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PAM Semester 4 > Pharm Reproduction Exam 1 > Flashcards

Pharm Reproduction Exam 1 Flashcards

1
Q

Vaginal antibacterial

A

Clindamycin

Metronidazole

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2
Q

Vaginal Antifungals

A

Butoconazole
Miconazole
Terconazole

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3
Q

Injectable Contraceptives

A

Medroxyprogesterone (Depo-Provera)

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4
Q

Vaginal contraceptives

A

Etonogestrel/ethinyl estradiol (Nuva Ring)

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5
Q

Monophasic oral contraceptives

A

Most common type of Birth control

They are single phase

Means they provide a steady dose of hormones throughout the entire pack

Usually start on low dose of estrogen

Switch to higher dose if they have bleeding or spotting

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6
Q

B-phasic oral contraceptives

A

Contain 2 types of pills at different strengths

Usually the amount of progestin changes and
the amount of estrogen stays the same the entire pack

until you get to the placebo pills

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7
Q

Tri-phasic oral contraceptives

A

Pills of 3 different doses

The level of progestin increases as you go through the pack (similar to the body)

Most common pattern is
7 days of one strength
7 days another strength
7 days another strength
7 days of inactive pills
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8
Q

Quad-phasic oral contraceptives

A

levonorgestrel/ethinyl estradiol

Estradiol valerate/dienogest

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9
Q

Oral progestin only contraceptives

A

norethindrone

drospirenone

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10
Q

Selective estrogen receptor modulators

SERM

A

Clomiphene (Clomid)
raloxifene (evista)
Tamoxifen (soltamox)

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11
Q

GYN bleeding (non hormones)

A

TXA (tranexamic acid (Lysteda)

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12
Q

Labor induction

A

Misoprostol (cytotec)

Oxytocin (pitocin)

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13
Q

Labor suppressives (tocolytics)

A

Mag sulfate

Terbutaline

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14
Q

Pregnancy termination meds (abortion)

A

Misoprostol (cytotec)
Mifepristone (Mifeprex)
Oxytocin (pitocin)

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15
Q

SSRI - GYN

For premenstrual dysphoric disorder

A

Paroxetine (Paxil)
Fluoxetine (Prozac)
Sertraline (Zoloft)

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16
Q

In GU Section from PAM 640!

Review ED, Infectious processes such as epididymitis, orchitis, STIs.

Review Hypogonadism and Testosterone!

A

In GU Section from PAM 640!

Review ED, Infectious processes such as epididymitis, orchitis, STIs.

Review Hypogonadism and Testosterone!

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17
Q

Pubertal gynecomastia typically develops at what age?

A

Ages 10 - 12

With a peak (65%) between ages 13-14

Regression follows in approximately 80% of cases in 6 months - 2 years

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18
Q

Treatment for adolescent boys with severe breast enlargement

A 
Brief trial (3 months) 
Tamoxifen (10mg BID) for tenderness
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19
Q

Are Aromatase inhibitors effective in the treatment of severe breast enlargement in adolescent boys?

A

No

Aromatase inhibitors are not effective

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20
Q

For men in whom no cause can be identified and the gynecomastia is tender and persists more than three months

What is the treatment?

A 
Brief trial (3 to 6 months) of a selective estrogen receptor modulator (SERM) 
for relief of tenderness.

Tamoxifen (10mg BID) for tenderness

Inadequate experience withraloxifene. (not used)

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21
Q

For men with already developed gynecomastia
and are on antiandrogen therapy

What is treatment?

A

Tamoxifen

If it is a recent onset
and if likely to be in proliferative phase

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22
Q

Gynecomastia Causes

A 
Spironolactone
Antiandrogens
Cimetidine
Ketoconazole
5 - alpha reductase inhibitors
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23
Q

Selective estrogen receptor modulators

SERM

A

Clomiphene (Clomid)
raloxifene (evista)
Tamoxifen (soltamox)

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24
Q

What does a SERM do to breast tissue?

Selective estrogen receptor modulators

A

Tamoxifen

Exerts an anti estrogenic effect in breast tissue

It is important in treatment of estrogen/progesterone receptor positive breast cancer

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25
Q

What does a SERM do to bone?

Selective estrogen receptor modulators

A

Tamoxifen and raloxifene

Have selective agonist activity of estrogen receptors in bone tissue.

They decrease the risk of osteoporosis

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26
Q

What does a Tamoxifen (SERM) do to the uterus?

Selective estrogen receptor modulators

A

Tamoxifen

A partial estrogenic effect occurs in the uterus

Increases risk of endometrial carcinoma and uterine sarcoma

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27
Q

What does a Raloxifene (SERM) do to the uterus?

Selective estrogen receptor modulators

A

Raloxifene

Has a antagonistic effect of estrogen receptors on the uterus

Decreases risk endometrial carcinoma and uterine sarcoma

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28
Q

SERM Overview of different tissues

Selective estrogen receptor modulators
Tamoxifen & Raloxifene

A

Tamoxifen
Treats breast cancer
Increases risk of endometrial carcinoma and uterine sarcoma

Raloxifene
Decreases risk endometrial carcinoma and uterine sarcoma

Both Tamoxifen and Raloxifene
Decrease risk of osteoporosis

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29
Q

Tamoxifen

A

Soltamox (anti-estrogen)

Treatment of metastatic breast cancer in men & women

Contra
Coumarin anticoagulants, history of DVT/PE, planned pregnancy, nursing mothers
CAT D

Adverse
Hot flashes, Vaginal discharge, altered menses, rash, HA, nausea

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30
Q

Raloxifene

A

Evista
(SERM) Selective estrogen receptor modulators

Contra
History of DVT/PE/Thrombotic events, nursing mothers, planned pregnancy
CAT X

Interactions
May antagonize warfarin, avoid cholestyramine

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31
Q

Goal of therapy in men with sexual dysfunction

A

Improve libido

address 2 vital sexual functions
acquire and maintain adequate erection
Treat premature ejaculation

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32
Q

Why are PDE-5 inhibitors recommended

A

Efficacy
ease of use
favorable side effects

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33
Q

Which PDE-5 inhibitor is best?

A

Sildenafil, tadalafil, avanafil
All are equally effective

Tadalafil

Contraindicated in men taking nitrates

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34
Q

Who are PDE 5-inhibitors contraindicated in?

A

Contraindicated in men taking nitrates

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35
Q

What are alpha adrenergic antagonists used for?

A

BPH

-osin

Terazosin
Tamsulosin
Alfuzosin
Silodosin
Doxazosin
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36
Q

What do alpha adrenergic antagonists cause when combined with PDE-5 inhibitors?

A

Symptomatic Hypotension

If used
Tamsulosin and silodosin are better and less likely to cause hypotension

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37
Q

Treatment for Premature Ejaculation

A

SSRI’s are first line

Clomipramine is second line

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38
Q

5 P’s of sexual history

A 
Partners
Practices
Protection from STD's
Past history of STD's
Pregnancy Prevention
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39
Q

STIs from CDC-

Read on your own and be prepared for questions on Exam

Chlamydia Treatment for Adolescents and Adults.
Chlamydia Treatment for Pregnancy
Chlamydia Treatment for Neonates
Gonorrhea for Adolescents and Adults
Bacterial Vaginosis
Trichomoniasis
PID
Epididymitis
Primary and Secondary Syphilis
Chancroid
Herpes Simplex
A

STIs from CDC-

Read on your own and be prepared for questions on Exam

Chlamydia Treatment for Adolescents and Adults.
Chlamydia Treatment for Pregnancy
Chlamydia Treatment for Neonates
Gonorrhea for Adolescents and Adults
Bacterial Vaginosis
Trichomoniasis
PID
Epididymitis
Primary and Secondary Syphilis
Chancroid
Herpes Simplex
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40
Q

Most frequent STD’s among women who have been sexually assaulted

A

Trichomoniasis
Bacterial vaginitis
Gonorrhea
Chlamydia

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41
Q

Treatment for sexual assaults in men

A

Empiric ABX for

Chlamydia

Ceftriaxone 500mg IM
Plus Doxy 100mg BID x 7 days

If over 150kg = 1 gram of Ceftriaxone

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42
Q

Treatment for sexual assaults in women

A

Empiric ABX for

Chlamydia
Gonorrhea
Trichomoniasis

Ceftriaxone 500mg IM
Plus Doxy 100mg BID x 7 days
Plus Metronidazole 500mg BID x 7 days

If over 150kg = 1 gram of Ceftriaxone

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43
Q

Infertility in men
resulting from secondary (hypogonadotropic) Hypogonadism

Treatment

A

Gonadotropin replacement therapy

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44
Q

Infertility in men
resulting from secondary (hypogonadotropic) Hypogonadism due to prolactin adenoma

Treatment

A

Dopamine agonist therapy

Cabergoline

(restores spermatogenesis and fertility)

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45
Q

Infertility in men resulting from

secondary (hypogonadotropic) Hypogonadism
Idiopathic dysspermatogenesis
Idiopathic male infertility

What not to use

A

Clomiphene citrate
Aromatase inhibitors
Gonadotropin therapy

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46
Q

Off label use Still being used despite up-to-date recommendations

(secondary Hypogonadism)

A

Clomiphene
anastrozole
hCG injection (Human chorionic gonadotropin)

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47
Q

Clomiphene Side effects

A

Changes in
Libido, Mood, Energy level

Increased aggression

Male pattern baldness

Enlarged prostate

Breast tenderness

Mild Acne

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48
Q

Clomiphene MOA

A

Pituitary gland secretes hormones into the blood

Clomiphene increases these hormones

This stimulates the production of testosterone and sperm in the testes

Boosted levels of these hormones will reduce symptoms of hypoandrogenism (low testosterone),
Increase sperm count, improve non obstructive azoospermia
(a blockage that prevent sperm from entering the semen)

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49
Q

Anastrozole MOA

A

Arimidex

Aromatase inhibitor

Originally for breast cancer

Now used off label for infertility in men

It blocks the enzyme aromatase
which prevents testosterone from changing into testosterone

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50
Q

Anastrozole Side effects

A

Arimidex

Aromatase inhibitor

Blood clots
cataracts
SJS

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51
Q

Herbs used in male fertility

Coenzyme 10

A

Infertility

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52
Q

Herbs used in male fertility

Yohimbe bark

A

ED

Libido

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53
Q

Herbs used in male fertility

Saw Palmetto

A

Low sperm count
Stress
Libido

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54
Q

Herbs used in male fertility

Maca root

A

Hormonal balance
Energy
Normal sexual function

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55
Q

Herbs used in male fertility

American Ginseng

A

Stamina

Immune system

56
Q

Herbs used in male fertility

Tribulus

A

Sperm count

Testosterone production

57
Q

Which of the below medications is known to cause gynecomastia?

Tamoxifen
Acetaminophen
ASA
spironolactone

A

spironolactone

58
Q

Which of the below medications is known to treat gynecomastia?

Tamoxifen
Acetaminophen
ASA
spironolactone

A

Tamoxifen

59
Q

Which of the following is the most updated antibacterial for the treatment of Gonorrhea?

Ceftriaxone
Doxycycline
Amoxicillin
Benzathine PCN G

A

Ceftriaxone

60
Q

Which of the following is the most updated antibacterial for the treatment of Chlamydia?

Ceftriaxone
Doxycycline
Amoxicillin
Benzathine PCN G

A

Doxycycline

61
Q

Which of the following is first-line medication for premature ejaculation in men?

Paroxetine
Clomiphene
Sildenafil
Finasteride

A

Paroxetine

62
Q

Which of the below vitamins/herbs has shown some efficacy for Male infertility?

Yohimbe bark
Co-enzyme 10
Saw Palmetto
American Ginseng

A

Co-enzyme 10

63
Q

Chlamydia treatment

Adults/adolescents

A

Doxycycline 100 mg PO BID for 7 days

64
Q

Chlamydia treatment

Pregnancy

A

Azithromycin 1 g orally in a single dose

65
Q

Chlamydia treatment

Neonates

A

Erythromycin base or ethyl succinate

50 mg/kg body weight/day orally

divided into 4 doses daily for 14 days

66
Q

Gonorrhea Treatment

Adults/adolescents

A

Ceftriaxone 500 mg* IM in a single dose for persons weighing <150 kg

If chlamydial infection has not been excluded, treat for chlamydia with doxycycline 100 mg PO BID for 7 days.

67
Q

Epididymitis Treatment

A

For acute epididymitis most likely caused by chlamydia or gonorrhea: Ceftriaxone 500 mg IM once, plus Doxycycline 100 mg PO BID for 10 days

For acute epididymitis most likely caused by chlamydia, gonorrhea, or enteric organisms (men who practice insertive anal sex): Ceftriaxone 500 mg once, plus Levofloxacin 500 mg PO QD for 10 days.

For acute epididymitis most likely caused by enteric organisms only: Levofloxacin 500 mg PO QD for 10 days

68
Q

Primary and secondary syphilis Treatment

A

Benzathine penicillin G 2.4 million units IM once

69
Q

Bacterial vaginosis treatment

A

Metronidazole 500 mg orally 2 times/day for 7 days

or

Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once daily for 5 days

or

Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days

70
Q

Trichomoniasis Treatment

A

Women
Metronidazole 500 mg orally 2 times/day for 7 days

Men
Metronidazole 2 g orally in a single dose

71
Q

PID Treatment

A

Ceftriaxone 1 g by every 24 hours
plus Doxycycline 100 mg PO or IV every 12 hours plus Metronidazole 500 mg PO or IV every 12 hours

or

Cefotetan 2 g IV every 12 hours
plus Doxycycline 100 mg orally or IV every 12 hours

or

Cefoxitin 2 g IV every 6 hours
plus Doxycycline 100 mg orally or IV every 12 hours

72
Q

Chancroid Treatment

A

Azithromycin 1 g orally in a single dose

or

Ceftriaxone 250 mg IM in a single dose

or

Ciprofloxacin 500 mg orally 2 times/day for 3 days

or

Erythromycin base 500 mg orally 3 times/day for 7 days

73
Q

Herpes Simplex Treatment

A

???? (-vir’s)

74
Q

Most primary breast abscesses are caused by?

A

Staphylococcus aureus.

Methicillin-resistantS. aureusinfections are increasingly common.

75
Q

Patients with recurrent breast abscess have an increased incidence of?

A

mixed flora and anaerobic infection.

76
Q

Management of primary breast abscess

A

Consists of drainage and antibiotic therapy.

77
Q

Which of the following is not part of the 5 P’s in taking a good history?

Practice
Pregnancy
Passing
Past History
Partners
A

Passing

78
Q

Which of the below medications is not considered a SERM?

clomiphene (Clomid)
raloxifene (Evista)
tamoxifen (Soltamox)
anastrozole (Arimidex)

A

anastrozole (Arimidex)

79
Q

Which of the following is considered a aromatase inhibitor?

clomiphene (Clomid)
raloxifene (Evista)
tamoxifen (Soltamox)
anastrozole (Arimidex)

A

anastrozole (Arimidex)

80
Q

Should breastfeeding continue during treatment for lactation-associated breast infections?

A

Yes

We suggest that breastfeeding continue during treatment for lactation-associated breast infections.

If there is difficulty with breastfeeding, hand expression or breast pumping can be effective for maintaining the milk supply until nursing can resume.

81
Q

In the setting of non-severe infection in the absence of risk factors for methicillin-resistantS. aureus(MRSA),

Treatment

A

outpatient therapy may be initiated withdicloxacillin(500 mg orally four times daily)

or

cephalexin(500 mg orally four times daily),

pending culture results.

In the setting of beta-lactam hypersensitivity,clindamycin(300 to 450 mg orally three times daily) may be used.

82
Q

In the setting of non-severe infection with risk for MRSA,

Treatment

A

outpatient therapy withtrimethoprim-sulfamethoxazole(1 to 2 tabs orally twice daily)

or

clindamycin (300 to 450 mg orally three times daily) may be initiated.

83
Q

In the setting of severe infection (eg, hemodynamic instability, progressive erythema)

Treatment

A

empiric inpatient therapy withvancomycin should be initiated

The optimal length of antibiotic therapy is not certain; 10 to 14 days following drainage is likely appropriate.

84
Q

How to rule out anything bad from fibrocystic breast changes?

A

Fine needle aspiration

85
Q

First-line therapy for breast pain It is typically safe but may not be effective.

Some practitioners also endorse therapies such as caffeine abstinence or evening primrose oil (EPO).

Although such therapies have not been proven effective by vigorous placebo controlled trials, they are generally harmless and may provide relief for some patients.

A

is conservative and typically includes reassurance that this is not a malignancy, physical support, over-the-counter analgesics, and manipulation of hormone-based medications for those who take them.

Acetaminophen or NSAID—Acetaminophenor a nonsteroidal anti-inflammatory drug (NSAID), or both, can be used to relieve breast pain.

86
Q

How long do you use first line therapies in breast pain

A

We prefer to treat with first-line therapy for six months before moving onto one of the second-line therapies,
which may be more effective but also have more side effects.

87
Q

Alternative therapies in breast pain

A

Although such therapies have not been proven effective by vigorous placebo controlled trials, they are generally harmless and may provide relief for some patients.

88
Q

Second-line therapy after NSAIDSfor breast pain

A

Tamoxifen

89
Q

Physiologic nipple discharge, or galactorrhea, is often caused by

A

hyperprolactinemia,

which may be secondary to medications, pituitary tumors, endocrine abnormalities, or other medical conditions.

90
Q

Causes of hyperprolactinemia

A 
may be secondary to 
medications, 
pituitary tumors, 
endocrine abnormalities, 
or other medical conditions.
91
Q

Medications associated with galactorrhea

A

metoclopramide,
phenothiazines,
selective serotonin reuptake inhibitors [SSRIs]

92
Q

Classes of medications that cause

galactorrhea

A 
Antipsychotics 1st and 2nd gen
Antidepressants (cyclic, SSRI, other)
Antiemetic and GI
Antihypertensive
Opioid analgesics
93
Q

Most episodes of lactational mastitis are caused by?

A

Staphylococcus aureus.

Methicillin-resistantS. aureus(MRSA) has become an important pathogen in cases of lactational mastitis.

94
Q

Medication that is used to preventbreast cancerin women and treat breast cancer in women and men.

A

Tamoxifen(Nolvadex)

95
Q

SERM that hasestrogenicactions on bone and anti-estrogenic actions on the uterus and breast.

A

Raloxifene(trade nameEvista)

is an oralselective estrogen receptor modulator(SERM)

96
Q

Ethinyl estradiol

A

EE2 is an orally bioactive estrogen used in many formulations of combined oral contraceptive pills and is one of the most commonly used medications for this purpose

97
Q

Aromatase inhibitors-used in postmenopausal females with breast cancer-Know

A

Androstenedione is converted to estrone estradiol by the enzyme aromatase

Aromatase inhibitors prevent this conversion

Antiestrogens prevent estrone estradiol from activating

98
Q

Aromatase inhibitors- in men

A

Testosterone is converted to estrogen by the enzyme aromatase

Aromatase inhibitors block this

99
Q

Tamoxifen and estrogen receptors

A

Tamoxifen blocks the estrogen receptor so estradiol cannot bind

100
Q

3rd generation aromatase inhibitors

Steroidal

A

Superselective

Exemestane (aromasin)

101
Q

3rd generation aromatase inhibitors

Non-Steroidal

A

Superselective

Anastrozole (Arimidex)

Letrozole (femara)

102
Q

Letrozole

A

Femara (aromatase inhibitor)

In postmenopausal women: Adjuvant treatment of hormone receptor positive early breast cancer

2.5mg QD

Contra
Pregnancy

Warnings
Monitor bone mineral density, serum cholesterol. Severe renal or hepatic impairment. Embryo-fetal toxicity;

Adverse
Pain (bone, musculoskeletal, and others), hot flashes, arthralgia, flushing, asthenia, edema,

103
Q

What are the two most common causes of acute cervicitis.

A

Neisseria gonorrhoeaeandChlamydia trachomatisare the two most common causes of acute cervicitis.

Mycoplasma genitaliumcontributes to cervicitis, but this organism is likely responsible for a substantial minority of cases.

104
Q

What is recurrent cervicitis and how is it treated?

A

Women who present with recurrent symptoms are reevaluated for possible re-exposure or treatment failure.

Treat persistent cervicitis for presumedM. genitaliumwith single-doseazithromycin(1 g orally),

105
Q

HPV Vaccines

A 
9-valent vaccine (Gardasil 9) 
quadrivalent vaccine (6, 11, 16, and 18)

9-valent vaccine (Gardasil 9)
targets the same HPV types as the quadrivalent vaccine (6, 11, 16, and 18)

106
Q

Gardasil 9

A

Contra
Yeast allergy

Adverse
Inj site reactions (eg, swelling, erythema, pain), headache; post-administration syncope (may be associated with tonic-clonic movements and other seizure-like activity).

107
Q

Management of Polycystic ovary syndrome

A

The management of polycystic ovary syndrome (PCOS) requires treatment of individual components of the syndrome, including

menstrual dysfunction and the risk of endometrial hyperplasia,
hyperandrogenism (hirsutism and acne),
metabolic risk factors (obesity, glucose intolerance, and dyslipidemia),
and in some women, anovulatory infertility.

The choice of therapy depends upon whether the patient is pursuing pregnancy or not.

108
Q

Management of Polycystic ovary syndrome
in women not pursuing pregnancy
and menstrual dysfunction

A

Menstrual dysfunction–

For women with PCOS, oligomenorrhea, and chronic anovulation we suggest COC therapy.

We typically start with a COC containing 20 mcg of ethinyl estradiol combined with a progestin such asnorethindroneor norethindrone acetate, progestins that have lower androgenicity, but similar VTE risk compared with levonorgestrel-containing COCs.

109
Q

Management of Polycystic ovary syndrome
in women not pursuing pregnancy
and hyperandrogenic symptoms

A

Women with hyperandrogenic symptoms–

For most women with hirsutism or other androgenic manifestations such as acne or female pattern hair loss, we also suggest starting with a COC (in addition to lifestyle measures).

We typically start with a COC containing 20 mcg of ethinyl estradiol combined with a progestin such asnorethindroneor norethindrone acetate, progestins that have lower androgenicity, but similar VTE risk compared with levonorgestrel-containing COCs.

110
Q

COC therapy for Polycystic ovary syndrome

in women not pursuing pregnancy

A

We typically start with a COC containing 20 mcg of ethinyl estradiol combined with a progestin such asnorethindroneor norethindrone acetate, progestins that have lower androgenicity, but similar VTE risk compared with levonorgestrel-containing COCs.

111
Q

Management of Polycystic ovary syndrome
in women not pursuing pregnancy
and metabolic disorders

A

Metabolic disorders–

Weight loss, which can restore ovulatory cycles, improve metabolic risk, and possibly improve live birth rates, is the intervention for most women.

112
Q

Management of Polycystic ovary syndrome

in women planning to become pregnancy

A

Anovulatory infertility and ovulation induction–

For women with PCOS and anovulatory infertility, attempts at weight loss should be tried first in those who are obese.

If this does not restore ovulatory cycles, ovulation induction is required.

Letrozole, an aromatase inhibitor, is now the first-line ovulation induction agent overclomiphenecitrate for women with PCOS.

113
Q

Uterine disorders

A

Endometriosis
Leiomyoma
Prolapse

114
Q

Endometriosis with mild to moderate pain

A

nonsteroidal anti-inflammatory drugs (NSAIDs)
and continuous hormonal contraceptives
rather than either agent alone.

These therapies are low-risk, have few side effects, are low-cost, and are generally well-tolerated compared with other medical therapies.

Women who wish to conceive can use the NSAID alone.

115
Q

Endometriosis with severe pain

A

Severe symptoms, symptoms that do not respond to the other therapies, or recurrent symptoms,

Trial of gonadotropin-releasing hormone (GnRH) analog with add-back hormonal therapy rather than surgical resection.

GnRH analog treatment has demonstrated efficacy without the risks or negative impact on ovarian reserve of surgery.

116
Q

Medical Treatment for endometriosis

A

Hormonal contraceptives

Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists

Progestin therapy

Danazol

Aromatase inhibitors

117
Q

GnRH agonist

A

leuprolide

118
Q

leuprolide depot 3.75mg

A

Lupron GNRH Agonist

3.75mg

Contra
Undiagnosed abnormal vaginal bleeding.
Pregnancy.
Nursing mothers.

When co-administered with norethindrone acetate, its contraindications also apply to this combination regimen.

119
Q

Danazol

A

Androgen derivative
Indications:
Endometriosis, Fibrocystic breast disease

Orally active

Inhibit ovulation for 4-9 months

120
Q

Danazol MOA

A

Weak synthetic androgen that suppresses the pituitary ovarian axis by inhibiting the output of pituitary gonadotropins

121
Q

Elagolix

A

Orissa (GNRH antagonist)

Indications
Moderate to severe pain associated with endometriosis.

Contraindications:
Pregnancy. Osteoporosis. Severe hepatic impairment.

122
Q

Leiomyoma treatment

A

Treatment of fibroids is aimed at resolving or reducing the symptoms associated with the lesions.

Common symptoms include prolonged or heavy menstrual bleeding (HMB), bulk symptoms, pain, and impaired fertility. Symptoms can be present in isolation or combination

123
Q

Leiomyoma symptoms

A 
Common symptoms include 
prolonged or heavy menstrual bleeding (HMB), 
bulk symptoms, 
pain, 
impaired fertility.

Symptoms can be present in isolation or combination

124
Q

Treatment or patients with all other types of fibroids
(ie, not exclusively submucosal)
who do not desire pregnancy
(Leiomyoma)

A

Initial treatment with a combined estrogen-progestin contraceptive
(oral pills, transdermal patch, or vaginal ring).

Alternatives treatments
levonorgestrel-releasing intrauterine devices,
tranexamic acid
progestin-only pills

125
Q

Alternatives treatments for patients with all other types of fibroids
(ie, not exclusively submucosal)
who do not desire pregnancy
(Leiomyoma)

A

Alternatives treatments
levonorgestrel-releasing intrauterine devices,
tranexamic acid
progestin-only pills

126
Q

For patients whose symptoms persist despite trial of one or more first-tier therapies for
(Fibroids/Leiomyoma)

A

Second-tier medical treatments for fibroid-associated HMB include

gonadotropin-releasing hormone (GnRH) agonists and antagonists

127
Q

Last line for (Fibroids/Leiomyoma)

A

Surgery

128
Q

Most common types of vaginitis

A

The most common infections,

bacterial vaginosis (BV),
Candidavulvovaginitis,
trichomoniasis,

account for over 90 percent of infections.

129
Q

Bacterial vaginosis (BV) treatments

A

Metronidazole 500 mg orally 2 times/day for 7 days

or

Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once daily for 5 days

or

Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days

130
Q

Candida treatment

A

OTC
Clotrimazole
Nystatin
Miconazole

Prescription
Terconazole
Tioconazole
Butoconazole
Fluconazole
Ibrexafungerp
131
Q

Treatment of complicated vaginitis

A

Severe or recurrent

Oral Fluconazole 150mg Q72h

132
Q

Treatment of complicated vaginitis

and pregenant

A

Topical
Clotrimazole
Miconazole
for 7 days

133
Q

Trichomoniasis

A

It is the most common non-viral sexually transmitted disease (STD) worldwide.

Women are affected more often than men

134
Q

The most common non-viral sexually transmitted disease (STD) worldwide.

A

Trichomoniasis

Women are affected more often than men

135
Q

Treatment of Trichomoniasis for both symptomatic and asymptomatic females and males.
(Non-pregnant)

A

For nonpregnant females and their sex partners, we suggest a seven-day course ofmetronidazole, 500 mg twice daily.

The single-dose regimen is a reasonable alternative for those who are unable to complete a seven-day treatment regimen or who prefer single-day treatment.

Oral administration is significantly more effective than topical administration.

Treatment reduces the prevalence ofT. vaginaliscarriage in the population, relieves symptoms, and reduces the risk of sequelae (including acquisition/transmission of HIV).

136
Q

Treatment of Trichomoniasis for both symptomatic and asymptomatic pregnant females

A

We prefer the seven-day regimen and reserve the single-dose regimen for patients who are unable to complete a seven-day treatment course.

7-day course ofmetronidazole, 500 mg twice daily.

We recommend treating symptomatic pregnant females with confirmedT. vaginalisinfections.

In addition, we suggest treating asymptomatic pregnant individuals with confirmed infection.

137
Q

Tinidazole vs metronidazole

Trichomoniasis treatment

A

Tinidazolegenerally causes fewer gastrointestinal side effects, but the cost is higher compared withmetronidazole

PAM Semester 4 (7 decks)

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