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ENRP > Exam 1 Clinical and Pharm > Flashcards

Exam 1 Clinical and Pharm Flashcards

1
Q

Tx for menopause sxs in woman without surgical hx

A

estrogen + progestin

  • no surgical hx implies present uterus
  • only need estrogen if w/o uterus
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2
Q

Unique risks for combined estrogen/progestin tx (2)

A
  • breast ca
  • CAD

universal risks: dementia, gallbladder dz, stroke, DVT/PE, urinary incontinence

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3
Q

Unique benefits for combined estrogen/progestin tx (1)

A

decreased risk of colorectal cancer

universal benefits: decreased fractures and diabetes

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4
Q

Unique risks for estrogen only tx (0)

A

none

universal risks: dementia, gallbladder dz, stroke, DVT/PE, urinary incontinence

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5
Q

Unique benefits for estrogen only tx (1)

A

decreased breast cancer risk

universal benefits: decreased fractures and diabetes

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6
Q

Ospemifene indication and MOA

*SERM

A

tx for dyspareunia (painful sex) and vag dryness

MOA: agonist and vagina, antagonist at breast

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7
Q

Clomiphene indication and MOA

*SERM

A

tx for infertility in anovulatory/irregular women, PCOS

MOA: blocks (-) feedback on GnRH at hypotalamus, increasing GnRH

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8
Q

Bazedoxifene indication and MOA

*TSEC

A

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)

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9
Q

Drug?

  • PGE1 analog
  • can induce uterine contractions and cervical ripening
  • can maintain PDA in infant
  • stable at room temperature
A

Misoprostol

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10
Q

Drug?

  • PGE2 analog
  • can induce uterine contractions and cervical ripening
  • can cause fever unresponsive to NSAID
  • NOT stable at room temperature
A

Dinoprostone

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11
Q

Drug?

  • PGF2a analog
  • can induce uterine contractions and treat postpartum bleeding
  • can cause HTN and pulm edema, low body temp
A

Carboprost

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12
Q

Drug?

  • posterior pituitary hormone
  • can induce uterine contractions and treat postpartum bleeding
  • can cause hyponatremia
A

Oxytocin

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13
Q

Drug?

  • stimulates adrenergic, DA, 5HT receptors
  • can induce prolonged uterine contractions
  • can cause St Anthony’s fire (psychosis, mania, gangrene)
A

Ergonovine

*2nd line for postpartum bleeding

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14
Q

Tx for NRDS

Betamethasone regimen

A

2 doses q24h

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15
Q

Tx for NRDS

Dexamethasone regimen

A

4 doses q12h

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16
Q

Tocolytic drug not available in US

B2 agonist that can cause severe hallucinations

A

Ritodrine

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17
Q

Tocolytic drug

also prevents eclamptic seizures and is neuroprotective

A

Magnesium sulfate

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18
Q

Tocolytic drug

Ca++ channel blocker
1st line for tocolysis (wk 32-34)

A

Nifedipine

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19
Q

Tocolytic drug

B2 agonist
2nd line for tocolysis

A

Terbutaline

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20
Q

Tocolytic drug

NSAID (blocks PG synthesis)
1st choice from 24-32 wk
Contraindicated after 32 weeks due to ductus arteriosus closure risk

A

Indomethacin

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21
Q

Tocolytic not available in the US

oxytocin inhibitor

A

Atosiban

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22
Q

Agent used to maintain a PDA

A

Alprostadil (PGE1 analog)

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23
Q

Agents used to close a PDA

A

Indomathacin or Ibuprofen

24
Q

1st line drugs available for HTN in pregnancy

A

a-methyldopa (a2-agonist), Labetalol (a/B blocker)

*2nd line are hydralazine (arterial vasodilator) and Na nitroprusside (a+v dilator)

25
Q

Lab findings in HELLP syndrome

A

LDH > 600 (hemolysis)
AST/ALT 2x normal (elevated liver enzymes)
plt < 100k (low platelets)

*immediate delivery necessary

26
Q

Management for abnormal cervical screening:

under 25 with ASC-US or LSIL

A

repeat cytology at 1y

27
Q

Management for abnormal cervical screening:

ASC-US w/ no HPV test

A

Do HPV test

if +, do colposcopy
if -, cotesting in 3y

28
Q

Management for abnormal cervical screening:

LSIL w/ - HPV test

A

repeat cotesting at 1y

29
Q

Management for abnormal cervical screening:

LSIL w/ no or + HPV test

A

colposcopy

30
Q

Management for abnormal cervical screening:

HSIL

A

colposcopy

31
Q

Major risk factors for cervical neoplasia

A

multiple sex partners
smoking
organ transplant
high parity

32
Q

Cervical screening 21-29

A

cytology q3y

33
Q

Cervical screening 30-65

A

HPV + cytology (cotesting) q5y

34
Q

Concerning colposcopy findings

A 
acetowhite changes
punctations
mosaicism
abnormal vessels
masses
35
Q

Next step in management?

abnormal breast exam in woman under 40

A

US, fine needle/core biopsy

US better for dense breast tissue of younger women

36
Q

Next step in management?

abnormal breast exam in woman over 40

A

Mammogram, fine needle/core biopsy

mam better for less dense breast tissue of older women

37
Q

Procedure to help determine solid vs cystic breast mass

A

fine needle aspiration

  • clear fluid needs no further eval
  • bloody fluid or mass determined requires diagnostic imaging
38
Q

Diagnosis?

  • Extremely tender erythematous dots on the vulva
  • Inflammation of one of the minor vestibular glands
  • Does not respond to abx
A

Vulvar vestibulitis

Tx w/ topical estrogens/steroids or surgery

39
Q

Diagnosis?

  • Slow growing solid tumor of the vulva
  • Can become gigantic (non-compliant pt)
A

Vulvar fibroma

Tx = surgical removal if they become problematic

40
Q

Diagnosis?

  • Woman riding bike has trauma to crotch
  • Labia appear bruised, swollen
  • Blood accumulates in the labial soft tissue, retroperitoneal space
A

Vulvar hematoma

Tx = watch and wait, surgery may be warrented

41
Q

Diagnosis?

  • Vulva appears thick and leathery due to constant itching and rubbing
  • Squamous cell hyperplasia
  • Elongated rete ridges***
A

Lichen simplex chronicus

  • chronicus for chronic itching
  • contrast with lichen sclerosis (loss of rete)
42
Q

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***
A

Lichen sclerosis

*contrast with lichen simplex chronicus (elongated rete)

43
Q

Diagnosis?

  • Pedunculated uterine mass that may protrude thru the cervical os
  • Assoc with heavy prolonged menstrual bleeding
A

Submucosal fibroid

44
Q

Diagnosis?

Ascites, right pleural effusion and ovarian fibroma

A

Meigs syndrome

45
Q

Determination of ectopic pregnancy based on discriminatory zone

A

<1500-2000 hCG level at 5 weeks suggests ectopic

46
Q

Cardinal movements of labor

A

Engagement, Descent, F, IR, E, ER, Expulsion

*Every Decent Fellow In England EatsRaw Eggs

47
Q

Diagnosis and Treatment:

vaginitis with white discharge and fishy odor
Clue cells on wet mount
pH>4.5

A

Bacterial vaginosis

Metronidazole/ Tinidazole (DNA damage)
Clindamycin (50s inhibitor)

48
Q

Diagnosis and Treatment:

vaginitis with thick white cottage cheese discharge
pseudohyphae on KOH mount

A

Vaginal candidiasis

-azoles (topical), oral fluconazole (inhibits ergosterol synth)

49
Q

Diagnosis and Treatment:

vaginitis/cervicitis with frothy green discharge and odor
strawberry cervix
trophozoites on wet mount
pH>4.5

A

Trichomoniasis

Metronidazole, Tinidazole (DNA damage)

50
Q

Gonorrhea and Chlamydia tx

A 
IM Ceftriaxone (3rd gen cef, B lactam)
PO Azithromycin (50s)

Doxycycline (30s) if azith allergy

51
Q

Outpatient PID tx

A

Ceftriaxone + Doxycycline (30s)

52
Q

Inpatient PID tx

A

Cefoxitin/Cefotetan (2nd gen cef)
Gentamycin (30s)
Doxycycline (30s)
Clindamycin (50s)

53
Q

Staphylococcal Toxic Shock Syndrome tx

A 
Vancomycin
Pip/tazo
Cefepime (4th gen cef)
Meropenem
Imipenem/Cilastin (cilastin is DHP1 inhib)
54
Q

Postpartum endometritis tx

A

Gentamycin (30s)

Clindamycin (50s) or amp/sulbactam

55
Q

Lactational mastitis tx

A 
MSSA = amox/clav
MRSA = TMP/SMX (inhibits TH4 synth in bacteria)
56
Q

Abx (discussed) that inhibit 30s ribosome

A

Doxycycline

Gentamycin

57
Q

Abx (discussed) that inhibit 50s ribosome

A

Clindamycin

ENRP (5 decks)

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