Indications / First-Line / Contraindications Flashcards
What are indications for estrogen use?
Contraception
Menopausal HRT
Endometriosis treatment
Estrogen can be used to treat what bone deficiency?
Osteoporosis
What are contraindications to estrogen use?
History of Breast CA DVT/PE MI CVA Anaphylatic Reaction Liver Disease
Should estrogen be used in pregnancy?
No
What are indications for progesterone use?
Secondary amenorrhea
HRT
Cervical Ripening
Endometrial Hyperplasia
What are indications for progestin use?
Contraception
Post-Menopausal HRT
Dysfunctional Uterine Bleeding
Can progestins be used to maintain pregnancy?
Yes
Should progestins be used in patients with a history of severe migraines?
No
Other than severe migraines, what are contraindications to progestin use?
DVT / PE
Unexplained bleeding
Breast CA
Liver Disease
Should OCPs be used in patients with uncontrolled HTN (> 160/110)
No, it should be avoided
A 36 y.o. female with a pack per day smoking history presents to dicuss use of OCPs….
is this a good idea?
No
OCPs should be avoided in patients >35 y.o with a half pack per day smoking history
A 4 week post-partum patient who is still breast feeding wants to start back on OCPs.
Is this a good idea?
No, OCPs are contraindicated in women <6 weeks postpartum who are still breastfeeding
T/F: Progestin only pills are commonly used post partum and are OK with breastfeeding
True
Should Levonorgestrel (Plan B) be given to women already pregnant?
Why?
No
higher incidence of ectopic pregnancy
Which emergency contraception is commonly used with missoprostol in abortions?
Mifepristone
Estrogen is used in post-menopausal HRT to relieve what?
Vasomotor symptoms
Which form of estrogen HRT has no-first pass effect?
Gels
Sprays
Emulsions
Should you give unopposed estrogen to a woman who still has their uterus?
NOOOOOOOOO
T/F: It is okay for women with a history or family history of breast cancer to use phytoestrogens?
False
They should be AVOIDED
Why should Dong Quai be avoided?
Carcinogenic effects
What recently approved HRT medication is indicated for pre-menopausal women with acquired generalized hypoactive sexual desire disorder (HSDD)?
Flibanserin (Addyi)
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?
It is contraindicated in patients with a history of EtOH abuse and hepatic impairment
Should you start with the lowest dose of estrogen?
Yes
T/F: The risks of estrogen replacement outweigh the benefits in women under 60
False
The benefits outweigh the risks
Which form of estrogen replacement best avoids first pass?
Transdermal
Which form of estrogen replacement avoids the most systemic effects?
Intravaginal
Is tamoxifen used as monotherapy for metastatic breast CA or as adjuvant?
Adjuvant Therapy
Which SERM is used best for breast CA prevention in high risk post-menopausal women?
Raloxifene
Which SERM is best used to treat dysparenuria due to vulvovaginal atrophy following menopause?
Ospemifene
Which SERM is indicated for treatment of metastatic breast cancer in postmenopausal women with estrogen-receptor positive or unknown tumors?
Toremifene
When estrogen receptors in breast CA become resistant to hormone therapies, what medication class is recommended?
Aromatase inhibitors
Do aromatase inhibitors work best in pre or post-menopausal women?
Post-menopausal
Should aromatase inhibitors be used as adjuvant or monotherapy
Adjuvant
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
False
It does have added benefits
Which medication is indicated for hormone receptor positive metastatic breast CA that has failed Tamoxifen?
Fulvestrant
Which medications are first-line for ED treatment?
PDE5 Inhibitors
Sildenafil
Vardenafil
Tadalafil
What medication is second line for ED treatment?
Synthetic PGE-1
Alprostadil
What percentage of ED patients will fail PDE5 inhibitors
30-40%
What levels should you check when treating ED with PDE5 inhibitors?
Testosterone
What medications are indicated to treat moderate to severe BPH with an AUA score > 8?
Alpha-1 Antagonists
Should non-selective or selective alpha-1 antagonist be AVOIDED in BPH and HTN?
Non-selective
Terazosin (Hytrin)
Doxazosin (Cardura)
Prazosin (Minipres)
What anti-hypertensive medication class should be used in HTN while treating ED?
ARBs
Is tamsulosin a good medication to treat BPH in the setting of HTN?
Yes
Selective alpha-1 antagonists are good in combination with anti-hypertensives
Which class of BPH medications is shown to reduce the prostate size up to 25% and lower PSA levels up to 50%?
5-alpha reductase inhibitors
Finasteride
Dutasteride
T/F: Combination therapy of alpha-1 antagonists and a 5-alpha reductase inhibitor is recommended to treat BPH
True
Which PDE5 inhibitor is also indicated for BPH treatment?
Tadalafil
Name one ‘natural product’ used to treat BPH?
Saw Palmetto
African Tree Bark
What are contraindications to testosterone replacement therapy?
Breast/Prostate CA
Porstate Nodule
PSA >3-4 in high risk individuals
Uncontrolled HF
A patient with a history of untreated sleep apnea is interested in testosterone replacement?
Are they a good candidate?
No, testosterone replacement is contraindicated in patients with a history of uncontrolled sleep apnea
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
Above 50%
T/F: You should check a baseline PSA before starting testosterone replacement therapy
True
At what testosterone levels should you consider treatment?
<300 ng/dL
After starting testosterone therapy….
you should check testosterone levels, a H&H, and PSA levels are what intervals?
3 - 6 Months
What medications are indicated for treatment of urge incontinence, urinary frequency, urinary urgency?
Anti-cholinergics
Oxybutynin Tolterodine Solifenacin Darifenacin Trospium (incontinence)
Mirabegron
What is first-line for OAB treatment?
Second line?
Third Line?
FIrst: Behavioral Therapy
Second: Antimuscarinics, Beta-3 Agonist
Third: Botox
What is the most common reason Epilepsy/Seizure treatment fails?
Non-compliance
What are indications to STOP AEDs?
How long should the taper be?
2-4 years without a seizure
Complete control within one year of onset
Normal Neurological Examination
Normal EEG
Taper: Slowly for 6 months
What AEDs are first line for focal seizures?
- Carbamazepine
- Lamotrigine (Adjunct in >2y.o, monotherapy in > 16)
- Valproic Acid (Depakote)
- Levetiracetam (Adjunct >4y.o.)
- Topiramate (> 2y.o.)
- Phenytoin
Should Carbamazepine be used in patients with a history of bone marrow depression?
No
Carbamazepine should be avoided in patients with HLA-B 1502, why?
Increased risk of SJS
What AEDs are used for partial seziures?
- Oxcarbazepine
Which AEDs are used to treat Tonic-Clonic Seizures?
- Lamotrigine (Lamictal)
- Valproic Acid (Depakote)
- Levetiracetam (Adjunct >6y.o.)
- Topiramate ( >2 y.o.)
- Phenytoin
Which AEDs are used to treat Mixed Seizures?
- Valproic Acid
Which AEDs are used to treat Lennox-Gastaut Syndrome?
- Valproic Acid
2. Topiramate (>2 y.o.)
Which AEDs are used to treat absence seizures?
- Valproic Acid
2. Ethosuximide
Should valproic acid be used in pregnancy?
No
It has associated neural tube defects
What AEDs are used to treat status epilepticus?
- Fosphenytoin
- Diazepam (Valium)
- Lorazepam (Ativan)
- Midazolam (Versed)
Which second-line AEDs are used to treat focal seizures?
- Zonisamide
- Lacosamide
- Perampanel (> 12 y.o.)
- Phenobarbital
- Primidone
- Gabapentin
- Pregabalin (Adjunct)
- Ezogabine (Adjunct)
Which second-line AEDs are used to treat tonic-clonic seizures?
- Perampanel
2. Primidone
Which second-line AEDs are used to treat Lennox-Gastaut Syndrome?
- Phenobarbital
When would phenobarbital be indicated to treat status epilepticus?
If benzodiazepines and phenytoin fail
Which benzodiazepines are used to treat Lennox-Gastuat Syndrome?
Clonazepam (Klonopin)
Clobazam
Which benzodiazepines are first line for status epilepticus?
Diazepam (Valium)
Lorazepam (Ativan)
Midazolam (Versed)
Which AEDs are used to treat refractory focal seizures in adults?
Vigabatrin
Felbamate (Last-line due to ADRs)
