Pharmacology Flashcards
Which medication prevents neural tube defects?
Folic Acid
Which medication prevents neural tube defects?
Folic Acid
What do you want to r/o before starting someone on folic acid?
B12 deficiency
Which medication helps with N/V during pregnancy?
Doxyalamine and pyridoxine
Why type of medication is Doxyalamine?
antihistamine
What is pyridoxine?
Vitamin B6
What do you give someone with Trichomoniasis?
Metronidazole
What do you give someone with gonorrhea?
Ceftriaxone
What do you give someone with bacterial vaginosis?
Metronidazole
What do you give someone with chlamydia?
Azithromycin
What do you give someone with syphilis?
Benzathine Penicillin G
What do you give someone with HSV?
valcyclovir/acyclovir
What do you give someone with candidiasis?
Clotrimazole cream
What do you have to warn people about topical -azole medications?
weaken latex, diaphragm
What do you give an HIV neg person for HIV prophylaxis?
Truvada (Tenofovir/Emtricitabine)
What do you need to do before starting someone on truvada?
confirm HIV neg
How often do you want to test for HIV?
every 3 months
What type of PG HTN can you use methyldopa for?
chronic/pre-existing HTN
What is the other PG HTN medication that can be used in all types of HTN?
labetolol
What drug class is methyldopa?
CNS alpha-adgrenergic inhibitor
What drug class is labetalol?
nonselective alpha1, Beta1 and 2 blocker
What are common SE of methyldopa?
depression/anxiety, hemolytic anemia
What are contraindications for labetalol?
bradycardia and bronchial asthma
What medication can be given for premature labor/eclampsia?
magnesium sulfate
What is the MOA of magnesium sulfate?
decr ach in motor nerve terminals; slows rate SA node impulse formation; relaxation bronchial smooth muscle
What are contraindications for magnesium sulfate?
heart block, myocardial damage
what is the DOC for pain treatment in pregnancy?
acetaminophen
What drugs do you want to avoid to treat pain?
NSAIDs
What do you want to watch out for with antipyschotics in pregnancy?
potential risk for extrapyramadil signs and withdrawl sxs in neonate
What anti-depressant do you want to use in PG?
fluoxetine (more SSRIs are Cat C)
What SSRI is cat D?
paxil
Benefits of contraception
- reduced risk endometrial CA
- reduced risk ovarian CA
- regulation of menstration, reduced dysmenorrhea
- fever breast fibroadenomas, cysts
- reduced risk PID
- improved acne control
What is the biphasic COC?
Lo Loestrin Fe
What is the quadraphasic COC?
Natazia
What is the monophasic COC?
Loestrin Fe 1/20
What is the triphasic COC?
Triphasil
What is the progestin only OCP?
Ovrette
When is ovrette useful to take?
when patient can’t take COC (tobacco, obesity, >35yo, HTN, lupus, migrain w/aura, etc.)
What are the 2 continuous/extended cycle COC?
- Lybrel
2. Quartette
How long can you use continuous COC?
4 years
What are absolute contraindications to using COC?
hx thromboembolic d/o hx CAD hx breast CA hx estrogen-dependent neoplasm hx abnormal uterine bleeding PG >15cigs/day and >35yo hx hepatic tumor active liver disease migraine w/aura
What are relative contraindications to using COC?
What are SE of COC?
bleeding
headache
GI
When should a headache cause you to stop COC and do a workup?
- start or more severe after starting COC
- associated with blurred vision or neuro deficit
- increased migraine frequency
What do you want to r/o before starting someone on folic acid?
B12 deficiency
Which medication helps with N/V during pregnancy?
Doxyalamine and pyridoxine
Why type of medication is Doxyalamine?
antihistamine
What is pyridoxine?
Vitamin B6
What do you give someone with Trichomoniasis?
Metronidazole
What do you give someone with gonorrhea?
Ceftriaxone
What do you give someone with bacterial vaginosis?
Metronidazole
What do you give someone with chlamydia?
Azithromycin
What do you give someone with syphilis?
Benzathine Penicillin G
What do you give someone with HSV?
valcyclovir/acyclovir
What do you give someone with candidiasis?
Clotrimazole cream
What do you have to warn people about topical -azole medications?
weaken latex, diaphragm
What do you give an HIV neg person for HIV prophylaxis?
Truvada (Tenofovir/Emtricitabine)
What do you need to do before starting someone on truvada?
confirm HIV neg
How often do you want to test for HIV?
every 3 months
What type of PG HTN can you use methyldopa for?
chronic/pre-existing HTN
What is the other PG HTN medication that can be used in all types of HTN?
labetolol
What drug class is methyldopa?
CNS alpha-adgrenergic inhibitor
What drug class is labetalol?
nonselective alpha1, Beta1 and 2 blocker
What are common SE of methyldopa?
depression/anxiety, hemolytic anemia
What are contraindications for labetalol?
bradycardia and bronchial asthma
What medication can be given for premature labor/eclampsia?
magnesium sulfate
What is the MOA of magnesium sulfate?
decr ach in motor nerve terminals; slows rate SA node impulse formation; relaxation bronchial smooth muscle
What are contraindications for magnesium sulfate?
heart block, myocardial damage
what is the DOC for pain treatment in pregnancy?
acetaminophen
What drugs do you want to avoid to treat pain?
NSAIDs
What do you want to watch out for with antipyschotics in pregnancy?
potential risk for extrapyramadil signs and withdrawl sxs in neonate
What anti-depressant do you want to use in PG?
fluoxetine (more SSRIs are Cat C)
What SSRI is cat D?
paxil
Benefits of contraception
- reduced risk endometrial CA
- reduced risk ovarian CA
- regulation of menstration, reduced dysmenorrhea
- fever breast fibroadenomas, cysts
- reduced risk PID
- improved acne control
What is the biphasic COC?
Lo Loestrin Fe
What is the quadraphasic COC?
Natazia
What is the monophasic COC?
Loestrin Fe 1/20
What is the triphasic COC?
Triphasil
What is the progestin only OCP?
Ovrette
When is ovrette useful to take?
when patient can’t take COC (tobacco, obesity, >35yo, HTN, lupus, migrain w/aura, etc.)
What are the 2 continuous/extended cycle COC?
- Lybrel
2. Quartette
How long can you use continuous COC?
4 years
What are absolute contraindications to using COC?
hx thromboembolic d/o hx CAD hx breast CA hx estrogen-dependent neoplasm hx abnormal uterine bleeding PG >15cigs/day and >35yo hx hepatic tumor active liver disease migraine w/aura
What are relative contraindications to using COC?
What are SE of COC?
bleeding
headache
GI
When should a headache cause you to stop COC and do a workup?
- start or more severe after starting COC
- associated with blurred vision or neuro deficit
- increased migraine frequency
What are estrogen-based SE of COC?
N/V
What are progestin-based SE of COC?
constipation, bloating, distention
How soon do GI SE usually resolve after starting COC?
1-3 months
What are other SE of progestin in COC?
- decreased libido
- depression
- dyslipidemia
What are other SE of estrogen in COC?
- mastalgia
2. weight gain
What does estrogen excess cause?
- bloating
- migraine headache
- decreased libido
- weight gain
What does estrogen deficiency cause?
- spotting
- amenorrhea
- vaginal dryness
What does progestin excess cause?
- acne
- increased appetite
- fatigue
- depression
- hirsutism
What does progestin deficiency cause?
amenorrhea
Why do a lot of medications decrease estrogen effectiveness?
It is a CYP3A4 substrate
What are benefits to progestin only OCP?
- less risk thromboembolic events
- minimize menses after 6-9 cycles
- continuous use
What are down sides of progestin only OCP?
- sometimes spotting
2. need to take consistently same time each day
What are down sides to the ortho-evra patch?
- higher failure rates in women> 90kg (200#)
2. possible increase rate VTE problems compared to COC
What are SE for depo?
- weight gain
2. potential for amenorrhea/infertility for 12-18 months after discontinue
What is the MOA of COC?
Suppression of FSH/LH with suppression of ovulation and reduced implantation; thickening cervical mucus, decr tubal motility
What is the progesterone agonist-antagonist emergency contraceptive?
Ella
How soon do you need to take an emergency contraceptive after intercourse?
120 hours
Can emergency contraceptives be used in women with most contraindications to OC?
YES!
What are goals of therapy of treating amenorrhea?
- preserve bone density
2. restore ovulation/fertility
What can be used in primary and secondary amenorrhea?
- estrogen and progestin therapy (CEE, ethinyl estradiol, COC)
What do you use to treat hyperprolactinemia?
Bromocriptine (dopamine agonist)
What do you use to treat polycycstic ovarian syndrome?
Metformine and TZD
What do you use to treat secondary amenorrhea?
DEPA (MPA)
How can you treat menorrheagia?
- NSAIDs (20-50%)
- COC (50%)
- Mirena IUD (most effective, 90%)
What can you use to treat dysmenorrhea?
- NSAIDs
- OCP
- Depa
- Mirena IUD (ok in nuliparous woman)
What causes anovulatory bleeding?
unopposed estrogen
How do you treat anovulatory bleeding caused by PCOS?
- COC (increases SHGB– increased androgen binding)
- MPA (oral or depo)
- metformin or TZD
What are some contraindications to hormone therapy?
- CHD
- hx breast CA
- PG
- liver disase
- undiagnosed vaginal bleeding
What are alternative treatments for menopause other than estrogen?
- SSRIs (low dose paxil, clonidine)
2. CAM
What are black box warning for estrogen (premarin)?
- CVD
- dementia
- malignancies
What do you use estrogen for?
- mod-severe vasomotor sxs
- vaginal mucosal atrophy
- hypogonadism
What drug do you use for dyspareunia?
Ospemifine
What drug do you use for hypoactive sexual desire in females?
Flibanserin
What disorder do you want to inhibit PDE5 enzyme?
ED
What receptors do you want to inhibit in BPH?
alpha 1 and 5-alpha reductase
What drugs can cause ED?
- B-blockers
- thiazides
- spironolactone
- alpha-blockers
- 5alpha-reductase inhibitors
What are contraindications of PDE5 inhibitors?
- high risk CV
- nitrates
- azole antifungals
- erythromycin
- > 170/100,
What is the MOA of viagra?
inhibits PDE5 to increase [NO] leading to corpus cavernosum relaxation and inflow of blood to cause erection
What are SE of viagra?
- headache
- flushing
- color vision changes
- angina
- hypotension
What are SE of testosterone?
- prostate hypertrophy
- emotional changes
- altered libido
- aggression
- acne
What is the MOA of alpha-adrenergic antagonists in BPH?
relax bladder neck, prostatic, urethral smooth muscle
What is the MOA of 5alpha-reducate inhibtors in BPH?
decrease prostatic tissue growth sec to inhibiting conversion testosterone to dihydrotestosterone
What is the drug class for finasteride?
5 alpha-reducase inhibitor
What is the drug class for tamsulosin?
alpha-adrenergic antagonist
Which medication is used as an anti-neoplastic agent for palliative treatment of prostate CA, endometriosis?
Leuprolide
Which medication is used for metastatic prostate CA w/ LHRH agonist?
Flutamide
What is impramine used for?
depression, offlabel for Urinary incontinence
What is the drug class of impramine?
tricyclic antidepressant
What is oxybutinin used for?
- overative bladder
2. urge incontinence
What is the drug class of oxybutinin and tolterodine?
anticholinergic agent
What is Mirabegron used for?
overactive bladder with sxs of urianry frequency, urgency or urge incontinence
What is the drug class for Mirabegron?
Beta2-agonist