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COPY 23 May > Endo-Electro-GI-Gyn-Uro > Flashcards

Endo-Electro-GI-Gyn-Uro Flashcards

1
Q

Long Acting Insulins (2)

A

Detemir, Glargine

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2
Q

Rapid Insulin?

Intermediate Insulin?

A

Regular

NPH

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3
Q

Very Rapid Insulins (3)

A

Aspart, Lispro, Glulisine

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4
Q

DPP4 Inhibitors

Name?

SEs:

Nasopharyngitis

Hypersensitivity

………………?

A

Sitagliptin

Pancreatitis

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5
Q

GLP1 Agonists

Name?

SEs:

Nausea/Vom/Diarrhea

……………..?

A

Exenatide, Liraglutide

Pancreatitis

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6
Q

Meglitinides

Name?

2 SEs?

A

Repaglinide

Hypoglycemia

Weight gain

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7
Q

SGLT2 Inhibitors

Name? 3 SEs:

  1. GU Infection

2,3 ?

A

Canagliflozin

Hypotension / Hypovolemia

Hyperkalemia

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8
Q

TZDs (PPAR gamma inhibitors)

Example? SEs (2)

A

Pioglitazone

Water retention, edema

Wt gain, worseningn of CHF

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9
Q

Alpha Glucosidase inhibitors

Example? SE? (1)

A

Acarbose

GI SEs

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10
Q

SUs

1st Gen Chlorpropamide

2nd Gen Gliburide

SEs (3)

  1. Hypoglycemia

2,3 ?

A
  1. Wt gain
  2. Hypothyroidism
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11
Q

Metformin

Cautions: If ClCr <30 , Lactic Acidosis

Class name?

A

Biguanides

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12
Q

DM

Dx Criteria:

1,2 Random Glc or 2h Glc above ………

  1. FBS above …….
  2. HbA1C above ……..
A

1,2 11.1

  1. 7
  2. 6.5%
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13
Q

DM T1

Total need in Insulin if Wt=70 kg, is 35 Units

Morning ?

Evening ?

A

M: 2/3 (2/3 NPH. 1/3 Regular)

E: 1/3 (1/2 NPH. 1/2 Regular)

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14
Q

DM

SEs of Insulin

1.Hypoglycemia

2,3 ?

A

Localized fat hypertrophy

Allergic reactions

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15
Q

DM

Tx if mild to moderate hypoglycemia: 15 Sugar PO

Tx if severe hypoglycemia

A

If alert:

20g Glucose PO (preferably tablet)

If unconcious:

Glucagon 1 mg IM or SC, then Glucose PO

(If IV access: D50W 20-50 mL in 1-3 minutes)

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16
Q

DM in Pregnancy

  1. Insulin is preferred
  2. Metformin or Gliburide are ok if necessary
  3. Folic Acid?
A

start 3 months before pregnancy 5 mg/day

switch to 1 mg/day after 1st trimestre is finished

continue until 3 months after delivery or until the end of breastfeeding

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17
Q

DKA, Tx

  1. NS IV (500 ml in 4h)
  2. Potassium algorithm ?
  3. Insulin (Regular) Infusion (unless K+ is <3.3) until AG is corrected (dose: 0.1 Units/kg/h)
  4. +/- Bicarbonate
A

Potassium:

If <3.5 then 40 meq/l

If 3.5-5.5 then 20 meq/l

If >5.5 or anuric: do not give K+

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18
Q

Thyroid

DOC in Hypo: Levothyroxine

What is the indication for Liothyronine (T3)?

A

Liothyronine (T3)

Only in short term management of thyroid cancer with hypothyroidism

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19
Q

Thyroid in Pregnancy:

Target in Hypo: Normalizing TSH to 2.5-3

Target in Hyper ?

A

Free T4 and Free T3 to be upper limit of NL

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20
Q

Thyroid

What is the SE of Levothyroxine in elderly if high dose?

A

Risk of bone Fx

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21
Q

Thyroid

A woman already diagnosed with hypothyroidism comes with a positive beta HCG test. Advice?

A

Add 2 tablets/week to levothyroxine she is already taking

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22
Q

Thyroid

Taking Levothyroxine with Iron at the same time?

A

There must be a 6 h interval

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23
Q

Thyroid

Myxedematous Coma, Tx

  1. ABCs, Hydration

2,3. ?

A

IV Levothyroxine + IV Hydrocortisone

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24
Q

Thyroid

MMZ and PTU, SEs:

  1. Allergic reactions
  2. Agranulocytosis

3 ?

A

Hepatotoxicity

Nephrotoxicity (Rare)

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25
Q

Thyroid

MMZ and PTU, Monitoring:

  1. Regular CBC, LFT
  2. Education for …………..
A

Fever

Rash

Jaundice

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26
Q

Thyroid

MMZ and PTU:

MMZ is considered 1st choice because …………….

A

It is less hepatotoxic than PTU

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27
Q

Thyroid

MMZ and PTU in Pregnancy?

A

1st trimetre: PTU is DOC

then switch to MMZ (also ok in breastfeeding)

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28
Q

Thyroid

MMZ and PTU in Children?

A

PTU is CI in children

MMZ is ok

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29
Q

Thyroid Storm

Tx:

  1. Hydration + Supportive Tx
  2. If fever: Acetaminophen (no ASA or NSAID)
  3. ………………………..
A

PTU + Propranolol + CS +/- Lugol’s solution

(Lugol’s is Iodine that is helpful in Tx of acute hyperthyroidism, to be prescribed 1h after PTU)

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30
Q

Thyroid

Hyperthyroidism in Pregnancy

Screening at week 22 for ?

A

Anti TSH Receptor Ab (TRAb)

If (+): High risk of hyperthyroidism in baby: Refer

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31
Q

Anemias

Nonpharmacological Tx for IDA:

Heme-Iron is important:

Liver, Red meat, tuna, clam, oyster, salmon, shrimp,

but not …….

A

Vegetables are not very effective (Non heme)

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32
Q

Anemias

Duration of Tx for IDA

A

3 months after correction of Hb

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33
Q

Anemias

Iron in Pregnancy

A

Routinely for all:

Start Iron 20 mg/day at week 20

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34
Q

Anemias

Two important SEs of Vitamin B12:

  1. In first few days …………………….
  2. Venous Thrombosis
A

Hypokalemia (Shift of K+ into the cells)

Monitorin K+ is very important in first few days

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35
Q

Anemias

Folate defficiency is usually seen in:

  • Alcoholics, Pregnancy
  • Taking MTX or ……. or ……….
A

Phenytoin

TMP

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36
Q

Anemias

SEs of Epoetin Aplha or Darbepoetin Alpha

  1. Cardiovascular, Venous thrombosis, HTN
  2. ……………
A

PRCA

Pure Red Cell Aplasia (Ab induced)

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37
Q

Obesity

3 Medications in Canada:

  1. ………………..
  2. Bupropion
  3. ………………
A
  1. Orlistat
  2. Liraglutide
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38
Q

Obesity

Orlistat is an inhibitor of lipase (gastric and pancreatic)

SEs:

1,2 ?

A

Fecal Urgency

Oily spotting

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39
Q

Obesity

Liraglutide (GLP1 Agonist, Incretin)

SEs:

  1. GI intolerance

2,3 ?

A

Severe Hypoglycemia

Pancreatitis

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40
Q

Obesity

Safety in Pregnancy ?

Orlistat, Bupropion, Liraglutide

A

Orlistat: Not recommended

B,L are OK

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41
Q

Dehydration

Severity of dehydration: Mild/Mod/Sev

Infants: 5%, 10%, 15%

Other: 3%, 7%, 10%

Capillary filling ?

A

Mi: <2 sec

Mod: 2-4 sec

Sev: >4 sec

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42
Q

Dehydration

Absolute indications for admission:

  1. Shock
  2. Severe N/V

3,4 ?

A

Sensorium change

Hyper or Hyponatremia

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43
Q

Dehydration

Relative indications for admission:

  1. HCO3- below 15
  2. ?
A

Weak response to oral hydration

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44
Q

Dehydration

Total fluids in 24h = Maintenance + Deficit

How to calculate maitenance in children?

A

(M is independent of severity of dehydration)

Hourly: 4-2-1 ml/kg/hour 15 kg: 50 ml/h

or

Daily: 100-50-20 ml/kg/day 15 kg: 1250 ml/day

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45
Q

Dehydration

Total fluids in 24h = Maintenance + Deficit

How to calculate deficit in children?

(based on severity of dehydration)?

A

Wt x Percent of dehydration

Example: 15 kg x 10% (severe) = 1,500 ml deficit

1/2: first 8 h, 1/2 next 16 h

(deficit is done in 24 h)

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46
Q

Dehydration

Total fluids in 24h = Maintenance + Deficit

Alternative way to calculate deficit in children?

(based on body wt only)

A

Example:

Wt=9 kg, Age=1 y

Average wt for 1 yo= (Agex3)+7=10 kg

deficit = 10-9= 1 kg = 1,000 ml

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47
Q

Dehydration

Total fluids in 24h = Maintenance + Deficit

How to calculate Na+ and K+ in maintenance?

A

Na+ = 3 meq/100 mL of Maintenance

K+ = 2 meq/100 mL of Maintenance

Example: If maintenance is 1,250 ml/day

Na=37.5 , K= 25

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48
Q

Dehydration

Total fluids in 24h = Maintenance + Deficit

How to calculate Na+ and K+ loss (in deficit)?

A

Na+ loss = K+ loss = 8 meq/100 ml of deficit

Example: If deficit = 1500 ml

then Na loss = K loss = 120 meq/day

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49
Q

Dehydration

Half Saline (0.45%) in 1 Liter, has:

4.5 g of NaCl = 1.78 g of Na = ……….. meq of Na

A

77 meq of Na

Example: if Na loss = 120 meq

then 120/77 = 1.55 liter of half salin will compensate it.

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50
Q

Dehydration

Oral Rehydration (with Pedialyte or Gastrolyte)

If mild to moderate, then …………..

If severe, then ……………..

A

If mild to moderate:

50 ml/kg in 4 hours Or 100 ml/kg in 1st day

If severe:

100 ml/kg in 4 hours Or 150 ml/kg in 1st day

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51
Q

Hypovolemia

Best for dehydration: Half Salin + D5W

Best for hypotension: ………………..

A

NS (0.9%)

Or Ringer Lactate

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52
Q

Hypovolemia

Ringer lactate caution?

A

Risk of hyperkalemia if renal function is impaired

(Ringer lactate contains K+)

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53
Q

Hypovolemia

Maintenance fluid in adults ?

(and Na+ and K+)

A

Maintenance fluid in adults is 2-2.5 Liters

Including Na+ =75 mmol and K+ = 50 mmol

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54
Q

Edema

Pitting or Non-pitting?

  1. Cardiac, Renal, Idiopathic
  2. Lumphatic, Hypothyroidism
A
  1. Pitting
  2. Non-pitting
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55
Q

Edema

Four classes of medications that cause edema

1,2 NSAIDs, CCBs

3,4 ?

A

CS, TZDs

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56
Q

Edema

Best Loop diuretic if allergic to sulfa?

A

Ethacrynic Acid

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57
Q

Edema

A good indication for Spironolactone is liver failure.

What are the interactions for K+ sparing diuretics?

1,2. ACEI, ARB

3,4. ?

A

NSAIDs, Beta blockers

and also caution in renal dysfunction and in Diabetes M.

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58
Q

Edema

Tx if refractory?

A

Reinforce Nonpharmacologic Tx

+ Consider Doubling the dose of loops every 5 days

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59
Q

Potassium

Normal is 3.5-5

Hypokalemia: Mild/Moderate/Severe : steps of 0.5

Hyperkalemia: Mild/Moderate/Severe ?

A

Mild: 5-6

Mod: 6.1-6.5

Severe: >6.5

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60
Q

Potassium

If hypokalemia is refractory, the reason might be …………….

A

Possible hypomagnesemia

in: Diarrhea, Diuretics, PPIbbbbb

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61
Q

Potassium

Hyperkalemia Tx:

  1. IV Calcium gluconate (Fast, short acting)
  2. …………
A

Insulin (longer acting)

+/- Salbutamol (if no CI like heart disease)

+/- (Hydration+Loops)

+/- Dialysis

(Resins are last resort, not recommended)

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62
Q

Potassium

Hypokalemia Tx:

  1. Best ?
  2. ?
A
  1. Oral KCl

(if Acidosis: Potassium Citrate)

  1. K+ Sparing diuretics
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63
Q

Potassium

Hypokalemia Tx:

Indications for parenteral KCl?

1,2 if unable to drink or if hepatic encephalopathy

3,4 ?

A

Respiratory muscle weakness

Cardiac arrhythmia

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64
Q

Hypercalcemia

Ca (NL) is below 10.5 mg/dlit or ……….

Hypercalcemia Mild/Mod/Severe

A

below 2.7 mmol/lit

2.7-2.9 / 2.9-3.5 / >3.5

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65
Q

Hypercalcemia

Tx of Mild hypercalcemia (2.7-2.9) is nonpharmacologic:

Avoiding the cause, avoiding sedentary lifestyle, avoiding Vit D, Callcium, …………………..

A

Providing 1-2 g/day oral Phosphate (except for renal dysfunction)

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66
Q

Hypercalcemia

Tx of Moderate hypercalcemia (2.9-3.5)?

A

Nonpharmacological + Bisphosphonates

+/- CS

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67
Q

Hypercalcemia

Tx of severe hypercalcemia (>3.5)

A

Calcitonin

then bisphospnonates and IV Salin + Loop diuretic

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68
Q

Hypercalcemia

Tx of hypercalcemia in Granulomatose diseases

A

CS + Avoiding sunlight

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69
Q

Upper GIB

If a patient loses 50% of blood volume,

then SBP, HR, Hb?

A

SBP, Hb <100

HR >100

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70
Q

Upper GIB

Old Tx: Lavage with NG Tube (not used any more)

Current Tx: …………………..

Gold standard Tx: Endoscopy

A

Prokinetics like Erythromycin

250 mg IV single dose

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71
Q

Upper GIB

Best PPI in Non-Variceal UGIB

A

Pantoprazole IV or PO (for 72 hours)

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72
Q

Upper GIB

Tx of Variceal UGIB (ER):

  1. Octreotide IV
  2. ……………
A

Norfloxacin PO for 7 days (or Ceftriaxone IV)

+/- Vasopressin (only if no IHD)

Consider TIPS (if Tx fails)

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73
Q

GERD

Tx if Mild?

A

Antacids

Alginates (Al Hydroxide)

H2 Blockers

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74
Q

GERD

Tx if moderate to severe?

A

PPIs for 8 weeks

Pantoprazole or Esmoprazole PO

once or twice a day (30-60 min before meals)

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75
Q

GERD

Rare but serious possible SEs of PPIs:

  1. Osteoporosis
  2. Hypo Mg

3,4 ?

A

Nosocomial Pneumonia

C. Difficil infection

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76
Q

GERD

Safety of PPIs in Pregnancy/ Breastfeeding

A

Better to avoid

(Not enough data is available)

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77
Q

GERD

Maintenance therapy:

  1. Step down ?
  2. Intermittent / on demand ?
  3. As needed ?
A
  1. Half of standard Tx for long term
  2. stop when Ok, start another course if relapse
  3. stop when Ok, take a few doses when needed
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78
Q

PUD

Dx tests for H Pylori

Best: EGD, Other:

  1. Serology
  2. UBT
  3. ?
A

H Pylori stool Ag test

(High Sp, Acceptable Sen)

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79
Q

PUD

Dx tests for H Pylori

UBT is a very good and practical test.

Limitations?

A
  1. No ABs or Bismuth within last month
  2. No PPI or H2 blocker within last week
80
Q

PUD

H Pylori Eradication:

Standard is Amoxicillin + Clarythromycin + PPI

What if betalactam allergic?

A

Replace Amoxi with Metronidazole

81
Q

PUD

H Pylori Eradication:

Standard is Amoxicillin + Clarythromycin + PPI

What is the quadraple alternative Tx?

A

PPI + Bismuth + Metronidazole + Tetracyclin

82
Q

PUD

H Pylori Eradication:

Standard is Amoxicillin + Clarythromycin + PPI

What is the strongest alternative?

A

PPI + Amoxi + Metro + Clarythro (3 ABs) 10-14 days

Or Sequential:

(PPI+Amoxi) 5-7 days,

then (Metro+Clarythro) 5-7 days

83
Q

IBD

Nonpharmacological Tx:

receive enough calories plus:

  1. Live vaccines?
  2. NSAIDs?
A
  1. CI
  2. better to avoid
84
Q

IBD

1st line Tx in UC?

A

Aminosalycilates

like 5ASA or Sulfasalazine

85
Q

IBD

Sulfasalazine SEs:

  1. Hemolytic Anemia
  2. Hepatotoxicity

3,4 ?

A

Hypersensitivity

Oligospermia

Crystalluria and renal stones

86
Q

IBD

Azathioprin SEs:

1,2 Stomatitis, Arthralgia

3,4 Opportunistic infections, blood dyscrasia

5,6 ?

A

Pancreatitis

Skin Cancers

87
Q

IBD

6MP SEs:

1,2 Stomatitis, Opportunistic infections

3,4 ?

A

Blood dyscrasia

Pancreatitis

88
Q

IBS

Anti TNF Alpha SEs:

1,2 Reactivation of TB, Pneumonia

3,4 ANA, Lupus like Sd

5,6 ?

A

Lymphoma

Skin Cancers

Cervical dysplasia

89
Q

IBD

Caution with:

  1. Anti diarrheals: Risk of toxic megacolon
  2. Opioids (2)
A
  • Toxic megacolon
  • Narcotic bowel Sd (Chronic abdominal pains)
90
Q

IBD

Ulcerative Proctosigmoiditis, Tx?

A

Per rectum

5ASA or CS (suppositories or enema)

91
Q

IBD

Safety of CS during Pregnancy?

A

Caution in 1st trimestre

may cause cleft palate

92
Q

IBD

1st line Tx in CD?

A

CS or Azathioprin or 6MP

93
Q

Irritable Bowel Sd

Tx:

  • If Diarrhea dominant ?
  • If Constipation dominant ?
A
  • D: Loperamide PRN
  • C: Psyllium or Bisacodyl PRN
94
Q

Ascites:

If SAAG < 11 g/Lit: Cancer or Infection

If SAAG > 11: Portal htn, Tx ?

  1. Spironolactone or ……….
  2. ………………….
A
  1. Amiloride
  2. Furosemide or Metolazone (loop)
95
Q

SBP

PMN count is > 250 (Or WBC > 500)

DOC= 3rd Gen Cephalosporin (5 days) + ………….

Then, prophylaxis with ……..

A

Albumin

Norfloxacin PO

96
Q

Hepatic Encephalopathy

DOC= …….

Altenative: …………….. +/- Lactulose

A

Rifaximine

Metronidazole

97
Q

PBC and PSC

DOC=…………. + Providing Vit A,D,K

For pruritis: Cholestyramine or Naltrexone

98
Q

Chronic Active Hepatitis (Autoimmune)

DOC ?

A

CS (Prednisone)

+/- Azathioprin or Mycophenolate

99
Q

PBC and PCS

If Ascending Chollangitis, DOC:

1- Mild to moderate ?

2- Severe?

A
  1. Ciprofloxacine PO
  2. Ampicillin + Gentamycin + Metronidazole

or Piperacillin/Tazobactam + Metronidazole

100
Q

Acoholic Hepatitis

Tx: Abstension from alcohol + ………….

A

CS +/- Pentoxifylline

101
Q

Wilson disease:

Tx: Penicillamine or ……………..

If intolerant: ……………

A

Trientine

Zinc + avoid foods containing Copper:

Peanuts, chocolate, liver, mushroom, shellfish

102
Q

GI

Safety in Pregnancy / Breastfeeding

  1. UDCA
  2. Penicillamine
A

Both:

P: safe

B: avoid!

103
Q

GI

Major poosibe SE with UDCA ?

A

Leukopenia

104
Q

GI

Major poosibe SEs with Deferoxamine ? (2)

A

Hearing or visual toxicity

Seizures

105
Q

GI

Major poosibe SEs with Penicillamine ? (2)

A

Nephrotoxicity, Pr Uria

Tasting sensory deficit

106
Q

GI

Major poosibe SE with Trientine ?

107
Q

Nausea in Adults

In ER, 1st choice is ………. or ………..

A

Metoclopramide IV

or Prochlorperazine IV

108
Q

Nausea in Adults

DOC in mild to moderate Nausea in Pregnancy (3)

A
  1. B6 (Pyridoxine)
  2. Ginger
  3. Accupressure P6
109
Q

Nausea in Adults

DOC severe Nausea in Pregnancy (Approved in Canada)

A

Diclectin (Doxylamine+Pyridoxine)

110
Q

Nausea in Adults

DOC in Uremia ?

DOC in vestibular nausea?

A

U: Chlorpromazine

V: Dimenhyrinate or Scopolamine

111
Q

Nausea in Adults

PONV (Post op) how to decrease it?

  1. Hydration
  2. Decreasing use of Opioids, ……. , ……..
A

Volatiles, N2O

112
Q

Diarrhea

DOC in Pregnancy / Breastfeeding

A

Loperamide

113
Q

Diarrhea

DOC for CDI:

If mild : Metronidazole PO

If moderate : Vancomycin PO

If severe?

A

Vancomycin PO + Metronidazole IV

114
Q

Diarrhea

Octreotide Vs Ondansetron

A

Oct: Antidiarreal, for VIPoma or Carcinoid Sd

Ond: Antiemetic (5HT) for severe Nausea

115
Q

Diarrhea

Cholestyramin: Indication, SE (2)

A

Diarrea caused by biliary salts

Vit A,D,K deficiency

Bleeding

116
Q

Diarrhea

Metronidazole SEs

1,2,3 Disulfiram reaction, Metalic taste, Anorexia

4 ?

A

Neurotoxic in long term use

117
Q

Diarrhea

Vancomycin SEs

1,2,3. Red man Sd, Eosinophilia, Fever

4 ?

A

Stomatitis

118
Q

Diarrhea

Bismuth SEs:

1,2. Encephalopathy, Salicilate toxicity

3,4 ?

A

black tongue

dark stools

119
Q

Diarrhea

Probiotics:

…………….. in prophlaxis and Tx of CDI

A

S. Boulardii

120
Q

Constipation Vs Diarrhea

Which one(s) cause C, which one(s) D?

Al, Mg, Ca Antacids

Bismuth, Iron, Cholestyramine, Psyllium, Sucralfate

A

Cause diarrea:

Mg, Psyllium

Cause Constipation:

Al, Ca, Bismuth, Iron, Chlestyramine, Sucralfate

121
Q

Constipation

  • Example of bulk formings: Psyllium
  • Example of Osmotics ………..
  • Example of Lubricants …………….
  • Example of Softeners …………..
A

Os: Lactulose, PEG

Lub: Glycerin, Mineral Oil, Caster Oil

Sof: Decusate

122
Q

Constipation

In Pregnancy: Nonpharmacological plus:

1st line?

2nd line?

A
  1. Bulk formings
  2. Mg hydroxide or Bisacodyl (short term)
  3. Osmotics (last choice)

Note: Caster oil, mineral oil ARE CI in Pregnancy

123
Q

Constipation

DOC for opioid induced constipation?

DOC for constipation in palliative care?

A

Op: Naloxegol

Pal: Methylnaltrexone

124
Q

Viral Hepatitis

In which one(s) vaccination for Hep A or Hep B is recommended?

Children (routine), HIV positives, Hep C patients,

High risk sexual behavior, chronic liver diseases,

IV drug abusers, Coagulopathies

A

Hep A vaccine: ONLY for 3:

1.Hep C patients, 2.chronic liver diseases, 3.Coagulopathies

Hep B vaccine: ALL are recommended

125
Q

Viral Hepatitis

Injection of Hep B vaccine and Ig at the same time?

A

It is ok as long as we use two separate sites of injection

126
Q

Viral Hepatitis

DOC for chronic Hepatitis B (2)

A

Tenofovir Or Entecavir

127
Q

Viral Hepatitis

DOC for chronic Hepatitis B if it is the wild form that is not able to produce HBeAg?

128
Q

Viral Hepatitis

Index used for starting the Tx?

Index used for Tx follow up: HBV DNA

129
Q

Viral Hepatitis

DOC for Tx of chronic Hepatitis C:

  1. If genotype 1,4 ?
  2. If genotype 2,3 ?
A

1,4 Sofosbuvir + Peg interferon + Ribavirin

2,3 Sofosbuvir + Ribavirin

130
Q

Viral Hepatitis

Tx for Hepatitis B in Pregnancy?

and breastfeeding?

A

During: Only supportive

After: Vaccine + Ig to the baby

Br: is OK unless bleeding from nipple

131
Q

Viral Hepatitis

Tx for Hepatitis C in Pregnancy?

and breastfeeding?

A

During: Only supportive

After: Start antivirals for mother

Br: is OK unless bleeding from nipple

132
Q

Viral Hepatitis

Important SEs of Peginterferon alpha 2a?

A

Neutropenia

Thrombocytopenia

(managed by dose reductions)

CIs: Severe Hepatic/renal/cardiac disease, pregnancy

133
Q

Viral Hepatitis

Important SEs of Entecavir?

A

Increased aminotransferase levels

134
Q

Viral Hepatitis

Important SE of Lamivudin?

A

Increased aminotransferase levels

135
Q

Viral Hepatitis

Important SEs of Ribavirin?

A

Hemolytic anemia

may cause MI

Neutropenia

Thrombocytopenia

136
Q

Viral Hepatitis

Important SEs of Adefovir?

A

Increased aminotransferase levels

Nephrotoxicity

Severe hepatomegaly with steatosis

137
Q

Viral Hepatitis

Important SEs of Tenofovir?

A

Renal Toxicity

Monitor renal function and serum P

Severe hepatomegaly with steatosis

138
Q

Viral Hepatitis

Important SEs of Sofosbuvir?

A

Neutropenia

(usually when combined with Ribavirin and Peginterferon)

139
Q

Contraception

Absolute CIs for COCs (Combined Oral Contraceptives)

Total=11

1-7 DM, MI, HTN (160/100), CVA, Valvular HD, ………. , ……….

8-11 Br CA, Migrain with aura, <6w Post partum, ………..

A

Hypercoagulation, Cirrhosis or hepatic tumor

Smoker >35 yo

140
Q

Contraception

Yaz, Yasmin: include Drospirenone

1 Pro ? 1 Con ?

A

Pro: antiandrogenic, good for PMDD

Con: increased VTE risk

141
Q

Contraception

Progestin-only: recommended if ?

A

CI to COCs, like smoker>35 yo or migrain or breastfeeding

142
Q

Contraception

DMPA SE?

A

Decreased bone density:

Take Vit D + Ca regularly

143
Q

Contraception

LNG= Levororgestrel Vs Mifepristone = RU 486

A

LNG is progestin-only, uses:

  1. LNG-IUS as a contraceptive wich decreases bleeding
  2. LNG Tab PO as a post-coital contraceptive

Mifepristone is anti-progestin, use:

  1. in abortion
  2. in post-coital (planB) (not 1st line)
144
Q

Contraception

Postcoital (Emergency) contraception

DOC (2)

A
  1. Tab LNG Single Dose 1.5 mg PO (upto 5d after)
  2. Copper IUD insertion (upto 7d after)
145
Q

Contraception

Breakthrough bleeding (more common with progestin-only) Tx?

A

Up to 3 months: No Tx

If more: Increase dosage of Estrogens to 35 ug

146
Q

Contraception

During Breastfeeding, DOC (2)

  1. Progestin-only (best)
  2. ……………
A

LNG-IUS (2nd choice)

Note: No Estrogens up to 6 weeks post partum

147
Q

Contraception

COCs Pros and Cons:

CVD ? VTE ? Br CA?

A

VTE: increased risk

CVD, Br CA: probably increased risk

148
Q

Contraception

COCs Pros and Cons:

Fibroids, Pain in endometriosis, Br benign dis,

Ovarian cysts, Dysmenorrhea, EP, PID, Pre-menopausal

A

ALL are decreased

149
Q

Contraception

Three methods for adolescents:

  1. COC + Male Condom

2,3 ?

A
  1. Copper IUD
  2. LNG IUS
150
Q

Contraception

COCs: Alarm signs to educate your patients

A

ACHES

A. Abdominal pain

C. Chest pain

H. Headache

E. Eyes

S. Severe leg pain

151
Q

Contraception

Relative CIs for COCs (5)

Estrogen sensitivity, Migrain, BP > 140/90

……………., ……………

A

Biliary disease

High BMI

152
Q

Contraception

CIs for Progestin-only:

Absolute (2) Pregnancy, …………..

Relative (2) Viral active Hepatitis, ……………..

A

A: Current Br CA

B: Hepatic Tumor

153
Q

Contraception

Copper IUD, CIs:

Infections, Pregnancy, bleeding, Cancer, inability to insert, …………

A

1st month post partum (relative CI)

(best at this time: Progestin-only or LNG-IUS)

154
Q

Menopause

Pros and Cons of HRT:

Br CA, Endometrial CA, VTE, MI, CVA ?

A

ALL: increased risk

155
Q

Menopause

Hot FLASHES: if a patient does not like to take Estrogens or it is CI for her, there are 3 alternatives:

  1. Nonpharma Tx

2,3 ?

A

Progestin-only

SSRI

156
Q

Menopause

HRT: Indications

  1. Estrogen-only
  2. E+P combined
A

If hysterectomy AND short term AND low dose:

Estrogen-only is OK

Otherwise: choose E+P combined

157
Q

Menopause

HRT including Estrogen. Absolute CIs (5)

  1. Vaginal bleeding of unknown origin
  2. Br or Endometrial CA
  3. Pregnancy

4,5 ?

A

VTE, Active liver disease

158
Q

Menopause

HRT including Progesterones. Absolute CIs (3)

  1. Vaginal bleeding of unknown origin

2,3 ?

A

Br or Endometrial CA

Pregnancy

159
Q

Menopause

Possible indication for LNG-IUS

A

If a woman is around menopause, with some times heavy bleeding and desire for contraception

160
Q

Menopause

Tx of vaginal atrophy or dryness is topical.

Type of cream?

A

If < 1y, Estrogen only is OK (Premarin vaginal cream)

Otherwise: E+P topical is recommended.

161
Q

Endometriosis

DOC if mild? how to use it?

A

NSAIDs

Start as soon as pain starts, continue untill the end of cycle and then stop

162
Q

Endometriosis

There are four hormone therapies available:

  1. COCs (effective in 75% of cases)
  2. ……………
  3. ……………
  4. …………..
A
  1. Progestin-only: DMPA or LNG-IUS
  2. Androgen Agonists: Danazol
  3. GnRH analogues: Leuprolide
163
Q

Endometriosis

SEs of therapies:

Danazol (3)

  1. Acne

2,3 ?

A

Hirsutism, Voice change, Vaginal dryness

Dyslipidemia

(Danazol is an androgen agonist)

164
Q

Endometriosis

Last line Tx is Leuprolide (GnRH). SEs and cautions:

  1. It needs add-back hormone therapies (E+P)
  2. Hot FLASHES, Insomnia, Mood changes
  3. ……….. , ………………
A

Vaginal Atrophy

Decreased bone density (needs Vit D + Ca)

165
Q

Endometriosis

Tx in pregnancy and breastfeeding

A

No need to Tx (it is usually suppressed)

166
Q

Menorrhagia

MeNorrhagia Vs. MeTROrrhagia

A

Meno: Bleeding is heavy (80 ml) or long (7d)

Metro: Bleeding is irregular and frequent

167
Q

Menorrhagia

The most important question when you choose a Tx is that………….

A

Is a contraception desired or not?

168
Q

Menorrhagia

If a contraception is desired, DOC:

1st choice = COC

2nd choice = ?

3rd choice = ?

A

2= LNG-IUS

3= DMPA

169
Q

Menorrhagia

If a contraception is NOT desired, DOC:

1st choice = ?

2,3 =

A

1= MPA PO for 21 days

  1. NSAIDs during the menses
  2. Tranexamic Acid
170
Q

Menorrhagia

If a contraception is desired, but a Tx with COCs or 2nd or 3rd choices fails, then Tx=?

A

Either Leuprolide (with add-back hormone Tx)

Or Danazol (androgen agonist)

171
Q

Menorrhagia

If a contraception is NOT desired, but a Tx with MPA or 2nd or 3rd choices fails, then Tx=?

A

We have to use COCs

172
Q

Menorrhagia

Acute Menorrhagia in ER:

  1. ………………
  2. …………….or ……………
A
  1. High dose Conjugated Estrogens (25 mg IV)
  2. High dose Progesterone Or Tranexamic Acid
173
Q

Menorrhagia

CIs for Tranexamic Acid (3)

  1. Thrombotic disease

2,3 ………………

A

SAH

Hematuria

174
Q

Dysmenorrhea

1st line Tx? how to use it?

A

NSAIDs (not ASA)

2-3 days/cycle regularly, for a trial of 3-6 months and then reevaluate

175
Q

Dysmenorrhea

  1. Indication for COCs?

If contraception is also desired or if not responding to NSAIDs trial of 3-6 months

  1. Alternative Tx?
A
  1. LNG-IUS (if heavy bleeder) or DMPA (if Estrogens are CI, like smoker above 35 yo)

(Note: for DMPA: add vit D + Ca, and avoid in <18 yo)

176
Q

Female Sx dysfunction

Tx for arousal/desire dysfunction?

A

Ask for Medications she uses

+ No drug is recommended +/- CBT

177
Q

Female Sx dysfunction

Tx for orgamsic dysfunction? (2)

A

Ask for Medications she uses

+/- Sildenafil or DHEA

+/- Coital alignement

178
Q

Female Sx dysfunction

Genito-pelvic pain/penetration Sd

(Dysparonia + Vaginismus),

Tx? (3)

A

Reverse Kegel exercises

Vaginal cones

Estrogen creams +/- lubricants

179
Q

Male Sx dysfunction

VEDs (Vacuum Erectile devices), CIs:

  1. Hx of periapism or high risk of that (hematological)
  2. …………………….
A

Taking Warfarin or high INR for any cause

180
Q

Male Sx dysfunction

Sildenafil and Vardenafil: SE with PDE6: …………..

Tadalafil (Cialis) : SE with PDE11: …………..

A

Eye problems

Myalgia

181
Q

Male Sx dysfunction

PG analogues for ED, example, use

A

Alprostadil

  1. Intracovernosal injection
  2. Urethral instillation (Pellet)
182
Q

Male Sx dysfunction

Premature ejaculation Nonpharma Tx (4)

1,2. Start-stop (1 min), Quiet vagina

3,4 ?

A

Adaptation (2nd erection)

Squeeze technic

183
Q

BPH

1st line: Alpha blockers (SEs)

  1. Doxazocin, Terazocin
  2. Tamsulosin
A
  1. first dose syncope, hypotension with Viagra
  2. No.
184
Q

BPH

A SE of Alpha blockers in Cataract surgery?

A

IFIS (Intraoperative Floppy Iris Sd)

185
Q

BPH

2nd line Tx: Finasteride (5 alpha red inhibitor)

Caution?

A

Decreased PSA may result in late dx of cancer

186
Q

BPH

Daily usage of PDE inhibitor is approved in combination with alpha blockers

A

Tadalafil (Cialis)

187
Q

Urinary Incontinence

In Stress UI:

1st line is Nonpharmacological ?

2nd: Adding Pessary or vaginal cones
3rd: Surgery

A

Nonpharmacological:

Pelvic floor muscle training (Kegel)

+ Bladder Training (=Timed Voiding)

Note: Kegel : 3-6 times a day for 6-8 weeks

188
Q

Urinary Incontinence

In Urge UI:

1st line is Nonpharmacological: (PFMT + Bladder Tr.)

2nd: Medications ?

A

Oxybutinin (PO or gel or patch)

or Darifenacin (new)

or Mirabegron (beta 3 agonist)

189
Q

Urinary Incontinence

In Overflow UI:

1st line is ?

A

Intermittent Catheterization

(No meds, No behavioral, no surgical)

190
Q

UI in Children

1st line Tx= Nonpharmacologic

2nd line Tx ………. , ………..

Last line Tx= Imipramine

A

Desmopressin (DDAVP)

Oxybutinin

191
Q

UI in Children

Nonpharmacological Tx:

1,2 Reduce fluid intake, Do not punish

3,4 ?

A

Reward the child

Use alarms

192
Q

UI in Children

Alarms Vs Desmopressin

fast response? relapse?

A

A: slow response, low relapse

D: fast response, high relapse

193
Q

Chronic Renal disease

Monitoring for ACEIs?

A

K+ and GFR should be measured:

before ACEI And 1-2 w after ACEI

If GFR decrease is > 15% then repeat GFR in two weeks

194
Q

Chronic Renal disease

in DM: Insulin dosage should be reduced

Best antidiabetic drug in renal disease is?

A

Gliclazide

195
Q

Chronic Renal disease

Two Tx for metabolic acidosis in renal disease:

  1. NaHCO3
  2. ?
A

Shohl’s solution

196
Q

Chronic Renal disease

Calcium: Supplementation is recommended

Phosphate: Low P diet +/- ……….

Vit D ?

A

Sevelamer (P binder) if hyperphosphatemia

If only PTH>53 then Calcitriol (Vit D analogue)

197
Q

Chronic Renal disease

High Phosphate foods to avoid (5)

A

Cheese

Fish

Pork

Beef

Seeds

COPY 23 May (5 decks)

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