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Pharm 37 Flashcards

1
Q

estrogen effects on liver function

A

a. Decreased LDL
b. Decreased lipoprotein (A)
i. Less plaque buildup in atherosclerotic disease
c. Increased HDL
d. Increased cholesterol secretion
i. Increased gallstones and incidence of gallbladder disease

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2
Q

estrogen effects on clotting factors

A

Increased blood clotting factors due to increased synthesis of the factors

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3
Q

estrogen effects on thyroid function

A

a. Oral estrogens increase the thyroxine binding globulin (TBG - the protein made by the liver that binds T4) due to the strong hepatic first pass effect
b. This leads to lower levels of free T4 and hypothyroidism

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4
Q

estrogen effects on adrenocortical function

A

a. Estrogen lowers levels of aldosterone (which means lower BP!)
b. Estrogen also increases angiotensin II (vasoconstrictor) to increase the BP

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5
Q

suppresses ovulation through suppression of FSH

A

MOA of estrogens

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6
Q

most potent oral estrogen

A

Diethylstilbestrol

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7
Q

most commonly used estrogen

A

Ethinyl estradiol (EE)

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8
Q

i) Prevention of osteoporosis in postmenopausal women

Reduces risk of breast cancer too!

A

Raloxifene

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9
Q

Contraindications of Raloxifene

A

Hx of VTE/stroke

Pregnancy

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10
Q

Moderate to severe dyspareunia due to vaginal/vulvar atrophy in postmenopausal women

A

Ospemifene

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11
Q

ADE of Ospemifene

A

increased menopasual vasomotor sx

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12
Q

contraindications of Ospemifene

A

Hx of VTE/stroke

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13
Q

i) Relief of moderate to severe menopause vasomotor symptoms

Prevents osteoporosis in postmenopausal women

A

Bazedoxifene/Conjugated Estrogens

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14
Q

inhibits LH surge to suppress ovulation, thickens cervical mucus, interferes with implantation

A

progestins

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15
Q

progesterone is usually in the form of…

A

medroxyprogesterone acetate (MPA)

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16
Q

Indications of progesterone

A

i) Contraception ii) Dysmenorrhea
iii) Endometriosis
iv) Post-coital contraception

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17
Q

2nd most androgenic progestins

A

norethindrone

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18
Q

most androgenic progestins

A

Levonorgestrel

Norgestrel

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19
Q

anti-androgens

A

drospierenone

dienogest

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20
Q

testosterone / nortestosterone drugs (4)

A

Levonorgestrel
Norgestrel
norethindrone
desogestrel

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21
Q

spironolactones (2)

A

Drospierenone

dienogest

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22
Q

i) Drugs that are:

Anti-androgenic

Anti-aldosterone (appear to lose weight when really just not gaining water from salt retention)

A

Drospierenone

dienogest

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23
Q

ADE of drospierenone, dienogest

A

i) K+ retention and Hyperkalemia

Drug interaction with St. John’s wort and carbamazepine

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24
Q

Contraindications of drospierenone, dienogest

A

Renal dysfunction

25
a) Suppress FSH secretion and ovulation b) Suppress endometrial lining c) Thickens cervical mucus d) Hampers ovum transport e) Interferes with implantation
effects of combo OCPs
26
Indications for COC's
a) Contraception b) Acne c) Dysmenorrhea d) Recurrent ovarian cysts e) Premenstrual syndrome/PMDD f) Post-coital contraception
27
ADE of estrogens (2)
1) N/V (estrogen) 2) HTN (estrogen) 3) increased coagulability
28
ADE of COC's (2)
1) HA (estrogen, progestin) | 2) Breast tenderness (estrogen, progestin)
29
ADE of progestins (2)
1) Fatigue (progestin) | 2) Mood changes (progestin)
30
ADE of androgens (4)
1) Weight gain (androgens) 2) Oily skin/acne (androgens) 3) Hirsutism (androgens) 4) Increased LDL / decreased HDL (androgens)
31
Contraindications to COC's (12)
1) DVT, PE or hx 2) Stroke or hx 3) Breast cancer or hx 4) Coagulopathy 5) Known/suspected pregnancy 6) Breastfeeding < 21 days postpartum 7) Age > 35 and > 15 cigarettes a day (20 in a pack) 8) Heart disease 9) Severe HTN (systolic >160 or diastolic >100) 10) Major surgery with prolonged immobilization (can induce a coagulable state) 11) Migraine with aura (suggestive of stroke instead) 12) Liver cancer or severe cirrhosis (impairs estrogen metabolism leading to increased coagulability)
32
suppresses ovulation, FSH secretion
estrogen
33
suppresses LH to prevent ovulation, increases cervical mucus, prevents implantation
Progestin
34
prevent estrogen production; similar to progesterone
Androgens
35
drugs that affect contraceptives
ABXs PCNs/tetracyclines Rifampin Griseofulvin
36
having more N/V
Decrease estrogen
37
having vasomotor sx, early to mid-cycle spotting
Increases estrogen
38
having late cycle spotting
Increase progestin
39
having more mood changes or breast tenderness
Decrease progestin
40
low estrogen levels
= < 20 mcg
41
moderate estrogen levels
25, 30, 35 mcg, 40 mcg
42
high estrogen levels
50mcg
43
Least androgenic (not anti-androgenic!)
Desogestrel | Norgestimate
44
types of contraceptives that are not pills (5)
``` injection patch vaginal ring implant IUD ```
45
vaginal ring limitations
BMI > 29
46
patch limitations
198 pounds (90kg)
47
unique patch formulation
has MUCH higher levels of estrogens and thus can have a way higher risk for DVT/stroke
48
indications for progestin only contraceptives (4)
a. Contraception b. Dysmenorrhea c. Endometriosis d. Post-coital contraception
49
advantages of progestin only contraceptives (3)
a. Less interference with breast feeding b. Less risk of thromboembolism c. No estrogenic side effects
50
disadvantages of progestin only contraceptives (3)
a. Must be taken at the same time every day b. Take every day c. Less effective
51
BV tx
Metronidazole 500mg BID for 7 days (even if pregnant) If pregnant: do not use clindamycin vaginal cream - use the oral formulation
52
Candidiasis tx
clotrimazole "azole" vaginal cream for 3-7 days i. Fluconazole: one dose orally
53
trichomoniasis tx
Metronidazole 2grams one time
54
cervicitis tx
gonorrhoeae: Ceftriaxone 250mg IM chlamydia: azithromycin 1 gram orally once or doxycycline 100mg orally BID for seven days Pregnant: amoxicillin (chlamydia)
55
Indications for local estrogenic preps to the female GU area
a. Vulvar/vaginal atrophy causing dyspareunia b. Vulvar/vaginal dryness c. Vasomotor symptoms
56
contraindications for local estrogenic preps to the female GU area
Estrogen only in women with a uterus causes cancer!
57
Boric acid use
candidasis
58
boric acid efficacy
ancedotal evidence for effectiveness

OBGYN (12 decks)

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