Week 3: Women as Patients

Question 1

Mnemonic used for possible thromboembolic events (women taking birth control/HRT are at high risk for)

Answer 1

ACHES
A- Abdominal pain
C- Chest pain
H- Headaches
E- Eye problems - change in vision
S- Severe leg pain

Question 2

Pharmacodynamic differences in women

Answer 2

• increased volume distribution of some drugs (opiods, warfarin/ASA, antipsychotics, antiretroviral drugs) due to increased adipose tissue
• this causes increased effectiveness/increased drug response - but also increased risk of ADR/toxicity
• Increased rate of metabolism for CYP450 3A4 substrates and decrease rate of metabolism for CYP 1A2 and CYP 2D6 substrates
• increased bioavailability/effectiveness increases the risk of toxicity (Lithium)
• If a drug has an increased risk of toxicity in general - will be even higher risk in women

Question 3

What is important to always keep in mind when treating female patients?

Answer 3

• In women of childbearing age - the possibility of pregnancy - pregnancy status
• Risk for violence - every female should be screened

Question 4

1st line treatment for dysmenoria

Answer 4

NSAIDs due to anti-prostaglandin properties

Question 5

What types of drugs would be more likely to pass through the placenta?

Answer 5

• Lipophilic
• Non-ionized
• Lower molecular weight
• Low protein binding

Question 6

What characteristic of breast milk is important to keep in mind?

Answer 6

Breast milk is more acidic - basic drugs will be more concentrated in breast milk - acidic drugs will be less concentrated in breast milk (think ion-trapping)
The higher the drug concentration in maternal plasma, the higher the concentration in breast milk
Use lowest therapeutic dose possible.

Question 7

What can cause suppression of the hypothalamic-pituitary-ovarian axis?

Answer 7

disordered eating and overexercise - leads to reduction of estrogen levels -> amenorrhea and decreased bone mineralization

Question 8

Pharmacokinetic changes in pregnancy

Answer 8

• increased drug absorption from lungs and skin
• increased plasma volume - affects volume of distribution
• increased drug clearance

Question 9

When treating a woman in menopause with HRT, if the woman has a uterus, what type of HRT should be used and why?

Answer 9

HRT containing both estrogen and progesterone - decreases the risk of endometrial cancer