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Therapeutics > Thrp: Exam 7 (Gender Specific Issues) > Flashcards

Thrp: Exam 7 (Gender Specific Issues) Flashcards

1
Q

Ethinyl Estradiol

A

Estrogen

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2
Q

Estradiol Valerate

A

Newest estrogen *Natazia only

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3
Q

Mestranol

A

Estrogen: Not used

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4
Q

Progestin MOA in Contraception

A 
Mimic Luteal phase: (-)feedback = No ovulation
Hostile Cervical Mucus
Inhospitable endometrium
Dec fallopian tube movement
(can do 1 or all at anytime)

*NOT CLEAN
Progestin, estrogen, androgen, endometrial activity

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5
Q

Desogestrel

A

Progestin: High progestin and low estrogen activity

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6
Q

Norgestimate

A

Progestin: Zero Estrogenic activity

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7
Q

Levonorgestrel

A

Progestin: Most androgenic activity w/ no estrogenic activity

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8
Q

Norethindrone Acetate

A

Progestin:

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9
Q

Norgestrel

A

Progestin: Zero Estrogenic activity

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10
Q

Norethindrone

A

Progestin:

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11
Q

Ethynodiol Diacetate

A

Progestin:

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12
Q

Drospirenone

A

Progestin: Spirinolactone anolog w/ ANTI-Androgenic activity
=Tx Acne, facial hair, PCOS

*Regular K+ Monitoring (~Potassium Sparing Diuretic)

(Yasmin and Yaz)

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13
Q

Dienogest

A

Progestin: Synthetic Progestin (no real advantage over others)
Anti-androgenic and zero estrogenic activity

(Natazia)

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14
Q

Nor-QD

A

Progestin only Minipill: Norethindrone 0.35mg

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15
Q

Ovrette

A

Progestin only Mini pill: *Norgestrel (0 estrogenic activity)

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16
Q

Medroxyprogesterone Depot

A

Contraception
150mg IM q12w
104mg SQ q12w
(3 month duration)

Back up needed for 1st week for the 1st time shot
OR if 1 wk late for next shot

CI: overweight (wt gain SE) Ab bleeding

Reversible dec in BMD due to no estrogen and (-) feedback (=Hypoestrogenic state)

  • worse if start early or >5yrs
  • dont use if other BMD risk factors (ex smoke, low Ca++)
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17
Q

Ortho-Evera

A 
Patch: norelegestromin + EE
3wk on (Δ q7d) 1wk off

Missed Dose = 2 Days
If wk 1 = Apply ASAR, back up X7D; new day 1
If wk2 = <2days Apply ASAR; OK
≥ 2days = new cycle; back up X7D
if wk 4: remove when remember/cont wear ok

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18
Q

Nuvaring

A

Vaginal Ring: Etnogestral + EE
3wk in 1 wk out

Removal >3hr = back up tell cont. 7 day use
or if > 1wk extra wear: new ring, back up X7D, rule out pregnancy

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19
Q

Nexplanon

A

Progestin rod implant
Effective 3 yrs w/ immediate return to fertility w removal

SE: (progestin only Rx)
Irregular bleeding that does NOT resolve

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20
Q

Yuzpe Regimen

A

EC: High dose EE 100 mcg + high dose progestin (levnorgestrel 1mg)
W/IN 72 hrs then repeat 12 hrs later (efficacy 75%)
(any OC X 2 dose - FDA Approved = Ovral (#2), Alesse (#5), Nordette (#4), LoOvral (#4))

if already conceived does NOT harm

SE: N/V **Can take antiemetic IF vomit w/in 2hrs REPEAT dose (high dose estrogen), heavy menses/breast tenderness

CI: known preg (not harmful but waist of $$), any OC CI, Hx of clots, cancer (only 1Xdose)

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21
Q

EC Levonorgestrel Only

A

Plan B= levonorgestrel 0.75mg take w/in 72hrs then repeat 12 hrs after 1st dose
OR take both w/in 72 hr = Plan B One Step (1.5mg)
**Acceptable efficacy up to 120 hrs after sex BUT loner the wain lower the efficacy

SE: Some N/V**Can take antiemetic IF vomit w/in 2hrs REPEAT dose , breast tenderness, HA, Dizziness

If not period w/in 3 wks need prego test

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22
Q

EC Copper IUD

A

EC up to 5 days AFTER ovulation

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23
Q

Mifepristone

A

EC: OFF LABEL use up to 5 days after sex (Abortifacient)

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24
Q

Ulipristal acetate

A

RX only EC: “SPRM” MOA: progesterone antagonist to prevent implantation (effective even if LH surge has begun)
*Suppression of dominant follicle growth, delay endometrial growth, postpone ovulation

DOSE: 30mg up to *120hrs post sex
(efficacy similar to (but better than) PlanB)

(Ella)

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25
Q

Mirena

A

Levornorgestrel IUD: Rel 20mcg/day
Effective 5 years w/ <1% failure

Local delivery = MOA: inhospitable endometrium, thick cervical mucus, changes in tubal motility (less ovulation effect/ (-) feedback)

AE: inc unexpected spotting/bleeding (dec over time; after 1yr many amennorheic)
SERIOUS but rare = uterine perforation
P.A.I.N.Sx: Period late/abnormal spotting, Abdominal pain/pain with intercourse, Infection exposure (STD)/abnormal vaginal discharge, Not feeling well (fever/chills), String mission/shorter or longer.

Counseling: check string qmo

Tx: Endometriosis

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26
Q

Skyla

A

New Levornorgestrel IUD: Rel 14mcg/day
Effective 3 years

Local delivery = MOA: inhospitable endometrium, thick cervical mucus, changes in tubal motility (less ovulation effect/ (-) feedback)
P.A.I.N.Sx: Period late/abnormal spotting, Abdominal pain/pain with intercourse, Infection exposure (STD)/abnormal vaginal discharge, Not feeling well (fever/chills), String mission/shorter or longer.

AE: inc unexpected spotting/bleeding (dec over time; after 1yr many amennorheic)
SERIOUS but rare = uterine perforation

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27
Q

ParaGard

A

Copper IUD Contraception MOA: Spermacide
Effectiveness for 10 years (failure rate 2.1 - 2.8%)

w/Copper IUD Always have period

CI: List*

P.A.I.N.Sx: Period late/abnormal spotting, Abdominal pain/pain with intercourse, Infection exposure (STD)/abnormal vaginal discharge, Not feeling well (fever/chills), String mission/shorter or longer.

AE: inc unexpected spotting/bleeding w/ reg cycle bleeding q.mo, heavy bleed w/cramping
SERIOUS but rare = uterine perforation

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28
Q

Ca++ for PMS

A

1200mg/day (women should get this much anyway)

Dec mood sx, fluid retention, pain (48%) VS. 30% Px

Low risk/cost intervention

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29
Q

Tx: PMS Bloating

A

Salt restriction: powerful (EDEMA too)

Spironalactone 25mg up to QID x 10d prior to menses

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30
Q

Tx: PMS Breast Pain

A

Vit E 400 IU QDay OR “Evening Primrose Oil” 500mg - 3g qd

Bromocriptine (DA Receptor Ag) if due to hyperprolactinemia

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31
Q

Tx: PMS Insomnia

A

Sleep Hygiene
Low dose Trazodone
intermittent diphenhydramine

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32
Q

Tx: PMS Anxiety

A

Buspirone: Cont or luteal phase only
(20-30mg/day in 2-3divided doses)

Avoid BDZ (Alprazolam)

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33
Q

Mifepristone

A

Medical Abortion: MOA: antiprogestin that blocks progestin activity resulting in changes the uterine lining and inc sensitivity to prostaglandins: -> cervical so feting and uterine contractions (i.e. medical abortion)
1 Dose followed by Misoprostol

Not available in pharmacies

Used UP TO 7wks (49days) from last period
*need three office visits, consent signed, agree to undergo surgical abortion if doesn’t work

CI: IUD, chronic steroid therapy, ectopic preg, **Hemorrhagic disorder or anticoag therapy (AE = bleeding for up to 30 days)

AE: bleeding up to 30 days (Heavy bleeding may mean incomplete abortion), uterine cramping, N/D, dizziness
Clostridium sordelli Toxic Shock Syndrome

34
Q

Misoprostol

A

Prostaglandin: MOA: Augment uterine contractions
Medical abortion: 400-800 mcg vag or PO given after Mifepristone

OTHER USES:
Dec GI effects of NSAIDS and PUD (200mcg QID)
Induce contraction at delivery
Miscarriage POST-Tx (can see at retail setting)
Insertion of IUD (little evidence for this but done)

35
Q

PMDD Tx

A

1° Tx = Education, support, diet, regular exercise
Ca++

2nd line = SSRI: Sertraline or fluoxetine: Dose during luteal phase OR continuos
SSRI’s Tx MOOD Sx

Yaz has approved indication for Tx of PMDD

36
Q

Spironolactone

A

MOA: Aldosterone Receptor Antagonist, K+ sparring diuretic

Tx: hirsutism & Acne in PCOS
50-100mg BID for 6-12 mo (may take 6-9mo for improvement)

Monitor K+ and renal fn

AE: Polymenorrhea, mastodynia, HA mood swings, fatigue, GI

37
Q

Clomiphene Citrate

A

MOA: antiestrogenic effect on hypothalamus. initiates hormonal cascade to produce ovulation and restore normal gonadotropin secretion

Dose: 50mg/day X 5 D started on cycle day 5. can inc by 50mg up to MAX: 200-250mg/day TOTAL of 6 cycles
*once dose attained to cz ovulation, little gained w/inc dose and more SE

AE: GI, vasomotor, sleep disturbances, ovarian hyperstim hepatotoxic (rare)

38
Q

Metformin

A

Insulin-senstizine agent:
(For PCOS: sensitizers can induce ovulation by dec serum LH and testosterone via improvement in insulin sensitivity

MOA: inhib hepatic glucose production and improve peripheral glucose uptake (improves insulin sensitivity)

Dose: 500 mg TID OR 850 - 1000mg BID
TITRATE UP if effective cont for 6mo-1yr

AE: N/D! big time D but transient. lactic acidosis (rare but fatal)
*not concerned about Hypoglycemia Rx does NOT inc insulin

Monitor: renal fn, LFT
CI: Cr >1.4, hepatic disease, pulmonary compromise->septic shock and lactic acidosis

39
Q

Pioglitazone

A

Thiazolidinediones insulin-senstitizing agent:
class being pulled
MOA: improve insulit sensitivity in muscle and adipose tissue and CAN induce ovulation too.

AE: edema, wt gain, hepatotoxic

(Actos)

40
Q

OC for Tx of Endometriosis

A

Continuos is KEY

Depot Medroxyprogesterone
Levonnorgestrel IUD - very effective

41
Q

Letrozole

A

Aromatase Inhibitor
Tx: endometriosis, only tx that decreases formation of estrogens by the endometrial implants themselves

MOA: inhibits estrogen syn

NOT FDA Aproved

42
Q

Anastrozole

A

Aromatase Inhibitor
Tx: endometriosis, only tx that decreases formation of estrogens by the endometrial implants themselves

MOA: inhibits estrogen syn

NOT FDA Aproved

43
Q

Danazol

A

inhibits ovarian steroid production and inc metabolism of estrogen

-> Pseudomenopause to Tx Endometriosis
NOT USED* tons of SE LAST LINE ONLY

44
Q

Leuprolide

A

GnRH Agonist: Tx: endometriosis

MOA: induce a hypoestrogenic state via negative feedback on ovarian steroid production
Takes 2 weeks

Daily SQ injection; Monthly depot inj

AE (=Menopause: hot flashes, vag dryness, dysparenunia, dec BMD)
TO avoid bone loss “Add Back Therapy”: add back predestine/estrogen - not OC need more use HRT regimes

Used for 6mo, effect retained for 6-12 mo After d/c

45
Q

Nafarelin

A

GnRH Agonist: Tx: endometriosis

MOA: induce a hypoestrogenic state via negative feedback on ovarian steroid production
Takes 2 weeks

Nasal Spray

AE (=Menopause: hot flashes, vag dryness, dysparenunia, dec BMD)
TO avoid bone loss “Add Back Therapy”: add back predestine/estrogen - not OC need more use HRT regimes

Used for 6mo, effect retained for 6-12 mo After d/c

46
Q

Goserelin

A

GnRH Agonist: Tx: endometriosis

MOA: induce a hypoestrogenic state via negative feedback on ovarian steroid production
Takes 2 weeks

Monthly SQ implant

AE (=Menopause: hot flashes, vag dryness, dysparenunia, dec BMD)
TO avoid bone loss “Add Back Therapy”: add back predestine/estrogen - not OC need more use HRT regimes

Used for 6mo, effect retained for 6-12 mo After d/c

47
Q

Estrace

A

19β estradiol:
PO - Standard dose 1-2mg; low dose 0.5mg
Vaginal cream 0.1mg/gm: 1g 1-3X/wk for maintenance (DO not need progestin at this dose) **IF QDAY then need progestin if pt has uterus

48
Q

Prempro

A

Continous combined estrogen+progestin

49
Q

Climera

A

Estradiol Patch: once weekly

50
Q

Climera Pro

A

Estradiol + levonorgestrel Once weekly patch

51
Q

Estring

A

Vaginal estrogen: 17β estradiol 7.5mcg/day replace q 3 mo.
=NOT systemic - no progestin needed
FOR urogenital Sx only

52
Q

Femring

A

vaginal ring: 0.05-0.1mg/day replace q 3 mo
Tx: hot flashes

THIS IS FOR SYSTEMIC SX: NEED PROGESTIN (if uterus)

53
Q

Topical estrogen for Systemic Sx

A

Many- need progestin if uterus
transfer risk
Follow exact directions: if 1 pump then *1PUMP

54
Q

Provera

A

Medroxyprogesterone (Progestin HRT products)

2.5, 5, 10mg

55
Q

Hot flashes Alternative Tx

A

Tx: hotflashes
Gabapentin 300mg TID: Start low and go slow
Limited efficacy but option

Other options
Venlafaxine, fluoxetine, paroxetine, citalopram, clonidine

  • *Raloxifene for postmenopausal osteoporosis can CZ hot flashes
  • Tamoxifen induced hotflashes: Estrogen Tx is CI** - use citalopram NOT other Alt.
56
Q

Ospemifene

A

SERM: Tx- dyspareunia due to vulvar/vaginal atrophy

Dose 60mg/day WITH FOOD

AE: Cz endometrial cancer VTE/stroke
RISK VS BENIFIT

57
Q

Vit D2

A

Ergocalciferol (Diet)

58
Q

Vit D3

A

Cholecalciferol (sun/skin)

59
Q

Activated Vit D3

A

Calcitriol

0.25mcg/day for renal impairment pts ONLY

60
Q

Calcium

A

Tx and Prevent Osteoporosis
DNE: 500-600mg/dose
Take w/meals (except Ca++ Citrate - Pretreated with acid)

Dose = (DIET + supplement)
>65yo = 1500mg/day 
51-64 = 1200mg /day
19-50yo = 1000mg
(1 dairy serving = 300mg)

AE: constipation, nausea

DDI:
Thiazide good DDI: dec renal Ca++ excretion
Loopers Bad DDI: inc renal Ca++ excretion

61
Q

Calcium Citrate

A

24% Elemental
Best Ca++ supp for elderly
Does not need acid for absorption
Food does still enhance ab

(Citrical)

62
Q

Calcium Carbonate

A

40% Elemental
Need to take w/food: ok supp for younger adults

(Tums)

63
Q

Vitamin D Tx

A

800 IU /day
Benifits are dose related: 800 IU (min) - 2000 IU MAX
Is Fat soluble -> will store can get toxicity

DDI: cholestyramine, mineral oil, phenytoin, barbiturates

Recheck levels for insufficient/deficiency its 3-4 mo after starting

(50K IU/wk usually 3 mo = OK; not long term)

64
Q

Raloxifene

A

Tx: osteoporosis: LAST LINE ONLY and C.I. in men
MOA: SERM - estrogen-like effect on bone w/o breast/endometrial cancer liability

Not great efficacy

Dose: 60mg Qday

AE: **Raloxifene for postmenopausal osteoporosis can CZ hot flashes, leg cramps, DVT/PE - Hx = CI

65
Q

Calcitonin

A

Tx Osteoporosis related fractures (NOT LONG TERM)

RISK OF CANCER = FDA: DO not use for osteoporosis

66
Q

Alendronate

A

(Fosamax) Tx: Osteoporosis
MOA: Bind bone and disrupt respiration (similar to estrogen MOA)
COUNSELING POINTS

AE:
Oral - GI* esophageal ulceration, ab pain, bone pain/body pain** DLT switch to other med**
IV - FIRST DOSE EFFECT=flu like Sx, bone pain; rare = jaw osteoporosis
- atypical femur fractures: w/ >5yr use, low trauma fractures -

CI in pts w/ CrCl<35***

  • DOSE: b/c its cheap
  • prevention: 5mg qday or 35mg q week
  • Tx: 10mg Qday or 70 mg q week
67
Q

Risedronate

A

Tx: Osteoporosis
MOA: Bind bone and disrupt respiration (similar to estrogen MOA)
COUNSELING POINTS

AE:
Oral - GI* esophageal ulceration, ab pain, bone pain/body pain** DLT switch to other med**
IV - FIRST DOSE EFFECT=flu like Sx, bone pain; rare = jaw osteoporosis
- atypical femur fractures: w/ >5yr use, low trauma fractures -

CI in pts w/ CrCl<35***

68
Q

Ibandronate

A

Tx: Osteoporosis
MOA: Bind bone and disrupt respiration (similar to estrogen MOA)
COUNSELING POINTS

AE:
Oral - GI* esophageal ulceration, ab pain, bone pain/body pain** DLT switch to other med**
IV - FIRST DOSE EFFECT=flu like Sx, bone pain; rare = jaw osteoporosis
- atypical femur fractures: w/ >5yr use, low trauma fractures -

CI in pts w/ CrCl<35***

69
Q

Zolendronic Acid

A

Tx: Osteoporosis
MOA: Bind bone and disrupt respiration (similar to estrogen MOA)
COUNSELING POINTS

AE:
Oral - GI* esophageal ulceration, ab pain, bone pain/body pain** DLT switch to other med**
IV - FIRST DOSE EFFECT=flu like Sx, bone pain; rare = jaw osteoporosis
- atypical femur fractures: w/ >5yr use, low trauma fractures -

CI in pts w/ CrCl<35***

DOSE: 5mg IV infused over not less than 15min ONCE YEARLY (or q2yr for prevention)
Indication = cant swallow or severe GI w/ oral

70
Q

Denosumab

A

Tx: osteoporosis (failed bis-P)
MOA: Anti-resorptive RANK-L inhibitor

Dose: 60mg SQ q6mo
AND 1000mg Ca+ and min of 400 IU Vit D

NO Renal adjustment but inc risk of hypocalcemia: CI in hypocalcemia pts

AE: Sim to bis-P but less common

Must monitor Ca++

71
Q

Teriparatide

A

Recombinant PTH
MOA: Only Tx to build bone

Pulsatile dosing: PTH Paradox
Dose: 20ug/day SQ
short term use 2yr MAX to form new bone: **Must follow up Tx w/ antiresorbtive agent to maintain newly formed bone

AE: dose dependent: N HA Dizzi leg cramps
Mild hypercalcemia

(Forteo)$$$$

72
Q

Sildenafil

A

Specific PDE-5 inhibitor: inhibits breakdown of cGMP -> potentiating smooth muscle relaxation and erection

Dose: 25-100mg PO 30min-4hr before sex MAX=One dose/day

t1/2=4hrs,
Fatty meals delay onset by one hour*

AE: nasal congestion, changes in color vision (loss of blue/green - transient), sudden vision loss, priapism/prolonged erection

DDI: alpha blocker (tamsulosin less of an issue), 3A4 inhibitors (HIV, ery/clarithromycin, -azole), Alcohol (increased vasodilatation, dec ability to achieve erection)

(Viagra (25, 50,100mg Tx ED), Revatio (20mg, 10mg/12.5ml inj Tx: PAH))

73
Q

Vardenafil

A

Specific PDE-5 inhibitor: inhibits breakdown of cGMP -> potentiating smooth muscle relaxation and erection

t1/2=4-5hrs
MAX 1 dose / day
AUC dec if taken w/ fatty meal

AE: nasal congestion, changes in color vision (loss of blue/green - transient), sudden vision loss, priapism/prolonged erection

(Levitra)

74
Q

Tadalafil

A

Specific PDE-5 inhibitor: inhibits breakdown of cGMP -> potentiating smooth muscle relaxation and erection

*t1/2=17.5 hrs (may cont to work up to 36hrs and still in system at 96hrs after single 20mg dose **NOT GOOD FOR CVD PTS)
Can take daily OR prn
Taken w/ or w/o food = OK

AE: nasal congestion, **NO changes in color vision (loss of blue/green - transient), sudden vision loss, priapism/prolonged erection
*Back pain/muscle ache (PDE11)

(Cialis)

75
Q

Avanafil

A

Specific PDE-5 inhibitor: inhibits breakdown of cGMP -> potentiating smooth muscle relaxation and erection

t1/2 = 5hr
w/ w/o food
one dose/day only (typ 100mg 30min prior to sex)

AE: nasal congestion, changes in color vision (loss of blue/green - transient), sudden vision loss, priapism/prolonged erection

(Stendra)

76
Q

Papaverine

A

Non-specific PDE inhibitor Intracavernosal injection

SE: Priapism, corporeal fibrosis, Hypotension

Combined with phentolamine +/- alprostadil

()

77
Q

Phentolamine

A

alpha antagonist that reduced peripheral adrenergic tone
Enhances cholinergic tone: improves cavernosal filling

INJECTION: used with papaverine

78
Q

Yohimbine

A

Herbal Prescription: central alpha blcoker

5.4mg TID (in most OTC products for ED)
Poor efficacy
AE: palpitation, anxiety, tremor, HTN

Avoid use in paitents with DM CAD anxiety levier/renal dysfn

79
Q

IM Testosterone

A

Tx: Hypogonadism ONLY
Goal: normal range, Sx resolution

IM 200-300mg enanthate or cypionate q 2-4 wks (NOT QDAY)
get “see-saw” effect but cheap

Monitor: baseline, 3mo, 6mo, yrly
PSA, DRE, Hematocrti
Voiding assessment
Breast exam

80
Q

Transdermal Testosterone

A

Tx: Hypogonadism ONLY
Goal: normal range, Sx resolution

Androderm Patch: 2mg/24hr or 4mg/24hrs MAX 6mg/day
Androgel/testim: 5gm applied qd in am MAX=10g/day)
Get physiologic levels that are constant

Monitor: baseline, 3mo, 6mo, yrly
PSA, DRE, Hematocrti
Voiding assessment
Breast exam

81
Q

TURP

A

Transurethral resection of the prostate

82
Q

Tamsulosin

A

selective alpha 1a inhibitor: relax smooth muscle of the prostate to improve urine flow rate and red BPH Sx

0.4mg PO Qday

Sex dysfn, orthostasis (less than non-selective Rxs), SJS, intraoperative flobby iris syndrome

Therapeutics (10 decks)

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