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PA- AP > Female health, Neuro And Endocrine > Flashcards

Female health, Neuro And Endocrine Flashcards

1
Q

Indication of cocp

A

Contraception
Reduce acne
reduce dysmenorrhoea
PCOS
endometriosis

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2
Q

side effects of cocp

A

headache
nausea and vomiting
depression
fluid retention
breast tenderness
increased risk of vte

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3
Q

Contraindication of cocp

A

focal migraine - aura
history of blood clotting / family history
liver problems
obesity
hypertension (greater than 140/90)
smoking
recent major surgeries
breast cancer
vte

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4
Q

key interaction of cocp

A

cytochrome p450 inducers like rifampicin and carbamazepine may reduced efficacy of the pill
pill may reduced absorption of lamotrigine impairing seizure control

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5
Q

administration of cocp

A

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

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6
Q

MOA of cocp

A

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

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7
Q

indication of pop

A

aka mini pill
contraception mainly if cocp is contraindicated
also used to control abnormal uterine bleeding and prevention of endometrial hyperplasia

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8
Q

MOA of pop

A

inhibition of ovulation and the thickening of cervical mucus
also causes thinning of endometrium

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9
Q

name some examples of pop

A

norethisterone , levonorgestrel
desogestrel

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10
Q

side effects of pop

A

breast tenderness
change in sex drive
cysts on ovaries
nausea and vomiting
headache or migraines
acne

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11
Q

contraindication of pop

A

pregnant
breast cancer
severe liver cirrhosis
liver tumors

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12
Q

pt education for pop

A

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

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13
Q

key interaction of pop

A

cytochrome p450 inducers like rifampicin and carbamazepine may reduced efficacy of the pill
pill may reduced absorption of lamotrigine impairing seizure control

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14
Q

which menopausal pt are progesterone pill not suitable for

A

pt who has had hysterectomy

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15
Q

Risk of HRT

A

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

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16
Q

Contraindication of HRT

A

Breast cancer
endometrial cancer
increased risk of VTE or CVD
migraine with aura
hx of heavy smoking

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17
Q

side effects of HRT

A

Nausea
bloating, weight gain , fluid retention
mood swings
breakthrough bleeding
breast tenderness

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18
Q

key interaction for HRT

A

Ospemifene
Pomalidomide
Raloxifene
Thalidomide

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19
Q

what are the 2 emergency contraception methods

A

copper intrauterine devices
hormonal methods

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20
Q

time frame for copper IUD for emergency contraception

A

upto 120 hours after UPSI

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21
Q

Contraindication of copper IUD for emergency contraception

A

copper allergy
genital mlignancy
Postpartum sepsis
Wilsons disease

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22
Q

side effects of copper IUD for emergency contraception

A

abdo pain
anemia
backpain
uterine perforation

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23
Q

2 types of hormonal emergency contraception

A

ulipristal acetate (120 hrs)
levonorgestrel (72 hrs)

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24
Q

Contraindication of hormonal emergency contraception

A

reduced effectiveness in individual taking enzyme inducing drugs
breast cancer pt
acute porphyrias

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25
Q

side effects of hormonal emergency contraception

A

breast tenderness
diarrhoea
fatigue and dizziness
hemorrhage
vomiting

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26
Q

indication of paracetamol (2)

A

used for most forms of acute and chronic pain
can reduce fever

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27
Q

MOA of paracetamol

A

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

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28
Q

side effects of paracetamol

A

in overdose paracetamol can cause liver failure

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29
Q

antidote for paracetamol overdose

A

acetylcysteine

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30
Q

contraindication of paracetamol

A

caution in :
-increased risk of lover toxicity
-chronic excessive alcohol abuse
-malnutrition
- low body weight (<50kg)

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31
Q

key interaction for paracetamol

A

risky in CYP inducers like phenytoin and carbamazepine

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32
Q

dosage for paracetamol

A

0.5g to 1g every 4-6 hrs
maximum 4g daily

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33
Q

Monitoring for paracetamol overdose

A

INR, ALT and creatinine conc should be measured

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34
Q

indication of opioids (4)

A

1) acute pain
2) chronic pain
3) breathlessness in palliative care
4) acute pulmonary oedema, alongside oxygen, furosemide and nitrates

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35
Q

MOA of opiods for pain

A

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

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36
Q

MOA of opiods for breathlessness

A

in the medulla they blunt the response to hypoxia and hypercapnia, reducing respiratory drive and breathless

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37
Q

MOA of opioids for pulmonary oedema

A

by relieving pain, breathlessness, opioids reduce sympathetic nervous system activity.
this reduced cardiac work and oxygen demand

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38
Q

side effects of opioids

A

respiratory depression
neurological depression
nausea and vomiting
constipation
pupillary constriction
dependence

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39
Q

Contraindication of opioids

A

caution in :
hepatic failure
renal impairment
older people
Do not give in resp failure

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40
Q

Key interaction of opioids

A

avoid co-prescription of other sedating drugs like antipsychotics, benzodiazapine and tricyclic antidepressant

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41
Q

Communication for opioids

A

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

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42
Q

Carbamazepine indication (2)

A

seizure prophylaxis in epilepsy
trigeminal neuralgia - first line

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43
Q

side effects of carbamazepine

A

Nausea and vomiting
dizziness and ataxia
odema
hyponatremia
hypersensitivity reaction

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44
Q

Contraindication of carbamazepine

A

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

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45
Q

key interaction of carbamazepine

A

drugs that are metabolised by CYP enzymes like warfarin, oestrogen and progesterone
caution with CYP inhibitors like macrolides
other antiepileptic drug like iamotrigine

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46
Q

Communication for carbamazepine

A

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

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47
Q

Monitoring for carbamazepine

A

should not be stopped suddenly

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48
Q

Indication of valproate(4)

A

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

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49
Q

side effects

A

tremor, ataxia
thrombocytopenia
hair loss
severe liver injury
pancreatitis
bone marrow failure

50
Q

Contraindication of sodium valproate

A

avoid in pregnancy - conception and first trimester
avoided in hepatic impairment and dose reduction in severe renal impairment

51
Q

key interaction for sodium valproate

A

Iamotrigine
drugs metabolised by cytochrome p450 enzymes like warfarin
carbamazepine
carbapenems

52
Q

Communication for sodium valproate

A

Advice on pregnancy risk
Avoid driving unless seizure free for 12 months

53
Q

Monitoring for sodium valproate

A

LFT before and during first 6 months of treatment

54
Q

indication of Lamotrigine (2)

A

prophylaxis in epilepsy
bipolar depression

55
Q

side effects of Lamotrigine

A

headache
drowsiness
irritability
blurred vision
dizziness

56
Q

Contraindication of lamotrigine

A

dose reduced in hepatic impairment

57
Q

Important interaction of lamotrigine

A

carbamazepine, phenyotin, oestrogen, rifampicin can cause lamatrigine levels to fall - treatment failure
Valproate can cause it to rise - increasing toxicity

58
Q

Levetiracetam indication (2)

A

seizure prophylaxis in epilepsy
established convulsive status epilepticus

59
Q

side effects of levetricaetam

A

drowsiness, weakness , dizziness and headache
mood disturbances and suicidal ideation

60
Q

contraindication of levetiracetam

A

dosage reduction in renal impairment

61
Q

Indication of benzodiazepine (4(

A

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

62
Q

side effects of benzodiazepines

A

drowsiness, sedation and coma
dependence

63
Q

contraindication of benzodiazepines

A

lower dose for older people
avoid in significant resp impairment and neuromuscular disease
avoid in liver failure

64
Q

Key interaction of benzodiazepines

A

amiodrone
diltiazem
macrolides
fluconazole

65
Q

communication of benzodiazepine

A

risk of dependence
should not drive or operate complex machinery after taking the drug

66
Q

Monitoring of benzodiazepine

A

close monitoring of clinical status and vital signs required for IV or high dose oral administration

67
Q

what are the 3 different antiemetics type

A

dopamine d2 receptor antagonist
histamine h1 receptor antagonist
serotonin 5ht3 receptor antagonist

68
Q

3 examples of dopamine d2 receptor antagonist

A

metoclopramide
prochlorperazine
domperidone

69
Q

indication of dopamine d2 receptor antagonist

A

prophylaxis and treatment of nausea and vomiting in a wide range of condition but particularly in the context of reduced gut motility

70
Q

side effects of dopamine d2 receptor antagonist

A

diarrhoea
QT interval prolongation
arrythmias

71
Q

Contraindication of dopamine d2 receptor antagonist

A

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

72
Q

Key interactions of dopamine d2 receptor antagonist

A

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

73
Q

indication of histamine h1 receptor antagonist

A

prophylaxis and treatment of nausea and vomiting in a wide range of condition but particularly in the context of motion sickness or vertigo

74
Q

examples of histamine h1 receptor

A

cyclizine
promethazine
cinnarizine

75
Q

side effects of histamine h1 receptor antagonist

A

drowsiness
dry throat and mouth
iv- tachycardia and palpitation

76
Q

Contraindication of histamine h1 receptor antagonist

A

avoid in pt at risk of hepatic encephalopathy
prostatic enlargement

77
Q

which histamine h1 receptor antagonist has the least sedating effect

A

cyclizine

78
Q

examples of serotonin 5 ht3 receptor antagonists

A

odanserton and granisetron

79
Q

indication of serotonin 5 ht3 receptor antagonists

A

prophylaxis and treatment of nausea and vomiting in a wide range of condition but particularly in the context of general anaesthesia and chemotherapy

80
Q

side effects of serotonin 5 ht3 receptor antagonists

A

constipation
headache
flushing
prolong QT interval

81
Q

contraindication of serotonin 5ht3 receptor antagonist

A

caution in prolonged QT interval
avoid ondansetron in first trimester of pregnancy

82
Q

key interaction of serotonin 5ht3 receptor antagonist

A

drugs that prolong qt interval like antipsychotics, quinine and SSRI

83
Q

What are triptans

A

serotonin 5-ht1 receptor agonists

84
Q

examples of triptans

A

sumatriptans and zolmitriptans

85
Q

indication of triptans

A

acute migraine

86
Q

side effects of triptans

A

chest and throat discomfort
nausea and vomiting
tiredness
dizziness

87
Q

contraindication of triptans (6)

A

ischaemic heart disease
cerebrovascular disease
peripheral vascular disease
uncontrolled hypertension
hemiplegic migraine
migraine with brainstem aura

88
Q

key interactions of triptans

A

Avoid with monoamine oxidase inhibitors
Caution with:
tramadol
SSRI
tricyclic antidepressants

89
Q

Communications of triptans

A

advice it is only effective if given early in the attack
do not take it as a preventative

90
Q

indication of metformin

A

type 2 diabetes

91
Q

MOA of metformin

A

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

92
Q

side effects of metformin

A

nausea and vomiting
taste disturbance
anorexia
diarrhoea
lactic acidosis

93
Q

Contraindication of metformin

A

caution in renal impairment, hepatic impairment, chronic alcohol abuse
withheld in AKI, severe tissue hypoxia , acute alcohol intoxication

94
Q

Key interaction of metformin

A

caution in IV contrast media
caution ACE i, NSAIDS , diuretics

95
Q

what medication oppose the action of metformin

A

prednisolone
thiazide
loop diuretics

96
Q

Monitoring of metformin

A

measure renal function before starting and annually
stop metformin if eGFR is less than eGFR 30ml/min per 1.73 m2

97
Q

Target HbA1c range for metformin

A

monotherapy of metformin = less than or equal to 48 mmol/mol
dual therapy or more then less than or equal 53 mmol/mol

98
Q

indication for insulin (3)

A

1) type 1 diabetes and last resort for type 2 diabetes
2) IV in the treatment of DKA and HSS
3) hyperkalaemia

99
Q

MOA of insulin

A

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

100
Q

Side effects of insulin

A

Hypoglycaemia
Repeated SC injection at same site can cause lipohypertrophy

101
Q

Contraindication of insulin

A

Caution in renal impairment

102
Q

Key interactions of insulin

A

Caution with Other hypoglycaemic drug

Systemic corticosteroids

103
Q

Monitoring of insulin

A

Capillary blood glucose
Hba1C annually
If IV then check K+ levels

104
Q

2 common indication of thyroid hormones

A

Primary hypothyroidism
Hypothyroidism secondary to hypopituitarism

105
Q

Examples of thyroid hormone

A

Levothyroxine
Liothyronine

106
Q

MOA of thyroid hormone

A

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

107
Q

Side effects of thyroid hormones

A

Usually due to excessive dose :
GI upset
Palpitation
Arrhythmia
Tremor
Restlessness
Insomnia
Weight loss

108
Q

Contraindication of thyroid hormones

A

Caution in :
Coronary artery disease
Hypopituitarism - corticosteroids therapy must be initiated before thyroids hormone replacement

109
Q

Key interactions of thyroid hormone

A

Antacids, calcium and iron salts so it needs to be separated from levothyroxine by 4 hours
Increase dose in pt taking phenytoin and carbamazepine

110
Q

What dose should older people or those with cardiac disease start with

A

25 mg daily

111
Q

Monitoring for thyroid hormone

A

TFT measured at 3 months after starting and after changing dose then annually

112
Q

Indication of carbimazole

A

Hyperthyroidism

113
Q

Side effect of carbimazole

A

Altered taste sensation
Nausea
Rash
Agranulocytosis
Symp of hypothyroidism : weight gain constipation drowsiness

114
Q

Contraindication of carbimazole

A

Withhold in severe blood disorder and hx of acute pancreatitis
Caution in pregnancy

115
Q

Key interaction of carbimazole

A

Digoxin and propiverine

116
Q

Monitoring for carbimazole

A

Monitor TSH TFT and LFT every six to twelve month

117
Q

Indication of prophylthiouracil

A

Used in in hyperthyroidism if intolerant to carbimazole
Usually recommended during the first 3 months of pregnancy

118
Q

Side effects of propylthiouracil

A

Nausea
Rash
Agranulocytosis
Acute liver injury
Symp of hypothyroidism: weight gain constipation and drowsiness

119
Q

Contraindication if propylthiouracil

A

Caution in hepatic and renal impairment and pregnancy

120
Q

Key interactions of propylthiouracil

A

Avoid with metyrapone

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