Pharm I Flashcards
what is the most effective treatment for vasomotor symptoms?
estrogen
what type of estrogen is preferred, oral or transdermal?
transdermal
your pt has CV risk factors like hypertension and she is post menopausal. would you give her oral or transdermal estrogen?
transdermal
what’s a major benefit for transdermal estrogen in post menopausal patients as compared to oral?
lower incidence of DVT
CIs of estrogen therapy (7)
- hx of thromboembolic dz
- endometrial cancer
- breast cx
- pregnancy
- liver dz
- undiagnosed vaginal bleeding
- uncontrolled htn
you use the CVD algorithm and find your patient has less than 5% 10-yr CVD risk. what can you give them in terms of estrogen therapy?
MHT ok for both!
you use the CVD algorithm and find your patient has a 5-10% 10-yr CVD risk. what can you give them in terms of estrogen therapy?
MHT ok, but use transdermal
you use the CVD algorithm and find your patient has a greater than 10% 10-yr CVD risk. what can you give them in terms of estrogen therapy?
none (avoid MHT!)
in addition to N, HA, bloating, bleeding and gallbladder dz, what are 3 big AEs of estrogen therapy?
stroke
DVT
breast cancer?
what should be added to estrogen treatment in women with uterus to minimize risk of endometrial hyperplasia/cancer?
progesterone
how many days per month should progesterone be taken with estrogen therapy?
12-14 days
in addition to N, HA, and bleeding, what are the AEs for progesterone (5)?
- weight gain
- irritability
- depression
- DVT
- decreased bone mineral density
what progesterone alternative can be used short term to treat symptoms during early menopause and is approved for hotflashes and osteoporosis prevention?
duavee (conjugated estrogens/bazedoxifene)
is estrogen +/- progestin protective or harmful against osteoporosis and fractures?
protective!
estrogen deficiency results in bone loss
HT long term risks? (4)
- VTE
- breast cancer
- heart disease ?
- dementia ??
HT long term benefits? (2)
osteoporosis
colon cancer ?
when should you discontinue hormone therapy for post menopausal women?
typically 2-5 years
what do all guidelines say about long term use of HT?
low dose of HT can continue in patients WITH symptoms
what is the one drug approved for hypoactive sexual desire in women?
flibanserin
what is a major contraindication of flibanserin? what happens?
alcohol
hypotension/syncope
what are the two drugs approved for treating pain with intercourse?
ospemifene and prasterone
what are the three types of estrogen in COCs?
ethinyl estradiol
mestranol
estradiol valerate
what are the two types of progesterone in COCs?
norethindrone
levonorgestrel
when are progestin-only pills typically used?
as an alternative for women unable to take estrogen-containing COCs
(can be used immediately post partum)
what two medications require back up contraception while taking it?
griseofulvin (antifungal)
rifampin
what BC exposes women to 60% more estrogen than women who take COCs and thus increases the risk of VTE
transdermal norelgestromin and ethinyl estradiol (Xulane)
how often do you get the depo-provera shot?
q3 months (with 2 week grace period)
what is the yuzpe method?
1 dose of 100mcg EE and 1 mg levonorgestrel followed by a 2nd dose of 100 mcg of EE and 1 mg levonorgestrel 12 hours later
uncomplicated gonorrhea treatment of cervix, urethra, rectum, pharynx
1 dose ceftriaxone (IM)
PLUS
1 g azithromycin or doxycycline (BID x 7 days)
are cephalosporins safe in pregnancy?
yeppers
chlamydia treatment
1 dose (1 g) azithromycin OR doxycycline (100mg BID x 7 days)
what is recommended for pregnancy and chlamydia infxn?
azithromycin
what is the response that the body has to penicillin when given for syphillis?
when does it present?
Jarisch-Herxheimer
2 hours - 24 hours
can you use tetracyclines in pregnancy?
nope
