Drugs Flashcards
1
Q
Ovulation test is checking for
A
- Check for LH level
2
Q
What test is used for pregnancy test
A
- Test for Beta-HCG level
3
Q
Estrogen
- Strength range
- MOA
A
- 20-50 mcg of estrogen
- Inhibit ovulation by suppressing hypothalamic release of FSH and LH
- Inhibits fertilized ovum implantation
- Accelerate ovum transport, decreasing fertilizing time
- Cycle control
4
Q
MOA of progestins
A
- Cycle control
- Thickens cervical mucus that slows sperm transport and ability to penetrate ovum
- Causes endometrial transformation
5
Q
Seasonale/Seasonique
- How many days
- How many day contain hormones
=> What is seasonique different from seasonale
A
Seasonale
- D: take 1 tab QD x 91 days
- Start on 1st sunday after onset of menstruation
- Contain 84 days of hormones and 7 days inactive
Seasonique
- Provide low dose of estrogen for last 7 days instead of placebo
- Worth try for women who get menstrual migraines => additional estrogen prevent migraines
6
Q
Lybrel
- Special
- Similar to which O.C
A
- Lybrel is a non-cyclic oral contraceptive product that is given QD, w/o a hormone-free interval for a year or longer
=> This means no scheduled periods & possibly a lower incidence of PMS, HA, and anemia
=> No regular menstrual cycle but spotting may occur
=> Up to 50% of the women have 7 or more days of bleeding or spotting during the 1st three months. It will decreases with continue use - Is very similar to Alesse w/o placebo
7
Q
Yasmin/Yaz
- Contain what
- Equal to what?
- A good choice for?
- SEs
A
- Progestin = drospirenone
- Drospirenone (increase risk of clot): is the progestin found in Yasmin and Yaz
- Equal to 25 mg of spironolactone w/ anti-mineral corticoid (anti-aldosterone) and anti-androgenic effects
- It’s a good choice for polycystic ovary syndrome (PCOS), PMS, mood swings, acne, or excess hair growth
- Less water retention
- Risk of hyperK
- Higher thrombosis risk
8
Q
Yasmin/Yaz = Drospirenone
- active days
- Avoid which medicines
A
Yasmin
- EE 30 mcg + 3 mg Drospirenone
- 21 days active; 7 days placebo
Yaz
- 20 mcg EE + 3 mg Drospirenone
- 24 days active; 4 days placebo
- Has shorter days of placebo
Avoid
- K+ spraring diuretics, ACEI, ARB, heparin, and NSAIDs
9
Q
Levomefolate Ca++
A
Metafolin
10
Q
Beyaz
- What special about this med
- What is the regiments
A
- Drospirenone - ethinyl estradiol - levomefolate calcium
- O.C that raises folate levels
- Is a 24/4 day regimen consisting of:
=> 24 days of
Drospirenone 3mg
Ethinyl estradiol 20 mcg
Levomefolate Ca++ (Metafolin) 451 mcg
=> 4 days of
Metafolin only
11
Q
Safyral
- Generics
- What special about this med
- What is the regimen
- What is the different b/w Beyaz and Safyral
A
- Drospirenone - ethinyl estradiol - levomefolate calcium
- O.C that raises folate levels
- Is a 21/7 day regimen consisting of:
=> 21 days of
Drospirenone 3mg
Ethinyl estradiol 30 mcg
Levomefolate Ca++ (Metafolin) 451 mcg
=> 7 days of
Metafolin only
12
Q
Lo Minastrin (has chewable tab)
A
- Form: chewable tabe
13
Q
Quartette
A
4 phases Extended cycle PO OC
- 91 total pills: 84 active 7 inactive
14
Q
Natazia
- How many phases
- Back up
- FDA also approved for?
A
- Estradiol valerate and dienogest
- 4 phases
- Back up form for contraceptive for the first 9 days of the 1st cycle (not 7)
- FDA approved for heavy menstrual bleeding
15
Q
Absolute CI for O.C from package insert
A
- Thrombo-embolic disorder or hx
- Hx of breast/uterus or any estrogen dependent neoplasia
- Undiagnosed vaginal bleeding
- Liver issues: cholestatic jaundice of pregnancy or hx of jaundice, hepatic adenomas/carcinoma
- Pregnancy
16
Q
CI from the WHO
A
- Lactation < 6 wks postpartum
- Age > 35 y.o & smoke > 15 cigarettes/day
- HTN
- Migraines
- DM with end organ disease
- Chest pain
17
Q
What are the routine PE before starting OC
A
- BP
- Breast examination
- Pelvic examination
- Pap smear
- Liver fxn
- Family hx clotting
- Social hx: smoking, hyper-coagulation
18
Q
Counseling on OC
- Start day
- Contact MD
A
- Start on Day 1: Start 1st day of menstrual bleeding
=> prevents ovulation in the 1st cycle => eliminating the use of alternative - Sunday starter: start on 1st sunday after menstrual bleeding begins
=> Prevents menstrual periods on weekend
=> Back up method is necessary for 1st 7 days
- Contact MD if experience ACHES => Abdominal pain => Chest pain, cough, SOB => HA, dizziness, numbness => Eye problems - vision loss/burning => Severe leg pain (Calf or thigh)
19
Q
Minipils
A
=> Progestin only
- Micronor
- Nor-QD
- Aygestin
- Camila
- Errin
- Jolivette
- Nora-BE
=> Norethindrone = 0.35mg
=> Mini = Micro but more breakthrough bleeding
20
Q
Minipils - Progestin
- How to take it
- Backup method
- If late for > 3H taking it:
A
- Imp to take at the same time everyday
- Use backup for entire first month of mini-pill
- Use back up for 2 days if > 3H late on dose
21
Q
Minipils - Progestin - #s of active pills - Contain => the downside - Good for
A
- All 28 pills: active. No inactive
- Not as effective as COC’s but lots safer
Contain
- Less progestin than COC’s => fewer SEs
- More breakthrough bleeding and spotting
- Some stop having periods for several months at a time
Good for
- Cannot tolerate estrogen: hx of CHD or emboli
- During lactation: estrogen decr milk production & postpartrum women are in hyper-coagulate state
22
Q
Depo-Provera
- Candidates for use:
- Avoid in whom?
A
- Medroxyprogesterone acetate
150mg/mL vial injection Q3M
Candidates for use:
- Indicated for contraception/endometriosis
- Contraception of > 1 year duration is desired
- Pts in whom estrogen should be avoided
- Non-compliant w/ COC
- Breast feeding is desired
- Hx of sz
- Amenorrhea (no bleeding) is desired
- AVOID in ppl w/ hx of depression of HA w/ aura
=> pure progesterone => cause hungry and depression
=> take > 1 yr to get pregnant
23
Q
DepO-Provera
- ADEs
A
- Irregular bleeding and spotting for up to 7 days during 1st few months
- Amenorrhea
- Weight gain
- Delayed fertility upon d/c (9mo - 1yr)
- HA, depression in some pts
- Risk of bone loss with prolonged administration, may be irreversible
- O: bone
24
Q
Depo-Provera
- Advantage
- Ok to use w/ what type of drugs
A
Advantage
- NO estrogen SEs
- No increase risk of blood clot
- Decr sz frequency
- Decr risk of endometrial cancer
- Incr Hgb and RBC survival in pt w/ sickle cell disease
- Incr protein in breast milk
- Ok w/ anticonvulsants drugs
25
Q
Implanon
- Generic
- Formula
- Indication
- DDI
- ADEs
A
Etonogestrel
- Subdermal etonogestrel rod implant => Release over 3 years
- I: when long term contraceptive is desired
- Inserted/removed by minor procedure
- DDI: Inducers decr drug
ADES
- Risk of thromboembolism
- Implantation site tenderness
26
Q
Ortho-Evra Patch - Formula - Dosage - When to start waring patch - What if the patch falls off Backup?
A
- F: Patch is a square Band-Aid 2x2
Worn on the skin. NEVER wear on breast - D: once a week: 3 weeks on 1 week off
- Released ~ 60% more estrogen into bloodstream than average O.C => risk of clot is high
Start wearing patch
- Usually start on 1st day of menstrual cycle or 1st sunday after period
Patch falls off
- 24H start a new 4-wk cycle w/ a NEW PATCH CHANGE DATE. Use BACK UP for at least the next week (1 wk)
27
Q
Nuvaring Vaginal Ring
- Frequency
- Storage
A
- D: use for 21 days QM (3 weeks on 1 week off)
- Storage
=> REFRIGERATE: until expiration date
=> RT: exp 4 months
28
Q
Copper Intrauterine Device (IUD)
- Prevention how many years
A
ParaGard
- Prevention up to 10 yrs
29
Q
Levonorgestrel IUD
- Insert how long?
A
Mirena
- Up to 5 yrs
Skyla
- Up to 3 years
30
Q
IUD
- Early danger signs
A
Sign of danger: PAINS
- P: Period late; pregnancy
- A: abdominal pain
- I: infection exposure/abdominal vaginal discharge
- N: not feeling well, fever, chills
- S: string missing
31
Q
IUD
- SEs
A
- PID: Pelvic inflammatory Disease
- Ectopic pregnancy
- Excessive uterine bleeding, or spotting, pain
- If become pregnant: 50% chance of spontaneous abortion (miscarriage) if IUD left in place & 25% chance of miscarriage if remove IUD
32
Q
Diaphragms
- Brands
A
Ortho-White Diaphragm
- I: for W w/ firm vaginal muscle tone or W who desire a THIN delicate rim w/ gentle spring strength for more comfort
Koromex
- For W w/ average virginal muscle tone & for W who can tolerate the STURDY rim and firm spring strength
All-Flex
Milex Wide-seal arching
