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OBGYN > Pharm 37 Objectives > Flashcards

Pharm 37 Objectives Flashcards

1
Q

What is the rationale for the replacement use of estrogen and estrogen/progestin in postmenopausal osteoporosis and for menopausal symptoms?

A
  • prevention of accelerated bone loss after menopause who cannot take non-estrogen medications
  • relief of menopausal symptoms: hot flashes, depression, insomnia, symptoms of vulvar, vaginal, and urethral atrophy
  • take the lowest dose for the shortest duration needed
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2
Q

What are the effects of estrogens on clotting factors?

A

enhance blood coagulation by increasing synths of coagulation factors

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3
Q

What are the effects of estrogen on cholesterol tests?

A

decrease LDL while increasing HDL

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4
Q

What are the effects of estrogen on thyroid hormone disposition?

A

high levels of exogenous estrogen increase thyroxine binding globulin
-cause hypothyroidism in those taking thyroid replacement

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5
Q

What are the effects of estrogen on FSH and LH?

A

high levels suppress FSH and LH in menstrual cycle

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6
Q

What are the types of estrogens used therapeutically?

A
  • ethinyl estradiol
  • estradiol valerate
  • mestranol
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7
Q

What is the therapeutic action of estrogen?

A

suppress ovulation

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8
Q

What is the therapeutic action of progestin?

A

create a hostile environment

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9
Q

What are the adverse effects of estrogen?

A

nausea, breast tenderness, hypertension, melisma, headache

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10
Q

What are the adverse effects of progestin?

A

breast tenderness, headache, fatigue, mood changes

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11
Q

What are the contradictions of estrogen?

A
  • DVT, PE or history of
  • Stroke or history of
  • Breast cancer or history of
  • Coagulopathy
  • Pregnancy
  • Breastfeeding <21 days
  • Age >35 + >15 cigarettes/day
  • Ischemic heart disease/cardiomyopathy
  • Severe hypertension
  • Major surgery with prolonged immobilization
  • Migraine with aura
  • Liver cancer or severe cirrhosis
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12
Q

What are the potential mechanism of action of combined oral contraceptives?

A
  • Feedback inhabitation of -GnRH section from the hypothalamus leading to decreased gonadotropic secretion and inhabitation of ovulation
  • Reduce FSH secretion and maturation of follicle (estrogen component)
  • Inhibit the midcycle LH surge required for ovulation (progestin component)
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13
Q

What are the most common drug interactions with combined oral contraceptives?

A
  • antibiotics: cause N/V/D and forgetfulness during illness
  • penicillins and tetracylines
  • rifampin and griseofulvin
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14
Q

What is the rational for the various dosage schedules?

A
  • personal preference

- cost

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15
Q

What estrogen is most commonly found in combined oral contraceptives?

A

ethinyl estradiol

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16
Q

What is the starting dose of EE?

A

start low at 20 mcg and titrate up to 30 to 35 mcg

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17
Q

When do you increase estrogen dose?

A

if there is early or mid-cycle spotting/BTB, vasomotor symptoms, atrophic vaginitis

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18
Q

When do you decrease the estrogen dose?

A

if there is nausea, breast tenderness, hypertension, melisma, headache

19
Q

What is a low estrogen dose?

A

10 mcg

20
Q

What are the most common progestins used in contraception?

A
  • progesterone
  • testosterone/notestosterone
  • spironolactone
21
Q

Rank each by relative androgenic potencies (most to least androgenic)

A

evonorgestrel/norgestrel > norethindrone > desogestrel/norgestimate > dosperinone/dienogest (anti-adrogenic)

22
Q

List the other type of hormonal contraceptive agents other than COCs

A
  • progestin-only
  • patch (Xulane or Evra)
  • vaginal ring (NuvaRing or Annovera)
  • implant (nexplanon)
23
Q

Limitations/CI of Xulane, Evra - Patch

A

higher incidence of thrombosis d/t higher estrogen level

- less effective in pts over 198 Ibs (90 kg)

24
Q

Limitations/CI of NuvaRing, Annovera - Vaginal Ring

A

Nuva: no need for back up methods if out for less than 48 hours
Anno: if out for >2 hours need 7 days of back up method and unknown effectiveness in pts BMI >29

25
Q

Limitations/CI of Nexplanon - Implant

A
  • liver disease or liver tumor
  • unexplained vaginal bleeding
  • breast cancer
26
Q

What is progestin-only contraception place in therapy?

A
  • Premenstrual dysphoric disorder (PMDD)-Yaz
  • Contraception
  • Dysmenorrhea
  • Endometriosis
  • Post-coital contraception
27
Q

What are the advantages of progestin-only contraception?

A
  • Less interface w/breast feeding
  • Less risk of thrombosis
  • No estrogenic SEs
28
Q

What are the disadvantages of progestin-only contraception?

A
  • Must be taken at the same time every day, within 3 hrs
  • Taken every day, not cyclically: NO placebo pills
  • Less effective contraceptive
29
Q

What is the MOA of Levonorgestrel (Plan-B One-Step)?

A

a progestin that prevents ovulation and fertilization by altering tubal transport of sperm and/or ova

30
Q

What is the MOA of Ulipristal -selective progesterone receptor modulator

A

not completely known

  • block rise in LH, represses progesterone, blocks ovulation
  • interacts with hormonal contraceptives: wait 5 days before restarting
31
Q

What is the MOA of mifepristone?

A
  • inhibits action of progesterone in body by blocking progesterone receptors
  • prevents implantation of fertilized eggs
32
Q

What is the offending agent for bacterial vaginosis?

A

garnerella vaginalis

33
Q

What is the treatment of bacterial vaginosis for non-pregnant women?

A
  • Metronidazole 500 mg BID x7 days
  • Metronidazole 0.75% vaginal gel one applicator full BID x 5 days
  • Clindamycin 2% vaginal cream 1 applicator full at bedtime x 7 days
34
Q

What is the treatment of bacterial vaginosis for pregnant women?

A
  • Metronidazole 500 mg BID x7 days
  • Metronidazole 250 mg TID x7 days
  • Metronidazole 0.75% vaginal gel one applicator full BID x 5 days
  • Clindamycin 300mg PO BID x 7 days
35
Q

What is the offending agent for candida vaginitis?

A

Candida albicans

36
Q

What is the OTC tx for candida vaginitis?

A
  • Clotrimazole vaginal cream or suppositories x3-7 days

- Miconazole vaginal cream or suppositories x3-7 days

37
Q

What is the Rx treatment for candida vaginitis?

A
  • Fluconazole oral tab-single dose
  • Complicated case: Fluconazole every 72 hrs (3 days) for 3 doses
  • Boric acid (compound capsule inserted vaginally) - DO NOT SWALLOW- Fatal
38
Q

What is the offending of trichomoniasis?

A

trichomoniasis vaginalis

39
Q

What is tx for trichomoniasis?

A
  • Metronidazole 2 gram PO 1 time only (preferred)

- Metronidazole 500 mg PO BID x 7 days

40
Q

What are the offending agent of cervicitis?

A

N. gonorrhoeae and Chlamydia (treat empirically for both)

41
Q

What is the treatment for cervicitis?

A

Use one:

  • Azithromycin
  • Doxycycline
  • If preg: amoxicillin
  • Add Ceftriaxone for N. gonorrhoeae
  • Alternative: Cefixime - require return in 1 wk for test-to-cure
  • Tx most recent sexual partners
  • Abstain for sexual intercourse until pt and partner are both treated - 7 days plus sx resolved
42
Q

What are the estrogenic preparations that are applied locally to the female genitourinary area?

A
  • vaginal ring
  • vaginal cream
  • vaginal tablet
43
Q

Indications for estrogenic preparations that are applied locally to the female genitourinary area

A
  • vulvar-vaginal atrophy
  • dryness
  • irritation
  • soreness
  • dyspareunia
44
Q

What the the contraindications for estrogenic preparations that are applied locally to the female genitourinary area?

A
  • pts with hx of DVT
  • breast cancer
  • endometrial cancer
  • liver disease

OBGYN (5 decks)

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