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Women's Health Flashcards

1
Q

Normal vagina

A

In normal mature vagina: 95% of organisms are lactobacillus ( vaginal flora):
-Hello to create an acidic environment PH 4-5
-conversion of glycogen to lactic acid
-acidic environment help to protect the vagina from infection with other bacteria
Vaginal discharge is normal ( increased during pregnancy, ovulation, after menses)

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2
Q

Bacterial Vaginosis

A

Thin, watery, fishy odor, discolored

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3
Q

Trichromoniasis

A

Frothy, copious, malodorous, discolored

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4
Q

Vulvovaginal candidiasis

A

Thick, cottage cheese like, no odor, normal pH

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5
Q

Vulvovaginal disorders

A

Many women who purchased nonprescription anti fungal products to treat vaginal symptoms actually did not have VVC symptoms
Non infectious conditions such as irritation or pruritus caused by allergic runs secondary to douching feminine hygiene products, latex rxns, spermicides or soaps may also add to the conclusion of diagnosis vaginal infection

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6
Q

Inappropriate use of vaginal anti fungal products

A

Unnecessary drugs use
Delay in effective treatment for actual conditions
Cost
Recommended the use of vaginal pH self testing device

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7
Q

VVC ( aka yeast infection)

Infectious agent

A

Candida fungi are the primary causative agent

- Candida albicans

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8
Q

VVC causes

A 
High dose combined oral contraceptives 
Estrogen 
Pregnancy 
Corticosteroids use
Food high in sugar 
Clothing tight fitting, nonabsorbent
Vagisil screening kit is available but has problems:
- vaginal swan to determine pH and pH <4.5 is favorable
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9
Q

Treatment goals for VVC

A

Relief of symptoms
Eradication of the infection
Reestablishment of normal vaginal flora

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10
Q

Uncomplicated VVC

A

May be candidate for self care
Infrequent episodes
Mild-moderate symptoms

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11
Q

Complicated VVC

A

More severe symptoms
Predisposing illness or medications
Recurrent VVC
-at least 4 documented infections/1 year period
- may be early signs of HIV or DM
-more resistant to imidazole anti fungal therapy
Need to be further evaluated by PCR
FDA warnings: symptoms that return within 2 months or infections that do not clear up easily upon treatment require medical evaluation

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12
Q

Exclusions to self care

A

Medically diagnosed with VVC at least once
Younger than 12 years old
Pregnant
Diabetes mellitus
HIV positive or aids
Have impaired immune system, including use of medications that may impair function of the immune system

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13
Q

Nonpharmacologic therapy if VVC

A 
Change diet: decrease sugar 
Life cultures yogurt 
Changing to low dose COC
Talk to md if other med are increasing risk such as antibiotic and immunosuppressants
-do not recommended to stop 
Avoid non absorbent clothing 
Sodium bicarbonate sits bath
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14
Q

Pharmacologic Treatment of VVC

A 
Imidazole: 
- butuconazole
-clotrimazole
-miconazole
-tioconazole
Available as such vaginal creams, suppositories and tablets 
Monistat Vaginal Drug Card
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15
Q

Imidazole MOA

A

Change fungal membrane permeability

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16
Q

Imidazole Treatment

A

1,3 or seven days

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17
Q

Imidazole ADE

A

Burning, Itching Irritation

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18
Q

Imidazole DDI

A

Warfarin
Miconazole
-Check INR

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19
Q

Clotrimazole 1% brand

A

Gyne-lotrimin 7 cream

Mycelex 7 cream

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20
Q

Clotrimazole 1% cream
Clotrimazole 100 mg tablets
Brand

A

Mycelex-7 combination pack

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21
Q

Clotrimazole 1% cream dose

A

Insert cream into vagina Daily for seven days

apply cream to Vulva devise daily for itching

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22
Q

Clotrimazole 1% tablet dosage

A

Insert tablet into vaginal daily for seven days

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23
Q

Clotrimazole 2% Brand

A

Gyne-lotrimin 3 cream

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24
Q

Clotrimazole 2% dosage

A

Insert Cream into vaginal daily for three days

Apply to Vulva twice daily for itching

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25
Butoconasole nitrate 2% brand
Gynazole I
26
Tioconazole 6.5% brand
Vagistat -1 ointment 1 -day ointment
27
Butoconasole nitrate 2% dosage
Insert cream into vagina daily for one day
28
Tioconazole 6.5% direction
Insert ointment into vagina daily for 1 day
29
Monistat I combination pack day/night | Monistat I daytime ovule
Cream: miconazole nitrate 2% 1200 mg per applicator fI’ll Suppository: miconazole nitrate 1200 mg
30
Monistat I combination pack day/night Monistat I daytime ovule Direction
Apply cream to Vulva twice daily as needed for itching up to seven days insert suppository into vagina daily (morning or bedtime) for one day
31
Monistat 3 combination pack
Cream: miconazole nitrate 2% Suppository: miconazole nitrate 200 mg per applicator full
32
Monistat 3 combination pack | Derection
Apply cream to Vulva twice daily as needed for itching up to seven days insert suppository into vagina for three days daily
33
Monistat 3 cream
Miconazole nitrate 4%
34
Monistat 3 cream | Direction
Insert cream into vagina daily for three days | Applied to Vulva twice daily as needed for itching
35
Monistat 7 cream | femizol-M cream
Miconazole nitrate 2%
36
Monistat 7 cream femizol-M cream Direction
Insert cream into vagina daily for seven days | apply to Vulva twice daily as needed for itching
37
Monistat 7 combination pack
Cream: miconazole nitrate 2% 100 mg per applicator full Suppository : miconazole nitrate 100 mg
38
Monistat 7 combination pack | Direction
Apply cream Tavola twice daily as needed for itching | Insert suppository into vagina daily for seven days
39
Patient counseling for VVC
Seek medical evaluation -symptoms persist beyond 1 week after treatment or if they recur within 2 months -more than three times in 12 months -on warfarin Use once a day ( night is preferred) Symptoms resolution within 2-3 days but may take a week for complete resolution
40
Complementary therapies for VVC
Lactobacillus preparation Vaginal tea tree oil preparation Gentian violet resistant VVC for 1-2 Times A day for up to five days Boric acid 600 mg PV daily a day for 14 days -non C. albicans infection
41
Atrophic vaginitis
Inflammation of vagina to atrophy of vaginal mucosa
42
Atrophic vaginitis etiology
Decreased estrogen such as menopause, after birth, or during breastfeeding Medications: antiestrogenic drugs ( mpa, danazol, GNrH inhibitors) Vaginal dryness, irritation, burning, dyspareunia: slight discharge or spotting New episode of postmenopausal vaginal bleeding need medical referral to rule out endometrial cancer
43
Atrophic vaginitis Treatment
Vaginal dryness => lubricant Water-soluble to help Moisten tissues: -no petrolatum due to difficulties removing -Internal and external use Examples: K-Y jelly, Astroglide -glycerin, peg, hydroxyethylcellulose, hydroxypropyl methylcelulose Moderate to severe symptoms might require the use of estrogen therapy
44
Vaginal douching
Cleanser for after menstruation May lead to adverse health outcomes Contraindicated during pregnancy and should be postponed for at least 8 hours after intercourses if spermicide was used
45
Vaginal douching | Increase risk of:
``` Vaginal infection Ectopic pregnancy PID Decreased fertility change pH and vaginal frora ```
46
Vaginal douching | Products
Water/vinegar ( acetic acid) Povidine/iodine Alternative cleansing method: luckwarm water and soap
47
Menstruation cycle
``` 28 days Day one is first day of menses Hypothalamic-pituitary-ovarian axis: GNRH, LH, FSH levels are released as response to changes on progesterone and estrogen levels If pregnancy: human chronic gonadropin ```
48
Menstruation disorders
Dysmenorrhea-painful in lower abdomen : -primarily: cram-like pain in lower abdomen -occurs at onset or 1-2 days before menstruation -secondary: pelvic underlying pathology: -variable pain cycle, throughout menses Pathology: -increased in prostaglandins and leukotrienes: Inflammation and pain, uterine contractions
49
Nonpharmacologic Treatment Of menstruation disorders
Avoid secondhand smoke and smoking Hot bath or heating pad Regular exercise
50
Pharmacologic Treatment Of menstruation disorders
OTC nsaid- first line begin at onset of manses or pain, Schedule doses not prn - naproxen ibuprofen ASA - Need higher doses to get anti-inflammatory effects. ADE: GI symptoms Take with food ASAP: 1000 mg four times a day still less effective than ibuprofen COC, levonorgestrel IUD( mirena), medroxyprogesterone acetate( depo-pro era)
51
Patient counseling for primary dysmenorrhea
Primary dysmenorrhea is normal Understand when to seek medical evaluation Nsaid are I preferred therapy If Response to the first agent is not adequate another nsaid can be tried
52
PMS
Cyclic disorder Physical emotional and behavioral symptoms: depression irritability breast tenderness, bloating ( occurs during five days prior to manses) PMDD is severe form of PMS
53
Nonpharmacologic Treatment of PMS
Exercise Changes in diet Behavioral therapy Try to avoid stress and develop stress copying strategies During 7 to 14 days before menstrual period reduce salt caffeine chocolate and alcohol beverages Eaton carbohydrate rich foods low protein During premenstrual interval
54
PMS Treatment
Pyridoxine( b6) up to 100 mg daily -ADE: neuropathy Calcium and vitamin D 600 mg PO twice a day may cause constipation stomach upset Mg 300 to 360 mg PO daily during premenstrual interval only food sources of Mg is spinach ,Swiss chard ,nuts ,vegetables and whole grains cereal‘s ; May diarrhea Nsaid for HAand muscle joints pain and mood symptoms Diuretics ( combined with APAP, nsaid) - Relieving water retention weight gain bloating swelling and feeling of fullness: -ammonium chloride -caffeine -pamabrom Midol products drug card
55
Ammonium chloride dosage
3 g a day in three divided doses
56
Ammonium chloride CI
Renal and liver impairment
57
Caffeine dose
100 to 200 mg every 3 to 4Hours
58
Caffeine MOA
Inhibits Renal tubular reabsorption of sodium and water
59
Pamabrom
Derivative of theophylline | 15 mg four times a day
60
pamabrom 50 mg brand
Aqua-ban tablets;Diurex Max; Diurex Water Capletts
61
Caffeine 100 mg brand
Diurex ultra water weight loss formula
62
``` Pamprin multisymptom; Premsyn PMS ( ingredients) ```
Pamabrom 25 mg | Acetaminophen 250 mg; pyrilamine maleate 15 mg
63
Pamprin Max (ingredients)
Caffeine 65 mg aspirin 250 mg acetaminophen 250 mg milligrams
64
Midol extended relief
Naproxen sodium 220 mg
65
Midol complete ( ingredients)
Coffeen 60 mg acetaminophen 500 mg pyrilamine maleate 15 mg
66
Midol teen
Pamabrom 25 mg ASAP 500 mg
67
Midol PM
AS PA 500 mg | Diphenhydramine 38 mg
68
Toxic shock syndrome
Caused by Toxin producing strains of S aureus and S pyogenes - production of an inflammatory response - malaise, myalgia, chills Within two days * Severe symptoms including seizures high fever cardiac and respiratory problems
69
Classic characteristics of TTS
Rush: sunburn like, diffuse, macular erythroderma, non pruritic Skin desquamation: face, trunk, soles of feet and palms
70
TSS prevention
Avoid tampons | Use low absorbing tampons

Self Care (6 decks)

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