Unit 4 Flashcards
4 non-contraceptive benefits of combination oral contraceptives
- decrease the risk of ovarian, endometrial, and colon cancer
- decrease the risk of benign breast disease and ovarian cysts
- decrease the risk of endometriosis, fibroids, ovulation pain, PMS/PMDD, cramps, migraines, and anemia
- may improve acne and hirsutism (excessive hair growth)
how to start a patient on oral contraceptives (2)
- start the pill pack on the first day of menses or start the Sunday after menses (if you want to avoid weekend menstruation)
- use backup form of birth control for the first 7 days
what oral contraceptive to order if the patient has a hx of smoking(4)
progestin only
depo-provera
IUD
nexplanon
what oral contraceptive to order if the patient is over 35
progestin only OCP
depo-provera
IUD
nexplanon
what contraceptive to order if the patient has uncontrolled HTN
progestin only OCP
depo-provera
IUD
nexplanon
what oral contraceptive to order if the patient has abnormal vaginal bleeding
progestin only OCP
depo-provera
IUD
nexplanon
what oral contraceptive to order if the patient has DM with vascular complications
progestin only OCP
depo-provera
IUD
nexplanon
what oral contraceptive to order if the patient has DVD
progestin only OCP
depo-provera
IUD
nexplanon
what oral contraceptive to order if the patient has hx of PE
progestin only OCP
depo-provera
IUD
nexplanon
what oral contraceptive to order if the patient has ischemic heart disease
progestin only OCP
depo-provera
IUD
nexplanon
what oral contraceptive to order if the patient has HA with focal neuro symptoms
progestin only OCP
depo-provera
IUD
nexplanon
what oral contraceptive to order if the patient has hx of breast CA
progestin only OCP
depo-provera
IUD
nexplanon
what oral contraceptive to order if the patient has active hepatitis or cirrhosis
progestin only OCP
depo-provera
IUD
nexplanon
2 contraindications of nexplanon
hepatic disease
thrombosis
what oral contraceptive to order if the patient has endometriosis
monophasic continuous therapy
what oral contraceptive to order if the patient is post-partum/lactating
progesterone-only minipill
what oral contraceptive to order if the patient is noncompliant
depo provera
subdermal implant
what oral contraceptive to order if the patient has breakthrough bleeding in first half of cycle
change to pill with high estrogen content in 1st half of cycle
what oral contraceptive to order if the patient has breakthrough bleeding in second half of cycle
change to pill with high progestin content in 1st half of cycle
what oral contraceptive to order if the patient is adolescent, perimenopausal, postpartum, non-lactating, and no medical risks
any OCP <50mcg EE
3 serious side effects of oral contraceptive pills
increased risk of
VTE
MI/stroke (esp >35 and smoker)
liver disorder
7 less serious side effects of oral contraceptive pills
breast tenderness
N/V
HA
bloating
acne
mood changes
spotting
3 side effects associated with progestin-only contraceptive pills
weight gain
fluid retention
acne
what type of contraceptive is depo provera and frequency
progestin-only
IM injection
q13 weeks
when to initiate depo provera
within first 5 days after menses
what to do if a patient presents after 13 weeks for their depo provera shot
pregnancy test before administering
6 SE of depo provera
wt gain
HA
dizziness
nervousness
amenorrhea
irregular bleeding
depo provera education
can cause reversible loss of bone mineral density– educate the patient to increase calcium and vitamin D intake along with regular exercise
depo provera reversal
70% of women can conceive within the first year and 90% within the first 2 years. Discuss family planning before initiating and continuing therapy
who is depo provera a safer option for? (5)
CV disease
stroke
VTE
PVD
sickle cell disease
what type of contraceptive is an IUD
progestin-only OR
non hormonal
IUD maintanence
check strings after each period
who is an IUD a good choice for
dysmenorrhea
menorrhagia
anemia
8 SE of IUD
PID
ectopic pregnancy
uterine perforation
expulsion
ovarian cysts
irregular bleeding
amenorrhea
pelvic pain
4 contraindications of IUD
suspected pregnancy
uterine abnormalities
PID
unexplained vaginal bleeding
which contraceptive method has decreased efficacy in patients with high BMI
xulane transdermal patch
xulane transdermal patch risk
increased risk of VTE if pt over 198lbs or BMI >30
when to prescribe emergency contraception
within 5 days of unprotected sex (3 is best)
how does emergency contraception work
stops ovulation
what to do if no period within 21 days after use of emergency contraception
pregnancy test
emergency contraceptive drug options
Copper IUD
Levonorgestrel
Ulipristal acetate
Yuzpe regimen
considerations for levonorgestrel (2)
<94% effectiveness
less effective in women over 165 lbs
considerations for ulipristal acetate (2)
98% effective
less effective in women over 195 lbs
considerations for yuzpe regimen (2)
less effective
causes N/V
first line therapy for VVC
OTC topical 1-7 days (monistat) +
1x fluconazole PO
second line therapy for VVC
cultures for recurrent VVC
7-14 topical
PO fluconazole q72h x3 doses
third line therapy for VVC
referral
10-14 days topical
PO with maintenance therapy with fluconazole 1x per week for 6 months
first line therapy for trichomonas
metronidazole or tinidazole 2g single dose OR
metronidazole 500mg BID x7 days
education for trichomonas
must also treat sex partners
avoid sex until therapy is completed and symptom-free
second line therapy for trichomonas
referral
first line treatment for bacterial vaginosis
PO flagyl
topical clinda cream
flagyl gel intravaginally
education for bacterial vaginosis treatment (3)
- flagyl can cause N/V if alcohol ingested during treatment or within 72 hours after stopping
- avoid tight-fitting clothes, allow vaginal ventilation
- avoid douching or other products that may alter pH
hormone therapy for patients with a uterus
progestin + systemic estrogen (oral or transdermal)
risk of taking estrogen alone for patients with a uterus
endometrial hyperplasia
increased risk of endometrial CA
hormone therapy for patients without a uterus
can use estrogen alone
contraindications of hormone therapy (6)
- estrogen-dependent neoplasia
- thrombophlebitis/thromboembolic disorder
- pregnancy
- undx vaginal bleeding
- uncontrolled HTN
- acute liver disease
monitoring for patients taking hormone therapy (5)
- F/u 4-8 wks after therapy initiation, then q3-6 mo
- review the decision to continue yearly
- continue mammograms, PAPs, and DEXA scans
- ht/wt, lipids, BP, breast exam, full pelvic exam
- d/c 1-3 years after menopause, taper gradually to reduce rebound
risk of taking hormone therapy for over 3-5 years
breast CA
best treatment for vasomotor symptoms when hormone therapy is contraindicated (4)
SSRI/SNRI
gabapentin
clonidine
progestin only
treatment for genitourinary syndrome of menopause (hormone therapy) (3)
low dose vaginal estrogen OR
transdermal estrogen OR
ospemifene
treatment for genitourinary syndrome of menopause (non hormonal)
vaginal lubricant and moisturizers and continued sexual intercourse
6 antibiotics used for PID
cephalosporins
Clindamycin
doxycycline
gentamycin
Metronidazole
probenecid
2 cephalosporins used for PID
ceftriaxone
cefotetan
2 SE of cephalosporins
colitis
PCN allergy
2 SE of doxy
photosensitivity
hepatotoxicity
when to use clinda for PID
tubo-ovarian abscess
3 SE of gentamycin
renal/oto/neurotoxicity
3 SE of probenecid
GI upset
uric acid
kidney stones
when to avoid probenecid
avoid with ASA
contraindications of flagyl
pregnancy/lactation
with alcohol
SE of flagyl (1)
phototoxicity
how to treat severe PID
parenteral therapy with transition to PO within 24-48 hrs after symptom improvement
treatment of gonorrhea in patients allergic to cephalosporins
gentamycin IM + azithromycin PO
3 medications for suppressive therapy in patients with genital herpes
acyclovir
valacyclovir
famiciclovir
2 medications for suppressive therapy in pregnant patients with genital herpes
acyclovir
valacyclovir
acyclovir considerations
low bioavailability
more frequent dosing
more difficult compliance
doxycycline contraindication
2nd-3rd trimester
treatment for pregnant patients with chlamydia
azithromycin 1g PO x1 dose (amox. as alt)
considerations for pregnant patients with chlamydia
retest 3-4 weeks after treatment and again after 3 months to make sure it is not passed to the child
3 patient-applied treatments for genital warts
- Imiquimod
- Podofilox
- Sinecatechins (green tea extract)
education for imiquimod
apply with finger at bedtime for up to 16 weeks
wash off in the morning
education for podofilox
apply solution with cotton swab or gel with finger BID x3days, 4 days off, repeat for 4 cycles
education for sinecatechins
apply up to 3x/day for up to 16wks
do NOT wash off
treatment for syphilis in pregnant patients with allergy to PCN
PCN G is only effective treatment during pregnancy
must desensitize (allows temporary tolerance) mom to PCN and treat with PCN G
first line treatment of ED (4)
phosphodiesterase-5 inhibitors:
Cialis
Vardenafil
Sildenafil
Avanafil
contraindiactions of phosphodiesterase-5 inhibitors (10)
nitrates
alpha-blockers
unstable angina
hypotension
uncontrolled HTN
recent stroke
arrhythmias
MI w/in 6 mo
severe HF
renal/hepatic failure
cialis usage
long duration of action and avoids the need to plan for sex
30 min onset
vardenafil usage
60 min onset
decreased absorption with fatty foods
sildenafil usage
take 30-60 min before sex
3-5 hr half-life
decreased absorption with fatty foods
avanafil onset and half-life
take 15 mins before sex
half-life 5-10 hours
MOA of antimuscarinics
inhibit binding of ACH at muscarinic receptors M3 on detrusor smooth muscle cells, causing relaxation and increasing bladder filling capacity
SE of antimuscarinics
anticholinergic SE (can’t pee, see, spit, shit)
contraindications of antimuscarinics
narrow-angle glaucoma
urinary retention
CYP450 drugs
which formulation of antimuscarinics is preferred
ER
first line treatment of uncomplicated UTI
Bactrim
Nitrofurantoin (macrobid)** best
Fosfomycin
first line medications to avoid for uncomplicated UTI in patients with renal dysfunction
bactrim and nitrofuratoin
nitrofurantoin pregnancy considerations
do not use in 1st trimester or last 30 days
bactrim pregnancy considerations
do not use
first line treatment for uncomplicated UTI in pregnant patients
fosfomycin
second line treatment for uncomplicated UTI
bactrim
fluroroquinolones
flurorquinolones black box warning
achilles tendon rupture
fluroquinolones pregnancy considerations
weight risk vs benefit
third line treatment of complicated UTI for males or post-menopausal women
levaquin
third line treatment of complicated UTI for pregnant women
amox
keflex
nitrofurantoin/bactrim (not in 1st trimester or last 30 days)
why is treatment required for prostatitis
inflammation of the prostate can restrict the urinary outflow via the urethra
S/sx of prostatitis (8)
pain
difficulty emptying bladder
weak stream
nocturia
fever
malaise
pain on ejaculation
rectal pain
first line treatment of prostatitis
fluoroquinolones best choice
bactrim
second line treatment of prostatitis
doxy
azithromycin
clarithromycin
how long is abx therapy for prostatitis
4-6 weeks
may need up to 12 wks due to poor tissue penetration
treatment of BPH
- alpha-adrenergic blockers
- 5-alpha-reductase inhibitors
- combo of 1+2
- PDE-5 inhibitors (cialis)
- Supplements
3 supplements for BPH
saw palmetto
ptgeum
zinc
MOA of alpha blockers
relax smooth muscle of the prostate and bladder neck to decrease bladder resistance to urinary outflow
SE of alpha blockers (7)
hypotension
ortho hypotension
fluid retention
HA
dizziness
weakness
drowsiness
who to avoid giving doxazosin to
CHF and renal failure pts
contraindication of tamsulosin
prostate CA
contraindication/consideration for silodosin (rapaflo)
hepatic/renal impairment
selective alpha antagonist so minimizes BP effects
MOA of 5-alpha reductase inhibitors
blocks 5-alpha reductase, weakening prostate growth by inhibiting the conversion of testosterone to DHT
5-alpha-reductase inhibitor suffix
-eride
alpha blocker suffix
-osin
SE of finasteride (2)
impotence
decrease libido
SE of dutasteride (3)
ortho hypotension
priapism
risk of prostate CA
monitoring for BPH treatment
monitor BP during first 2 weeks
keep open discussion about sexual health
AUA symptom score (3-4 point improvement is significant)
how to treat an AUA symptom score of 7
pharm treatment
how to treat an AUA symptoms score of <7
lifestyle mod
risk factors with long term use of agents that treat GERD
reduced efficacy and tolerance with H2RAs
treatment regimen for NSAID-induced PUD
- find another pain management modality
- use enteric-coated NSAIDs, take with meals, add misoprostol, switch to selective COX-2 inhibitor
- pharmacological treatment
first line medications for NSAID-induced PUD
PPI
H2RA
sucralfate
3 antacid medication
calcium-carb
mag salts
aluminum salts
SE of antacids (6)
rebound hyperacidity
diarrhea (mag)
constipation (alum)
nausea
stomach pain
hypercalcemia
contraindications of antacids
none
instructions for antacids
take 1-4 hours after iron, sulfonylureas, tetracyclines, and quinolones
symptom relief only, doesn’t heal ulcers
first line treatment hepatic encephalopathy
lactulose oral or rectal
second line treatment hepatic encephalopathy
rifaximin
third line treatment hepatic encephalopathy
miralax
treatment recommendation for mild UC
PO and rectal aminosalicylates
treatment recommendation for mod UC
add steroid
treatment recommendation for severe UC
hospitalization
treatment for mild Crohn’s
oral/rectal amiosalicylate OR
rectal steroid
treatment for mod Crohn’s
PO and rectal aminosalicylate AND short term steroids
treatment for severe Crohn’s
IV steroids and/or IV cyclosporine
treatment for fulminant Crohn’s (3)
IV steroids and/or IV cyclosporine
IV infliximab or SC adalimumab
supportive care (IVF, bowel rest, TPN)
goals of management of inflammatory bowel disease (7)
- resume normal ADLs
- restore general physical/mental well-being
- maintain appropriate nutritional status
- maintain remission
- decrease frequency and severity of exac.
- decrease med SE
- increase life expectancy
2 aminosalicylates
azulfidine
mesalamine
MOA of aminosalicylates
decrease inflammation in the GI tract by inhibiting PG synthesis
MOA of steroids for CD/UC
immunosuppression and PG inhibition
3 immunosuppressive agents for CD/UC
imuran
puriethnol
rheumatrex
MOA of immunosuppressive agents for CD/UC
decrease prod. of various inflammatory mediators
2 abx used to treat CD/UC
flagyl
cipro
3 TNFa inhibitors for CD/UC
remicade
humira
cimzia
MOA of TNFa inhibitors
overexpression of immunologic cytokines including TNF seen in CD-> TNF inhibitors neutralize soluble forms of TNF and inhibit its binding to TNF
2 selective adhesion molecule inhibitors for CD/UC
tysabri
entyvio
MOA of selective adhesion molecule inhibitors for CD/UC
prevent migration of inflammatory lymphocytes into the gut mucosa
ingestion/admin causes of N/V (5)
chemo
opiates
abx
NSAIDs
HT
how to treat chemo induced N/V (4)
benzos
zofran
marinol/dronabinol
steroids
GI causes of N/V (2)
outlet obstruction
motility disorders
how to treat GI induced N/V
reglan
neuro causes of N/V (4)
cerebellar hemorrhage
tumor
hydrocephalus
elevated ICP
how to treat neuro causes of N/V (2)
surgery
steroids
metabolic causes of N/V (4)
Addisons
vol. depletion
DKA
hypercalcemia
how to treat metabolic causes of N/V
treat cause
how to treat PONV (2)
phenothiazines (compazine)
droperidol
how to treat anxiety related N/V
benzos
how to treat pregnancy related N/V (3)
antihistamines
anticholinergics
promethazine
how to treat motion sickness (2)
antihistamines
anticholinergics
first line treatment of N/V
phenothiazine
second line treatment of N/V
antihistamine
anticholinergic
third line treatment of N/V
re-eval cause
3 medications used for motion sickness
hydroxyzine
meclizine
dramamine
scopolamine
first line treatment of IBS-C
linacoltide or lubiprostone +osmotic laxative used to avoid diarrhea
second line treatment of IBS-C
osmotic laxative
third line treatment of IBS-C
stimulant laxative short term
first line treatment of IBS-D
loperamide
second line treatment of IBS-D (2)
Lomotil for short term
rifaximin for long term
constipation first line agent
bulk-forming laxative
constipation second line agent
mag hydroxide
saline laxative
constipation third line agent
stimulant laxative
enema contraindication
under 2 y/o
length of OTC constipation therapy
<7 days in a row
how to treat constipation in pregnancy
colace safe
avoid castor oil
constipation treatment considerations for the elderly
risk of electrolyte imbalance with laxative use
eliminate causative agent (antipsychotics, TCAs, Ca)
MOA of lomotil
decrease GI motility
MOA of loperamide
opioid receptor agonist acts on myenteric plexus of colon
5 types of medications used to treat diarrhea
antimotility agents
adsorbents
absorbents
semisynthetic antibiotic
atypical/antisecretory agents
2 antimotility agents
lomotil
loperamide
contraindications of antimotility agents
infectious diarrhea
caution in hepatic dys
SE of antimotility agents
constipation
drowsiness
blurry vision
lomotil interactions
HTN crisis with MAOIs
adsorbent medication
kaopectate
kaopectate MOA
binds to diarrhea and toxins to solidify stool
add a dose after each BM
absorbent medication
fibercon
MOA fibercon
absorbs water in the GI tract to make stool less watery
semisynthetic antibiotic medication
rifaximin
indications for rifaximin for diarrhea
noninvasive strains of e.coli
best for travelers diarrhea
contraindications for rifaximin
hypersensitivity
SE of rifaximin (6)
peripheral edema
nausea
fatigue
dizziness
HA
muscle spasm
how to treat diarrhea in peds
oral rehydration is priority
antidiarrheal agents not recommended
lomotil age limits
not for children under 4
indications for laxative use
lifestyle modifications fail
eliminated secondary cause
lifestyle modifications for constipation
diet
exercise
bowel training
subsalicylate medication
pepto bismol
kaopectate
contraindications of subsalicylates
hypersensitivity to ASA
kids with flu or chicken pox (Reye syndrome)
SE of subsalicylates (3)
black stool
dark tongue
tinnitus
subsalicylates interaction
warfarin
first line agents for IBS in pregnant women
colace and bulk forming agents (not absorbed systemically)
lactulose ok in pregnancy?
yes
sorbitol ok in pregnancy?
yes
stimulant laxatives ok in pregnancy?
only occasionally if necessary
castor oil ok in pregnancy?
no
risk of uterine contractions
mineral oil ok in pregnancy?
no
inhibits vitamin absorption
long term SE of PPIs
dementia
osteoporosis
first line treatment for GERD and length (2)
PPI 8-12 wks
diet and lifestyle mod.
treatment for hot flashes
paxil
rome 3 criteria
At least three months, with onset at least six months previously, of recurrent abdominal pain or discomfort associated with two or more of the following:
Improvement with defecation; and/or
Onset associated with a change in frequency of stool; and/or
Onset associated with a change in form (appearance) of stool.
