Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAMS > Prescription Therapies > Flashcards

Prescription Therapies Flashcards

1
Q

Types of contraception

A

-despite decline in fertility during peri meno, pregnancy is still possible until menopause is reached
-hormone contraception helpful for sxs for perimeno and in cont pregnancy prevention
-long-active, reversible contraceptive methods (i.e. copper IUD) one of the four levonorgestrel-releasing intrauterine systems (LNG-IUS), and the etonogestrel subdermal implant provide long-term protection from pregnancy & tx AUB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of contraception (cont)

A

-combo estrogen-progestin contraceptives (pills, patch, ring) are only appropriate for healthy, lean, nonsmoking perimeno women; contraindicated in women aged 35yo who smoke, other potential contraindication include HTN, DM, obesity, other comorbidities
-CDC guidelines through US selected practice recs for contraceptive use (SPR) and the US Medical Eligibility Criteria for Contraceptive Use (MEC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

nexplanon

A

-etonogestrel subdermal implant
-a progestin (synthetic progestogen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

LNG-IUS

A

-levonorgestrel-releasing intrauterine system
-a progestogen
-can provide long-term protection from pregnancy & treat AUB
-Skyla 13.5mg - 3 yrs
-Kyleena 19.5mg - 5 yrs
-Liletta & Mirena 52mg - 5-7 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

skyla

A

-LNG-IUS contraception
-13.5mg; 3yrs
-may be better options for nulliparous or if smaller cervix/uterus
-AE: irregular spotting+, subsides, no menses 13% @1yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

kyleena

A

-LNG-IUS contraception
-19.5mg; 5yrs
-similar size as 13.5mg device
-AE: irregular spotting+, subsides, no menses 19% @1yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mirena & liletta

A

-LNG-IUS contraception
-52mg; 5-7yrs
-for heavy menses, endometriosis pain (off label), endometrial hyperplasia/bleeding w ET (off label)
-AE: irregular spotting+, subsides, no menses 19% @1y, 37% @3y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

copper T380A

A

-IUD contraception
-10-12yrs
-incr cramping/menses flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

intrauterine contraception

A

-safe, highly effective, convenient long-term contraception, office procedure
-risk for uterine perf is 1:1000 insertions (6x worse if breastfeeding)
-expulsion rates ~10% over 3yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

progestin-only contraceptives

A

-best for perimeno who cannot have estrogen dose
-safer alternative for smokers +35yo, women w HTN, and hx of VTE
-IUD, subdermal implant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

progestin-only contraception injection

A

-depot MPA
-150mg buttock or UE q3 mo
-some wt gain, fertility return 12-18mo delay
-AE: irregular spotting+, no menses by 4th injection, lower BMD
-alternative: Norethindrone (Aygestin) 200mg IM q2mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

progestin-only contraception oral

A

-nortehindrone 0.35mg daily
-good for perimeno; needs to be taken same time daily
-no hormone-free (inactive) pills
-unscheduled bleeding can happen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

combo (estrogen-progestin) contraceptives

A

-mostly OCs, transdermal patch, vaginal ring
-safe, effective for midlife women healthy, lean, and do not smoke
-AE: VTE, unscheduled bleeding
-several OC forms based on 24/4 regimen (better ovarian follicular activity suppression) vs traditional 21/7
-ultralow doses available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

combo (E-P) contraceptives (cont.)

A

-drospirenone differs from other synthetic progestins (derived from 17A-spironolactone) so has mild antimineralocorticoid effects
–> approved for tx premens dysphoric disorder when combined w ethinyl estradiol (EE)
-most OCs include EE for estrogen
-2 others: estradiol valerate and dienogest - approved for contraception and heavy menses bleeding
-extended OC formulations result in less-than-monthly withdrawal bleeding and are equally as effective and safe –> continuing low-dose EE during inactive pill periods or discontinuing active tablets 3 days can reduce unscheduled bleeding w extended-cycle regimens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

emergency contraception

A

-taken after sex to prevent pregnancy, meant for occasional use bc other methods more reliable
-72-120hrs after sexual intercourse
-most effective form is copper IUD (99%), inhibits fertilization & implantation
-progestin-only (POP) uses LNG as two 0.75mg tabs taken 12h apart or as a single 1.5mg dose which reduces pregnancy by 88%
-POP EC available OTC wo rx
-ulipristal acetate can be used up to 5 days after unprotected sex & is rx only; more effective than POP EC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

noncontraceptive benefits of OC

A

-restores regular menses
-decreased dysmenorrhea
-reduces heavy menses
-reduces pain a/w endometriosis (continuous use of OC)
-suppression of VMS
-enhanced BMD & possible prevention of osteoporotic fxs
-decreased need for bx for benign breast disease
-prevention of epithelial ovarian & endometrial malignancies
-improves acne that may flare up with perimeno

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

transitioning from hormone contraception to HT

A

-individualization
-may cont contraception until typical age of meno (52yo) or mid-50s, when women will likely reach meno (90% by 55yo)
-can transition from OCs to HT if still symptomatic
-as low-dose OCs have higher hormone levels than HT, hot flashes may reappear transiently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ET HT

A

-unopposed estrogen for postmeno who have undergone hysterectomy or in low doses for women w vaginal sxs regardless of prescence of uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

EPT HT

A

-for postmeno w uterus
-progestogen reduces risk of endometrial adenocarcinoma bc of unopposed estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

estrogen agonist/antagonist therapy HT

A

-SERM
-for postmeno w uterus who prefer a progestogen-free option
-has similar effect to progestogen on the uterine lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

conjugated equine estrogens (CEE)

A

-type of ET
-on the US market >65yrs now
-most used in RCTs
-more is known about efficacy and safety than any other estrogen product
-approved for prevention of osteoporosis

22
Q

synthetic conjugated estrogens (CE)

A

-type of ET
-US govt does not view as a generic equivalent to CEE; approved generic equivalent in Canada
-not approved for prevention of osteoporosis

23
Q

estradiol

A

-type of ET
-mostly widely used estrogen in Europe
-only estrogen available in a govt-approved, bioidentical formulation
-approved for prevention of osteoporosis

24
Q

esterified estrogens

A

-type of ET
-oral products of synthetic estrogen mixtures containing 75-85% sodium estrone sulfate (E1S)
-not indicated for osteoporosis

25
Q

estropipate

A

-type of ET
-oral forme of estrone sulfate that has been solubilized and stabilized by piperazine
-approved for prevention of osteoporosis

26
Q

ethinyl estradiol

A

-type of ET
-widely used in combination contraceptives

27
Q

oral ET administration

A

-most widely used form in North America
-bc of first-pass uptake & metabolism in the GI & the liver
–>incr HDL cholesterol, a/w 25% incr triglycerides; incr hepatic globulins, coagulation factors, & some inflammatory markers; decr E-selectin, which may affect CAD

28
Q

vaginal ET administration

A

-cream, tablet, insert, rings (low dose for local therapy & two higher doses for systemic therapy) available
-small amounts of E administered locally are effective for treating GSM
-endometrial protection is not needed w local doses of estrogen
-women w uterus using one of the synthetic rings need endometrial protection (add progestogen

29
Q

transdermal/topical ET administration

A

-patch, gel, spray, emulsion forms available
-not subjected to first-pass hepatic metabolism
-a/w more stable serum levels
-minimal effect on sexual functioning
-risk of skin-to-skin transfer of small amounts
-some studies have shown incr in VTE & stroke w oral ET but not transdermal
-stroke & VTE events were comparable across oral, transdermal, & placebo groups in the Kronos Early Estrogen Prevention Study (KEEPS)

30
Q

micronized progesterone (MP)

A

-type of PT
-compound identical to endogenous progesterone
-prometrium is the only FDA-approved bioidentical progestogen
-contraindicated in women w peanut allergy
-bedtime dosing advised bc of sedating effects

31
Q

progestin

A

-type of PT
-synthetic products w progesterone-like activity
-classified into 2 groups based on structure
-1) chemical structure similar to progesterone:
MPA (medroxyprogesterone acetate) most commonly used & studied in the US for endometrial protection
-2) chemical structure similar to testosterone:
more potent than those structurally similar to MP or progesterone

32
Q

Continuous-cyclic (sequential) EPT administration

A

-daily estrogen w progestogen added cyclically for 12-14 d/mo
-80% of women will experience bleeding w progestogen withdrawal

33
Q

Continuous-cyclic (sequential) LONG-cycle EPT administration

A

-daily estrogen w progestogen added 14 d/2-6mo
-reduces withdrawal bleeding episodes but results in heavier, longer bleeding
-not recommended as standard therapy
-requires endometrial monitoring

34
Q

Continuous-combined EPT administration

A

-daily estrogen and progestogen
-low rates of endometrial hyperplasia
-higher rates of amenorrhea
-decreased breakthrough bleeding after 2yrs

35
Q

Intermittent-combined EPT administration

A

-daily estrogen w progestogen dose intermittently administered in cycles of 3 d on, 3 d off
-1yr clinical trials have shown amenorrhea rates of 80% & favorable safety profiles

36
Q

ET w estrogen agonist/antagonist

A

-tissue-selective estrogen complex (TSEC)
-daily estrogen w daily selective estrogen-receptor modulator (SERM)
-approved for tx of VMS and prevention of osteoporosis
-amenorrhea rates similar to placebo
-safety profile comparable to placebo

37
Q

Alternative progestogen options

A

-progestin-containing IUD and progesterone vaginal gel
-potentially may provide endometrial ca protection
-long-term efficacy data is needed

38
Q

Contraindications to HT

A

-undiagnosed abnormal genital bleeding
-known, suspected, or hx of breast ca, except in appropriately selected patients being treated for metastatic disease or w oncology involvement
-suspected estrogen-dependent neoplasia
-active or history of DVT, PE
-active or recent (w/in past year) arterial thromboembolic disease
-liver dysfunction or disease
-known or suspected pregnancy
-known hypersensitivity to ET or EPT
-porphyria cutanea tardis

39
Q

Potential AE of HT

A

-uterine bleeding (starting or returning)
-breast tenderness (sometimes enlargement)
-nausea
-abdominal bloating
-fluid retention in extremities
-changes to the shape of the cornea (sometimes leading to contact lens intolerance)
-headache (sometimes migraine)
-dizziness
-mood changes w EPT, particularly w progestin
-angioedema
-gallstones, pancreatitis

40
Q

Timing of HT initiation

A

-possibly less risk a/w HT use and potential CHD benefit if initiated closer to the time of menopause
-in contrast, HT use initiated further from menopause may be harmful
-per WHI: absolute risk of CHD was lower in younger, recent postmeno; MI risk incr during first year of EPT in older women, use of HT w/in 10yrs of menopause onset was a/w lower CHD risk than if started >20yrs from LMP; women 50-59yo in the ET arm had more favorable all0cause mortality & fewer MIs
-Early Estrogen Prevention Study & the Early Versus Late Intervention Trial With Estradiol also showed safety of HT use initiated early in menopause

41
Q

Monitoring HT

A

-annual return visits - more frequent visits for new starts or those with AES
-annual mammogram
-endometrial sampling is not required unless postmeno bleeding develops
-clinical goal: use appropriate HT dose, duration, regimen, route of admin; periodic evaluation

42
Q

Stopping systemic HT

A

-decision should be individualized on the basis of severity of sxs & risk-benefit ration considerations
-approximately 50% of women will experience recurrence of sxs w discontinuation
-low-dose, local ET may be continued as long as vaginal sxs are present

43
Q

Bioidentical HT

A

-marketing term not recognized by FDA
-hormones that are chemically identical to the hormones produced by the ovaries during the reproductive yrs
-term used for custom-compounded HT by compounding pharmacies - these are not FDA approved
-several FDA-approved preparations on market (estradiol pills, patches, gels, sprays, vaginal ring) and oral micronized progesterone

44
Q

Pros of custom-compounded HT formations

A

-allows individualized dosing & combinations of therapy
-allows for different modes of administration: subdermal implants, sublingual tablets, rectal suppositories, nasals sprays
-products can be prepared so binders, fillers, dyes, preservatives, or adhesives

45
Q

Cons of custom-compounded HT formulations

A

-do not have to undergo FDA approval
-not FDA regulated - doesn’t require proof of claim & are not held to same standard of manufacture
-often not covered by 3rd party payers
-not found to be safer than FDA-approved formulations in clinical trials; may even have harms a/w unknown pharmacokinetics
-lack of evidence of efficacy superior to FDA-approved products
-concerns about purity & potency
-lack of monitoring AEs

46
Q

Bioidenticals: 2020 NASEM Recs

A

-July 2020 National Academy of Sciences, Engineering, & Medicine (NASAM) issued report that assessed clinical utility of compounded bioidentical hormone therapy (cBHT); recs:
- restrict use of cBHT to certain situations such as ppl w allergies, unavailable doses in FDA-approved products, or testosterone for women w sexual dysfunction
- improved education for prescribers & pharmacists who market, prescribe, compound, & dispense cBHT preparations
- expending & improving oversight & review of compounding pharmacies
- collection & disclosing info on conflicts of interest
- the evidence base on safety, effectiveness, & use of cBHT preps should be strengthened & expanded
- patient preference is not reason alone to use these products

47
Q

SERM (selective estrogen-receptor modulators)

A

-aka estrogen receptor agonists/antagonists
-exhibits both agonist & antagonist properties, depending on target tissue
-lipid soluble properties
-like estrogen, bind to hormone receptors ER-a & ER-b
-naturally occurring: phytoestrogens - isoflavones, coumestans, prenylflavonoids; food sources: nuts, oil containing seeds, legumes, & soy-containing products

48
Q

Tamoxifen

A

-SERM
-potent antiestrogen in breast tissue
-can reduce risk of invasive ER+ breast ca in high-risk women by 49%
-estrogen agonist on bone, liver, & uterus

49
Q

Raloxifene

A

-2nd gen SERM
-estrogen agonist on bone
-minimal effect on uterine endometrium
-antiestrogen if effects on breast
-lower risk of uterine ca, VTE, & cataracts compared w tamoxifen

50
Q

Ospemifene

A

-SERM
-estrogen agonist on vaginal tissue
-FDA approved for treatment of moderate to severe dyspareunia
-modes incr in hot flashes compared w placebo (9.6% vs 3.4%)
-estrogenic-type response on endometrium but was not aw incr in hyperplasia or endometrial ca w/in first year
-a/w slight incr risk hemorrhagic stroke & VTE (black box warning)

51
Q

Bazedoxifene

A

-3rd gen SERM
-estrogen agonist on bone
-estrogen antagonist on breast & endometrial tissue
-approved in Europe & Japan for tx of osteoporosis
-combined w CEE is available in US for tx of VMS & prevention of osteoporosis

52
Q

Toremifene

A

-SERM
-r/t tamoxifen
-FDA approved to treat advanced estrogen-sensitive breast ca & as adjuvant tx of early breast ca
-weaker effect on endometrium compared w tamoxifen
-may prolong QT interval in the heart (black box warning)

NAMS (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions