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Therapeutics > Exam 5 Drugs > Flashcards

Exam 5 Drugs Flashcards

1
Q

Breast exam recs

A

-age 40-50 every 1-2 years
-HIGH RISK: annually at 30

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2
Q

Pelvic exam recs

A

-usally only if symptomatic

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3
Q

PAP smear recs

A

-age 21-29: every 3 years
-age 30-65: or HPV test q 3years or both q 5 years

-not if hysterectomy

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4
Q

HPV

A

-most common
-age 18-59
-warts

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5
Q

HPV screening

A

-normal cervial screening for F
-only HIGH RISK men or msm maybe anal PAP

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6
Q

Gardasil-9

A

-HPV vax
-age 9-45
-if <15, 2 dose 0, 6-12 months
-if >15, 3 dose 0, 2, 6 months

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7
Q

HPV vax side effects

A

-inj site pain
-dizziness/fatigue
-headache
-syncope
-vomiting
-myalgia

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8
Q

Behavioral birth control

A

-coitus interruptus
-FAM
-LAM
-NFP

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9
Q

FAM and NFP techniques (5)

A

-Basal body temp
-Billings ovulation (mucus)
-calendar
-standard days
-2 day method

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10
Q

Side effects of too much estrogen

A

-bloating
-breast tenderness
-mood
-headache
-nausea
-HEAVY menses
-fibroid grwoth
-melasma
-vision changes
-weight gain

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11
Q

Side effects of not enough estrogen

A

-LIGHT menses
-vaginal DRYNESS
-spotting
-no withdrawal bleeding

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12
Q

Estrogen (EE) dosing

A

-very low dose <20mcg
-low dose 20-35 mcg
high dose 50 mcg

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13
Q

Too much progestin side effects

A

-acne
-hirsutism
-dec libido
-spression
-inc appetite
-inc sex drive
-noncyclical weight gain
-less energy
-jaundice
-yeast infection
-hair loss
-swelling in arms and legs

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14
Q

side effects of not enough progesstin

A

-breakthrough bleeding late in cycle
-no withdrawal bleeding
-HEAVY menses

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15
Q

Hormonal contraceptives

A

-Implant
-LNG IUD
-copper IUD
-DMPA
-COC
-NN POP
-D POP
-ring
-patch

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16
Q

Implant (nexplanon)

A

-progestin only
-3 years
-delayed or within 6 week return to fertility

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17
Q

Implant side effects

A

-irregular bleeding (normal)
-mood, headache, acne

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18
Q

LNG IUD

A

-progestin only
-3-8 years
-lighter periods
-safe to breast feed
-lower cancer risk

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19
Q

LNG IUD brands

A

-Mirena/Liletta 52mg 8 yr
-Skyla 13.5 mg 3 year
-Kyleena 19.5mg 5 yr

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20
Q

DMPA shot

A

-150mg IM
-104 SC
-progestin only
-weight gain
-lighter periods
-acne
-maybe delayed return in fertility

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21
Q

COC

A

-nausea
-blood clots, stroke
-improved acne
-lighter period

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22
Q

mini-pill

A

-norethindrone and norgestrel
-daily within 3 hours of same time
-could cause ectopic pregnancy

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23
Q

D POP (Slynd)

A

-4mg daily
-no placebo
-hyperkalemia
-more likely for spotting changes
-

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24
Q

Disposable vaginal ring

A

-Etonogestrel and EE
-blood clot, stroke
-improve acne
-regular periods

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25
Q

Annual vaginal ring

A

-segesterone and EE

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26
Q

hormonal contraceptive patch

A

-norelgestromin and EE (Xulane)
-LNG and EE (twirla)

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27
Q

use backup method if starting contraceptive

A

-more than 1-6 days after period start
-use for 2-7 days

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28
Q

Restarting after emergency contraception

A

-immediately if LNG
-5 days later if ulipristal

-backup method 7 daus

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29
Q

If contraception is causing breast tenderness

A

-dec estrogen

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30
Q

Serious side effects of combined methods (ACHES)

A

-ab pain
-chest pain
-headache
-eye problems
-severe leg pain

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31
Q

Progestin only contraindications

A

-breast cancer

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32
Q

Contraception for trans men

A
  1. Progestin only
  2. COC
  3. non-hormonal
  4. irreversible
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33
Q

Emergency contraception methods

A

-Copper IUD
-LNG
-Ulipristal acetate

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34
Q

Drugs with delayed return of fertility

A

-Implant
-DMPA

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35
Q

Medication abortion

A

-mifepristone
-misoprostol

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36
Q

medication abortion contraindications

A

-current IUD
-long term corticosteroids
-adrenal failure
-blood coagulation
-porphyria

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37
Q

Mifepristone

A

-SPRM
-nerosis, softening, prostaglandin sensitivity
-200mg PO once

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38
Q

Misoprostol

A

-contractions
-800 mcg bucally 1-2 days later

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39
Q

Dysmenorrhea treatment

A
  1. NSAID +/- contraceptive
  2. DMPA or LNG IUD
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40
Q

!! Drugs that induce amenorrhea

A
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41
Q

Amenorrhea treatment

A
  1. underlying cause

-supplemental estrogen if HYPOestrogenic (conjugated equine estrogen 0.625-1.25 mg PO days 1-25 or 0.1mg patch weekly)
-dopamine agonist

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42
Q

Dopamine agonists

A

-dec prolactin levels
-treat drug-induced amenorrhea
-Bromocriptine
-Cabergoline

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43
Q

Bromocriptine

A

-dopamine agonist
-treat drug amenorrhea
-multiple daily dosing

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44
Q

Cabergoline

A

-dopamine agonist
-treat drug amenorrhea
-weekly or twice weekly

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45
Q

contraindications to dopamine agonist

A

-breast feeding and uncontrolled HTN

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46
Q

Monitoring for dopamine agonists

A

-BP, HR
-liver and kidney
-preg status
-prolactin level
-avg time 6-8 weeks
-try the other one if it doesnt work

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47
Q

Chronic hormonal HMB treatment

A

-CHC
-progestins
-LNG IUD
-Danazol
-GnRH agonists

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48
Q

Chronic nonhormonal HMB treatment

A

-NSAIDs
-tranexamic acid
-iron to treat deficiency

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49
Q

Tranexamic acid

A

-nonhormonal chronic treatment of HMB
-prevents degradation of blood clots
-1,300mg PO TID for 5 days at start of menses

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50
Q

Tranexamic acid contraindications

A

-DVT, PE
-seizure

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51
Q

Acute HMB treatment

A
  1. High dose estrogen (25mg equine IV q4-6h for 24 h)
    -monophasic 30-35 mcg EE PO q6-8h until bleeding stops
  2. medroxyprogesterone 20mg PO TID x 7 days
  3. Tranexamic acid 1,300mg PO TID 5 days
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52
Q

Goals of endometriosis therapy

A

-minimize lesions
-prevent endometriosis progression
-minimize pelvic pain
-repair fertility

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53
Q

Endometriosis treatment

A
  1. NSAIDs, CHCs, progestins
  2. GnRH (ant)agonists, danazol
  3. aromatase inhibitors
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54
Q

Danazol

A

-androgen
-suppresses FSH and LH
-PO BID
-acne, weight gain, hirsutism, lipid, liver, glucose
-black box for thromboembolism
-do NOT use if preg or breastfeeding

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55
Q

Goals of Fibroid therapy

A

-reduce size
-reduce symptoms
-respect fertility
-improve QOL

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56
Q

Nonpharmacological treatment of fibroids

A

-expectant therapy
-myomectomy
-hysterectomy (no fertility)

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57
Q

Fibroid treatment

A

-NSAIDs
-contraceptives
-tranexamic acid
-GnRH agonists
-SPRM

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58
Q

GnRH agonists

A

-treat fibroids
-pre-op or near menopause
-dec blood loss and recovery time
-bone loss

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59
Q

SPRM for uterine fibroids

A

-treat fibroids
-pre-op or near menopause
-dec size
-not associated w hypoestrogenic effects
-mifepristone 10-50mg qd
-ulipristal 5-10mg qd
-neither FDA for fibroids tho

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60
Q

Drugs that reduce fibroid size

A

-LNG IUD
-GnRH agents
-SPRMs

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61
Q

Fibroid drugs that do not help dysmenorrhea

A

-tranexamic acid
-SPRMs
-both help HMB tho

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62
Q

Fibroids in pregnancy treatment

A

-avoid myomectomy
-acetaminophen, opiod, NSAIDs

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63
Q

Nonpharmacologic treatment for PMS

A

-limit sodium, caffeine, alcohol
-aerobic exercide
-sleep
-calcium
-magnesium
-vitamin BDE

64
Q

PMS treatment

A
  1. SSRIs, NSAIDs, Spirinolactone
  2. SSNRIs, COCs, Clomipramine, Alprazolam
  3. GnRH agonists, surgery

-complement w Ginkgo or St. John’s Wort

65
Q

SSRIs

A

-PMS treatment
-Fluoxetine 20mg
-Sertraline 50-150mg
-Paroxetine 12.5-25 mg
-Citalopram 20-30mg
-Escitalopram 10-20mg

-start day 14 of cycle stop 1-2 days after onset of menses or continuous use

66
Q

SSRI counseling

A

-suicide
-nausea, drowsiness, sexual dysfunction, sweating, insomnia, diarrhea, HA, weight gain
-wait 2-3 cycles

67
Q

Spirinolactone for PMS

A

-interfere w testosterone synthesis
-100mg qd days 15-28
-dec weight gain, somatic symptoms, negative mood

68
Q

Spirinolactone side effects

A

-hyperkalemia
-somnolence
-irreg menses
-diarrhea/nausea
-headache

69
Q

SNRIs for PMS

A

-venlafaxine 75-112mg during luteal phase ot 50-200 mg qd
-Duloxetine 60mg qd
-HA, inc BP

70
Q

COCs for PMS

A

-EE 20 mcg
-drospirenone 3 mg qd 24 days
-use if also asking for contraception

71
Q

Clomipramine

A

-treat PMS
-25-75 mg qd
-blurred vision, dry mouth, constipation, fatigue, HA

72
Q

Alprazolam

A

-treat PMS
-0.25-1mg TID-QID luteal phase
-sedation and risk of dependence

73
Q

Spirinolactone improves which symptoms

A

-breast tenderness
-bloating
-negative mood

74
Q

Clincal presentation of PCOS

A

-HYPERanrogenism (hirsutism, acne, alopecia)
-Menstrual disturbances (amenorrhea, oligomenorrhea, anovulation)
-overweight or obese

75
Q

PCOS potential causes

A

-inappropriate gonadotropin secretion (elevates androgen levels)
-insulin resistance w hyperinsulinemia (elevates androgen levels)
-excessive androgen production

76
Q

Inappropriate gonadotropin secretion cause of PCOS

A

-inc GnRH = LH surge too soon = no rise in FSH

-no dominant follicle
-no ovulation = no luteal phase = inc LH
=elecvated androgen levels

77
Q

PCOS diagnostic criteria

A

-HYPERandrogenism + irregular cycles
-if only one test for hyperandrogenism and request ultrasound in adult

78
Q

Treatment goals of PCOS

A

-maintain normal endometrium
-block androgens
-reduce insulin resistance
-reduce weight
-prevent long-term complications
-ovulation induction

79
Q

Treatment of PCOS

A

-COC
-spironolactone
-5-a reductase inhibitors
-metformin

80
Q

COC for PCOS

A

-1st line
-lowest effective dose 20-30mcg EE
-noregestimate < LNG < norethindrone
-monophasic usually

81
Q

Spironolactone for PCOS

A

-50-100mg BID
-block androgenic effects
-monitor K
-bleeding, tenderness, HA, dissiness
-teratogenic use contraception
-add on therapy for hirsutism and acne

82
Q

5-a reductase inhibitor

A

-treat PCOS
-prevent DHT
-use if the other ones dont work
-finasterise (proscar) 2.5-5mg qd
-HA, orthostasis
-must use contraception

83
Q

Metformin for PCOS

A

-1st line in PCOS BMI > 25
-2nd line for menstrual irreg
-reduce insulin and androgen
-500mg PO qd to 1000mg BID
-up to 6 months to see effect
-monitor B12
-disc if preg
-not endometrial protective until reg menses and ovulation are established
-helpful when lifestyle interventions fail

84
Q

PCOS treatment in insulin resistance

A
  1. lifestyle
  2. metformin
85
Q

PCOS treatment for menstrual irreg

A
  1. COC
  2. progestins or metformin
86
Q

Hyperandrogenism treatment

A
  1. COC
  2. anti-androgens (spironolactone, finasteride)
    3, Topical Vanqia facial hair
  3. cosmetic procedures
87
Q

Treatment of PCOS if preg is wanted

A

-aromatase inhibitors (letrozole)

88
Q

Letrozole (femara)

A

-aromatase inhibitor
-treat PCOS if preg wanted
-stops conversion of androgens to estrogen = inc LH and FSH
-2.5-7.5 mg PO 5 days day 3 of menses
-inc by 2.5mg next cycle if no period up to 5 cycles
-avoid CYP2A6 substrate
-monitor use w tamoxifen and methadone
-hot flashes, edema, dizziness, fatigue, HA
-do NOT use if preg

89
Q

Anovulation treatment in PCOS

A
  1. Letrozole (aromatase inhibitor)
  2. Clomiphene + metformin, gonadotropin therapy, ovarian drilling
  3. IVF, IVM
90
Q

when to evaluate women < 35 for infertility

A

-inability to become pregnant after 12 months

91
Q

when to evaluate women 35-40 for infertility

A

-after 6 months no preg

92
Q

when to evaluate women > 40 for infertility

A

-after less than 6 months no preg

93
Q

Infertility treatment

A

-aromatase inhibitor (letrozole)
-gonadotropins
-assissted techniques

94
Q

Aromatase inhibitors for ovulation

A

-Letrozole (femara)
-2.5-10mg PO 5 days start day 3
-avoid use w CYP2A6
-monitor w tamoxifene and methadon

95
Q

Gonadotropins for fertility

A

-hCG injection at end of ovulation
-inc FSH
-multiple follicles
-careful monitoring
-dose specialized to clinic

96
Q

Growth hormone (somatotropin)

A

-inc production of IGF-1
-reduced insulin sensitivity
-disulfide bond
-treat short kids and HYPOglycemia
-anti obesity
-athletics

97
Q

Mecasermin

A

-rIGF-1
-treat severe IGF-1 deficiency
-might result in HYPOglycemia

98
Q

Growth hormone antagonists and Somatostatin analogs

A

-Octreotide
-Lanreotide
-Pegvisonmant
-treat GH-secreting ademonas (acromegly)

99
Q

Prolactin

A

-responsible for lactation
-inhibited by dopamine
-can’t treat hypo but can treat hyper w dopamine agonists

100
Q

Vasopressin

A

-Desmopressin
-ADH, arginine vasopressin
-released in response to rising plasma toniciy or falling blood volume
-inc reabsorption of water
-inc blood volume and BP
-IV or IM
-treat pituitary diabetes, nocturnal pissing, coagulopathy
-water intoxication, careful in CVD, ab cramps

101
Q

V1 receptor

A

-vasoconstriction
-Ca++
-smooth muscle

102
Q

V2 receptor

A

-inc water absorption
-cAMP
-renal tubule cells

103
Q

Desmopressin V receptor activity

A

-more V2 - more anti-diuretic

104
Q

Vasopressin antagonists

A

-treat hyponatremia (asc w CVD)
-IV in hospital
-Conivaptan IV
-Tolvaptan (V2 oral)

105
Q

Oxytocin

A

-labor contractions
-milk ejection
-GPCR -> ca -> contraction
-weak vasopressor activity at high doses
-induce labor, control hemorrhage (IV), enhance milk ejection (nasal)

106
Q

Oxytocin contraindications

A

-fetal distress
-abnormal fetal presentation
-cephalopelvic disproportion

107
Q

Which vax for preg people

A

-inactivated flu
-Tdap
-RSV
-Covid

108
Q

vax NOT for preg people

A

-HPV
-MMR
-live flu
-varicella
-yellow and typhoid fever

109
Q

N/V treatment pregnancy

A
  1. Pyridoxine
  2. Doxylamine
  3. Pyridoxine
  4. diphenhydramine
110
Q

GERD treatment pregnancy

A

-antacids
-sucralfate
-histamine

111
Q

which analgesic in preg

A

-acetaminophen
-AVOID NSAIDs and aspirin

112
Q

UTI treatment in preg

A

-cephalexin
-amox or nitro

113
Q

levothyroxine in pregnancy

A

-inc dose

114
Q

Hyperthyroidism in preg

A

-propyluracil first semester
-methimazole after

115
Q

Thromboembolism in preg

A

-LMWH 2 months and until 3 weeks postpartum
-AVOID WARFARIN

116
Q

Preeclampsia management

A

-Hydralazine
-Labetalol
-nitroprusside
-nifedipine
-AVOID ACE/ARBs

117
Q

Eclamsia in preg

A

-seizures
-Mg sulfate 4-6g bolus
-phenytoin, benzos, immediate delivey

118
Q

Strep in preg

A

-PCN G or ampicillin IV in labor
-cefasolin, clinda/vancomycin if allergy

119
Q

Preterm labor treat

A

-200mg progesterone suppository
-250mg IM weekly if history

120
Q

Premature membrane rupture in preg

A

if <34 weeks, corticosteroids, antibiotics, tocolytics, mg sulfate

121
Q

Labor dystocia treatment

A

-oxytocin
-cesarean section

122
Q

When to induce labor

A

-41-42 weeks
-preeclampsia
-infection
-fetal compromise
-DM, renal , pulmonary disease, HTN

123
Q

Oxytocin regimen

A

-1-2 up to 4-6 ml/min q15-40 min
-max 40

124
Q

Oxytocin for abortion

A

-2nd trimester
-admit to labor and delivery
-higher dose 50/500ml over 3 hours

125
Q

relative infant doses (RID)

A

-infant dose/mother dose
-ideally <5%

126
Q

lactation risk category (safe to least safe)

A
  1. acetaminophen, amox
  2. diphenhydramine, fluoxetine
  3. pseudofed, hydrocodone
  4. colchicine, dapsone
  5. amiodarone, chemo
127
Q

Drugs to inc milk supply

A

-metoclopramide
-domperidone
-sulpiride

128
Q

HYPOgonadism treatment in men

A

-IM testosterone esters
-50mg monthly inc by 25 up to 100

129
Q

Alopecia treatment

A
  1. Finasteride (5-a reductase)
  2. Minoxidil
  3. combo
130
Q

Finasteride for alopecia

A

-1mg PO qd
-dec libido
-very effective

131
Q

Minoxidil for alopecia

A

-enlarge mini hair follicles
-apply to DRY scalp BID

132
Q

ideal testosterone levels

A

->300ng/kl
->5ng/dl free

133
Q

THT

A

-IM 100mg weekly or 200mg biweekly
-patches 1-2 at night
-gel 5-10g
-solution 30-120mg to armpits
-buccal tablet 30mg q12h
-SQ pellet 3-6 months

134
Q

Contraindications to THT

A

-prostate and breast cancer
-hematocrit >50%
-baseline PSA > 4, 3 in high risk men
-CVD

135
Q

THT monitoring

A

-3-6months
-measure testosteone and hematocrit, stop if over 54%

136
Q

Prostate cancer screening

A

-PSA > 4, yearly testing
-not over 70

137
Q

drugs that cause Erectile Dysfunction

A

-SSRis
-anti HTN
-estrogens
-5-a reductase inhibitors
-chemo

138
Q

ED treatment

A
  1. treat known causes (THT if hypogonadism)
  2. PDE-5 inhibitors or vacuum
  3. intraurthral
  4. combo
  5. prostetic
139
Q

PDE-5 inhibitors for ED

A

-relaxation
-sildenafil 50-100mg
-tadalafil 10-20mg but 2.5-5mg if qd
-food delays absorption

140
Q

start sildenafil at 25 instead of 50mg for

A

->65 yo
-liver probs
-CrCL <30
-drug interaction

141
Q

PDE-5 precautions

A

-nitrates
-a-blockers (start at lower dose)
-pt w CAD

142
Q

Pulmonary HTN treatment

A

-Sildenafil 20mg po TID
-tadalafil 40mg qd

143
Q

Transurethral tx of ED

A

-alprostadil pellets (MUSE)
-less effective than injection
-125-1000mcg
-alprostadil injection max once a day 3 per week

144
Q

intracavernosal injections for ED

A

-alprostadil 2.5mcg to 10-20mcg
-Trimix

145
Q

Drugs that induce priapism

A

-antidepressants
-clozapine, chlorpromazine
-heparin, warfarn
-cocaine
-alcohol

146
Q

treatment of priapism

A

-phenylephrine 0.1-1mg
-blood aspiration
-saline irrigation
if not painful use coldpack

147
Q

BPH treatment w ED

A

-a-antagonist
-PDE inhibitor
-or both

148
Q

BPH treatment w small prostate, low PSA

A

-a-antagonist

149
Q

BPH treatment large prostat and inc PSA

A

-5-a reductase inhibitor +/- a-antagonist

150
Q

BPH treatment with voiding symptoms

A

-a-antagonist
-anticholinergic agent (avoid in pts >200ml)

151
Q

A-1 blockers for BPH

A

-tamsulosin 0.4mg hs
-alfuzosin 10mg qd
-silodosin 4mg qd

-doxazosin 1mg hs to 4-8
-terazosin 1mg hs to 10-20mg

152
Q

PDE inhibitors for BPH

A

-if also ED
-tadalafil 5mg qd
-2.5mg is CrCl 30-50
-do NOT use if < 30ml

153
Q

Hormonal therapy of BPH

A

-dec prostate size
-5-a reductase inhbitors
-can take 6 months
-finasteride 5mg
-dutasteride 0.5mg

154
Q

tolterodine

A

in OAB

155
Q

Testosterone for trans men

A

-cypionate or enanthate inj
-gel
-patch

156
Q

antiandrogens for trans women

A

-spironolactone
-finasteride/dutasteride

157
Q

hormone injection requirement

A

-1ml syringe
-18-20g to draw injection
-smaller 22-25 g after
-IM 1.5 in
-SC 5/8 in

Therapeutics (78 decks)

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