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Clin Med II > Repro tx > Flashcards

Repro tx Flashcards

1
Q

Medical abortion with pills

A

Mifepristone (Mifeprex) + Misoprostol (Cytotec)

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2
Q

When can Mifepristone (Mifeprex) + Misoprostol (Cytotec) be used for abortion?

A

up to 9 weeks (63 days) gestation

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3
Q

CI of mifepristone

A 
Ectopic pregnancy
Severe anemia (must have hgb >10)
Coagulopathy
Anticoagulant therapy
Chronic adrenal failure
Long-term corticosteroid use Current IUD in place
Allergy
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4
Q

When should you follow up after medical abortion?

A

2 wks check with US to confirm complete

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5
Q

Medical abortion with injection

A

Methotrexate + misoprostol

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6
Q

Methotrexate + misoprostol MOA

A

inhibits embryonic cell division

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7
Q

When is Methotrexate + misoprostol indicated

A

if ectopic is suspected otherwise rarely used

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8
Q

Septic abortion

A

Clindamycin + Gentamycin ± Ampicillin

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9
Q

progestin moa for contraception

A

inhibit LH release and prevent ovulation

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10
Q

estrogen moa for contraception

A

inhibit FSH and prevent folliculogenesis

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11
Q

Turner’s Syndrome

A

Replace estrogen and cyclic progesterone to induce menses

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12
Q

Mullerian Agenesis

A

Surgical reconstruction of the vagina

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13
Q

Imperforate Hymen

A

Surgical

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14
Q

Transverse Vaginal Septum

A

Surgical

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15
Q

Functional Hypothalamic Amenorrhea

A

Manage nutritional status

OCPs for estrogen replacement

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16
Q

Sheehan Syndrome

A

Replace pituitary hormones

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17
Q

Premature Ovarian Failure

A

HRT
Estrogen + progesterone

Weight-bearing exercise

Calcium and Vitamin D supplement

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18
Q

Asherman Syndrome

A

Hysterscopic lysis of adhesions

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19
Q

Endometriosis

A

NSAIDS + Continuous Hormonal therapy

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20
Q

PMS and PMDD

A

SSRI Fluoxetine (Prozac) 20 mg po QD
or
Sertaline (Zoloft) 50-150 mg po QD

OCPs (2nd line)

if mild just lifestyle mod

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21
Q

Ovarian Hyperstimulation Syndrome (OHSS)

A

Mild/moderate – treat symptomatically/expectant management at home

Severe – hospitalization and aspiration of fluid (may need to repeat several times)

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22
Q

1st line tx for infertility due to ovulatory d/o

A

Clomid

2nd line is Femara

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23
Q

Endometrial Polyps

A

Sx polyps should be removed (or if over 50) via hysteroscopy

If asymptomatic- expectantly manage unless > 1.5 cm, multiple, infertile or prolapsed

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24
Q

Adenomyosis

A

Expectantly manage

NSAIDs PRN pain

LNG IUD. Or OCP to control bleeding (not to treat condition)

Hysterectomy is definitive tx

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25
Q

Leiomyoma

“fibroids”

A

Hysterecomy is definitive tx

Hormonal therapy (tp stop bleeding)- LNG IUD, implant, OCP, GnRH analogues

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26
Q

Endometrial Hyperplasia

A

Surveillance

Progestin therapy - to shed lining

Hysterectomy

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27
Q

Endometrial Cancer

A

Stage I & II- total hysterectomy w/ bilat salpingo- oophorectory (TAH-BSO) ± pelvic radiation

Stage III & IV- pelvic and para-aortic lymphadenectomy, omentectomy if type II

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28
Q

Leiomyosarcoma

A

poor prognosis

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29
Q

Ovarian Cysts

A

Most resolve spontaneously w/in 1-2 menstrual cycles

Sx tx- NSAIDs, heat

Hormonal- OCP (simple cysts)

Surgical mgmt- cyst aspiration, laparoscopy (>4-5 cm + sx)

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30
Q

Endometrioma

A

do NOT resolve spontaneously

Expectantly manage

Removal - laparoscppy if >5 mm

OCP

Lupron in form of depot

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31
Q

Medullary and Germ cell Tumors

A

Do NOT typically resolve w/ time

Monitor and resect

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32
Q

Ovarian Torsion

A

De-torsion and ovarian conservation, possibly ovarian cystectomy, possible oopherectomy

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33
Q

Polycystic Ovarian Syndrome (PCOS)

A

Endometrial protection: OCP, progesterone IUD (mirena, lyletta, kyleena, Skyla), provera x 10-14 d q1-2 months, metformin

Acne: spironoloactone, Tri-cyclic OCP

Hirsuitism: low androgen OCP (desogestrel, drospirinone), spironolactone

Infertility: weight loss, metformin, Clomiphene citrate (Clomid), letrozole, FSH injections, IUI, IVF, ovarian drilling

Insulin resistance and/or hyperandrogenism: weight loss, Metformin

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34
Q

Prostatitis Type I

(Acute Bacterial) <35 risk of STI

A

treat for N gonorrhoeae and Chlamydia
Ceftriaxone 250 mg IM x 1 or 400 mg po x 1
PLUS Azithromycin 1000 mg po x 1

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35
Q

Prostatitis Type I

(Acute Bacterial) >35 low STI risk

A

treat for gram - rods
Ciprofloxacin 500 mg po BID x 4 wks OR
Levofloxacin 500-750 mg po or IV x 4 wks OR
TMP-SMX po BID x 4 wks

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36
Q

Prostatitis Type I

(Acute Bacterial) Severe infection

A

inpatient, IV ampicillin and gentamicin OR levofloxacin then switch to po abx if afebrile and can pass urine, treat for 6-8 wks

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37
Q

Prostatitis Type II

Chronic bacterial

A

Ciprofloxacin 500 po BID x 6 wks OR
TMP-SMX 80/400 po BID x 6 wks

Repeated prostatic massage and cx after Abx completed

May require a-blocker therapy for urine retention

Recurrence is common

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38
Q

Prostatitis Type III

Chronic abacterial prostatitis

A

Refer to urology

Empiric therapy ineffective

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39
Q

Prostatitis Type IV

Asymptomatic inflammatory

A

No tx necessary

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40
Q

Benign Prostatic Hyperplasia

A

Mild- reassure and f/u

Mod- drug therapy + lifestyle mod, DEc fluids if polyuria

Severe- refer

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41
Q

Meds for moderate BPH

A

α-blockers-prazosin

PDE5 Inhibitors- tadalafil

5α reductase inhibitors- finesteride, dutasteride

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42
Q

Prostate Cancer low risk tx

A

active surveillance

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43
Q

Prostate Cancer Localized, intermediate risk

A

radical prostatectomy (not necessarily curative and may cause urinary and erectile dysfn), radiation therapy (only used post radical prostatectomy), cryosurgery (less common, fewer adverse events, minimally invasive)

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44
Q

Prostate Cancer Metastatic tx

A

Androgen deprivation therapy- orchiectomy and/or luteinizing hormone releasing hormone analog *1st line

Bone targeting agents- bisohosphonates (prevent bone pain and prevent fx)
Chemo- docetaxel (if fail ADT)
Vaccines (expensive)

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45
Q

Testicular Torsion

A

Do not delay time to surgery (90% salvage at 6 hr)

Manual detorsion is a temporary fix but surgery required to prevent
recurrence

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46
Q

Epididymitis

A

Abx directed at likely pathogen

Ceftriaxone + Azythro or Fluoroquinolone

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47
Q

Orchitis

A

Symptomatic treatment

Bed rest

Hot or cold packs

Scrotal elevation

48
Q

Varicocele

A

Can try surgical repair if infertile but poor

success rate of pregnancy

49
Q

Hydrocele

A

Usually resolve on their own in < 1 year

Otherwise may need surgery and drainage

50
Q

Spermatocele

A

No tx unless painful → surgically excise

SE of surgery is infertility and chronic pain

51
Q

Testicular Cancer

A

Unilateral orchiectomy w/ pathological evaluation

Post-op: CT of chest, abd, and pelvis to look for metastases

52
Q

Phimosis

A

May require circumcision

53
Q

Paraphimosis

A

Immediate manual reduction

Permanent therapy/prevention requires
circumcision or dorsal slit

54
Q

Priapism

A

Drainage and irrigation with sympathomimetic (phenylephrine)

55
Q

Erectile Dysfunction

A

Treat underlying condition, lifestule moditications, counseling

PDE5 Inhibitors- Sildenafil, tadalafil, vardenafil *1st line

Local Alprostadil injection, mechanical or prosthetic devices, herbal remedies

56
Q

Nabothian Cyst

A

No tx necessary

57
Q

Ectropian

A

No tx necessary

58
Q

Cervical Dysplasia

Cervical Intraepithelial Neoplasia

A

Treat if high grade (exceptions if pregnant)

Ablation (cryogenic) or excision (LEEP/cold knife core)

59
Q

Cervical Cancer

A

Stage IA – radical hysterectomy

Stage IB-IIA – surgery and/or pelvic radiation

Stage IIB-IVA – Radiation and chemotherapy

Stage IVB – Palliative care

60
Q

Gold standard for BPH tx

A

transurethral resection of the prostate

61
Q

Prenatal vitamin for preg women should contain:

A

Folic acid 400 mcg
DHA
Iron

62
Q

Absolute CI to methotrexate

A

Hemodynamically unstable or clinical evidence of ruptured ectopic

Liver disease or alcoholism

Blood dyscrasias

Renal dysfunction

Immunodeficiency

Active pulmonary disease

PUD

Breastfeeding

63
Q

Relative CI to methotrexate

A

Bhcg > 5000

Gestational sac > 35mm

+ Fetal heart tones

Patient unwilling/unable to comply with follow up

Patient unwilling to accept blood transfusion

64
Q

What meds are used for preterm labor and when should they be stopped

A

Betamethasone – for fetal lung maturity (FLM) – STOP @ 37 wks

Magnesium sulfate – for cerebral palsy prevention – STOP @ 32 wks

GBS prophylaxis – Penicillin (not indicated if GBS negative)

65
Q

Ectopic Pregnancy

A

Methotrexate (MTX) 50 mg IM on day 1

Check βhCG on day 1, 4 and 7 (should ↓ 15% btwn day 4 and 7)

Rhogam if RH ⊖

Follow until βhCG is <5

Laparoscopic Salpingectomy/Salpingostomy if evidence of ruptire, hemodynamically unstable or CI to MTX

66
Q

Gestational Trophoblastic Disease (GTD)

A

Rhogam if RH ⊖

D&C

Serial βhCG weekly until <5 then monthly x 6 mo

Contraception bc do not want to get pregnant while monitoring for 6 mo

67
Q

GTN

A

Single agent for low risk (WHO <6): MTX (Methotrexate) or Actinomycin-D

Multi-agent for High risk (WHO >6): EMA-CO (Etoposide, Methotrexate, Actinomycin-D, Cyclophosphamide,
Vincristine)

68
Q

Gestational diabetes

A

Diet

Exercise

Blood sugar monitoring
4-5 times per day

Meds if cannot control w/ diet: insulin, metformin, glyburide (↑ risk of macrosomia and hypoglycemia)

6-12 wk Postpartum OGTT

69
Q

Gestational HTN

A

Wkly NST and labs

BP meds: Labetalol, Hydralazine, Nifedipine, (Methyldopa)

Delivery at 37-39 wks

70
Q

Pre-eclampsia w/o severe features

A

Weekly NST Twice weekly labs

Delivery at 37 wks

71
Q

Pre-eclampsia w/ severe features

A

Magnesium sulfate to ↓ seizure risk

BP meds: Labetalol, Hydralazine, Nifedipine, (Methyldopa)

Inpatient

Delivert at 34 wks

72
Q

Eclampsia

A

Magnesium sulfate

Lorazepam

Immediate delivery

73
Q

preterm labor <24 wk

A

Counsel on comfort measures vs NICU intervention

74
Q

preterm labor 24-32 wk

A

Betamethsone (BMZ) 12 gm IM q24hrs x2 doses (for fetal lung maturity) + magnesium sulfate (forr cerebral plasy prevention) + tocolysis (to prevent contractions)

75
Q

preterm labor 32-34 wk

A

Betamethsone (BMZ) 12 gm IM q24hrs x2 doses ± tocolysis, GBS pphx

76
Q

preterm labor 34-37 wk

A

Betamethsone (BMZ) 12 gm IM q24hrs x2 doses + GBS pphx

77
Q

PROM 24-32 wk

A

Betamethasone (BMZ) 12 gm IM q24hrs x2 doses + magnesium sulfate + tocolysis, + abx (amoxicillin and erythromycin x 5 days), deliver at 34 wk

78
Q

PROM 32-34 wk

A

BMZ + tocolysis + abx, deliver at 34 wk

79
Q

PROM 34-37 wk

A

BMZ + GBS pphx and deliver

80
Q

PROM > 37 wk

A

deliver

81
Q

What should you administer if contractions are weak?

A

oxytocin

82
Q

Stimulate cervical ripening

A

Prostaglandin E2 or E1 (mc)
Transcervical foley catheter
Hygroscopic dilators (Laminaria)

83
Q

Sexual assault abx pphx

A

Chlamydia/Gonorrhea/Trichomonas

Ceftriaxone 250mg IM
Azithromycin 1g PO
Metronidazole 2g PO

84
Q

Preg pphx post sexual assualt

A

Plan B (72 hours)
Ulipristal (120 hours)
Paragard (120 hours)

85
Q

Bacterial Vaginosis (BV)

A 
First line: 
Metrogel Vag (0.75%) insert one aplicator (5g) imtravaginally QHS x 5 days

Metronidazole 500 mg P.O. BId x 7 days (metallic taste, can’t drink alcohol) recommended for pregnant pts

Clindamycin cream (2%) insert one applicator (5 g) intravaginally QHS x 7 days (or ovules x 3 days)

2nd line
Clindamycin 300 mg P.O. BID x 7 days

86
Q

Uncomplicated Vulvovaginal Candidiasis

Yeast infection

A

If asymptomatic don’t have to treat

Uncomplicated tx
Diflucan (fluconazole) 150 mg po x 1

Topical
Miconazole (monistat), clottimazole (gynelotrimin, tercnoazole (terazol) insert 1 applicator 5g intravaginally at bedtime x 1-3 days
87
Q

Complicated Vulvovaginal Candidiasis

Yeast infection

A

Complicated tx (immunocompromised, pregnant, poorly controlled DM)

Diflucan 150 mg po x 2-3 doses 72 hrs apart or
vaginalis imidazole x 7-14 days

Pregnant- clotimazole or micnkazole x 7 days only (NO diflucan)

If Glabrata use boric acid 600 mg intravaginally x 14 days

88
Q

Trichomoniasis

A

Partner must be treated and screen for other STIs

First line
Metronidazole 2 g po x 1
Metronidazole 500 mg po BOD x 7 days ( no alohol for 1 wk)

2nd line- Tindazole 2 g po x 1

89
Q

Trichomoniasis for pregnant pt

A

Pregnancy associated with preterm delivery and LBW

Tx = Metronidazole 2g po x 1

90
Q

Bartholin Gland Cyst

A

no tx if asymptomatic but consider bx to r/o malignancy

91
Q

Batrholin Gland abscess

A

I&D with word catheter (bring back in 4-6 wks), +/- broad spectrum Abx (Bactrim DS 1 tab po BId x 7 days)

92
Q

Vulvar Cancer

A

Surgery - wide iincision to preserve vulva & inguinal lymph node dissection

Radical vulvectomy & reginal lymphadenectomy (try to avoid)

Radiation, chemo

Tx based on stage

93
Q

Vaginal Cancer

A

Surgical excision (hysterectomy + upper vaginectomy)

Radiation therapy

94
Q

Mastalgia

A

If cyclic just reassurance, sports bra or more supportive bra, weight reduction, pain mgmt, test underlying conditions

95
Q

Mastitis

A

Abx if sx > 12-24 hr

Dicloxacillin 500 mg po QID x 10-14 d

if no improvement r/o breast abscess w/ US

96
Q

Nipple Discharge

A

Physiologic- no breast stimulation and ST f/u in 2-3 mo, endo referral (pituitary Adenoma)

Refer to breast specialist if malig discharge, abnormal findings

97
Q

Fibrocystic Breast Disease

A

Low fat diet, avoid caffeine, coffee soar, chocolate, ETOH (to help with pain)

Manage contraception, hormone replacement therapy, supportive bra, medication as needed

98
Q

Fibroadenoma

A

ST f/u w/ repeat sono/breast exam

Expectantly manage

Surgical excision

99
Q

Chlamydia

A

Azithromycin 1g single dose

Doxycycline 10p mg BID x 7 days (not in pregnancy because teeth defects in children)

LGV treat for at least 3 wks

100
Q

Gonorrhea

A

Ceftriaxone 250 mg IM single dose with 1 g Azithromycin po to prevent resistance

101
Q

PID

A

Outpatient
Ceftriaxone 250 mg IM once plus doxcycline 100 mg po BID x 14 days w/ or w/ metronidazole 500 mg bid x 14 days

Inpatient
Cefotetan 2 g IV 1 12 h plus doxycycline 100 mg po BID x 14 d

102
Q

Chancroid

A

Azithromycin 1 go po once

Ceftriaxone 250 mg IM once

Ciprofloxacin 500 mg po BID x 3 days

Erythromycin 500 mg TID x 7 days (but avoid because of nausea)

103
Q

Granuloma Inguinale (Donovanosis)

A

Azithromycin 1 g weekly or 500 mg QD x 3 wks or until cleared

104
Q

Syphilis

A

Early disease (less than one year) penicillin G benzathine (Bicillin‐LA) 2.4 MU, IM, otherwise 3 injections

Can use doxy or deftriaxone

Neurosyphilis IV penicillin ONLY OPTION

105
Q

Pubic Lice

A

Permetherin (Nix OTC or Rx Elimite

Malathion

Lindane-

Decontaminate environment and treat partners

106
Q

Scabies

A

Permetherin 5% cream

Lindane 1% lotion/cream (↑ resistance, cheaper)

Ivermectin 200mcg/kg PO single dose

107
Q

Menopausal sx (hot flashes) and osteoporosis

A

estrogen alone (only if no uterus)

combo progesterone and estrogen (if uterus)

transdermal estrogen (patch, spray, gel)

108
Q

CI to tx for Menopausal sx (hot flashes) and osteoporosis

A

hx of breast ca, thromboembolism. undiagnosed vag bleeding, use longer than 3-5 yr for HRT or 7 yr for ERT

109
Q

hot flashes, osteoporosis, vulvovaginal atrophy

A

SERM

Raloxifene- good for osteoporosis

Ospemifene- helps with vag atrophy and dysparenunia

CI if thromboembolism hx

110
Q

Hot flashes due to menopause

A

SSRI and SNRI to dec vasomotor sx freq

Brisdale is only FDA approved

CI if suicidal ideation or on tamoxifen

111
Q

postmenopausal osteoporosis

A

calcium, vit D, weight bearing exercises, fall risk prevention, biphosphonates (prevent fx)

112
Q

sexual arousal d/o

A

androgen (not FDA approved)

SE: facial hair, acne, voice changes

113
Q

vulvovaginal atrophy

A

local estrogen therap- vag ring, cream tablet

non-estrogen med-osphena (acts like estrogen)

vag lubricants/moistuirzers

114
Q

uterine prolapse

A

kegels, pessary use or surgery

115
Q

rectocele

A

pessaries + estrogen, or surgery

116
Q

cystocele

A

mild-no tx, kegels, pessary, estrogen to help pelvic floor muscles or surgery

Clin Med II (19 decks)

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