exam 1 Flashcards

1
Q

Factors to consider for Drug Use During Pregnancy

A

Look at all factors together!

  1. maternal blood concentration
  2. molecular weight
  3. plasma elimination half-life
  4. lipid solubility
  5. ionization at physiologic pH
  6. plasma protein binding
  7. placental metabolizing enzymes
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2
Q

_______ - stimulates production of milk

A

prolactin

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3
Q

_______ - stimulates ejection of milk

A

oxytocin

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4
Q

Physiology of lactation:
o Abrupt decrease in progesterone after delivery allows __________ to stimulate production of breast milk
o ________ stimulates milk ejection by causing contraction of myoepithelial cells in alveoli and small milk ducts
o ________ produced during the 1st few days, small quantity; full of immunoglobulins & anti-oxidants
o ________ milk produced in the first 5 minutes of nursing, 2-3% lipid
o ________ produced after 5 minutes of nursing, 10% lipid; more nutrition/calories

A
  • prolactin
  • oxytocin
  • colostrum
  • foremilk
  • hindmilk
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5
Q

Duration of breastfeeding:

A

exclusively 4-6 months

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6
Q

Factors to consider for Drug Use During Lactation

A

Look at all factors together!

  1. molecular weight
  2. lipid solubility
  3. maternal plasma level of drug
  4. plasma protein binding
  5. ionization at physiologic pH
  6. bioavailability
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7
Q

Milk/plasma ratio

A
  • Ratio of concentrations of a drug in milk and plasma may be used as a measure of a drug’s passage into breastmilk
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8
Q

o Milk/plasma ratio > 1 means:

(more/less) drug in the milk ?

A

more drug in the milk

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9
Q

o Milk/plasma ratio = 1 means:

A

baby is taking in drug (ex. Alcohol)

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10
Q

Relative infant dose

A
  • Standardized means of referencing infant exposure to maternal exposure on a dose/weight basis
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11
Q

Relative infant dose: RID (%)

A
= absolute infant dose (mg/kg/day) via milk / 
maternal dose (mg/kg/day)
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12
Q

Drugs that decrease milk ejection

A

o Ethanol – inhibits oxytocin

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13
Q

Drugs that decrease milk production

A
– decrease prolactin
o	Anticholinergics 
o	Diuretics 
o	Dopaminergic agents 
o	Estrogens 
o	Cigarette smoking
o	Sympathomimetic vasoconstrictors
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14
Q

Drugs that increase milk supply (galactagogues)

A

o Dopamine antagonists (metoclopramide)

o Fenugreek

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15
Q

Contraception effectiveness are measured by ________ ____ in the first year of use.

A

failure rates

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16
Q

Contraception typical use:

A

= unintended or accidental pregnancy during the year but not all use the method perfectly for a year; condom broke, not consistently, missing dose

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17
Q

Contraception perfect use:

A

= % of couples who used the method correctly and consistently everytime they had intercourse for a year but had an accidental pregnancy (even if used correctly and consistently)

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18
Q

Non-Hormonal Forms of Contraception:

A
  • lactational amenorrhea
  • fertility awareness-based (cycle beads, symptothermal)
  • barrier techniques (diaphragm, cervical cap, male condom, female condom)
  • spermicides
  • sponge
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19
Q

Latex condom can be used with _____-based lubricants

A

water

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20
Q

What types of method are more effective?

A

IUD, implanon, sterilization

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21
Q

What types of method tend to be used longer (higher continuation rates) and are more effective?

A

Hormonal methods

22
Q

Diaphragm

A
  • Fill with spermicides and covers cervix (dome shape);
  • Can be put in 6 hours before needed and can be left in at least 6 hrs and no more than 24 hours (longer can cause toxic shock syndrome);
  • If more than one intercourse within the time period need to use a condom
23
Q

Cervical cap

A
  • smaller in size and fits snuggly;
  • fill with spermicide and can be put/left in 6/6 hrs and can be left in up to 48 hours
  • if longer Toxic shock syndrome
24
Q

Male condom - latex

A
  • Oil-based drug formulations and lubricants can decrease the barrier strength of latex by 90% in 60 seconds
  • **Latex condom can be used with water-based lubricants
  • can prevent bacterial STDs
25
Q

Male condom - lambskin

A

– do not provide STD protection; viruses can penetrate

• Lambskin or synthetic are used if allergic to latex

26
Q

Male condom - synthetic

A
  • (usually polyurethane)

• Lambskin or synthetic are used if allergic to latex; synthetic are not degraded by oil

27
Q

Female condom

A
  • do not use with male condom at the same time
28
Q

Spermicides

A

– nonoxynol-9→
o chemical surfactants that destroys sperm cell walls;
o Important counseling: if it needs to be dissolved then it may take a long time to do so prior; foam and cream are ready to go.
o If she is having sex more than twice
o It may increase the likelihood of getting HIV → disrupts the vaginal lining
o Foams, creams, suppositories, jellies, films
• DO NOT prevent STDs

29
Q

Sponge

A

o Contains 1 g of nonoxynol-9 (spermicide)-
o Women can insert 6 hrs before and stays in place for 6 hrs after;
o It can be left for 24 hours
o if multiple intercourse it can be left in and do not need to add other contraceptives

30
Q

Combined Hormonal Contraceptives

A

combination of progestin and estradiol

31
Q

Estrogens used in combined hormonal contraceptives (3):

A
  1. ethinyl estradiol (EE)
  2. mestranol
  3. estradiol valerate
32
Q

Estrogen MOA

A

Supress LH and FSH⇒ ovulation is decreased or does not happen; keep endometrium at a constant level; prevent spotting and bleeding (constant)

33
Q

Estrogen dosing

A

o Anything 50 or higher = high dose
• Low dose is 30-35 micrograms
• Ultra low dose 25 or less

34
Q

Progesting MOA

A

Supress LH surge; will not have ovulation; thicken cervical mucuos; make sperm go into fallopian tube more difficult

35
Q

Progestin 1st class

A
  • norethindrone, norethindrone acetate, ethynodiol diacetate
36
Q

Progestin 2nd class

A
  • More potent than 1st generation

- norgestrel, levonorgestrel

37
Q

Progestin 3rd class

A
  • Fewer androgenic and metabolic effects vs 1st generation

- norgestimate, desogestrel

38
Q

Progestin (Other)

A
  • Antiandrogen effects

- drospirenone, dienogest

39
Q
COC Side Effects:
o	Based on \_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_, and \_\_\_\_\_\_\_\_\_\_ components
o	Warning signals
•	A =
•	C = 
•	H =
•	E = 
•	S = 
o	\_\_\_\_\_ → primarily due to estrogen
A

o estrogenic, progestational, and androgenic
o Warning signals
• A = abdominal pain→ indicate pregnancy or clots; gallbladder disease (gall stones)
• C = chest pain→ Clot, pulmonary embolism, MI
• H = headache→ stroke, hypertension
• E = eye problems→ hypertensive emergency, migraines, stroke,
• S = severe leg pain → thrombosis
o CLOTS

40
Q

Monitoring

A

o Blood Pressure

o K+ only with Drospirenone

41
Q

Return to fertility

A

o 1-2 weeks;

o ovulation resumes; wait for 2 months to restore rhythm and cycle.

42
Q

Drug Interactions:

A

o Antibiotics – Rifampin will decrease it (Broad spectrum = tetracycline, Augmentin, etc.)
o Drugs that affect motility in the GI tract
• Increase motility – will not give enough time for it to be absorbed
o Enzyme inducers
o Phenytoin – higher dose is ok since it won’t effect; compensate it
o Potassium – ACE, Spironolactone with Drospirenone

43
Q

Considering for Initiating COCs

A
  • Concomitant medical conditions
  • Estrogen and progestin dose
  • Monophasic vs phasic
  • Monophasic followed by triphasic
  • Cycle Length
44
Q

Concomitant medical conditions:
o U.S. Medical Eligibility Criteria for Contraceptive Use – 4 categories
• Category 1 – condition for which there is __ __________ for the use of the contraceptive method
• Category 2 – condition for which the _________ of using the method generally _______ the theoretical or proven risks
• Category 3 – condition for which the ________ or _____ risks usually _______ the advantages of using the method
• Category 4 – condition that represents an __________ ______ ____ if the contraceptive method is used

A
  • no restriction
  • advantages, outweigh
  • theoretical or proven, outweigh
  • unacceptable health risk
45
Q

Estrogen and Progestin Dose:
o Low progestin and androgen activity; Ex. Norgestimate w/ 30-35 estrogen
o Exception: adolescents and very thin women, start with a __mcg
o Progestin that will not cause side effects

A

o Low progestin and androgen activity; Ex. Norgestimate w/ 30-35 estrogen
o Exception: adolescents and very thin women, start with a 20
o Progestin that will not cause side effects

46
Q
Monophasic vs Phasic
o	Monophasic = 
•	all 21 \_\_\_\_\_ pills are the same dose, 7 \_\_\_\_\_\_ days; 
•	easier to identify \_\_\_\_ \_\_\_\_\_\_ 
•	Give a woman more \_\_\_\_\_\_\_

o Biphasic = Active pills change dose ___ time (2 phases); dose changes mid-cycle

o Triphasic = Changes _____ (3 phases)

o Four-phasic = Natazia dose changes _____ times (4 phases) – newest

A

o Monophasic =
• active, placebo
• side effects
• progestin

o Biphasic = one

o Triphasic = twice

o Four-phasic = three

47
Q

Monophasic followed by triphasic

A

o Monophasic – have more progestin in them; progestin deficient is good to use it
o Triphasic – low progestin

48
Q

Cycle Length

A
  • traditional monthly cycle: 21 active + 7 placebo
  • monthly regimens, short placebo
  • extended regimen, regular placebo
  • continuous regimen, NO placebo
49
Q

Start Date:
o First day start =
o Sunday start =
o Quick start =

A

o First day start = Take on the 1st day of menses; don’t have to use back-up; women might forget or change their minds

o Sunday start = After menstruation then you will take Sunday after that; use back up for 7 days
• AFTER PLACEBO 2 DAYS; MENSTRUAL CYCLE WILL START
• ADVANTAGE: NO MENSES ON THE WEEKEND
• Disadvantage: have to wait to start the pack, might forget

o Quick start = Take first pill at the office after negative preg test; use back up for 7 days; Get started on it as soon as possible

50
Q

Patient Counseling for Combined Oral Contraceptives

A
  • Compliance
  • Common side effects & warning signals
  • Benefits and risks
  • Drug interactions
  • When to use backup method
  • Instructions for missed pills