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NAPLEX STUDY > Male and Female Health > Flashcards

Male and Female Health Flashcards

(52 cards)

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1
Q

Most oral contraceptives contain

A

ethinyl estradiol, progestin, (norethindrone, levonorgestrel, drospirenone)

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2
Q

monophasic

A

contain the same dose of estrogen and progestin throughout the pack
-Junel Fe, Microgestin Fe, Sprintec, Loestrin, Yasmin

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3
Q

biphasic, triphasic, and quadriphasic

A

mimic the estrogen and progesterone level
-biphasic/triphasic: ortho tri cyclen lo; tri sprintec
-quadriphasic: natazia

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4
Q

Drospirenone

A

-used to reduce adverse effects
-potassium-sparing diuretic which decreases bloating, PMS symptoms, weight gain
-Yasmin, Yaz
-has a higher risk of blood clots, increased potassium. Do not use with kidney, liver, or adrenal gland disease

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5
Q

Extended cycle formulation

A

seasonique

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6
Q

Progestin-only

A

Errin, Camila, Nora-BE
-must be taken at the same time everyday to be effective - if missed by 30 min extra contraception is needed for 48 hrs

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7
Q

Lo

A

indicates < 35 mcg of estrogen

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8
Q

Fe

A

indicates iron

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9
Q

24

A

indicates shorter placebo time

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10
Q

ACHES

A

-abdominal pain (indicate a ruptured liver tumor or cyst, mesenteric or pelvic vein thrombosis,
-chest pain (sharp, crushing, or heavy pain)
-headaches (sudden and severe with vomiting or weakness/numbeness on one side of the body)
-eye problems (blurry vision)
-swelling or sudden leg pain

do not use in women > 35 who smoke, hx of DVT/PE, stroke, CAD, breast/ovarian/liver cancer, or those with migraines w/ aura

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11
Q

breakthrough bleeding

A
  • taking < 30 mcg estrogen daily: increase estrogen dose
  • taking > 30 mcg estrogen daily: try a different progestin
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12
Q

clomiphene

A

-acts as estrogen to increase LH/FSH –> cause ovulation

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13
Q

aromatase inhibitors

A

suppress estrogen to increase FSH –> cause ovulation

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14
Q

Gonadotropin

A

drugs act as LH, FSH, or hCG –> cause ovulation

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15
Q

pregnancy category: A

A

no risk

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16
Q

pregnancy category: B

A

animal studies have not demonstrated fetal risk

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17
Q

pregnancy category: C

A

animal studies have shown harm - no well-controlled studies in pregnant women
-benefit outweighs risk

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18
Q

pregnancy category: D

A

positive evidence of risk to the human fetus - benefits may outweigh the risk

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19
Q

Teratogen: Acne

A

isotetinoin, topical retinoids

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20
Q

Teratogen: antibiotics

A

quinolones, tetracyclines

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21
Q

Teratogen: anticoagulants

22
Q

Teratogen: dyslipidemia, HF and HTN

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A

statins, RAAS inhibitors

23
Q

Teratogen: hormones

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A

all, raloxifene, duavee, testosterone, contraceptives

24
Q

Teratogen: Migraine

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A

dihydroergotamine, ergotamine

25
Teratogen: other
hydroxyurea, lithium, methotrexate, misoprostol, NSAIDs, paroxetine, ribavarin, thalidomide, topiramate, weightloss drugs, valproic/divaloprex
26
medications that increase the risk of osteoprosis
anticonvulsants, aromatase inhibitors, depo-medroxyprogesterone, GnRH agonists, lithium, PPIs, steroids (>5 mg daily of prednisone or prednisone equivalent), thyroid hormones, others (loop diuretics, SSRIs, TZDs)
27
Diagnosising osteoprosis
-DEXA scan for T-Score -women > 65 years and men > 70 years -Normal: > -1 -Osteopenia (low bone mass): -1 to 2.4 -Osteoporosis: < -2.5
28
Calcium and Vitamin D
-Calcium: recommended daily intake 1-1.2 g (do not exceed 500-600 mg of elemental calcium per dose) -vitamin D: required for calcium absorption -serum vitamin D < 30; treat with cholecalciferol daily or weekly
29
Bisphosphonates: Alendronate (Fosamax - inj Bonvia), Risedronate (Actonel), Ibrandronate (Boniva), Zoledronic Acid (Reclast)
-first line for treatment or prevention in most patients -PO admin: must stay upright for 30 min (60 min for ibrandronate) and drink 6-8 oz of water -side effects: esophagitis, hypocalcemia, GI effects -Rare: atypical femur fractures, osteonecrosis of the jaw -PO: weekly or IV: quarterly/yearly -Tx for 3-5 years in patients with a low risk of fracture -reduce the risk of vertebral and hip fracture (except ibandronate reduces vertebral fractures)
30
Denosumab (Prolia - RANKL)
-alternative to bisphosphonates -SC admin every 6 months -hypocalemia
31
Teriparatide (Forteo), Abaloprartide (Tymlos
-recommended for very high risk patients only -SC admin only -hypercalcemia
32
Raloxifene (Evista - SERM), Bazedoxifene/estrogens (Duavee)
-alternative to bisphosphonates if high risk of vertebral fractures -increased risk for VTE and stroke -raloxifene can be used if low VTE risk or high breast cancer risk (side effects: vasomotor symptoms) -bazedoxifene/estrogens: can be used in women with intact uterus for prevention of osteoporosis (also used for vasomotor symptoms, increased risk of breast cancer) -last line/not recommended: estrogen for prevention only in post menopausal women with vasomotor symptoms; calcitonin for treatment only if there are no other options)
33
Hormone therapy for menopause
Estrogen: -most effective tx for vasomotor symptoms -women with a uterus: use in combination with a form of progesterone. Unopposed estrogen increases the risk of endometrial cancer -associated with significant safety risks; including boxed warnings for VTE stroke, dementia, and BC Progestin: -can be given as a part of combination pill or as a separate tablet (medroxyprogesterone) -can cause mood disturbances -micronized progestin are considered to be safer than synthetic progestin
34
Criteria for use of hormone therapy
-healthy, symptomatic women who are within 10 years of menopause, < 60 YOA and have no contraindications to use -extending tx beyond age 60 years may be acceptable if the lowest possible dose is used and the woman is advised of safety risks -consider QOL priorities and personal risk factors
35
Local hormone therapies
-17 Beta Estradiol (Estrace, Estring, Vagifen) -Conjugated Equine Estrogens (Premarin)
36
Systemic Hormone Therapies
-Estradiol (alora, Climara, Vivelle-Dot; patches) -17-beta-Estradiol -Conjugated Equine Estrogens (Premarin) -Conjugated Equine Estrogens and medroxyprogesterone -Medroxyprogesterone (Provera) -Micronized Progesterone (Prometrium) *endometrial cancer (if used in women with a uterus), dementia, increased risk of VTE and stroke, breast cancer *CI: BC, uterine bleeding, VTE, pregnancy
37
SSRI
-paroxetine (paxil) - do not use with warfarin (increases bleeding risk) or tamoxifen (decreases tamoxifen efficacy)
38
Drugs that cause erectile/sexual dysfunction
-alcohol -antidepressants: SSRIs, SNRIs (including decreased libido) -antihypertensives: BB, clonidine, thiazides -antipsychotics: first gen (chlorpromazine) & risperidone, paliperidone -BPH medications: finasteride, dutasteride, silodosin
39
Natural products for ED
yohimbe, L-arginine and panax ginseng
40
PDE-5
Sildenafil (viagra) Tadalafil (Cialis) -impaired color discrimination, hearing loss, vision loss, hypotension, priapism, headache/flushing/dizziness/dyspepsia
41
PDE-5 inhibitor dosing
Typical dosing: -50 mg viagra -10 mg cialis Reduce dose if: -> 65 years -using alpha blocker -using CYP3A4 inhibitor -severe renal or liver disease Decrease starting dose: -25 mg viagra -5 mg cialis
42
Drugs that worsen BPH
-centrally acting anticholinergics -drugs with anticholinergic effects: antihistamine, decongestants, phenothiazines, TCAs -caffiene -Diuretics -SNRIs -Testosterone products
43
natural product for BPH
Saw Palmetto
44
Drug tx for BPH
-alpha-blockers alone or in combination with a 5 alpha-reductase inhibitor
45
5-alpha reductase inhibitor: Finasteride (Proscar)
-decrease prostate size -should not be used in men without an enlarged prostate -contraindicated in women of childbearing potential, pregnancy -impotence, decreased libido, ejaculation disturbances, breast enlargement, and tenderness
46
alpha-blockers: -Non-selective: doxazosin (Cardura, Cardura XL), Terazosin -Selective: tamsulosin (Flomax)
-first-line tx for moderate to severe symptoms -inhibit alpha-1 adrenergic receptors, causing relaxation of smooth muscle -reduces bladder outlet obstruction and improves urinary flow -orthostatic hypotension/syncope, dizziness, fatigue, headache, abnormal ejaculation, intraoperative floppy iris syndrome -Cardura leaves a ghost tablet
47
Urge incontinence/mixed incontinence treatment
1st line: anticholinergics (oxybutynin) or beta-3 receptor antagonist (mirabegron) 2nd line: Botox (higher efficacy but not first line) 3rd line: nerve stimulation or surgical treatment
48
Anticholinergics for incontinence
-Oxybutin IR, ER (Ditropan XL), patch (oxytol) -Tolterodine (Detrol), Tolterodine ER (Detrol LA) -Solifenancin (Vesicare) -CI: uncontrolled narrow angle glaucoma -agitation, confusions, drowsiness, dizziness, blurred vision -oxybutnin ER leaves ghost tablet
49
anticholinergic side effects
-peripheral: dry mouth, dry eyes/blurred vision, urinary retention, constipation, tachycardia -central: sedation, dizziness, cognitive impairment
50
combating dry mouth with anticholinergic
-ER formulation -gel or patch formulation -mirabegeron -use ice chips, water, sugar free candy or gum
51
desmopressin tablet (DDAVP)
helps with nocturia treatment
52
Mirabegron (Myrbetriq)
-CrCl < 15 mL/min not reccomended -urinary retention -increased BP

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