Men & Women's Health Flashcards
common drugs absolutely contraindicated in pregnancy (category X)
especially P450 inducers
The mnemonic CRAP GPs can be used to easily remember common CYP450 inducers:
Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
statins, anticoagulants, BZO, antiviral, hormones (OCP, gonadotropin), immune suppressive, retinoids, steroids
Warfarin
Phenytoin (anticonvulsants/P450 inducer)
Valproic Acid
Carbamazepine (P450 inducer)
Lithium
ACE inhibitors
Thalidomide
Ethanol
Retinoids
Misoprostol
NSAIDs (trimester specific)
Statins
drugs that commonly interact with hormonal contraception
anticonvulsants (oxcarbazepine, pheytoin, etc.)
lamictal
griseofulvin
nonnucleoside reverse transcriptase inhibitors (end in “irine”)
protease inhibitors (end in “avir”)
rifampin, rifabutin
st johns wort
theophylline
modafinil, armodafinil
pitolisant
what defines pregnancy categories A-D & X
Category A: No risk in human studies (studies in pregnant women have not demonstrated a risk to the fetus during the first trimester).
Category B: No risk in animal studies (there are no adequate studies in humans, but animal studies did not demonstrate a risk to the fetus).
Category C: Risk cannot be ruled out. There are no satisfactory studies in pregnant women, but animal studies demonstrated a risk to the fetus; potential benefits of the drug may outweigh the risks.
Category D: Evidence of risk (studies in pregnant women have demonstrated a risk to the fetus; potential benefits of the drug may outweigh the risks).
Category X: Contraindicated (studies in pregnant women have demonstrated a risk to the fetus, and/or human or animal studies have shown fetal abnormalities; risks of the drug outweigh the potential benefits).
What are some relative and absolute contraindications to initiation and continuation of hormonal contraceptives (based on USMEC)?
absolute contraindications:
hx thromboembolic disease
stroke
CAD/PAD/ischemic heart
breast carcinoma
estrogen-dependent neoplasm
pregnancy
abnormal vaginal/uterine bleeding
breastfeeding < 21 post partum
heavy smoking > 35 y/o
hepatic tumor or liver disease
migraines w/ focal neuro sx
postpartum x21 days
relative:
lighter smoking
migraine w/o focal neuro
HTN
fibroids
MS
DM
hyperlipidemia
sickle cell
age > 50
controversy with broad spectrum antibiotics in pregnancy
Antibiotics account for 80 % of all prescribed medication in pregnancy [22], yet surprisingly, few published human studies have carefully evaluated the direct effects of antibiotics during pregnancy on either the maternal or fetal microbiome, or evaluated long-term sequelae of such antibiotic use.
certain antibiotics is linked to a significantly higher rate of neonatal necrotizing enterocolitis, although antibiotic treatment is also associated with a reduced rate of lung complications and major cerebral abnormalities
increased risk of asthma in early childhood [32–34], increased risk of childhood epilepsy, and increased risk of childhood obesity
ssx menopause
vasomotor sx (hot flashes, night sweats)
sleep disturbances
mood changes
GU syndrome of menopause: dry, burning, irritation, dysuria, urgency
depression
issue w/ concentration & memory
*sx more severe if from surgery
FSH > 40
confirmed by 12 months of amenorrhea
What is the approach to therapy for menopause patients with moderate to severe vasomotor symptoms versus local symptoms such as vulvovaginal atrophy
menopausal hormone therapy (MHT) most effective for mod-severe sx. Usually sx have to effect quality of life
mod/servere vasomotor= estrogens (with or w/o GU sx)
local sx= SERMs (Osemifene), DHEA, lubricants/moisturizers
Why/when does HRT for menopause does progestin need to be combined with an estrogen?
if intact uterus need progestogen w/ estrogen due to increased risk of endometrial hyperplasia and endometrial cancer w/ estrogen monotherapy
What are some risks, benefits, relative, and absolute contraindications to HRT?
risks= cardiovascular disease & stroke risk if intact uterus, breast cancer, clot
benefits= sx relief (VSM, GU)
relative=
absolute contraindications= breast or endometrial cancer, CVD/coronary heart, stroke, TIA, liver, undx vaginal bleeding, > 60, hypertriglicerides
What do guidelines say about dose and duration of therapy and discontinuation HRT?
lowest dose, shortest duration possible
start close to menopause
route of admin to min. risk
x4-5 years tx then tapered at d/c over 3-6mo.
if menopause < 45 y/o, use MHT until average age menopause onset
- HOPE trial (Women’s Health, Osteoporosis, Progestin, and Estrogen) - body weight/fat increases with tx
- WHI trial (Women’s Health Initiative)- double bind placebo study stopped early d/t significant cardiovascular risk
What meds contribute to development/worse ED
ED= anything that affects function of vascular, neuro, hormonal, psychological systems
- antihypertensives (bblocker, thiazide diuretics, centrally acting like clonidine, spironolactone, alpha block)
- CNS depress (opioid, BZO, hypnotics)
- lipid management (gemfibrozil, HMG-CoA reductase inhibitor)
- antidepress/psychotic (TCA, MAOI, SSRI, SNRI, lithium)
- anticonvulsants (carbamazepine, phenytoin)
- GI agents (H2RA, PPI)
- 5 alpha reductase inhibitors, progeterone/estrogen, corticosteroids)
- recreational drugs (THC, ETOH, cocaine, opiates)
Meds for BPH & indication
Drugs if mod-severe w/o compication:
alpha adrenergic antagonists preferred bc faster onset & improve sx independent of prostate size
5alpha reductase inhibitors most effective large prostate > 30g
combos= expensive and more SE
surgery high risk disease progression, prostate > 40g, PSI > 1.6, don’t respond to drugs, complications of BPH
What non-pharmacologic and pharmacologic options are available for the treatment of ED?
non-pharm= healthy diet, wt loss, physical activity, smoking/drug cessation, reduce ETOH, vacuum erection devices (VED; not in sickle cell, use w/ caution if bleeding disorder), prostheses
pharm=
phosphodiesterase type 5 inhibitors (PDE5i)
alprostadil (prostaglandin E1 analog)
testosterone (only if testosterone low)
What factors may influence the choice of therapy for ED? When is testosterone replacement therapy appropriate?
History, CV status, patient preference, cost
All PDE5Is have comparable efficacy for ED
testosterone only if low test. contraindicated if prostate cancer, erythrocytosis, uncontrolled HF, OSA
tips for pt education benefits/risk meds during pregnancy
absolute numbers not relative
negatively & positively framed info (3% chance on malformation, 97% no malformation)
same denominator when discussing probability
pharmacokinetics effected by pregnancy
absorption- decreased GI transit= delay drug peak, increase contact time GI mucosa, possible increase absorption
distribution- volume of distribution increases
metabolism- some increased some decreased activity of isoenzymes
renal elimination- renal blood flow/GFR increases > decreased half life drugs excreted renally
common meds that need dose adjustment in pregnancy
caffeine
digoxin
carbamazepine
lithium
Lamictal
levothyroxine
SSRI
tx UTI pregnancy
beta lactams (cefadroxil, cefprozil, cephalexin, amox), nitrofurantoin, fosfomycin
quinolones reserve for resistance
Meds when there’s preterm labor threat (before 37 weeks)
corticosteroids for fetal pulmonary development
ABX to lower risk of strep B
mag sulfate for neuroprotection
tocolytics can prolong pregnancy up to 48 hrs
tx HTN in pregnancy
**labetolol
**nifedipine ER
methyldopa
hydrochlorothiazide
what do combination OCP contain
synthetic estrogen (ex ethinyl estradiol) and one of several steroids w/ progestational activity (norethindorne, levonorgestrel, etc.)
benefits other than preventing pregnancy from CHC (combo hormonal contraceptives)
reduced endometrial & ovarian cancer, menstruation regulation/decreased anemia risk, decrease fetal neural tube defects, relief sx premenstrual, prevent benign breast disease, prevent ovarian cysts, decrease endometriosis sx, acne control
Risks of CHC (combo hormone contraception)
STI bc less condom use, cardiovascular events & HTN (affects aldosterone activity), venous thromboembolism (enhance hepatic clotting factors), gallbladder disease, hepatic tumor, cervical cancer, breast cancer
