Women's Health

Question 0

PK changes in pregnancy

Answer 0

Increased AUC
Increased Vd, increase loading doses

Increased 3A4, 2D6

Increased gastric pH
Decreased albumin

Question 1

G4P2113

TPAL

Answer 1

Gravidity: # of pregnancies
Parity: # reaching 20 weeks gestation

1) term deliveries
2) premature deliveries
3) aborted pregnancies
4) living children

Question 2

Estrogens

Answer 2

Estradiol
Mestranol

Inhibit ovulation suppress LH FSH

Protective effects in ovary/vagina via hormone suppression

Causes nausea, contacts fit

Question 3

Progestins

Answer 3

Levonorgestrel (most androgenic)
Norethindrone
Dienogest
Drosperinone

Some suppression of LH

Hair loss , fatigue
Inhibit sperm penetration and maturation

Increase appetite, weight gain, acne mostly due to androgenic effects
PEA activity

Question 4

Monophasic

Answer 4

Constant dose of estrogen and progestin

Flexible

Question 5

Multiphasic

Answer 5

Minimize breakthrough bleed

Less estrogen
More progestin

More confusing, harder to rectify AE

Question 6

Ortho-Evra

Answer 6

Patch

Question 7

Nuva ring

Answer 7

Stable for 4 months EXP date

Vaginal insertion

Risk for DVT

Question 8

Depo provera DMPA

Answer 8

Medroxyprogesterone IM q 12 weeks

No menses, no cramps

Not readily reversible takes more than 3 months

Use if heavy smoker, progestin only

Question 9

Inserted and removed by healthcare professional

Answer 9

Skyla: intrauterine 3 years
Mirena: IUD 5 years

Implanon - Subdermal 3 years

Question 10

Long term risks

Answer 10

Decreased risk of endometrial, ovarian cancer

Increased risk of cervical cancer

Mild BP increase

Estrogen Increases clotting factors 2,7,9,10 and thromboembolic disorders
Drosperinone, desorgestrel may increase DVT

Question 11

Drugs that decrease effectiveness of OC

Answer 11

Rifampin
Phenytoin, phenobarbital, carbamazepine
SJW
Protease inhibitors -avir

Question 12

Seasonique

Answer 12

Placebo pills contain estrogen

Menses every 3 months

Question 13

DC OC if ACHES

Answer 13

Abdominal pain (gallbladder pancreas)
Chest pain (SOB PE)
Headache (severe)
Eye problems (blurry vision)
Severe leg pain (DVT)

Question 14

OC contraindications

Answer 14

Thromboembolic disease (stroke)
Coronary artery disease
Breast cancer
Abnormal uterine bleeding 
Pregnancy
Heavy smoker (use progestin only or DMPA)
Hepatic tumor

Question 15

Vasomotor Menopausal Nonpharmacological

Answer 15

Dress in layers
Reduce spicy/hot foods & drinks
Use fans

Diet: phytoestrogens in soybeans, seeds, and grains

Question 16

Vasomotor Menopausal pharmacological

Answer 16

Paroxetine: risk suicide, osteoporosis

Escitalipram: less hot flashes

Venlafaxine: fatigue

Estradiol: more satisfaction, insomnia
Clonidine if can’t take estrogens

Question 17

Vasomotor Menopausal hormone therapy

Answer 17

Give both estrogen and progestin if intact uterus

Combo Not for history of breast cancer, heart disease, venous thromboembolism

Conjugated estrogen better if HF or breast cancer

3 year duration

Question 18

Ovulation

Answer 18

Surge of LH

Question 19

Corpus luteum

Answer 19

Remnants of follicle

Increase progesterone&endometrium

Question 20

Increased BP with OC

Answer 20

Estrogen and drosperinone (spironolactone analog)

Question 21

Due date

Answer 21

Last menstrual period + 1 week minus 3 months

Question 22

FDA pregnancy category C

Answer 22

Most dangerous because of unknown risk

Question 23

Pregnancy vitamins and minerals

Answer 23

Iron
Calcium
Folic acid

Question 24

Morning sickness

Answer 24

Light snack before getting out of bed

Pharm:

1) doxylamine/pyridoxine (Vit B6) diclegis
2) meclizine, diphenhydramine
3) metoclopramide
4) rectal phenothiazine (AE sedation)

Question 25

GERD

Answer 25

Nonpharmacological

2) antacid
3) H2RA
4) PPI

Question 26

Cold and cough

Answer 26

Don’t give anything

Question 27

Rhinitis

Answer 27

Diphenhydramine, meclizine
First gen

2) budesonide, beclamethasone

Question 28

Acute pain

Answer 28

APAP

Question 29

Hypertension >140/90 after 20 weeks

Especially if diastolic >100

Answer 29

1) Labetalol
2) nifedipine

NOT ACE/ARB

Question 30

Pre-eclampsia

Answer 30

HTN plus proteinuria>300
Risk: hemolysis, Elevated LFT, low platelets

Prevention 81 aspirin

Question 31

Severe preeclampsia

Answer 31

Immediate delivery

Betamethsdone, dexamethasone for lung maturation

IV labetalol if BP>160/110
Alternative: IV hydralazine
Keep diastolic 90-100

IV mag sulfate for seizure prevention

Question 32

Gestational DM

Answer 32

USA 2 step

50g >130

OGTT>200
Or 2 levels >140

Give NPH/regular insulin
Increase in 2/3 trimesters
Can use metformin

Question 33

Coagulation disorder

Increased 2,7,9,10
Decrease antithrombin

Answer 33

Give heparin, reversal with protamine
Alternative: LMWH (less osteoporosis risk)

NOT warfarin X!

Question 34

Drug excretion to breast milk

Answer 34

Nonionized cross membranes

Weak bases become trapped in milk

Take dose @night HS
Minimize exposure with short half life drugs,
Short term: pump and dump
Pump and store clean milk

Question 35

Pregnancy vitals

Answer 35

Increase cardiac output 
Decrease blood pressure
Increase O2 intake
Increase renal blood flow, GFR
Decrease Scr
Increase pH, less acidity 
Decrease albumin

Question 36

Drug transfer

Answer 36

Weak acids and bases with pKa 4.3-8.5

Question 37

Constipation

Answer 37

Dietary fiber

1) Psyllium
2) docusate

Question 38

Congestion

Answer 38

Saline nasal spray

Pseudoephedrine