Exam 5 Drugs Flashcards
1
Q
Breast exam recs
A
-age 40-50 every 1-2 years
-HIGH RISK: annually at 30
2
Q
Pelvic exam recs
A
-usally only if symptomatic
3
Q
PAP smear recs
A
-age 21-29: every 3 years
-age 30-65: or HPV test q 3years or both q 5 years
-not if hysterectomy
4
Q
HPV
A
-most common
-age 18-59
-warts
5
Q
HPV screening
A
-normal cervial screening for F
-only HIGH RISK men or msm maybe anal PAP
6
Q
Gardasil-9
A
-HPV vax
-age 9-45
-if <15, 2 dose 0, 6-12 months
-if >15, 3 dose 0, 2, 6 months
7
Q
HPV vax side effects
A
-inj site pain
-dizziness/fatigue
-headache
-syncope
-vomiting
-myalgia
8
Q
Behavioral birth control
A
-coitus interruptus
-FAM
-LAM
-NFP
9
Q
FAM and NFP techniques (5)
A
-Basal body temp
-Billings ovulation (mucus)
-calendar
-standard days
-2 day method
10
Q
Side effects of too much estrogen
A
-bloating
-breast tenderness
-mood
-headache
-nausea
-HEAVY menses
-fibroid grwoth
-melasma
-vision changes
-weight gain
11
Q
Side effects of not enough estrogen
A
-LIGHT menses
-vaginal DRYNESS
-spotting
-no withdrawal bleeding
12
Q
Estrogen (EE) dosing
A
-very low dose <20mcg
-low dose 20-35 mcg
high dose 50 mcg
13
Q
Too much progestin side effects
A
-acne
-hirsutism
-dec libido
-spression
-inc appetite
-inc sex drive
-noncyclical weight gain
-less energy
-jaundice
-yeast infection
-hair loss
-swelling in arms and legs
14
Q
side effects of not enough progesstin
A
-breakthrough bleeding late in cycle
-no withdrawal bleeding
-HEAVY menses
15
Q
Hormonal contraceptives
A
-Implant
-LNG IUD
-copper IUD
-DMPA
-COC
-NN POP
-D POP
-ring
-patch
16
Q
Implant (nexplanon)
A
-progestin only
-3 years
-delayed or within 6 week return to fertility
17
Q
Implant side effects
A
-irregular bleeding (normal)
-mood, headache, acne
18
Q
LNG IUD
A
-progestin only
-3-8 years
-lighter periods
-safe to breast feed
-lower cancer risk
19
Q
LNG IUD brands
A
-Mirena/Liletta 52mg 8 yr
-Skyla 13.5 mg 3 year
-Kyleena 19.5mg 5 yr
20
Q
DMPA shot
A
-150mg IM
-104 SC
-progestin only
-weight gain
-lighter periods
-acne
-maybe delayed return in fertility
21
Q
COC
A
-nausea
-blood clots, stroke
-improved acne
-lighter period
22
Q
mini-pill
A
-norethindrone and norgestrel
-daily within 3 hours of same time
-could cause ectopic pregnancy
23
Q
D POP (Slynd)
A
-4mg daily
-no placebo
-hyperkalemia
-more likely for spotting changes
-
24
Q
Disposable vaginal ring
A
-Etonogestrel and EE
-blood clot, stroke
-improve acne
-regular periods
25
Annual vaginal ring
-segesterone and EE
26
hormonal contraceptive patch
-norelgestromin and EE (Xulane)
-LNG and EE (twirla)
27
use backup method if starting contraceptive
-more than 1-6 days after period start
-use for 2-7 days
28
Restarting after emergency contraception
-immediately if LNG
-5 days later if ulipristal
-backup method 7 daus
29
If contraception is causing breast tenderness
-dec estrogen
30
Serious side effects of combined methods (ACHES)
-ab pain
-chest pain
-headache
-eye problems
-severe leg pain
31
Progestin only contraindications
-breast cancer
32
Contraception for trans men
1. Progestin only
2. COC
3. non-hormonal
4. irreversible
33
Emergency contraception methods
-Copper IUD
-LNG
-Ulipristal acetate
34
Drugs with delayed return of fertility
-Implant
-DMPA
35
Medication abortion
-mifepristone
-misoprostol
36
medication abortion contraindications
-current IUD
-long term corticosteroids
-adrenal failure
-blood coagulation
-porphyria
37
Mifepristone
-SPRM
-nerosis, softening, prostaglandin sensitivity
-200mg PO once
38
Misoprostol
-contractions
-800 mcg bucally 1-2 days later
39
Dysmenorrhea treatment
1. NSAID +/- contraceptive
2. DMPA or LNG IUD
40
!! Drugs that induce amenorrhea
41
Amenorrhea treatment
1. underlying cause
-supplemental estrogen if HYPOestrogenic (conjugated equine estrogen 0.625-1.25 mg PO days 1-25 or 0.1mg patch weekly)
-dopamine agonist
42
Dopamine agonists
-dec prolactin levels
-treat drug-induced amenorrhea
-Bromocriptine
-Cabergoline
43
Bromocriptine
-dopamine agonist
-treat drug amenorrhea
-multiple daily dosing
44
Cabergoline
-dopamine agonist
-treat drug amenorrhea
-weekly or twice weekly
45
contraindications to dopamine agonist
-breast feeding and uncontrolled HTN
46
Monitoring for dopamine agonists
-BP, HR
-liver and kidney
-preg status
-prolactin level
-avg time 6-8 weeks
-try the other one if it doesnt work
47
Chronic hormonal HMB treatment
-CHC
-progestins
-LNG IUD
-Danazol
-GnRH agonists
48
Chronic nonhormonal HMB treatment
-NSAIDs
-tranexamic acid
-iron to treat deficiency
49
Tranexamic acid
-nonhormonal chronic treatment of HMB
-prevents degradation of blood clots
-1,300mg PO TID for 5 days at start of menses
50
Tranexamic acid contraindications
-DVT, PE
-seizure
51
Acute HMB treatment
1. High dose estrogen (25mg equine IV q4-6h for 24 h)
-monophasic 30-35 mcg EE PO q6-8h until bleeding stops
2. medroxyprogesterone 20mg PO TID x 7 days
3. Tranexamic acid 1,300mg PO TID 5 days
52
Goals of endometriosis therapy
-minimize lesions
-prevent endometriosis progression
-minimize pelvic pain
-repair fertility
53
Endometriosis treatment
1. NSAIDs, CHCs, progestins
2. GnRH (ant)agonists, danazol
3. aromatase inhibitors
54
Danazol
-androgen
-suppresses FSH and LH
-PO BID
-acne, weight gain, hirsutism, lipid, liver, glucose
-black box for thromboembolism
-do NOT use if preg or breastfeeding
55
Goals of Fibroid therapy
-reduce size
-reduce symptoms
-respect fertility
-improve QOL
56
Nonpharmacological treatment of fibroids
-expectant therapy
-myomectomy
-hysterectomy (no fertility)
57
Fibroid treatment
-NSAIDs
-contraceptives
-tranexamic acid
-GnRH agonists
-SPRM
58
GnRH agonists
-treat fibroids
-pre-op or near menopause
-dec blood loss and recovery time
-bone loss
59
SPRM for uterine fibroids
-treat fibroids
-pre-op or near menopause
-dec size
-not associated w hypoestrogenic effects
-mifepristone 10-50mg qd
-ulipristal 5-10mg qd
-neither FDA for fibroids tho
60
Drugs that reduce fibroid size
-LNG IUD
-GnRH agents
-SPRMs
61
Fibroid drugs that do not help dysmenorrhea
-tranexamic acid
-SPRMs
-both help HMB tho
62
Fibroids in pregnancy treatment
-avoid myomectomy
-acetaminophen, opiod, NSAIDs
63
Nonpharmacologic treatment for PMS
-limit sodium, caffeine, alcohol
-aerobic exercide
-sleep
-calcium
-magnesium
-vitamin BDE
64
PMS treatment
1. SSRIs, NSAIDs, Spirinolactone
2. SSNRIs, COCs, Clomipramine, Alprazolam
3. GnRH agonists, surgery
-complement w Ginkgo or St. John's Wort
65
SSRIs
-PMS treatment
-Fluoxetine 20mg
-Sertraline 50-150mg
-Paroxetine 12.5-25 mg
-Citalopram 20-30mg
-Escitalopram 10-20mg
-start day 14 of cycle stop 1-2 days after onset of menses or continuous use
66
SSRI counseling
-suicide
-nausea, drowsiness, sexual dysfunction, sweating, insomnia, diarrhea, HA, weight gain
-wait 2-3 cycles
67
Spirinolactone for PMS
-interfere w testosterone synthesis
-100mg qd days 15-28
-dec weight gain, somatic symptoms, negative mood
68
Spirinolactone side effects
-hyperkalemia
-somnolence
-irreg menses
-diarrhea/nausea
-headache
69
SNRIs for PMS
-venlafaxine 75-112mg during luteal phase ot 50-200 mg qd
-Duloxetine 60mg qd
-HA, inc BP
70
COCs for PMS
-EE 20 mcg
-drospirenone 3 mg qd 24 days
-use if also asking for contraception
71
Clomipramine
-treat PMS
-25-75 mg qd
-blurred vision, dry mouth, constipation, fatigue, HA
72
Alprazolam
-treat PMS
-0.25-1mg TID-QID luteal phase
-sedation and risk of dependence
73
Spirinolactone improves which symptoms
-breast tenderness
-bloating
-negative mood
74
Clincal presentation of PCOS
-HYPERanrogenism (hirsutism, acne, alopecia)
-Menstrual disturbances (amenorrhea, oligomenorrhea, anovulation)
-overweight or obese
75
PCOS potential causes
-inappropriate gonadotropin secretion (elevates androgen levels)
-insulin resistance w hyperinsulinemia (elevates androgen levels)
-excessive androgen production
76
Inappropriate gonadotropin secretion cause of PCOS
-inc GnRH = LH surge too soon = no rise in FSH
-no dominant follicle
-no ovulation = no luteal phase = inc LH
=elecvated androgen levels
77
PCOS diagnostic criteria
-HYPERandrogenism + irregular cycles
-if only one test for hyperandrogenism and request ultrasound in adult
78
Treatment goals of PCOS
-maintain normal endometrium
-block androgens
-reduce insulin resistance
-reduce weight
-prevent long-term complications
-ovulation induction
79
Treatment of PCOS
-COC
-spironolactone
-5-a reductase inhibitors
-metformin
80
COC for PCOS
-1st line
-lowest effective dose 20-30mcg EE
-noregestimate < LNG < norethindrone
-monophasic usually
81
Spironolactone for PCOS
-50-100mg BID
-block androgenic effects
-monitor K
-bleeding, tenderness, HA, dissiness
-teratogenic use contraception
-add on therapy for hirsutism and acne
82
5-a reductase inhibitor
-treat PCOS
-prevent DHT
-use if the other ones dont work
-finasterise (proscar) 2.5-5mg qd
-HA, orthostasis
-must use contraception
83
Metformin for PCOS
-1st line in PCOS BMI > 25
-2nd line for menstrual irreg
-reduce insulin and androgen
-500mg PO qd to 1000mg BID
-up to 6 months to see effect
-monitor B12
-disc if preg
-not endometrial protective until reg menses and ovulation are established
-helpful when lifestyle interventions fail
84
PCOS treatment in insulin resistance
1. lifestyle
2. metformin
85
PCOS treatment for menstrual irreg
1. COC
2. progestins or metformin
86
Hyperandrogenism treatment
1. COC
2. anti-androgens (spironolactone, finasteride)
3, Topical Vanqia facial hair
4. cosmetic procedures
87
Treatment of PCOS if preg is wanted
-aromatase inhibitors (letrozole)
88
Letrozole (femara)
-aromatase inhibitor
-treat PCOS if preg wanted
-stops conversion of androgens to estrogen = inc LH and FSH
-2.5-7.5 mg PO 5 days day 3 of menses
-inc by 2.5mg next cycle if no period up to 5 cycles
-avoid CYP2A6 substrate
-monitor use w tamoxifen and methadone
-hot flashes, edema, dizziness, fatigue, HA
-do NOT use if preg
89
Anovulation treatment in PCOS
1. Letrozole (aromatase inhibitor)
2. Clomiphene + metformin, gonadotropin therapy, ovarian drilling
3. IVF, IVM
90
when to evaluate women < 35 for infertility
-inability to become pregnant after 12 months
91
when to evaluate women 35-40 for infertility
-after 6 months no preg
92
when to evaluate women > 40 for infertility
-after less than 6 months no preg
93
Infertility treatment
-aromatase inhibitor (letrozole)
-gonadotropins
-assissted techniques
94
Aromatase inhibitors for ovulation
-Letrozole (femara)
-2.5-10mg PO 5 days start day 3
-avoid use w CYP2A6
-monitor w tamoxifene and methadon
95
Gonadotropins for fertility
-hCG injection at end of ovulation
-inc FSH
-multiple follicles
-careful monitoring
-dose specialized to clinic
96
Growth hormone (somatotropin)
-inc production of IGF-1
-reduced insulin sensitivity
-disulfide bond
-treat short kids and HYPOglycemia
-anti obesity
-athletics
97
Mecasermin
-rIGF-1
-treat severe IGF-1 deficiency
-might result in HYPOglycemia
98
Growth hormone antagonists and Somatostatin analogs
-Octreotide
-Lanreotide
-Pegvisonmant
-treat GH-secreting ademonas (acromegly)
99
Prolactin
-responsible for lactation
-inhibited by dopamine
-can't treat hypo but can treat hyper w dopamine agonists
100
Vasopressin
-Desmopressin
-ADH, arginine vasopressin
-released in response to rising plasma toniciy or falling blood volume
-inc reabsorption of water
-inc blood volume and BP
-IV or IM
-treat pituitary diabetes, nocturnal pissing, coagulopathy
-water intoxication, careful in CVD, ab cramps
101
V1 receptor
-vasoconstriction
-Ca++
-smooth muscle
102
V2 receptor
-inc water absorption
-cAMP
-renal tubule cells
103
Desmopressin V receptor activity
-more V2 - more anti-diuretic
104
Vasopressin antagonists
-treat hyponatremia (asc w CVD)
-IV in hospital
-Conivaptan IV
-Tolvaptan (V2 oral)
105
Oxytocin
-labor contractions
-milk ejection
-GPCR -> ca -> contraction
-weak vasopressor activity at high doses
-induce labor, control hemorrhage (IV), enhance milk ejection (nasal)
106
Oxytocin contraindications
-fetal distress
-abnormal fetal presentation
-cephalopelvic disproportion
107
Which vax for preg people
-inactivated flu
-Tdap
-RSV
-Covid
108
vax NOT for preg people
-HPV
-MMR
-live flu
-varicella
-yellow and typhoid fever
109
N/V treatment pregnancy
1. Pyridoxine
2. Doxylamine
3. Pyridoxine
4. diphenhydramine
110
GERD treatment pregnancy
-antacids
-sucralfate
-histamine
111
which analgesic in preg
-acetaminophen
-AVOID NSAIDs and aspirin
112
UTI treatment in preg
-cephalexin
-amox or nitro
113
levothyroxine in pregnancy
-inc dose
114
Hyperthyroidism in preg
-propyluracil first semester
-methimazole after
115
Thromboembolism in preg
-LMWH 2 months and until 3 weeks postpartum
-AVOID WARFARIN
116
Preeclampsia management
-Hydralazine
-Labetalol
-nitroprusside
-nifedipine
-AVOID ACE/ARBs
117
Eclamsia in preg
-seizures
-Mg sulfate 4-6g bolus
-phenytoin, benzos, immediate delivey
118
Strep in preg
-PCN G or ampicillin IV in labor
-cefasolin, clinda/vancomycin if allergy
119
Preterm labor treat
-200mg progesterone suppository
-250mg IM weekly if history
120
Premature membrane rupture in preg
if <34 weeks, corticosteroids, antibiotics, tocolytics, mg sulfate
121
Labor dystocia treatment
-oxytocin
-cesarean section
122
When to induce labor
-41-42 weeks
-preeclampsia
-infection
-fetal compromise
-DM, renal , pulmonary disease, HTN
123
Oxytocin regimen
-1-2 up to 4-6 ml/min q15-40 min
-max 40
124
Oxytocin for abortion
-2nd trimester
-admit to labor and delivery
-higher dose 50/500ml over 3 hours
125
relative infant doses (RID)
-infant dose/mother dose
-ideally <5%
126
lactation risk category (safe to least safe)
1. acetaminophen, amox
2. diphenhydramine, fluoxetine
3. pseudofed, hydrocodone
4. colchicine, dapsone
5. amiodarone, chemo
127
Drugs to inc milk supply
-metoclopramide
-domperidone
-sulpiride
128
HYPOgonadism treatment in men
-IM testosterone esters
-50mg monthly inc by 25 up to 100
129
Alopecia treatment
1. Finasteride (5-a reductase)
2. Minoxidil
3. combo
130
Finasteride for alopecia
-1mg PO qd
-dec libido
-very effective
131
Minoxidil for alopecia
-enlarge mini hair follicles
-apply to DRY scalp BID
132
ideal testosterone levels
->300ng/kl
->5ng/dl free
133
THT
-IM 100mg weekly or 200mg biweekly
-patches 1-2 at night
-gel 5-10g
-solution 30-120mg to armpits
-buccal tablet 30mg q12h
-SQ pellet 3-6 months
134
Contraindications to THT
-prostate and breast cancer
-hematocrit >50%
-baseline PSA > 4, 3 in high risk men
-CVD
135
THT monitoring
-3-6months
-measure testosteone and hematocrit, stop if over 54%
136
Prostate cancer screening
-PSA > 4, yearly testing
-not over 70
137
drugs that cause Erectile Dysfunction
-SSRis
-anti HTN
-estrogens
-5-a reductase inhibitors
-chemo
138
ED treatment
1. treat known causes (THT if hypogonadism)
2. PDE-5 inhibitors or vacuum
3. intraurthral
4. combo
5. prostetic
139
PDE-5 inhibitors for ED
-relaxation
-sildenafil 50-100mg
-tadalafil 10-20mg but 2.5-5mg if qd
-food delays absorption
140
start sildenafil at 25 instead of 50mg for
->65 yo
-liver probs
-CrCL <30
-drug interaction
141
PDE-5 precautions
-nitrates
-a-blockers (start at lower dose)
-pt w CAD
142
Pulmonary HTN treatment
-Sildenafil 20mg po TID
-tadalafil 40mg qd
143
Transurethral tx of ED
-alprostadil pellets (MUSE)
-less effective than injection
-125-1000mcg
-alprostadil injection max once a day 3 per week
144
intracavernosal injections for ED
-alprostadil 2.5mcg to 10-20mcg
-Trimix
145
Drugs that induce priapism
-antidepressants
-clozapine, chlorpromazine
-heparin, warfarn
-cocaine
-alcohol
146
treatment of priapism
-phenylephrine 0.1-1mg
-blood aspiration
-saline irrigation
if not painful use coldpack
147
BPH treatment w ED
-a-antagonist
-PDE inhibitor
-or both
148
BPH treatment w small prostate, low PSA
-a-antagonist
149
BPH treatment large prostat and inc PSA
-5-a reductase inhibitor +/- a-antagonist
150
BPH treatment with voiding symptoms
-a-antagonist
-anticholinergic agent (avoid in pts >200ml)
151
A-1 blockers for BPH
-tamsulosin 0.4mg hs
-alfuzosin 10mg qd
-silodosin 4mg qd
-doxazosin 1mg hs to 4-8
-terazosin 1mg hs to 10-20mg
152
PDE inhibitors for BPH
-if also ED
-tadalafil 5mg qd
-2.5mg is CrCl 30-50
-do NOT use if < 30ml
153
Hormonal therapy of BPH
-dec prostate size
-5-a reductase inhbitors
-can take 6 months
-finasteride 5mg
-dutasteride 0.5mg
154
tolterodine
in OAB
155
Testosterone for trans men
-cypionate or enanthate inj
-gel
-patch
156
antiandrogens for trans women
-spironolactone
-finasteride/dutasteride
157
hormone injection requirement
-1ml syringe
-18-20g to draw injection
-smaller 22-25 g after
-IM 1.5 in
-SC 5/8 in
