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2022 Adv Pharm Faculty Landing Page > Reproductive/GU > Flashcards

Reproductive/GU Flashcards

1
Q

Main groups of hormonal contraceptives (2 groups)

A

Estrogen-progestin contraceptives

Progestin-only contraceptive

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2
Q

Estrogen-progestin contraceptives Mechanism of Action

A

Estrogens: suppress FSH release, stabilize the endometrial lining, provide cycle control

Progestins: block the LH surge = no ovulation, thicken cervical mucus delay sperm transport, induce endometrial atrophy/inhibit endometrial proliferation

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3
Q

Estrogen-progestin contraceptives - indications

A

Abnormal bleeding (menorrhagia/ metrorrhagia/ amenorrhea) – assuming other causes have been excluded, Dysmenorrhea Endometriosis, PCOS Acne, PMS/PMDD

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4
Q

Estrogen-progestin contraceptives - cautions

A

breastfeeding - may decrease milk supply, HLD, DM with complications, prolonged immobility/long leg cast (clot), migraine without aura over the age of 35

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5
Q

Estrogen-progestin contraceptives - contraindications

A

Thromboembolic disease, CAD, Active liver disease, Breast cancer, Smoker over 35 yo, Migraine with aura, Uncontrolled HTN, Undiagnosed vaginal bleeding

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6
Q

Estrogen adverse effects (Excess and deficiency)

A
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8
Q

Progestin adverse effects (excess and deficiency)

A
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9
Q

High doses of estrogen-progestin contraceptives increases the risk of

A

Breast cancer, stroke, MI, DVT

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11
Q

Androgenic adverse effects

A

Acne

Weight gain

Hirsutism

Fatigue

Depression

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12
Q

Progestin only contraceptive options

A

Minipill

Nexplanon implant

DMPA injection - Depo-Provera

IUD - Mirena, Skyla, Lilletta

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13
Q

Continuous dosing of estrogen-progestin ocps is possible with which formulation?

A

monophasic

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14
Q

Transdermal contraceptive patch - adverse effects

A

Greater incidence of venous throboembolism (black box warning_

-60% more estrogen exposure than OC

Not indicated for weight > 198lbs

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15
Q

Depo Provera risks/side effects

A

Bleeding irregularities

Delayed return of fertility (up to 6-18 months)

-don’t use more than 2 yrs

Weight gain

Decrease in bone mineral density

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16
Q

Progestin-only contraceptives Mechanism of Action

A

Inhibition of ovulation- suppression of midcycle peaks of LH & FSH

Thickened, decreased cervical mucous

Thinner, atrophic endometrium

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17
Q

Progestin-only contraceptives - adverse effects

A

Spotting

Amenorrhea

Irregular menstruation

Ectopic pregnancy - increased risks

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18
Q

Paragard IUD Mechanism of Action

A

MOA: copper toxic to sperm, prevents implantation

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19
Q

Paragard benefits/side effects

A

Benefits: nonhormonal, use for up to 10 years

Side effects: increased menstrual flow and dysmenorrhea

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20
Q

Emergency Contraception Options

A

Plan B

Ella

Paragard

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21
Q

Emergency Contraception Mechanism of Action

A

Suppresses Ovulation (if taken prior to LH surge)

Prevent fertilization of an ovulated egg

Copper IUD: may also prevent implantation

No impact if already pregnant

22
Q

Hormone Replacement Therapy (HRT) Indications

A

Menopausal vasomotor symptoms

Vaginal atrphy - vaginal preparations

Added benefits: –increased bone density however decreased bone density is not an indication to start HRT –decreases risk of colon cancer

23
Q

Prescribing HRT

A

Use lowest dose for shortest duration possible

Less risky in younger women

Vaginal preparation less risky than oral/transdermal

In people with an intact uterus both estrogen and progesterone must be used - unopposed estrogen in those with a uterus increases risk for endometrial cancer

24
Q

HRT contraindications

A

Breast cancer, CHD, VTE hx or high risk, liver disease, unexplained vaginal bleeding

25
Q

Estrogen/progestin contraceptive counseling

A

How/when to start

Whether or not a back up method is needed

Common side effects and how to avoid Dangerous side effects

No protection against STIs

Follow-up visit

For pills: strategies to remember to take and what to do if a dose is missed

ACHES

26
Q

Contraindications to IUD placement

A

Current PID/cervicitis or PID within the last 3 months

Nulliparity or remote hx of PID (>3 mos) is not a contraindication

27
Q

Testosterone replacement indications

A

Primary – disorders of the testes, Low serum testosterone and elevated LH/FSH

Congenital: Klinefelter syndrome, cryptorchidism

Acquired: mumps, radiation, chemo, medications, trauma, testicular torsion

Secondary – disorders of the hypothalamus/pituitary Low serum testosterone and normal or low LH/FSH

Congenital syndromes causing GnRH deficiency

Acquired: Tumors, eating disorders, post-androgen abuse, DM, Infiltrative diseases, head trauma, Drug use (marijuana, anabolic steroids, opioids)

28
Q

Testosterone Replacement Adverse Effects

A

Acne, Gynecomastia, Edema, Increased risk of CV disease, Increased risk of prostate cancer, Lower HDL, elevated triglycerides, Increased homocysteine, Male pattern baldness, Mood changes, Increased risk of sleep apnea

29
Q

Men on testosterone replacement should be screened for

A

prostate cancer

30
Q

Non-estrogen medications used in treatment of menopausal vasomotor symptoms

A

Antidepressants

Black Cohosh

Soy

31
Q

Mechanism of action for Mirena

A

Progestin releasing IUD

  • Impairs sperm motility and function
  • Inhibits conception
  • Thickens cervical mucus
  • Endometrium atrophy
  • Impaired tubal motility
32
Q

Progestin IUD benefits and adverse effects

A

Benefits:

Acts locally (systemic effects rare), lighter periods, no weight gain

Adverse effects:

Irregular cycle 3-6 months

33
Q

Yuzpe Method

A

Can be used with any combined or progestin only OC

Not as effect as other EC methods

Can have significant nausea

34
Q

Plan B

A

Available OTC

Effective until LH surge

-Best within 3 days, can be used up to 5 days

Effectiveness decreases with BMI>25

35
Q

Ella

A

Effective until LH peak

-Effective up to 5 days after unprotected sex

Prescription only

Decrease efficacy in BMI>30

36
Q

Copper IUD as Emergency Contraceptive

A

Effective at anytime in cycle

Not impacted by BMI

Insert up to 5 days after unprotected sex

37
Q

Black box warning for testosterone replacement therapy

A

Risk for MI, CVA, HF, depression, hostility, liver toxicity

38
Q

BPH non-pharm management

A

Fluid restriction (prior to bedtime especially)

Limit caffeine and ETOH

Double voiding

Seated voiding

Avoid diuretics when possible

39
Q

Classes of drugs used to treat BPH

A

Alpha 1 blockers

5 alpha reductase inhibitors

Anticholinergic agents

PDE-5 inhibitors

40
Q

Alpha 1 Blockers Mechanism of Action and Examples

A

Block alpha1 receptors in the vasculature resulting in arterial and venous vasodilation. This causes smooth muscle relaxation and decreases urethral resistance.

Doxazosin and Terazosin are older and need more titrating

Alfuzosin, Tamsulosin, and Silodosin are newer, and more uroselective – less risk for hypotension and no need to titrate

41
Q

Alpha 1 blockers side effects

A

Hypotension is major side effect

Headache, dizziness, nasal congestion, fluid retention, impotence, palpitations, drowsines

Tamsulosin: intraoperative floppy iris syndrome

42
Q

5 Alpha Reductase Inhibitors Mechanism of Action and Examples

A

Inhibits 5-alpha reductase converstion of testosterone to dihydrotestosterone (DHT) which is responsible for prostate cell proliferation and inhibits apoptosis (cell death) of prostate cells

Finasteride (Proscar)

Dutasteride (Avodart)

43
Q

5 Alpha Reductase Inhibitor Side Effects

A

Decreased libido, impotence, decreased semen quantity

Decreases PSA by up to 50%, get a baseline prior to intiating if monitoring for change

44
Q

Medications that can exacerbate BPH

A
45
Q

PDE-5 Inhibitor Mechanism of Action and Examples

A

PDE-5 converts cGMP to GMP resulting in increased levels of cGMP (necessary for erection to occur).

Sildenafil (Viagra)

Tadalafil (Cialis)

Vardenafil (Levitra)

Avanafil (Stendra)

46
Q

PDE-5 Inhibitor Contraindication

A

On nitrate therapy

MI/stroke or life threatening arrhythmia in past 6 months

Caution with HF, uncontrolled hypo/hypertension, unstable angina, prolonged QT and alpha blocker use

47
Q

PDE-5 Inhibitor Side Effects

A

Priapism, visual disturbances, hearing loss

48
Q

Anticholinergic indications and side effects

A

1st line for the treatment of overactive bladder

  • Urinary retention, dry mouth, constipation, dizziness, blurry vision, tachycardia, drowsiness
  • Increase dementia risk

Use extended release formulations to decrease side effects

49
Q

Anticholinergic contraindications

A

Contraindicated in narrow angle closure glaucoma and uncontrolled tachycardia

2022 Adv Pharm Faculty Landing Page (22 decks)

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