

2.2.4.2. testosterone enanthate (Delatestryl)

2.2.4.2.1. 50-400 mg q 2-4 weeks

2.2.4.3. testosterone patch (Androderm)

2.2.4.3.1. 2.5-5mg/day

2.2.4.4. testosterone gels (Androgel, testim)

2.2.4.4.1. 5-10 g of gel /day

2.3. BPH Treatment

2.3.1. SELECTIVE - α1A blocker

2.3.1.1. MOA: block adrenoreceptors in prostate

2.3.1.2. C/I: -avir, -conazole

2.3.1.3. AE: abdominal pain, back pain, bronchitis, dizziness, HA, impotence, liver impairment

2.3.1.4. Alfuzosin (uroxatral)

2.3.1.4.1. 10mg PO qD after food

2.3.1.5. Tamsulosin (flomax)

2.3.1.5.1. .4 PO qD 30min after same meal each day

2.3.1.5.2. Tx BPH, bladder outlet obstruction, ureteral stones

2.3.1.5.3. OK for renal/hepatic

2.3.2. NONSELECTIVE - α1 blocker

2.3.2.1. hypotension, dizziness, fatigue

2.3.2.1.1. take at bedtime to avoid syncope

2.3.2.2. C/I: -evir, -afil, -osin, yohimbe liver disease, CVA,

2.3.2.3. MOA: vessel dilation, decrease TPR

2.3.2.3.1. Can treat HTN

2.3.2.4. Doxazosin (Cardura)

2.3.2.4.1. IR - 1-8mg/day PO

2.3.2.4.2. ER - 4mg/day PO

2.3.2.5. Terazosin (Hytrin)

2.3.2.5.1. 1mg PO qHS

2.3.2.6. Prazosin (Minipress)

2.3.2.6.1. can treat PTSD

2.3.2.6.2. .5mg PO q12hrs

3. WOMEN

3.1. ESTROGENS

3.1.1. NO VTE, migraine, smokers > 35, history of DVT

3.1.2. TX menopausal sx, hypogonadism, osteoporosis, prostate CA, abnormal uterine bleeding,

3.1.3. AE: abdominal pain, breast enlargement, HA, arthralgia, sinusitis, diarrhea, endometrial CA, breast CA, CV risk,

3.1.4. C/I: ospemifene

3.1.5. Premarin

3.1.5.1. Conjugated equine

3.1.5.2. oral/Topical/Vaginal

3.1.5.2.1. .3mg PO once daily continuous or cyclic

3.1.6. Estradiol (Alora)

3.1.6.1. Patch

3.1.6.1.1. estroderm

3.1.6.2. 1-2mg PO once daily x 3 weeks, with 1 week off

3.2. PROGESTIN ONLY

3.2.1. breastfeeding or contraindication to progesterone

3.2.2. C/I: breast cancer, liver dx, HTN, DM,

3.2.3. Norethindrone 350 mcg (Micronor)

3.2.3.1. Estrogen sensitive patients

3.2.3.1.1. severe nausea, enlarged uterus, uterine fibroids, large/painful breasts, heavy menstruation, dysmenorrhea

3.2.3.2. 1 tablet .35mg PO qDay, continuous administration

3.2.4. Norgestrel 75 mcg (Ovrette)

3.2.4.1. .075mg PO qDay at same time each day

3.2.5. ANTIPROGESTINS

3.2.5.1. Mifepristone (Mifeprex)

3.2.5.1.1. Abortion

3.2.5.1.2. C/I: anything with increased bleeding, steroids, lovastatin

3.2.5.1.3. AE: abd pain, cramping, N/V/D, HA,

3.2.5.1.4. MOA: stimulates uterine contractility, increases postaglandins

3.3. MULTIPHASIC (BI/TRI)

3.3.1. Biphasic delvier the same amount of estrogen but progesterone is increased halfway through the cycle

3.3.1.1. Norethindrone/EE (ortho-novum 10/11)

3.3.1.2. Norethindrone acetate/EE/Iron (Estrostep FE)

3.3.1.3. Desogestrel/EE (Mircette)

3.3.1.3.1. irregular menses with no underlying

3.3.1.3.2. PCOS

3.3.2. Triphasic have 3 different doses of progesterone and estrogen that change q 7 days

3.3.2.1. Levongestrel/EE (Trivora)

3.3.2.2. Norgestimate/EE (Ortho Tricyclen)

3.3.2.3. Norethindrone/EE (Ortho-novum 7/7/7)

3.3.2.3.1. For moderate flow and average cramps

3.4. MONOPHASIC ESTROGEN (35 mcg)

3.4.1. Contain a constant amount of estrogen and progesterone in each pill

3.4.2. For estrogen deficient

3.4.3. For moderate flow and average cramps

3.4.4. 35/0.25 EE/norgestimate (Ortho-Cyclen)

3.4.5. 35/1 EE/Norethindrone (Ortho-Novum)

3.4.6. 35/0.5 EE/norethindrone (Modicon)

3.5. HIGH DOSE MONOPHASIC ESTROGEN (50 mcg)

3.5.1. Constant amount of estrogen and progesterone throughout cycle

3.5.2. for short term tx of BTB (initial)

3.5.3. For heavy flow and severe cramps (Decrease dose once stable)

3.5.4. 50/1 EE/ethynodiol diacetate (Zovia 1/50)

3.5.5. 50/1 EE/norethindrone (Ortho-Novum)

3.6. LOW DOSE MONOPHASIC ESTROGEN (20-30 mcg)

3.6.1. Constant amount of estrogen and progesterone throughout cycle

3.6.2. More likely to have BTB

3.6.3. For perimenopausal women with irregular cycles

3.6.3.1. Relieve hot flashes

3.6.4. For light flow and mild cramps

3.6.5. 20/1 EE & NORETHINDRONE ACETATE & IRON (Loestrein Fe 1/20)

3.6.5.1. For progesterone deficient

3.6.6. 20/.01 EE & LEVONGESTREL (Aviane)

3.6.7. 20/1 EE/norethindrone acetate (Loestrine)

3.6.8. 30/1.5 EE/norethindrone acetate/iron (Loestrine Fe 1.5/30)

3.6.8.1. Menorrhagia

3.6.9. 30/0.3 EE/norgestrel (Low-Ogestrel)

3.6.10. 30/3 EE/drospirenone (Yasmin, YAZ)

3.6.10.1. Drospirenone has no androgenic activity

3.6.10.2. First line PCOS

3.6.10.3. Progesterone senstivie

3.6.10.3.1. PMS symptoms, edema, abominal bloating, HA, depression

3.6.11. 30/0.15 EE/levonorgestrel (Levora)

3.6.12. 30/1.5EE/norethindrone acetate (Loestrin 1.5/30)

3.6.13. 30/0.15 EE/desogestrel (Ortho-Cept)