Exam 1 Clinical and Pharm Flashcards
Tx for menopause sxs in woman without surgical hx
estrogen + progestin
- no surgical hx implies present uterus
- only need estrogen if w/o uterus
Unique risks for combined estrogen/progestin tx (2)
- breast ca
- CAD
universal risks: dementia, gallbladder dz, stroke, DVT/PE, urinary incontinence
Unique benefits for combined estrogen/progestin tx (1)
decreased risk of colorectal cancer
universal benefits: decreased fractures and diabetes
Unique risks for estrogen only tx (0)
none
universal risks: dementia, gallbladder dz, stroke, DVT/PE, urinary incontinence
Unique benefits for estrogen only tx (1)
decreased breast cancer risk
universal benefits: decreased fractures and diabetes
Ospemifene indication and MOA
*SERM
tx for dyspareunia (painful sex) and vag dryness
MOA: agonist and vagina, antagonist at breast
Clomiphene indication and MOA
*SERM
tx for infertility in anovulatory/irregular women, PCOS
MOA: blocks (-) feedback on GnRH at hypotalamus, increasing GnRH
Bazedoxifene indication and MOA
*TSEC
tx for menopause sxs in women w/ uterus intolerant to progestin, post-menopausal osteoporosis in women w/ uterus
MOA: systemic estrogenic effects w/ antiestrogenic effects at endometrium (no need for supp progesterone)
Drug?
- PGE1 analog
- can induce uterine contractions and cervical ripening
- can maintain PDA in infant
- stable at room temperature
Misoprostol
Drug?
- PGE2 analog
- can induce uterine contractions and cervical ripening
- can cause fever unresponsive to NSAID
- NOT stable at room temperature
Dinoprostone
Drug?
- PGF2a analog
- can induce uterine contractions and treat postpartum bleeding
- can cause HTN and pulm edema, low body temp
Carboprost
Drug?
- posterior pituitary hormone
- can induce uterine contractions and treat postpartum bleeding
- can cause hyponatremia
Oxytocin
Drug?
- stimulates adrenergic, DA, 5HT receptors
- can induce prolonged uterine contractions
- can cause St Anthony’s fire (psychosis, mania, gangrene)
Ergonovine
*2nd line for postpartum bleeding
Tx for NRDS
Betamethasone regimen
2 doses q24h
Tx for NRDS
Dexamethasone regimen
4 doses q12h
Tocolytic drug not available in US
B2 agonist that can cause severe hallucinations
Ritodrine
Tocolytic drug
also prevents eclamptic seizures and is neuroprotective
Magnesium sulfate
Tocolytic drug
Ca++ channel blocker
1st line for tocolysis (wk 32-34)
Nifedipine
Tocolytic drug
B2 agonist
2nd line for tocolysis
Terbutaline
Tocolytic drug
NSAID (blocks PG synthesis)
1st choice from 24-32 wk
Contraindicated after 32 weeks due to ductus arteriosus closure risk
Indomethacin
Tocolytic not available in the US
oxytocin inhibitor
Atosiban
Agent used to maintain a PDA
Alprostadil (PGE1 analog)
Agents used to close a PDA
Indomathacin or Ibuprofen
1st line drugs available for HTN in pregnancy
a-methyldopa (a2-agonist), Labetalol (a/B blocker)
*2nd line are hydralazine (arterial vasodilator) and Na nitroprusside (a+v dilator)
Lab findings in HELLP syndrome
LDH > 600 (hemolysis)
AST/ALT 2x normal (elevated liver enzymes)
plt < 100k (low platelets)
*immediate delivery necessary
Management for abnormal cervical screening:
under 25 with ASC-US or LSIL
repeat cytology at 1y
Management for abnormal cervical screening:
ASC-US w/ no HPV test
Do HPV test
if +, do colposcopy
if -, cotesting in 3y
Management for abnormal cervical screening:
LSIL w/ - HPV test
repeat cotesting at 1y
Management for abnormal cervical screening:
LSIL w/ no or + HPV test
colposcopy
Management for abnormal cervical screening:
HSIL
colposcopy
Major risk factors for cervical neoplasia
multiple sex partners
smoking
organ transplant
high parity
Cervical screening 21-29
cytology q3y
Cervical screening 30-65
HPV + cytology (cotesting) q5y
Concerning colposcopy findings
acetowhite changes punctations mosaicism abnormal vessels masses
Next step in management?
abnormal breast exam in woman under 40
US, fine needle/core biopsy
US better for dense breast tissue of younger women
Next step in management?
abnormal breast exam in woman over 40
Mammogram, fine needle/core biopsy
mam better for less dense breast tissue of older women
Procedure to help determine solid vs cystic breast mass
fine needle aspiration
- clear fluid needs no further eval
- bloody fluid or mass determined requires diagnostic imaging
Diagnosis?
- Extremely tender erythematous dots on the vulva
- Inflammation of one of the minor vestibular glands
- Does not respond to abx
Vulvar vestibulitis
Tx w/ topical estrogens/steroids or surgery
Diagnosis?
- Slow growing solid tumor of the vulva
- Can become gigantic (non-compliant pt)
Vulvar fibroma
Tx = surgical removal if they become problematic
Diagnosis?
- Woman riding bike has trauma to crotch
- Labia appear bruised, swollen
- Blood accumulates in the labial soft tissue, retroperitoneal space
Vulvar hematoma
Tx = watch and wait, surgery may be warrented
Diagnosis?
- Vulva appears thick and leathery due to constant itching and rubbing
- Squamous cell hyperplasia
- Elongated rete ridges***
Lichen simplex chronicus
- chronicus for chronic itching
- contrast with lichen sclerosis (loss of rete)
Diagnosis?
- Thin white inelastic skin patches on the vulva
- “onion skin, cig paper, parchment paper”
- Inflammatory cells at BM on biopsy
- Loss of rete ridges***
Lichen sclerosis
*contrast with lichen simplex chronicus (elongated rete)
Diagnosis?
- Pedunculated uterine mass that may protrude thru the cervical os
- Assoc with heavy prolonged menstrual bleeding
Submucosal fibroid
Diagnosis?
Ascites, right pleural effusion and ovarian fibroma
Meigs syndrome
Determination of ectopic pregnancy based on discriminatory zone
<1500-2000 hCG level at 5 weeks suggests ectopic
Cardinal movements of labor
Engagement, Descent, F, IR, E, ER, Expulsion
*Every Decent Fellow In England EatsRaw Eggs
Diagnosis and Treatment:
vaginitis with white discharge and fishy odor
Clue cells on wet mount
pH>4.5
Bacterial vaginosis
Metronidazole/ Tinidazole (DNA damage)
Clindamycin (50s inhibitor)
Diagnosis and Treatment:
vaginitis with thick white cottage cheese discharge
pseudohyphae on KOH mount
Vaginal candidiasis
-azoles (topical), oral fluconazole (inhibits ergosterol synth)
Diagnosis and Treatment:
vaginitis/cervicitis with frothy green discharge and odor
strawberry cervix
trophozoites on wet mount
pH>4.5
Trichomoniasis
Metronidazole, Tinidazole (DNA damage)
Gonorrhea and Chlamydia tx
IM Ceftriaxone (3rd gen cef, B lactam) PO Azithromycin (50s)
Doxycycline (30s) if azith allergy
Outpatient PID tx
Ceftriaxone + Doxycycline (30s)
Inpatient PID tx
Cefoxitin/Cefotetan (2nd gen cef)
Gentamycin (30s)
Doxycycline (30s)
Clindamycin (50s)
Staphylococcal Toxic Shock Syndrome tx
Vancomycin Pip/tazo Cefepime (4th gen cef) Meropenem Imipenem/Cilastin (cilastin is DHP1 inhib)
Postpartum endometritis tx
Gentamycin (30s)
Clindamycin (50s) or amp/sulbactam
Lactational mastitis tx
MSSA = amox/clav MRSA = TMP/SMX (inhibits TH4 synth in bacteria)
Abx (discussed) that inhibit 30s ribosome
Doxycycline
Gentamycin
Abx (discussed) that inhibit 50s ribosome
Clindamycin
