Medications Exam 5 Flashcards
Contraception Efficacy rank
Most
Implant
IUD
Sterilization
Injection
Pill
Patch
Vaginal Ring
Diaphragm
Male condom
Female condom
Cervical cap
Sponge
FAM
Spermicide
Which depot can we prescribe
Subq NOT IM
If patient is experiencing acne, what contraception to use or not
USE:
-COC
-Rings
-Patch
DO NOT USE
-Implant (nexplanon)
If patient is experiencing heavy painful periods, contraception to use/not to use
Use
-Levonorgestrel IUD
-SHOT DMPA
-COC
-Monthly ring
-Annual ring
Do not Use
-Copper IUD
-Shot DMPA
Contraceptives that are safe for breastfeeding
Shot DMPA
POP - Norethindrone (mini-pill)
POP - Drosperinone 4mg
How to solve irregular bleeding
Take pills at same time
-Ibuprofen 800mg 3x a day x 5days
May improve with continued use
Serious SE of combined methods
Abdominal Pain
Chest Pain (SOB, coughing)
Headache
Eye problems (double vision, blurry vision)
Severe leg pain
A
C
H
E
S
Medication Abortion
Mifepristone (Mifeprex)
200mg orally x 1 dose
Misoprostol (Cytotec)
800mcg buccally 24-48 hours later
2 x 200 mcg tablets in each cheek (30ming)
Abortion counseling points
Bleeding
-Bleeding and cramping are expected
-Heavier than menses
Contact
-HEAVY bleeding (.2 pads/hour for 2 consecutive hours; blood clots larger than a lemon)
-Chills and any fever >101 F or 100.4 F for >4 hours
Adverse Effects
-Nausea, vomiting, diarrhea
-HA, dizziness
-Hot flushes, chills
Pain
-NSAIDs recommended
-Most severe ~2.5-4 hours after misoprostol
Dysmenorrhea first and second line treatment
First-Line
-Non-steroidal anti-inflammatory (NSAID), +/-
Oral contraceptives +/-
Non-pharmacologic
Second line
-Depot medroxyprogesterone acetate (DMPA)
-Levonorgestrel-releasing IUD
Non-Pharmacologic treatment for Dysmenorrhea
-Heating pad
-Exercise
-Nutritional supplementation: omega-3 fatty acids, vitamin B, ginger
-Smoking cessation
-Acupuncture
NSAID therapy: dysmenorrhea
Celecoxib
Diclofenac
Ibuprofen
Naproxen
Drug induced amenorrhea
First gen antipsychotics
-Prochlorpezaine
Chlorpromazine
-Haloperidol
Second-Generation Antipsychotics
-Risperidone
Antihypertensives
-Verapamil
Gi promotility agents
-metoclopramide
First line treatment for amenorrhea
Rule out pregnancy
Determine underlying cause
Treatment for amenorrhea: non-pharmacologic
if cause is anorexia
-Weight gain
-Consider work-up for eating disorder
-Cognitive behavioral therapy (CBT)
Excessive exercise
-Reduction in exercise quantity and intensity
Medications
-May consider alternative agents that do NOT inhibit dopamine receptor or increase prolactin levels OR -> initiate dopamine agonist
Treatment for amenorrhea - pharmacologic: hypoestrogenic
-Provide supplemental estrogen
-must include progestin component
Conjugated equine estrogen
(Common brands: premarin, cenestin, enjuvia)
Estradiol (patch)
Common brands: Climara, Vivelle dot
Treatment for amenorrhea - pharmacologic: cause by medications that increase prolactin levels
Provide Dopamine agonist
-Bromocriptine
Multiple daily dosing (short half-life)
-Cabergoline
Weekly or twice weekly dosing (long half-life)
Contraindications: breast feeding, uncontrolled HTN
Mild side effects: N/D, HA, orthostatic hypotension, fatigue
HMB chronic management
Hormonal
-CHC
-Progestins
-Levonorgestrel IUD
-Danazol
-GnRH agonists
Non-Hormonal
-NSAIDs
-Tranexamic Acid
-Iron
Tranexamic Acids
Intended for SHORT TERM USE
Nonhormonal; usually reserved for those unable to take CHCs or wanting to conceive
Contraindications
-Active and or h/o deep vein thrombosis (DVT) or pulmonary embolism (PE)
H/O seizure
Side effects
-Generally well tolerated
-Can cause HA, Nasal symptoms
Treatment for endometriosis: Non-pharmacologic
Exercise
Acupuncture
Massage
CBT
Surgery
First, second, and third line therapy for Endometriosis
First line
-NSAIDs
-CHCs
-Progestins
Second-line
-GnRH agonists/antagonists
-Danazol
Third-Line
-Aromatase inhibitors
Danazol
Tx: Endometriosis
Intolerable SE:
-weight gain
-acne
-hirsutism
-lipid abnormalities
-Liver dysfunction
-Changes in blood glucose
Black box warning for thromboembolism
Fibroid Tx considerations
Severity of symptoms
Patient age
Reproductive plans
Non-pharmacologic treatment - uterine fibroids
Expectant therapy
-No action unless condition changes
-Asymptomatic, Mildly symptomatic
-Fertility
Myomectomy
-Removal of fibroids (surgical or endoscopic)
-Resolution of symptoms while preserving uterus
-Fertility preserved
Hysterectomy
-Removal of uterus
-Definitive treatment
-Fertility NOT preserved
Treatment overview - uterine fibroids
NSAIDs
-Hormonal contraceptives
-Tranexamic acid
-Gonadotropin-releasing hormone (GnRH) agonists
-Selective Progesterone receptor modulators (SPRM)
Tx for PMS/PMDD - Non-pharmacologic
Limit sodium, caffeine, and alcohol consumption
-Aerobic exercise
-Relaxation techniques (yoga, mediation)
-Structured sleep schedule
-Calcium (elemental of 1200mg/day)
-Magnesium (200-400mg/day)
Vitamin B, D, E
PMS/PMDD - Treatment Overview
First line
-Selective Serotonin Reuptake Inhibitors (SSRIs); NSAIDs; Spironolactone
Second-Line
Venlafaxine; Duloxetine; Clomipramine; Alprazolam; COCs
Last Line
-GnRH agonists; surgery
Complementary therapy
Ginkgo; St. John’s Wort
SSRI counseling
Black Box Warning
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders
Side Effects
-Varies based on SSRI selected
-Nausea, drowsiness, sex dysfunction, sweating, insomnia, diarrhea, HA, weight gain
Improvement in symptoms
-Usually within 2-3 menstrual cycles
