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OBGYN > Pharm 37 > Flashcards

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
Q

a) Suppress FSH secretion and ovulation
b) Suppress endometrial lining
c) Thickens cervical mucus
d) Hampers ovum transport
e) Interferes with implantation

A

effects of combo OCPs

26
Q

Indications for COC’s

A

a) Contraception
b) Acne
c) Dysmenorrhea
d) Recurrent ovarian cysts
e) Premenstrual syndrome/PMDD
f) Post-coital contraception

27
Q

ADE of estrogens (2)

A

1) N/V (estrogen)
2) HTN (estrogen)
3) increased coagulability

28
Q

ADE of COC’s (2)

A

1) HA (estrogen, progestin)

2) Breast tenderness (estrogen, progestin)

29
Q

ADE of progestins (2)

A

1) Fatigue (progestin)

2) Mood changes (progestin)

30
Q

ADE of androgens (4)

A

1) Weight gain (androgens)
2) Oily skin/acne (androgens)
3) Hirsutism (androgens)
4) Increased LDL / decreased HDL (androgens)

31
Q

Contraindications to COC’s (12)

A

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
Q

suppresses ovulation, FSH secretion

A

estrogen

33
Q

suppresses LH to prevent ovulation, increases cervical mucus, prevents implantation

A

Progestin

34
Q

prevent estrogen production; similar to progesterone

A

Androgens

35
Q

drugs that affect contraceptives

A

ABXs
PCNs/tetracyclines
Rifampin
Griseofulvin

36
Q

having more N/V

A

Decrease estrogen

37
Q

having vasomotor sx, early to mid-cycle spotting

A

Increases estrogen

38
Q

having late cycle spotting

A

Increase progestin

39
Q

having more mood changes or breast tenderness

A

Decrease progestin

40
Q

low estrogen levels

A

= < 20 mcg

41
Q

moderate estrogen levels

A

25, 30, 35 mcg, 40 mcg

42
Q

high estrogen levels

A

50mcg

43
Q

Least androgenic (not anti-androgenic!)

A

Desogestrel

Norgestimate

44
Q

types of contraceptives that are not pills (5)

A 
injection
patch
vaginal ring
implant
IUD
45
Q

vaginal ring limitations

A

BMI > 29

46
Q

patch limitations

A

198 pounds (90kg)

47
Q

unique patch formulation

A

has MUCH higher levels of estrogens and thus can have a way higher risk for DVT/stroke

48
Q

indications for progestin only contraceptives (4)

A

a. Contraception
b. Dysmenorrhea
c. Endometriosis
d. Post-coital contraception

49
Q

advantages of progestin only contraceptives (3)

A

a. Less interference with breast feeding
b. Less risk of thromboembolism
c. No estrogenic side effects

50
Q

disadvantages of progestin only contraceptives (3)

A

a. Must be taken at the same time every day
b. Take every day
c. Less effective

51
Q

BV tx

A

Metronidazole 500mg BID for 7 days (even if pregnant)

If pregnant: do not use clindamycin vaginal cream - use the oral formulation

52
Q

Candidiasis tx

A

clotrimazole “azole” vaginal cream for 3-7 days

i. Fluconazole: one dose orally

53
Q

trichomoniasis tx

A

Metronidazole 2grams one time

54
Q

cervicitis tx

A

gonorrhoeae: Ceftriaxone 250mg IM
chlamydia: azithromycin 1 gram orally once or doxycycline 100mg orally BID for seven days

Pregnant: amoxicillin (chlamydia)

55
Q

Indications for local estrogenic preps to the female GU area

A

a. Vulvar/vaginal atrophy causing dyspareunia
b. Vulvar/vaginal dryness
c. Vasomotor symptoms

56
Q

contraindications for local estrogenic preps to the female GU area

A

Estrogen only in women with a uterus causes cancer!

57
Q

Boric acid use

A

candidasis

58
Q

boric acid efficacy

A

ancedotal evidence for effectiveness

OBGYN (12 decks)

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