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Pharm 2 > Womens Health 1 > Flashcards

Womens Health 1 Flashcards

1
Q

What should be considered when prescribing meds to a woman of childbearing age?

A

Teratogenicity
Inadequate prenatal care could be harmful
Breastfeeding could pass medicines
Cultural beliefs may influence how a women considers and accepts health counseling from a clinician

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2
Q

Why do women absorb many oral drugs differently than men?

A
  • have longer gastric emptying times
  • estrogen
  • lower BMI than men
  • higher proportion of fat
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3
Q

Why do women have lower levels of lipophilic drugs circulating the plasma?

A

Higher proportion of body fat compared to men, therefore, the drugs absorb more easily

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4
Q

Why are women better liver metabolizers than men?

A

Have more CYP450 3A4 substrate compared to men

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5
Q

Tx options form PMS and PMDD

A

Conventional medications, exercise, dietary changes (caffeine reduction, supplements, mind-body approaches, and counseling)

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6
Q

What is a med that can be used to tx PMS/ PMDD associated anxiety?

A

alprazolam (Xanax)

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7
Q

What is a med that can be used to tx PMS/ PMDD associated endometriosis?

A

danazol (Cyclomen)

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8
Q

What is a med that can be used to tx PMS/ PMDD associated dysmenorrhea?

A

Ibuprofen

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9
Q

What is a med that can be used to tx PMS/ PMDD associated behavioral sxs?

A

SSRIs - citalopram, fluoxetine, paroxetine, sertraline

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10
Q

Herbal options for PMS/ PMDD

A

primrose oil
chaste tree berry
calcium salts
magnesium salts
Vit E and Vit B

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11
Q

Meds that may cause abnormal vaginal bleeding?

A

Progesterone only OCPs
Phenytoin
Tamoxifen
Antipsychotics
Oral steroids

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12
Q

Which herbal supplements can cause abnormal vaginal bleeding?

A

Garlic
ginkgo biloba
soy
St. John’s wort

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13
Q

What are the primary goals of management of dysfunctional uterine bleeding?

A

Stabilize the bleeding
Prevent endometrial hyperplasia or cancer

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14
Q

What are the steps for stopping severe dysfunctional uterine bleeding?

A
  • correct volume status
  • stop uterine bleeding
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15
Q

What is used to stop uterine bleeding when it is severe?

A

Rapid onset of IV conjugate equine estrogen therapy is effective

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16
Q

What can be used to stop uterine bleeding that is not severe?

A

Oral estrogen can also be administered, 2.5 mg every 6 hours until bleeding stops

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17
Q

High dose estrogen SE

A

Nausea, vomiting, headache, fluid retention, edema, thrombosis, MI, stroke

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18
Q

What is the general rule of thumb w/ OCPs and which women should avoid taking them?

A

Caution should be taken with women who have a history of liver disease, >35 years, and/or smoke

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19
Q

In which women is high dose oral estrogen contraindicated?

A

history of a thromboembolic event or an estrogen-dependent tumor

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20
Q

What is an alternative for estrogen (for women w/ hx of thromboembolic event/ estrogen dependent tumor)?

A

combination oral contraceptives (COC), oral progestins, surgical intervention (if not responsive to therapy)

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21
Q

How can heavy menstrual bleeding be tx?

A

levonorgestrel- releasing intrauterine device (IUD) (Mirena)
OR estrogen containing contraceptives (w/ long term use)

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22
Q

How can endometrial hyperplasia w/o atypia be tx?

A

can be treated with the off-label use of cyclic or continuous progestins

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23
Q

Selection of OCP should be guided by?

A

Selection requires care in selecting the formulation with the lowest dose of estrogen that can be tolerated

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24
Q

How are low-dose monophasic oral contraceptives used?

A

continuous or extended daily dosing pattern lasting 2-3 months

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25
Q

How often will a woman have her menses on a low-dose monophasic oral contraceptive?

A

allows a woman to have her menses 4x/year

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26
Q

Multiphasic pills are best used to tx?

A

menstrual migranes

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27
Q

Multiphasic pills may only be used for regular monthly cycles, what occurs when doses are missed?

A

Breakthrough bleeding?

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28
Q

Progesterone-only pills are effective when?

A

always used in continuous-dose fashion with no withdrawal breaks, these pills are effective only when taken in regular 24-hour intervals

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29
Q

Women w/ a family hx of ovarian CA should be placed on what type of OCP and why?

A

use of combined oral contraceptives offers reduced risk of ovarian cancer

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30
Q

How do Combined Oral Contraceptives work?

A

Suppress the pituitary-ovarian axis and generally prevent ovulation

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31
Q

How are Combined Oral Contraceptives doses scheduled?

A

regular cyclic pattern (21 days on, 7 days off) - less blood loss than a non-medicated cycle

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32
Q

Which pts should not be prescribed OCPs?

A

history of CVA, complicated migraines, heart or liver disease, clotting disorders, estrogen-sensitive cancers, undiagnosed vaginal bleeding, or possible pregnancy

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33
Q

OCPs can cause an increased risk of thrombosis, as such, which pts should avoid their use d/t this risk?

A

personal or family history of DVT or factor V Leiden, protein C or S deficiency

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34
Q

OCP SE concerning for stroke

A

unilateral numbness, tingling, weakness, slurring of speech, or vision loss could suggest stroke

35
Q

OCPs DO NOT reduce the risk of this type of CA?

A

They do not reduce the risk of cervical cancer

36
Q

If a pt forgets to take a OCP pill, what should they be advised to do?

A

patients should be taught appropriate catch-up strategies, and should be warned to use backup methods of contraception for the remainder of their cycle

37
Q

How should OCPs first be prescribed and f/u?

A

Prescribe a 3-month supply and schedule a return visit at 3 months to evaluate the patient

38
Q

Which estrogens are commonly used in OCPs?

A

Mestranol
Ethinyl estradiol
Estropipate

39
Q

Which progastrins are commonly used in OCPs?

A

Norethindrone
Ethynodiol diacetate
Norethynodrel
Levonorgestrel
Norgestimate
Desogestrel
Drospirenone
Medroxyprogesterone
Entonogestrel

40
Q

What does the estrogen in combination oral contraceptives do?

A

estrogen stabilizes the endometrial lining and controls bleeding

41
Q

What does progestin in combination oral contraceptives do?

A

progestin that halts follicle growth

42
Q

OCP Estrogen MOA

A

Stabilizes the endometrial lining
Inhibition of ovulation

43
Q

OCP Progestin MOA

A

Halts follicle growth
“Hostile cervical mucus”

44
Q

COC uses

A

For cycle regulation, contraception, and acne relief

45
Q

Estrogen SE

A

Breast tenderness
Cerebrovascular accidents
Myocardial infarction
Thrombosis
Hepatic adenoma

46
Q

Estrogen deficiency sxs

A

Mimic menopause sxs
Hot flashes
Early and midcycle spotting
Decreased libido
Dry vaginal mucosa
Irritability, nervousness, depression

47
Q

Progestin SE

A

Hypertension
Oily scalp, acne
Weight gain

48
Q

Progestin deficiency sxs

A

Late breakthrough bleeding and spotting
Heavy menstrual flow
Delayed onset of menses
Dysmenorrhea
Weight loss

49
Q

General OCP SE

A

Hypercoagulability, DVT and PE, and CVA risks
Liver abnormalities

50
Q

Contraindications for OCPs

A

Cigarette smoking/HTN (patient over 35 years)
Liver disease
Heart disease
Thromboembolic disease
Breast cancer
Breast feeding
Undiagnosed vaginal bleeding
Pregnancy
Complicated migraine
Major surgery with prolonged immobilization

51
Q

Which progestin OCP has the highest risk of clots?

A

Drospirenone (Yasmin)

52
Q

Combo OCP black box warning

A

Women over age of 35 yrs who smoke should not use

53
Q

Which meds decrease OCP efficacy?

A

Anticonvulsants, PCN, Rifampin, Griseofulvin, St Johns Wort, and Topiramate by inducing the OCP metabolism in the liver

54
Q

Transdermal contraception contain which hormones?

A

Estrogen and progesterone

55
Q

Transdermal Contraception MOA

A

Suppress ovulation and cause thickening of cervical mucus.

56
Q

How long do transdermal patches stay on?

A

3 wks to allow for bleeding

57
Q

Benefit of transdermal patch over OCP in terms of interactions?

A

Avoids 1st pass - be less affected by use of antibiotics, antacids, and other drugs

58
Q

Transdermal patch is the best option for?

A

pts who are unable to reliably take a daily OCP on schedule (teenagers, shift workers, college students, and other women with hectic schedules)

59
Q

Transdermal patch SE

A

Increased risk of DVT
Contact dermatitis, adhesive intolerance, or skin hyperpigmentation

60
Q

Transdermal patch contraindications

A

Same as OCP

61
Q

How often should the patch be replaced?

A

Needs to be replaced once weekly

62
Q

In which pts is the patch unreliable?

A

May not achieve reliable hormone levels to suppress ovulation in patients weighing >200 lbs

63
Q

How are injectable contraceptives formulated?

A

progestin-only product that is effective for 2-3 months or a combined formulation that contains both a progestin and an estrogen and is effective for 1 month

64
Q

Injectable contraception MOA

A

thicken cervical mucus

65
Q

Injectable contraception SE

A

little to no increased risk of cardiovascular events with the use of progestin-only injectables
Acne
Liver tox
Decreased libido

66
Q

Injectable contraceptive’s efficacy can be lessened by?

A

Drugs that induce liver enzymes may lessen the efficacy of the injectable hormones.

67
Q

Contraindications for injectable contraceptives

A

Not for IV usage; use IM only + same as w/ other hormonal contraceptives

67
Q

Contraindications for injectable contraceptives

A

Not for IV usage; use IM only + same as w/ other hormonal contraceptives

67
Q

Contraindications for injectable contraceptives

A

Not for IV usage; use IM only + same as w/ other hormonal contraceptives

68
Q

Disadvantages of injectable contraceptives

A

pain of injection, weight gain, and irregular menses

69
Q

Depo-provera injections are every?

A

3 months

70
Q

Implants contain which hormones

A

Single hormone progesterone-based subdermal agents

71
Q

Implant advantages

A

Lack of first-pass metabolism through the liver
The ability to avoid daily dose requirement
Inhibits ovulation effectively for 3 years

71
Q

Implant advantages

A

Lack of first-pass metabolism through the liver
The ability to avoid daily dose requirement
Inhibits ovulation effectively for 3 years

72
Q

Implant SE

A

irregular bleeding, weight gain, and acne

73
Q

In which women is the implant a great choice for?

A

women with heart or liver disease, breastfeeding mothers, women with clotting disorders, and smokers >35 years

74
Q

Intravaginal rings should not be used in?

A

the ring does contain estrogen, it should not be used in patients with a contraindication to estrogen

75
Q

Which hormones do intravaginal rings contain?

A

Made of a soft ethylene polymer, which elutes 15 mcg of ethinyl estradiol daily and 120 mcg of etonogestrel (desogestrel) daily

76
Q

Intravaginal rings have fewer drug interactions because?

A

minimizes systemic side effects because circulating hormone levels remain lower than even low-dose oral contraceptive levels

77
Q

How should the intravaginal ring be used?

A

The preferred method is 3 weeks on (in) and 1 week off (out) to allow for withdrawal bleed

78
Q

Diaphragms and cervical caps must be obtained via rx because?

A

must be fitted by a clinician for each individual user

79
Q

Spermicides can increase transmission of STDs because?

A

Contains nonoxynol-9, which is an irritant to mucous membranes

80
Q

Contraceptive sponges

A

Non-prescription, unfitted vaginal insert containing a specified quantity of spermicide

Pharm 2 (8 decks)

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