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Pharmacology II - EXAM 1 > Indications / First-Line / Contraindications > Flashcards

Indications / First-Line / Contraindications Flashcards

1
Q

What are indications for estrogen use?

A

Contraception
Menopausal HRT
Endometriosis treatment

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2
Q

Estrogen can be used to treat what bone deficiency?

A

Osteoporosis

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3
Q

What are contraindications to estrogen use?

A 
History of Breast CA
DVT/PE 
MI
CVA
Anaphylatic Reaction
Liver Disease
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4
Q

Should estrogen be used in pregnancy?

A

No

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5
Q

What are indications for progesterone use?

A

Secondary amenorrhea
HRT
Cervical Ripening
Endometrial Hyperplasia

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6
Q

What are indications for progestin use?

A

Contraception
Post-Menopausal HRT
Dysfunctional Uterine Bleeding

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7
Q

Can progestins be used to maintain pregnancy?

A

Yes

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8
Q

Should progestins be used in patients with a history of severe migraines?

A

No

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9
Q

Other than severe migraines, what are contraindications to progestin use?

A

DVT / PE
Unexplained bleeding
Breast CA
Liver Disease

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10
Q

Should OCPs be used in patients with uncontrolled HTN (> 160/110)

A

No, it should be avoided

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11
Q

A 36 y.o. female with a pack per day smoking history presents to dicuss use of OCPs….

is this a good idea?

A

No

OCPs should be avoided in patients >35 y.o with a half pack per day smoking history

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12
Q

A 4 week post-partum patient who is still breast feeding wants to start back on OCPs.

Is this a good idea?

A

No, OCPs are contraindicated in women <6 weeks postpartum who are still breastfeeding

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13
Q

T/F: Progestin only pills are commonly used post partum and are OK with breastfeeding

A

True

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14
Q

Should Levonorgestrel (Plan B) be given to women already pregnant?

Why?

A

No

higher incidence of ectopic pregnancy

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15
Q

Which emergency contraception is commonly used with missoprostol in abortions?

A

Mifepristone

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16
Q

Estrogen is used in post-menopausal HRT to relieve what?

A

Vasomotor symptoms

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17
Q

Which form of estrogen HRT has no-first pass effect?

A

Gels
Sprays
Emulsions

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18
Q

Should you give unopposed estrogen to a woman who still has their uterus?

A

NOOOOOOOOO

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19
Q

T/F: It is okay for women with a history or family history of breast cancer to use phytoestrogens?

A

False

They should be AVOIDED

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20
Q

Why should Dong Quai be avoided?

A

Carcinogenic effects

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21
Q

What recently approved HRT medication is indicated for pre-menopausal women with acquired generalized hypoactive sexual desire disorder (HSDD)?

A

Flibanserin (Addyi)

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22
Q

An alcoholic women with a history of liver failure is diagnosed with HSDD. You think about prescribing Flibanserin, but remember this is a bad idea.

Why?

A

It is contraindicated in patients with a history of EtOH abuse and hepatic impairment

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23
Q

Should you start with the lowest dose of estrogen?

A

Yes

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24
Q

T/F: The risks of estrogen replacement outweigh the benefits in women under 60

A

False

The benefits outweigh the risks

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25
Q

Which form of estrogen replacement best avoids first pass?

A

Transdermal

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26
Q

Which form of estrogen replacement avoids the most systemic effects?

A

Intravaginal

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27
Q

Is tamoxifen used as monotherapy for metastatic breast CA or as adjuvant?

A

Adjuvant Therapy

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28
Q

Which SERM is used best for breast CA prevention in high risk post-menopausal women?

A

Raloxifene

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29
Q

Which SERM is best used to treat dysparenuria due to vulvovaginal atrophy following menopause?

A

Ospemifene

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30
Q

Which SERM is indicated for treatment of metastatic breast cancer in postmenopausal women with estrogen-receptor positive or unknown tumors?

A

Toremifene

31
Q

When estrogen receptors in breast CA become resistant to hormone therapies, what medication class is recommended?

A

Aromatase inhibitors

32
Q

Do aromatase inhibitors work best in pre or post-menopausal women?

A

Post-menopausal

33
Q

Should aromatase inhibitors be used as adjuvant or monotherapy

A

Adjuvant

34
Q

T/F: Switching to an aromatase inhibitor after 2-3 years of Tamoxifen does NOT have adding benefit when compared to just FIVE years of Tamoxifen

A

False

It does have added benefits

35
Q

Which medication is indicated for hormone receptor positive metastatic breast CA that has failed Tamoxifen?

A

Fulvestrant

36
Q

Which medications are first-line for ED treatment?

A

PDE5 Inhibitors

Sildenafil
Vardenafil
Tadalafil

37
Q

What medication is second line for ED treatment?

A

Synthetic PGE-1

Alprostadil

38
Q

What percentage of ED patients will fail PDE5 inhibitors

A

30-40%

39
Q

What levels should you check when treating ED with PDE5 inhibitors?

A

Testosterone

40
Q

What medications are indicated to treat moderate to severe BPH with an AUA score > 8?

A

Alpha-1 Antagonists

41
Q

Should non-selective or selective alpha-1 antagonist be AVOIDED in BPH and HTN?

A

Non-selective

Terazosin (Hytrin)
Doxazosin (Cardura)
Prazosin (Minipres)

42
Q

What anti-hypertensive medication class should be used in HTN while treating ED?

A

ARBs

43
Q

Is tamsulosin a good medication to treat BPH in the setting of HTN?

A

Yes

Selective alpha-1 antagonists are good in combination with anti-hypertensives

44
Q

Which class of BPH medications is shown to reduce the prostate size up to 25% and lower PSA levels up to 50%?

A

5-alpha reductase inhibitors

Finasteride
Dutasteride

45
Q

T/F: Combination therapy of alpha-1 antagonists and a 5-alpha reductase inhibitor is recommended to treat BPH

A

True

46
Q

Which PDE5 inhibitor is also indicated for BPH treatment?

A

Tadalafil

47
Q

Name one ‘natural product’ used to treat BPH?

A

Saw Palmetto

African Tree Bark

48
Q

What are contraindications to testosterone replacement therapy?

A

Breast/Prostate CA
Porstate Nodule
PSA >3-4 in high risk individuals
Uncontrolled HF

49
Q

A patient with a history of untreated sleep apnea is interested in testosterone replacement?

Are they a good candidate?

A

No, testosterone replacement is contraindicated in patients with a history of uncontrolled sleep apnea

50
Q

A patient presents to discuss possibly starting testosterone replacement therapy. Wisely you draw a CBC because you no a hematocrit above __ would contraindicate starting testosterone replacement therapy

A

Above 50%

51
Q

T/F: You should check a baseline PSA before starting testosterone replacement therapy

A

True

52
Q

At what testosterone levels should you consider treatment?

A

<300 ng/dL

53
Q

After starting testosterone therapy….

you should check testosterone levels, a H&H, and PSA levels are what intervals?

A

3 - 6 Months

54
Q

What medications are indicated for treatment of urge incontinence, urinary frequency, urinary urgency?

A

Anti-cholinergics

Oxybutynin
Tolterodine
Solifenacin
Darifenacin 
Trospium (incontinence)

Mirabegron

55
Q

What is first-line for OAB treatment?

Second line?

Third Line?

A

FIrst: Behavioral Therapy

Second: Antimuscarinics, Beta-3 Agonist

Third: Botox

56
Q

What is the most common reason Epilepsy/Seizure treatment fails?

A

Non-compliance

57
Q

What are indications to STOP AEDs?

How long should the taper be?

A

2-4 years without a seizure
Complete control within one year of onset
Normal Neurological Examination
Normal EEG

Taper: Slowly for 6 months

58
Q

What AEDs are first line for focal seizures?

A
  1. Carbamazepine
  2. Lamotrigine (Adjunct in >2y.o, monotherapy in > 16)
  3. Valproic Acid (Depakote)
  4. Levetiracetam (Adjunct >4y.o.)
  5. Topiramate (> 2y.o.)
  6. Phenytoin
59
Q

Should Carbamazepine be used in patients with a history of bone marrow depression?

A

No

60
Q

Carbamazepine should be avoided in patients with HLA-B 1502, why?

A

Increased risk of SJS

61
Q

What AEDs are used for partial seziures?

A
  1. Oxcarbazepine
62
Q

Which AEDs are used to treat Tonic-Clonic Seizures?

A
  1. Lamotrigine (Lamictal)
  2. Valproic Acid (Depakote)
  3. Levetiracetam (Adjunct >6y.o.)
  4. Topiramate ( >2 y.o.)
  5. Phenytoin
63
Q

Which AEDs are used to treat Mixed Seizures?

A
  1. Valproic Acid
64
Q

Which AEDs are used to treat Lennox-Gastaut Syndrome?

A
  1. Valproic Acid

2. Topiramate (>2 y.o.)

65
Q

Which AEDs are used to treat absence seizures?

A
  1. Valproic Acid

2. Ethosuximide

66
Q

Should valproic acid be used in pregnancy?

A

No

It has associated neural tube defects

67
Q

What AEDs are used to treat status epilepticus?

A
  1. Fosphenytoin
  2. Diazepam (Valium)
  3. Lorazepam (Ativan)
  4. Midazolam (Versed)
68
Q

Which second-line AEDs are used to treat focal seizures?

A
  1. Zonisamide
  2. Lacosamide
  3. Perampanel (> 12 y.o.)
  4. Phenobarbital
  5. Primidone
  6. Gabapentin
  7. Pregabalin (Adjunct)
  8. Ezogabine (Adjunct)
69
Q

Which second-line AEDs are used to treat tonic-clonic seizures?

A
  1. Perampanel

2. Primidone

70
Q

Which second-line AEDs are used to treat Lennox-Gastaut Syndrome?

A
  1. Phenobarbital
71
Q

When would phenobarbital be indicated to treat status epilepticus?

A

If benzodiazepines and phenytoin fail

72
Q

Which benzodiazepines are used to treat Lennox-Gastuat Syndrome?

A

Clonazepam (Klonopin)

Clobazam

73
Q

Which benzodiazepines are first line for status epilepticus?

A

Diazepam (Valium)
Lorazepam (Ativan)
Midazolam (Versed)

74
Q

Which AEDs are used to treat refractory focal seizures in adults?

A

Vigabatrin

Felbamate (Last-line due to ADRs)

Pharmacology II - EXAM 1 (5 decks)

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