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Pharmacotheraputics > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

Classes of Drugs

A

estrogens

SERMs

progestogens

progesterone agonist/antagonist

androgens

anti-androgens

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2
Q

DEA drug schedule class I

A

high abuve potential with no accepted medical use *heroin, LSD

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3
Q

DEA drug schedule class II

A

high potential for abuse, some medical indications with high restrictions (morphine, cocaine, oxycodone)

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4
Q

DEA drug schedule class III

A

less abuse potential than I and II, all have accepted medical uses (codeine, steroids, marinol)

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5
Q

DEA drug schedule class IV

A

low potential for abuse, accepted medical uses (benzodiazepines, phenobarbitol)

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6
Q

DEA drug schedule class V

A

lowest abuse potential (low dose codeine, opium, pregabalin

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7
Q

FDA use in pregnancy ratings category A

B

C

D

X

A

controlled studies show no risk

no evidence of risk in humans but no controlled studies

risk cannot be ruled out OR animal studies show risk to fetus

positive evidence of risk but benefits may outweigh risks

contraindicated in pregnancy

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8
Q

where do most drugs fall on the FDA use in pregnancy list

A

category B and C

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9
Q

how is the FDA safe in pregnancy list changing as of 2015

A
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10
Q

trends in worldwide contraception, what is used most

A

sterilization 20%

IUD 15%

oral 8%

condom 5%

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11
Q

what types of contraception are used most in developing nations

A

injectable contraceptives and IUDs

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12
Q

what types of contraception are considered (SC) steroid contraception

A

oral

patches

nuvaring

intramuscular

progestin IUD

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13
Q

general strategies used to make contraceptives work

A

block sperm

block ovulation

block sperm access to the cervix

block sperm transit through the uterus

block fallopian tubes

block embryo implantation

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14
Q

types of male contraceptives

A

permanent (vasectomy)

reversible (barrier contraception, gonadotropin suppression)

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15
Q

how does gonadotropin based male contraception work

what is the failure rate

A

testosterone enanthate/undeconoate injections to suppress FSH and cause azosperima or oligospermia

2-3%

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16
Q

how long does injected male contraception take to work

what are the draw backs

A

8-12 weeks to reach 90% azoospermia

requires frequent follow up for injections and semen analysis

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17
Q

how does contraception block ovulation

what drugs use this method

A

suppression of FSH

steroid contraceptives, GnRH analogs (lupron)

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18
Q

steroid components of contraceptives:

estrogens

progestins

A

estrogens: ethinyl estradiol (most common), estradiol valerate, mestranol
progestins: >8 forms, 21 carbon deriviatives, 19-notestosterone dervitives, estranes, gonanes

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19
Q

common steroid contracptive doses:

estrogen

progestin

A

estrogen: 10-50mcg
progestin: 0.15-1mg

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20
Q

adverse side effects of estrogen contraception

A

increased clotting (increased risk of DVT, MI, CVA)

activaion of RAA cycle (5% risk of HTN, poss fluid retention)

increase in cholestasis

increased risk of endometrial hyperplasia if not given with progestins

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21
Q

mortality related to estrogen use

A

MI

venous thrombosis

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22
Q

Why are estrogen contraceptives contraindicated for smokers over 35

A

there is a significant increased risk of MI compared to non-smokers

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23
Q

at what point in using estrogen contraceptives is the risk of venous thrombosis minimal

A

2 years

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24
Q

T/F Pregnancy is safer than usings OC

A

false, OC is much safer than pregnancy

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25
Q

issues related to progestin contraception

A

lipid changes

some are androgenic

can cause dysphoria

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26
Q

lipid changes associated with progestin

A

Triglycerides and LDL go up, HDL goes down

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27
Q

2 21 carbon progestin choices

how many 19-nortestosterone progestins are there

A

provera, progesterone

four generations with over dozens of choices

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28
Q

issues with fourth generation progestin contraception

A
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29
Q

why are GnRH analogs not used to for contraception

A

because it would cause an extreme loss of estrogen and put women at risk for heart disease and osteoporosis if they aren’t added back

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30
Q

why is ethinyl estradiol the most commonly used estrogenn for OC

A

because it is well absorbed orally

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31
Q

if a patient presents a medication for oral contraception called mestranol 1/50, what does the 1/50 mean

A

1 is the dose of progestin, 50 is to dose of estradiol

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32
Q

what are the advantages of combined estrogen/progestin OC

what is the function of progestin

estrogen

A

highly effective

progestin blocks ovulation and makes cervical unimplantable

estrogen controls uterine bleeding with a 3 weeks on, 1 wk off

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33
Q

T/F period are necessary to maintain health

A

false, estrogen flucuaton is

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34
Q

methods of oral contraception adminstration

A

cyclic with a fixed dose or triphasic dose

continuous

35
Q

why is HTN related to estrogen contraception not as common anymore

A

because pills used to be much high dose and the risk of HTN is dose dependany

36
Q

T/F it is possible to take OC continuously without time off for menstruation

A

true

37
Q

three types of non-cyclic OCs

A

seasonale (7 placebos that give 3 periods)

seasonique (only one period at the end)

Lybrel (no periods, continuous

38
Q

advantages of non-cyclic OCs

A

less dysmenorrhea and issues with endometriosis

fewer hormone flucuations lead to less premenstrual dysphoria and menstrual migranes

39
Q

issues with non-cyclic OC use

A

more total hormone doses mean more exposure and cost

breakthrough bleeding

40
Q

how to deal with breakthrough bleeding related to non-cyclic OC use

A

if its mild reassure that patient that all is well

persistent, withdraw treatment for 1 wk then resume

41
Q

issues with fourth generation progestin use

A

blocks to effect of aldosterone that prevents fluid retention but increases the risk of hyperkalemia

drospirenone seems to increase thrombosis risk

42
Q

describe what makes triphasic OCs unique

A

estrogen and progestins vary during the cycle

mimics a normal cycle

43
Q

what issues are found with triphasic OCs

A

some individuals will have menstrual migrains and PMS

44
Q

what percent of pregnancy are the result of contraceptive failures

how many women miss 1 pill/mo

3/mo

when is it most dangerous to miss a pill

A

50%

50%

30%

at the beginning of a pill pack

45
Q

possible issues with contraceptive patches

A

some patch adhesive reactions

less effective in women over 200lvs

46
Q

are contraceptive patches safe

A

yes, early studies show a higher risk of DVT and PE due to higher estradiol levels but recent studies don’t bear that out

47
Q

what issues are associated with vaginal ring contraceptive use

A

the ring can fall out

if the ring isn’t inserted on day 1 after the break it can cause failure

48
Q

if contraception starts on cycle day 1 or 2, when will they take effect

what if you start whenever you want

A

contraception starts immediately

restart with a new pack after the first period and use condoms until the second pack

49
Q

side effects related to estrogen oral contraceptives

progestin

A

breast tenderness, nausea, fluid retention

dysphoria, breast tenderness, oily skin, fat gain

50
Q

how likley is breakthrough bleeding to occur with OC use

what should you do if this occurs

A

5-30% in the first two cycles

warn them ahead of time, reassure them

change to a different pill with more estradiol or add a short course of extra extrogen

51
Q

what challenges are there in prescribing OCs to women under 30

A

there are compliance issues due to side effects

the side effects don’t outweigh the risk of getting pregnant

52
Q

what a challenges are found with women over 35 and contraceptive use

A

they never want to quit, but if they are smoking or have HTN, DM, etc they need to stop

53
Q

absolute contraindications for OC

A

smokers after age 35

undiagnosed breast tumors

undiagnosed vaginal bleeding

acute liver disease

history of DVT or hypercoagulation

54
Q

two factors that will reduce OC efficacy

A

large body size and drug interactions

55
Q

drug interactions associated with decreasd OC efficacy

A

st johns wort

some anti convulsants

anti fungal agents

56
Q

advantages of OC

A

reduced quantity and duration of menstrual bleeding

reduced dysmenorrhea

predictable periods or no periods

reduced risk of uterine and ovarian cancer

57
Q

what happens that makes missing OC pills risky

A

follicular development is still happening, if the pill isn’t resumed fast enough the follicle may survive and they may ovulate

58
Q

T/F OC does not effect future fertility

A

true

59
Q

where can OC patches NOT be placed

A

over bony prominences or on your breasts

60
Q

guidelines to decide which OC to use

A

match estrogen to body size

use 2nd, 3rd, 4th generation progestin

be familiar with 4-5 brands with different progestins

go with what the patient tells you

61
Q

general guidelines to match estrogen to body size

A

15-20 mcg for small to average size women

30-35 mcg for larger women

62
Q

what is the advantage to starting OC on the first sunday after a period

disadvantage

A

you will have your period on a monday or tuesday vs the weekend

you have to use condoms for the first month

63
Q

T/F progestins are more effective than other OCs

issues related

A

false, they are slightly less effective

irregular bleeding, metabolic changes

64
Q

choices for long acting reversible contraception (LARC)

A

injectable progestins

implantable progestins

IUDs

injectable GnRH analogs

65
Q

side effects related to injectable progestin contraception

A

bleeding, weight gain, dysphoria

66
Q

concerns related to injectable progestins

A

CV/lipid concerns

probably bone loss (Low E2)

female sexual dysfunction from low androgens and dysphoria

67
Q

types of implantable progestins

side effects

A

implanon, nexplanon

risks and side effects similar to progestins

68
Q

how does plan B prevent or dely ovulation

A

disrupting follicle growth or blunting the LH surge

69
Q

what is the method of action for IUDs

A

inflammatory response that blocks the passage of sperm

70
Q

progestine blockers for emergency contraception uses

mirepristone

ulipristal

A

will terminate a pregnancy before 7 wks; contraception; used to treat cushings

71
Q

goals of menopausal hormone support

A

reduce/prevent hot flashes

improve sleep to improve cognition and reduce depression

prevent bone loss

maintain healt of the GI system

72
Q

health risks associated with menopause HRT

A

cardiovascular risk

breast cancer risk increase

probably no help in cognition

73
Q

five possible treatments of hot flashes

A

estrogen (high efficacy)

SSRI (moderate to good)

gabapentin (moderate)

progestin (moderate)

clonidine (some help)

74
Q

two types of vaginal estrogen creams

what are they used for

A

estradiol and conjugated estrogens

treatment of vaginal atrophy (dysparenunia, urinary incontinence/urgency)

75
Q

risks of unopposed estrogen

how to fix this

A

endometrial hyperplasia and carcinoma

if there is a uterus you must add progestin

76
Q

common methods of estrogen replacement

A

estradiol (tablets, patch, spray)

conjugated estrogens

+ progesins (combipatch, prempro, fem HRT)

77
Q

strategy for dosing estrogen for HRT pills

A

start with a moderate dose that can be titrated up or down based on relief of symptoms

78
Q

why would you use vaginal vs oral estrogen

A

vaginal creams for vagina atrophy, orals for hot flashes

79
Q

is there an advantage to used in progestin on a daily vs cyclic schedule

A

no, in fact you take a lower total dose with continuous scheduling

80
Q

three SERMs and their uses

A

tamoxifen (nolvadex) breast cancer prevention and treatment

raloxifene (evista) osteoporosis

bazedoxifene (duavee) SERM + estrogen for HRT

81
Q

what is the benefit of giving a SERMs with estrogen for HRT

A

blocks estrogen receptors in the breast and uterus so there is no need for progestin

82
Q

should HRT be used for every

A

no, focus on those with significant hot flashes for 3-5 years

83
Q
A

Pharmacotheraputics (10 decks)

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