GU pharm lectures Flashcards
(163 cards)
1
Q
what are the two supplements used during pregnancy?
A
- folic acid
2. B6 pyridoxine
2
Q
what is the anti nausea drug used in pregnancy?
A
pyridoxine plus doxylamine
3
Q
what are the two anti hypertensive drugs that are used in pregnancy?
A
methyldopa
labetalol
4
Q
what are the three tocolytics used in pregnancy?
A
- magnesium sulfate
- nifedipine
- terbutaline
5
Q
what is considered normal BP in pregnancy?
A
SBP: less than 140
DBP: less than 90
6
Q
what is considered mild HTN in pregnancy?
A
SBP: 140-160
DBP: 90-100
7
Q
what is considered moderate HTN in pregnancy?
A
SBP: 160-180
DBP: 100-110
8
Q
what is considered severe HTN in pregnancy?
A
SBP: greater than 180
DBP: greater than 110
9
Q
what are the qualifications for chronic/preexisting HTN?
A
before 20 weeks or pre PG
greater than 140/90
10
Q
what is the goal BP in chronic/preexisting HTN?
A
SBP: less than 140-160
DBP: 90-100
11
Q
what 4 antihypertensive drugs should you not use in pregnancy? why?
A
- ACE
- ARB
- direct renin inhibitor
- atenolol
Don’t use these because fetal tissue has angiotensive II receptors
12
Q
what are the HTN classifications for preclampsia?
A
SBP: greater than 140
DBP: greater than 90
AND
proteinuria greater than 0.3 in 24 hour urine
13
Q
what are the HTN classifications for gestational HTN?
A
SBP: greater 140
DBP: greater than 90
and
NO Proteinuria
AFTER 20th week gestation
14
Q
what are the HTN classifications for postartum HTN? for how long?
A
SBP: greater than 140
DBP: greater than 90
exists beyond 12 weeks
AND
PROTEINURIA greater than 0.3 gm
can persist up to 6 months post partum and reverts
15
Q
how much folic acid does a woman need? and how much do they typically get from baked goods?
A
a woman needs: 400 mcg/day
a woman gets: 200 mcg day from baked goods.
16
Q
what is the purpose of supplementing folic acid to a pregnant woman?
A
prevents neural tube defects
17
Q
what can folic acid obscure?
A
vitamin B12 deficiency
18
Q
what can folic acid interfere with? what are these used for? 2
A
decrease the effects of pheytoin and phenobarbitol that are used for seizure control
19
Q
what must you rule out before giving folate supplement to pregnant lady?
A
B12 deficiency
20
Q
topical azoles do what?
A
weaken latex condoms/diaphrams so keep this in mind!!!
21
Q
what are the four classifications for HTN in pregant woman?
A
chronic/preexcisting HTN
preeclamptic
gestational
postpartum HTN (preeclamtic HTN that exists 12 weeks post partum)
22
Q
what is the organ BP for pregant woman?
A
SBP: less 140-160
DBP: 90-100
23
Q
how do you tx postpartum HTN?
A
the same as you would in a non-pregnant woman!
24
Q
what antihypertensive med do you use to treat preeclampsia and gestational HTN?
A
labetalol
25
what antihypertensive meds do you use in postpartum HTN?
labetalol
26
what antihypertensive do you use in chronic or preexisting HTN?
labetalol
| methyldopa
27
what is the drug class of methyldopa?
cental alpha-adrenergic inhibitor
28
what is the drug class for labetalol?
b1, b2 and alpha 1 blocker
29
what is a contraindiction for labetalol?
bronchial asthma
30
what is the ration of alpha to beta receptor blockade when given orally or IV for labetalol?
1: 3 orally
1: 7 IV
this means stronger when given IV
31
what does the drug class tocolytics mean?
mean they slow down labor
32
what are the new reccomendations for medication saftey rating for pregnancy?
1. fetal risk summary
2. clinical considerations
3. data
33
what are 4 other medications you need to avoid in pregnancy because they can cause harm to the fetus?
1. opoids-codeine, hydrocodone, oxycodone
2. antipsychotics-can cause withdrawals in neonate
3. antidepressants-paxil D, other SSRIs C
4. antiseizure medications- C
34
what are the two hormones that are considered for contraceptive methods?
estrogen and progestin
35
what are the two estrogen options used for contraception use? why might his only really be considered one?
1. ethinyl estradiol
2. metstranol (prodrug that is converted to ethinyl estradiol so really, it appears like there is only 1 estrogen option which is ethinyl estradiol)
36
how many generations of estrogen based contraceptives are there? what is considered low dose estrogen?
there are 3 generations
low dose is considered an estrogen content less than 30 mcg
37
what is the risk you run when using a low dose estrogen?
increased risk of failure and obesity
| higher efficacy results outside of US
38
how many generations of progestins are there? what happens to their affinity for progesterone receptors and androgenic effect as the generations increase?
4 generations of progestins
as you go through the generations the affinity for progesterone receptors increase and androgenic activity decreases
39
what are 6 additional benefits of combined oral contraception (COC) in addition to contraception?
1. reduced risk of endometrial cancer
2. reduced risk of ovarian cancer
3. regulation of menstration, reduced dysmenorrhea
4. fewer breast fibroadenomas, cysts
5. reduced risk of PID
6. improved acne control
40
who are progestin only OC useful in? who would you consider using these in? (8)
use when they can't take COC
1. tobacco
2. obesity
3. age >35
4. HTN with vascular disease
5. lupus
6. migraine with focal aura
7. VTE
8. coronary or cerebral vascular disease (stroke)
41
what are 7 ABSOLUTE contraindications for COC?
1. DVT/PE
2. CVS/CAD
3. breast cancer
4. more than 15 cigs a day and older than 35
5. hepatic tumor
6. active liver disease
7. migraine with aura
42
what are 6 RELATIVE contraindications for COC?
1. any smoking
2. migraine disorder
3. HTN
4. fibroid tumors of uterus
5. breast feeding
6. diabetes
43
what are 4 common SE of COC?
1. N/V
2. headaches
3. weight gain
4. breakthrough bleeding 30-50% women
44
when does breakthrough bleeding when using a COC usually resolve?
3-4th menstrual cycle
45
depending on when breakthrough bleeding occurs during menses when using a COC can tell you wnat you need to do to fix it...what do you do in these situations:
1. bleeding late in active pills?
2. prolonged menses?
3. midcycle bleeding?
1. bleeding late in cycle: increase progestin
2. prolonged menses: increase estrogen dose
3. midcycle bleeding: increase estrogen AND progestin dosing
46
if a COC caused a headache...what should you do? when?
if they get blurred viision or neuro deficit or increased frequency of migraine, STOP COC and workup!!!
47
what can progestin in COC cause?
decreased libido, depression, dyslipidemia, bloating, constipation
48
what can estrogen in COC cause? (2)
mastalgia
| weight gain
49
when do GI SE of COC resolve?
bloating, constipation, and N/V usually resolve within 1-3 months of use
50
what are four side effects of estrogen excess?
1. bloading
2. migraine headache
3. decrease libido
4. weight gain
51
what are the 3 SE of estrogen deficiency?
spotting
amennorhea
vaginal dryness
52
what are the 4 SE of progestin excess?
1. acne
2. increased appetitie
3. fatigue
4. dperession
53
what is the SE of progestin deficiency?
amenorrhea
54
is estrogen a CYP34A substrate? what are five things can make this less effective?
YES!!!
1. anticonvulsants
2. corticosteroids
3. penicillins
4. st. johns wart
5. rifampin
55
what is one really important benefit of progestin only OC?
less risk of thromboembolytic event
56
what are the two options for progesterone?
1. norethindrone
| 2. norgestrel
57
what is one down side of progestin OC?
it must be taken at the same time each day to maintain adequate levels of the drug in patient system
58
what are the prototype drugs for each of the COC drugs?
monophasic: loestrin FE 1/20
norethiadone acetate, ethinyl estradiol
biphasic: lo lostrin FE 1/10
norethiadone acetate, ethinyl estradiol
triphasic: triphasil
levonorgestrel/ethinyl estradiol
quadraphasic: natazia
dionogest/estradiol valerate
59
what is important to do with both the triphasic and quadriphasic COC?
make sure you take it at the same time each day to avoid breakthrough bleeding
60
what is the progestin only called? what does it do less of when compared with OCP?
ovrette
containing norgestrel
inhibits ovulations less than COC
61
are progestin only BC and COC the same efficacy?
progestin only OCP has about the same effiiacy as COC with 20 to 30 mcg of EE
62
what can progestin only BC cause in a woman who has been taking it long term?
can cause breakthrough bleeding and amenorrhea
63
who are extended cycle OC helpful for?
women who have menstrual related sxs like HA, menorrhagia, anemia, endometriosis related pain
64
what is the name of the extended cycle OC that has a constant amount of leveonorgestrel/EE?
Lybrel
65
what is normal during the first few months of taking an extended cycle OC?
breakthrough bleeding in the first few months since the EE content is low
66
what is the name of the ascending dose levonorgestrel/EE extended cycle OC?
Quartette
67
what is the cycel length for Quartette which is the ascending dose extended cycle OC?
91 day cycle
68
how long have recent studies shown continuous use of extended cycle OC?
up to four years of continuous COC use
69
how long can the levonorgestrel (progestin) only IUD mirena be used for?
5 years
70
how long can the copper IUD paraguard be used for?
10 years
71
what are the two options for emergency contraception? what time frame must you take them in? are they RX? what are they made of?
1. plan B one step-levonorgestrel
- progestin only
- OTC in most states
2. Ella: progesterone agonist/anatgonist
- RX only
MUST TAKE BOTH OF THESE WITHIN 120 hours!!!
72
Ammenorhea: 3 goals of tx?
1. preserve bone density
2. prevent bone loss
3. restore ovulation and fertility
73
what is the tx for amennohrea in these situations:
1. CEE
2. hyperprolactinemia
3. PCOS
1. CEE: EE, COC
2. hyperprolactinemia: bromocriptine
3. PCOS: metformin
74
what do you use to tx secondary ammenorhea?
provera
75
what are the three options used to tx menorrhagia? what percents do they decrease bleeding?
1. NSAIDS 20-50% reduction
2. COC 43-53% reduction
3. IUD with levonorgestrel 90% reduction
76
what is dysmennohea?
crampy pelvic pain with or just prior ot menses
77
what is thought to be the cause of dysmennorhea?
prostenoids that induce uterine contrations
78
what are the 4 tx options for dysmennorhea?
1. NSAIDS
2. OCP
3. Depro-vera
4. levonorgestrel-releasing IUD
**3 later ones regulate the hormones**
79
anovulatory bleeding results from_____ and you should always do ______
anovulatory bleeding results from UNOPPOSED ESTROGEN and you should always do PREGNANCY TEST
80
what are the four main causes of anovulatory bleeding?
1. hyperandrogenic anvoluation (70%)
- PCOS, androgen-producing tumors
2. hyperprolactinemia 10%
3. primary pituiatry disease 10%
4. premature ovarian failure 10%
81
what is the most frequent etiology of anovulatory bleeding?
PCOS
82
what are the 3 tx options of anovulatory bleeding in PCOS?
1. COC tx (increases SHBG causing increased androgen binding)
2. MPA (oral or depot) progestin that supresses pituitary gonadotropins and circulating andrgens
3. metformine (increases insulin sensitivitiy with increase in SHBG, increases ovulation and glucose intolerance)
83
what is the preferred method of tx for anovulatory adolescent?
low dose COC with less thatn 35 mcg of ethinyl estradiol
84
what is the definition of menopause and what is it caused by?
amennorhea for 12 months
cause: loss of ovarian follicular development
85
what are two labs you will see elevated in menopause?
FSH, LH
86
what are 4 sxs you will see with menopause?
1. hot flashes
2. vulvovaginal atrophy
3. mood swings
4. insomnia
87
WHAT MUST BE TAKEN INTO CONSIDERATION IF YOU ARE TXING SOMEONE WITH HORMONAL THERAPY FOR MENOPAUSE
MUST TAKE INTO CONSIDERATION IF THE WOMAN HAS A UTERUS OR NOT
88
IF A WOMAN HAS A UTERUS AND MENOPAUSE....TX WITH...
ESTROGEN AND PROGESTERONE! DECREASES RISK OF ENDOMETRIAL CANCER
89
IF A WON'T DOESN'T HAVE A UTERUS AND MENOPAOUSE.....TX WITH....
ESTROGEN REPLACEMENT ONLY!!!
90
what are the contraindications for hormonal tx of menopause?
```
DVT
CAD
Beast cancer
undiagnosed vaginal bleeding
liver disease
```
91
what are the options estrogen for tx of menopause? 3 options
1. conjugated equine estrogen CEE "premarin" estrogen supplement
2. transdermal estrogen
3. topical estrogen for intravaginally
92
what are the progesterone oprions for tx of menopause?
1. MPA (oral)
| 2. transdermal levonorgestrel
93
what are the combination tx options for menopause?
1. oral conjugate equine estrogen (premarin) + MPA (prempro)
2. transdermal: estradiol + norethiadrone
94
what are the risks of using hormone therapy to tx menopausal sxs are?
1. CHD
2. CVA
3. breast cancer
4. VTE
95
what are alternatives for the tx of menopause other than hormonal interverntion? 2 options
SSRIs (low dose)
| clonidine
96
what is the name of the estrogen used to tx menopause?
combined equine estrogen
97
what does a person who is taking combined estrogen hormones need to monitor?
breast exams for estrogen induced breast masses
98
what is the black box warning for conjugated equine estrogen
in CVD, dementia, malignancy
99
what is tenofovir/emtricitabine used for?
the prevention of the transmission of HIV-1
100
who should you use tenofovir/emtricitabine in? (only people you use it in)?
only use in HIV negative people!!
101
what must be done if takining tenofovir/emtricitabine?
q3 months serial HIV testing
102
what are the two black box warnings for tenofovir/emtricitabine?
1. lactic acidosis
| 2. hepatomegally
103
what might giving someone tenofovir/emtricitabine with a underdetermined HIV status do?
increase resistances
104
what is the target receptor for erectile dysfunction?
PDE5 enzyme inhibitors
105
what is the target receptor for hypogonadism?
testosterone receptor stimulation
106
what is the target receptors for benign prostatic hypertrophy? 2
alpha 1 inhibtors
| 5 alpha reductase inhibitors
107
what receptor is the target for malignant prostate dxs?
androgen receptors (anti-androgens)
108
what are the three targeted receptors for urinary incontinence?
1. M3 muscarinic receptor inhibitors
2. tricyclic antidepressants inhibitors
3. estrogen receptor (topical stimulation)
109
what are the causes of erectile dysfunction?
1. organic 80%
- vascular, neurogenic, hormones
2. psychogenic 30%
110
how is an erection formed?
1. increased testosterone
2. increased sexual arousal
3. INCREASED PARASYM, DECREASE SYMPATHETIC ACTIVITY
4. increase in NO
5. aterial SM relaxation and trebecular sm relaxation
6. arterial dilation and expansion of sinussoidal spaces (causing venous occlusion and decreased venous outflow)
7. increased intracavernous pressure
8. erection!
111
how is an erection lost?
INCREASE SYMPATHETIC ACTIVITY
constricts corproal ateriole smooth muscle and leads to flaccidity
112
what are the three causes of erectile dysfunction?q
1. vascular
2. neurogenic
3. hormonal
113
what are 6 potential drugs that can cause erectile dysfunction?
1. antihypertensives
2. antidepressants
3. antipsychotiics
4. anticonvulsants
5. antiandrogens (5 alpha reductase inhibitors, progesterone and estrogen)
6. recreational drugs: alcohol, cocaine, MJ, opiates
114
what can Erectile dysfunction sometimes be the presenting feature of sometimes?
cardiovascular disease!!! so suspect this if someone presents with ED!!!
115
what are 2 tx options for ED?
1. testosterone ONLY IF DEFICIENT
| 2. PDE5 inhibitors
116
how do PDE5 inhibitors for ED work?
prevent degredation of NO/cGMP (creates dilation in penis) maintaining arteriolar SM relaxation and corporal blood inflow greater than outflow
117
what is the most common tx of ED? two drugs?
PDE5 inhibitors
sildenafil
tadalafil
118
what are the SE seen with PDE5 inhibitors? 3
1. headache
2. hypotension
3. nasal congestion
119
what are two ABSOLUTE contraindications for the use of PDE5 inhibtors? (sildenafil and tadalafil)
hx of CV disease
| nitrates ABSOLUTE!
120
what are the contraindications for PDE5 inhibitors? 4
1. CVD
2. nitrates
3. hyptertension over 170/110
4. hypotension less than 90/50
121
what drug class and two drugs is a CYP34A substrate so you should avoid what?
PDE5 inhibitors sildenafil and tadalafil for ED
122
when giving a patient either sildenafil or tadalafil what do you need to instruct them to do if this SE occurs?
an erection last longer that 4 hours....tell healthcare provider
need to inject epi into the penis to decrease parasynpathetic stimulation and get rid of the erection
123
what is the difference between the half life of sildenafil and tadalafil? what does this influence?
sildenafil: 4 hours (short term)
tadalafil: 15-17.5 hours
this explains why tadalafil can be taking low dose on a daily basis
124
what is the differences between the PRN dosing and daily dosing for tadalafil?
prn: 10 mg up to once daily
daily: 2.5 mg dose
**can do this since the halfilfe is 15-17.5 hours!**
125
who should testosterone be used in?
only those who are testosterone deficient
126
what forms does testosterone come in? what do you need to be careful and warn partners about?
injection, patch, gel, pellet
causes virilization in female sex partners!!! need to warn them not to touch places where the gel or patch is because they can absorb it and get the same effects
127
what is prostate disease? what causes it?
starts over age 40 from
coversion of testosterone to dihydrotestosterone from type II 5alpha reductase activates
128
what are the two tissue types that are effected in prostatic hypertrophy?
1. glandular/epithelia=androgens
| 2. muscle or stroma=contractile via alpha2A receptors
129
explain the static factors contributing to prostate hypertrophy and their sxs?
urethral compression secondary to glandular enlargement
OBSTRUCTIVE SIGNS: hesitation dribbling straining
130
explain the dynamic factors contributing to prostate hypertrophy and their sxs?
excessive stimulation of a1A adrenergic receptors of the prostate and urethal SM
OBSTRUCTIVE SIGNS: hestiation, driblling, straining
131
explain the detrussor factors contributing to prostate hypertrophy and their sxs?
bladder detrussor muscle instability secondary to chronic distention secondary to outlet obstruction (stretches so much that it doesn't work)
IRRITATIVE SIGNS: urgency and frequency
132
what are the three contributing factors to prostatic hypertrophy?
1. static
2. dynamic
3. detrussor
133
what is the breakdown in outcomes for prostatic hypertrophy?
1/3 watchfun waiting
1/3 require tx
1/3 require surgery
134
what does a serum PSA over 1.5 mean?
implies the gland weighs more than 30 gm
135
how much of a percent reduction in AUA score for prostatic hypertrophy can you expect when using either a alpha-adenrenergic antagonist or 5alpha-reductase inhibitor?
30-50% reduction
136
what is the name of the two drugs used to tx BPH and their drug class?
5alpha-reductase inhibitor: finasteride
alpha1 adrenergic antagonist: tamullosin
137
what is first line tx for sildenafil?
tamulosin
138
what do you need to caution opthalmolagists when taking tamulosin for BPH?
that they are on the medication because it can cause floppy iris syndrome so they need to know this BEFORE cataract surgery
139
how long does it take tamulosin to work?
1-2 weeks, so works quickly hence why this is first line
140
if a patient is on tamulosin and also takes sildenafil what do you need to instruct them to do? why?
make sure they take it at least 4 hours apart
take tamulosin at least four hours after because they are both CYP34A drugs and if taken close together will inhibit each other
141
what is second line tx for BPH?
finasteride
142
why does finasteride decrease the size of the prostate?
because it induces apoptosis of glandular cells and thus decreasing static factor
143
how long does it take finasteride to work?
up to 6 months
144
why should people taking finasteride avoid contact with pregnant females?
can cause feminitization of the male fetus
145
how much can finasteride decrease PSA levels?
up to 50%
146
can you use both finasteride and tamulosin together?
YES
147
what are the 3 tx options for prostate malignancy?
1. leuprolide
2. flutamide
3. estrogen
148
what might leuprolide cause when used to treat progstate malignanct?
1-2 week flare of tumor causing BONE PAINE, NEUROPATHY) sxs at the initiation of tx secondary to increase in testosterone levels
149
how my does flutamide increase survival in prostatic malignancy when used in conjunction with leuprolide (the other anti-neoplastic agent)?
7 month increased survival
150
STRESS INCONTINENCE:
involved anatomy?
sxs? 2
urethra spinchter failure
sxs:
1. leakage with increased abdominal stress
2. no nocturia
151
URGE INCONTINENCE:
involved anatomy?
sxs?2
bladder detrussor overactivitiy
sxs:
1. nocturia
2. enuresis
152
OVERFLOW INCONTINENCE:
involved anatomy?
sxs? 3
chronic bladder outlet obstruction or overactivity
sxs
1. episodic leakage
2. nocturia
3. large residual urine volume
153
what are 4 lifestyle modifications that can help tx urinary incontinence?
1. medication management
2. scheduled voiding
3. keagles
4. anti-incontinence devices
154
what is first line tx for urge urinary incontinence (UUI)? class and 3 options. GOAL?
goal: control detressor MUSCLE activitiy
M3 antimuscarininc drugs:
1. tolterodine
2. oxybutinin
3. ditropan
155
what are the 2 M3 muscarinic drugs used to control Urge urinary intcontinence?
1. tolterodine
2. oxybutinin
3. ditropan
156
what do you use to tx stress urinary incontinence? goal?
CONTROL SPHINCTER CONTROL
1. keagles
2. vaginal estrogen cream
157
what can you use to tx outflow urinary incontinece WITHOUT BLADDER OUTFLO OBSTRUCTION?
alpha-adrenergic antagonis Tamulosin
158
what can you use to relieve ouflow urinary incontinence (OUI) with bladder outflow obstruction
remove the obstruction duh
159
what is the name of the tricyclic antidepressant that cab be used to tx urinary incontinence but is NOT a first line drug? why?
imipramine
don't use as much because of dx-dx interaction and Se
160
if a person has heart disease and urge urinary incontinence, which drug would you be more apt to use?
use oxybutinin instead of tolterodine because it is LESS LIKELY TO PRODUCE QT prolongation
161
what do you need to be cautious of when txing urge incontience in the eldery?
both oxybutinin and tolterodine have increased SE in he eldery
162
what are some of the SE seen with the M3 antimuscarinic drugs used to tx urge urinary incontinence? 4
1. dry mouth
2. headache
3. diarreah
4. confusion
163
of the M3 antimuscarinic drugs, which one is more likely to cause QT prolongation?
tolteroine!
