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EndoRepro > stuff Arsh probably should memorize but won't > Flashcards

stuff Arsh probably should memorize but won't Flashcards

1
Q

Provide drugs that can be used for urinary incontinence.

A
  • Treatment
    • Medications – oxybutynin (muscarinic (M3) antagonist → treats OAB), tolteridine (muscarinic (M3) antagonist → treats OAB), flavoxate (anticholinergic → relax smooth muscles), imipramine (beta agonist → treats OAB)
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2
Q

What are the two treatments for bacterial vaginosis?

  • For each, provide MOA, SOA, SE
A
  • Tx (both cause NVD)
    • Metronidazole (po, topical)
      • MOA: inhibits nucleic acid synthesis → disrupts bacterial DNA → bacteriostatic
      • SOA: anaerobes, protozoa, and microaerophilic bacteria
      • SE: disulfiram reaction (no alcohol), metallic taste, CYP2C9 inhibitor (increases warfarin levels)
    • Clindamycin (topical)
      • MOA: binds 50s rRNA → inhibits translocation → bactericidal
      • SOA: gram positive bacteria and anaerobes
      • SE: pseudomembranous colitis (C. Diff)
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3
Q

SERMS

  • MOA?
  • 2 examples?
  • SE?
A
  • SERMs – competitive inhibitors of estrogen binding to estrogen receptors on tumor tissue
    • i.e. Tamoxifen, Raloxifene
    • SE: hot flashes, endometrial hyperplasia/cancer, DVT, cataracts (due to agonist effects)
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4
Q

Aromatase inhibitor

  • MOA?
  • SE?
A
  • Aromatase inhibitors – blocks conversion of androgens to estrogen
    • SE: decreased bone density, joint pains, vaginal atrophy, hyperlipidemia
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5
Q

Trastuzamab

  • MOA?
  • SE?
A
  • Trastuzumab (Herceptin) – MAB that binds to the extracellular domain of HER2 → inhibiting HER1 and HER2 dimerization → blocking cellular proliferation and angiogenesis
    • SE: LV dysfunction → CHF, hypersensitivity, pulmonary toxicity
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6
Q

what are the functions of the following Placental peptide hormones

Leptin, neuropeptide Y, inhibin & activan

A
  • Leptin: anti-obesity hormone normally secreted by adipocytes → decreased food intake
  • Neuropeptide Y: secreted from cytotrophoblasts → increase in CRH release
  • Inhibin and Activin:
    • Inhibin: secreted by ovarian granulosa cells → ceases possibility of ovulation
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7
Q

define the following

threatened, inevitable, incomplete, complete, missed abortion

how to treat missed abortion

A
  • Threatened abortion (miscarriage): bleeding in first trimester without loss of fluid or tissue
  • Inevitable abortion (miscarriage): bleeding or rupture of membranes in the presence of cervical dilatation (>2 cm – can put speculum in cervix)
  • Incomplete abortion (miscarriage): documented pregnancy where passage of some blood and some tissue occurs, but some products of conception remain within the uterus
  • Complete abortion (miscarriage): documented pregnancy that ends with the spontaneous passage of all of the products of conception
  • Missed abortion (miscarriage): the retention of a failed intrauterine pregnancy with a gestational age less than 28 weeks, for 8 weeks or more
    • Expectant Tx, Dilation and curettage, and misoprostol (painful)
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8
Q

what are the FDA drug classifications

A
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10
Q

FAS

patho? abnormalities?

A
  • Pathogenesis: failure of cell migration during gestation
  • Congenital abnormalities: growth restriction, facial abnormalities (shortened palpebral tissues, low-set ears, midfacial hypoplasia, smooth philtrum, and thin upper lip) and CNS dysfunction (microcephaly, mental retardation, and ADD)
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11
Q

Leading cause of low birth weight, pre-term labor, placental problems, IUGR, SIDS

A

Nicotine (vasoconstriction) and CO (impaired O2 delivery)

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12
Q

Associated with low birth weight, pre-term birth, IUGR, and placental abruption

A

Cocaine (vasoconstriction)

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13
Q

Most common teratogen that causes birth defects, intellectual disability, fetal alcohol syndrome (FAS)***

A

Alcohol

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14
Q
  • Exposure to less than 5 rads is not associated with fetal anomalies

If exposed to more leads to microcephaly and intellectual disability

A

Radiation

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15
Q

Associated with irreversible arthroapthies and cartilage erosion

A

Aminoglycosides

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16
Q

Associated with yellow-brown discoloration of teeth and inhibited bone growth

A

Tetracycline

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17
Q

Ototoxicity

A

Aminoglycosides

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18
Q

Avoid near delivery as they are associated with hyperbilirubinemia

A

Sulfa drugs

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19
Q

Often used in pregnancy, but is associated with hemolytic anemia in G6PD deficiency

A

Nitrofurantoin

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20
Q

Avoid near delivery as they are associated with thrombocytopenia, bleeding, and electrolyte disturbances

A

Thiazide diuretics

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21
Q

Associated with fetal growth restriction, neonatal hypoglycemia, possible transient hypotension

A

Beta blockers

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22
Q

Renal damage → polyhydramnios (growth restriction, limb contractures, abnormal skull/calvarium development)

A

ACEi/ARBs

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23
Q

Only SSRI with an increased risk of ventral/atrial septal cardiac defects

A

Paroxetine (SSRI)

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24
Q

Avoid use late in pregnancy as it is associated with neonatal behavioral syndrome (increased muscle tone, irritability, jitteriness, & respiratory distress)

A

SSRIs

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25
Q

Associated with Ebstein anomaly (apical displacement of the tricuspid valve → atrialization of the RV)

A

Lithium (depression med)

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26
Q

Associated with spina bifida/neural tube defects with exposure during embryogenesis → Tx: folate supplements before sex

A

Valproic acid and carbamazepine

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27
Q

Associated with abnormal facies, cleft lip/palate, microcephaly, growth deficiency, and hypoplasia of nails/DIPs

A

Phenytoin

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28
Q

Severe fetal malformation → contraception is mandatory with use

A

Isotretinoin (acne med) /VitA

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29
Q
  • Methotrexate is used in ectopic pregnancy

Contraindicated in normal pregnancy due to neural tube defects

A

Methotrexate/ Trimethoprim (folate antagonists)

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30
Q
  • Easily crosses the placenta

Contraindicated in first trimester as it is associated with bone deformities, fetal abnormalities, abortion, ophthalmologic abnormalities

A

Warfarin

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31
Q

Long-term use usually avoided as it can be associated with ductus arteriosus constriction → pulmonary HTN

A

NSAIDS

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32
Q

Associated with aplasia cutis congenita (absence of skin à hole in head)

A

Methimazole (hyperthyroidism med)

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33
Q

Associated with flipper limb defects

A

Thalidomide

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34
Q

Can result in caudal regression syndrome, congenital heart defects, macrosomia, and neonatal hypoglycemia

A

Diabetes

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35
Q

Associated with absence of digits and other anomalies

A

Alkylating agents (cancer drug)

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36
Q

Associated with vaginal clear cell carcinoma and congenital Müllerian anomalies

A

Diethylstilbestrol (DES)

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37
Q

Associated with congenital goiter or hypothyroidism (causes cretinism: stunted physical/mental growth)

A

Iodine (lack/excess)

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38
Q

explain the following drugs

oxytocin, misoprostol, mehtylergonovine, prostaglandin F2/E2

MOA? SE? and contraindiactions

A
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39
Q

Found in swordfish, shark, tilefish, king mackerel → neurotoxicity

Fish is safe when less than 12oz/week

A

Methylmercury

40
Q

Provide the MOA of the two hormones involved in contraceptives?

A
  • Progestin (prevents ovulation and fertilization)
    • Suppresses LH surge, thickens cervical mucus, reduces ovum motility, thins endometrium
  • Estrogen
    • Suppresses FSH, potentiates progestin
41
Q

Provide the following generally:

  • half-life of each hormone
  • where are they metabolized
  • which two drugs do not have a rapid return to fertility?
  • what is the effect on obese patients?
  • What are general side effects of all?
A
  • General pharmacokinetics/pharmacology
    • Half-life: estrogen (long), progestin (short
    • Metabolism: liver (P450s)
    • Return to fertility: rapid except for depo (9-10 months) and Nexplanon (1-2 months)
    • Effect in obese patients: Nexplanon and OCPs may be slightly less effective (others are equally effective)
    • General side effects: all can cause spotting of blood except copper IUD (can cause heavy bleeding)
42
Q

For Surgical sterilization (vasectomy, tubal ligation, Essure):

  • MOA
  • Benefits
  • Risks
A
43
Q

For Levonorgestrel (LNG) intrauterine device (IUD) (mirena, Skyla, kyleena):

  • MOA
  • Benefits
  • Risks
A
44
Q

For Copper IUD (ParaGard):

  • MOA
  • Benefits
  • Risks
A
45
Q

For Levonorgestrel implant (nexplanon):

  • MOA
  • Benefits
  • Risks
A
46
Q

For Depot medroxyprogesterone acetate (aka Depo-provera):

  • MOA
  • Benefits
  • Risks
A
47
Q

For Combined hormonal methods (oral contraceptive pill, ring, patch):

  • MOA
  • Benefits
  • Risks
A
48
Q

For Progestin only pills (POP):

  • MOA
  • Benefits
  • Risks
A
49
Q

For Barrier methods (condom, cervical cap, diaphragm):

  • MOA
  • Benefits
  • Risks
A
50
Q

For Fertility awareness methods (calendar, temperature, cervical mucus):

  • MOA
  • Benefits
  • Risks
A
51
Q

For Emergency contraception (Plan B/levonorgestrel):

  • MOA
  • Benefits
  • Risks
A
62
Q

Two meds for medication induced abortion? Provide MOA and SE if any?

When are these indicated?

A
  • Medication-induced abortion (indicated up to 70 days with ~70% success)
    • Prostaglandin E1 analog – Misoprostol (given at very high dose on day 2)
      • MOA: cervical ripening and uterine contractions
      • SE: severe cramping, heavy bleeding
    • Antiprogesterone – Mifepristone (given day 1)
      • MOA: lack of progesterone à lack of uterine maintenance à abortion
63
Q
  • Phentermine (Adipex/Fastin)
A
  • MOA: inhibits reuptake of monoamines (i.e. HT, DA, NE) → satiety
  • SE: tachycardia, palpitations, tremors, mood swings
64
Q
  • Orlistat (Xenical/Alli)
A
  • MOA: lipase inhibitors → decreased fat absorption
  • SE: diarrhea, steatorrhea
65
Q
  • Lorcaserin (Belviq)
A
  • MOA: selective serotonin agonist → stimulates POMC production → appetite suppression
  • SE: same as Phentermine (tachycardia, tremors, mood swings)
66
Q
  • Phentermine/Topiramate (Qysmia) – most effective
A
  • MOA: diminishes appetite via unknown mechanism in hypothalamus
  • SE: fatigue, cognitive decline
67
Q
  • Buproprion/Naltrexone (Contrave)
A
  • MOA:
    • Buproprion (anti-depressant): dopamine/norepinephrine reuptake inhibitor → stimulates POMC production → appetite suppression
    • Naltrexone: opioid antagonist → suppresses POMC inhibition → appetite suppression
  • SE: N/V, constipation
68
Q
  • Liraglutide (Saxenda) – same as Victoza (used to treat DM-2)
A
  • MOA: injected GLP-1 (glucagon-like peptide) → increases insulin production and activates parts of brain involved in appetite suppression → weight loss
  • SE: C-cell hyperplasia (thyroid), nausea, abdominal pain, bloating
69
Q

PCOS

treatment

talk about OCP, letrozole, clomiphene and metformin

A
  • Overall treatment: metformin
    • Treats insulin resistance, some benefit to infertility/hirsutism
  • Letrozole (aromatase inhibitor) > clomiphene (SERM) > metformin
    • MOA (treats infertility): aromatase inhibitor → interferes with estrogen feedback at the hypothalamus → increased release of FSH from pituitary
  • Clomiphene
    • MOA (treats infertility): SERM → decreases estrogen feedback at the hypothalamus → increased release of FSH from pituitary
    • Risk: exacerbates metabolic dysfunction (increases BMI)
  • OCP:
    • Treats hirsutism and acne; prevents diabetes, CVD, and endometrial cancer
    • Risk: can worsen insulin resistance
  • Diet and exercise
    • Decreases incidence of diabetes
70
Q

Glipizide

A

MOA:Blocks ATP-sensitive K-channels → membrane depolarization → influx of Ca → insulin release

SE:Hyperinsulinemia, weight gain, hypoglycemia

OTHER: Long acting

71
Q

Repaglinide

A

MOA:Blocks ATP-sensitive K-channels → membrane depolarization → influx of Ca → insulin release

SE:Hyperinsulinemia, weight gain, hypoglycemia

OTHER: rapid acting

72
Q

metformin

A

MOA:

  1. Inhibits gluconeogenesis in liver (increased production of lactic acid instead of pyruvate)
  2. Reduce insulin resistance via increased AMPK → increased GLUT4 expression

SE:Diarrhea, decreased absorption of B9/B12, lactic acidosis

OTHER: Contraindicated in renal dx due to lactic acidosis

73
Q

Pioglitazone

A

MOA:Activates peroxisome proliferator-activator receptor gamma (PPAR-gamma) → activates insulin responsive genes → increase glucose uptake

SE: Edema, fractures (due to decreased aromatase)

OTHER:

74
Q

acarbose

A

MOA:Inhibit alpha glucosidase → decreased breakdown of complex carbs → decreased glucose absorption in gut

SE:Diarrhea (osmotic), abdominal pain

OTHER:

75
Q

Pramlintide

A

MOA:Synthetic analog of amylin (usually co-secreted with insulin) → enhances satiety, slows gastric emptying, suppresses glucagon (mirrors insulin effects)

SE: N/V (slowed gastric emptying), hypoglycemia

OTHER:

76
Q

Exenatide

Lirglutide

A

MOA:GLP-1 receptor analog → increases insulin secretion → slows gastric emptying, suppresses glucagon (effects of GLP-1)

SE:Nausea, bloating (delayed gastric emptying)

OTHER:

Take 60min BEFORE meal

Risk of c-cell thyroid CA

77
Q

Sitagliptin

A

MOA:Prevents degradation of GLP-1 → increases insulin secretion → slows gastric emptying, suppresses glucagon (effects of GLP-1)

SE:Nausea, bloating (delayed gastric emptying)

OTHER:

78
Q

Canaglifozin

A

MOA: Reduces absorption of glucose from kidney → increase in urinary glucose, SGLT2i

SE:UTI/yeast infection, dehydration, AKI, ketoacidosis

OTHER:

79
Q

difference between insulins

  • humulog/novolog
  • novolin
  • long acting
A
80
Q

What are some treatments of thyrotoxicosis?

A
  • Treatment: beta blockers, thionamides (methimazole, propylthiouracil), radioactive iodine (I-131 ablation), surgery (thyroidectomy)
81
Q

Oxytocin

MOA, SE, Use, other fun facts

A

MOA: Peptide binds Gq → release of Ca → contractions

SE: Mom: Fluid retention (vasopressin is structurally similar to oxytocin)

USE: Uterine contractions

OTHER: Fetus: Uterine rupture, distress

82
Q

Desmopressin

MOA, SE, Use, other fun facts

A

MOA: ADH analog → fluid retention

SE: Rhinitis, hyponatremia

USE: Central diabetes insipidus (too little ADH)

OTHER: Contraindicated: HF, uncontrolled HTN

83
Q

Aquaretics: Conivaptan

MOA, SE, Use, other fun facts

A

MOA: ADH antagonist → water excretion

SE:

USE: Hyponatremia (too much ADH)

OTHER: Used in patients with CHF

84
Q

Dopamine receptor agonists: Bromocriptine

MOA, SE, Use, other fun facts

A

MOA: Inhibits prolactin secretion and decreases GH release (unsure MOA)

SE: Postural hypotension, N/V (CTZ), hallucinations

USE: Hyperprolactinemia, acromegaly

OTHER:

85
Q

Dopamine receptor antagonists: Metoclopramide

MOA, SE, Use, other fun facts

A

MOA: Inhibits dopamine → prolactin secretion occurs

SE:

USE: Hyperprolactinemia, acromegaly

OTHER:

86
Q

Pegvisomant (subQ)

MOA, SE, Use, other fun facts

A

MOA: Growth hormone receptor antagonist

SE: Infection (subQ), elevated LFTs

USE: acromegaly

OTHER:

87
Q

Growth hormone replacement: Somatotropin, Somatrem

MOA, SE, Use, other fun facts

A

MOA: Exogenous GH

SE:

Kids: elevated HbA1c, eosinophilia, increased risk of secondary malignancies

Adults: fluid retention, myalgia

USE: Dwarfism (GH deficiency)

OTHER: Drug interactions: estrogens, androgens, thyroid hormones

88
Q

GHRH injection: Sermorelin

MOA, SE, Use, other fun facts

A

MOA: Exogenous GHRH → GH

SE:

Kids: elevated HbA1c, eosinophilia, increased risk of secondary malignancies

Adults: fluid retention, myalgia

USE: Dwarfism (GH deficiency)

OTHER: Drug interactions: estrogens, androgens, thyroid hormones

89
Q

Mecasemerin

MOA, SE, Use, other fun facts

A

MOA: Exogenous IGF-1 → acts at insulin-like receptor → growth

SE: Tonsillar hypertrophy, lipohypertrophy, hypoglycemia

USE: IGF-1 deficiency in children (not GH deficient, but resistant to effects of GH)

OTHER:

90
Q

Fludrocortisone

MOA, SE, Use, other fun facts

A

MOA: Aldo agonist → Na/H20 reabsorption

SE: Fluid retention, hypokalemia

USE: CAH: 11-beta hydroxylase deficiency, adrenal insufficiency

OTHER:

91
Q

Spironolactone, Eplerenone

MOA, SE, Use, other fun facts

A

MOA: Aldo antagonist → blocks Na/H20 reabsorption

SE: Gynecomastia, menstrual issues (block androgen/ glucocorticoid receptors)

USE: HTN, hypokalemia

OTHER:

92
Q

Aminoglutethemide

MOA, SE, Use, other fun facts

A

MOA: Cholesterol desmolase inhibitor (rate-limiting step)

SE: Extreme sedation, nausea, severe skin rashes

USE: Cushing’s syndrome

OTHER:

93
Q

Metyrapone

MOA, SE, Use, other fun facts

A

MOA: Inhibits 11-hydroxylase activity

SE: Hirsutism (increased androgens), acne, HTN, N/V, sedation

USE: Cushing’s syndrome

OTHER:

94
Q

Ketoconazole (antifungal)

MOA, SE, Use, other fun facts

A

MOA: Inhibits 11-hydroxylase activity

SE: Gynecomastia, low testosterone levels, elevates LFTs, CYP450 inhibitor

USE: Cushing’s syndrome

OTHER:

95
Q

Mitotane

MOA, SE, Use, other fun facts

A

MOA: Causes degeneration of zona fasiculata and reticularis cells → atrophy of adrenal gland

SE: Lethargy and extreme sedation, CNS effects

USE: Cushing’s syndrome

OTHER: Use: Inoperable cortical carcinoma

96
Q

Mifepristone

MOA, SE, Use, other fun facts

A

MOA: Progesterone and glucocorticoid receptor antagonist

SE: Vaginal bleeding, pregnancy termination, nausea

USE: Cushing’s syndrome

OTHER:

97
Q

Hydrocortisone

MOA, SE, Use, other fun facts

A

MOA: Activates cytosolic glucocorticoid receptors → release of cortisol

SE: Cushingoid effects

USE: Adrenal insufficiency, inflammation, asthma, eczema, etc

OTHER: Metabolism slowed by estrogens, liver disease, age, pregnancy, hypothyroidism

98
Q

Iodides

MOA, SE, Use, other fun facts

A

MOA: Iodine analog → negative feedback of T3/T4 synthesis

SE: Hypothyroidism SE

USE: Short term hyperthyroidism (pre-operatively)

OTHER:

99
Q

Propylthiouracil (PTU)

MOA, SE, Use, other fun facts

A

MOA: Substrate for TPO, inhibits MIT/DIT coupling to thyroglobulin, blocks peripheral conversion of T4/T3

SE: Hypothyroidism, rashes, arthralgias, SLE-like syndrome, hypersensitivity reactions, hepatotoxicity

USE: Thyroid storm, hyperthyroidism, when methimazole is not tolerated

OTHER: Indicated: pregnancy

100
Q

Methimazole

MOA, SE, Use, other fun facts

A

MOA: Substrate for TPO, inhibits MIT/DIT coupling to thyroglobulin,

SE: Hypothyroidism, rashes, arthralgias, SLE-like syndrome, hypersensitivity reactions, birth defects

USE: Hyperthyroidism

OTHER:

101
Q

Synthroid, Levothroid, Levothryxine

MOA, SE, Use, other fun facts

A

MOA: Synthetic T4 (protein bound, can be converted to T3, slow onset)

SE: Cardiac events

USE: Hypothyroidism

OTHER:

Drug interactions: warfarin (TH reduces clotting factors), beta blockers

Increased T4 clearance by: Rifampin, Phenytoin

102
Q

Natural desiccated thyroid

MOA, SE, Use, other fun facts

A

MOA: Animal T4

SE: Allergic reactions

USE: Hypothyroidism

OTHER:

Drug interactions: warfarin (TH reduces clotting factors), beta blockers

Increased T4 clearance by: Rifampin, Phenytoin

103
Q

Liothyronine (Ctyomel)

MOA, SE, Use, other fun facts

A

MOA: Synthetic T3 (fast onset, not protein bound)

SE: Cardiac events

USE: Hypothyroidism, myxedena

OTHER: higher cost

104
Q

Liotrix

MOA, SE, Use, other fun facts

A

MOA: T4/T3

SE: Cardiac events

USE: Hypothyroidism

OTHER: EXPENSIVE

EndoRepro (8 decks)

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