Womens Health Pharmacology Flashcards
1
Q
topical emollients
A
> E45, Diprobase cream, emulsifying ointment
Moisturise and soften the skin by forming an occlusive barrier to reduce water loss.
used for eczema and psoriasis
2
Q
Topical hydrocortisone
A
> mild potency
used for eczema, contact derm
suppresses cytokine production
3
Q
side effects of topical steroids
A
skin thinning, striae, acne eruptions with LT use
4
Q
CI to steroid use
A
Untreated infections, perioral dermatitis
5
Q
Moderate potency topical steroid
A
Clobetasone
6
Q
Steroid ladder
A
Hydrocortisone: mild eczema/ derm
clobetasone: moderate
betamethasone - resistant
clobetasol - severe inflammaory skin disoeders
7
Q
caution with betamethasone
A
short term use to avoid systemic abs
8
Q
tacrolimus mech
A
Inhibits calcineurin → ↓ T-cell activation and cytokine release → ↓ inflammation.
9
Q
indications for tacrolimus
A
moderate to severe ecxema unresp to topical steroids
10
Q
side effects of tacrolimus
A
> burning> skin infections> photosensitivity
11
Q
CI of tacrolimus
A
immunocomp, active skin infections
12
Q
interactions of tacrolimus
A
Avoid concurrent use with other immunosuppressants or UV therapy.
13
Q
ciclosporin mx
A
Inhibits calcineurin → ↓ IL-2 → ↓ T-cell activation.
14
Q
indications of ciclosporin
A
Severe atopic dermatitis, psoriasis, pyoderma gangrenosum.
15
Q
Side effects of ciclosproin
A
- nephrotoxic
- HTN
- hirtutism
16
Q
CI of ciclosporin
A
Uncontrolled hypertension, renal impairment, malignancy history.
17
Q
indications of methotrex
A
psoriasis, severe eczema, dermatomyositis
18
Q
SE of methotrexate
A
GI upset, hepatotoxicity, marrow suppression, pneumonitis.
19
Q
CI of methotrexate
A
Pregnancy, liver disease, immunodeficiency.
20
Q
interactions of methotrex
A
trimethoprim, alcohol - hepatox
21
Q
caliciportiol mechanism
A
- regulates keratinocyte proliferation, vit D analogue
- used in psoriasis
22
Q
SE of calciportriol
A
Skin irritation, burning, hypercalcaemia if used excessively.
23
Q
Tazarotene mechanism
A
> retinoid
Binds to retinoic acid receptors → modulates cell proliferation and inflammation.
24
Q
SE of retinoids
A
mood changes, peeling, photosensitivity
25
CI of retinoids
pregnancy - teratogenic
26
interactions of retinoids
avoid concurrent use w photosensiitve drugs - tetracyclines
27
How does isotret work
> oral retinoid
> ↓ Sebum production, anti-inflammatory, normalises keratinisation.
28
indications of isotret
severe nodulocystic acne
29
SE of isotret
Teratogenicity, mood changes, dry skin/lips, ↑ cholesterol/triglycerides, liver dysfunction.
30
Interactions of isotret
Tetracyclines (↑ intracranial pressure), Vitamin A (↑ toxicity), alcohol (↑ liver risk).
31
Alitretinoin mechanism
retinoid
32
Alitret Ix
severe eczema unresp to steroids
33
CI of alitretinoin
avoid pregnancy for 1m after
34
Coal tar loation mechanism
Antimitotic, reduces epidermal cell turnover.
35
Coal tar uses
Psoriasis, seborrhoeic dermatitis, eczema.
36
coal tar SE
Photosensitivity, skin irritation
37
dianthrol mechanism
inhibits keratinocyte proliferation through free radials
38
Dianthrol Ix
chronic plaque psoriasis
39
SE of dianthrol
> staining of skin and clothing
40
CI of dianthrol
pustular psoriasis, face/genital use
41
Adalimunab mechanism
Monoclonal antibody against TNF-α → ↓ inflammation.
42
Ix of adalimumab
Psoriasis
43
SE of adalimumab
increased infection risk espes TB
44
benzyl peroxide mechanism
bacteriacidal agent against Cutibacterium acnes
45
SE of BP
bleaching of hair and clothing
46
application of BP
Can deactivate topical retinoids — apply separately.
47
Clindamycin mechanism
> binds to 50s ribosomal subunit preventing protein synthesis
48
CI for clindamycin
c diff
49
Mupirocin mech
Inhibits bacterial isoleucyl tRNA synthetase.
50
Mupirocin indications
Localised skin infections (e.g., impetigo).
51
Oxytetreacycline/ doxy
> tetracycline ab
> inhibit 30s subunit
> acne and roseacea
52
se of oxytet/ doxy
> Gi upset
> photosensitivity
> tooth discoloration
53
CI of doxy and oxytetracycline
: Pregnancy, <12 years old.
54
Fluoxacillin mechanism
B lactam, inhibts synthesis of bacterial cell walls
55
indications of fluox
Septic arthritis and cellulitis
56
SE of fluox
Gi upset, cholestatic jaundice
57
Erythromycin mechanism
Macrolide, inhibits 50S ribosomal subunit.
58
Indications of erythromycin
Acne (especially in pregnancy), skin infections -cellulitis in pregnancy
59
SE of erthromycin
QT prolongation
60
Goserelin mechanism
GnRH analogue → downregulation of GnRH receptors → ↓ FSH/LH.
61
Indications of goserelin
ndometriosis, prostate cancer, breast cancer.
- Fibroid shrinkage b4 surgery
62
SE of goserelin
Hot flushes, ↓ libido, osteoporosis.
63
Infertility drugs
HMG and clomifene
64
HmG mechanism
Contains FSH and LH - stimulates ovulation and follicular development
65
what is the indication for HMG
Anovulatory infertility
66
SE of HMG
OHSS, multiple pregnancy
67
Clomifene mechanism
> Selective oestrogen receptor modulator → ↑ GnRH → ↑ FSH/LH.
> Anovulatory infertility (e.g., PCOS).
68
Clomifene SE
Hot flushes, mood swings, visual disturbances.
69
examples of the COCP
Gedarel, Mercilon, Yasmin, Femodene, Cilest, Microgynon
70
how does he COCP work
Oestrogen + progestogen → inhibits ovulation, thickens cervical mucus.
71
SE of COCP
VTE. breast tenderness, nausea
72
Interactions of COCP
enzyme inducers like rifampicin which reduce effectiveness
73
POP examples
Desogestrel (Cerelle, Cerazette), Levonorgestrel (Norgeston)
74
how do POP work
thickens mucus.
75
SE of POP
Irregular bleeding, acne, mood change.
76
Nonoxinol-9 (Gygel) MAO
> Spermicide; disrupts sperm cell membranes.
> Used as a contraceptive adjunct
77
SE of noxinol
Vaginal irritation, ↑ STI risk with frequent use.
78
CI of nonoxinol
Broken mucosa.
79
Int of nonoxinol
Latex condom degradation.
80
IUS system mech
Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus
81
SE of IUS
Spotting, amenorrhoea, ovarian cysts.
82
cOPPER iud mech
Sperm toxic environment; prevents fertilisation.
83
SE of copper IUD
Heavier periods, cramps.
84
CI of copper IUD
Wilson’s disease, pelvic infection.
85
EC - levonorestrogel mech
> inhibitsov
> up to 72 h
86
uplipristal mech
> 120 h
> progesterone receptor modulator - inhibits ov
87
Copper IUD - EC mx
- prevents implantation, works 5 days post intercourse OR ovulation whichever is latest - most effective form
- decreases sperm motility and survival - primary
- secondary is inhibiting implantation
88
Cocp - increases risk of
> VTE
> breast and cerv cancer - what we screen for
89
Depo injection mechanism
- Primary: Inhibits ovulation
-Also: thickens cervical mucus
90
how long does the depo last
12 weeks
91
Implant mechanism
- Primary: Inhibits ovulation
Also: thickens cervical mucus
92
Implant SE
- Irregular bleeding a common side-effect
Last 3 years
93
Which POP also inhibits ovulation
desogesterol
94
what is the pearl index
the number of pregnancies that would be seen if one hundred women were to use the contraceptive method in question for one yeaR
95
starting the POP PP
- Can start any time, even if BP
- After day 21 use additonal C for 2 days
96
Starting COCP after PP
- absolutely contraindicated - UKMEC 4 - if breastfeeding < 6 weeks post-partum
UKMEC 2 - if breastfeeding 6 weeks - 6 months postpartum*
97
How soon after PP can COCP be started
- 21 days if not BF - use exra contraception for 7 days
- 6 months if BF
98
IUD/ IUS after pp
The intrauterine device or intrauterine system can be inserted within 48 hours of childbirth or after 4 weeks.
99
LAM method
is 98% effective providing the woman is fully breast-feeding (no supplementary feeds), amenorrhoeic and < 6 months post-partum
100
For women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine:
UKMEC 3: the COCP and POP
UKMEC 2: implant
UKMEC 1: Depo-Provera, IUD, IUS
101
For women taking lamotrigene
UKMEC 3: the COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS
102
UKMEC 3 for COCP
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
103
ukmec 4 dor COCP
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
104
gastric sleeve/ bypass CI
Patients who have had a gastric sleeve/bypass/duodenal switch cannot have oral contraception ever again due to lack of efficacy, including emergency contraception.
105
Obesity and COCP
BMI UNDER 34 IS UKMEC 2 AND BMI OVER 35 IS UKMEC 3 FOR COCP
106
Mifepristone mechanism
Progesterone antagonist → decidual breakdown.
107
Gemeprost =
PGE1 -> Cervical ripening, uterine contraction.
108
Ix of mifepristone and gemeprost
Medical termination of pregnancy.
109
Uses of antidepressants in perimenipause
- Fluoxetine, Citalopram, Venlafaxine
Use: For vasomotor symptoms if HRT is unsuitable.
110
SE of AD
GI upset, insomnia, sexual dysfunction.
111
oxytocin mechanism
Stimulates uterine contraction.
112
Ix of oxytocin
Labour induction, PPH management.
113
Dinoprostone (PGE2)
- Mechanism: Cervical ripening.
Indications: Induction of labour.
114
use of carboprost
PPH
115
use of ergometrine
PPH
116
ergometrine - avoid in
HTN
117
Carboprost - avoid in
asthma
118
Tocolytics examples
Nifedipine, Salbutamol/Terbutaline, Atosiban
119
indication of tocolytics
uterine relaxation to delay labour (preterm labour)
120
SE of nifedipine
hypotension
121
SE of salb/ terbutaline
B2 agonists - tachycardia
122
1st lines in hyperemessing
- promethazine and cyclizine, chlorpromazine or procholerperazine
- antihistamines
123
2nd line in hyperemesis
Metoclopramide (2nd line): ↑ gastric motility. Use <5 days due to EPS risk.
124
Sedating AH
Chorpheamine and promethazine
125
Oestroadiol (HRT) Ix
> menopausal sx
- Oestrogen alone: for women without a uterus
Combined with progestogen: for women with a uterus (protects endometrium)
126
MAO of oestrodial (HRT)
Replaces falling oestrogen levels → alleviates menopausal symptoms
Progestogen prevents oestrogen-induced endometrial hyperplasia
127
SE of oestradiol - HRT
- Breast tenderness
- N
- headaches
- ↑ risk of VTE, stroke, CHD, and breast cancer (esp. with combined HRT)
128
oestradiol (HRT) CI
Known or suspected breast cancer
Untreated endometrial hyperplasia
Active or history of VTE or stroke
Liver disease
Undiagnosed vaginal bleeding
129
Ralofexine ix
- Prevention and treatment of postmenopausal osteoporosis
- oestrogen receptor + BC
130
MAO - ralofexine
- SERM: oestrogen agonist in bone → ↑ bone density
Antagonist in breast and uterus → ↓ risk of cancer
131
ralofexine SE
- hot flushes
- inc VTE
- flu like sx
132
CI of ralofexine
- Active or past VTE
Pregnancy and breastfeeding
Severe hepatic impairment
133
Ix of tibolone
- Menopausal symptoms (especially low libido)
Prevention of osteoporosis in postmenopausal wome
134
Mao of tibolone
- Converts into metabolites with mixed hormone activity → mimics natural cycle
- synthetic steroid with oestrogen, progestrogenic and androgenic activity Single agent (no separate oestrogen/progestogen needed)
135
HRT route
- HRT can be taken orally or transdermally (via a patch or gel)
transdermal is preferred if the woman is at risk of venous thromboembolism (VTE), as the rates of VTE do not appear to rise with transdermal preparations
136
BC risk with HTT
> inc by progestogen addition
- the risk of breast cancer begins to decline when HRT is stopped and by 5 years it reaches the same level as in women who have never taken HRT
137
endometrial cancer risk w HRT
- oestrogen by itself should not be given as HRT to women with a womb
reduced by the addition of a progestogen but not eliminated completely
the BNF states that the additional risk is eliminated if a progestogen is given continuously
138
high risk VTE women should be ? before starting HRT
Ref to haem before startinge ven transfermal
139
HRT SE
- VTE - inc by addition of progestogen
- stroke
- IHD
140
Atosiban mechanism
oxytocin receptor ant, tocolytic
141
