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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
Lab findings in HELLP syndrome
LDH > 600 (hemolysis) AST/ALT 2x normal (elevated liver enzymes) plt < 100k (low platelets) *immediate delivery necessary
26
Management for abnormal cervical screening: under 25 with ASC-US or LSIL
repeat cytology at 1y
27
Management for abnormal cervical screening: ASC-US w/ no HPV test
Do HPV test if +, do colposcopy if -, cotesting in 3y
28
Management for abnormal cervical screening: LSIL w/ - HPV test
repeat cotesting at 1y
29
Management for abnormal cervical screening: LSIL w/ no or + HPV test
colposcopy
30
Management for abnormal cervical screening: HSIL
colposcopy
31
Major risk factors for cervical neoplasia
multiple sex partners smoking organ transplant high parity
32
Cervical screening 21-29
cytology q3y
33
Cervical screening 30-65
HPV + cytology (cotesting) q5y
34
Concerning colposcopy findings
``` acetowhite changes punctations mosaicism abnormal vessels masses ```
35
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
36
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
37
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
38
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
39
Diagnosis? - Slow growing solid tumor of the vulva - Can become gigantic (non-compliant pt)
Vulvar fibroma Tx = surgical removal if they become problematic
40
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
41
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)
42
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)
43
Diagnosis? - Pedunculated uterine mass that may protrude thru the cervical os - Assoc with heavy prolonged menstrual bleeding
Submucosal fibroid
44
Diagnosis? Ascites, right pleural effusion and ovarian fibroma
Meigs syndrome
45
Determination of ectopic pregnancy based on discriminatory zone
<1500-2000 hCG level at 5 weeks suggests ectopic
46
Cardinal movements of labor
Engagement, Descent, F, IR, E, ER, Expulsion *Every Decent Fellow In England EatsRaw Eggs
47
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)
48
Diagnosis and Treatment: vaginitis with thick white cottage cheese discharge pseudohyphae on KOH mount
Vaginal candidiasis -azoles (topical), oral fluconazole (inhibits ergosterol synth)
49
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)
50
Gonorrhea and Chlamydia tx
``` IM Ceftriaxone (3rd gen cef, B lactam) PO Azithromycin (50s) ``` Doxycycline (30s) if azith allergy
51
Outpatient PID tx
Ceftriaxone + Doxycycline (30s)
52
Inpatient PID tx
Cefoxitin/Cefotetan (2nd gen cef) Gentamycin (30s) Doxycycline (30s) Clindamycin (50s)
53
Staphylococcal Toxic Shock Syndrome tx
``` Vancomycin Pip/tazo Cefepime (4th gen cef) Meropenem Imipenem/Cilastin (cilastin is DHP1 inhib) ```
54
Postpartum endometritis tx
Gentamycin (30s) | Clindamycin (50s) or amp/sulbactam
55
Lactational mastitis tx
``` MSSA = amox/clav MRSA = TMP/SMX (inhibits TH4 synth in bacteria) ```
56
Abx (discussed) that inhibit 30s ribosome
Doxycycline | Gentamycin
57
Abx (discussed) that inhibit 50s ribosome
Clindamycin

ENRP (5 decks)

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