midterm questions Flashcards
what is Yohimbine used for?
erectile dysfunction- psychogenic
yohimbine MOA
alpha 2 antagonist that acts at brain center to control libido and penile erection
which medication for ED causes penile fibrosis and potential hepatotoxicity
papaverine
what are some RF for priapism? what drug do these factors cause a contraindication for?
RF: sick cell anemia, MM, leukemia, anatomical deformity of penis
causes contraindication for alprostadil (PGE1) injection
PGE1 MOA
increases AC = more cAMP and causes smooth muscle relaxation, vasoocclusion, and erection
which 2 ED drugs should not be taken with food
sildenafil, vardenafil
butea superba MOA
corpus cavernosum relaxation for ED- not recommended rn
how is L arginine used in ED
used with PDE5i if pt is resistant
what is the most common intracavernosal sympathomimetic for priapism
phenylephrine
what oral sympathomimetics can be used for priapism
terbutaline, pseudoephedrine
what are the conditions for a menopause diagnosis
12mths with no period + elevated FSH =>30mIU/ml
when are VMS of menopause most intense?
1. early evening
2. early morning
3. late evening
4. during sleep
1
what causes the change in vaginal pH from acidic to basic in menopause
decreased glycogen production
which of the following sx are more common in perimenopause than menopause
1. muscle/ joint pains
2. breast tenderness
3. headaches/ migraines
4. heart palpitations
5. low libido
6. dry skin or eyes
7. hair changes
select all that apply
2,3
how long does it take for isoflavones to work for menopausal sx
8-12wks
why is P used with E in MHT
endometrial protection from endometrial cancers caused by systemic estrogen
describe an EPT cyclic regimen
estrogeh continuous, progestogen for 12-14 days
what were the results of the womens health initiative RCT, EPT arm
increase in VTE (only sig result), stroke, CHD, breast cancer
decrease in hip fractures, CRC
what were the results of the womens health initiative RCT, ET arm
increase in VTE and stroke
decrease in hip fractures
what hormones were used int eh women’s health initiative RCT
medroxyprogesterone and CEE
what kind of estrogen in MHT can lower VTE risk
transdermal- but may just be due to lower systemic dose
what is considered strong family hx as a CI for MHT
2 or more first degree relatives prior to menopause
oral ET have a high first pass effect, resulting in increased
TG, SHBG, TBG, CRP
oral ET effect on lipids
1. increased HDL, lowered LDL
2. lowered HDL, lowered LDL
3. increased HDL, increased LDL
4. lowered HDL, increased LDL
1
when should you choose transdermal RT over oral
smoker, high TG, HPTN, low libido, VTE/ CVD, gallbladder disease
shift worker, migraines, malabsorption issues
0.625mg CEE = ___ 17b estradiol
1mg
0.625mg CEE = ___ patch
50ug
0.625mg CEE = ___ estrogel
1-2 pumps
0.625mg CEE = ___ EE
5ug
when is BTB normal with MHT? when should we investigate further?
normal 6-9mths, investigate if >12mthswhat is tibolone
what is tibolone
a STEAR
what is bazedosifen
a SERM with antagonistic ER effects on uterus and breast, agonist eff on bones
what is duavive
bazedoxifen + CE
4 nonhormonal rx meds for menopause? what do they do and how long does it take to kick in?
SSRI/SNRI = mood
oxybutynin = GSM
clonidine (meh)
gabapentin/ pregabalin = sleep
2-4wks
what is ospemaifene used for
oral SERM for vaginal dryness
CA-125 may be a lab test for
endo, but more specific for ovarian cancers- specificity may be increased if endo on ovaries
what is dienogest used for
management of pelvic pain for endo- as effective as leuprolide
is a progestin
what is danazol used for
endometriosis- an androgen that suppresses FSH/LH
what is the only nonreversible AE of danazol
lowering of voice
what are the 2 CI for danazol
severe liver disease, hyperlipidemia
what shoudl be monitored in danazol use
LFTs if using for >6mths
how long does it take buserelin to work
4-8wks
what is elagolis
a direct antagonist for GnRH used in endometriosis
when is add back therapy required for orilissa/ elagolis
> 200mg BID
what is LUNA
laparoscopic uterine nerve ablation
first line therapy for endo
CHC+ NSAIDs
progestins
2nd line therapy for endo
LNG_IUS or GnRH agonist/ antagonist + add back
third lien tx for endo
laparoscopy
what are some “other” options for endo
TCAs, SNRIs, gabapentinoids, muscle relaxants
trial 2-3mths
which endo tx are most associated with BTB
POP, danazol
which 3 endo tx are best for pain
POP, danazol, GnRH agonists
