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Pharmacy CPS Flashcards > GI/GU& REPRODUCTION > Flashcards

GI/GU& REPRODUCTION Flashcards

1
Q

what causes prostatic enlargement?

A

diphydrotestosterone ( DHT)

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2
Q

pharmacological treatment for BPH

A

alpha blockers ( silodosin, alfuzosin, tamsulosin)

5- alpha reductase inhibitors (Finasteride, dutasteride)

Phosphodiesterase type ( tadalafil)

antimuscarinics and beta 3 agonist

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3
Q

which alpha blockers is selective vs non selective

A

selective: silodosin, alfuzosin, tamsulosin

non selective: doxazosin, terazosin

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4
Q

MOA of alpha blockers, side effects

A

mediates smooth muscle activity in the bladder neck, which allows for improved urinary flow rate

AE: hypotension, dizziness, somnolence, fatigue, dyspnea

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5
Q

Unique AE of tamsulosin

A

intraoperative floppy iris syndrome, cataract formation,

retrograde ejaculation

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6
Q

counselling points for alpha blockers

A

administer silodosin and alfuzosin with food, tamsulosin may be administered with or without food

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7
Q

does alpha blocker provide reduction of prostate

A

no, symptomatic relieve only

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8
Q

MOA of finasteride and dutasteride

A

blocks conversion of testosterone to DHT

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9
Q

Onset of 5 alpha reductase vs alpha blockers

A

5 alpha: 6 -12 months

alpha: immediate

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10
Q

AE of finasteride and dus-

A

impotence, sexual dysf, decreased libido, gynecomastia ( rare)

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11
Q

which agent to avoid when crcl< 30 ml/min

A

silodosin

tadalafil

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12
Q

AE of tadalafil

A

dyspepsia, headache, nasal congestion, back pain, flushing, visual disturbances, permanent vision or hearing loss ( rare)

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13
Q

MOA of desmopressin

A

synthetic analogue of the antidiuretic hormone vasopressin. useful in men with nocturnal polyuria

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14
Q

AE of desmopressin

A

Hyponatremia, xerostomia ( dry mouth), headache, dizziness, abdominal pain

** sodium levels must be taken at baseline in all men, followed by 7 days and 30 days after initiation of therapy

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15
Q

what combination is recommended for BPH

A

alpha blocker+ 5 alpha reductase inhibitor

rapid relief by alpha blocker and sustained relief by reductase inhibtior

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16
Q

which agent may be choosen if symptoms were predominantly storages symptoms?

A

antimuscarinics and beta 3 agonist (Mirabegron)

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17
Q

When does progesterone peak during the menstrual cycle?

A

During the middle of the luteal phase of the menstrual cycle.

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18
Q

when does estrogen peak d

A

before ovulation

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19
Q

can the Evra patch be used for women weighing >90 kg

A

no

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20
Q

which type of COC decreases acne

A 
Estrogen dominant ( higher estrogen) 
progestins with higher androgenic activity may likely increase acne
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21
Q

early cycle bleeding is likely due to

A

insufficient estrogen

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22
Q

late cycle bleeding is likely due to

A

insufficient progestin

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23
Q

advantages and disadvantages of progestin only

A

ad: decreased dysmenorrhea, bleeding, risk of endometrial cancer
- lower doses of progestin
- best for patients that have a contraindication to combined hormonal use

dis: tight regular schedule ( >3 hr= missed dose)
- higher incidence of ectopic pregnancy
- irregular bleeding

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24
Q

what is the main disadvantage of depo provera

A

delayed fertility up to 1 yeaer
weight gain
black box warning of increase risk of osteoporosis

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24
Q

what is the main disadvantage of depo provera

A

delayed fertility up to 1 yeaer
weight gain
black box warning of increase risk of osteoporosis

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25
Q

which drug decreases efficacy of COC

A

phenytoin
CBZ
Phenobarbital

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26
Q

how effective is levonorgestrel (plan B) and Ulipristal ( Ella) after unprotected sex

A

plan B: 3 days (72 hrs)

ella 5 days (120hrs)

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27
Q

plan B AE

A

N/V, cramps dizziness, irregular menstrual bleeding or spotting

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28
Q

how long can cooper IUD effective after unprotected sex

A

7 days

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29
Q

IS plan B effective in over weight patient

A

Ella is recommended for women with BMI >/ 25kg/m2

Plan B have reduced efficacy

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30
Q

when can u start using COC after post partum

A

6 weeks

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31
Q

is lactational amenorrhea an effective birth control

A

2015 contraception guidelines say its effective on its own (98%) if patient is <6 months postpartum, >75% breast feeding and remains amenorrheic

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32
Q

which progestin have reduce androgenic activity

A

norgestimate and desogestrel ( better than levonorgestrel) thus helpful for acne

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33
Q

common AE of COC

A

BTB, amenorrhea, N/V, bloating, breast tenderness, mod chagnes

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34
Q

can overweight women use evra patch

A

no, not effective for women weighing >90 kg

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35
Q

definition of chronic constipation

A

ROME criteria

>/ 3 months with an onset of >/ 6 months before diagnosis

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36
Q

bulk forming laxatives are contraindicated in what

A

fecal impaction

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37
Q

what is methylnaltrexone use for

A

opioid induced constipation in palliative care patients

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38
Q

indication for naloxegol

A

opioid induced constipation in non-cancer patient not responding to other treatment

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39
Q

MOA of linaclotide

A

guanylate cyclase c agonist
increases chloride and bicarb secretion + inhibits sodium reabsorption—> increased water secretion into intestinal lumen

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40
Q

red flags symptoms of constipation

A

GI bleedin
unintentional weight loss
family history of colon cancer
symptoms onset >/ 50 years old

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41
Q

indiation of linaclotide

A

is indicated for the treatment of chronic idiopathic constipation and IBS-C in adults

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42
Q

drug of choice for constipation of childnre

A

PEG, lactulose, sorbitol

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43
Q

complications of constipation includes

A

hemorrhoids, anal fissure, fecal impaction

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44
Q

When is the onset of action of bisacodyl tablets

A

6-12 hrs

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45
Q

What is the onset of action of Milk of Magnesia (magnesium hydroxide)?

A

0.5-6 hrs

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46
Q

Which of the following laxatives can cause aspiration pneumonia

A

mineral oil

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47
Q

which constipation drug is NOT recommended in pregnancy

A 
docusate 
linaclotide 
prucalopride 
pastor oil 
mineral oil
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48
Q

common causes of diarrhea in neonates

A

rotavirus

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49
Q

most common bacterium responsible for antibiotic-associated infectious diarrhea.

A

c.diff

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50
Q

mac dose of loperamide/day

A

4mg STAT, then 2mg after loose BM ( max 16/day) x 3 days

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51
Q

what characteristic of drug increases the chance of placental transfer

A

high fat solubility
low degree of ionization
low degree of protein binding
low molecular mass ( <500 kDa rapid transit

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52
Q

which drugs are INCOMPATIBLE with breastfeeding

A 
alcohol 
anticonvulsants ( phenobar, ethosuximide, primidone) 
COC 
ergot 
iodine 
Lithium carbonate 
tetracyclines
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53
Q

1st line treatment for H.Pylori

A
  1. PAMC x 14 days

2. PBMT X 14 days ( first line in patient with pen/amoxi allergy)

54
Q

what are restricted first line options

A

PAC, PAM, PMC

Restricted to areas with known clarithromycin resistance <15% or proven high local eradication rates >85%.

55
Q

long term AE of PPI

A

B12, mg deficiency
Enteric infection risk ( c.diff, gastroenteritis)
bone loss, fractures

56
Q

AE of H2RAs

A

headache, dizziness, drowsiness

gynecomastia ( <4%)

57
Q

GERD options for pregnancy

A

Antacids ( except sodium bicarb)
PPIs
H2RAs

58
Q

what tests are done to determine if H. pylori is present?:

A

urea breath test (UBT)

serology

59
Q

patient on clopidogrel should avoid which PPI

A

avoiding concurrent use with omeprazole due to the possibility that combined use may result in decreased clopidogrel effectiveness. Although all the proton pump inhoibitors may lower the effectiveness of clopidogrel, pantoprazole (or rabeprazole) may be a lower-risk alternative

60
Q

which NSAID is best for peptic ulcer disease

A

Celecoxib

61
Q

what is endometriosis

A

endometrial glands and stroma tissue outside of uterus

62
Q

symptoms of EM ( endometriosis)

A

dysmenorrhea, pelvic ain, dyspareunia, bowel upset, bowel pain
** INFERTILITY

63
Q

pain management for EM

A

1: NSAID ( inhibits prostagladins)
2: COC ( continuous use preferred)
3: progestin only

64
Q

goal standard of EM diagnosis

A

laparoscopu +/ biopsy
serum CA 125 levels include pelvic inflammatory disease, epithelial ovarian cancer and pregnancy ** not routine recommended**

65
Q

list the GnRH agonist

A

goserelin, leuprolide, triptorelin

66
Q

list GnRH Antagonist

A

elagolix

67
Q

which GnRH do not cause flare up

A

GnRH antagonists ( elagolix)

68
Q

what is “add back” HT

A

“Add-back” hormone therapy (HT) is used to mitigate the perimenopausal-type symptoms and bone density loss that occur with GnRH agonists
Ex: MPA and Norethindrone acetate 5mg

69
Q

ovulation induction therapy

A

letrozole 2.5mg day 3-7 of cycle

70
Q

what else is recommended for women taking GnRH agonist with HT

A

vitamin D ( 400-1000 units/ day) and clacium ( 1200 mg/day)

71
Q

CI of PD1-I

A

nitrates

72
Q

if nitrates was to be used, when to seperate it by

A

24 hrs after slidenafil & vardenafil

48 hrs after tadalafil

73
Q

food interaction with PD5-I

A

slidenafil and vardenafil avoid with fatty meals

tadalafil: no effect

74
Q

which PD5-I IS NOT RECOMMENDED in CrCl <30 ml/min

A

tadalafil

75
Q

protein limit for HE

A

1.2-1.5g/kg/day

76
Q

score use to assess prognosis of chronic liver diease

A

CHILD-PUGH

77
Q

MOA of lactulose

A

converts ammonia ( NH3) into ammonium ( NH4) which is ionized and not absorbed resulting in lowering blood ammonia [c]

78
Q

pathophysiology if hepatic encephalopathy

A

unknown, high levels of ammonia ma be the cause

79
Q

management of portal hypertesion

A

fluid restriction
Na+ restriction of <2g/day
reduce portal pressure <12mmhg ( use BB)

80
Q

drug approved for abortion

A

mifepristone/misoprostol in <63 days gestation

81
Q

MOA of mifepristone and misoprostool

A

Mifepristone is a potent progesterone receptor modulator with strong antiprogestogen and antiglucocorticoid activity

Misoprostol is a prostaglandin analogue, a potent synthetic form of prostaglandin E1 that causes the cervix to soften and the uterus to contract, causing expulsion of the pregnancy

82
Q

can methotrexate be used in abortion

A

yes, off label used

50 mg IM on day 1 followed by misoprostol

83
Q

menopause

A

no menses for 12 months making the end of reproductive life

84
Q

long term complication of menopause

A

osteoporosis, CVD, cancer

85
Q

hormone that is responsible for weight gain, breast tenderness and uterine bleeding

A

excess progestogen

86
Q

indication for combined estrogen and SERM modulator

A

-women with uterus wishing to avoid progesteogen

moderate-severe vasomotor symptoms in women <75years

87
Q

is estrogen cardioprotective

A

maybe if initiated at onset of menopause but harmful if started >10 years or >60 years of year

88
Q

hormonal decreases risk of what and increases risk of what

A

decrease:
endometriosis, endometrial cancer, ovarian cancer,

increases:
BREAST cancer, cervical cancer and gall bladder disease

89
Q

non pharm for vasomotor symptoms

A

cooling techniques (e.g., dressing in layers, using fans, lowering the ambient temperature) and avoidance of triggers (e.g., spicy foods, hot drinks, caffeine, alcohol).

90
Q

hormone therapy for patient with hysterctomy

A

ET alone

91
Q

what is the role of progestogen in combo with ET

A

reduce the risk of endometrial hyperplasia

92
Q

oral vs topical application of ET

A

less incidence of increase triglyceride, reduced risk of VTE in topical

93
Q

Endometrial hyperplasia

A

lining of uterus becomes thicken and can lead to endometrial cancer

94
Q

does progsterone cream as effective as oral

A

no, cream does not provide endometrial protection

95
Q

best way to take progestrogen

A

can be taken either continuously every day (continuous EPT) or cyclically for 12–14 consecutive days every calendar month (cyclic EPT).

96
Q

other options for vascomotor symptoms

A

citalopram, escitalopram, paroxetine, venlafaxine, desvenlafaxine

gabapentin

clonidine

vitaminE?

97
Q

is progestin indicated for vaginal estrogen

A

no

98
Q

neurotransmitter that is thought to be associated with motion sickness

A

acetylcholine and histamine thought to be most responsible neurotransmitters signaling the medulla oblongata

99
Q

chemo drugs that are high emetic risk

A

cisplatin
cyclophosphamide (> 1500mg/m2)
mechlorethamine

100
Q

chemo drugs that are high moderate risk

A

carboplatin
cyclophosphamide ( < 1500 mg/m2)
oxaliplatin

101
Q

acute CINV time and causes

A

1-2 hrs after chemmo - may last up to 24 hrs

cause: serotonin, type 2 dopamine and neurokinin 1

102
Q

delayed CINV timing and causes

A

> 24 hrs after chemo, may last up to one week

causes: sustance P plays a large part ( serotonin plays CINV)

103
Q

key patient factors for CINV

A

<50 years of age, female, hx of motion/pregnancy sickness

104
Q

key factors for PONV

A

female sex, non smoker, history of motion sickness, opioid use

105
Q

options for motion sickness

A

dimenhydrinate or diphenhydramine
promethazine ( longer duration than dimenhydrinate)

scopolamine: place behind ear atleast 4 hr prior to motion exposure

106
Q

most effective combo against acute and delayed emesis with moderte high emetic chemo

A

5-HT3RA
cortocosteriod
NK-1 RA

107
Q

treatment for NVP

A

mild: diclectin ( pyriodoxine/doxylamine)

moderate-severe: dimenhydrinate, promethazine, diphenhydramine

108
Q

AE of diclectin

A

sedation, diarrhea, disorientation,

109
Q

MOA of domperidone and metoclopramide

A

dopamine antagonist

110
Q

signs of dehydration

A

sunken eyes, decreased skin turgor, dry mouth and tongue, decreased urination

111
Q

infertility

A

inability to conceive after 12months of regular unprotected intercourse in women < 35 years of age

112
Q

when is teratogen highest in pregnancy

A

1st trimester

113
Q

what vitamins are recommended for PMS

A

Ca2+, vitamin B6, Mg2+

114
Q

what can calcium help with PMS

A

1200mg daily
improvement in mood, water retention, cravings and pain

** most evidence for use

115
Q

antidepressant for PMS

A

1st line treatment.
Citalopram, escitalopram, fluoxetine, paroxetine or sertraline: during luteal phase ( day 14 start of menses) or continuously

116
Q

COC for PMS

A

2nd line,

117
Q

smoking and IBD

A

smoking: bad for crohn

protective against UC

118
Q

difference between CD and UC

A

CD: inflammation can occur from mouth to anus. terminal iluem most affected
- transmural inflammation
UC: limited to colon, inflammation does not extend beyond mucosa

119
Q

Triad of UC

A

diarrhea, rectal bleeding and abdominal pain

inflammation

120
Q

triad symptoms of CD

A

abdominal pain, diarrhea, fatigue/weight loss

121
Q

pharmacological options of UC and CD

A

aminosalicylates ( PO and PR)
sterioids
immunomodulators
biologics

122
Q

efficacy of aminosalicylates

A

Sulfasalazine, mesalamine, olsalazine

1st line for UC ( induction and remission)
modest effect in CD ( not efffective in inducing remission in mild CD except sulfasalize

123
Q

which aminosalicylates is released in SB and which in colon

A

Salofalk and Pentasa release 5-ASA in the small bowel, allowing it to be available in the small bowel and colon

Sulfasalazine, olsalazine, Asacol and Mezavant release 5-ASA primarily in the colon.

124
Q

which mesalamine is available as once daily

A

mezavant

125
Q

efficacy of cortiosteroid in UC and CD

A

1st line induction of remission in moderate-severe UC ( more effective than 5-ASA in both UC and CD) * not used for maintenance

126
Q

AE of steriods

A

GI upset, dyspepsia, edema, hyperglycemias, hyperlipidemia, HPA suppression, impaired wound healing,

127
Q

monitoring for sterioids

A

annual eye exam, bone mineral density, blood sugars, and monitor for infections

128
Q

efficacy of azathioprine

A

azathioprine, 6- mercaptopurine

MD of remission for moderate-severe UC/CD ** not for induction as monotherapy**

129
Q

interaction with azathioprine

A

allopurinol and febuxostat

130
Q

role of methotrexate

A

maintenance of remission for moderate-severe UC/CD

131
Q

anti-TNF-alpha role

A

adalimumab, certolizumab pegol, golimumab and infliximab.

for induction and maintenance of remission

(2/3 of patient show response, with 1/3 showing remission for both UC and CD)

132
Q

know treatment algorithm for CD

A

see pic

133
Q

know treatment algorithm with UC

A

see pic

Pharmacy CPS Flashcards (27 decks)

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