Medications Exam 5

Question 1

Contraception Efficacy rank

Answer 1

Most
Implant
IUD
Sterilization
Injection
Pill
Patch
Vaginal Ring
Diaphragm
Male condom
Female condom
Cervical cap
Sponge
FAM
Spermicide

Question 2

Which depot can we prescribe

Answer 2

Subq NOT IM

Question 3

If patient is experiencing acne, what contraception to use or not

Answer 3

USE:
-COC
-Rings
-Patch

DO NOT USE
-Implant (nexplanon)

Question 4

If patient is experiencing heavy painful periods, contraception to use/not to use

Answer 4

Use
-Levonorgestrel IUD
-SHOT DMPA
-COC
-Monthly ring
-Annual ring

Do not Use
-Copper IUD
-Shot DMPA

Question 5

Contraceptives that are safe for breastfeeding

Answer 5

Shot DMPA
POP - Norethindrone (mini-pill)
POP - Drosperinone 4mg

Question 6

How to solve irregular bleeding

Answer 6

Take pills at same time
-Ibuprofen 800mg 3x a day x 5days
May improve with continued use

Question 7

Serious SE of combined methods

Answer 7

Abdominal Pain
Chest Pain (SOB, coughing)
Headache
Eye problems (double vision, blurry vision)
Severe leg pain

A
C
H
E
S

Question 8

Medication Abortion

Answer 8

Mifepristone (Mifeprex)
200mg orally x 1 dose
Misoprostol (Cytotec)
800mcg buccally 24-48 hours later
2 x 200 mcg tablets in each cheek (30ming)

Question 9

Abortion counseling points

Answer 9

Bleeding
-Bleeding and cramping are expected
-Heavier than menses
Contact
-HEAVY bleeding (.2 pads/hour for 2 consecutive hours; blood clots larger than a lemon)
-Chills and any fever >101 F or 100.4 F for >4 hours
Adverse Effects
-Nausea, vomiting, diarrhea
-HA, dizziness
-Hot flushes, chills
Pain
-NSAIDs recommended
-Most severe ~2.5-4 hours after misoprostol

Question 10

Dysmenorrhea first and second line treatment

Answer 10

First-Line
-Non-steroidal anti-inflammatory (NSAID), +/-
Oral contraceptives +/-
Non-pharmacologic

Second line
-Depot medroxyprogesterone acetate (DMPA)
-Levonorgestrel-releasing IUD

Question 11

Non-Pharmacologic treatment for Dysmenorrhea

Answer 11

-Heating pad
-Exercise
-Nutritional supplementation: omega-3 fatty acids, vitamin B, ginger
-Smoking cessation
-Acupuncture

Question 12

NSAID therapy: dysmenorrhea

Answer 12

Celecoxib
Diclofenac
Ibuprofen
Naproxen

Question 13

Drug induced amenorrhea

Answer 13

First gen antipsychotics
-Prochlorpezaine
Chlorpromazine
-Haloperidol

Second-Generation Antipsychotics
-Risperidone

Antihypertensives
-Verapamil

Gi promotility agents
-metoclopramide

Question 14

First line treatment for amenorrhea

Answer 14

Rule out pregnancy
Determine underlying cause

Question 15

Treatment for amenorrhea: non-pharmacologic

Answer 15

if cause is anorexia
-Weight gain
-Consider work-up for eating disorder
-Cognitive behavioral therapy (CBT)

Excessive exercise
-Reduction in exercise quantity and intensity

Medications
-May consider alternative agents that do NOT inhibit dopamine receptor or increase prolactin levels OR -> initiate dopamine agonist

Question 16

Treatment for amenorrhea - pharmacologic: hypoestrogenic

Answer 16

-Provide supplemental estrogen
-must include progestin component
Conjugated equine estrogen
(Common brands: premarin, cenestin, enjuvia)

Estradiol (patch)
Common brands: Climara, Vivelle dot

Question 17

Treatment for amenorrhea - pharmacologic: cause by medications that increase prolactin levels

Answer 17

Provide Dopamine agonist
-Bromocriptine
Multiple daily dosing (short half-life)

-Cabergoline
Weekly or twice weekly dosing (long half-life)

Contraindications: breast feeding, uncontrolled HTN
Mild side effects: N/D, HA, orthostatic hypotension, fatigue

Question 18

HMB chronic management

Answer 18

Hormonal
-CHC
-Progestins
-Levonorgestrel IUD
-Danazol
-GnRH agonists

Non-Hormonal
-NSAIDs
-Tranexamic Acid
-Iron

Question 19

Tranexamic Acids

Answer 19

Intended for SHORT TERM USE
Nonhormonal; usually reserved for those unable to take CHCs or wanting to conceive

Contraindications
-Active and or h/o deep vein thrombosis (DVT) or pulmonary embolism (PE)
H/O seizure

Side effects
-Generally well tolerated
-Can cause HA, Nasal symptoms

Question 20

Treatment for endometriosis: Non-pharmacologic

Answer 20

Exercise
Acupuncture
Massage
CBT
Surgery

Question 21

First, second, and third line therapy for Endometriosis

Answer 21

First line
-NSAIDs
-CHCs
-Progestins

Second-line
-GnRH agonists/antagonists
-Danazol

Third-Line
-Aromatase inhibitors

Question 22

Danazol

Answer 22

Tx: Endometriosis
Intolerable SE:
-weight gain
-acne
-hirsutism
-lipid abnormalities
-Liver dysfunction
-Changes in blood glucose
Black box warning for thromboembolism

Question 23

Fibroid Tx considerations

Answer 23

Severity of symptoms
Patient age
Reproductive plans

Question 24

Non-pharmacologic treatment - uterine fibroids

Answer 24

Expectant therapy
-No action unless condition changes
-Asymptomatic, Mildly symptomatic
-Fertility

Myomectomy
-Removal of fibroids (surgical or endoscopic)
-Resolution of symptoms while preserving uterus
-Fertility preserved

Hysterectomy
-Removal of uterus
-Definitive treatment
-Fertility NOT preserved

Question 25

Treatment overview - uterine fibroids

Answer 25

NSAIDs
-Hormonal contraceptives
-Tranexamic acid
-Gonadotropin-releasing hormone (GnRH) agonists
-Selective Progesterone receptor modulators (SPRM)

Question 26

Tx for PMS/PMDD - Non-pharmacologic

Answer 26

Limit sodium, caffeine, and alcohol consumption
-Aerobic exercise
-Relaxation techniques (yoga, mediation)
-Structured sleep schedule
-Calcium (elemental of 1200mg/day)
-Magnesium (200-400mg/day)
Vitamin B, D, E

Question 27

PMS/PMDD - Treatment Overview

Answer 27

First line
-Selective Serotonin Reuptake Inhibitors (SSRIs); NSAIDs; Spironolactone

Second-Line
Venlafaxine; Duloxetine; Clomipramine; Alprazolam; COCs

Last Line
-GnRH agonists; surgery

Complementary therapy
Ginkgo; St. John’s Wort

Question 28

SSRI counseling

Answer 28

Black Box Warning
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders

Side Effects
-Varies based on SSRI selected
-Nausea, drowsiness, sex dysfunction, sweating, insomnia, diarrhea, HA, weight gain

Improvement in symptoms
-Usually within 2-3 menstrual cycles