Unit 4 Flashcards by Brooke Kready | Brainscape

Q

4 non-contraceptive benefits of combination oral contraceptives

A

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)

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Q

how to start a patient on oral contraceptives (2)

A

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

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Q

what oral contraceptive to order if the patient has a hx of smoking(4)

A

progestin only
depo-provera
IUD
nexplanon

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Q

what oral contraceptive to order if the patient is over 35

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

what contraceptive to order if the patient has uncontrolled HTN

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

what oral contraceptive to order if the patient has abnormal vaginal bleeding

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

what oral contraceptive to order if the patient has DM with vascular complications

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

what oral contraceptive to order if the patient has DVD

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

what oral contraceptive to order if the patient has hx of PE

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

what oral contraceptive to order if the patient has ischemic heart disease

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

what oral contraceptive to order if the patient has HA with focal neuro symptoms

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

what oral contraceptive to order if the patient has hx of breast CA

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

what oral contraceptive to order if the patient has active hepatitis or cirrhosis

A

progestin only OCP
depo-provera
IUD
nexplanon

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Q

2 contraindications of nexplanon

A

hepatic disease
thrombosis

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Q

what oral contraceptive to order if the patient has endometriosis

A

monophasic continuous therapy

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Q

what oral contraceptive to order if the patient is post-partum/lactating

A

progesterone-only minipill

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Q

what oral contraceptive to order if the patient is noncompliant

A

depo provera
subdermal implant

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Q

what oral contraceptive to order if the patient has breakthrough bleeding in first half of cycle

A

change to pill with high estrogen content in 1st half of cycle

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Q

what oral contraceptive to order if the patient has breakthrough bleeding in second half of cycle

A

change to pill with high progestin content in 1st half of cycle

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Q

what oral contraceptive to order if the patient is adolescent, perimenopausal, postpartum, non-lactating, and no medical risks

A

any OCP <50mcg EE

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Q

3 serious side effects of oral contraceptive pills

A

increased risk of
VTE
MI/stroke (esp >35 and smoker)
liver disorder

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Q

7 less serious side effects of oral contraceptive pills

A

breast tenderness
N/V
HA
bloating
acne
mood changes
spotting

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Q

3 side effects associated with progestin-only contraceptive pills

A

weight gain
fluid retention
acne

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Q

what type of contraceptive is depo provera and frequency

A

progestin-only
IM injection
q13 weeks

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Q

when to initiate depo provera

A

within first 5 days after menses

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Q

what to do if a patient presents after 13 weeks for their depo provera shot

A

pregnancy test before administering

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Q

6 SE of depo provera

A

wt gain
HA
dizziness
nervousness
amenorrhea
irregular bleeding

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Q

depo provera education

A

can cause reversible loss of bone mineral density– educate the patient to increase calcium and vitamin D intake along with regular exercise

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Q

depo provera reversal

A

70% of women can conceive within the first year and 90% within the first 2 years. Discuss family planning before initiating and continuing therapy

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Q

who is depo provera a safer option for? (5)

A

CV disease
stroke
VTE
PVD
sickle cell disease

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Q

what type of contraceptive is an IUD

A

progestin-only OR
non hormonal

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Q

IUD maintanence

A

check strings after each period

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Q

who is an IUD a good choice for

A

dysmenorrhea
menorrhagia
anemia

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Q

8 SE of IUD

A

PID
ectopic pregnancy
uterine perforation
expulsion
ovarian cysts
irregular bleeding
amenorrhea
pelvic pain

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Q

4 contraindications of IUD

A

suspected pregnancy
uterine abnormalities
PID
unexplained vaginal bleeding

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Q

which contraceptive method has decreased efficacy in patients with high BMI

A

xulane transdermal patch

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Q

xulane transdermal patch risk

A

increased risk of VTE if pt over 198lbs or BMI >30

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Q

when to prescribe emergency contraception

A

within 5 days of unprotected sex (3 is best)

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Q

how does emergency contraception work

A

stops ovulation

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Q

what to do if no period within 21 days after use of emergency contraception

A

pregnancy test

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Q

emergency contraceptive drug options

A

Copper IUD
Levonorgestrel
Ulipristal acetate
Yuzpe regimen

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Q

considerations for levonorgestrel (2)

A

<94% effectiveness
less effective in women over 165 lbs

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Q

considerations for ulipristal acetate (2)

A

98% effective
less effective in women over 195 lbs

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Q

considerations for yuzpe regimen (2)

A

less effective
causes N/V

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Q

first line therapy for VVC

A

OTC topical 1-7 days (monistat) +
1x fluconazole PO

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Q

second line therapy for VVC

A

cultures for recurrent VVC
7-14 topical
PO fluconazole q72h x3 doses

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Q

third line therapy for VVC

A

referral
10-14 days topical
PO with maintenance therapy with fluconazole 1x per week for 6 months

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Q

first line therapy for trichomonas

A

metronidazole or tinidazole 2g single dose OR
metronidazole 500mg BID x7 days

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Q

education for trichomonas

A

must also treat sex partners
avoid sex until therapy is completed and symptom-free

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Q

second line therapy for trichomonas

A

referral

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Q

first line treatment for bacterial vaginosis

A

PO flagyl
topical clinda cream
flagyl gel intravaginally

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Q

education for bacterial vaginosis treatment (3)

A

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

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Q

hormone therapy for patients with a uterus

A

progestin + systemic estrogen (oral or transdermal)

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Q

risk of taking estrogen alone for patients with a uterus

A

endometrial hyperplasia
increased risk of endometrial CA

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Q

hormone therapy for patients without a uterus

A

can use estrogen alone

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Q

contraindications of hormone therapy (6)

A

estrogen-dependent neoplasia
thrombophlebitis/thromboembolic disorder
pregnancy
undx vaginal bleeding
uncontrolled HTN
acute liver disease

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Q

monitoring for patients taking hormone therapy (5)

A

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

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Q

risk of taking hormone therapy for over 3-5 years

A

breast CA

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Q

best treatment for vasomotor symptoms when hormone therapy is contraindicated (4)

A

SSRI/SNRI
gabapentin
clonidine
progestin only

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Q

treatment for genitourinary syndrome of menopause (hormone therapy) (3)

A

low dose vaginal estrogen OR
transdermal estrogen OR
ospemifene

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Q

treatment for genitourinary syndrome of menopause (non hormonal)

A

vaginal lubricant and moisturizers and continued sexual intercourse

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Q

6 antibiotics used for PID

A

cephalosporins
Clindamycin
doxycycline
gentamycin
Metronidazole
probenecid

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Q

2 cephalosporins used for PID

A

ceftriaxone
cefotetan

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Q

2 SE of cephalosporins

A

colitis
PCN allergy

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Q

2 SE of doxy

A

photosensitivity
hepatotoxicity

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Q

when to use clinda for PID

A

tubo-ovarian abscess

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Q

3 SE of gentamycin

A

renal/oto/neurotoxicity

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Q

3 SE of probenecid

A

GI upset
uric acid
kidney stones

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Q

when to avoid probenecid

A

avoid with ASA

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Q

contraindications of flagyl

A

pregnancy/lactation
with alcohol

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Q

SE of flagyl (1)

A

phototoxicity

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Q

how to treat severe PID

A

parenteral therapy with transition to PO within 24-48 hrs after symptom improvement

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Q

treatment of gonorrhea in patients allergic to cephalosporins

A

gentamycin IM + azithromycin PO

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Q

3 medications for suppressive therapy in patients with genital herpes

A

acyclovir
valacyclovir
famiciclovir

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Q

2 medications for suppressive therapy in pregnant patients with genital herpes

A

acyclovir
valacyclovir

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Q

acyclovir considerations

A

low bioavailability
more frequent dosing
more difficult compliance

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Q

doxycycline contraindication

A

2nd-3rd trimester

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Q

treatment for pregnant patients with chlamydia

A

azithromycin 1g PO x1 dose (amox. as alt)

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Q

considerations for pregnant patients with chlamydia

A

retest 3-4 weeks after treatment and again after 3 months to make sure it is not passed to the child

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Q

3 patient-applied treatments for genital warts

A

Imiquimod
Podofilox
Sinecatechins (green tea extract)

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Q

education for imiquimod

A

apply with finger at bedtime for up to 16 weeks
wash off in the morning

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Q

education for podofilox

A

apply solution with cotton swab or gel with finger BID x3days, 4 days off, repeat for 4 cycles

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Q

education for sinecatechins

A

apply up to 3x/day for up to 16wks
do NOT wash off

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Q

treatment for syphilis in pregnant patients with allergy to PCN

A

PCN G is only effective treatment during pregnancy
must desensitize (allows temporary tolerance) mom to PCN and treat with PCN G

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Q

first line treatment of ED (4)

A

phosphodiesterase-5 inhibitors:
Cialis
Vardenafil
Sildenafil
Avanafil

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Q

contraindiactions of phosphodiesterase-5 inhibitors (10)

A

nitrates
alpha-blockers
unstable angina
hypotension
uncontrolled HTN
recent stroke
arrhythmias
MI w/in 6 mo
severe HF
renal/hepatic failure

Q

cialis usage

A

long duration of action and avoids the need to plan for sex
30 min onset

Q

vardenafil usage

A

60 min onset
decreased absorption with fatty foods

Q

sildenafil usage

A

take 30-60 min before sex
3-5 hr half-life
decreased absorption with fatty foods

Q

avanafil onset and half-life

A

take 15 mins before sex
half-life 5-10 hours

Q

MOA of antimuscarinics

A

inhibit binding of ACH at muscarinic receptors M3 on detrusor smooth muscle cells, causing relaxation and increasing bladder filling capacity

Q

SE of antimuscarinics

A

anticholinergic SE (can’t pee, see, spit, shit)

Q

contraindications of antimuscarinics

A

narrow-angle glaucoma
urinary retention
CYP450 drugs

Q

which formulation of antimuscarinics is preferred

A

ER

Q

first line treatment of uncomplicated UTI

A

Bactrim
Nitrofurantoin (macrobid)** best
Fosfomycin

Q

first line medications to avoid for uncomplicated UTI in patients with renal dysfunction

A

bactrim and nitrofuratoin

Q

nitrofurantoin pregnancy considerations

A

do not use in 1st trimester or last 30 days

Q

bactrim pregnancy considerations

A

do not use

Q

first line treatment for uncomplicated UTI in pregnant patients

A

fosfomycin

Q

second line treatment for uncomplicated UTI

A

bactrim
fluroroquinolones

Q

flurorquinolones black box warning

A

achilles tendon rupture

Q

fluroquinolones pregnancy considerations

A

weight risk vs benefit

Q

third line treatment of complicated UTI for males or post-menopausal women

A

levaquin

Q

third line treatment of complicated UTI for pregnant women

A

amox
keflex
nitrofurantoin/bactrim (not in 1st trimester or last 30 days)

Q

why is treatment required for prostatitis

A

inflammation of the prostate can restrict the urinary outflow via the urethra

Q

S/sx of prostatitis (8)

A

pain
difficulty emptying bladder
weak stream
nocturia
fever
malaise
pain on ejaculation
rectal pain

Q

first line treatment of prostatitis

A

fluoroquinolones best choice
bactrim

Q

second line treatment of prostatitis

A

doxy
azithromycin
clarithromycin

Q

how long is abx therapy for prostatitis

A

4-6 weeks
may need up to 12 wks due to poor tissue penetration

Q

treatment of BPH

A

alpha-adrenergic blockers
5-alpha-reductase inhibitors
combo of 1+2
PDE-5 inhibitors (cialis)
Supplements

Q

3 supplements for BPH

A

saw palmetto
ptgeum
zinc

Q

MOA of alpha blockers

A

relax smooth muscle of the prostate and bladder neck to decrease bladder resistance to urinary outflow

Q

SE of alpha blockers (7)

A

hypotension
ortho hypotension
fluid retention
HA
dizziness
weakness
drowsiness

Q

who to avoid giving doxazosin to

A

CHF and renal failure pts

Q

contraindication of tamsulosin

A

prostate CA

Q

contraindication/consideration for silodosin (rapaflo)

A

hepatic/renal impairment
selective alpha antagonist so minimizes BP effects

Q

MOA of 5-alpha reductase inhibitors

A

blocks 5-alpha reductase, weakening prostate growth by inhibiting the conversion of testosterone to DHT

Q

5-alpha-reductase inhibitor suffix

A

-eride

Q

alpha blocker suffix

A

-osin

Q

SE of finasteride (2)

A

impotence
decrease libido

Q

SE of dutasteride (3)

A

ortho hypotension
priapism
risk of prostate CA

Q

monitoring for BPH treatment

A

monitor BP during first 2 weeks
keep open discussion about sexual health
AUA symptom score (3-4 point improvement is significant)

Q

how to treat an AUA symptom score of 7

A

pharm treatment

Q

how to treat an AUA symptoms score of <7

A

lifestyle mod

Q

risk factors with long term use of agents that treat GERD

A

reduced efficacy and tolerance with H2RAs

Q

treatment regimen for NSAID-induced PUD

A

find another pain management modality
use enteric-coated NSAIDs, take with meals, add misoprostol, switch to selective COX-2 inhibitor
pharmacological treatment

Q

first line medications for NSAID-induced PUD

A

PPI
H2RA
sucralfate

Q

3 antacid medication

A

calcium-carb
mag salts
aluminum salts

Q

SE of antacids (6)

A

rebound hyperacidity
diarrhea (mag)
constipation (alum)
nausea
stomach pain
hypercalcemia

Q

contraindications of antacids

A

none

Q

instructions for antacids

A

take 1-4 hours after iron, sulfonylureas, tetracyclines, and quinolones
symptom relief only, doesn’t heal ulcers

Q

first line treatment hepatic encephalopathy

A

lactulose oral or rectal

Q

second line treatment hepatic encephalopathy

A

rifaximin

Q

third line treatment hepatic encephalopathy

A

miralax

Q

treatment recommendation for mild UC

A

PO and rectal aminosalicylates

Q

treatment recommendation for mod UC

A

add steroid

Q

treatment recommendation for severe UC

A

hospitalization

Q

treatment for mild Crohn’s

A

oral/rectal amiosalicylate OR
rectal steroid

Q

treatment for mod Crohn’s

A

PO and rectal aminosalicylate AND short term steroids

Q

treatment for severe Crohn’s

A

IV steroids and/or IV cyclosporine

Q

treatment for fulminant Crohn’s (3)

A

IV steroids and/or IV cyclosporine
IV infliximab or SC adalimumab
supportive care (IVF, bowel rest, TPN)

Q

goals of management of inflammatory bowel disease (7)

A

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

Q

2 aminosalicylates

A

azulfidine
mesalamine

Q

MOA of aminosalicylates

A

decrease inflammation in the GI tract by inhibiting PG synthesis

Q

MOA of steroids for CD/UC

A

immunosuppression and PG inhibition

Q

3 immunosuppressive agents for CD/UC

A

imuran
puriethnol
rheumatrex

Q

MOA of immunosuppressive agents for CD/UC

A

decrease prod. of various inflammatory mediators

Q

2 abx used to treat CD/UC

A

flagyl
cipro

Q

3 TNFa inhibitors for CD/UC

A

remicade
humira
cimzia

Q

MOA of TNFa inhibitors

A

overexpression of immunologic cytokines including TNF seen in CD-> TNF inhibitors neutralize soluble forms of TNF and inhibit its binding to TNF

Q

2 selective adhesion molecule inhibitors for CD/UC

A

tysabri
entyvio

Q

MOA of selective adhesion molecule inhibitors for CD/UC

A

prevent migration of inflammatory lymphocytes into the gut mucosa

Q

ingestion/admin causes of N/V (5)

A

chemo
opiates
abx
NSAIDs
HT

Q

how to treat chemo induced N/V (4)

A

benzos
zofran
marinol/dronabinol
steroids

Q

GI causes of N/V (2)

A

outlet obstruction
motility disorders

Q

how to treat GI induced N/V

A

reglan

Q

neuro causes of N/V (4)

A

cerebellar hemorrhage
tumor
hydrocephalus
elevated ICP

Q

how to treat neuro causes of N/V (2)

A

surgery
steroids

Q

metabolic causes of N/V (4)

A

Addisons
vol. depletion
DKA
hypercalcemia

Q

how to treat metabolic causes of N/V

A

treat cause

Q

how to treat PONV (2)

A

phenothiazines (compazine)
droperidol

Q

how to treat anxiety related N/V

A

benzos

Q

how to treat pregnancy related N/V (3)

A

antihistamines
anticholinergics
promethazine

Q

how to treat motion sickness (2)

A

antihistamines
anticholinergics

Q

first line treatment of N/V

A

phenothiazine

Q

second line treatment of N/V

A

antihistamine
anticholinergic

Q

third line treatment of N/V

A

re-eval cause

Q

3 medications used for motion sickness

A

hydroxyzine
meclizine
dramamine
scopolamine

Q

first line treatment of IBS-C

A

linacoltide or lubiprostone +osmotic laxative used to avoid diarrhea

Q

second line treatment of IBS-C

A

osmotic laxative

Q

third line treatment of IBS-C

A

stimulant laxative short term

Q

first line treatment of IBS-D

A

loperamide

Q

second line treatment of IBS-D (2)

A

Lomotil for short term
rifaximin for long term

Q

constipation first line agent

A

bulk-forming laxative

Q

constipation second line agent

A

mag hydroxide
saline laxative

Q

constipation third line agent

A

stimulant laxative

Q

enema contraindication

A

under 2 y/o

Q

length of OTC constipation therapy

A

<7 days in a row

Q

how to treat constipation in pregnancy

A

colace safe
avoid castor oil

Q

constipation treatment considerations for the elderly

A

risk of electrolyte imbalance with laxative use
eliminate causative agent (antipsychotics, TCAs, Ca)

Q

MOA of lomotil

A

decrease GI motility

Q

MOA of loperamide

A

opioid receptor agonist acts on myenteric plexus of colon

Q

5 types of medications used to treat diarrhea

A

antimotility agents
adsorbents
absorbents
semisynthetic antibiotic
atypical/antisecretory agents

Q

2 antimotility agents

A

lomotil
loperamide

Q

contraindications of antimotility agents

A

infectious diarrhea
caution in hepatic dys

Q

SE of antimotility agents

A

constipation
drowsiness
blurry vision

Q

lomotil interactions

A

HTN crisis with MAOIs

Q

adsorbent medication

A

kaopectate

Q

kaopectate MOA

A

binds to diarrhea and toxins to solidify stool
add a dose after each BM

Q

absorbent medication

A

fibercon

Q

MOA fibercon

A

absorbs water in the GI tract to make stool less watery

Q

semisynthetic antibiotic medication

A

rifaximin

Q

indications for rifaximin for diarrhea

A

noninvasive strains of e.coli
best for travelers diarrhea

Q

contraindications for rifaximin

A

hypersensitivity

Q

SE of rifaximin (6)

A

peripheral edema
nausea
fatigue
dizziness
HA
muscle spasm

Q

how to treat diarrhea in peds

A

oral rehydration is priority
antidiarrheal agents not recommended

Q

lomotil age limits

A

not for children under 4

Q

indications for laxative use

A

lifestyle modifications fail
eliminated secondary cause

Q

lifestyle modifications for constipation

A

diet
exercise
bowel training

Q

subsalicylate medication

A

pepto bismol
kaopectate

Q

contraindications of subsalicylates

A

hypersensitivity to ASA
kids with flu or chicken pox (Reye syndrome)

Q

SE of subsalicylates (3)

A

black stool
dark tongue
tinnitus

Q

subsalicylates interaction

A

warfarin

Q

first line agents for IBS in pregnant women

A

colace and bulk forming agents (not absorbed systemically)

Q

lactulose ok in pregnancy?

A

yes

Q

sorbitol ok in pregnancy?

A

yes

Q

stimulant laxatives ok in pregnancy?

A

only occasionally if necessary

Q

castor oil ok in pregnancy?

A

no
risk of uterine contractions

Q

mineral oil ok in pregnancy?

A

no
inhibits vitamin absorption

Q

long term SE of PPIs

A

dementia
osteoporosis

Q

first line treatment for GERD and length (2)

A

PPI 8-12 wks
diet and lifestyle mod.

Q

treatment for hot flashes

A

paxil

Q

rome 3 criteria

A

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.