Rx

Question 1

What are some potential non contraceptive benefits to taking hormone contraceptives?

Answer 1

treat dysmenorrhea, menorrhagia, and pelvic pain from endometriosis.

Question 2

Whats the difference between a monophasic and multiphase monthly COC pill?

Answer 2

monophasic pills have an equal quantity of hormone in each tablet whereas multiphasic pills try to mimic the natural hormone fluctuations of a woman by varying the dose or hormones. (no proven benefit to the later method)

Question 3

When taking COC the convenience of having no scheduled menstrual bleeding should be weighed against what?

Answer 3

Inconvenience of breakthrough bleeding

Question 4

Almost all COC use ethanol estradiol as the estrogen component how does the alternative therapy work?

Answer 4

Mestranol is the alternative therapy which is a pro-drug and is converted in vivo to ethinyl estradiol

Question 5

What three major categories of progestins are used in COC pills? Name some others

Answer 5

Norethindrone, levonorgestrel, Drospirenone

Medroxyprogesterone acetate, prometrium

Question 6

What are the 4 major MOA of oral contraceptives? Which are exclusive to progestins?

Answer 6

Estrogen and progestins
1-inhibit ovulation through neg feedback on hypothalamus
2-alter the endometrial lining making implantation less likely

Progestin only
3-thicken cervical mucus making it difficult for sperm to enter
4-reduce the ciliary activity in the uterine tubes decreasing tubal transport

Question 7

Your patient was started on a POP recently and states that she was ovulating normally for a while but is now having breakthrough bleeding. Is this normal and if so why does it happen?

Answer 7

Yes its normal: 40% women on POPs have normal ovulation but breakthrough bleeding is common because the dose of progestin is below the ovulation inhibitory dose. This means natural estradiol and progesterone are produced and affect bleeding leading to irregularity.

Question 8

Your breast feeding patient has been having baby brain and forgetting to take her POPs pills on time each day sometimes missing it by an hour or two; what should you do?

Answer 8

Nothing, just remind her that if she misses by more than 3hrs she needs back up birth control. Also, there is no placebo pill and they need to be taken everyday at the same time.

Question 9

Recently you saw a women vomiting on the sidewalk and after a brief conversation find out she just got on a new birth control pill. Curious you ask about the dose which is 35mcg of estradiol. She also mentioned that after a recent bp test at publix her blood pressure had gone up significantly. Are these symptoms related to her birth control? Are they both the effect of this single hormone?

If you were her physician and reduced her ethinyl estradiol dose what might you warn her about?

Answer 9

Yes, and yes

estrogens side effects include: headache, nausea, HTN, breast tenderness, and fluid retention.

I would warn her about breakthrough bleeding as a result of compromising cycle control.

Question 10

After a year with another provider your patient returns to you, shamed at ever having left the fold. You had her cholesterol under control but notice now that its not. Which of the following is most likely to have caused the problem?

1- OCP
2- IUD
3- Depot proverb shot
4-pull out method of birth control

Answer 10

OCP have a detrimental effect of serum lipids

Question 11

You just has sex with a 17 y/o girl without knowing it. To top it off she isn’t using birth control and you need an emergency contraceptive. Worried she might tell the physician that you’re in your 30s you have her use what non prescription emergency contraceptive? How does it work and how soon after unprotected sex can you take it?

Answer 11

Levonorgestrel-high dose

works like other progestins, take within 3 days of unprotected sex

Will not terminate pregnancy or harm the fetus

Question 12

How does Ulipristal work? When is it C/I?

Answer 12

progesterone agonist/antagonist and inhibits ovulation
Take within 5 days of unprotected sex
Prescription medication
R/O pregnancy before prescribing (category X drug)

Question 13

The drug stem -azole is usually not associated with anti fungal medications as these are -conazoles; what’s the exception?

Answer 13

clotrimazole

Question 14

How does a woman typically treat a yeast infection?

Answer 14

topical intravaginal -conazole or oral fluconazole

Question 15

What is the MOA of -conazoles?

Answer 15

Inhibition of ergosterol which is an essential part of the yeast membrane. This increases permeability and destroys the yeast.

Question 16

When is oral fluconazole contraindicated?

Answer 16

pregnant women

Question 17

What is the best medication for the treatment of Gardenerella a bacterial vaginosis agent?

Answer 17

metronidazole or Tinidazole or clindamycin

Question 18

MOA of metronidazole and Tinidazole?

Answer 18

Prodrug that is activated by anaerobic gram - bacteria and certain protozoa (like trichomonad vaginitis). It’s reduction releases free radicals and damages nucleic acids.

Question 19

What’s the most common pathogenic anaerobe in the f genital tract?

Answer 19

Bacteroides fragilis.

Question 20

Pelvic infections need to treat both E.coli and B. frag which 3 options do you have for treatment therapy?

Answer 20

pip/tazo
Ertapenem
Cefazolin or ceftriaxone or tobramycin with metronidazole

Question 21

Trichomonas vaginitis requires what treatment, what the route of administration, and who should you remember?

Answer 21

metronidazole
oral
partner

Question 22

What are the 4 most common agents responsible for cervicitis?

Answer 22

Chlamydea, Gonorrhea, HPV, HSV

Question 23

How do you treat Chlamydea, and Gonorrhea separately and combined? What’s the assumption here?

Answer 23

Assume co infection
Treat with azithromycin

If Gonorrhea alone: Ceftriazone (cephalosporin)
If Chlamydea alone: Doxycycline, or azithromycin but if pregnant then erythromycin or amoxicillin.

Question 24

Your patient has a bad ugly case of genital warts (HPV) that could make a horny teenage boy become celibate. What provider administered therapy options are there?

Answer 24

Podophyllin resin in tincture of benzoin

Trichloroacetic acid

Question 25

What therapeutic products are used in the treatment of menorrhagia?

In an emergency
with someone needing contraception
someone on depot proverb
PCOS
ovulating woman that doesn't need contraception

Answer 25

Emergency IV premarin

contraception COC

Depot some estrogen (atrophic endometrium)

PCOS cyclic progestins like medroxyprogesterone, of levonorgestrel

Ovulating woman that doesn’t need contraception- NSAIDS or tranexamic acid

Question 26

How does tranexamic acid work; MOA?

Answer 26

It binds to plasminogen as a lysine analog thereby preventing its conversion to plasmin and thus its ability to break up fibrin is retarded. This will decrease clot lysis.

Question 27

When is the use of t-PA indicated and how does it work?

Answer 27

Stroke or MI to break up clots. It activates plasminogen so it can covert to plasmin and then bind fibrin in order to dissolve a clot.