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Fall 2018/P3 Year' > Therapeutics Exam 4 (Women's Health) > Flashcards

Therapeutics Exam 4 (Women's Health) Flashcards

1
Q

Definition of Oligomenorrhea

A

menstrual cycle > 35 days

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2
Q

Definition of Polymenorrhea

A

menstrual cycle < 21 days

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3
Q

what things are seen as abnormal bleeding?

A 
bleeding b/w periods
after sex
spotting at any point of menstrual cycle
heavier bleeding than normal
longer/shorter bleeding than normal
bleeding after menopause
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4
Q

what is secondary dysmenorrhea:
onset in ______
poor response to _________
_______ and vaginal _____

A

onset in 20 - 30s
poor response to NSAIDs/oral contraceptive pills
dyspareunia/ discharge

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5
Q

Risk factors for Dysmenorrhea

A 
< 20 y.o 
wt loss attempts
depression/anxiety
heavy menses
nulliparity
smoking
family hx
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6
Q

Nonpharm options for dysmenorrhea?

A

heating pad
exercise
omega 3 fatty acids and vit B (???)
smoking cessation

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7
Q

drugs for dysmenorrhea treatment?

A

danazol (an androgen)
leuprolide
NSAIDs (use only during symptoms!!)
oral contraceptives

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8
Q

how to treat oligomenorrhea or polymenorrhea and metorrhagia?

A

treat underlying cause..

hormonal contraception!

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9
Q

possible causes for oligomenorrhea

A 
anovulation
heavy exercise
eating disorders
thyroid disease
prolactinoma
adolescent age
perimenopause
medications (antipsychotics and antiepileptics)
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10
Q

what is menorrhagia?

A

heavy menstrual bleeding (> 80 mL)

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11
Q

causes of menorrhagia?

A

hormonal imbalance
infection
fibroids
coaglupathy

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12
Q

How to treat menorrhagia?

A

iron supplementation
NSAIDs
Hormonal contraceptive
Target underlying cause

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13
Q

How to treat acute menorrhagia treatment

A 
tranexmic acid (TID x5 days)
Medroxyprogesterone (TID x 1 wk)
HD estrogen (IV q4H until bleeding slows; OR

monophasic OC TID x 1 wk!! (like a whole pack of sprintec in a week!!)

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14
Q

definition of metorrhagia?

A

bleeding b/w periods

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15
Q

what can cause metorrhagia

A 
IUD
infections
meds
hormone imbalance
fibroids, polyps, endometriosis
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16
Q

what is the billings ovulation method

A

monitoring cervical mucous (clear and thin = ovulation)

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17
Q

Review of Menstrual Cycle:

______ stimulates FSH and LH

A

estradiol/estrogen

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18
Q

Review of Menstrual Cycle:

Two phases?

A

folicular phase then Luteal phase

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19
Q

Review of Menstrual Cycle:
what hormone is higher during follicular phase?
vs
what hormone is higher during luteal phase?

A

follicular: estradiol
luteal: progesterone

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20
Q

Review of Menstrual Cycle:

what is Day 1?

A

start of the menstruation

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21
Q

Review of Menstrual Cycle:

_______ surge –> ovulation

A

FSH and LH surge

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22
Q

Changes in a Women’s Body:
Menstrual Cycle, Pregnancy or Elderly Women?
will have increased gastric pH

A

pregnancy and elderly

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23
Q

Changes in a Women’s Body:
Menstrual Cycle, Pregnancy or Elderly Women?
decreased creatinine clearance

A

elderly

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24
Q

Changes in a Women’s Body:
Menstrual Cycle, Pregnancy or Elderly Women?
increase blood volume and decrease albumin

A

pregnancy

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25
Q

Changes in a Women’s Body:
Menstrual Cycle, Pregnancy or Elderly Women?
decreased Vd for hydrophilic and increased Vd for lipophilic

A

elderly

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26
Q

what age are women supposed to start get cervical screenings?

A

age 21

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27
Q

how often are women to get a cervical screening

A

every 3 years

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28
Q

roles of estrogen in contraception

A

suppress FSH

increase SHBG

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29
Q

why is estrogen increase SHBG good

A

more SHBG = increase binding of free androgens = acne is better!

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30
Q

roles of progestin in contraception

A

prevent LH surge
thicken cervical mucus
change motility of fallopian tubes
atrophy of endometrium

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31
Q

why is estrogen suppress FSH good

A

it prevents a dominant follicle

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32
Q

why is progestin preventing the LH surge good

A

inhibit ovulation

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33
Q

why is progestin thickening the cervical mucus good

A

inhibit sperm/penetration/transport

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34
Q

why is progestin changing the motility of fallopian tubes good

A

impair transport of sperm/ova

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35
Q

why is progestin causing atrophy of endometrium good

A

impair implantation

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36
Q

what are side effects from estrogen that mean there is not enough estrogen

A 
breakthrough bleeding early in cycle
light menses
vaginal dryness
spotting
(no withdrawl bleeding??)
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37
Q

what are the 3 different characteristics of progesterone components

A

progestational
androgenic
estrogenic

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38
Q

what are the side effects of androgenic progestin

A

acne
hirsutism
(want low androgenic activity!!)

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39
Q

why is it good to have estrogenic components of progestin

A

it is there to oppose the androgenic side effects!

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40
Q

what specific progestins are 3rd/4th gen aka they will have the fewest side effects

A

norgestimate
desogestrel/etonogestrel
drosperinone

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41
Q 
Implant:
what hormone(s)?
good for how long?
return on fertility effect?
A

progestin only
3 years
may be delayed

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42
Q 
Levonorgestrel IUD:
what hormone(s)?
good for how long?
return on fertility effect?
A

progestin only
3 - 5 years (depends on IUD)
immediate fertility

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43
Q

Serious side effects of IUD?

A

expulsion
uterine perforation
infection

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44
Q 
Copper IUD:
what hormone(s)?
good for how long?
return on fertility effect?
A

no hormone, duh!
10+ years!!!!
immediate fertility

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45
Q 
Birth Control Shot:
what hormone(s)?
good for how long?
return on fertility effect?
A

progestin only
shot given every 3 months
delayed return of fertility

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46
Q

Birth Control Shot:
given every 3 months (____ - ____ weeks)
considered late after _____ weeks

A

11 - 13

15 weeks = late = use back up for a week!

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47
Q

serious ADEs of the Birth Control Shot?

A

lower bone desnity

heavy bleeding

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48
Q

potential benefits of IUDs?

A

lower risk of uterine cancer
safe to breastfeed
long term protection
(lighter periods with hormonal IUD but NOT copper)

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49
Q

potential benefits of the Birth Control Shot?

A

lower risk of uterine cancer
safe to breastfeed
(lighter periods with hormonal IUD but NOT copper)
(aka just like IUD but no longer term protection..)

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50
Q

The combined pill: what strengths are very low dose, low dose, and high dose

A

very low: 20 - 25 mcg

low: 30 - 35 mcg
high: 50 mcg

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51
Q

Mini Pill:
hormone?
must be taken within hour many hours everyday?

A

progestin only

3 hours

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52
Q

Nuvaring:
hormones?
if left out for _____ hours use backup for 7 days

A

progestin and estrogen

> 3 hours

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53
Q

Patch:
hormones?
if off for more than ____ or if on for more than ____ - use back up for 7 days

A

progestin and estrogen
off more 24 hours
on more than 9 days

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54
Q

serious side effects from combined methods

A 
(ACHES)
Abdominal pain (liver or gallbladder or clot)
Chest pain (PE or MI)
headache (HTN or stroke) 
eye problems (bc HTN or stroke)
severe leg pain (DVT)
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55
Q

potential mechanisms of antibiotics and COC

A

altered intestinal flora
increased N/V/D from abx
altered metabolism

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56
Q

main contraindication for progestin only contraception

A

current breast cancer

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57
Q

what are the 3 emergency contraception options

A

copper IUD
Ulipristal acetate
Levonorgestrel pill

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58
Q

what is usually 1st line recommendation for all women for contraception?

A

LARCs! (IUD and implants!!)

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59
Q

Emergency Contraception:

Must take within _____ of unprotected sex

A

5 days!

package will say 72 but up to 5 days is ok!

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60
Q

Emergency Contraception:

Wait 5 days to restart hormonal birth control if _____ is used

A

ulipristal (Ella)

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61
Q

Side effects of Emergency Contraception?

A

N/V
headache/dizziness
breast or stomach pain
next period may start early/spotting

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62
Q

HPV non-cancer risks?

A

Anogenital warts
Recurrent respirator papillomatosis
Cervical Cell Abnormalities

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63
Q

HPV cancer risks?

A

anal
head and neck
CERVICAL!

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64
Q

Ideal vaccination time/age?

A

before onset of sexual activity/ age 11 - 12

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65
Q

what HPV vaccine is currently available? (others have been withdrawn)

A

Gardasil 9

66
Q

Gardasil vaccine:
if < 15 y.o – get how many vaccines
if > 15 y.o – get how many vaccines

A

< 15: 2 vaccines

> 15: 3 vaccines

67
Q

current ages approved by FDA for gardasil

A

9 - 45 now!!!

used to be years 9 - 26.. just approved for 27 - 45!

68
Q 
HPV Vaccine logistics:
Shake it or dont shake it before giving
solution will look like \_\_\_\_\_\_\_\_
given (SQ or IM)
(Live or non-live) vaccine?
A

shake it!!
soln is white/CLOUDY
IM
non-live!

69
Q

Contraindications to HPV vaccine

A

hypersensitivity..
Severe allergic rxns to YEAST (it is a vaccine component)
Allergic rxn to previous dose

70
Q

Warnings/Precautions to HPV vaccine?

A

syncope!

have appropriate medical treatment available in case if anaphylactic rxn

71
Q

what is CRPS or POTS

A

CRPS: complex regional pain syndrome
POTS: postural orthostatic tachycardia syndrome

– possible HPV vaccine reactions!!

72
Q 
PMS and PMDD:
Recurrent moderate \_\_\_\_\_ and \_\_\_\_\_ symptoms
Occur during the \_\_\_\_ phase
Should resolve with \_\_\_\_\_
Over 200 symptoms!!
A

moderate psychological and physical symptoms
during the luteal phase
resolve w/ menstruation

73
Q

PMS and PMDD:

Pathophys is not super well understood — what are some possible casuses tho

A 
serotonin
GABA
allopregnanolone
estrogen
progesterone
74
Q

PMS Definition/Diagnosis:
at least one symptom associated with __________
___ days before onset of menses
Present for at least __#__ consecutive menstrual cycles

A

assoc. w/ economic or social dysfunction
5 days before
3 cycles

75
Q 
PMDD Definition/Diagnosis:
\_\_\_\_ symptoms final week before menses
Improves within a few days of onset of menses
Present in majority of cycles
Starts \_\_\_\_\_ days before menses
A

5 symptoms!!!

7 days

76
Q

Non-Pharm options for PMS and PMDD?

A 
AEROBIC exercise (2 - 3 x/wk)
Relaxation Techniques
Calcium Carb
Vit. B6
Reduced CAFFEINE, Refined SUGARS, and SODIUM
77
Q

Pharm Treatment of PMS/PMDD?

A 
1st/2nd line: SSRI
3rd line: Alprazolam
4th: GnRH agonists
(Oral contraceptives or spironolactone could be good)
Surgery if insanely bad
78
Q

T or F: For PMS/PMDD treatment alprazolam is typically used to replace SSRIs

A

false!! never to REPLACE only to augment!!! used when pt has hella anxiety symptoms – NOT for any physical sxs

79
Q

GnRH analogs for PMS/PMDD:

Must add _____ therapy after ____ months because of ________

A

add back hormone thearpy!
6 - 9 months
b/c reductions in bone mass

80
Q

GnRH analogs for PMS/PMDD:

effective in pschyoemotional sxs, physical sxs, or both?

A

both!!

but used hella last line

81
Q

Oral Contraceptives for PMS/PMDD:

Good for/effective in pschyoemotional sxs, physical sxs, or both?

A

only physical sxs!!

82
Q

Oral contraceptives: doing a shortened _____ interval = greater reduction in symptoms

A

shortened pill free*

83
Q

Spironolactone for PMS/PMDD:
take doses during ______ of cycle
Will work to decrease what things?

A

during luteal phase

decreases weight gain, somatic symptoms (breast tenderness or bloating) and negative mood

84
Q

Treatment options for Female orgasmic disorder?

A 
CBT
EROS-CTD (like vacuum device for the clitoris)
NON FDA approved Meds:
Bupropion
Apomorphine SL...?
85
Q

Female Sexual Interest/arousal disorder treatment options?

A

estrogen or testosterone..

Addyi(filbanserin)

86
Q

MOA of Addyi?

A

Mixed 5HT1a agonist/ 5HT2a antagonist

87
Q

Contraindications for Addyi?

A

Alcohol use
Strong/moderate CYP3A4 inhibitors
Hepatic impairment

88
Q

T or F: Addyi has a REMS program

A

True

89
Q

ADEs of Addyi?

A

dizziness
nausea
fatigue

90
Q

Pre-Natal Diet: what things are needed for sure to be adequate?

A 
folate
iron
calcium
omega 3 fatty acids
calories!
91
Q

All women of childbearing age should have ____ folic acid daily
If high risk or hx of NTD: women should have ____ folic acid daily

A

0.4 mg

4 mg

92
Q

Food sources for folic acid?

A 
fortified foods
green leafy veggies
citrus
fruits
liver
legumes
whole wheat bread
93
Q

Pregnancy: Iron recommendations:

_____ mg of iron

A

27 - 30 mg QD

94
Q

Food sources of iron?

A 
lean red meat
fish
poultry
dried fruits
iron fortified cereals
95
Q

Adequate calcium intake for pregnant women may decrease risk of _____ and ____

A

HTN and preeclampsia

96
Q

what fish should be avoided in pregnant women?

A 
king mackerel
shark
swordfish
tilefisk
raw rish
(refrigerated smoked seafood?)
97
Q

what fish CAN pregnant women have

A 
shrimp
canned light tuna
salmon
pollock
catfish
98
Q

prenatal diet:

Caffeine: recommended = < _____ mg/day

A

200 mg/day

99
Q

Prenatal genetic screenings?

A

Sickle cell
Cystic fibrosis
aneuploidy

100
Q

what are some third trimester/late pregnancy testing?

A 
glucose tolerance test
CBC
HIV
Syphilis
Group B Beta Strep
101
Q

Vaccination in Pregnancy?
what can they not get?
which ones should they get during pregnancy?

A

NO LIVE VACCINES!!

should get flu and TDaP

102
Q

Pregnancy PK Changes:

Absorption: ______ gastric emptying

A

slower

103
Q

Pregnancy PK Changes:
Distribution: _____ blood volume;
change in protein binding;
_____ ratio of lean muscle to adipose tissue

A

large blood volume

lower ratio

104
Q

Pregnancy PK Changes:

Elimination: ________ renal and hepatic blood flow

A

increased

105
Q

Pregnancy PK Changes:
Metabolism:
Changes in ________ metabolism enzymes

A

phase 1 and phase 2 metabolism

106
Q

Pregnancy and Timing of Medication Exposure:
First 2 weeks after conception — all or nothing
Weeks 3 - 10: ______genesis – critical if exposed to a teratogen

A

organogenesis

107
Q

3 major teratogens that were listed in lecture?

A

Thalidomide
ACE Inhibitors
Warfarin

108
Q

Prescription drug labeling sections: what are the 3 sections

A

pregnancy
lactation
female/male reproductive potential

109
Q

what are the 3 common pregnancy complaints we might have to recommend things for?

A

N/V
Heartburn
Constipation

110
Q

Non-Pharm options for NVP?

A 
Start prenatals 3 months before conception
Avoid triggers (smells, foods, motion)
Eat small, frequent, low-fat meals
drink chilled beverages
Ginger
111
Q

FIRST line NVP pharm treatment option?

A

1st line: Pyridoxine +/- doxylamine

112
Q

SECOND line NVP pharm treatment option?

A 
antihistamines
phenothiazines
anticholinergics
Dopamine antagonists
serotonin inhibitors
113
Q

LAST line NVP pharm treatment option?

A

glucocorticoids

114
Q

main safety concerns of serotonin inhibitors in pregnancy?

A

QT prolongation (for mom)
cleft palate
fetal cardiac abnormalities

115
Q

heartburn for pregnant women is worst in what trimester?

A

third

116
Q

causes of heartburn in pregnant women?

A

increased progesterone

enlarged uterus

117
Q

non pharm options for heartburn - pregnancy lecture

A

diet - avoid trigger foods
eat small, well balanced meals
raise head of bed 6 - 8 inches
chewing gum

118
Q

causes of constipation in pregnancy?

A 
dietary changes
decreased physical activity
iron containing vitamins
mechanical factors
progesterone
119
Q

Non pharm options for pregnant women with constipation

A 
increased fiber and fluid
avoid constipating foods...
regular exercise
limit stress
avoid constipating meds...
120
Q

what are some acute issues in pregnancy?

A

UTI
pain/fever/HA
VTE

121
Q

may concern of UTIs in pregnancy being left untreated?

A

pyelonephritis

122
Q

Non-pharm options for treating UTI in pregnancy?

A 
hydration
wipe from front to back
void before/after sex
avoid scented feminine products
wear cotton underwear
avoid tight fitting clothes
123
Q

what antibiotics should HELLA not be used for UTI in pregnancy treatment

A

fluroquinolones (cipro and levo)
tetracyclines
bactrim (sulfa-TMP)

124
Q

what antibiotics are ok to use in tx of UTI in pregnancy

A

cephalexin
nitrofurantoin
ampicillin
sulfisoxazole

125
Q

avoid what antibiotics for UTI in pregnancy?

A

fluoroquinolones (Cipro and levofloxacin)
tetracyclines
SMZ-TMP

126
Q

Acute issues in pregnancy:
If fever unresolved in _____ - go see OB

if headache persists and women is over ____ weeks - go see OB

A

fever: 24 - 36 hours

HA: over 20 weeks (bc worried about preeclampsia)

127
Q

what is the DOC for pain/fever in pregnancy

A

APAP

128
Q

Pregnancy -Pain/HA

NSAIDs: avoid use after ______ weeks (premature ductal closure)

A

32 weeks

129
Q

risk factors for thromboembolism in pregnancy?

A 
> 35 yo
Obesity (BMI > 30)
grand multiparity
personal/family hx of VTE
bed rest
immobility > 4 days
hyperemesis
dehydration
preeclampsia
surgery/trauma
130
Q

Managing thromboembolism in pregnancy:
Postpartum —- Restart anticoag….
___ hours after natural delivery

A

6 hours

131
Q

Managing thromboembolism in pregnancy:
Postpartum —- Restart anticoag….
______ hours after epidural removal

A

12 hours

132
Q

Managing thromboembolism in pregnancy:
Postpartum —- Restart anticoag….
_____ horus after C -section

A

24 hours

133
Q

Managing thromboembolism in pregnancy:
Postpartum:
Continue anticoag for at least _____ postpartum

A

6 weeks

134
Q

Managing thromboembolism in pregnancy:
Postpartum:
want to do a TOTAL duration for at least ______

A

6 months

135
Q

Managing thromboembolism in pregnancy - delivery:
scheduled induction or C-section at ____ weeks
- stop LMWH ____ prior
- stop Factor Xa/direct thrombin inhibitor ______ prior

A

at 37 weeks
stop LMWH: 24 hours prior
other 2: 24 - 48 hours…. (so 24 hrs for all!)

136
Q

Managing thromboembolism in pregnancy - delivery:

switch to _____ at 36-37 weeks gestation b/c shorter half life

A

UFH

137
Q

Preterm birth is known as before ______ weeks gestation

A

37 weeks

138
Q

What are some MATERNAL risk factors for premature birth?

A 
hispanic race
< 6 mos b/w pregnancies
physically strenuous work
pre-pregnancy BMI < 19 (aka underweight)
Medical conditions (DM, HTN, thyroid disease)
139
Q

What are some PREGNANCY characteristics risk factors for premature birth?

A 
infections
cocaine/heroin use
multiple gestation -- twins/triplets 
shortened cervix
tobacco use
uterine abnormalities
placental abruption
140
Q

Preventing Preterm Birth:
if hx of preterm birth: ______ q week (weeks 6 - 36)
if no hx of preterm birth _______ daily as early has 18 weeks based on cervix

A

if hx: hydroxyprogesterone IM

no hx of preterm = vaginal progesterone suppository

141
Q

if Preterm labor and contractions: what drugs are used?

A
  • magnesium sulfate (fetal neuroprotection)
  • corticosteroids (betamethasone and dexamethasone)
  • Penicillin (Group B strep prophylaxis) — do if not tested before
  • tocolytics
142
Q

what drugs are tocolytics

A

nifedipine
indomethacin
terbutaline
magnesium sulfate

143
Q

Pre-Term labor & contractions - Magnesium sulfate: prevent _______ and is for ________ protection

A

prevent cerebal palsy

fetal neuroprotection

144
Q

Pre-Term labor & contractions

Corticosteroids used in weeks 24 - 34 for developing _______

A

lungs

145
Q

Pre-Term labor & contractions

Tocolytics are used in weeks 24 - 34 to ________

A

stop contractions

146
Q

Pre-Term Membrane rupture:

use what drugs?

A

corticosteroids and magnesium sulfate and “latency abx”

147
Q

common meds for HTN in pregnancy

A 
labetalol
amlodpine
nifedipine
HCTZ
hydralazine
methyldopa
148
Q

gestational HTN:
elevated BP after ____ weeks
generally do not treat if BP is < ______

A

20 weeks

160/110 mmHg

149
Q

risk factors fro gestational HTN

A

gestational diabetes
hx of preeclampsia
obesity
age

150
Q

Preeclampsia = new onset BP of > _______ and proteinuria > _________

A

140/90

300 mg / 24 hrs

151
Q

risk factors for preeclampsia

A 
microvascular disease (diabetes, HTN, vascular diseases)
nephropathy
Age < 20 y.o or > 35 y.o
Family/personal hx or preeclampsia
first pregnancy
152
Q

Preeclampsia:

_______ is only cure

A

delivery

153
Q

Preeclampsia:

what are severe symptoms?

A

neurologic: headache and blurry vision
end organ damage (kidney and liver and placental function)
may deliver at 34 weeks or earlier…

154
Q

Goals of managing preeclampsia?

A

prevent seizures
lower Blood pressure
avoid maternal end organ damage

155
Q

Preeclampsia seizure prophylaxis agents?

A

magnesium sulfate;
phenytoin
benzo

156
Q

what is HELLP syndrome and what does it stand for?

A

it is a variant of severe pre-eclampsia

Hemolysis, Elevated, Liver enzymes, Low Platelets

157
Q 
if pregnant lady has pre-existing diabetes: 
Patient should do SMBG \_\_\_\_\_ times a day
Has more (strict or relaxed) blood glucose goals?
A

4 x/day

more strict!!

158
Q

which antidepressant should be avoided for sure in pregnancy

A

paroxetine

159
Q

what ___% for RID range means a large amount of drug is transferred to milk/risk to infant exists

A

10%

160
Q

______ lactation risk category:

what values/what represents - what is safest and what is contraindicated?

A

Hale’s

L1 = safest –> 2, 3, 4, L5 = contraindicated

161
Q

what does RID do and what does it stand for?

A

Relative infant dose:

can be used to calculate potential exposure

Fall 2018/P3 Year' (16 decks)

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