Exam 5 Flashcards
(182 cards)
1
Q
What year is mens growth is considered “delayed puberty”?
A
14yo
2
Q
What is the most common cause of hypogonadism in children/young adults?
A
Constitutional delay of growth and puberty (CDGP_
3
Q
How is hypogonadism in children/young adults treated?
A
IM testosterone esters- 50mg monthly, increasing by 25mg (100mg max)
4
Q
What is the prognosis and treatment for testicular cancer?
A
Prognosis: Good even up to stage III
Treatment: orchiectomy, radiation, chemo
5
Q
Which type of alopecia is characterized by being the most common form or “male pattern baldness.”
Alopecia areata
Androgenic alopecia
Alopecia universalis
Traction alopecia
A
Androgenic alopecia
6
Q
What androgen is responsible for elevated testosterone causing alopecia?
A
Dihydrotestosterone (DHT)
7
Q
Which type of alopecia is an autoimmune response resulting in small round patches?
Alopecia areata
Androgenic alopecia
Alopecia universalis
Traction alopecia
A
Alopecia areata
8
Q
Which type of alopecia results in complete hair loss on scalp and body?
Alopecia areata
Androgenic alopecia
Alopecia universalis
Traction alopecia
A
Alopecia universalis
9
Q
Which type of alopecia results from constant tension on hair?
Alopecia areata
Androgenic alopecia
Alopecia universalis
Traction alopecia
A
Traction alopecia
10
Q
What is Finasteride (Propecia)s MOA, Dose and SE?
A
Finasteride- used for alopecia
MOA: inhibits Type II 5-alpha reductase, inhibiting conversion of testosterone to DHT
Dose: 1 mg PO once daily
SE: Decreased libido, ED, Women of child-bearing age avoid handling
11
Q
What is Minoxidil (Rogaine), MOA and application?
A
MOA: enlarging miniaturized hair follicles
Application: apply to dry scalp twice daily every day
12
Q
What is the criteria for being diagnosed with adult hypogonadism?
A
Low testosterone levels with symptoms
13
Q
When should serum testosterone levels be measured? What level characterizes low testosterone?
A
Blood test should be in the morning, <300 ng/dl is positive for low testosterone.
Confirm with 2nd test, if <5 ng/dl confirms low T
14
Q
What is the frequency of administration and notes regarding IM Injection for Testosterone therapy?
A
Freq: 100mg IM weekly or 200mg IM q other
Notes: very high conc, possible mood swings but most economical
15
Q
What is the frequency of administration and notes regarding the patch for testosterone therapy?
A
1-2 patches applied nightly; most similar to physiologic t-levels, apply away from pressure areas
16
Q
What is the frequency of administration and notes regarding the gel for testosterone therapy?
A
Admin: 5-10g applied to covered area daily
Notes: Shoulders, upper arms, abdomen
17
Q
What is the frequency of administration and notes regarding the solution for testosterone therapy?
A
Admin: 1-4 apps to arm pits dail
Notes: apply deodorant first
18
Q
What is the frequency of administration and notes regarding the buccal tablet for testosterone therapy?
A
Admin: 30mg tab q12h
Notes: Do not chew or swallow
19
Q
What is the frequency of administration and notes regarding the SQ pellet for testosterone therapy?
A
Admin: Implanted q3-6mon
Notes: Delayed onset (3-4mon)
20
Q
What is the frequency of administration and notes regarding the oral capsule Jatenzo for testosterone therapy?
A
Admin: 158-237mg BID
Notes: Take with food, draw serum test 6hrs after AM dose
21
Q
What is the goal level for testosterone?
A
btw 400-700 ng/dL
22
Q
What are the three subtypes of erections?
Psychogenic
Kinetogenic
Reflexogenic
Nocturnal
A
Psychogenic
Reflexogenic
Nocturnal
23
Q
Erections are initiated by (parasympathetic/sympathetic) response and suppressed by (parasympathetic/sympathetic)
A
parasympathetic, sympathetic
24
Q
What is the mechanism for erections (starting with NO)
A
NO activates guanylate cyclase
guanylate cyclase converts GTP to cGMP
high cGMP results in Ca release
Ca release produces smooth muscle relaxation
Smooth muscle relaxation allows blood to flood chambers, making veins be squeezed shut preventing drainage
25
What is the 5 step treatment of ED
1. Treat or eliminate known causes
2. Oral PDE-5 Inhibitors
3. Intraurethral or Intracavernous Tx
4. Possible combination therapy
5. Penile prosthesis
26
What is Sildenafil's drug class, starting and max doses, and onset and duration?
pde-5 inhibitors: take on empty stomach
Starting: 50mg Max: 100mg
Onset: 30-60 min Duration: 4 hrs
27
What is Vardenafil's drug class, starting and max doses, and onset and duration?
pde-5 inhibitors: take on empty stomach
Start: 10mg Max: 20mg
Onset: 30-60min Duration: 4hrs
28
What is Tadalafil's drug class, starting and max doses, and onset and duration?
pde-5 inhibitors: Ok to take with food
Start: 10mg Max: 20mg
Onset: 60min Duration: 36hrs
29
What is Avanafil's drug class, starting and max doses, and onset and duration?
pde-5 inhibitors: Ok to take with food
Start: 100mg Max: 200mg
Onset: 30-60min Duration: 6hr
30
What is the drug/food interaction associated with PDE-5 Inhibitors?
CYP3A4 Inhibitors: grapefruit juice (Prolongs effect of the drugs), Fatty food delays absorption, patients on alpha-blockers (BP), or have severe CAD
31
What patients should avoid the vacuum erection devices?
Sickle-cell patients
32
What drug is used for transurethral suppositories? Intracavernosal injections?
Suppositories- Alprostadil Pellets (Muse) less effective than injection
Intracavernosal- Alprostadil (Caverject) best for neurogenic ED, no stimulation required
33
A condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended
priapism
34
Xiaflex is used to treat what condition:
Erectile Dysfunction
Peyronie's Disease
BPH
Peyroine + BPH
Peyronie's Disease
35
What converts testosterone to DHT?
Type-II 5-alpha reductase
36
How many voids per night constitute nocturia polyuria?
2 or more
37
What are the ranges of AUAs characterizing mild, moderate, and severe?
Mild: <7
Mod: 8-19
Severe: >20
38
What drugs should be avoided with BPH?
anti-cholinergics: benadryl
anti-muscarinics: atropine
Diuretics and nasal decongestants
39
What drug class is Terazosin? Starting and maintenance dose?
alpha-1 adrenergic blocker
Start: 1 mg hs
Maint: 10-20 mg hs
40
What drug class is Doxazosin? Starting and maintenance dose?
alpha-1 adrenergic blockers
Start: 1 mg hs
Maint: 4-8 mg hs
41
What drug class is Tamsulosin? Starting and maintenance dose?
alpha-1 adrenergic blockers
Start: 0.4 mg hs
Maint: 0.4-0.8 mg hs
42
What drug class is Alfuzosin? Starting and maintenance dose?
alpha-1 adrenergic blocker
Start: 10mg daily
Maint: 10mg daily
43
What drug class is Silodosin? Starting and maintenance dose?
alpha-1 adrenergic blocker
start: 4mg daily
Maint: 4-8mg daily with meal
44
What drug can be used for the treatment of BPH and ED?
Tadalafil 5mg daily
45
What prostate size benefits most from hormonal therapy? What are these drugs and the clinical pearls?
>40 grams
Finasteride (Proscar) 5mg PO daily
Dutasteride (Avodart) 0.5mg PO daily
Both Cat X- Women avoid handling (teratogenic)
46
What combination drugs can be used for mod-severe BPH?
Jalyn (Dutasteride + Tamsulosin)
Finasteride + tadalafil (BPH + ED)
Tamsulosin + tolterodine (BPH +OAB)
47
What are the two severe surgical options of BPH?
TUMT: balloon catheter
TURP: scrapes away prostate tissue
48
Which HPV strands indicate cancer? Genital warts?
Cancer: HPV-16 and -18
Genital Warts: HPV-6 and -11
49
Which HPV vaccine is used currently for treating the most serotypes?
Cervarix or Gardasil 9
Gardasil 9
50
Combines at least 2 indicators (ex BBT and secretions)
Symptothermal Method
Electronic Monitoring
Marquette Method
Symptothermal method
51
Detect LH in urine, electrolytes in saliva, or visual forming of cervical mucus or saliva via handheld microscope
Symptothermal method
Electronic Monitoring
Marquette Method
Electronic monitoring
52
Combo of ClearBlue Fertility Monitor (urine hormone detection) and other NFP methods
Symptothermal method
Electronic Monitoring
Marquette Method
Marquette Method
53
Which of the following are STI preventative
Sperimicide
Cervical Cap
Internal Condom
Cervical Cap
Male Condom
Vaginal Sponge
Internal Condom, Male Condom
54
Rank the following from most effective to least
Vaginal ring, IUD, Male Condom, Implant, Pill
Implant, IUD, Pill, Vaginal ring, Male Condom
55
Which suppresses FSH production, prevent dominant follicle, increases sex-hormone binding globulin and increases binding of free androgens?
Estrogen
Progestin
Testosterone
Estrogen
56
Which prevents LH surge, inhibits ovulation, and thickens cervical mucus?
Estrogen
Progestin
Testosterone
Progestin
57
What is desirable (higher/lower) for these progestin components?
Progestational
Androgenic
Antiestrogenic
Progestational- higher
Androgenic- lower
Antiestrogenic- lower
58
What hormones are used in nexplanon? What is the freq of admin? Common side effects? Return of fertility?
Progestin, Left in place up to 3 years, irregular bleeding for first 6-12mon, may be delayed (within 6 weeks)
59
What hormones are used in LNG IUD? What is the freq of admin? Common side effects? Return of fertility?
Progestin, q3-7yrs based on IUD, most side effects due to procedure, spotting first 3-6mon, immediate return to fertility
60
What hormones are used in copper IUDs? What is the freq of admin? Common side effects? Return of fertility?
No hormones, left in place 10+ yrs, historically bleeding worse than LNG IUD, immediate return to fertility
61
What hormones are used in the Depo Shot? What is the freq of admin? Benefits? Common side effects? Return of fertility?
Progestin, 150mg IM or 104mg subcut q 3mon, lower risk of uterine cancer and safe to breastfeed, lower bone density and weight gain common, possible delay in fertility
62
What are the very low, low dose, and high doses for COC? What if late for dose? Benefits and side effects?
Very low: 20-25mcg Low dose: 30-35mcg High: 50mcg
If late one pill, take ASAP. 2 or more, take 1 ASAP and next pill at usual time using backup for 7 days
Benefits: lower ovarian/uterine cancer and improved acne
SE: blood clots (estrogen) and mood
63
What hormones are used in the Mini-pill? What is the freq of admin? If late? Benefits and Common side effects?
Progestin, Daily within 3hrs of the same time with no placebos, if >3 hrs late take asap and backup for 2 days
Benefits: safe to breastfeed
SE: severe headaches, heavy bleeding, ectopic pregnancy
64
What hormones are used in SLYND (POP)? What is the freq of admin? If late? Benefits? Common side effects?
Progestin, daily with 4 placebo,
Late: if late 2 or more pills use backup for 7 days
Benefit: safe to breastfeed
SE: Hyperkalemia, heavy bleeding, severe headaches
65
What hormones are used in the Nuvaring? What is the freq of admin? If late? Benefits and Common side effects?
Hormones: EE + P, releasing 15mcg EE/day
Freq: left in 3 weeks, removed for 1 week with new after 7 days
Late: out for >3hr, reinsert and use backup for 7 days
Benefits: Improved acne and lighter less painful periods
SE: blood clots
66
What hormones are used in Annovera ring? What is the freq of admin? If late? Benefits and Common side effects?
Hormones: EE + P, 13mcg/day
Freq: left in 3 weeks removed for 1 week. Wash with mild soap/warm water
Late: >2 hrs reinsert and use back-up for 7 days
Benefits: improved acne, device up to 13 times
67
What hormones are used in the patch (Xulane, Zafemy)? What is the freq of admin? If late? Benefits and Common side effects?
Hormones: EE (35mcg/day) + P
Freq: new patch q 3 weeks, patch free 7 days
Late: apply new patch, backup 7 days
Benefits: lower ovarian/uterine cancer, lighter periods
SE: Blood clots
68
What hormones are used in the Tweirla patch? What is the freq of admin? If late? Benefits and Common side effects?
Hormones: EE (30mcg/day- less than others) + P
Freq: New patch q 3 weeks, patch free 7
Late: off<24 hrs no backup needed. Off>24hrs 7 days
Benefits: improved acnes, lighter periods
SE: blood clots, skin irritation
69
A patient calls your pharmacy around 10a and says that she forgot to take her COC yesterday afternoon, which she usually takes around 1p. She tells you she only forgot one pill. What should she do?
A. Take her pill and use a form of backup for 7 days
B. Take her pill ASAP and use a form of backup for 2 days
C. Take her pill ASAP; no backup needed
C. Take her pill ASAP; no backup needed
70
A patient calls your pharmacy around 10a and says that she forgot to take her mini-pill yesterday afternoon, which she usually takes around 1p. She tells you she only forgot one pill. What should she do?
A. Take her pill and use a form of backup for 7 days
B. Take her pill ASAP and use a form of backup for 2 days
C. Take her pill ASAP; no backup needed
B. Take her pill ASAP and use a form of backup for 2 days
71
What are the serious side effects from estrogen? (ACHES)
A- abdominal pain (liver, gallbladder, clot)
C- chest pain (SOB, coughing)
H- headache (Stroke, HTN, Migraines)
E- eye problems (double vision, blurry)
S- swelling or sudden leg pain (DVT)
72
Which emergency contraception uses progestin?
Copper IUD
Plan-B
Ella
Plan-B
73
What is the longer amount of time post unprotected sex that can utilize emergency contraceptives?
5 days: the longer the lower the efficacy
74
Which is the most effective emergency contraceptive for all weights?
Copper IUD
Ella
Plan-B
Copper IUD
75
Which EC interferes with sperm viability and function?
Copper IUD
Ella
Plan-B
Copper IUD
76
Which EC inhibits ovulation and leads to follicular rupture?
Copper IUD
Ella
Plan-B
Ella
77
Which EC inhibits ovulation and is labeled for 72 hours?
Copper IUD
Ella
Plan-B
Plan-B
78
When is the latest abortion can occur?
70 days (10 weeks)
79
What are the two medications and the uses in medication abortion?
1. Mifepristone (Mifeprex)- blocks hormones and stops pregnancy
2. Misoprostol (Cytotec)- extracts pregnancy through contractions
80
What doses of Mifepristone and Misoprostol are used during abortion?
Mifepristone- 200mg PO once
Misoprostol- 800mcg (2x200mcg) buccally
81
What is considered heavy bleeding in abortion?
>2pads/hr for 2 consecutive hours, blood clots larger than a lemon
82
If a patient comes in with irregular bleeding, what should be given for the first round (second for pills) to help decrease amount of bleeding?
Ibuprofen 800mg PO TID x 5 days
83
If a patient comes in with heavy/prolonged bleeding, after taking Ibuprofen 800mg, what is next?
EE 50mcg for 21 days (or COC)
84
What is the normal cycle length, menstruation lasting rate, and mL of blood/day?
Cycle length: 22-35 days
Menstruation lasting 3-7 days
35mL of blood/day
85
What type of abnormal bleeding is characterized by abnormal pain associated with menstruation
Dysmenorrhea
Amenorrhea
Oligomenorrhea
Metrorrhagia
Dysmenorrhea
86
What characterizes Primary vs Secondary Dysmenorrhea?
1: normal ovulatory cycles and pelvic anatomy
2: Underlying anatomic or physiologic cause
87
What is the patho of dysmenorrhea?
Buildup of fatty acids in cell membrane released during menses
Prostaglandins and leukotrienes released in uterus
Inflammatory response causes symptoms
88
What is the first line treatment of dysmenorrhea? Second line?
1: NSAID, OC, Non-pharmacologic
2: depo shot (DMPA), Levo-releasing IUD
89
What is the MOA for NSAID therapy?
Inhibits COX 1 and 2, leading to decreased prostaglandin production
90
What type of abnormal bleeding is characterized by absence of the menstrual cycle?
Dysmenorrhea
Amenorrhea
Oligomenorrhea
Metrorrhagia
Amenorrhea
91
What characterizes primary vs secondary amenorrhea?
1: No menses by age 15
2: No menses x 3mon (in menstruating women)
92
What four organs can affect amenorrhea?
Uterus, Ovaries, Pituitary gland, and hypothalamus
93
What drugs induce amenorrhea?
first and second gen antipsychotics, antihypertensives, and GI promotility agents
94
What are pharmacological treatment options for amenorrhea?
Conjugated equine estrogen, estradiol patch
Estrogen with progestin component
95
What type of abnormal bleeding is characterized by a menstrual cycle over 35 days (but less than 90 days)?
Dysmenorrhea
Amenorrhea
Polymenorrhea
Oligomenorrhea
Metrorrhagia
Oligomenorrhea
96
What type of abnormal bleeding is characterized by a menstrual cycle less than 21 days apart?
Dysmenorrhea
Amenorrhea
Oligomenorrhea
Polymenorrhea
Metrorrhagia
Polymenorrhea
97
What characterizes heavy menstrual bleeding (HMB)?
Bleeding > 80mL or lasting > 7 days
98
What are the four etiologies of HMB?
Hematologic- bleeding/clotting disorder
Hepatic- Cirrhosis
Endocrine- Hypothyroidism
Uterine- structural abnormalities, uterine fibroids
99
What are the hormonal treatment options of HMB?
CHC, Progestins, Levo-IUD, Danazol, GnRH agonists
100
What are the non-hormonal treatment options of HMB?
NSAIDs, Tranexamic Acid, and Iron
101
What is the MAO and Dosing of Tranexamic Acid?
MOA: antifibrinolytic (prevents degradation of blood clots)
Dosing: 1300mg PO TID x 5 days (at onset of menses)
102
What type of abnormal bleeding is characterized by irregular menstrual bleeding between cycles?
Dysmenorrhea
Amenorrhea
Oligomenorrhea
Polymenorrhea
Metrorrhagia
Metrorrhagia
103
What are the most common symptoms of endometriosis?
Dysmenorrhea, infertility, dyspareunia, chronic pelvic pain
104
What is the first, second, and third line treatment for endometriosis?
1: NSAIDs, CHCs, Progestins
2: GnRH agonist/antagonists, Danazol
3: Aromatase inhibitors
105
What is the MOA for Danazol?
MOA: androgen that suppresses FSH and LH production
106
Noncancerous tumor formations; smooth muscle cells and fibroblasts of the myometrium
uterine fibroids
107
What are the two surgical options of uterine fibroids and their fertility preservation?
Myomectomy- preserves fertility, removes fibroids (not permanent soln)
Hysterectomy- removes uterus, definitive treatment, not fertile
108
What uterine fibroid treatments induce a menopausal-like state for surgical treatment?
GnRH and SPRM
109
What is the key difference and similarities in PMS and PMDD
Difference: PMS- at least one symptoms for 3 menstrual cycles
PMDD- mental health disorder five symp for 2 consecutive months
Similarities: start of follicular phase
110
What is the first, second and last line treatment for PMS/PMDD?
1: SSRI, NSAIDs, Spironolactone
2 (in order): Venlafaxine, Duloxetine, Clomipramine, Alprazolam, COCs
3: GnRH agonists, surgery
111
What are three clinical presentations of PCOS?
Hyperandrogenism, menstrual disturbances, and overweight or obese
112
What are three clinical presentations of PCOS?
Hyperandrogenism, menstrual disturbances, and overweight or obese
113
What are the three possible mechanisms of PCOS?
*Inappropriate gonadotropin secretion
*Insulin resistance with hyperinsulinemia
*Excessive androgen production
114
Which follicular phase do PCOS stay in?
Follicular
115
What is the mechanism of gonadotropin secretion in PCOS?
Increase GnRH -> Increase in LH too soon -> No rise in FSH -> No dominant follicle -> No ovulation -> Unopposed estrogen -> Luteal phase never entered -> Elevated androgen
116
How does insulin resistance result in hyperandrogenism with PCOS?
The pancreas over-produces insulin to compensate for the lack of maintenance of normal blood sugar levels in the body. This increases adipose tissue, leading to insulin resistance. This blocks SHBG synthesis in the liver, allowing increased free testosterone, increasing androgen levels (hyperandrogenism)
117
What are the diagnosis criteria of PCOS?
Hyperandrogenism
Chronic Anovulation
Polycystic ovaries
(Must present 2/3)
118
How does exercising improve ovarian function?
Decreases free testosterone and hyperinsulinemia
119
What is the first line treatment option for PCOS and its dosing/components?
COC- commonly monophasic
Estrogen: Lowest effective dose (20mcg) titrate up
Responsible for LH suppression and decreasing androgen production
Progestin: preferred- norgestimate and northindrone
AVOID: desogestrel, drospirenone, gestodene
Increases risk for VTE
120
Which one of the following birth control regimens would be most appropriate to initiate in a 29-yr old women with BMI of 34 kg/m2?
A. EE 30 mcg/northindrone acetate 1.5mg daily
B. EE 20 mcg/norethindrone acetate 1mg daily
C. EE 30 mcg/desogestrel 0.15mg daily
D. Norethindrone 0.35mg daily
B. EE 20 mcg/norethindrone acetate 1mg daily
121
What is spironolactone's MOA, Dosing, and Clinical Pearls?
MOA: Anti-androgen at the follicle
Dosing: 50mg - 100mg BID
Pearls: Teratogenic- must be on OC
122
What is Proscar's MOA, Dosing, and Clinical Pearls?
MOA: 5-alpha reductase inhibitor
Dosing: 2.5-5 mg daily
Pearls: teratogenic
123
What is Proscar's MOA, Dosing, and Clinical Pearls?
MOA: 5-alpha reductase inhibitor
Dosing: 2.5-5 mg daily
Pearls: teratogenic
124
What is Metformin's MOA, Dosing, and Clinical Pearls?
MOA: Insulin Sensitizer
Dosing: 500mg PO daily -> 1000mg BID (2000 total)
Pearls: taken with meal (GI), discontinue if pregnant
125
Which statement is FALSE regarding the use of metformin in PCOS?
A. Dose is 500mg PO QD
B. Offers reliable endometrial protection
C. Results may take up to 6 mon to be seen
D. GI side effects will decrease after 2-3 weeks
B. Offers reliable endometrial protection
126
What is the second-line treatment for PCOS Menstrual Irregularity?
Cyclic progestin therapy
(Medroxyprogesterone 5mg-10mg or Micronized progesterone 200 for 10-14 days q 1-2mon)
Progestin-only OC
Levo-IUD
127
What medication should PCOS patients take if they want to become pregnant? What is its mechanism?
Letrozole (Femara)- aromatase inhibitor
Induces ovulation by triggering hypothalamus to increase LH and FSH secretion
128
What is Letrozole (Femara) dosing?
2.5-7.5mg PO x 5 days, starting day 3 of menses
If ovulation does not occur, increase by 2.5mg up to 5 cycles
129
What is the difference between primary and secondary infertility?
1: never before prego
2: have been prego and trying again
130
T/F: Women are the biggest cause of infertility
False: equal between men and women
131
What two factors are the most common in female infertility?
* Tubal and peritoneal factors (blocked fallopian tubes or alteration of the pelvic environ.)
* Ovulatory factors (PCOS)
132
Which product(s) detect surge in LH levels?
OvuSense Device
Urine Ovulation Predictor Kits
Oova Fertility Translator
Urine Ovulation Predictor Kits
Oova Fertility Translator
133
In fetal development, which weeks are the most critical in development?
First 8 weeks
134
How much should a women increase their calories when pregnant?
300-400 extra calories/day
135
What is the limit for caffeine intake in pregnancy?
<200 mg/day
136
What are the three important prenatal supplements? Their dosage?
Folate
Vit D
Calcium
Magnesium
Iron
Folate: 400-600mcg/day
Ca: 1000-1300mg/day
Iron: 27-30mg/day
137
When should prenatal supplements ideally be started?
3 mon prior to conception
138
What vaccines are recommended if pregnant? Not recommended?
Recommend: Inactivated Flu before end of Oct and Tdap btw 27-36 wks of pregnancy
NOT recommended: Live vaccines (ex: HPV, MMR)
139
What are the 6 teratogens to know?
(Will Sam)
Warfarin
Isotretinoin
Lisinopril
Lithium
Statins
Alcohol
Methotrexate
140
What section of package inserts can pregnancy info be found?
Section 8
141
What is the preferred treatment for diabetes management during pregnancy? What should be avoided?
DOC: Insulin
AVOID: Metformin, oral options
142
What is the DOC for hypertension management in pregnancy? What should be avoided?
DOC: Labetalol
Avoid: Lisinopril, Valsartan
143
What is the first line non-pharma treatment for nausea and vomiting?
Avoid triggers, eat smaller, dry meals, avoid spicy food, avoid completely empty stomach
144
What is the 1st and 2nd line pharmacological treatments for nausea and vomiting in pregnancy?
1: Pyridoxine
2: Doxylamine and Pyridoxine
145
For treatment of pain, fevers, and headaches, what should be avoided after 32 weeks?
NSAIDs
146
For treating cough and cold in pregnancy, what is recommended?
Nasal saline spray
147
What is the recommended treatment for urinary tract infections?
1st gen cephalosporins, nitrofurantoin, amoxicillin
148
What scale is used to measure depressive disorders? What is its scoring?
Edinburgh Depression Scale
>10 is indicative of possible depression
149
What is recommended for treating depressive disorders in pregnancy?
CBT (Cognitive Behavior Therapy)
150
What is recommended for treatment of thromboembolism in pregnancy?
Non-Pharma: IVC filter and compression stockings
Pharma: Anticoagulation for at least 6 mon
151
What characterizes preeclampsia?
BP >140/90 mmHg AND
Proteinuria (>300 mg/dL q 24hr)
152
How can preeclampsia be prevented with meds?
Aspirin 60-80mg starting late first trimester
153
What characterizes severe preeclampsia and what is the DOC?
>180/120 (either #)
Hydralazine
154
What is the DOC in seizure management during pregnancy?
Magnesium sulfate 4-6g IV bolus
155
What characterizes HELLP Syndrome?
Hemolysis
Elevated Liver enzymes
Low Platelet count
156
What is the first line treatment of Group B Strep in Pregnancy?
Penicillin G or Ampicillin
157
What time period is preterm labor?
Labor before week 37 gestation
158
What medication prevents preterm labor?
Progesterone
200mg vaginal suppository if no history or preterm birth with prior pregnancies
250mg IM weekly if history
159
Occurs before onset of labor when water breaks but no contraction
Premature Membrane Rupture
160
What treatment options are for preterm labor?
Corticosteroids, Antibiotics, and Toxolytics
161
Which reduces the risk of respiratory distress syndrome in preterm labor treatment?
A. Antibiotics
B. Corticosteroids
C. Tocolytics
D. Magnesium Sulfate
B. Corticosteroids
162
Which treats Group B strep prophylaxis in preterm labor treatment?
A. Antibiotics
B. Corticosteroids
C. Tocolytics
D. Magnesium Sulfate
A. Antibiotics
163
Which inhibits uterine contractions in preterm labor treatment?
A. Antibiotics
B. Corticosteroids
C. Tocolytics
D. Magnesium Sulfate
C. Tocolytics
164
Which provides fetal neural protection in preterm labor treatment?
A. Antibiotics
B. Corticosteroids
C. Tocolytics
D. Magnesium Sulfate
D. Magnesium Sulfate
165
What antibiotics are used in premature membrane rupture?
ampicillin + erythromycin
166
Which stage of labor does the cervix relax, causing it to dilate and thin out?
Stage I
Stage II
Stage III
Stage I
167
Which stage of labor does the uterine contractions increase in strength and the infant is delivered?
Stage I
Stage II
Stage III
Stage II
168
Which stage of labor is the placenta expelled?
Stage I
Stage II
Stage III
Stage III
169
What are the three (P) categories of labor dystocia?
1. Powers: inadequate contractions or pushing
2. Passenger: position, presentation or size of fetus
3. Passage: Maternal bony pelvis and soft tissues impede the progress
170
When is oxytocin administered in labor?
When hypotensive and uterine hyperstimulated
171
What is oxytocin's adverse affect of tachysystole characterized by?
> 5 contractions/10 min
172
T/F: There is a difference of efficacy between c-section and expectant managment
False
173
T/F: Use of oxytocin during labor makes it less likely to require antibiotics before or during labor
T
174
What is the first-line treatment for uterine atony (hemorrhage) to prevent excessive blood loss?
Oxytocin
175
What are the RID ranges for Minimal, Small Amt, Moderate, and Large amount of transfer to milk
<2%: Minimal
2-5%: Small amt
5-10% Moderate
>10%: Large
176
Mom is taking aspirin 325 mg/day
Mom= 75kg
Infant= 5kg
ASA theo Infant dose: 0.25 mg/kg/day
What is the RID?
Maternal: 325/75= 4.33 mg/kg/day
RID: 0.25/4.33= 0.0577 or 5.77%
177
What is 1st line antidepressant treatment for breastfeeding mothers?
Paroxetine and Sertraline
178
What is the safest Hale Risk Category (L)?
L1 safest -> L5 contraindicated
179
If a patient is in methadone-maintenance program can the breastfeed?
Yes
180
What happens to milk production on buprenorphine?
Decrease
181
If opioids must me used, which is the best for breastfeeding mothers?
Morphine- poor oral availability
182
When is the greatest milk supply?
First thing in the morning
