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Pharmacology > Q6 - Menstruation, Menopause, Contraception And Pregnancy > Flashcards

Q6 - Menstruation, Menopause, Contraception And Pregnancy Flashcards

1
Q

Monophonic COC (same dose of progestin and estrogen in active pills)
-June FE, Microgesting Fe, Sprintec, Loestrin, Yasmin
LOW estrogen.

A
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2
Q

Biphasic COCs – same dose of estrogen, progestin dose decreased ½ way
Extended cycle formulations (Seasonique) <- why would someone want an extended cycle formulation?

A

Decrease the amount of bleeding they have throughout the year.

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3
Q

What is different about Amethyst?

A

Continuous COC - no placebo pills so no periods. Menstrual related anemia and menstrual migraines.
Only approved continuous COC, however others are used off label this way as well.

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4
Q

Starting COCs?

A

“Quick start” - use back up protection for 7 days with COC, but with protestin only pills, quick start only requires back up protection for first 48hours.
Sunday start
First day of Menses

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5
Q

Missed dose of COC?

A

1 pill is late or missed - take as soon as you remember. No back up needed
48hrs of missed pills? Take one as soon as you remember, and discard the other one. Skip placebo week. Back up for 7 days.
Progestin only pill Late pill (>3hrs)? - take as soon as you remember and back up protection for 48hrs.

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6
Q

SEs tend to decrease _____ after starting OCPs.

A

3months

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7
Q

Xulane, Zafemy, Twirla

A

Contraceptive patches

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8
Q

Contraceptive patches have ______ estrogen exposure than COCs. What does this mean?

A

Higher.
CI are more strict - higher risk of clotting

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9
Q

What could happen with obese patients on contraceptive patches?

A

Decreased contraception effectiveness in Those who weigh >198lbs

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10
Q

postpartum women should NOT be given a ________ - why?

A

Patch. Higher concentration of estrogen, so higher blood clotting risk.

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11
Q

NuvaRing and Annovera.
SE?

A

Vaginal ring. Same SE profile as COCs.

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12
Q

Annovera is reusable - 1 ring for the whole year.

A
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13
Q

Most effective forms of reversible contraception?

A

IUDs

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14
Q

IUD AEs?

A

Uterine perforation, PID, embedment, IUD breakage.

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15
Q

Nexplanon - 3 year implantable progestin only.

A
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16
Q

1st line for menstrual cramps?
CI?

A

NSAIDS - started 1-2 days prior to onset of menses or at the start. Decrease prostaglandin synthesis.
Renal impairment

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17
Q

1st line for Dysmenorrhea

A

NSAIDS – start 1-2 days prior to your period. CI in renal impairment.

18
Q

1st line for amenorrhea

A

AFTER identifying cause – nutrition, hormonal, endocrine disorder)
Transdermal estrogen patch + cyclic (long term) oral progestins.

19
Q

Tx of heavy menstruation

A

AFTER ruling out other causes)
NSAIDS, CHCs, Progestins, Iron supp (WITH stool softener)
TXA

20
Q

TXA MOA? AEs?

A

Prevent fibrin degradation to reduce bleeding. AEs? Abd px, HA, back px, MSK px and sinus symptoms.

21
Q

Menopause is a decrease in __________ which causes ____ to increase, leading to __________ symptoms

A

Estrogen/progestin, FSH, vasomotor

22
Q

Expected results of estrogen to treat menopause?

A

Estrogen Decreases LH and helps with maintaining temp control and bone mineral density

23
Q

SE and CI for Estrogen replacement therapy

A

SE – dementia, clots, breast cancer, ovarian cancer, increase HDL, TG, decreases LDL
CI – hx breast ca, active VTE, coagulopatheis, hepatic impairment or pregnancy.

24
Q

Progestin replacement therapy in menopause

A

MOA: suppresses release of FSH and LH. SE – mood disorders and spotting.

25
Q

Would topical estrogen formulation be helpful for someone experiencing mental fogginess, HA, night sweats and vaginal dryness?

A

No

26
Q

HRT comes in 4 different options:

A

Topical estrogen only
Systemic estrogen only
Systemic combination (estrogen and progestin)
Systemic progestin only.

27
Q

T/F: HRT patch must be removed prior to MRI?

A

True

28
Q

Approved Non-hormonal method for VMS in menopause tx? MOA? BBW? SE?

A

Paroxetine (Brisdelle)
MOA: SSRI regulate body temp
BBW: suicide
SE: sedation, insomnia, restlessness, tremor, weakness, dry mouth, constipation, diaphroesis. 4 weeks to take effect

29
Q

Treatment for Dyspareunia? MOA? SE? What line?

A

Ospemifene – oral estrogen agonist/antagonist – short term use only. Hot flashes, vaginal discharge, hyper hidrosis.
Only for severe not treated with vaginal estrogen gel

30
Q

Intrarosa – clinical considerations?

A

Used to treat dyspareunia. Can take 12 weeks to see results. Moderate to severe vaginal dryness and dyspareunia. Administer 1 vaginal insert at bedtime QD.

31
Q

Teratogens:

A

Acne: Isotretinoin, topical retinoids
Antibiotics: quinolones, tetracyclines
Anticoagulants: warfarin
Dyslipidemia, HF and HT: statins, RAAS inhibitors (ACE inhibitors, ARBs, aliskiren, sacubitril/valsartan)
Hormones: estradiol, progesterone, raloxifene, testosterone
Migraine: dihydroergotamine
Others: hydroxyurea, lithium, methotrexate, misoprostol, NSAIDs, paroxetine, ribavirin, thalidomide, topiramate, weight loss drugs, valproic acid/divalproex

32
Q

Meds for heartburn in pregnancy?

A

Tums, simethicone.

33
Q

Tx Constipation in pregnancy?

A

Metamucil with LOTS of fluids
Docusate.

34
Q

Cough/cold/allergies in pregnancy

A

Cromolyn, Benadryll, loratadide, cetirizine, fluticasone. Avoid products with alcohol.
Phenelyphrine and Sudafed are NOT to be used in 1st trimester because they can cause constriction of blood vessels to the fetus.

35
Q

Pain in pregnancy

A

Tylenol - no more than 3.5G/day (less than normal 4G)
NO NSAIDS/opioids (xcept for aspirin in preeclampsia prevention)

36
Q

Infection in pregnancy

A

PCN, cefalosporins, erythromycin, Azithromycin, topicals.
NOT SAFE: FQ, tetracyclines, doxy

37
Q

UTI in pregnancy

A

Cephalexin, ampicillin (w/Clav).
Nitrofurantoin/bactrim reserved for last line - can cause hemolytic anemia/increased chance of jaundice.

38
Q

T/F: all bacteriuria in pregnancy must be treated

A

True. Whether symptomatic or not.

39
Q

Macrobid and bactrim in pregnancy

A

Last line. - not for first trimester or >36wks.

40
Q

T/F: ibuprofen and Tylenol safe while breastfeeding

A

True.

Pharmacology (20 decks)

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