Contraindications for HRT
- • Known or suspected pregnancy
- • History of breast cancer
- • History of hormone-sensitive cancer
- • Unexplained uterine bleeding
- • Liver disease (this especially applies to oral ET)
- • History of blood clots
- • Confirmed cardiovascular disease
- Danger Signs of HRT: abn. Vag bleeding, calf pain, chest pain, SOB, hemoptysis, severe headache, vision probs, breast changes abd. Pain, and jaundice
Discuss the assessment, treatment, and follow up of a patient with a positive PPD using evidence-based protocols and guidelines.
- The CDC's recommendations found in Morbidity and Mortality Weekly Report (MMWR)
- The management of TB depends on the classification of the disease based on the pathogenesis and diagnostic results.
- Class 0 and 1 no tx. Class 1 should have a repeat test several months after exposure.
Class 2 Main purpose of preventive therapy is decrease the risk that LTBI will progress to active TB. Isoniazid (INH) 300mg/day 6-12 months.
Class 3 requires multidrug therapy. Initial tx regimen: isoniazid, rifampin, pyrazinamide (PZA) and ethambutol is used to prevent MDR TB. Once drug susceptibility to isoniazid and rifampin is demonstrated, administration of these two drugs is continued after the initital 2 months of multidrug therapy.
Monthly follow up evals at the least
DX of TB
TB skin tests
Chest x-ray or sputum smears may be recommended in high risk populations
Dx of active disease:
3 sputum specimens for BOTH smear exam and culture
presumptive dx can be made with detection of acid fast bacilli (AFB)
a positive sputum culture for M. tuberculosis is essential to confirm but can take weeks
TB skin test is helpful: absence does not exclude Dx
Using the National Cholesterol Education Program Adult Treatment Panel III guidelines how would you manage a 56 year old male with type 2 diabetes and is a smoker
- National Cholesterol Education Program ATP III Guidelines
- ATP III counts diabetes as a CHD risk equivalent., age and smoker also increases risk. According to the guidelines The LDL cholesterol goal is <100 mg/dL.
ATP III TLC guidelines
- Reduced intakes of saturated fats and cholesterol
- ● Therapeutic dietary options for enhancing LDL lowering (plant stanols/sterols and increased soluble fiber)
- ● Weight reduction
- ● Increased regular physical activity