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Pharm III > Lecture 9, part 2 (GYN)- Exam 5 > Flashcards

Lecture 9, part 2 (GYN)- Exam 5 Flashcards

1
Q

Sorry… a lot

What is all that needs to be done as a routine txt after a sexual assault?

A
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2
Q

*

A
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3
Q

Fill covered spots

A
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4
Q

Bacterial vaginosis
* What is it not?
* What is the organism?

A
  • Not an STI but can be transmitted sexually
  • Organism: Gardnerella vaginalis
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5
Q

Bacterial vaginosis
* What are the first line treatments? (3)

A
  • Metronidazole 500 mg PO BID x 7 days
  • Metronidazole vaginal gel – 1 applicator intravaginally once daily x 5 days
  • Clindamycin 2% vaginal cream 5 gm intravaginally at bedtime x 7 days
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6
Q

What is the treatment for BV in preg patients?

A

Oral metronidazole or oral clindamycin x 7 days

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7
Q

Bacterial vaginosis
* What is the treatment for refractory/recurrent infections? What is recommended?

A

Boric acid capsules 600 mg intravaginally daily x 21 days after initial antibiotic treatment complete
* Partner condom recommended (acid + penis = pain)

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8
Q

*

BV
* What is the Amstel criteria?
* What abotu sex during treatments?

A
  • Amstel criteria: picture
  • 50% increase in cure rate if patients abstain from intercourse or use condoms during treatment
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9
Q

Candida vulvovaginitis
* What is it?
* What are the RFs? (5)
* What is the most prominent sxs?

A
  • Fungal infection usually caused by Candida albicans
  • Risk factors – broad-spectrum antibiotics, pregnancy, diabetes, immune compromise, silk underwear or workout clothing
  • Pruritis may be severe, and is most prominent symptom
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10
Q

Candida vulvovaginitis
* What is the discharge like?
* odor and ph?
* Dx how?

A
  • Thick, adherent curd like white discharge in vaginal vault
  • Not malodorous and pH is normal (<4.5)
  • Diagnosed by clinical appearance or KOH prep of slide with microscopy
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11
Q

Candida vulvovaginitis treatments
* What are the topical therapies?

A

1-to-7-day regimens (OTC or Rx)

Antifungal tablets or creams
* Butoconazole
* Clotrimazole
* Miconazole
* Terconazole

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12
Q

*

Candida vulvovaginitis treatments
* What is the oral therapy? not recommended when?

A
  • Fluconazole 150mg PO x 1 to 3 doses (q 72 hours)
  • Not recommended in first trimester
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13
Q
A
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14
Q

Trichomonas vaginalis
* What is the first line txt?

A
  • Metronidazole 500mg PO BID x 7 days (women) – considered safe in pregnancy
  • Metronidazole 2gm PO x 1 dose (men
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15
Q

Trichomonas vaginalis
* What is the alternative txt?
* Treat who?
* What is not effective?

A
  • Tinidazole 2mg PO x 1 dose
  • Treat sexual partners
  • Metronidazole gel not effective
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16
Q

*

N. Gonorrhaeae
* What is the organism?
* What are the sxs? (3)
* What are the locations? (4)
* What is the treatment?

A

(*) 1000mg IM x 1 dose if ≥ 150kg or for conjunctivitis
#conconmittant treatment for C. trachomatis recommended

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17
Q

*

A

+Azithromycin 1gm x 1 dose if pregnant

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18
Q

Syphilis (treponema pallidum)

A
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19
Q

Syphilis (treponema pallidum)

A
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20
Q

Syphilis treatment

A
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21
Q

Syphilis treatment

A
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22
Q

Syphilis treatment

A
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23
Q

Syphilis treatment
* pregnancy patients?

A

Penicillin recommended for all pregnant patients; if allergic desensitize

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24
Q

Pelvic Inflammatory Disease (PID)
* What is it?
* Bacteria?

A
  • Acute (typically ascending) infection of the upper genital tract structures in women, involving any or all of the uterus, oviducts, and ovaries
  • Polymicrobial; predominant organisms responsible for initiating the infection are gonorrhea and chlamydia
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25
Q

Pelvic Inflammatory Disease (PID)
* What are the RFs? (3)

A
  • Previous PID infection
  • Multiple sex partners
  • Not using condoms
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26
Q

Pelvic Inflammatory Disease (PID): Dx
* What is the CDC criteria for empirical treatments?

A

Cervical motion tenderness (chandelier sign) or uterine or adnexal tenderness in the presence of lower abdominal or pelvic pain

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27
Q

Pelvic Inflammatory Disease (PID): Dx
* Additional criteria to support a clinical diagnosis? (5)

A
  • Temp > 101° F
  • Mucopurulent cervical discharge
  • Abundant WBCs on microscopy of vaginal secretions
  • Elevated ESR
  • Elevated CRP
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28
Q

Pelvic Inflammatory Disease (PID): Treatment
* Geared towards what?
* What is usually required? Transition?

A

Geared towards primary cause (GC/Chlamydia)

Hospitalization is usually required
* Transitioning from parenteral to oral therapy started after 24 hours of sustained clinical improvement

29
Q

Pelvic Inflammatory Disease (PID)
* What is the sequelae? (3)

A
  • Development of tubo-ovarian abscess (surgical/IR involvement)
  • Infertility secondary to scarring of fallopian tubes
  • Ectopic pregnancy
30
Q

Pelvic inflammatory disease
* When should you consider outpatient txt?

A
  • WBC < 11,000/mm3
  • Temp < 38° C
  • Minimal evidence of peritonitis
  • Active bowel sounds
  • Tolerating PO
  • Reliable
31
Q

*

What is the outpt txt of PID?

A
  • Ceftriaxone 500mg* IM x 1 plus
  • Metronidazole 500mg PO BID x 14d
  • Doxycycline 100mg PO BID x 14d

KNOW DOSES

(*)1000mg if >150kg and documented gonococcal infection

32
Q

Pelvic inflammatory disease
* What is the inpatient treatment?
* May swithc what?

A
  • Ceftriaxone 1gm IV q24h plus
  • Doxycycline 100mg IV q12h plus
  • Metronidazole 500mg IV q12h

May switch to oral regimen when clinically improving and tolerating PO

33
Q

Pelvic inflammatory disease
* For inpatient txt, what is the discharge medications?
* Patients should be screened for what?
* Partners?

A

Discharge medications include:
* Doxycycline 100mg PO BID plus
* Metronidazole 500mg PO q12h x 14 days total

Patients should be screened for other STIs including HIV, syphilis

Partners should be screened and treated

34
Q

Endometriosis
* What happens?
* MC where?
* Functionally the same as what?

A
  • Endometrial cells migrate and implant outside uterus
  • MC ovaries, fallopian tubes, uterine ligaments
  • Functionally the same as cells inside of the uterus
35
Q

Endometriosis
* receptors?
* Go through what?
* Bleeds when?

A
  • Same estrogen receptors
  • Go through proliferation, secretion, and menstrual cycle
  • Bleed during menses
36
Q

Endometriosis
* High levels of what?
* Releases what?
* What grows blood vessels?

A
  • High levels of aromatase and produce their own estrogen
  • Release proinflammatory factors – inflammation, scarring, adhesions
  • Estrogen and proinflammatory factors grow blood vessels
37
Q

Endometriosis treatments
* What are the goals?

A

Manage pain (dysmenorrhea)

Limit progression of implants

Address subfertility
* Not treated with drug therapy

38
Q

Endometriosis treatments
* What is first line agents? Second line? Last line?

A

First-line:
* NSAIDs
* CHCs
* Progestins

Second-line:
* Gonadotropin releasing hormone analogs
* Danazol

Last line:
* Aromatase inhibitors

39
Q

Endometriosis: first-line agents
* First line combo and what does it cause?? Alternative?

A

First-line: NSAIDS plus continuous CHCs
* Induces a pseudopregnancy state
* Reduces the effects of painful lesions

NSAIDS plus progestins for women with estrogen contraindications

Multiple combinations can be attempted in women who do not initially respond

40
Q

Endometriosis: first-line agents

A
41
Q

Endometriosis: first-line agents

A
42
Q

Endometriosis: second-line agents
* When should this be tried?
* Induces what?

A
  • Patients not responding to first line therapy should be switched to a GnRH analog with add-back therapy
  • Induces a pseudomenopausal state
43
Q

LY

Endometriosis: second-line agents

A
44
Q

LY

Endometriosis: second-line agents

A
45
Q

LY

Endometriosis: second-line agents

A
46
Q

Gonadotropin analogs
* Hypothalamus stimulates what?What does that cause?

A

Hypothalamus stimulates the release of GnRH
* GnRH stimulates the ANTERIOR pituitary to release LH and FSH

47
Q

Gonadotropin analogs
* What does LH and FSH stimulate?

A
  • Ovaries to make estrogen
  • Testicles to make testosterone
  • Estrogen / testosterone act as a negative feedback on the pituitary and hypothalamus
48
Q

LONG

Gonadotropin analogs
* What is the MOA of Gonadotropin agonists?

A
49
Q

LONG

Gonadotropin analogs
* What is the MOA of Gonadotropin antagonists?

A
50
Q

Gonadotropin analogs
* What are the SEs? (9)

A
  • Headaches
  • Acne
  • Depression
  • Low estrogen
  • Hot flashes
  • Vaginal dryness
  • Insomnia
  • Increased lipids
  • Loss of bone mineral density with prolonged use

LY

51
Q

Gonadotropin analogs
* What is hte add back therapy?

A
  • Recommended to reduced loss of BMD and provide symptom relief
  • Low dose progesterone ± estrogen ± bisphosphonates
52
Q

Gonadotropin analogs
* What are the contraindications? (3)

A
  • Pregnancy
  • Osteoporosis
  • Liver disease
53
Q

Gonadotropin analogs
* What do you monitor? (2)

A
  • Monitor BMD every 1-2 years with prolonged use
  • Monitor lipid levels every 6 to 12 months
54
Q

Endometrosis:
* What is a disadvantage of medical txt?
* What can you do?

A
55
Q

Cervicitis
* What are the MC organisms? Often what?
* Women have what?
* When should women be screened?

A

MC organisms chlamydia and gonorrhea
* Often asymptomatic, symptoms non-specific

Women: increased vaginal discharge, endocervical bleeding

Annual screening recommended for sexually active females < 25 years and older women with high-risk behavior

56
Q

Cervicitis
* how do you dx it?
* Empiric txt is usually when?

A

Diagnosis – NAAT
* Men – urine sample
* Women – vaginal secretions / urine sample

Empiric treatment usually initiated prior to test results in patients with high suspicion / poor compliance

57
Q

*

A

21-29 -> PAP every 3 years
> 30 -> PAP and HPV every 5 years

58
Q

U. S. Preventive Services Task Force Recommendation (2018)
* What do you women aged 21-29 get? 30-65?

A

Women 21-29 years:
* Screening with cervical cytology (pap smear) every 3 years

Women 30-65 years
* Screening with cytology every 3 years + HPV testing every 5 years OR with co-testing (both) every 5 years

59
Q

U. S. Preventive Services Task Force Recommendation (2018)
* Screening > 65 can stop if what? (3)
* When do you have to continue yearly screenings?

A

Screening > 65 can stop if:
* 3 consecutive negative cytology results OR
* 2 consecutive negative co-testing results within 10 years OR
* 20 years since treatment or spontaneous regression of precancerous lesions

ANY previous abnormal cytology screening or HIV or DES exposure in utero -> continue yearly screening

60
Q

American cancer society (2020)
* Women 21-24? 25-65 screening?

A
61
Q

American cancer society (2020)
* Women over 65?
* Women status post hysterectomy with cervix present?

A

Women > 65 years
* Screening discontinuation recommendations similar to USPTF recommendations

Women status post hysterectomy with cervix present – screen per age-appropriate guidelines

62
Q

Cervical Intraepithelial Neoplasia (CIN)
* What is premalignant cells?
* Where does 90% of CIN occur?
* Dx how?

A
  • Dysplasia of the cervix – premalignant cells
  • > 90% of squamous cervical intraepithelial neoplasia (CIN) occurs within the transformation zone
  • Diagnosis: Pap smear
63
Q

*

Cervical Intraepithelial Neoplasia (CIN)
* What is the MCC? What are the high risk ones for cancer?
* MC types for genital warts?

A

MCC human papillomavirus (HPV) types.
* High risk HPV-cancer related types: 16 and 18 (70%), 31, 33 and 45
* HPV types associated with genital warts: 6 & 11 [(90%) condyloma acuminata]

64
Q

*

Cervical Dysplasia Summary
* What do you do if pap results show ASCUS or LSIL?

A
65
Q

*

Cervical Dysplasia Summary
* Do do you do if HSIL is shown on pap?

A

Colposcopy and biopsy

66
Q

*

Cervical Dysplasia Summary
* If colposcopy CIN 1->
* If colposcopy CIN 2 or 3 ->

A
  • If colposcopy CIN 1-> next steps determined by additional risk factors
  • If colposcopy CIN 2 or 3 -> loop electrosurgical excision procedure (LEEP)
67
Q

*

Cervical dysplasia – primary prevention
* What is the vaccine? What does it protect?
* Recommended to who?

A

Prevention: Gardasil-9 valent vaccine
* Protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58
* Recommended for all teens and young adults up to age 26; conditional recommendations up to age 45

Cervical lesions in females due to HPV have decreased by 40% since introduction of the vaccine

68
Q

Cervical dysplasia – primary prevention
* What is the dosing timeline for HPV?

A

Pharm III (14 decks)

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