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Mens/Womens Health Flashcards

1
Q

benefits of estrogen HT in menopause

A

decrease hip fx 25%
decrease vertebral fx 50%
decrease vaginal atrophy
decrease hot flashes

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2
Q

do not forget this if you do HT and have a uterus

A

also use a progesterone

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3
Q

risks of estrogen HT

A

gallbladder increases
increased risk of breast cancer - increases w/progesterone
endometrial cancer - lessens w/progesterone
heart disease

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4
Q

benefits of progesterone HT

A

decreases estrogen effects of irregular bleeding and hyperplasia and carcinoma

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5
Q

risks of progesterone HT

A

weight gain
irritability
depression - worse with higher doses
unpredictable bleeding w/continuous estrogen/progestin during first 8-12 months

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6
Q

when to use trandermal estrogen vs oral

A

if moderate risk of CHD and estrogen is needed
or does not tolerate oral well

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7
Q

vaginal estrogen for vasomotor symptoms

A

femring vaginal ring q3mo
estradiol acetate

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8
Q

estrogen/progesterone strategies

A

use progestin for 10-14 days and have a normal period
use continuous progestin, irregular bleeding, then amenorrhea
could do 3 days on and 3 days off but that’s rarely used any more

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9
Q

where do you apply the Divigel estrogen gel and the evamist estrogen spray?

A

gel - thighs
spray - forearm

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10
Q

progesterone primarily used in menopause for unopposed estrogen

A

medroxyprogesterone acetate

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11
Q

estrogen receptor agonist/antagonist for menopause sxs

A

ospemifene 60mg tabs (Osphena) - for vaginal atrophy

conjugated estrogens/bazedoxifene - prevent osteoporosis and mod to severe vasomotor symptoms - SERM

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12
Q

prasterone

A

vaginal atrophy
inactive steroid converted to androgen or estrogen
vaginal insert
caution in hx of breast cancer

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13
Q

definition of T scores in osteoporosis

A

-1 = 2x more likely to have a fracture

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14
Q

low bone mass and osteoporosis in relation to T score

A

-1 to -2.5 = low bone mass
>-2.5 = osteoporosis

low trauma spine or hip fx regardless of T score
low bone mass AND fragility fx or high FRAX score

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15
Q

drugs that increase risk of osteoporosis

A

SSRI’s
anticonvulsants, lithium
steroids
estrogen deficiency
excess levothyroxine
heparin
GNRH agonists
oncology
PPI’s

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16
Q

recommended daily Ca and Vit D intake

A

Calcium 1g
Vit D 1000 units

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17
Q

osteoporosis screening recommendations

A

women >70 and men >80 - Xrays of spine, hips, femoral neck
DXA scan or quantitative CT to measure T scores
may do younger women if T scores high or low trauma fractures or height loss significant

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18
Q

first line therapy for osteoporosis

A

bisphosphonates (except ibandronate - doesn’t help non-vertebral fx)

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19
Q

bisphosphonate side effects

A

GI - esophageal ulcer - don’t lie down 60 mins after
esophageal cancer
musculoskeletal pain
osteonecrosis of jaw
atypical fractures

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20
Q

duration of bisphosphonate therapy

A

treat orally for 5 years of IV for 3years and then reassess risk
may use for double this time frame if high risk of fractures

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21
Q

only bisphosphonate to show decreased mortality

A

zoledronic acid

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22
Q

bisphosphonate CrCl cut offs

A

CrCl <35 in alendronate and zoledronic acid
CrCl <30 in risedronate or ibandronate

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23
Q

RANKL inhibitors

A

denosumab - second line therapy for osteoporosis

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24
Q

SERMs

A

raloxifene 60mg daily
Duavee (conj. estrogen + bazedoxifene)

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25
raloxifene
decreased bone turnover, estrogen antagonist in uterus and breast does not reduce hip fractures can cause hot flashes, leg cramps, VTE
26
conj. estrogens and bazedoxifene
prevention only ADE: hot flashes, muscle cramps, throat/neck/muscle pain, N/V VTE contraindications
27
human parathyroid hormone peptide analogs
teriparatide abaloparatide
28
teriparatide
Forteo regulates bone metabolism, Ca absorption and Ca/Phos absorption treatment only, usually T -3 and fracture hx not shown to decrease hip fractures contraindicated in high Ca, bone tumors, alk Phos elevations caused osteosarcoma in rats after 2 years 20mcg/daily SQ
29
abaloparatide
Tymlos regulates bone metabolism, Ca absorption and Ca/Phos absorption treatment only, usually T -3 and fracture hx not shown to decrease hip fractures caused osteosarcoma in rats after 2 years 80mcg/daily SQ
30
Evenity Romosuzumab
sclerostin inhibitor, build bone and decrease resorption treatment only precaution for major CV outcomes, atypical fracture
31
calcitonin salmon
inhibits bone resorption increased risk of malignancies, not used as much, not a first line agent intranasal therapy
32
first line agents for osteoporosis
alendronate risedronate zoledronic acid denosumab
33
recommended duration of estrogen HT for menopause side effects
5 years, should evaluate after 3 months though and continually
34
when to jump to injectables for first line therapy in osteoporosis
T -3 or greater and history of fractures already, skip PO
35
known teratogenic drugs
alcohol all hormones ACE / ARB / ARNI statins anticonvulsants antineoplastics / oncology cocaine fluconazole in high doses isotretinoin (Acutane) metals - lead, lithium, mercury methotrexate methimazole paroxetine TCN warfarin
36
drugs contraindicated in lactated
amphetamines oncology benzos bromocriptine cocaine ergotamine kava lithium nicotine yohimbe herbs opioids
37
first line agents in morning sickness
doxylamine and pyridoxine 10mg-10mg: 2 HS, max 4 daily doxylamine ER 20-20mg: 1 BID may use Benadryl, dimenhydrinate, ondansetron, reglan, or promethazine if necessary
38
drugs to avoid for constipation for pregnancy
stimulants are not first line mineral oil may interfere with vitamin k absorption
39
drugs to avoid for headache with pregnancy
ergotamine NSAIDs triptans
40
pre-eclampsia problems
HTN > 140/90 + one of the following proteinuria renal insufficiency thrombocytopenia impaired liver function enzymes x2 ULN pulmonary edema HA unresponsive to therapy vision changes
41
eclampsia definition
pre-eclampsia plus seizures
42
prevention of pre-eclampsia
ASA 81mg daily or BID
43
drugs that decrease contractions
terbutaline - beta agonist - must use IV/SQ, off label, <48 hrs use magnesium - DOC in DM, keep high level, antagonizes calcium prostaglandin inhibitor - indomethacin - limit 72 hrs lot of scary side effects CCBs - limited to 48 hrs, nifedipine - caution if using with mag b/c doubling down on calcium decrease, hypotension
44
induction using prostaglandins
misoprostol - off label - prostaglandin E1 dinoprostone - vaginal only, gel or insert applied to uterus
45
breakthrough bleeding during contraceptive use and how to adjust
if early in cycle - increase estrogen if mid cycle - increase progesterone when in doubt - increase hormone content
46
ACHES with contraceptives
Abdominal pain - possible liver problems or gallbladder Chest pain - SOB, blood cough, MI or PE Headache - stroke or blood clot Eye problems - optic neuritis, stroke or clot Severe leg pain - DVT
47
emergency contraceptive comparison
levonorgestrol - OTC - most effective 72 hours, BMI <25 ulipristal - RX, 120hrs, BMI < 35 copper IUD - 120 hrs, office implant, no weight restriction
48
reasons for progestin only birth control
>35yo and smokes migraine with aura cardiovascular risks, MI, stroke, afib, HTN > 160/100 liver disease, diabetic vision problems breastfeeding surgery in last 4 weeks
49
drugs that decrease efficacy of birth control
anticonvulsants (carbamazepine and oxcarb), phenytoin, phenobarb, primidone some abx - TCN, PCN, cephalosporins emend HIV meds modafinil actos
50
oral contraceptive start times
any day or Sunday start - use bc for 7 days first day of period
51
missed 2 pills of contraceptives advice
back up method for 7 days emergency contraceptive if sex in past 5 days
52
high and very low estrogen contraceptive cutoff
35mcg ethinyl estradiol 10mcg ethinyl estradiol
53
drosperinone pros and cons
decreased acne, hair excess, estrogen bloating increased risk of VTE
54
birth control patch cannot be used for which weights
BMI > 30 or weight over 90kg
55
duration a vaginal ring can be out for birth control
3 hours by manufacturer, others say 4 8 hours like others
56
vaginal ring for birth control and suppository rule
do not use oil based suppositories like those for miconazole
57
administration of progestin only birth control pills
must take within 3 hours of same time every day
58
birth control shot notes
can take up to 18 months to regain fertility decreases bone mineral density when used for years - reversible progressive weight gain
59
Side effects for long acting birth control
Period late - abnormal bleeding Abdominal pain Infection exposure, discharge Not feeling well, chills String missing
60
Weight limits on implanted birth control etonogestrel
Not studied in women > 130% ideal body weight
61
Ulipristal and resuming contraceptives note
Should not resume contraceptives hormonally for 5 days or decreases effectiveness of EC. This is a progesterone antagonist and birth control overrides it
62
High prolactin treatments
Bromocriptine 2.5mg daily Cabergoline 0.25mg BIW
63
Endometriosis drugs
Birth control GnRH agonist - goserelin, leuprolide, nafarelin, triptorelin GnRH antagonist - elagolix Danazol - androgen agonist Aromatize inhibitors - anastrozole, letrozole
64
Drugs for fertility
Clomiphene - 5 days early in cycle Aromatize inhibitors - letrozole, single births usually Human menopausal gonadotropin Human chorionic gonadotropin - given before implantation FSH - inj GnRH
65
HSV drug dosing - initial
Acyclovir 400mg TID Famciclovir 250mg TID Valacyclovir 1g BID 7-10 days
66
67
HSV treatment second time
Acyclovir 800mg BID X 5D or 800mg TID 2 days Famciclovir 125 BID 5d, or 250mg BID 5 D or 1g BID valacyclovir 500mg BIDx 3, or 1g daily x 5 days
68
Disseminated HSV
Acyclovir 5-10mg/kg IV q8h 2-7 days then oral for ten total days of therapy
69
HSV suppressive therapy
If > 6 episodes a year Acyclovir 400mg bid Famciclovir 250 bid Valacyclovir 500daily up to 1g if severe
70
Syphilis dosing
PCN 2.4 mil or doxy 100 bid 14d If over 90 days of injection go to 28d Latent or tertiary- PCN weekly x 3, doxy 4 wks
71
Neuro syphilis treatment
PCN 3-4 mil IV Q4h 10-14 days Ceftriaxone 2g
72
Chlamydia treatment
Doxy bid seven days Zmax 1g x 1 Levofloxacin 500 daily x 7
73
Gonorrhea tx
Ceftriaxone 0.5mg IM (1g if over 150kg) Gent 240 + zmax 2g
74
PID tx
Ceftriaxone 1g + doxy+ flagyl bid Cefotetan 2g q12h + doxy Cefoxitin 2g q6h + doxy Unasyn 3g q6h + doxy Clinda 900mg q8h + gent 2mg/kg, then 1.5 q8h IV for 24-48 hrs then oral to finish 14 days
75
Std. When should partners be treated?
90 days past for syphilis Past 60 days for others
76
Bacterial vaginosis tx
Flagyl 500 bid x 7 or clinda gel Hs Clinda 100mg PV HS x 3 Clinda 300mg bid x7 Tindazole 2g daily X2 or 1g x 5 Secnidazole 2g sache
77
Trichomoniasis tx
Flagyl 500mg bid x 7 Men 2 g x 1 Tindazole 2g x 1@
78
Prophylaxis for yeast infection
OTC vaginal 7 days course
79
Recurrent yeast infection tx
Fluconazole 100-200mg q72h x3 Or weekly x 6 months
80
Prostatitis tx
Cipro 500 bid or levaquin 750 daily Bactrim bid or trimethoprim 200bid 14-28 days
81
Chronic prostatitis
4-6 weeks, up to 12 wks Cipro 500bid, levaquin 750, ofloxacin or norfloxacin bid Mini cyclone 100mg bid, doxy 100 bid, bactrim bid
82
Epididymitis tx
Chlamydia, gonorrhea, enteric Ceftriaxone 0.5g (1g over 150kg) + doxy 10 days Enteral - levaquin 500 daily x 10
83
Timing of PDE 5 inhibitors
Tadalafil 5mg 36 hrs before or 5mg daily Sildenadil and other 30-1 he before

Notes (14 decks)

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