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misc Flashcards

1
Q

A pt is prescribed Zoloft for depression and azithromycin to treat an infection. What will you do?

A

Both prolong QT, request an order for a different antibiotic. Can increase the risk of fatal dysrhythmias

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2
Q

Pt has a headache and takes some Tylenol. She was telling you about her headache and mentioned that after the Tylenol and wine she had, she felt better. What recommendations and/or education do you provide

A

combining Tylenol with alcohol can increase the risk of hepatotoxicity. Even one or 2 drinks can be dangerous

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3
Q

what systemic electrolyte imbalance affects Digoxin and how

A

in the presence of hypokalemia, the ability of Digoxin to induce dysrhythmias is greatly increased

pts receiving digoxin must undergo regular measurements of serum potassium

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4
Q

what type of tolerance refers to tolerance associated with long term administration of drugs such as morphine and heroin

  • increased drug levels are required to produce an effective response, the minimum effective concentration (MEC) of a drug becomes abnormally high.
  • you need more to get desired effect
A

pharmacodynamic tolerance

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5
Q

what type of tolerance is resulting from accelerated drug metabolism

this type of tolerance does not affect the MEC (minimum effective concentration). Dosage must be increased to maintain therapeutic levels due to the rate of drug metabolism

A

metabolic tolerance

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6
Q

what type of tolerance is resulting from a reduction in drug responsiveness brought on by repeated dosing over a short time

an example is transdermal nitroglycerin - effects are lost in less than 24 hours if the patch is left in place around the clock. This is due to the loss of effects from depletion of a cofactor required for nitroglycerin to act. When nitro is administered on an intermittent schedule, the cofactor can be replenished between doses and no loss of effect occurs.

A

Tachyphylaxis

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7
Q

the amount of an active drug that reaches the systemic circulation from its site of administration

A

Bioavailability

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8
Q

does diarrhea or constipation affect drug absorption?

A

yes

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9
Q

gender differences for Digoxin

A

when used to treat heart failure, digoxin may increase mortality in women while having no effect on mortality in men

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10
Q

gender differences for alcohol

A

alcohol is metabolized more slowly by women as opposed to men. A woman who drinks the same amount as a man (on a weight adjusted basis) will become more intoxicated.

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11
Q

gender differences for opioid analgesics (pentazocine, nalbuphine)

A

they are more effective in women then men

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12
Q

gender differences for Quinidine

A

causes greater QT prolongation in women then in men

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13
Q

what antihypertensive med can a asthma pt not take

A

b blocker

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14
Q

CYP variant for Tamoxifen

A

can greatly reduce the benefits of Tamoxifen which is used to prevent breast cancer recurrence. To work Tamoxifen must be converted to its active form endoxifen. Women with the CYP2D6 gene cannot activate the drug well, so they get minimal benefit from treatment.

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15
Q

CYP and Plavix

A

These people experience a weak antiplatelet response, which places them at increased risk for stroke, mI and other events. People with this genetic variation should use a different antiplatelet drug

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16
Q

CYP Isoniazid

A

a drug for tuberculosis. This increases chances for rapid metabolism of the drug. The rapid metabolizers may experience treatment failure.
The slow metabolizers may experience toxicity

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17
Q

CYP codeine

A

unable to convert codeine into morphine (the active form of codeine. As a result, codeine cannot relieve pain in these people

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18
Q

CYP and warfarin (Coumadin)

A

increase the risk for toxicity. metabolized warfarin slowly

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19
Q

CYP and thiopurine methyltransferase

A

delay metabolic inactivation of two thiopurine anticancer drugs, thioguanine and mercaptopurine. Pt with inherited deficiency, these drugs can accumulate to high levels, posing a risk for potentially fatal bone marrow damage

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20
Q

fluorouracil and cyp

A

about 1% of population produces a form of dihydropyrimidine dehydrogenase that does a poor job of metabolizing fluorouracil. Leads to toxic levels

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21
Q

genetic variation and fda recommendation for Carbamazepine (Tegretol)

A

HLA-B-1502 triggers a cellular immune response in patients of Asian descent. FDA recommends anyone of Asian descent to be screened prior to starting tegretol.

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22
Q

how long is the time for the serum levels to decrease by 50%

A

this number is equal to the half life of the drug

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23
Q

A ________of a drug must be present before a reaction occurs within the cells to bring about the desired therapeutic effect

A

critical concentration

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24
Q

A ________is obtained from absorption of a drug from the site of drug entry, distribution to the active site, metabolism in the liver, and excretion from the body to have a critical concentration

A

dynamic equilibrium

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25
Q

the ability of a drug to attach only to those systems found in foreign cells.

A

selective toxicity

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26
Q

the process that uses energy to actively move a molecule across a cell membrane

A

active transport

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27
Q

what can change absorption in an IM injection

A

environmental temp, cold can cause vasoconstriction and decrease absorption and heat can cause vasodilation and increase absorption

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28
Q

by the third trimester there is an accelerated clearance of drugs that are eliminated by glomerular filtration. What drug is given as the example that the elimination is increased by 100%

A

Lithium

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29
Q

3 seizure drugs are affected by the increased hepatic metabolism in the 3rd trimester

A

phenytoin
carbamazepine
valproic acid

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30
Q

bowel effects of drug elimination in pregnancy

A

tone and motility of bowel decrease in pregnancy. This causes intestinal transit time to increase. Because of prolonged transit, there is more time for drugs whose absorption is normally poor. This can lead to a prolongation of effects

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31
Q

heparin in pregnant patients

A

can cause osteoporosis, which in turn can cause compression fractures of the spine

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32
Q

prostaglandins in pregnancy (ie misoprostol)

A

stimulate uterine contraction which can cause abortion

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33
Q

ASA in pregnancy near term

A

can suppress contractions in labor and can increase the risk for serious bleeding

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34
Q

withdrawal symptoms in newborn

A

shrill crying
vomiting
extreme irritibility

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35
Q

teratogenesis preimplantation/presomite period

A

conception through week 2 - all or nothing. either death or they completely recover

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36
Q

Teratogenesis embryonic period

A

this is roughly the first trimester.(week 3-8) Gross malformations

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37
Q

Teratogenesis fetal period

A

week 9-term usually disrupts function rather than gross anatomy. growth and development of the brain are esp important. Can result in learning deficits and behavioral abnormalities

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38
Q

does lack of proof of teratogenicity mean that the drug is completely safe?

A

no, it just means that there may be insufficient data

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39
Q

does proof of teratogenicity mean that every exposure will result in a congenital anomaly?

A

no, the risk for malformation after exposure is only about 10%

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40
Q

Pregnancy risk categories

A 
A is remote risk
gets greater the further down
A
B
C
D
X - proven risk for fetal harm
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41
Q

what type of drugs cross the placenta more readily

A

lipid soluble drugs

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42
Q

what type of drugs have a harder time crossing the placenta

A

Drugs that are highly polar, ionized and protein bound

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43
Q

when a medication is given IV what is the difference between a infant and an adult

A

In an infant the levels decline more slowly. As a result the drug level in the infant remain above the MEC (minimum effective concentration) longer than in the adult, thereby causing effects to be prolonged.

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44
Q

when a drug is administered subcutaneously in an infant vs an adult

A

levels in the infant remain above the MEC longer than in the adult, but these levels also rise higher, causing effects to be more intense as well as prolonged

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45
Q

for drugs that are absorbed primarily from the stomach, delayed gastric emptying ______absorption

A

enhances

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46
Q

for drugs that are absorbed primarily from the intestine, absorption is ______

A

delayed

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47
Q

Gastric acidity after birth

A

is very low for 24 hours after birth and does not reach adult values for 2 years. Because of low acidity, absorption of acid-labile drug (drug that is easily destroyed in an acidic environment) is increased

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48
Q

transdermal absorption in infants

A

more rapid and complete in infants as opposed to older children and adults which makes them at increased risk for toxicity

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49
Q

complete maturation of the liver develops by

A

1 year

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50
Q

Adult levels of renal function are achieved by

A

1 year

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51
Q

children older than 1 metabolize drugs ____ than adults

A

faster. Drug -metabolizing capacity is elevated until 2 years then gradually declines

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52
Q

adverse drug reactions for kids caused by glucocorticoids

A

growth suppression

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53
Q

adverse drug reactions for kids caused by tetracyclines

A

discoloration of developing teeth

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54
Q

adverse drug reactions for kids caused by sulfonamides

A

kernicterus (brain damage from high levels of bili) also causes vision and teeth problems

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55
Q

As a rule, the ____ of an oral dose that becomes absorbed does not usually change with age. However, the ____ may change. As a result, drug responses may be somewhat delayed.

A

percentage, rate

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56
Q

What four major factors can alter drug distribution in older adults

A

1) increased % body fat
2) decreased % of lean body mass
3) decreased total body water
4) reduced concentration of serum albumin

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57
Q

the increase in body fat seen in older adults provides a storage depot for lipid soluble drugs which does what?

A

the plasma levels of these drugs are reduced, causing a reduction in responses

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58
Q

Because of the decline in lean body mass and total body water, water soluble drugs such as ethanol become what?

A

distributed in a smaller volume than in younger adults. This means the concentration of these drugs is increased, causing effects to be more intense.

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59
Q

in older adults what lab test properly measures renal function

A

creatinine clearance not serum creatinine levels - that can be normal even with renal function significantly reduced

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60
Q

what antihypertensive med is not as effective in older adults

A

b blockers

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61
Q

what is the Beers list

A

identifies drugs with high likelihood of causing adverse effects in older adults

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62
Q

which medications out of this list would you be concerned about an older adult taking? (On the BEERS list)

Tylenol
Zoloft
Allegra
Benadryl
Oxycodone
Amitriptyline (Elavil)
OTC laxative
Zolpidem (Ambien)
A

Amitriptyline (Elavil) - anticholinergic effects

Benadryl - causes blurred vision

and when given together they both have CNS effects that can compound on each other

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63
Q

meperidine (Demerol) and older adults

A

not as effective at usual doses and can cause confusion. Morphine is a better choice

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64
Q

progestogens

A

estrogens and progestins

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65
Q

the principal endogenous estrogen is

A

estradiol - produced by overies

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66
Q

the principal endogenous progestational hormone is

A

progesterone - produced by overies

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67
Q

what do the progestogens do

A

promote female maturation and help regulate the ongoing activity of the female reproductive organs. in addition, they affect bone mineralization and lipid metabolism

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68
Q

first half of the cycle - days 1-14 is what phase

A

follicular phase

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69
Q

second half of the cycle days 15-28 is what phase

A

luteal phase

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70
Q

what two pituitary hormones play central roles in regulating the menstrual cycle

A

LH and FSH

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71
Q

this hormone block bone resorption and may promote mineral deposition. During puberty when levels grow high enough they promote epiphyseal closure and bring linear growth to a stop. In postmenopausal women this can lead to osteoporosis

A

estrogen

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72
Q

estrogen and atherosclerosis and cholesterol

A

decrease atherosclerosis through fav effects on cholesterol

decrease LDL
increase HDL

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73
Q

estrogen and insulin

A

estrogen increases insulin sensitivity to promote glucose uptake

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74
Q

effects of decreased estrogen

A 
vasomotor symptoms - hot flashes, night sweats
sleep disturbances
urogenital atrophy
bone loss
altered lipid metabolism
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75
Q

mental changes in menopause

A

cognitive changes - difficulty in problem solving and short term memory loss around when menopause begins. Others experience depression or an increase in anxiety.

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76
Q

what are some causes of estrogen deficiency

A 
primary ovarian failure
hypopituitarism
bilateral oophorectomy (removal of both ovaries)
Turner syndrome (genetic disorder that impairs gonadal function)
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77
Q

estrogen therapy adverse effects

A

endometrial hyperplasia
endometrial cancer
breast cancer
cardiovascular thromboembolic events

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78
Q

the potential for endometrial hyperplasia and endometrial cancer with estrogen therapy can be resolved by prescribing a

A

progestin

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79
Q

is cholasma dangerous when seen as an adverse effect of estrogen replacement therapy

A

no but it may cause significant distress for some women

patchy brown facial discoloration

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80
Q

who should not take estrogen

A

History of DVT, PE, Stroke, MI

pregnant
history of liver disease, estrogen dependent tumors or breast cancer (except when used for treatment)

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81
Q

drug interactions for estrogen

A

Estrogens are major substrates of CYP1A2 and CYP3A4

  • inducers may lower estrogen levels
  • inhibitors may raise estrogen levels

may decrease effectiveness of some antidiabetic drugs and thyroid preparations

can also interact with anticoagulants

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82
Q

esterified estrogen

A

plant based

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83
Q

conjugated estrogen

A

natural preparations derived from the urine of pregnant horses

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84
Q

phytoestrogens

A

natural plant based
strong support for it but RCTs are inconsistent so they aren’t recommended but they also are not discouraged either

same risks as estrogen

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85
Q

what baseline data do you need for estrogen replacement

A 
HR
BP
weight
pregnancy test
TSH
serum triglyceride (or full lipid panel)
breast cancer screening
screening for heart disease
gynecologic exam if indicated
86
Q

monitoring for estrogen replacement

A 
BP
weight
serum triglycerides
TSH if on thyroid replacement
Regular breast and pelvic exams

endometrial biopsy for unscheduled bleeding that continues for 6 mos

87
Q

most common side effect of nausea that goes away with time

A

nausea

88
Q

tamoxifen (Nolvadex-D)
toremifene (Fareston)
raloxifene (Evista)
bazedoxifene (Duvavee)

A

SERMS (selective estrogen receptor modulators)

89
Q

what SERM is special in that it is used to prevent and treat breast cancer. This also protects against osteoporosis.

A

tamoxifen (Nolvadex-D)

produces hot flashes
increases risk for endometrial cancer and thromboembolism

90
Q

Which SERM is only approved for prevention and treatment of osteoporosis and for prevention of breast cancer in high risk women. This drug also does not pose a risk for uterine cancer

A

Raloxifene

91
Q

what is the SERM that is a estrogen agonist/antagonist that reduces the risk for excessive growth of the lining of the uterus that can occur with the estrogen component

A

Duavee (combination estrogens/basedoxifene)

contraindications are the same for other estrogen containing products

92
Q

what does progesterone affect

A 
endometrium
endocervical glands
breasts
body temp
respiration
mood
suppress the contraction of uterine smooth muscle
also suppresses contraction of GI smooth muscle - constipation
93
Q

Progestins are used in

A

menopausal hormone therapy
dysfunctional uterine bleeding
amenorrhea
endometrial hyperplasia and carcinoma (do not prolong life)

94
Q

3 drugs used for endometrial hyperplasia which is a potentially precancerous condition

A 
megestrol acetate (Megace)
medroxyprogesterone acetate (Provera)
Mirena IUD
95
Q

adverse effects of Progestins

A 
breast tenderness
headache
abd discomfort
arthralgias
depression
96
Q 
medroxyprogesterone acetate (Provera)
norethindrone (Micronor)
Norethindrone acetate (Aygestin)
megestrol acetate (Megace)
levonorgestrel (Plan B one step, Next choice)
Progeserone (Prometrium)
norgestimate, drospirenone sold as Prefest and Angeliq
Depo Prevara
Progesterone gel (Crinone)
Nexplanon (Sub q implant)
NuvaRing (vaginal ring)

all examples of

A

Progestins

97
Q

Baseline data for progestins

A

HR
BP
assess for fluid retention, including weight
transvaginal us for undiagnosed bleeding that continues for 6 mos

98
Q

pt education for progestins

A

report any abnormal or prolonged bleeding

99
Q

In hormone replacement therapy what is the purpose of the progestin

A

to counterbalance estrogen-mediated stimulation of the endometrium

100
Q

benefits of Hormone replacement therapy

A

controlling vasomotor symptoms, improved sleep, restoration of libido, improved cognition and enhanced mood

medical side - suppression of vasomotor symptoms, prevention of urogenital atrophy
prevention of osteoporosis

101
Q

risk for complications with hormone replacement therapy increase with ____

A

age

102
Q

to keep risk as low as possible HT should be used

A

in the lowest dosage and for the shortest time needed to accomplish treatment goals

103
Q

HT has only 3 approved indications

A

treatment of moderate to severe vasomotor symptoms secondary to menopause (treatment is 3-4 years)

treatment of genitourinary syndrome of menopause (treatment is 3-4 years)

prevention of postmenopausal osteoporosis - requires lifelong treatment so risk for harm is higher

104
Q

primary prevention of bone loss

A 
calcium
vit d
regular weight bearing exercise
avoid smoking
avoid excessive alcohol use
105
Q

to decrease risk of Heart disease postmenopausal women should

A

avoid smoking
perform regular aerobic exercise
decrease intake of saturated fats
take prescribed drugs for treatment of HTN, DM and High cholesterol

106
Q

what is dose tapering for d/c of hormone therapy

A

dosing is done every day but size of daily dose is gradually reduced. If intense symptoms return after a dosage reduction, further reductions are delayed until symptoms improve.

during the taper the progestin dose should remain unchanged so it does not stimulate endometrial growth which can lead to endometrial hyperplasia

107
Q

Day tapering for d/c of hormone therapy

A

the daily dose remains unchanged but the number of days between doses is gradually increased starting with dosing every other day, then every third day and so on.

during the taper the progestin dose should remain unchanged so it does not stimulate endometrial growth which can lead to endometrial hyperplasia

108
Q

Estring is for what and remains in the vagina for how long

A

estrogen replacement - 3 months

109
Q

estrogen in geriatric population

A

no

also not for prepubertal children, or pregnant or breastfeeding

110
Q

Flibanserin (Addyi)

Bremalanotide (Vyleesi)

A

drugs for management of Female Sexual Interest-Arousal Disorder (FSIAD)

111
Q

How long does it take for Flibanserin (Addyi) to work

A

requires daily doses for several weeks before benefits are seen (discontinue after 8 weeks if no improvement is seen)

112
Q

adverse reactions/risks for Flibanserin (Addyi)

A

CNS depression
Hypotension - with and without syncope

CYP3A4 so drug interactions are common

expensive!

113
Q

What must prescribers and pharmacies have enrollment and training with to prescribe Flibanserin (Addyi)

A

Risk Evaluation and Mitigation Strategy (REMS)

114
Q

How is Bremelanotide (Vyleesi) given

A

subcutaneous injection at least 45 min before sexual activity occurs

limit one dose in 24 hours and no more than 8 doses in a month

115
Q

side effects for Bremelanotide (Vyleesi)

A

n/v
flushing
headache
injection site reaction
transient rise in BP can occur lasting up to 12 hours after dose
1% had darkening of gums and portions of skin

116
Q

what estrogen has local with no systemic affects and bypasses the liver used primarily to treat vulval and vaginal atrophy

A

Premarin vaginal

117
Q

what type of estrogen therapy has fewer side effects (route of administration)

A

transdermal

118
Q

If a pt has had a hysterectomy, what hormones are needed to control postmenopausal symptoms

A

Estrogen

Progestin is not necessary due to the hysterectomy

119
Q

most effective methods of birth control are

A

etonogestrel implant (Nexplanon)
IUD
sterilization

120
Q

what are the two categories of oral contraceptives

A

estrogen plus a progestin - combination OCs (used most often)
Progestin only known as Minipills

121
Q

adverse effects of combo OCs

A

nausea
menstrual irregularity
thromboembolic disorders

122
Q

absolute contraindications for combo ocs

A 
Thromboembolic disorders
cerebral vascular disease
a condition that exposes them to the above 
abnormal liver function
known or suspected breast cancer
undiagnosed abnormal vaginal bleeding
known or suspected pregnancy
smokers older than 35
123
Q

relative contraindications for combo ocs (use with caution)

A 
HTN
Cardiac disease
DM
History of cholestatic jaundice of pregnancy
gallbladder disease
uterine leiomyoma
epilepsy
migraine
124
Q

what two progestins carry the greatest risk

A

drospirenone

desogestrel

125
Q

what are the lower risk progestins for OCs

A

Ethynodiol diacetate

Norethindrone

126
Q

Pt education for combo OC use

A

consult prescriber for symptoms of thrombosis or embolism

  • leg tenderness or pain
  • sudden chest pain
  • shortness of breath
  • severe headache
  • sudden visual disturbance
127
Q

women with a history of a thrombosis should avoid what oral contraceptive and can take what

A

avoid estrogen/progestin products

can still use a progestin only method such as Mirena, Depo-Provera
Nexplanon
Minipill

128
Q

Oral contraceptives protect against what type of cancer

A

ovarian
endometrial cancer

they have no effect on cervical cancer - caused by HPV

129
Q

Oral OCs and hypertension

A

can cause but low risk
you can either dc oc
or add on antihypertensive

130
Q

what type of OC is preferred for breastfeeding moms

A

progestin only OCs have little or no effect on milk production

Later on when milk supply is well established and addition of solids to the infants diet has occurred, combo ocs can be resumed

131
Q

OCs in women with history of migraines

A

increase risk for thrombotic stroke
absolute increase il low
if they are younger than 35, do not smoke and are healthy this they do not have auras it is considered generally safe

132
Q

OCs can ____ blood glucose

A

elevate (caused by the progestins)

133
Q

glucose intolerance may be less likely to occur with OCs that contain ______ or ______

A

desogestrel

norgestimate

134
Q

noncontraceptive benefits of oral contraceptives

A 
decreases risk of 
ovarian cancer
endometrial cancer
ovarian cysts
PID
benign breast disease
iron deficiency anemia
acne
in menstrual associated migraines (OCs can reduce migraine frequency)
may even benefit women with RA
135
Q

cyp and OCs

A

Products that induce CYP can accelerate OC metabolism and can reduce OC effects

136
Q

OCs and Warfarin

A

can decrease the effectiveness of Warfarin

137
Q

OCs can impair the hepatic metabolism of what agents

A

theophylline (bronchodilator )
tricyclic antidepressants (Amitriptyline, Nortriptyline)
Diazepam (Ativan)
Chlordiazepoxide (Librium) - treat anxiety

watch for signs of toxicity

138
Q

what combo oc also has levomefolate (a metabolite of folic acid) to reduce risk for neural tube defects if pregnancy would to occur

A

Beyaz
YAZ plus
Safyral
Tydemy

139
Q

what combo OC do you not need to monitor potassium levels in

A

Natazia (ESTRADIOL VALERATE/DIENOGEST)

140
Q

for starting a birth control sequence, which option is protection conferred immediately?

A

if the sequence is begun on the first day of the menstrual cycle

141
Q

for starting a birth control sequence, which option is done so that menses occur on weekdays rather than the weekend? what is the downside

A

starting the first Sunday after menses

protection is not immediate and an alternate form of birth control should be used during the first 7 days of the pill pack

142
Q

how do you take oral birth control

A

Take at the same time every day with a meal or at bedtime.

143
Q

explain the extended cycle method using monophasic combo OCs

A

purchase 4 packets of a 28 day product and then take the active pills for 84 days straight. The drugs suppress the endometrial thickening thus monthly bleeding is not required to slough off hypertrophied tissue

benefits - decreases episodes of withdrawal bleeding, the associated menstrual pain, premenstrual symptoms, headaches and other problems

144
Q

for the extended/continual cycle dosing of combo ocs, when the pills have been taken previously for 3 weeks, how long can be missed with little to no increased risk of pregnancy

A

7

145
Q

what adverse affects that are seen in combo ocs are not seen with minipills

A

they do not cause thromboembolic disorders, headaches, nausea, or most of the other side effects

146
Q

downside to the minipills

A

less effective and more likely to cause irregular bleeding

taking a pill even 3 hours late can reduce their efficacy and back up protection is recommended for at least 2 days

147
Q

Xulane Patch (ethinyl estradiol/norelgestromin)

A

same mechanism as combo OCs
apply patch during the first 24 hrs of menstrual period

if patch becomes partially or completely detached, replace. If the patch has been off more than 24 hours , a new cycle will need to be started with backup contraception for 7 days

148
Q

which patch causes a higher incidence of discomfort and dysmenorrhea

A

Triphasil patch

149
Q

NuvaRing (etonogestrel, ethinyl estradiol) instructions

A

combo OC
insert and leave for 3 weeks then remove
insert new one week later even if still having withdrawal bleeding
If its expelled before 3 weeks, it can be rinsed off in warm water (not hot) and reinserted
if more than 3 hours pass, use back up contraception for 7 days

150
Q

most common side effects of NuvaRing

A 
vaginitis
headaches
upper resp infection
leukorrhea (whitish discharge, thick)
sinusitis
weight gain
nausea

serious adverse effects
thrombosis
embolism
HTN

151
Q

Nexplanon (etonogestrel)

A

Progestin Birth control
rod is implanted subdermally in the groove between biceps and triceps in the nondominant arm
provides contraception for 3 years

152
Q

drugs that reduce efficacy of Nexplanon and should not be used

A

agents that induce hepatic enzymes

  • barbiturates (-barbital) antiseizure
  • phenytoin - (antiseizure)
  • rifampin(Abx - used to treat TB)
  • carbamazepine (Tegretol) seizures
  • topiramate (topamax) Migraine
  • HIV protease inhibitors
  • St johns wort
153
Q

Nexplanon is safe to use during breastfeeding after the ___ postpartum day

A

21st

154
Q

Depot Medroxyprogesterone Acetate

A

given Im or subq every 3 months

progestin

155
Q

what form of birth control poses a reversible risk for bone loss

A

Depot Medroxyprogesterone Acetate

156
Q

IUDs screening prior to insertion

A

Gonorrhea and chlamydia due to associated risk of PID

157
Q

IUDs can cause cramping and alteration of menses. Most intense upon insertion. What can be done to help

A

minimized by applying a topical anesthetic (2% lidocaine intracervical gel) or by premediating with ibuprofen

158
Q

2 classes of IUDs

A

Hormone free Copper IUD (TCu380A or Paragard)

Levonorgestrel containing IUD

159
Q

How are spermicides used

A

before intercourse but no more than 1 hour in advance. must be reapplied each time intercourse is anticipated.
douching should be postponed for at least 6 hours post coitus

160
Q

How are contraceptive sponges used (Today Sponge)

A

a single sponge is effective for 24 hours regardless of how often coitus takes place. After 24 hours, the sponge should be removed. Rates of unintended pregnancy are high

causes vaginal irritation and dryness

161
Q

two types of Emergency contraception

A

morning after pill

inserting a copper-T IUD

162
Q

Plan B One step
Next Choice one dose
next choice

A

Progestin only emergency contraception

OTC for ages 15 and older

most effective within 3 days of intercourse

163
Q

How many days after intercourse can the ECPs still be effective

A

earlier is best

up to 5 days

164
Q

will Plan B one step and Next choice one dose cause major congenital malformations if pregnancy still occurs

A

no

165
Q

Will plan B one step or Next choice terminate a existing pregnancy or harm a fetus if present

A

no

166
Q

Ulipristal acetate (ella)

A

remains highly effective when taken up to 5 days after intercourse

requires a prescription

167
Q

what is Mifepristone (Mifeprex)

A

abortifacient drug

cotreatment of misoprostol is required

168
Q

serious adverse effect for using Mifepriston (Mifeprex) and Misoprostol

A

sepsis and fatal septic shock

169
Q

contraindications to Mifepriston (Mifeprex)

A

ectopic pregnancy
hemorrhagic disorders
anticoagulant drugs

blocks receptors for glucocorticoids - should not be used in women with adrenal insufficiency on long term glucocorticoid therapy

170
Q

Pt should stop taking oral contraceptives how long before surgery

A

4 weeks

171
Q

if you have multiple sexual partners, what form of birth control puts you at increased risk of STDs

A

IUD

172
Q

spermicides containing nonoxynol-9 have been linked to increased transmission of

A

HIV

173
Q

depot shot should be given when

A

during first 5 days of menstrual period

174
Q

siladenafil (Viagra)
tadalafil
vardenafil
avanafil

A

PDE-5 inhibitors for Erectile dysfunction

175
Q

siladenafil (Viagra) can be dangerous if they are taking

A

certain vasodilators
B blockers - can cause severe hypotension
nitroglycerin
nitrates for angina

176
Q

You should stop using Viagra if you experience

A

hearing loss

177
Q

when is Siladenafil (Vilagra), tadalafil or vardenafil taken

A

1 hour before sexual intercourse

178
Q

pt education when taking PDE-5 inhibitors for ED

A

can take with or without food, avoid a high fat meal with the exception of tadalafil

Avoid grapefruit juice (raise PDE5 inhibitor levels)

men with cardiovascular disease- if you experience angina pain, lightheadedness during sex-refrain from further sexual activity and discuss event with provider

go to ER for erection lasting more than 4 hours (can cause permanent damage) (Priapism)

stop med and seek immediate medical attention if experience sudden vision loss in one or both eyes or if hearing loss develops

179
Q

Take avanafil approx ____ min before sex, avoid nitrates for at least ___ hours after taking avanafil

A

15-30 min
12 hours
due to hypotension

180
Q

How long to avoid nitrates after taking sildenafil or vardenafil

A

24 hours

due to hypotension

181
Q

how long to avoid nitrates after taking tadalafil

A

48 hours

due to hypotension

182
Q

adverse effects of Siladenafil

A

headache
flushing
dyspepsia

also
nasal congestion
diarrhea
rash
dizziness
may worsen sleep apnea
183
Q

what PDE5 inhibitor can cause QT prolongation

A

Vardenafil

184
Q

when taking tadalafil avoid b blockers due to drop in BP except

A

tamsulosin

185
Q

For the PDE 5 inhibitors, reduce dosing if pt is also on

A

CYP3A4 inhibitors (ketoconazole- antifungal, ritonavir-HIV treatment, erythromycin, cimetidine, grapefruit juice)

186
Q

cardiac drugs that can can cause ED

A 
Digoxin
Clonidine (Catapres)
Propanolol 
Hydrochlorthiazide
Spironolactone
187
Q

CNS drugs can cause ED

A 
Prozac
Isocarboxazid (Marplan)
Amitriptyline (Elavil)
Chlorpromazine (Thorazine)
Lithium 
Alcohol
188
Q

Urogenital drugs that can cause ED

A

Finasteride (Proscar)

189
Q

older adult consideration for PDE 5 inhibitors

A

consider lower dosing for adults 65 and older

190
Q

what food should be avoided when taking PDE 5 inhibitors

A

Grapefruit juice

alcohol

191
Q

effects of tadalafil lasts for

A

36 hours and has fastest onset of action

192
Q

Which PDE 5 inhibitor has adverse effects of headache, dyspepsia, back pain, myalgia, limb pain, flushing and nasal congestion. Very rarely the drug can alter color vision

A

Tadalafil

193
Q

which PDE 5 inhibitor has the fastest onset

A

Avanafil

194
Q

what PDE 5 inhibitor is the only one approved for daily dosing

A

Tadalafil

195
Q

overgrowth of epithelial cells causes ________of the urethra in men

A

mechanical obstruction

196
Q

overgrowth of smooth muscle causes ______ of the urethra in men

A

dynamic obstruction

197
Q 
urinary hesitancy
urinary urgency
increased frequency of urination
dysuria
nocturia
straining to void
postvoid dribbling
decreased force and caliber of the urinary stream
sensation of incomplete bladder emptying

symptoms of

A

BPH

198
Q

what drug class is best used for mechanical obstruction of the prostate - very large prostate

A

5 alpha reductase inhibitors (Finasteride, dutasteride)

on it for life

199
Q

what drug class is best used for dynamic obstruction of the prostate - relatively small prostate

A

Alpha blockers

200
Q

Finasteride, dutasteride

A

5 alpha reductase inhibitors

-reduces prostate size and takes several months for a noticeable effect (6-12 months)

201
Q

Finasteride

A

protects against low grade prostate cancer
can decrease libido
gynecomastia
teratogenic

202
Q

pt education for Finasteride and dutasteride

A

Women should not handle this drug
men who are taking this drug cannot donate blood

for dutasteride
do not break open capsules to sprinkle on food
must be swallowed due to irritation of the oropharyngeal mucosa

203
Q

monitoring while taking Finasteride

A 
PSA levels (marker for prostate cancer)
should be determined before treatment and 6 months later. These numbers should decline 30-50% 
if they do not fall, pt should be evaluated for prostate cancer
204
Q

half life of dutasteride

A

very long - 5 weeks

205
Q 
alfuzosin (Uroxatral)
terazosin (Hytrin)
doxazosin (cardura)
Silodosin (Rapaflo)
Tamsulosin (Flomax)
A

Alpha Adrenergic Antagonists

206
Q

which 3 alpha adrenergic antagonists also cause hypotension

A

alfuzosin, terazosin, doxazosin

207
Q

what 2 alpha adrenergic antagonists have no effect on BP

A

silodosin

tamsulosin

208
Q

men who are anticipating cataract surgery should

A

Postpone use of an alpha adrenergic antagonist until after surgery due to risk of floppy iris syndrome

209
Q

strong inhibitors of CYP3A4 can dramatically ____ the levels of alfuzosin and silodosin

A

increase

210
Q

what medication is approved for men who have BPH and ED

A

Tadalafil

pharm comprehensive prep (4 decks)

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