Obstetrics & Gynecology Flashcards
What is a contraindication to an estrogen-containing patch?
-BMI > 30
How many hours can someone be late taking a progestin-only pill?
Within 3 hours of usual time (or 48 hours of backup contraception needed)
Which oral contraceptive is associated with reversible bone loss after 2 years+ of use?
Medroxyprogesterone
What are disadvantages of estrogen/progesterone products?
-Increased BP
-Increased risk of stroke + MI
-Increased risk of thromboembolic events
What are contraindications to estrogen-containing products?
-> 35 years old and smoking
-History of thromboembolism
What are disadvantages of progestin-only products?
-Irregular menses and increased risk of breakthrough bleeding
-Increased need for adherence
What are symptoms of estrogen deficiency?
-Vasomotor symptoms
-Breakthrough bleeding/spotting
-Decrease libido
-Dyspareunia
What are symptoms of progestin deficiency?
-Weight loss
-Heavy menstrual bleeding
-Dysmenorrhea
When may levonorgestrel be ineffective?
BMI > 25
When may ulipristal be ineffective?
BMI > 35
Why is transdermal estradiol w/ cyclin progestin used in amenorrhea?
to prevent bone loss
What medication is used to treat hyperprolactinemia?
Cabergoline
How much folic acid is recommended during pregnancy?
0.4 mg daily
How much iron is recommended during pregnancy?
27 mg daily (during 2nd and 3rd trimesters)
What is recommended first-line for N/V during pregnancy?
Vitamin B6 +/- doxylamine
What is recommended second-line for N/V during pregnancy?
-Diphenhydramine
-Prochlorperazine
-Promethazine
What is recommended third-line for N/V during pregnancy?
-Metoclopramide
-Ondansetron
-Trimethobenzamide
What medication used for GERD should be avoided in pregnancy?
Sodium bicarbonate
What medications used for constipation should be avoided in pregnancy?
-Castor oil
-Mineral oil
What medication used for diarrhea should be avoided in pregnancy?
Diphenoxylate + atropine
What medications used for pain should be avoided in pregnancy?
NSAIDs + aspirin (for longer than 48 hrs after 20 weeks gestation)
What is goal BP for gestational HTN?
120-160/80-110 mmHg
What is goal BP for chronic HTN in pregnancy?
< 140/90 mmHg
What is recommended first-line for HTN in pregnancy?
-Nifedipine
-Labetalolol
What is recommended second-line for HTN in pregnancy?
-Methyldopa
What is recommended first-line for DM in pregnancy?
Insulin
-Long-Acting: glargine or detemir, NPH
-Short-Acting: aspart or lispro
Which seizure medications should be avoided in pregnancy?
-Phenobarbital
-Phenytoin
-Valproic acid
Which anticoagulant(s) is preferred in pregnancy?
-Heparin (> 36 weeks or near delivery)
-Enoxaparin (< 36 weeks)
What must be given to postmenopausal women with an intact uterus?
Progestins
What are absolute contraindications to HT/ET in symptomatic postmenopausal women?
-VTE
-Known or suspected pregnancy
-Undiagnosed vaginal bleeding
-Breast cancer
-Active liver disease
-MI, stroke, or TIA
What are concerns with oral estrogen?
-GI intolerance
-Increase in triglycerides
-Liver disease
-Gallbladder disease
What forms of contraception should be avoided in patients with structural abnormalities of the uterus?
-IUDs
-Contraceptive sponge
What forms of contraception should be avoided in patients with history of cerebrovascular accident?
-Estrogen-containing
-Progestin-only
What is the first-line treatment for dysmenorrhea?
NSAIDs
What is the second-line treatment for dysmenorrhea?
Estrogen-progestin contraceptives (extended-interval dosing can decrease frequency of menses)
What type of contraception is contraindicated if SBP > 160 mmHg and/or DBP > 100 mmHg
Estrogen-containing
What is the optimal
dosing window for levonorgestrel?
72 hours
What is the optimal dosing window for ulipristal
120 hours
What are contraindications to getting an IUD inserted?
Active purulent cervicitis, chlamydia, or gonococcal infection
