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Reproductive Block > Pharm - Teratogens, STDs, Bladder issues, Ovarian Chemo > Flashcards

Pharm - Teratogens, STDs, Bladder issues, Ovarian Chemo Flashcards

1
Q

HSV drugs

A

Acyclovir or Famciclovir or Valacyclovir for 7-10 days

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2
Q

Acyclovir and Valacyclovir MOA

A

competitively inhibits viral DNA polymerase; competes with deoxyguanosine triphosphate for incorporation into viral DNA; requires activation intracellularly in thymidine kinase

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3
Q

Famciclovir MOA

A

metabolized (de-acetylated) to penciclovir, does not cause chain termination

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4
Q

Acyclovir, Valacyclovir AE

A

crystalline neurotoxicity including seizures, and nephrotoxicity; make sure patient is well hydrated to avoid; adjust dose in renal dysfunction

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5
Q

Syphilis treatment

A

Benzathine Penicillin G intramuscularly

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6
Q

Benzathine Penicillin MOA

A

binds PBP causing cell lysis; IM allows 2 week depot of the drug; poor CSF penetration (not effective in CNS infection)

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7
Q

Jarisch-Herxheimer Reaction

A

observed in patients with syphilis after initial penicillin injection; chills, fever, HA, myalgias, arthralgias, increased edema/color at cutaneous lesion; fades within 48hrs

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8
Q

Chlamydia treatment

A

Azithromycin or Doxycycline or Erythromycin or Levofloxacin or Ofloxacin; in pregnancy use Amoxicillin

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9
Q

Azithromycin, Erythromycin MOA

A

binds 50s ribosomal subunit, bacteriostatic

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10
Q

Doxycycline MOA

A

binds 30s ribosomal subunit, bacteriostatic

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11
Q

Levofloxacin MOA

A

inhibits DNA gyrase (topo II) in gram negative, bactericidal; inhibits topo IV in gram-positive, bactericidal

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12
Q

Ofloxacin MOA

A

inhibits topo IV in gram-positive, bactericidal; inhibits DNA gyrase (topo II) in gram negative, bactericidal

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13
Q

Amoxicillin MOA

A

bactericidal beta-lactam; binds PBPs causing cell lysis

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14
Q

Erythromycin PKPD

A

short half life, P-gp and CYP3A4 substrate and inhibitor; minimal elim in urine most in stool

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15
Q

Azithromycin AE

A

GI upset; vaginitis

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16
Q

Doxycycline AE

A

GI upset, hepatic damage in high dose esp in pregnancy (cat D); photosensitivity with sunlight

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17
Q

Erythromycin AE

A

GI upset; increases toxicity of CYP3A4 substrates; estolate preparations may cause cholestatic jaundice; risk of cardiac death with 3A4 inhibitors; may cause hypertrophic pyloric stenosis in neonates

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18
Q

Levofloxacin and Ofloxacin AE

A

taste disturbance, GI upset, BBW of tendonitis and rupture and exacerbation of muscle weakness; Cat C for pregnancy

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19
Q

Drugs for Chancroid

A

Azithromycin, Ceftriazone, Ciprofloxacin, or Erythromycin

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20
Q

Ceftriaxone MOA

A

bactericidal beta lactam: binds PBPs causing cell lysis

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21
Q

Ciprofloxacin MOA

A

inhibits DNA gyrase (topo II) in gram negative: bactericidal; inhibits topo IV in gram-positive: bactericidal

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22
Q

Ciprofloxacin and pregnancy

A

Contraindicated; distributes into breast milk and crosses placenta

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23
Q

Treatment of gonococcal infections of cervix, urethra, rectum

A

Ceftriaxone or Cefixime, plus Azithromycin or Doxycycline

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24
Q

Treatment of gonococcal infections of pharynx

A

Cetriaxone plus Azithromycin or Doxycycline

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25
Q

Cefixime MOA

A

bactericidal beta-lactam: binds PBPs causing cell lysis

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26
Q

Cefixime AE

A

diarrhea, GI upset; rarely may increase clotting time; false positive for urinary glucose in diabetic patients

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27
Q

Urethritis/Cervicitis treatment choices

A

Azithromycin or Doxycycline or Erythromycin or Levofloxacin or Ofloxacin

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28
Q

Recurrent Urethritis/Cervicitis treatment choices

A

Metronidazole or Tinidazole plus Azithromycin

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29
Q

Trichomoniasis treatment choices

A

Metronidazole or Tinidazole

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30
Q

Metronidazole, Tinidazole MOA

A

amebicidal, bactericidal, and trichomonacidal; unionized drug taken up by organisms which disrupts DNA’s helical structure, thereby inhibiting bacterial nucleic acid synthesis

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31
Q

CYP interactions and elimination with Metronidazole and Tinidazole

A

M inhibits CYP2C9; T metabolized by 3A4; both cause urine discoloration

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32
Q

Metronidazole, Tinidazole AE

A

avoid in pregnancy and breastfeeding; GI upset, candidiasis, disulfiram-like effect (avoid alcohol), potentially 2ndary malignancies

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33
Q

Bacterial Vaginosis treatment options

A

Metronidazole, Clindamycin, or Tinidazole

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34
Q

Clindamycin MOA

A

binds 50S ribosomal subunit to inhibit protein synthesis; bacteriostatic

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35
Q

Clindamycin AE

A

use intravaginally during 1st trimester to avoid low birthweight, pre-term delivery, premature rupture of the membrane, and neonatal infections; excreted in breast milk; vaginal inflammation and itching

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36
Q

Candidiasis treatment options

A

OTC - butoconazole, clotrimazole, miconazole, tioconazole; Rx - Butoconazole, Terconazole, Fluconazole(only oral)

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37
Q

Azole MOA

A

block ergosterol synthesis through interaction with 14-alpha demethylase, a CYP necessary conversion of lanosterol to ergosterol

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38
Q

Azole AE

A

Flu inhibits 2C9 and is widely distributed; high doses can cause abdominal wall defects and cleft palate in a fetus; can weaken condoms and diaphragms

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39
Q

Genital wart drugs

A

Podofilox, Imiquimod, Sinecatechins

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40
Q

Podofilox MOA

A

plant derived mitotic spindle inhibitor blocking microtubular activity in keratinocytes

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41
Q

Imiquimod MOA

A

an immune response modifier

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42
Q

Sinecatechins MOA

A

green tea extract antioxidant; can cause pain and discomfort at application site

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43
Q

Fetal therapeutics

A

corticosteroids for lung maturaiton; digoxin or flecainide for fetal arrhythmias, NSAIDs for ductus arteriosus, anti HIV drugs to prevent infection from mother

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44
Q

Signs of withdrawal in newborns

A

autonomic hyperactivity, with irritability, excessive crying, poor feeding and abnormal reflexes featuring prominently

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45
Q

Issues with withdrawal signs in a newborn

A

it may mimic other conditions such as infection, hypoglycemia, hyperthyroidism, intracranial hemorrhage, hypoxic-ischemic encephalopathy, and hyperviscosity

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46
Q

Determinants of trans-placental drug passage

A

lipid solubility, degree of ionization, Mol. wt < 600 (can cross), duration and timing of exposure, maternal plasma concentration, placental development and blood flow, energy dependent drug transporter proteins

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47
Q

Placental drug metabolism

A

aromatic oxidation (hydroxylation, N-dealkylation, demethylation) may decrease fetal exposure and toxicity, can increase exposure to carcinogens; hepatic metabolism affects toxicity

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48
Q

Timing for major morphologic abnormalities

A

3-9 weeks

49
Q

Pharmacokinetic properties of newborns

A

slower GI but fast IM absorption, more body water than lipid, limited protein binding, larger liver/body wt, immature enzymes, larger brain/body wt ration, higher BBB permeability, immature renal function

50
Q

Types of drugs to avoid in breast feeding

A

CNS drugs that cause sedation or dependence in the infant, thyroid suppressants, bone marrow suppression (chloramphenicol)

51
Q

Mechanism of paternal teratogenicity

A

mutation in the DNA or altered gene expression, direct contact with fetus via seminal fluid

52
Q

Classes of drugs with known male teratogenicity

A

antivirals (contra), retinoids, adnrogen receptor antagonist, DMARD, AED, MABs, Anticancer drugs

53
Q

Anticholinergics

A

Darifenacin, Fesoterodine, Oxybutynin, Solifenacin, Tolterodine, Trospium Botulinum toxin

54
Q

Sympathomimetics

A

Mirabegron, Pseudoephedrine, Ephedra, Ma Huang

55
Q

Drugs for Urinary Retention

A

Bethanechol, Neostigmine

56
Q

Drugs for opiate induced urinary retention

A

Methylnaltrexone and Naloxone

57
Q

Most common drugs for urinary incontinence

A

tolterodine and oxybutynin

58
Q

Treatment for incontinence due to urge (detrusor overactivity)

A

Anticholinergics - Oxybutynin and Tolterodine

59
Q

Treatment for incontinence due to stress (outlet incompetence)

A

Topical estrogen, alpha agonists, non-drug method

60
Q

Treatment for incontinence due to mixed etiologies

A

focus treatment on predominant symptoms

61
Q

Treatment for incontinence due to atonic bladder

A

catheterization

62
Q

Treatment for functional incontinence

A

therapy choice to eliminate cause

63
Q

Effects of muscarinic blockage on salivary glands

A

dry mouth

64
Q

Effects of muscarinic blockage on cardiac tissue

A

tachycardia, palpitations, prolonged QTc interval

65
Q

Effects of muscarinic blockage on GI tract

A

slowing of transit time (constipation), effects on sphincter tone and gastric acid secretion

66
Q

Effects of muscarinic blockage on CNS, brain (cortex and hippo-campus)

A

effects on memory, cognition and psychomotor speed, confusion, delirium, hallucinations, sleep disruption

67
Q

Effects of muscarinic blockage on bladder (detrusor muscle)

A

decreased contraction, urinary retention

68
Q

Type of muscarinic receptors in bladder

A

M2 (opposes beta receptor) and M3 (acts by direct effect)

69
Q

Organ systems with same receptors as bladder

A

M2 - Cardiac, GI, CNS

M3 - Salivary glands, Eye, GI, CNS

70
Q

Effects of muscarinic blockage on eye

A

dry eyes, blurred vision

71
Q

Peripheral adverse effects of anticholinergic drugs

A

dry mouth, mydriasis, constipation, urinary retention, tachycardia

72
Q

Central adverse effects of anticholinergic drugs

A

sedation, confusion/delirium, hallucinations, slowed cognitive function, sleep disruption

73
Q

Anticholinergic that does not cross BBB

A

Trospium due to quaternary amine structure

74
Q

Selective receptor binding anticholinergic

A

Darifenacin

75
Q

Anticholinergic without CYP metabolism

A

Trospium

76
Q

CYPs used by most anticholinergics

A

3A4+/-2D6

77
Q

Trospium absorption and excretion

A

Poor oral bioavailability - take on empty stomach; Renal tubular secretion; 80% urinary excretion as parent drug

78
Q

Anticholinergics with best oral absorption

A

Solifenacin (90%), Tolterodine (75%), Fesoterodine ER (52%)

79
Q

Anticholinergic with longest half life

A

Solifenacin (45-68 hours)

80
Q

Anticholinergics contraindications

A

angle closure or narrow-angle glaucoma, urinary and gastric onstruction, need for mental alertness, Alzheimer’s type dementia

81
Q

Benefits of extended release anticholingergics

A

more convenient dosing; reduces risk of dry mouth without loss of efficacy

82
Q

Botox effects of bladder

A

peripheral afferent desensitization, inhibition of expression of purinergic and proposed SP receptors, blocks excitarory effect on suburothelial afferent and detrusor parasympathetic nerve endings during urine storage

83
Q

Mirabegron MOA

A

beta 3 agonist; increases bladder capacity by relaxing detrusor smooth muscle

84
Q

Mirabegron PKPD

A

low oral absorption (decreased more by food), CYP3A4»2D6 metabolism and butylcholinesterase, UGT, and alcohol dehydrogenase metabolism; 50hr half life

85
Q

Pseudoephedrine MOA

A

direct and indirect alpha and beta agonist (alpha>beta effects)

86
Q

Pseudoephedrine half life

A

9-16hrs depending on urinary pH (increased urinary excretion with acidic urine)

87
Q

Ephedra, Ma-Huang MOA

A

indirect non-selective alpha and beta agonist

88
Q

Ephedra, Ma-Huang half life

A

5hrs

89
Q

Mirabegron AE

A

increased BP, tachycardia

90
Q

Pseudoephedrine AE

A

HTN, tachyarrhythmia, A-fib, insomnia, anxiety, restlessness, MAOI interactions

91
Q

Ephedra AE

A

HTN, tachyarrhythmia, A-fib, insomnia, anxiety, restlessness, MAOI interactions

92
Q

Methionine MOA and uses

A

ancillary drug that creates ammonia free urine by acidifying urine pH; used to control odor, dermatitis, and ulceration in incontinent adults

93
Q

Methionine dosing and AE

A

take with food or milk or other liquid; can cause drowsiness, n/v

94
Q

Bovine Collagen uses

A

sterile, highly purified dermal collaged that is injected into urethra/bladder neck for incontinence due to intrinsic sphincter deficiency. Used for patients failing other therapies for >12mo

95
Q

Bovine Collagen MOA

A

forms a soft cohesive network of fibers increasing tissue bulk around the urethral lumen

96
Q

Bovine Collagen AE

A

urinary retention, hematuria, injection site reaction, worsening incontinence, erythema, urticaria, abscess formation

97
Q

Bethanechol MOA

A

muscarinic agonist in urinary bladder and GI tract; ionized and does not cross BBB

98
Q

Neostigmine MOA

A

inhibits acetylcholinesterase, augments action of Ach at both muscarinic and nicotinic receptors

99
Q

Neostigmine metabolism and excretion

A

inactivated by cholinesterases and hepatic microsomal enxymes; primarily urinary excretion as parental drug

100
Q

Bethanechol AE

A

lightheadedness, syncope, diarrhea, stomach cramps, dizziness, excessive tear production, miosis, urgent desire to urinate

101
Q

Neostigmine AE

A

AV block, bradyarrhythmia, cardiac arrest, cardiac dysrhythmia, hypotension, syncope, tachycardia

102
Q

Mechanism of opiate urinary incontinence

A

mediated by mu and delta receptors in sacral cord inhibiting parasympathetic outflow and thus detrusor activation

103
Q

Chemotherapeutics for Ovarian Cancer

A

Carboplatin, Cisplatin, Cyclophosphamide, Doxorubicin, Paclitaxel

104
Q

Chemotherapeutics for Bladder Cancer

A

Bacillus Calmette-Guerin (BCG), Cisplatin, Doxorubicin, Mitomycin C, Thiotepa

105
Q

Treatment for stage 1 &2 ovarian cancer

A

Carboplatin or Cisplatin (intraperitoneal) with cyclophosphamide and/or doxorubucin

106
Q

Treatment for stage 3&4 ovarian cancer

A

Carboplatin or cisplatin with paclitaxel

107
Q

BCG MOA

A

binds to urothelial cells, activating APCs, which induces production of effector cells; increased response with successive cycles

108
Q

Carboplatin/Cisplatin MOA

A

forms DNA intrastrand crosslinks and adducts

109
Q

Cyclophosphamide MOA

A

pro-drug of active alkylating moiety

110
Q

Doxorubucin MOA

A

intercalator, free radical generator, topo II inhibitor

111
Q

Mitomycin C MOA

A

mono and bi functional alkylating agent

112
Q

Paclitaxel MOA

A

microtubule stabilized inhibiting depolymerization

113
Q

Thiotepa MOA

A

polyfunctional alkylator with loss of azindine (alylator) moiety

114
Q

Doxorubicin AE

A

myelosuppression, CHF, Hepatic disease, secondary malignancies, extravasational necrosis, n/v

115
Q

Cyclophosphamide AE

A

blood dyscrasias, hemorrhagic cystitis, amenorrhea/infertility, secondary malignanies, pulmonary fibrosis

116
Q

Mitomycin C AE

A

pancytopenia, chemical cystitis, contact dermatitis, palmar/plantar erythemas

117
Q

Paclitaxel AE

A

taxane hypersensitivity, myelosuppression, myalgia, arthralgia

118
Q

Thiotepa AE

A

pancytopenia, dysuria, urinary retention, chemical/hemorrhagic cystitis, renal dysfunction

Reproductive Block (4 decks)

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