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Drugs- Basic High Yield Stuff for Boards > Reproductive > Flashcards

Reproductive Flashcards

1
Q

When are fetuses most susceptible to the effects of a teratogen?

A

3rd-8th week of pregnancy (embryonic period of organogenesis)

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2
Q

Teratogen Medication List (12)

A
  1. ACEi (and ARBs)
  2. Alkylating agents
  3. Aminoglycosides
  4. Antiepileptic drugs (commonly valproate, carbamazepine, phenytoin, phenobarbital)
  5. Diethylstillbestrol (DES)
  6. Folate antagonists (trimethoprim/ methotrexate, anti epileptic drugs)
  7. Isotretinoin
  8. Lithium
  9. Methimazole
  10. Tetracyclines
  11. Thalidomide
  12. Warfarin
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3
Q

Substance abuse teratogen (3)

A
  1. Alcohol
  2. Cocaine
  3. Smoking (nicotine, CO)
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4
Q

Miscellaneous teratogens (5)

A
  1. Iodine (lack or excess)
  2. Maternal diabetes
  3. Methylmercury
  4. Vitamin A excess
  5. Xrays
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5
Q 
Teratogen effect:
ACE inhibitors (and ARBs)
A

Renal damage

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6
Q 
Teratogen effect:
Alkylating agents (2)
A
  1. absence of digits

2. multiple anomalies

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7
Q

Teratogen effect:

Aminoglycosides(1)

A

Ototoxicity

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8
Q

Teratogen effect:
Antiepileptic drugs(4)
Names (4)
recommended supplementation?

A

Valproate, Carbamazepine,
Phenytoin, Phenobarbital

  1. Neural tube defects (high dose folate supplementation)
  2. Cardiac defects
  3. cleft palate
  4. skeletal abnormalities (phalanx/nail hypoplasia, facial dysmorphism)
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9
Q

Teratogen effect:

Diethylstillbestrol (DES) (2)

A
  1. Vaginal clear cell adenocarcinoma

2. Congenital Mullerian anomalies

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10
Q

Teratogen effect:
Folate antagonists (1)
Name 3 examples

A

Neural tube defects

  1. Trimethoprim
  2. Methotrexate
  3. Anti-epileptic drugs
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11
Q

Teratogen effect:
Isotretrinoin (1)
Recommendation

A

“isoTERATinoin”
Multiple severe birth defects

CONTRACEPTION MANDATORY

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12
Q

Teratogen effect:

Lithium(1)

A

Ebstein anomaly

apical displacement of tricuspid valve–>enlarged atrium

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13
Q

Teratogen effect:

Methimazole

A

aplasia cutis congenita

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14
Q

Teratogen effect:

Tetracycline(2)

A
  1. discolored teeth

2. inhib bone growth

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15
Q

Teratogen effect:

Thalidomide

A

“LIMB defects with ‘tha-limb-domide’”

- Limb defects (phocomelia, micromelia=flipper limbs)

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16
Q

Teratogen effect:

Warfarin(4)

A
  1. bone deformities
  2. Fetal hemorrhage
  3. abortion
  4. ophthalmologic abnormalities

” Do not wage WARFARe on the baby, keep it HEPpy with HEPARIN(doesn’t cross placenta)

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17
Q

Teratogen effect:

Alcohol

A 
Fetal Alcohol syndrome
#1 common cause of birth defects and intellectual disability
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18
Q

Teratogen effect:
Cocaine (4)
how?

A
  1. low birth weight
  2. preterm birth
  3. IUGR
  4. Placental abruption

cocaine–>vasoconstriction

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19
Q

Teratogen effect:
Smoking (5)
how?

A
  1. low birth weight (leading cause in developed countries)
  2. preterm labor
  3. placental problems
  4. IUGR
  5. SIDS

Nicotine–>Vasoconstriction
CO–> impaired O2 delivery

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20
Q

Teratogen effect:

Iodine (lack or excess) (2)

A
  1. congenital goiter

2. hypothyroidism (cretinism)

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21
Q 
Teratogen effect:
Maternal diabetes (4)
A
  1. Caudal regression syndrome(anal atresia - sirenomelia)
  2. Congenital Heart defects
  3. Neural tube defects
  4. macrosomia
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22
Q

Teratogen effect:
Methylmercury
Source (4)

A
  1. Neurotox
  • swordfish
  • shark
  • tilefish
  • king mackerel
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23
Q

Teratogen effect:

Vitamin A excess

A

EXTREMELY HIGH RISK

  1. spontaneous abortions
  2. birth defects (cleft palate, cardiac)
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24
Q

Teratogen effect:
X-rays

minimized by?

A
  1. microcephaly
  2. intellectual disability

-minimized by lead shielding

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25
Q

Treatment for gestational hypertension(4)

Define gestational hypertension (pregnancy-induced hypertension)

A

BP > 140/90 after 20wks. No pre-existing hypertension. No proteinuria or end-organ damage

“Hypertensive Moms Love Nifedipine”

  1. Hydralazine
  2. a-Methyldopa
  3. Labetalol
  4. Nifedipine
    * deliver at 37-39wks
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26
Q

Treatment for Preeclampsia (3)

Definition

A

New-onset HTN with either protienuria or End-organ dysfunction after 20wks (less than 20wks suggests molar pregnancy).

  1. antihypertensives
  2. MgSO4
  3. Delivery= definitive treatment
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27
Q

Treatment of Eclampsia (3)

Definition

A

Pre-eclampsia + maternal seizures
Maternal death due to stroke/Intracranial hemorrhage, or ARDS

  1. IV magnesium sulfate
  2. antihypertensive (a-methyldopa, hydralazine) + bedrest
  3. immediate delivery
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28
Q

treatment for HELLP (1)

Definition

A

Hemolysis, Elevated Liver-enzymes, Low Platelets.
A manifestation of severe preeclampsia. Blood smear shows schistocytes. Can lead to hepatic subcapsular hematomas–> rupture–> severe hypotension

  1. Immediate delivery
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29
Q

Treatment for PCOS (5)

A
  1. weight reduction (helps with insulin resistance-can use metformin as well)
  2. OCPs
  3. clomiphene citrate
  4. ketoconazole
  5. spironolactone
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30
Q

Treatment for Adenomyosis

Definition

A

Extension of endometrial tissue into uterine myometrium

  1. GnRH agonist
  2. hysterectomy
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31
Q

Treatment for Endometritis

Definition

A

Inflam of endometrium associated with retained products of conception following delivery, miscarriage, abortion, or with foreign body (IUD)

Treatment:
Gentamicin + Clindamycin +/- Ampicillin

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32
Q

Treatment for Endometriosis

Definition

A

Non-neoplastic endometrial glands/ stroma outside endometrial cavity

  1. NSAIDs
  2. OCPs
  3. progestins
  4. GnRH agonist
  5. danazol
  6. laproscopic removal
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33
Q

drugs causing gynecomastia

A

“STACKED”

  1. Spironolactone
  2. THC (marijuana)
  3. Alcohol (chronic)
  4. Cimetidine
  5. Ketoconazole
  6. Estrogens
  7. Digoxin
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34
Q

drug induced hot flashes (2)

A
  1. Tamoxifen

2. clomiphene

35
Q

treatment of Varicocele (2)

A
  1. varicocelectomy

2. embolization

36
Q

treatment of BPH (3)

A
  1. a1-antagonists (terazosin, tamsulosin)–>relax of sm. muscle
  2. 5a-reductase inhib (finasteride)
  3. tadalafil
37
Q

Leuprolide:
MOA
Clinical Use (5)

A

“LEUprolide can be used in LIEU of GnRH”

  • GnRH analog->agonist if pulsatile fashion
  • GnRH analog->antagonist if continuous fashion (downreg. GnRH-R in pituitary->decrease FSH/LH)
  1. Uterine fibroids
  2. endometriosis
  3. precocious puberty
  4. prostate cancer
  5. infertility
38
Q

Leuprolide:

Adverse (3)

A
  1. startup flair
  2. hypogonadism
  3. N/V
39
Q

Estrogens:

Name 3

A
  1. Ethinyl estradiol
  2. DES
  3. Mestranol
40
Q

Estrogens:
MOA
Clinical Use (6)

A
  • Bind estrogen-R
  1. Hypogonadism
  2. Ovarian failure
  3. Menstrual abnormalities
  4. HRT in postmen women
  5. androgen-dep. prostate cancer (men)
  6. OCPs
41
Q

Estrogens:
Adverse (4)
Contra (2)

A
  1. increase risk of endometrial (maybe breast) cancer
  2. bleeding in postmenopausal women
  3. Clear cell adenocarcinoma in Vagina (DES)
  4. thrombi

Contra:

  1. ER+ breast cancer
  2. DVT history
42
Q

Selective estrogen-R modulators:

Name 3

A
  1. Clomiphene
  2. Tamoxifen
  3. Raloxifene
43
Q

Clomiphene:
MOA(2)
Use (1)

A
  1. Antagonist at E-R in hypothalamus–>prevents normal feedback inhibition.
  2. Increase release of LH/FSH form pituitary–> stimulates ovulation

Use: infertility due to anovulation (like PCOS)

44
Q

Clomiphene:

Adverse (4)

A
  1. Hot flashes
  2. Ovarian enlargement
  3. Multiple simultaneous pregnancies
  4. Visual disturbances
45
Q

Tamoxifen:
MOA (2)
Use (1)

A
  1. Antagonist at Breast
  2. Agonist at Bone/Uterus (pro-bone)

Use: treat/prevent recurrence of ER/PR+ breast cancer

46
Q

Tamoxifen:

Adverse (2)

A
  1. increase risk of thromboembolic events

2. increase risk of endometrial cancer

47
Q

Raloxifene:
MOA
Use (2)

A
  1. Antagoist at Breast/Uterus
  2. Agonist at Bone (pro-bone)

Use: osteoporosis

48
Q

Raloxifene:

Adverse(1)

A
  1. increase risk of thromboembolic events

* no increase risk of endometrial cancer like with tamoxifen

49
Q

Aromatase Inhibitors:

Name 3

A
  1. Anastrozole
  2. Letrozole
  3. Exemestane
50
Q

Aromatase Inhibitors: Anastrozole, letrozole, exemestane
MOA
Clinical Use (1)

A
  • inhib peripheral conversion of androgens–>estrogen

1. ER+ breast cancer in postmenopausal women

51
Q

Hormone Replacement Therapy:

Use(3)

A

Relief/Prevent Menopausal symptoms:

  1. Hot flashes
  2. Vaginal atrophy/dyspareunia
  3. Osteoporosis (increase estrogen/decrease osteoclasts)
52
Q

Hormone Replacement Therapy:

Adverse(2)

A
  1. Unopposed estrogen–> increase endometrial cancer risk
    (must admin with progesterone)
  2. Cardiovascular risk (heart attack/stroke)
53
Q

Main treatment for Prostate Cancer (2)

A
  1. Flutamide

2. Leuprolide

54
Q

Progestins:

Name 5

A
  1. Levonorgestrel
  2. Medroxyprogesterone
  3. Etonogestrel
  4. Norethindrone
  5. Megestrol

*often combined with estrogen

55
Q

Progestins:
MOA
Clinical Use(3)

A

Bind P-R–> decrease growth and increased vascularization of endometrium & thicken cervical mucus

  1. Contraception (pill, IUD, implant, depot)
  2. endometrial cancer
  3. abn. uterine bleeding
56
Q

Explain the Progestin Challenge

A

presence of withdrawal bleeding excludes anatomic defects (Asher syndrome) and chronic anovulation without estrogen

57
Q

Anti-progestins:

Name 2

A
  1. Mifepristone (=RU-486)

2. Ulipristal

58
Q

Antiprogestins:
MOA
Clinical use (

A

-Competitive inhb of progestins at P-R

  1. Termination of pregnancy (mifepristone w/ misoprosto-PGE1 analog)
  2. emergency contraception (ulipristal)
  3. peptic ulcer disease (mifepristone)
59
Q

Combined contraception:
Components
Forms(3)
MOA(3)

A
  • Progestins & EE
  • pill, patch, vaginal ring
  1. estrogen&progestins inhib LH/FSH–>prevent estrogen surge/LH surge–>No ovulation
  2. Progestins thicken cervical mucous (limit sperm access to uterus)
  3. Progestins inhib endometrial prolif (limits implantability)
60
Q

Combined contraception:

Contra

A
  1. smokers >35yo (increase Cardiovascular events)
  2. patients at increased risk of CV events(VTE history, CAD, stroke)
  3. migraine (esp. with aura)
  4. breast cancer
61
Q

Copper Intrauterine device:
MOA
Clinical Use(2)

A
  • Produces local Inflam Rxn toxic to sperm/ova
    (prevents fertilization/implantation)
  • No hormones
  1. Long acting reversible contraception
  2. Most effective emergency contraception
62
Q

Copper Intrauterine device:
Adverse (3)
Contra (1)

A

Adverse:

  1. Heavier/longer menses
  2. dysmenorrhea
  3. PID risk with insertion

Contra: PID/ pelvic infection

63
Q

Terbutaline, Ritodine:
MOA
Use

A

Terbutaline (B1/B2)
Ritodrine (B2)

-B2 agonists that relax the uterus
Use: decrease contraction frequency in women during labor/decrease premature contractions (a.k.a=tocolytic)

64
Q

Danazol:
MOA
Clinical Use (2)

A

-synthetic androgen that acts as partial agonist at androgen-R1

  1. Endometriosis
  2. hereditary angioedema
  • Danazol has largely been replaced by Leuprolide/Goserelin for endometriosis
65
Q

Danazol:

Adverse (7)

A
  1. Weight gain
  2. edema
  3. acne/hirsutism
  4. masulinization (of fetus w/ pregnancy)
  5. decrease HDL levels
  6. hepatotox
  7. pseudotumor cerebri (increase ICP, papilledeam, HA)
66
Q

Drugs causing pseudotumor cerebri

A
  1. Danazol

2. excess Vit A

67
Q

Testosterone, Methyltestosterone:
MOA
difference between the 2 drugs?
Clinical Use(3)

A
  • Androgen-R agonist
  • Methyltestosterone has better oral bioavailability
  1. Hypogonadism
  2. promote dev. of 2ary sex characteristics
  3. stimulate anabolism to promote recovery after burn/injury
68
Q

Testosterone, Methyltestosterone:

Adverse(4)

A
  1. masculinizationof Females
  2. decrease intratesticular testosterone in males via (-) feedback on LH–> gonadal atrophy
  3. premature closure of epiphyseal plates
  4. increase LDL, decrease HDL (not good)
69
Q

Antiandrogens:

Name 4

A
  1. Finasteride
  2. Flutamide
  3. Ketoconazole
  4. Spironolactone
70
Q

Finasteride:
MOA
Clinical Use (2)
Adverse

A

-5a-reductase inhibitor
(decrease testosterone–>DHT conversion)

  1. BPH (drug of choice w/o HTN)
  2. male pattern baldness

Adverse: impotence, gynecomastia, abn. sex function

71
Q

Flutamide:
MOA
Clinical use(1)
Used with what?

A

-Nonsteroidal Competitive inhib at androgen-R –> decrease Testosterone

  1. Prostate carcinoma w/ Leuprolide
    (decrease LH/FSH)
72
Q

Ketoconazole:

MOA

A

inhib steroid synthesis

inhib 17,20-desmolase which prevents chol–>pregnenolone

73
Q

Spironolactone:

MOA

A

inhib steroid binding, 17a-hyrdoxylase, and 17,20-desmolase

74
Q

Ketoconazole & Spironolactone:
Clinical Use(1)
Adverse (2)

A
  • PCOS to reduce androgenic symptoms
  1. gynecomastia
  2. amenorrhea
75
Q

Tamsulosin:
MOA
Clincial Use

A
  • selective a1(A,D)-antagonist–> inhib sm. muscle contraction on prostate (limited effect on vascular a1(B)-R)
    1. BPH

(in contrast to non-specific a1-antagonist which all end in “-zosin” 1. prazosin 2. terazosin 3. doxazosin and can cause adverse orthostatic hypotension)

76
Q

Phosphodiesterase Type5 inhibitors:

Name 3

A

“PDE type5 inhibitors FILl the penis”

  1. Sildenafil
  2. Tadalafil
  3. Vardenafil
77
Q

Phosphodiesterase Type5 inhibitors:

MOA

A
  1. Inhib PDE-5–> increase cGMP–>prolong sm. muscle relaxation in response to NO
  2. this increases b.flow in corpus cavernous of penis
  3. decrease pulm. vascular resistance
78
Q

Phosphodiesterase Type5 inhibitors:
Clinical Use (3)
Adverse

A
  1. Erectile dysfunction
  2. Pulm HTN
  3. BPH (Tadalafil)

Adverse: “Hot and sweaty, but then HA, Heartburn, Hypotension”

  1. HA, Flushing
  2. Dyspepsia
  3. cyanopia = Blue-tinted vision (“viagra is a blue little pill”)
79
Q

Phosphodiesterase Type5 inhibitors:

DD interaction

A

Risk of life-threatening Hypotension in patients taking NITRATES

  • IF suspecting MI in patient, ask about erectile dysfunction drugs b/c NItrates+Sidenafil–>life-threatening hypotension
80
Q

Minoxidil:
MOA
Clinical Use

A

-Direct arteriolar vasodilator (K+ channel blocker)

  1. Androgenic alopecia (“Rogaine”)
  2. Severe refractory Hypertension
81
Q

Only anti fungal with anti-androgenic effects?

A

Ketoconazole

w/ adverse of gynecomastia

82
Q

Drug of choice for BPH w/o HTN?

w/ HTN?

A 
w/o= Finasteride
w/ = Tamsulosin
83
Q

Drug which impairs Blue-Green vision?

Drug which impairs Red-Green vision?

A 
Blue-Green= PDE-5 inhib
Red-Green= Ethambutol

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