Women's Health

Question 1

What are combined oral contraceptives?

Answer 1

Ethinyl estradiol + progestins (norethindrone, levonorgestrel, desogestrel, dropsirenone)

Question 2

What is the MOA of COCs?

Answer 2

Estrogen inhibit FSH, suppressing follicular development.
Progestins suppress LH to prevent ovulation, thicken cervical mucus, and make the endometrium less suitable for implantation.

Question 3

What are adverse effects of COCs?

Answer 3

Nausea, breast tenderness, HA.

Increased risk of thromboembolism, HTN, and stroke (especially in smokers >35)

Question 4

What is the Patch called?

Answer 4

Xulane

Question 5

What is the Ring called?

Answer 5

NuvaRing

Question 6

What is the MOA of Patches and Rings?

Answer 6

Same as COCs because it contains estrogen and progestin- it is just delivered trans dermally (patch) or intravaginally (ring).

Question 7

When do you have to change the patch and ring?

Answer 7

Patch is weekly application (excluding menstrual week) and ring is monthly application.

Question 8

What are the Progestin only methods?

Answer 8

Norethindrone (mini-pill), Depo-Provera, Nexplanon, levonorgestrel IUDs (Mirena, Skyla).

Question 9

Who are progestin only methods most useful for?

Answer 9

Suitable for breastfeeding women, smokers, and those intolerant to estrogens. Also good for long term contraception (IUD and implants).

Question 10

What are adverse effects of progestin only drugs?

Answer 10

Irregular bleeding, weight gain, and delayed fertility return with Depo-Provera
IUDs carry risk of PID and ectopic pregnancy

Question 11

How should progestin only drugs be taken?

Answer 11

Mini-pill taken daily, Depo-Provera lasts 3 months and implants/IUD lasts 3-5 years.

Question 12

What are the medications under emergency contracpetions?

Answer 12

Plan B, Ella, copper IUD, and high dose ethinyl estradiol + levonorgestrel

Question 13

What is the MOA of emergency contraceptives?

Answer 13

Prevents ovulation and fertilization.
Copper IUD disrupts sperm motility and endometrial environment.

Question 14

What is the purpose of emergency contraceptives?

Answer 14

prevents pregnancy after unprotected intercourse (up to 72 hours for Plan B, 5 days for Ella and copper IUD)

Question 15

What are the main drugs under androgens and antiandrogens?

Answer 15

Androgen: Testosterone
Antiandrogens: Flutamide, Finasteride

Question 16

What is the primary use for androgens and antiandrogens?

Answer 16

Not primarily used in contraception but can be used for treatment of hormone driven conditions such as hirsutism and PCOS.

Question 17

What drug regimens are used to treat menopausal symptoms?

Answer 17

HRT, SERMs, Nonhormonal options, Vaginal Estrogens, and Bioidentical Hormone therapy

Question 18

What are the drugs under the hormone replacement therapy class?

Answer 18

Estrogens: Estrace, Alora
Conjugated Estrogens: Premarin
Esterified Estrogens: Menest
Estrogen+Progestin: Prempro, Activella, Climara Pro

Question 19

What is the MOA of HRT?

Answer 19

Estrogens replace declining levels of natural hormone, alleviating symptoms like hot flashes and vaginal atrophy.
Progestins are added in wome with a uterus to reduce the risk of estrogen induced endometrial cancer.

Question 20

What are adverse effects of HRT drugs?

Answer 20

Increased risk of blood clots (DVT), stroke, and breast cancer.
Nausea, breast tenderness, and fluid retention.
Elevated BP and risk of gallstones.

Question 21

What are the drugs for SERMs?

Answer 21

DuaVee and Evista

Question 22

What is the MOA of SERMs?

Answer 22

SERMs selectively mimic or block estrogen activity depending on the tissue.
Duavee opposes estrogen effects on uterine tissue, reducing the risk of endometrial cancer.

Question 23

How are SERMs excreted?

Answer 23

Rapidly absorbed and undergo extensive metabolism, and then excreted in bile.

Question 24

What are adverse effects of SERMs?

Answer 24

Hot flashes, leg cramps, increased risk of DVT and pulmonary embolism.

Question 25

What are the drugs under the nonhormonal options?

Answer 25

SSRI: Paroxetine
Clonidine
Gabapentin

Question 26

What are the MOA of the nonhormonal options?

Answer 26

Paroxetine reduces hot flashes by influencing serotonin pathways.
Clonidine elevates the threshold for vasomotor symptoms by acting on CNS receptors.
Gabapentin reduces hot flashes.

Question 27

What are the drugs under vaginal estrogens?

Answer 27

Vagifem
Estring
Premarin cream

Question 28

What is the MOA of vaginal estrogens?

Answer 28

Restore estrogen levels locally in vaginal tissues, relieving symptoms like dryness, itching and painful intercourse.

Question 29

What are key considerations for treatment for menopausal symptoms?

Answer 29

Short term use of HRT (less than 5 years) is recommended to manage menopausal symptoms like hot flashes and vaginal atrophy.
Nonhormonal options are suitable for women with contraindications to hormone therapy (hx of breast cancer or blood clots)

Question 30

What is the treatment regimen for Trichomoniasis?

Answer 30

Flagyl orally, single dose.
Tinidazole orally with food, single dose.

Question 31

What is the treatment for cytomegalovirus?

Answer 31

Reassurance for mild cases.
Severe cases: Foscarnet or Cidofovir

Question 32

What is the treatment for HSV?

Answer 32

Acyclovir, Valacyclovir, or Famciclovir for 2-3 times daily for 7-10 days.

Question 33

What is the treatment for HPV?

Answer 33

Podofilox solution: Apply to warts twice daily for 3 days and then repeat weekly up to 4 cycles
Imiquimod cream: Apply x3 week for up to 16 weeks

Question 34

What is the treatment for Syphilis?

Answer 34

Aqueous Penicillin IM single dose
or Doxy x2 daily for 14 days

Question 35

What is the treatment for gonorrhea?

Answer 35

Rocephin IM + Azithromycin oral single dose