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NU 560 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

oral contraceptives decrease risk of…

A

ovarian cancer
colon cancer
endometrial cancer
benign breast disease
ovarian cysts
endometriosis
fibroids
ovulation pain
PMS, PMDD

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2
Q

oral contraceptives may improves

A

Acne
Hirsutism

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3
Q

What day should po contraceptives be started

A

First day of menses or sunday after first day

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4
Q

Education for starting pt on po contraceptive

A

use backup birth control method for first 7 days

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5
Q

Reasons to choose progestin only contraceptives, depo-provera, IUD or nexplanon

A

Hx smoking
Over age 35
Abnormal vaginal bleeding
DM with vascular complications
DVT
PE
Ischemic heart disease
Breast cancer
Headache with focal neuro symptoms

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6
Q

Who cannot use nexplanon

A

History of hepatic disease or thrombosis

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7
Q

OBC choice for endometriosis

A

monophasic continuous therapy

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8
Q

OBC choice for post-partum/lactating

A

progesterone only (mini pill)

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9
Q

OBC choice for noncompliant patient

A

Depo shot, subdermal implant

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10
Q

OBC choice for breakthrough bleeding in first half of cycle

A

High estrogen content in first half of cycle

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11
Q

OBC choice for breakthrough bleeding in second half of cycle

A

High progestin content in first half of cycle

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12
Q

OBC choice for adolescent, peri-menopausal, post-partum nonlactating, and no medical risks

A

Any OCP <50mcg EE

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13
Q

Serious side effects of oral contraceptives

A

Increased risk of:
VTE
MI/Stroke (esp over 35 y/o)
Liver disorders

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14
Q

Frequency of depo-provera

A

every 13 weeks. If presenting after 13 week mark, must take pregnancy test first

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15
Q

Hormones in depo-provera

A

Progestin only

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16
Q

When to start depo-provera

A

Within 5 days after menses

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17
Q

Side effects of depo-provera

A

Weight gain, HA, dizziness, nervousness, amenorrhea, irregular bleeding

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18
Q

Effect of depo-provera on fertility

A

Slower reversal: 70% of women can conceive within the first year and 90% within the first 2 years. Not best choice if wanting to get pregnant right away after stopping. Discuss family planning before starting.

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19
Q

Depo-provera is safer choice for women with….

A

CV disease, stroke, VTE, PVD, and sickle cell disease

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20
Q

Efficacy rate of IUD

A

<1% risk of failure

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21
Q

Education for IUD

A

Easily reversible
Hormonal (progestin) and non-hormonal options
Maintenance is checking strings after period
Good choice for dysmenorrhea, menorrhagia, and anemia

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22
Q

SE of IUD

A

PID
Ectopic pregnany
Uterine perforation
Expulsion
Ovarian cysts
Irregular bleeding
Amenorrhea
Pelvic pain

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23
Q

Contraindication of IUD

A

Suspected pregnancy
Uterine abnormalities
PID
Unexplained vaginal bleeding

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24
Q

Contraception that has decreased efficacy in pts with high BMI

A

Xulane transdermal patch
-Increased failure rate and risk of VTE in patients with BMI >30 or over 198lbs

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25
Q

Best practices for using emergency contraception

A

1) Use within 5 days of unprotected sex but 3 days in best
2) Perform pregnancy test if no period within 21 days
3) Works by preventing ovulation

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26
Q

Drug options for emergency contraception

A

1) Copper IUD - most effective and offers long term protection up to 10 years
2) Levonorgestral (LNg, Plan B, Julie) -94% or less effective, best within 3 days, less effective for women over 165lbs
3) Ulipristal Acetate (UPA or Ella) - 98% effective, best within 3 days, less effective if over 195 lbs
4) Yuzpe (combo) - less effective, causes N/V

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27
Q

First Line Treatment for VVC (yeast infection)

A

OTC monistat (tioconazole, miconazole, clotrimazole) X 1-7 days
OR
Diflucan (fluconazole) PO 1 time dose

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28
Q

Second Line Treatment for VVC

A

Cultures for recurrent VVC
7-14 days topical
PO Fluconazole q72h x3 doses

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29
Q

Third Line Treatment for VVC

A

Referral
10-14 days topical OR
PO fluconazole maintence therapy 1x a week for 6 months

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30
Q

First Line Treatment Trichomonas

A

Metronidazole or Tinidazole 2g single dose
OR
Metronidazole 500mg BID x 7 days
Must also treat sex partners.
Avoid sex until treatment complete and symptom-free

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31
Q

Second Line Treatment Trichomonas

A

Try alternative 1st line option and refer to a specialist after recurrent failure

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32
Q

First Line Treatment Bacterial Vaginosis

A

PO metronidazole, topical clindamycin cream, metronidazole gel intravaginally

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33
Q

Education for treatment of BV

A

Metronidazole and Tinidazole - can cause n/v if alcohol ingested during treatment or w/in 72 hours after stopping
Avoid tight fitting clothes, allow ventilation, avoid douching or other hygiene products, avoid scented products that may alter pH
Instill vaginal creams and suppositories at bedtime and wear pad or pantyliner

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34
Q

Menopause hormone therapy for patient WITH uterus

A

Systemic estrogen (po or transdermal) PLUS progestin.
Estrogen alone can cause endometrial hyperplasia/cancer

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35
Q

Menopause hormone therapy for patient WITHOUT uterus

A

Estrogen alone

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36
Q

Hormone therapy contraindications

A

Estrogen-dependent neoplasia, thrombophlebitis/thromboembolic disorder, pregnancy, vaginal bleeding, uncontrolled HTN, acute liver disease

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37
Q

Monitoring for patients taking hormone therapy

A

1) Follow up 4-8 weeks after initiation and then every 3-6 months
2) Reevaluate yearly
3) Continue mammograms, Paps, and DEXA scans
4) Height/weight, lipids, BP, breast exam, full pelvic exam
5) stop 1-3 years after menopause
6) stop gradually to reduce rebound symptoms
7) risk of breast cancer if used over 3-5 years

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38
Q

Best treatment for vasomotor symptoms of menopause when hormone therapy contraindicated

A

SSRI
SNRI
Gabapentin
Clonidine

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39
Q

SSRIs for VMS

A

Paxil, Zoloft, Celexa, Lexapro

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40
Q

SNRIs for VMS

A

Effexor, Pristiq

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41
Q

Best route of treatment for Genitourinary syndrome of menopause (GSM)

A

Hormonal: Low dose vaginal estrogen OR transdermal estrogen OR ospemifene
Transdermal and vaginal have lower risk of VTE compared to oral.
Non-hormonal: Vaginal lubricant and moisturizers, continued sexual intercourse

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42
Q

Medications used to treat Pelvic Inflammatory Disease

A

Cephalosporins (ceftriaxone)
Doxycycline
Clindamycin
Gentamycin
Probenecid
Metronidazole
Empiric, broad spectrum coverage of ALL likely pathogens

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43
Q

Treatment of mild to moderate Pelvic Inflammatory Disease

A

Parenteral or PO/IM treatment with cephalosporins, doxycycline, clindamycin, gentamycin, probenecid, or metronidazole

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44
Q

Treatment of Severe Pelvic Inflammatory disease

A

Parenteral therapy with transitioin to PO within 24-48 hours after symptom improvement

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45
Q

Treatment of Gonorrhea in patients allergic to Cephalosporins

A

Gentamycin IM PLUS azithromycin PO

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46
Q

Suppressive therapy for Genital Herpes

A

Acyclovir, Valacyclovir, Famciclovir
Acyclovir has more frequent dosing due to low bioavailability so compliance may be harder

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47
Q

Genital herpes treatment for pregnant women

A

Acyclovir or valacyclovir

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48
Q

Treatment of Chlamydia for pregnant patient

A

Azithromycin 1g PO x 1 dose
Amoxicillin is alternative
Doxycycline is contraindicated in 2nd and 3rd trimester
Retest 3-4 weeks after treatment and again after 3 months to make sure it doesn’t pass to child

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49
Q

Patient Applied treatment for Genital Warts

A

Imiquimod (aldara): apply with finger at bedtime for up to 16 weeks. Wash off after 6-10 hours.
Podofilox (Condylox): Apply with cotton swab or gel with finger BIDx3 days, then no therapy for 4 days. Repeat 4 cycles.
Sinecatechins (green tea extract): Apply up to 3x/day for up to 16 weeks. DO NOT wash off.

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50
Q

Treatment for Syphilis in pregnant patient with allergy to Penicillin

A

PCN G is only effective treatment during pregnancy. Must desensitize mom to PCN and treat with PCN G. Allows temporary tolerance.

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51
Q

Contraindications of Phosphodiasterase-5 inhibitors

A

Do not use with Nitrates - causes extreme hypotension
Alpha blockers, angina, hypotension, uncontrolled HTN, recent stroke, arrhythmias, MI w/in 6 months, severe HF, renal failure, liver failure, potent CYP450 inhibitors

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52
Q

First Line treatment of erectile dysfunction

A

Phosphodiasterase-5 Inhibitors:
Cialis
Vardenafil
Sildenafil
Avanafil

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53
Q

Considerations for Cialis

A

Long MOA, avoids need to plan for sex, 30 min onset

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54
Q

Consideratons for Vardenafil

A

60 min onset, decreased absorption with fatty foods

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55
Q

Considerations for Sildenafil

A

Take 30-60 minutes before sex, 3-5hr half life, decreased absorption with fatty foods

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56
Q

Considerations for Avanafil

A

Take 15 min before sex, half life 5-10 hrs

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57
Q

Second line treatment for ED

A

Refer to urologist

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58
Q

Complimentary treatment for ED

A

yohimbine, gingko biloba, ginseng, HCG, l-argine

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59
Q

MOA of antimuscarinics

A

Inhibit binding of acetylcholine at muscarinic receptors M3 on detrusor smooth muscle cells, causing relaxation and increasing bladder filling capacity

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60
Q

SE of antimuscarinics

A

Anticholinergic side effects: Constipation, dry mouth (xerostomia), urinary retention

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61
Q

Contraindication of antimuscarinics

A

Narrow angle glaucoma, urinary retention, other CYP450 drugs

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62
Q

Names of Antimuscarinics for overactive bladder

A

Oxybutynin/Ditropan
Tolterodine/Detrol
Solifenancin/Vesiare

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63
Q

First line treatment of uncomplicated UTI

A

Bactrim x3 days
Nitrofurantoin (Macrobid)
Fosfomycin (Monurol)
Macrobid best choice per text.
NO Bactrim if allergy to Sulfa drugs.

64
Q

Second Line treatment of uncomplicated UTI

A

Increase Bactrim to 7 days if no allergy.
If Sulfa allergy, use Cipro or Levaquin (fluoroquinolones)

65
Q

Black box warning for fluoroquinolones

A

Achilles tendon rupture

66
Q

Macrobid considerations

A

Caution in renal dysfunction. Do not use if creat clearance is less than 30.
Do not use during 1st trimester or last 30 days of pregnancy.

67
Q

Bactrim considerations

A

Not to be used in sulfa allergy.
Caution with renal dysfunction.
Not used in pregnancy or breastfeeding.
Concerns for resistance and sulfa skin reaction.

68
Q

Third line treatment of uncomplicated UTI

A

Treat based on culture results.
Keflex, Amox, Augmentin only if susceptible on report

69
Q

Treatmeant of complicated UTI in males, post-menopausal women, patients with catheters

A

Ciprofloxacin or levafloxacin for at least 10 days

70
Q

Treatment of complicated UTI in pregnant women

A

NOT fluoroquinolone.
Start with amoxicillin
Keflex
Macrobid and Bactrim but not in the first trimester or last 30 days of pregnancy

71
Q

Treatment of UTI in geriatrics

A

Often asymptomatic. First s/s altered mental status.
Nitrofurantoin (macrobid) not recommended.

72
Q

Special considerations for treating UTI in pregnancy

A

Take ALL UTIs seriously, treat even asymptomatic.
30% of UTIs in pregnancy develop pyelonephritis.
Urine culture 1 week after treatment and then every 4-6 weeks.

73
Q

Special considerations for treating UTI in children

A

UTI can indicate genitourinary abnormality.
Treat quickly to reduce renal scarring in <5 years old.
Kids <3 should have renal US

74
Q

First Line treatment of UTI in children

A

First Line: Augmentin, cephalexin, cefpodoxime, Bactrim (abcc)

75
Q

Why is treatment required for prostatitis

A

Because inflammation (presence of pro-inflammatory cytokines) of the prostate can restrict the urinary outflow via the urethra.
S/S lower abdominal pain, difficulty emptying, weak stream, nocturia, fever, malaise, pain on ejaculation, rectal pain if very large

76
Q

First Line therapy for prostatitis

A

Fluoroquinolones: Cipro or levaquin are best choice
Sulfa (Bactrim) may not be as effective
4-6 weeks up to 12 weeks

77
Q

Second Line therapy for prostatitis

A

Doxycycline or Azithromycin or Calrithromycin

78
Q

Classes of meds prescribed for BPH

A

Alpha-Adrenergic Blockers
5-Alpha-Reductase Inhibitor
Combo
PDE-5 Inhibitors

79
Q

Alpha-Adrenergic Blockers MOA

A

Relax smooth muscle of the prostate and bladder neck to decrease bladder resistance to urinary flow

80
Q

Names of Alpha-Adrenergic Blockers

A

For BPH
Terazosin
Doxazosin
Tamsulosin
Silodosin

81
Q

Side effects of Alpha-Adrenergic Blockers

A

Hypotension
Orthostatic hypotension
Fluid retention
HA
Dizziness
Weakness
Drowsiness

82
Q

CI of tamsulosin

A

contra in prostate CA

83
Q

CI of doxazosin

A

Avoid in CHF and renal failure

84
Q

CI of silodosin

A

Contraindicated in hepatic/renal impairment

85
Q

5-Alpha-Reductase Inhibitor MOA

A

weakens prostate growth by inhibiting the conversion of testosterone to DHT.
pregnant women should NOT handle drug (affects fetus genitals)

86
Q

Names and side effects of 5-Alpha-Reductase inhibitors

A

Finasteride: Impotence, decreased libido
Dutasteride: Orthostatic hypotension, priapism, risk of prostate ca

87
Q

Combo tamsulosin/dutasteride MOA

A

complementary mechanisms affect hormonal and smooth muscle pathways, inhibiting enlargement of the prostate and producing muscular relaxation, resulting in a decrease of symptoms

88
Q

PDE-5 Inhibitors Side effects and contraindications

A

Cialis: Headache, flushing, GI upset. CI with nitrates and alpha blockers. Good for patients who also have erectile dysfunction.

89
Q

Monitoring during BPH treatment

A

BP during first 2 weeks. Open discussion about sexual health.
AUA symptom score: Over 7 = pharm treatment
<7 lifestyle modification
Monitor for decrease in score after starting treatment. 3-4 point improvement is significant.
Try different agent if side effects occur.

90
Q

First Line Treatment for BPH

A

AUA 7 or less: watchful waiting

91
Q

Second Line treatment for BPH

A

AUA >7: Alpha adrenergic blocker OR 5-alpha-reductase inhibitor OR PDE5 inhibitor

92
Q

Third Line treatment BPH

A

Combo therapy of 5 alpha reductase inhibitor AND alpha blocker

93
Q

Fourth Line treatment BPH

A

Refer to urology for possible surgical intervention

94
Q

Consideration for Terazosin (BPH)

A

Somnolence, take at bedtime

95
Q

Risk factors with longer term use of H2RAs (histamine type 2 receptor antagonists) Famotadine and other “dines”

A

May lead to reduced efficacy or tachyphylaxis and tolerance to the medication. Intermittent use preferred.

96
Q

Risk factors with longer term use of PPI (prazole)

A

Can cause hypergastrinemia, fractures with osteoporosis, GI infections (cdiff and bacterial gastroenteritis) vitamin B12 deficiency, hypomagnesemia. High dose >1 year= osteoporosis/fracture

97
Q

Treatment regimen for NSAID induced PUD

A

1) Test for H pylori and treat if present
2) D/C NSAID and give alternative pain med
3) Use enteric coated NSAIDs, take with meals, add misoprostol
4) Switch to selective COX-2 inhibitor

98
Q

First Line treatment for NSAID induced PUD

A

PPI, Histamine 2 Receptor Antagonists (H2RA), sucralfate (if NSAID can be dc’d)

99
Q

Treatment for PUD if NSAID cannot be dc’d

A

Treat with PPI x8 weeks with NSAID (or misoprostol)

100
Q

Treatment for PUD if NSAID can be dc’d

A

Treat with PPI for 4 weeks

101
Q

Misoprostol contraindication

A

Pregnancy

102
Q

Side effects of Tums, Mag salts, and aluminum salts

A

Rebound hyperacidity
Diarrhea (with mag containing)
Constipation (aluminum containing)
Nausea
Stomach pain
Chalky taste
Hypercalcemia

103
Q

Considerations for antacids

A

No contraindications
Take 1-4 hours after taking iron, sulfonylureas, tetracyclines, and quinolones
Do not heal ulcers, only provide symptom relief

104
Q

First Line treatment for nausea/vomiting

A

Phenothiazine (promethazine, prochlorperazine) for mild/mod

105
Q

Second Line treatment for nausea/vomiting

A

Antihistamine/anticholinergic (hydroxyzine/atarax, meclizine/bonin) useful for mild n/v

106
Q

Third line treatment for nausea/vomiting

A

re-evaluate cause, eliminate insulting agent

107
Q

How to manage motion sickness

A

Hydroxyzine (vistaril, atarax)
Meclizine (bonine, antivert)
Dramamine
Scopolamine

108
Q

Antimotility agents for diarrhea

A

Lomotil
Loperamide

109
Q

Lomotil MOA

A

Decrease GI motility

110
Q

Loperamide MOA

A

Opioid receptor agonist, acts on myenteric plexus of the large intenstine

111
Q

Contraindications of antimotility agents

A

Infectious diarrhea.
Don’t use with fevers, bloody diarrhea, fecal leukocytes.
Caution in hepatic dysfunction.

112
Q

Side effects of Antimotility agents

A

Constipation, drowsiness, blurry vision, lomotil can increase risk of HTN if used with MAOIs

113
Q

MOA Adsorbents

A

Kaopectate
Binds to diarrhea and toxins to solidify stool. Add a dose after each BM

114
Q

MOA Absorbents

A

Fibercon
Absorbs H2O in the GI tract to make stool less watery

115
Q

Best treatment for travelers diarrhea

A

Rifaximin

116
Q

Use of antidiarrheals in pediatrics

A

Oral rehydration in priority. Agents are not recommended in children 1 months to 5 years.
Lomotil not for children under 4

117
Q

Atypical antidiarrheal antisecretory agent

A

subsalicylate (pepto bismol, kaopectate)

118
Q

SUbsalicylate MOA

A

not well understood, Anti-inflammatory, antacid, antibacterial properties

119
Q

Subsalicylate contraindications

A

Hypersensitivity to ASA (breaks down into salicylate)
Not used in kids with flu or chicken pox - ASA induced Reye Syndrome

120
Q

Subsalicylate side effects

A

Black stool, dark tongue, tinnitus.
May interact with warfarin

121
Q

Indications for laxative use

A

Attempt lifestyle modifications first (diet, exercise, bowel training).
Eliminate secondary cause if possible.
Then add pharmacologic therapy.

122
Q

Goal of laxative therapy

A

Increase water content of the feces and increase motility of the intestines using the lowest dose of a laxative for the least amount of time.

123
Q

Types of drugs that increase gastric motility

A

Stimulant laxatives (bisacodyl, sennakot)
Saline laxatives (mag citrate, mag hydroxide, mag sulfate, sodium phosphate, sodium biphosphate)
Bulk forming laxatives (metamucil, citrucel)
Hyperosmolar laxatives (lactulose, sorbitol, miralax)

124
Q

Antimotility agent

A

Imodium - decreases GI motility

125
Q

MOA stimulant laxatives

A

Bisacodyl, sennakot
increase peristalsis, effects smooth muscle of intenstines

126
Q

MOA saline laxatives

A

Mag citrate, mag hydroxide, mag sulfate, sodium phosphate, sodium biphosphate
Draw water into the intestines through osmosis - increase intraluminal pressure - increase intestinal motility

127
Q

MOA Bulk forming laxatives

A

Metamucil, citrucel
Bind to the fecal contents and pull water into the stool - stimulates movement of the intestines

128
Q

MOA hyperosmolar laxatives

A

Lactulose, sorbitol, miralax
Osmotic pressure by drawing fluid from less concentrated gradient to a more concentrated gradient - increased osmotic pressure - stimulates intestinal motility

129
Q

First line constipation treatment

A

Bulk-forming laxative: Metamucil, citrucel

130
Q

Second line constipation treatment

A

Mag hydroxide, saline laxative

131
Q

Third line constipation treatment

A

Stimulant laxative: bisacodyl, sennakot

132
Q

Length of use for OTC laxatives

A

OTC not to be used for more than 7 days in a row

133
Q

Enema contraindication

A

CI in children under 2 years old

134
Q

Gastric motility management in pregnancy

A

Docusate is safe. Avoid castor oil.

135
Q

Geriatric considerations with gastric motility management

A

Bowel obsessed
Risk of electrolyte imbalances with laxative use
Eliminate causative agents (antipsychotics, TCAs, Ca)

136
Q

Effect of IBD on pregnancy

A

increased rates of abortions, stillbirths, and developmental defects with active disease.
Treat aggressively to prevent dehydration, anemia, nutritional deficiency

137
Q

Azathioprine during pregnancy

A

Controversial, if absolutely necessary to limit pancytopenia in the fetus, dose of 2mg/kg/d or less

138
Q

IBD meds contraindicated during pregnancy and lactation

A

Methotrexate - may cause spontaneous abortion and teratogenicity
Caution with all TNF-alpha inhibitors, inadequate human data

139
Q

IBD meds contraindicated during nursing

A

Azathioprine and mecaptopurine: potential of fetal immunosuppression

140
Q

IBD med used for severe refractory cases

A

Cyclosporine - can cause growth retardation

141
Q

Considerations for sulfasalazine

A

Women taking it should be given higher doses of folate (2mg/d) because sulfasalazine interferes with folate absorption

142
Q

Counseling for IBD in pregnancy

A

Give attention to maintaining body weight before conception and preventing exacerbations during pregnancy. Preconception counseling should discuss the condition, lifestyle changes, nutritional issues, and treatment options

143
Q

Aminosalicylates MOA

A

Azulfidine/sulfasalazine, mesalamine/asacol
Decrease inflammation in the GI tract by inhibiting PG synthesis.
Quick onset, 1 week

144
Q

Corticosteroids MOA

A

Prednisone, methylpred, hydrocortisone, dexamethasone, budesonide.
Immunosuppression and PG inhibition if aminosalicylates fail

145
Q

Immunosuppressive agent MOA

A

Imuran/azathioprine, puriethnol/6-mercaptopurine, rheumatrex/methotrexate.
Decrease production of various inflammatory mediators

146
Q

Antibiotics forUC and CD MOA

A

Flagyl, Cipro.
Link between IBD and infectious cause. Abx that act against gram neg and mycobacterial organisms with low SE profile

147
Q

Biologics: TNF Inhibitors MOA

A

Remicade/infliximab, humira/adalimumab, cimzia.
Overexpression of immunologic cytokines including TNF seen in CD - TNF inhibitors neutralize soluble forms of TNF and inhibit its binding to TNF

148
Q

Biologics: Selective Adhesion Molecule Inhibitors MOA

A

Tysabri/natalizumab, entyvio/vedolizumab.
Prevent migration of inflammatory lymphocytes into the gut mucosa

149
Q

Ulcerative colitis mild disease treatment

A

PO and Rectal aminosalicylates (combo therapy)

150
Q

Ulcerative colitis moderate disease treatment

A

add corticosteroid to PO and Rectal aminosalicylates

151
Q

Ulcerative colitis severe disease treatment

A

Hospitalization, d/c oral and topical agents, add corticosteroids.
If no improvement in 7-10 days:
IV cyclosporin
IV iremicade
Humira
IV entyvio

152
Q

Crohn’s Disease Mild treatment

A

Oral/rectal aminosalycylates OR rectal corticosteroid

153
Q

Crohn’s Disease Moderate treatment

A

PO AND Rectal aminosalycylate AND short-term steroids

154
Q

Crohn’s Disease Severe treatment

A

IV corticosteroid and/or IV cyclosporine, IV remicade, SQ humira, and supportive care (ivf, bowel rest, tpn)

155
Q

Agent to treat hepatic encephalopathy

A

1) Lactulose oral and rectal
2) Add rifaximin
3) Add Miralax

156
Q

ROME III criteria for IBS

A

Criteria met for 3 months with onset 6 months prior.
Recurrent abdominal pain at least 3 days/month associated with 2 of following:
Improvement with defecation
Onset associated with change in frequency of stool
Onset associated with change in form of stool

NU 560 (2 decks)

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