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Treatments > Reproduction > Flashcards

Reproduction Flashcards

1
Q

What drugs are Teratogenic

A

-Warfarin

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2
Q

Treatment of DVT/PE during pregnancy

A

Low molecular weight heparin (LMWH)

[WARFARIN IS TERATOGENIC]

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3
Q

Management of Maternal Sepsis

A

-Prompt IV administration
-Full septic screen;
Blood cultures, LVS, MSSU, wound swabs
-Antipyretic measures
-Fluids

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4
Q

How to induce ovulation

A

-Clomifene

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5
Q

How does Clomifene work

A

-Binds to oestrogen receptors which causes the pituitary to release gonadotropins

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6
Q

Side effects of Clomifene

A
  • Vasomotor (hot flashes)

- Visual

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7
Q

Treatment for Azoospermia

A

-Surgical retrieval of sperm
Micro-epididymal sperm aspiration
Testicular sperm extraction

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8
Q

Treatment of Ectopic Pregnancy

A
  • Methotrexate, single IM into buttocks
  • Surgical removal of fallopian tube
  • Expectant management, if pregnancy is small it may dissolve by itself
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9
Q

Caution after receiving methotrexate

A
  • Avoid alcohol, methotrexate + alcohol = liver damage

- Reliable contraception for 3 months after, as methotrexate will harm the foetus

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10
Q

If prescribing Isotretinoin, to a woman of child bearing age, what 2 things must also be done with regards to the patient, according to the BNF

A
  • Monthly pregnancy checks

- Use at least one (preferably 2) methods of contraception

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11
Q

When should you avoid using Trimethoprim for a UTI

A

BNF says avoid during 1st trimester

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12
Q

Baby JR

  • 3 weeks old
  • Breast feeding
  • Mother has lower back pain

What can she safely take

A
  • Paracetamol + Ibuprofen, BNF notes amounts too small to be harmful in breast milk (though some manufacturers state avoid ibuprofen)
  • Codeine USUALLY too small to be harmful, but maternal metabolism very variable so risk of morphine OD in baby
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13
Q

Management of an ectopic pregnancy

A
  • Medical = Methotrexate
  • Surgical = Mostly laproscopical salpingectomy/salpingotomy (removal of fallopian tube)
  • Conservative = If pregnancy is small enough it may dissolve by itself
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14
Q

Management of placenta praevia

A
  • Caesarean section

- Watch for post partum haemorrhage (PPH)

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15
Q

Management for antepartum haemorrhage

A

-Will vary from expectant treatment to attempting vaginal delivery to caesarean section
-Depends on;
Amount of bleeding
Condition of mother + baby
Gestation

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16
Q

Management of preterm delivery

A
  • Consider possible cause (abruption, infection)
  • <24-26 weeks, Generally regarded as very poor prognosis
    -Cases considered viable;
    Consider tocolysis to allow steroid transfer,
    Steroids unless contraindicated
    Transfer to NICU
    Aim for vaginal delivery
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17
Q

Treatment for chronic hypertension in pregnancy

A
  • Beta-blockers (Labetalol)
  • Calcium channel blocker (Nifedipine)
  • Centrally acting antihypertensive drugs (Methyldopa)
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18
Q

Treatment of eclamptic seizures

A

Magnesium sulphate bolus + IV infusion

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19
Q

Prophylaxis for pre-eclampsia in subsequent pregnancies

A

Low dose aspirin, from 12 weeks till delivery

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20
Q

Treatment for diabetes during pregnancy

A

Can continue with oral metformin but may need to change to insulin for tighter glucose control

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21
Q

Management of GDM

A

Control blood sugars with;

  • Diet
  • Metformin/insulin if sugars remain high
  • 6-8 weeks post delivery check OGTT
  • Yearly check of HbA1c (due to higher risk of developing overt diabetes)
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22
Q

4 methods of management for UI

A
  • Lifestyle changes
  • Medical treatments
  • Physiotherapy
  • Surgery
23
Q

Describe the mechanism of SUI and treatment for it

A

-SUI occurs when intra-abdo pressure exceeds urethral pressure, resulting in leakage
-Urethral closure pressure is increased by;
Pelvic floor muscle training
Surgery
Pharmacological agents

24
Q

4 lifestyle changes for UI treatment

A
  • Smoking cessation
  • Weight loss
  • Healthier diet
  • Stop drinking alcohol and caffeine
25
Q

3 components pelvic floor muscle training (PFMT)

A
  • Reinforcement of cortical awareness of muscle groups
  • Hypertrophy of existing muscle fibres
  • General increase in muscle tone and strength
26
Q

Pharmacological treatment for SUI (moderate to severe) and who should receive it

A
  • Duloxetine (should still include PFMT)
  • If PFMT has failed or would be enhanced with Duloxetine
  • After failed surgery or those unfit for or not interested in surgery
27
Q

3 surgical treatments for SUI

A
  • Colposuspension
  • Mid-urethral sling
  • Retro-pubic TVT (Tension-free Vaginal Tape)

TVT has now replaced Colposuspension as 1st choice surgical treatment of SUI
8 year 80% cure rate

28
Q

4 lifestyle changes to treat OAB

A
  • Normalise fluid intake
  • Reduce caffeine
  • Smoking cessation
  • Weight loss
29
Q

Pharmacological treatment of OAB

A 
Antimuscarinic Drugs (type of anticholinergic drug) 
E.g. Oral Solifenacin
30
Q

2 recent treatments for OAB

A
  • Botox

- Neuromodulation (Needle stimulation s2-4, reflex inhibition of detrusor muscle, cheap and minimally invasive)

31
Q

Treatment for Polycystic Ovaries Syndrome (PCOS)

A
  • Oral contraceptive pill

- Weight loss

32
Q

Menorrhagia treatment

A

-Progesterone only pill or Combined oral contraceptive -Tranexamic Acid (Antifibrinolytic)(pregnancy category B)

33
Q

Management of vulvovaginitis

A
  • Improved hygiene (may be curative)
  • Treatment is indicated if there it is chronic or there’s difficulty urinating
  • Lubrication of the labia with a bland ointment
  • Topical oestrogen
  • Surgical separation is rarely necessary
34
Q

Management of a vaginal discharge

A
  • Culture to identify causative organism
  • Urinalysis to rule out cystitis
  • Review proper hygiene
  • Perianal exam with transparent tape to test for pinworms
  • If persistent discharge, exam under general anaesthetic is indicated to rule out foreign body
35
Q

Treatment of endometriosis

A

-Medical
Progesterone or combined pill
GnRH analogues (Leuprorelin)

-Surgical
Excision of deposits from peritoneum/ovary
Diathermy/laser ablation of deposits
Hysterectomy AND Oophorectomy

May recur after Rx

36
Q

Treatment of adenomyosis

A
  • Mirena may help (IUD containing progestin)
  • Medical Rx often fails
  • Hysterectomy
37
Q

Fibroids treatment

A
  • Myomectomy
  • Standard menorrhagia Rx (if cavity not too distorted)
  • GnRH analogues
  • Anti-progestogen
  • Uterine artery embolisation
  • Hysterectomy
38
Q

Menorrhagia treatment

A
  • Tranexamic acid
  • Combined oral contraceptive pill
  • Injected progestogen
39
Q

Treatments for DUB

A

-Fertility conserving treatment
Menfenamic acid
Combined oral contraceptive pill
Progesterone IUD (Mirena)

-If family complete
Endometrial ablation
Hysterectomy

40
Q

Prevention + treatment of osteoporosis

A
  • Weight bearing exercise
  • Adequate Ca + Vit D
  • HRT
  • Bisphosphonates
  • Calcitonin
  • Monoclonal antibody to osteoclasts (Denosumab)
41
Q

Benefit of transdermal HRT vs oral

A

Transdermal avoids first pass metabolism, reducing risk of VTE

42
Q

Treatment of Polycystic Ovary Syndrome (PCOS)

A
  • Weight loss/exercise
  • Combine hormonal contraception (Antiandrogen)
  • Endometrial protection (progesterone, mirena IUS)
  • Fertility Rx metformin/clomiphene
43
Q

Treatment for POP

A
  • Physiotherapy (PFMT)
  • Pessaries (silicone is favoured)
  • Surgery
44
Q

Treatment of axilla in breast cancer with +ve sentinel lymph node

A

-Remove them all surgically (axillary clearance)
or
-Radiotherapy to all nodes in the axilla

45
Q

3 methods of treatment for micrometastases

A
  • Hormone therapy
  • Chemotherapy
  • Targeted therapies
46
Q

Type of hormone therapy given if premenopausal

A

Tamoxifen for 5 years

47
Q

Type of hormone therapy given if postmenopausal

A
  • Tamoxifen for 5 years (if excellent prognosis)
  • Aromatase inhibitor for 5 years (if poorer prognosis)

(intermediate prognosis tamoxifen for 2yrs + AI for 3yrs)

48
Q

2 types of chemotherapy drug used to treat micrometastases

A
  • Anthracyclines

- Taxanes

49
Q

Drug used in anti-her2 therapy

A

Trastuzumab (monoclonal antibody against Her2 receptor

50
Q

Drug class and 2 examples for the treatment of vulvovaginal candidosis

A
  • Azole antifungals
  • Clotrimazole (500mg PV once)
  • Fluconazole (150mg PO once)
51
Q

2 drugs and their mode of delivery to treat bacterial vaginosis

A
  • Metronidazole, Oral(avoid alcohol) or vaginal gel

- Clindamycin, Vaginal

52
Q

Treatment for congenital hypothyroidism (CHT) and when should it start by

A
  • Thyroxine tablets

- 21 days of age

53
Q

Emergency treatment for Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD)

A

Glucose polymer (maxijul) + IV dextrose

Treatments (12 decks)

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