Female health, Neuro And Endocrine Flashcards
Indication of cocp
Contraception
Reduce acne
reduce dysmenorrhoea
PCOS
endometriosis
side effects of cocp
headache
nausea and vomiting
depression
fluid retention
breast tenderness
increased risk of vte
Contraindication of cocp
focal migraine - aura
history of blood clotting / family history
liver problems
obesity
hypertension (greater than 140/90)
smoking
recent major surgeries
breast cancer
vte
key interaction of cocp
cytochrome p450 inducers like rifampicin and carbamazepine may reduced efficacy of the pill
pill may reduced absorption of lamotrigine impairing seizure control
administration of cocp
if the pill was started within the first 6 days of the women’s cycle : no additional method needed
if not: barrier method need to be used or sex should be avoided for the first 7 days
Take 1 everyday for 21 days and have 7 day pill free break where you get a bleed
MOA of cocp
progesterone : inhibits ovulation by acting on the axis to reduce production of LH and FSH.
Oestrogen: thickens the cervical mucus which prevents passage of sperm
thins the uterus wall - prevents implantation
indication of pop
aka mini pill
contraception mainly if cocp is contraindicated
also used to control abnormal uterine bleeding and prevention of endometrial hyperplasia
MOA of pop
inhibition of ovulation and the thickening of cervical mucus
also causes thinning of endometrium
name some examples of pop
norethisterone , levonorgestrel
desogestrel
side effects of pop
breast tenderness
change in sex drive
cysts on ovaries
nausea and vomiting
headache or migraines
acne
contraindication of pop
pregnant
breast cancer
severe liver cirrhosis
liver tumors
pt education for pop
tale it everyday for it to be effective
choose same time daily
if pt vomit or has diarrhoea , wont protect them fully
periods may stop, become irregular or more frequent
does not protect against STI
key interaction of pop
cytochrome p450 inducers like rifampicin and carbamazepine may reduced efficacy of the pill
pill may reduced absorption of lamotrigine impairing seizure control
which menopausal pt are progesterone pill not suitable for
pt who has had hysterectomy
Risk of HRT
increased risk of HRT with combined but less on oestrogen alone
increased risk of ovarian and endometrial cancer
if oral then increased risk of VTE
Contraindication of HRT
Breast cancer
endometrial cancer
increased risk of VTE or CVD
migraine with aura
hx of heavy smoking
side effects of HRT
Nausea
bloating, weight gain , fluid retention
mood swings
breakthrough bleeding
breast tenderness
key interaction for HRT
Ospemifene
Pomalidomide
Raloxifene
Thalidomide
what are the 2 emergency contraception methods
copper intrauterine devices
hormonal methods
time frame for copper IUD for emergency contraception
upto 120 hours after UPSI
Contraindication of copper IUD for emergency contraception
copper allergy
genital mlignancy
Postpartum sepsis
Wilsons disease
side effects of copper IUD for emergency contraception
abdo pain
anemia
backpain
uterine perforation
2 types of hormonal emergency contraception
ulipristal acetate (120 hrs)
levonorgestrel (72 hrs)
Contraindication of hormonal emergency contraception
reduced effectiveness in individual taking enzyme inducing drugs
breast cancer pt
acute porphyrias
side effects of hormonal emergency contraception
breast tenderness
diarrhoea
fatigue and dizziness
hemorrhage
vomiting
indication of paracetamol (2)
used for most forms of acute and chronic pain
can reduce fever
MOA of paracetamol
reduces availability of oxidised COX-2
this interferes with transmission of pain signals between spinal cord and higher centres reducing pain sensitivity
it also reduced PGE2 concentration in the thermoregulatory region of the hypothalamus reducing fever
side effects of paracetamol
in overdose paracetamol can cause liver failure
antidote for paracetamol overdose
acetylcysteine
contraindication of paracetamol
caution in :
-increased risk of lover toxicity
-chronic excessive alcohol abuse
-malnutrition
- low body weight (<50kg)
key interaction for paracetamol
risky in CYP inducers like phenytoin and carbamazepine
dosage for paracetamol
0.5g to 1g every 4-6 hrs
maximum 4g daily
Monitoring for paracetamol overdose
INR, ALT and creatinine conc should be measured
indication of opioids (4)
1) acute pain
2) chronic pain
3) breathlessness in palliative care
4) acute pulmonary oedema, alongside oxygen, furosemide and nitrates
MOA of opiods for pain
agonism of mu receptors in the central nervous system
activation of the G protein coupled receptor has several effects that overall reduced excitability and pain transmission
MOA of opiods for breathlessness
in the medulla they blunt the response to hypoxia and hypercapnia, reducing respiratory drive and breathless
MOA of opioids for pulmonary oedema
by relieving pain, breathlessness, opioids reduce sympathetic nervous system activity.
this reduced cardiac work and oxygen demand
side effects of opioids
respiratory depression
neurological depression
nausea and vomiting
constipation
pupillary constriction
dependence
Contraindication of opioids
caution in :
hepatic failure
renal impairment
older people
Do not give in resp failure
Key interaction of opioids
avoid co-prescription of other sedating drugs like antipsychotics, benzodiazapine and tricyclic antidepressant
Communication for opioids
most effective for severe short term pain
prolonges use should be avoided
Nausea very common - settles after few days
Constipation very common- keep hydrated and offer laxative like senna
advice not to drive if they feel drowsy or confused
Carbamazepine indication (2)
seizure prophylaxis in epilepsy
trigeminal neuralgia - first line
side effects of carbamazepine
Nausea and vomiting
dizziness and ataxia
odema
hyponatremia
hypersensitivity reaction
Contraindication of carbamazepine
exposure in utero is associated with neural tube defects - so women with epilepsy planning pregnancy should discuss with specialist and take high dose folic acid before treatment
risk of steven- Johnson’s syndrome is strongly associated with carriage of HLA-B*1502 allele - prevalent in han Chinese and thai who should be tested before starting treatment
caution in hepatic, renal and cardiac disease
key interaction of carbamazepine
drugs that are metabolised by CYP enzymes like warfarin, oestrogen and progesterone
caution with CYP inhibitors like macrolides
other antiepileptic drug like iamotrigine
Communication for carbamazepine
reduce seizure freq- doe snot cure epilepsy
saftey net on signs for hypersensitivity
for women- discuss contraception and pregnancy
advice driving is not allowed unless seizure free for 12 months
Monitoring for carbamazepine
should not be stopped suddenly
Indication of valproate(4)
1) seizure prophylaxis in epilepsy
2) established convulsive status epilepticus
3) bipolar disorder - for acute manic episodes and prophylaxis against recurrence
4) prevent frequent migraine attacks
side effects
tremor, ataxia
thrombocytopenia
hair loss
severe liver injury
pancreatitis
bone marrow failure
Contraindication of sodium valproate
avoid in pregnancy - conception and first trimester
avoided in hepatic impairment and dose reduction in severe renal impairment
key interaction for sodium valproate
Iamotrigine
drugs metabolised by cytochrome p450 enzymes like warfarin
carbamazepine
carbapenems
Communication for sodium valproate
Advice on pregnancy risk
Avoid driving unless seizure free for 12 months
Monitoring for sodium valproate
LFT before and during first 6 months of treatment
indication of Lamotrigine (2)
prophylaxis in epilepsy
bipolar depression
side effects of Lamotrigine
headache
drowsiness
irritability
blurred vision
dizziness
Contraindication of lamotrigine
dose reduced in hepatic impairment
Important interaction of lamotrigine
carbamazepine, phenyotin, oestrogen, rifampicin can cause lamatrigine levels to fall - treatment failure
Valproate can cause it to rise - increasing toxicity
Levetiracetam indication (2)
seizure prophylaxis in epilepsy
established convulsive status epilepticus
side effects of levetricaetam
drowsiness, weakness , dizziness and headache
mood disturbances and suicidal ideation
contraindication of levetiracetam
dosage reduction in renal impairment
Indication of benzodiazepine (4(
1) first line for status epilepticus
2) first line alcohol withdrawal reaction
3) sedation in palliative care or rapid tranquilisation
4)short term treatment for severe anxiety or insomnia
side effects of benzodiazepines
drowsiness, sedation and coma
dependence
contraindication of benzodiazepines
lower dose for older people
avoid in significant resp impairment and neuromuscular disease
avoid in liver failure
Key interaction of benzodiazepines
amiodrone
diltiazem
macrolides
fluconazole
communication of benzodiazepine
risk of dependence
should not drive or operate complex machinery after taking the drug
Monitoring of benzodiazepine
close monitoring of clinical status and vital signs required for IV or high dose oral administration
what are the 3 different antiemetics type
dopamine d2 receptor antagonist
histamine h1 receptor antagonist
serotonin 5ht3 receptor antagonist
3 examples of dopamine d2 receptor antagonist
metoclopramide
prochlorperazine
domperidone
indication of dopamine d2 receptor antagonist
prophylaxis and treatment of nausea and vomiting in a wide range of condition but particularly in the context of reduced gut motility
side effects of dopamine d2 receptor antagonist
diarrhoea
QT interval prolongation
arrythmias
Contraindication of dopamine d2 receptor antagonist
avoid in neonates and perforation
caution in children and young adults and intestinal obstruction
avoid in Parkinsons but not domperidone is okay as it does not cross BBB
domperidone:
caution in severe hepatic impairment
avoid in cardiac conduction defect
avoid in people who weight less than 35 kg
Key interactions of dopamine d2 receptor antagonist
dopaminergic agents for Parkinsons disease
drugs that prolong QT interval - e.g. antipsychotics , quinine and SSRI
drugs that inhibit cytochrome p450 enzymes like amiodarone, diltiazem , macrolides , fluconazole
indication of histamine h1 receptor antagonist
prophylaxis and treatment of nausea and vomiting in a wide range of condition but particularly in the context of motion sickness or vertigo
examples of histamine h1 receptor
cyclizine
promethazine
cinnarizine
side effects of histamine h1 receptor antagonist
drowsiness
dry throat and mouth
iv- tachycardia and palpitation
Contraindication of histamine h1 receptor antagonist
avoid in pt at risk of hepatic encephalopathy
prostatic enlargement
which histamine h1 receptor antagonist has the least sedating effect
cyclizine
examples of serotonin 5 ht3 receptor antagonists
odanserton and granisetron
indication of serotonin 5 ht3 receptor antagonists
prophylaxis and treatment of nausea and vomiting in a wide range of condition but particularly in the context of general anaesthesia and chemotherapy
side effects of serotonin 5 ht3 receptor antagonists
constipation
headache
flushing
prolong QT interval
contraindication of serotonin 5ht3 receptor antagonist
caution in prolonged QT interval
avoid ondansetron in first trimester of pregnancy
key interaction of serotonin 5ht3 receptor antagonist
drugs that prolong qt interval like antipsychotics, quinine and SSRI
What are triptans
serotonin 5-ht1 receptor agonists
examples of triptans
sumatriptans and zolmitriptans
indication of triptans
acute migraine
side effects of triptans
chest and throat discomfort
nausea and vomiting
tiredness
dizziness
contraindication of triptans (6)
ischaemic heart disease
cerebrovascular disease
peripheral vascular disease
uncontrolled hypertension
hemiplegic migraine
migraine with brainstem aura
key interactions of triptans
Avoid with monoamine oxidase inhibitors
Caution with:
tramadol
SSRI
tricyclic antidepressants
Communications of triptans
advice it is only effective if given early in the attack
do not take it as a preventative
indication of metformin
type 2 diabetes
MOA of metformin
its a biguanide
lowers blood glucose primarily by reducing hepatic glucose output
Does not affect Insulin pathway (no hypoglycaemia)
Increases glucose uptake and utilisation by skeletal muscle
side effects of metformin
nausea and vomiting
taste disturbance
anorexia
diarrhoea
lactic acidosis
Contraindication of metformin
caution in renal impairment, hepatic impairment, chronic alcohol abuse
withheld in AKI, severe tissue hypoxia , acute alcohol intoxication
Key interaction of metformin
caution in IV contrast media
caution ACE i, NSAIDS , diuretics
what medication oppose the action of metformin
prednisolone
thiazide
loop diuretics
Monitoring of metformin
measure renal function before starting and annually
stop metformin if eGFR is less than eGFR 30ml/min per 1.73 m2
Target HbA1c range for metformin
monotherapy of metformin = less than or equal to 48 mmol/mol
dual therapy or more then less than or equal 53 mmol/mol
indication for insulin (3)
1) type 1 diabetes and last resort for type 2 diabetes
2) IV in the treatment of DKA and HSS
3) hyperkalaemia
MOA of insulin
it stimulates glucose uptake and utilisation from circulation into tissue
Insulin stimulates glycogen, lipids, and protein synthesis and inhibits gluconeogenesis and ketogenesis
Also activates Na+/K+ ATPase driving K+ into cells and reducing serum K+ conc
Side effects of insulin
Hypoglycaemia
Repeated SC injection at same site can cause lipohypertrophy
Contraindication of insulin
Caution in renal impairment
Key interactions of insulin
Caution with Other hypoglycaemic drug
Systemic corticosteroids
Monitoring of insulin
Capillary blood glucose
Hba1C annually
If IV then check K+ levels
2 common indication of thyroid hormones
Primary hypothyroidism
Hypothyroidism secondary to hypopituitarism
Examples of thyroid hormone
Levothyroxine
Liothyronine
MOA of thyroid hormone
Thyroid gland produce thyroxine (t4 ) which is converted into a more active form called triodothyronine (t3) in target tissue.
Levothyroxine is a synthetic T4
Liothyronine is a synthetic T3
Liothyronine has a quicker onset and shorter half life than Levothyroxine hence used in emergency
Side effects of thyroid hormones
Usually due to excessive dose :
GI upset
Palpitation
Arrhythmia
Tremor
Restlessness
Insomnia
Weight loss
Contraindication of thyroid hormones
Caution in :
Coronary artery disease
Hypopituitarism - corticosteroids therapy must be initiated before thyroids hormone replacement
Key interactions of thyroid hormone
Antacids, calcium and iron salts so it needs to be separated from levothyroxine by 4 hours
Increase dose in pt taking phenytoin and carbamazepine
What dose should older people or those with cardiac disease start with
25 mg daily
Monitoring for thyroid hormone
TFT measured at 3 months after starting and after changing dose then annually
Indication of carbimazole
Hyperthyroidism
Side effect of carbimazole
Altered taste sensation
Nausea
Rash
Agranulocytosis
Symp of hypothyroidism : weight gain constipation drowsiness
Contraindication of carbimazole
Withhold in severe blood disorder and hx of acute pancreatitis
Caution in pregnancy
Key interaction of carbimazole
Digoxin and propiverine
Monitoring for carbimazole
Monitor TSH TFT and LFT every six to twelve month
Indication of prophylthiouracil
Used in in hyperthyroidism if intolerant to carbimazole
Usually recommended during the first 3 months of pregnancy
Side effects of propylthiouracil
Nausea
Rash
Agranulocytosis
Acute liver injury
Symp of hypothyroidism: weight gain constipation and drowsiness
Contraindication if propylthiouracil
Caution in hepatic and renal impairment and pregnancy
Key interactions of propylthiouracil
Avoid with metyrapone
