misc Flashcards
(210 cards)
1
Q
A pt is prescribed Zoloft for depression and azithromycin to treat an infection. What will you do?
A
Both prolong QT, request an order for a different antibiotic. Can increase the risk of fatal dysrhythmias
2
Q
Pt has a headache and takes some Tylenol. She was telling you about her headache and mentioned that after the Tylenol and wine she had, she felt better. What recommendations and/or education do you provide
A
combining Tylenol with alcohol can increase the risk of hepatotoxicity. Even one or 2 drinks can be dangerous
3
Q
what systemic electrolyte imbalance affects Digoxin and how
A
in the presence of hypokalemia, the ability of Digoxin to induce dysrhythmias is greatly increased
pts receiving digoxin must undergo regular measurements of serum potassium
4
Q
what type of tolerance refers to tolerance associated with long term administration of drugs such as morphine and heroin
- increased drug levels are required to produce an effective response, the minimum effective concentration (MEC) of a drug becomes abnormally high.
- you need more to get desired effect
A
pharmacodynamic tolerance
5
Q
what type of tolerance is resulting from accelerated drug metabolism
this type of tolerance does not affect the MEC (minimum effective concentration). Dosage must be increased to maintain therapeutic levels due to the rate of drug metabolism
A
metabolic tolerance
6
Q
what type of tolerance is resulting from a reduction in drug responsiveness brought on by repeated dosing over a short time
an example is transdermal nitroglycerin - effects are lost in less than 24 hours if the patch is left in place around the clock. This is due to the loss of effects from depletion of a cofactor required for nitroglycerin to act. When nitro is administered on an intermittent schedule, the cofactor can be replenished between doses and no loss of effect occurs.
A
Tachyphylaxis
7
Q
the amount of an active drug that reaches the systemic circulation from its site of administration
A
Bioavailability
8
Q
does diarrhea or constipation affect drug absorption?
A
yes
9
Q
gender differences for Digoxin
A
when used to treat heart failure, digoxin may increase mortality in women while having no effect on mortality in men
10
Q
gender differences for alcohol
A
alcohol is metabolized more slowly by women as opposed to men. A woman who drinks the same amount as a man (on a weight adjusted basis) will become more intoxicated.
11
Q
gender differences for opioid analgesics (pentazocine, nalbuphine)
A
they are more effective in women then men
12
Q
gender differences for Quinidine
A
causes greater QT prolongation in women then in men
13
Q
what antihypertensive med can a asthma pt not take
A
b blocker
14
Q
CYP variant for Tamoxifen
A
can greatly reduce the benefits of Tamoxifen which is used to prevent breast cancer recurrence. To work Tamoxifen must be converted to its active form endoxifen. Women with the CYP2D6 gene cannot activate the drug well, so they get minimal benefit from treatment.
15
Q
CYP and Plavix
A
These people experience a weak antiplatelet response, which places them at increased risk for stroke, mI and other events. People with this genetic variation should use a different antiplatelet drug
16
Q
CYP Isoniazid
A
a drug for tuberculosis. This increases chances for rapid metabolism of the drug. The rapid metabolizers may experience treatment failure.
The slow metabolizers may experience toxicity
17
Q
CYP codeine
A
unable to convert codeine into morphine (the active form of codeine. As a result, codeine cannot relieve pain in these people
18
Q
CYP and warfarin (Coumadin)
A
increase the risk for toxicity. metabolized warfarin slowly
19
Q
CYP and thiopurine methyltransferase
A
delay metabolic inactivation of two thiopurine anticancer drugs, thioguanine and mercaptopurine. Pt with inherited deficiency, these drugs can accumulate to high levels, posing a risk for potentially fatal bone marrow damage
20
Q
fluorouracil and cyp
A
about 1% of population produces a form of dihydropyrimidine dehydrogenase that does a poor job of metabolizing fluorouracil. Leads to toxic levels
21
Q
genetic variation and fda recommendation for Carbamazepine (Tegretol)
A
HLA-B-1502 triggers a cellular immune response in patients of Asian descent. FDA recommends anyone of Asian descent to be screened prior to starting tegretol.
22
Q
how long is the time for the serum levels to decrease by 50%
A
this number is equal to the half life of the drug
23
Q
A ________of a drug must be present before a reaction occurs within the cells to bring about the desired therapeutic effect
A
critical concentration
24
Q
A ________is obtained from absorption of a drug from the site of drug entry, distribution to the active site, metabolism in the liver, and excretion from the body to have a critical concentration
A
dynamic equilibrium
25
the ability of a drug to attach only to those systems found in foreign cells.
selective toxicity
26
the process that uses energy to actively move a molecule across a cell membrane
active transport
27
what can change absorption in an IM injection
environmental temp, cold can cause vasoconstriction and decrease absorption and heat can cause vasodilation and increase absorption
28
by the third trimester there is an accelerated clearance of drugs that are eliminated by glomerular filtration. What drug is given as the example that the elimination is increased by 100%
Lithium
29
3 seizure drugs are affected by the increased hepatic metabolism in the 3rd trimester
phenytoin
carbamazepine
valproic acid
30
bowel effects of drug elimination in pregnancy
tone and motility of bowel decrease in pregnancy. This causes intestinal transit time to increase. Because of prolonged transit, there is more time for drugs whose absorption is normally poor. This can lead to a prolongation of effects
31
heparin in pregnant patients
can cause osteoporosis, which in turn can cause compression fractures of the spine
32
prostaglandins in pregnancy (ie misoprostol)
stimulate uterine contraction which can cause abortion
33
ASA in pregnancy near term
can suppress contractions in labor and can increase the risk for serious bleeding
34
withdrawal symptoms in newborn
shrill crying
vomiting
extreme irritibility
35
teratogenesis preimplantation/presomite period
conception through week 2 - all or nothing. either death or they completely recover
36
Teratogenesis embryonic period
this is roughly the first trimester.(week 3-8) Gross malformations
37
Teratogenesis fetal period
week 9-term usually disrupts function rather than gross anatomy. growth and development of the brain are esp important. Can result in learning deficits and behavioral abnormalities
38
does lack of proof of teratogenicity mean that the drug is completely safe?
no, it just means that there may be insufficient data
39
does proof of teratogenicity mean that every exposure will result in a congenital anomaly?
no, the risk for malformation after exposure is only about 10%
40
Pregnancy risk categories
```
A is remote risk
gets greater the further down
A
B
C
D
X - proven risk for fetal harm
```
41
what type of drugs cross the placenta more readily
lipid soluble drugs
42
what type of drugs have a harder time crossing the placenta
Drugs that are highly polar, ionized and protein bound
43
when a medication is given IV what is the difference between a infant and an adult
In an infant the levels decline more slowly. As a result the drug level in the infant remain above the MEC (minimum effective concentration) longer than in the adult, thereby causing effects to be prolonged.
44
when a drug is administered subcutaneously in an infant vs an adult
levels in the infant remain above the MEC longer than in the adult, but these levels also rise higher, causing effects to be more intense as well as prolonged
45
for drugs that are absorbed primarily from the stomach, delayed gastric emptying ______absorption
enhances
46
for drugs that are absorbed primarily from the intestine, absorption is ______
delayed
47
Gastric acidity after birth
is very low for 24 hours after birth and does not reach adult values for 2 years. Because of low acidity, absorption of acid-labile drug (drug that is easily destroyed in an acidic environment) is increased
48
transdermal absorption in infants
more rapid and complete in infants as opposed to older children and adults which makes them at increased risk for toxicity
49
complete maturation of the liver develops by
1 year
50
Adult levels of renal function are achieved by
1 year
51
children older than 1 metabolize drugs ____ than adults
faster. Drug -metabolizing capacity is elevated until 2 years then gradually declines
52
adverse drug reactions for kids caused by glucocorticoids
growth suppression
53
adverse drug reactions for kids caused by tetracyclines
discoloration of developing teeth
54
adverse drug reactions for kids caused by sulfonamides
kernicterus (brain damage from high levels of bili) also causes vision and teeth problems
55
As a rule, the ____ of an oral dose that becomes absorbed does not usually change with age. However, the ____ may change. As a result, drug responses may be somewhat delayed.
percentage, rate
56
What four major factors can alter drug distribution in older adults
1) increased % body fat
2) decreased % of lean body mass
3) decreased total body water
4) reduced concentration of serum albumin
57
the increase in body fat seen in older adults provides a storage depot for lipid soluble drugs which does what?
the plasma levels of these drugs are reduced, causing a reduction in responses
58
Because of the decline in lean body mass and total body water, water soluble drugs such as ethanol become what?
distributed in a smaller volume than in younger adults. This means the concentration of these drugs is increased, causing effects to be more intense.
59
in older adults what lab test properly measures renal function
creatinine clearance not serum creatinine levels - that can be normal even with renal function significantly reduced
60
what antihypertensive med is not as effective in older adults
b blockers
61
what is the Beers list
identifies drugs with high likelihood of causing adverse effects in older adults
62
which medications out of this list would you be concerned about an older adult taking? (On the BEERS list)
```
Tylenol
Zoloft
Allegra
Benadryl
Oxycodone
Amitriptyline (Elavil)
OTC laxative
Zolpidem (Ambien)
```
Amitriptyline (Elavil) - anticholinergic effects
Benadryl - causes blurred vision
and when given together they both have CNS effects that can compound on each other
63
meperidine (Demerol) and older adults
not as effective at usual doses and can cause confusion. Morphine is a better choice
64
progestogens
estrogens and progestins
65
the principal endogenous estrogen is
estradiol - produced by overies
66
the principal endogenous progestational hormone is
progesterone - produced by overies
67
what do the progestogens do
promote female maturation and help regulate the ongoing activity of the female reproductive organs. in addition, they affect bone mineralization and lipid metabolism
68
first half of the cycle - days 1-14 is what phase
follicular phase
69
second half of the cycle days 15-28 is what phase
luteal phase
70
what two pituitary hormones play central roles in regulating the menstrual cycle
LH and FSH
71
this hormone block bone resorption and may promote mineral deposition. During puberty when levels grow high enough they promote epiphyseal closure and bring linear growth to a stop. In postmenopausal women this can lead to osteoporosis
estrogen
72
estrogen and atherosclerosis and cholesterol
decrease atherosclerosis through fav effects on cholesterol
decrease LDL
increase HDL
73
estrogen and insulin
estrogen increases insulin sensitivity to promote glucose uptake
74
effects of decreased estrogen
```
vasomotor symptoms - hot flashes, night sweats
sleep disturbances
urogenital atrophy
bone loss
altered lipid metabolism
```
75
mental changes in menopause
cognitive changes - difficulty in problem solving and short term memory loss around when menopause begins. Others experience depression or an increase in anxiety.
76
what are some causes of estrogen deficiency
```
primary ovarian failure
hypopituitarism
bilateral oophorectomy (removal of both ovaries)
Turner syndrome (genetic disorder that impairs gonadal function)
```
77
estrogen therapy adverse effects
endometrial hyperplasia
endometrial cancer
breast cancer
cardiovascular thromboembolic events
78
the potential for endometrial hyperplasia and endometrial cancer with estrogen therapy can be resolved by prescribing a
progestin
79
is cholasma dangerous when seen as an adverse effect of estrogen replacement therapy
no but it may cause significant distress for some women
patchy brown facial discoloration
80
who should not take estrogen
History of DVT, PE, Stroke, MI
pregnant
history of liver disease, estrogen dependent tumors or breast cancer (except when used for treatment)
81
drug interactions for estrogen
Estrogens are major substrates of CYP1A2 and CYP3A4
- inducers may lower estrogen levels
- inhibitors may raise estrogen levels
may decrease effectiveness of some antidiabetic drugs and thyroid preparations
can also interact with anticoagulants
82
esterified estrogen
plant based
83
conjugated estrogen
natural preparations derived from the urine of pregnant horses
84
phytoestrogens
natural plant based
strong support for it but RCTs are inconsistent so they aren't recommended but they also are not discouraged either
same risks as estrogen
85
what baseline data do you need for estrogen replacement
```
HR
BP
weight
pregnancy test
TSH
serum triglyceride (or full lipid panel)
breast cancer screening
screening for heart disease
gynecologic exam if indicated
```
86
monitoring for estrogen replacement
```
BP
weight
serum triglycerides
TSH if on thyroid replacement
Regular breast and pelvic exams
```
endometrial biopsy for unscheduled bleeding that continues for 6 mos
87
most common side effect of nausea that goes away with time
nausea
88
tamoxifen (Nolvadex-D)
toremifene (Fareston)
raloxifene (Evista)
bazedoxifene (Duvavee)
SERMS (selective estrogen receptor modulators)
89
what SERM is special in that it is used to prevent and treat breast cancer. This also protects against osteoporosis.
tamoxifen (Nolvadex-D)
produces hot flashes
increases risk for endometrial cancer and thromboembolism
90
Which SERM is only approved for prevention and treatment of osteoporosis and for prevention of breast cancer in high risk women. This drug also does not pose a risk for uterine cancer
Raloxifene
91
what is the SERM that is a estrogen agonist/antagonist that reduces the risk for excessive growth of the lining of the uterus that can occur with the estrogen component
Duavee (combination estrogens/basedoxifene)
contraindications are the same for other estrogen containing products
92
what does progesterone affect
```
endometrium
endocervical glands
breasts
body temp
respiration
mood
suppress the contraction of uterine smooth muscle
also suppresses contraction of GI smooth muscle - constipation
```
93
Progestins are used in
menopausal hormone therapy
dysfunctional uterine bleeding
amenorrhea
endometrial hyperplasia and carcinoma (do not prolong life)
94
3 drugs used for endometrial hyperplasia which is a potentially precancerous condition
```
megestrol acetate (Megace)
medroxyprogesterone acetate (Provera)
Mirena IUD
```
95
adverse effects of Progestins
```
breast tenderness
headache
abd discomfort
arthralgias
depression
```
96
```
medroxyprogesterone acetate (Provera)
norethindrone (Micronor)
Norethindrone acetate (Aygestin)
megestrol acetate (Megace)
levonorgestrel (Plan B one step, Next choice)
Progeserone (Prometrium)
norgestimate, drospirenone sold as Prefest and Angeliq
Depo Prevara
Progesterone gel (Crinone)
Nexplanon (Sub q implant)
NuvaRing (vaginal ring)
```
all examples of
Progestins
97
Baseline data for progestins
HR
BP
assess for fluid retention, including weight
transvaginal us for undiagnosed bleeding that continues for 6 mos
98
pt education for progestins
report any abnormal or prolonged bleeding
99
In hormone replacement therapy what is the purpose of the progestin
to counterbalance estrogen-mediated stimulation of the endometrium
100
benefits of Hormone replacement therapy
controlling vasomotor symptoms, improved sleep, restoration of libido, improved cognition and enhanced mood
medical side - suppression of vasomotor symptoms, prevention of urogenital atrophy
prevention of osteoporosis
101
risk for complications with hormone replacement therapy increase with ____
age
102
to keep risk as low as possible HT should be used
in the lowest dosage and for the shortest time needed to accomplish treatment goals
103
HT has only 3 approved indications
treatment of moderate to severe vasomotor symptoms secondary to menopause (treatment is 3-4 years)
treatment of genitourinary syndrome of menopause (treatment is 3-4 years)
prevention of postmenopausal osteoporosis - requires lifelong treatment so risk for harm is higher
104
primary prevention of bone loss
```
calcium
vit d
regular weight bearing exercise
avoid smoking
avoid excessive alcohol use
```
105
to decrease risk of Heart disease postmenopausal women should
avoid smoking
perform regular aerobic exercise
decrease intake of saturated fats
take prescribed drugs for treatment of HTN, DM and High cholesterol
106
what is dose tapering for d/c of hormone therapy
dosing is done every day but size of daily dose is gradually reduced. If intense symptoms return after a dosage reduction, further reductions are delayed until symptoms improve.
during the taper the progestin dose should remain unchanged so it does not stimulate endometrial growth which can lead to endometrial hyperplasia
107
Day tapering for d/c of hormone therapy
the daily dose remains unchanged but the number of days between doses is gradually increased starting with dosing every other day, then every third day and so on.
during the taper the progestin dose should remain unchanged so it does not stimulate endometrial growth which can lead to endometrial hyperplasia
108
Estring is for what and remains in the vagina for how long
estrogen replacement - 3 months
109
estrogen in geriatric population
no
| also not for prepubertal children, or pregnant or breastfeeding
110
Flibanserin (Addyi)
| Bremalanotide (Vyleesi)
drugs for management of Female Sexual Interest-Arousal Disorder (FSIAD)
111
How long does it take for Flibanserin (Addyi) to work
requires daily doses for several weeks before benefits are seen (discontinue after 8 weeks if no improvement is seen)
112
adverse reactions/risks for Flibanserin (Addyi)
CNS depression
Hypotension - with and without syncope
CYP3A4 so drug interactions are common
expensive!
113
What must prescribers and pharmacies have enrollment and training with to prescribe Flibanserin (Addyi)
Risk Evaluation and Mitigation Strategy (REMS)
114
How is Bremelanotide (Vyleesi) given
subcutaneous injection at least 45 min before sexual activity occurs
limit one dose in 24 hours and no more than 8 doses in a month
115
side effects for Bremelanotide (Vyleesi)
n/v
flushing
headache
injection site reaction
transient rise in BP can occur lasting up to 12 hours after dose
1% had darkening of gums and portions of skin
116
what estrogen has local with no systemic affects and bypasses the liver used primarily to treat vulval and vaginal atrophy
Premarin vaginal
117
what type of estrogen therapy has fewer side effects (route of administration)
transdermal
118
If a pt has had a hysterectomy, what hormones are needed to control postmenopausal symptoms
Estrogen
| Progestin is not necessary due to the hysterectomy
119
most effective methods of birth control are
etonogestrel implant (Nexplanon)
IUD
sterilization
120
what are the two categories of oral contraceptives
estrogen plus a progestin - combination OCs (used most often)
Progestin only known as Minipills
121
adverse effects of combo OCs
nausea
menstrual irregularity
thromboembolic disorders
122
absolute contraindications for combo ocs
```
Thromboembolic disorders
cerebral vascular disease
a condition that exposes them to the above
abnormal liver function
known or suspected breast cancer
undiagnosed abnormal vaginal bleeding
known or suspected pregnancy
smokers older than 35
```
123
relative contraindications for combo ocs (use with caution)
```
HTN
Cardiac disease
DM
History of cholestatic jaundice of pregnancy
gallbladder disease
uterine leiomyoma
epilepsy
migraine
```
124
what two progestins carry the greatest risk
drospirenone
| desogestrel
125
what are the lower risk progestins for OCs
Ethynodiol diacetate
| Norethindrone
126
Pt education for combo OC use
consult prescriber for symptoms of thrombosis or embolism
- leg tenderness or pain
- sudden chest pain
- shortness of breath
- severe headache
- sudden visual disturbance
127
women with a history of a thrombosis should avoid what oral contraceptive and can take what
avoid estrogen/progestin products
can still use a progestin only method such as Mirena, Depo-Provera
Nexplanon
Minipill
128
Oral contraceptives protect against what type of cancer
ovarian
endometrial cancer
they have no effect on cervical cancer - caused by HPV
129
Oral OCs and hypertension
can cause but low risk
you can either dc oc
or add on antihypertensive
130
what type of OC is preferred for breastfeeding moms
progestin only OCs have little or no effect on milk production
Later on when milk supply is well established and addition of solids to the infants diet has occurred, combo ocs can be resumed
131
OCs in women with history of migraines
increase risk for thrombotic stroke
absolute increase il low
if they are younger than 35, do not smoke and are healthy this they do not have auras it is considered generally safe
132
OCs can ____ blood glucose
elevate (caused by the progestins)
133
glucose intolerance may be less likely to occur with OCs that contain ______ or ______
desogestrel
| norgestimate
134
noncontraceptive benefits of oral contraceptives
```
decreases risk of
ovarian cancer
endometrial cancer
ovarian cysts
PID
benign breast disease
iron deficiency anemia
acne
in menstrual associated migraines (OCs can reduce migraine frequency)
may even benefit women with RA
```
135
cyp and OCs
Products that induce CYP can accelerate OC metabolism and can reduce OC effects
136
OCs and Warfarin
can decrease the effectiveness of Warfarin
137
OCs can impair the hepatic metabolism of what agents
theophylline (bronchodilator )
tricyclic antidepressants (Amitriptyline, Nortriptyline)
Diazepam (Ativan)
Chlordiazepoxide (Librium) - treat anxiety
watch for signs of toxicity
138
what combo oc also has levomefolate (a metabolite of folic acid) to reduce risk for neural tube defects if pregnancy would to occur
Beyaz
YAZ plus
Safyral
Tydemy
139
what combo OC do you not need to monitor potassium levels in
Natazia (ESTRADIOL VALERATE/DIENOGEST)
140
for starting a birth control sequence, which option is protection conferred immediately?
if the sequence is begun on the first day of the menstrual cycle
141
for starting a birth control sequence, which option is done so that menses occur on weekdays rather than the weekend? what is the downside
starting the first Sunday after menses
protection is not immediate and an alternate form of birth control should be used during the first 7 days of the pill pack
142
how do you take oral birth control
Take at the same time every day with a meal or at bedtime.
143
explain the extended cycle method using monophasic combo OCs
purchase 4 packets of a 28 day product and then take the active pills for 84 days straight. The drugs suppress the endometrial thickening thus monthly bleeding is not required to slough off hypertrophied tissue
benefits - decreases episodes of withdrawal bleeding, the associated menstrual pain, premenstrual symptoms, headaches and other problems
144
for the extended/continual cycle dosing of combo ocs, when the pills have been taken previously for 3 weeks, how long can be missed with little to no increased risk of pregnancy
7
145
what adverse affects that are seen in combo ocs are not seen with minipills
they do not cause thromboembolic disorders, headaches, nausea, or most of the other side effects
146
downside to the minipills
less effective and more likely to cause irregular bleeding
taking a pill even 3 hours late can reduce their efficacy and back up protection is recommended for at least 2 days
147
Xulane Patch (ethinyl estradiol/norelgestromin)
same mechanism as combo OCs
apply patch during the first 24 hrs of menstrual period
if patch becomes partially or completely detached, replace. If the patch has been off more than 24 hours , a new cycle will need to be started with backup contraception for 7 days
148
which patch causes a higher incidence of discomfort and dysmenorrhea
Triphasil patch
149
NuvaRing (etonogestrel, ethinyl estradiol) instructions
combo OC
insert and leave for 3 weeks then remove
insert new one week later even if still having withdrawal bleeding
If its expelled before 3 weeks, it can be rinsed off in warm water (not hot) and reinserted
if more than 3 hours pass, use back up contraception for 7 days
150
most common side effects of NuvaRing
```
vaginitis
headaches
upper resp infection
leukorrhea (whitish discharge, thick)
sinusitis
weight gain
nausea
```
serious adverse effects
thrombosis
embolism
HTN
151
Nexplanon (etonogestrel)
Progestin Birth control
rod is implanted subdermally in the groove between biceps and triceps in the nondominant arm
provides contraception for 3 years
152
drugs that reduce efficacy of Nexplanon and should not be used
agents that induce hepatic enzymes
- barbiturates (-barbital) antiseizure
- phenytoin - (antiseizure)
- rifampin(Abx - used to treat TB)
- carbamazepine (Tegretol) seizures
- topiramate (topamax) Migraine
- HIV protease inhibitors
- St johns wort
153
Nexplanon is safe to use during breastfeeding after the ___ postpartum day
21st
154
Depot Medroxyprogesterone Acetate
given Im or subq every 3 months
| progestin
155
what form of birth control poses a reversible risk for bone loss
Depot Medroxyprogesterone Acetate
156
IUDs screening prior to insertion
Gonorrhea and chlamydia due to associated risk of PID
157
IUDs can cause cramping and alteration of menses. Most intense upon insertion. What can be done to help
minimized by applying a topical anesthetic (2% lidocaine intracervical gel) or by premediating with ibuprofen
158
2 classes of IUDs
Hormone free Copper IUD (TCu380A or Paragard)
| Levonorgestrel containing IUD
159
How are spermicides used
before intercourse but no more than 1 hour in advance. must be reapplied each time intercourse is anticipated.
douching should be postponed for at least 6 hours post coitus
160
How are contraceptive sponges used (Today Sponge)
a single sponge is effective for 24 hours regardless of how often coitus takes place. After 24 hours, the sponge should be removed. Rates of unintended pregnancy are high
causes vaginal irritation and dryness
161
two types of Emergency contraception
morning after pill
| inserting a copper-T IUD
162
Plan B One step
Next Choice one dose
next choice
Progestin only emergency contraception
OTC for ages 15 and older
most effective within 3 days of intercourse
163
How many days after intercourse can the ECPs still be effective
earlier is best
| up to 5 days
164
will Plan B one step and Next choice one dose cause major congenital malformations if pregnancy still occurs
no
165
Will plan B one step or Next choice terminate a existing pregnancy or harm a fetus if present
no
166
Ulipristal acetate (ella)
remains highly effective when taken up to 5 days after intercourse
requires a prescription
167
what is Mifepristone (Mifeprex)
abortifacient drug
| cotreatment of misoprostol is required
168
serious adverse effect for using Mifepriston (Mifeprex) and Misoprostol
sepsis and fatal septic shock
169
contraindications to Mifepriston (Mifeprex)
ectopic pregnancy
hemorrhagic disorders
anticoagulant drugs
blocks receptors for glucocorticoids - should not be used in women with adrenal insufficiency on long term glucocorticoid therapy
170
Pt should stop taking oral contraceptives how long before surgery
4 weeks
171
if you have multiple sexual partners, what form of birth control puts you at increased risk of STDs
IUD
172
spermicides containing nonoxynol-9 have been linked to increased transmission of
HIV
173
depot shot should be given when
during first 5 days of menstrual period
174
siladenafil (Viagra)
tadalafil
vardenafil
avanafil
PDE-5 inhibitors for Erectile dysfunction
175
siladenafil (Viagra) can be dangerous if they are taking
certain vasodilators
B blockers - can cause severe hypotension
nitroglycerin
nitrates for angina
176
You should stop using Viagra if you experience
hearing loss
177
when is Siladenafil (Vilagra), tadalafil or vardenafil taken
1 hour before sexual intercourse
178
pt education when taking PDE-5 inhibitors for ED
can take with or without food, avoid a high fat meal with the exception of tadalafil
Avoid grapefruit juice (raise PDE5 inhibitor levels)
men with cardiovascular disease- if you experience angina pain, lightheadedness during sex-refrain from further sexual activity and discuss event with provider
go to ER for erection lasting more than 4 hours (can cause permanent damage) (Priapism)
stop med and seek immediate medical attention if experience sudden vision loss in one or both eyes or if hearing loss develops
179
Take avanafil approx ____ min before sex, avoid nitrates for at least ___ hours after taking avanafil
15-30 min
12 hours
due to hypotension
180
How long to avoid nitrates after taking sildenafil or vardenafil
24 hours
| due to hypotension
181
how long to avoid nitrates after taking tadalafil
48 hours
| due to hypotension
182
adverse effects of Siladenafil
headache
flushing
dyspepsia
```
also
nasal congestion
diarrhea
rash
dizziness
may worsen sleep apnea
```
183
what PDE5 inhibitor can cause QT prolongation
Vardenafil
184
when taking tadalafil avoid b blockers due to drop in BP except
tamsulosin
185
For the PDE 5 inhibitors, reduce dosing if pt is also on
CYP3A4 inhibitors (ketoconazole- antifungal, ritonavir-HIV treatment, erythromycin, cimetidine, grapefruit juice)
186
cardiac drugs that can can cause ED
```
Digoxin
Clonidine (Catapres)
Propanolol
Hydrochlorthiazide
Spironolactone
```
187
CNS drugs can cause ED
```
Prozac
Isocarboxazid (Marplan)
Amitriptyline (Elavil)
Chlorpromazine (Thorazine)
Lithium
Alcohol
```
188
Urogenital drugs that can cause ED
Finasteride (Proscar)
189
older adult consideration for PDE 5 inhibitors
consider lower dosing for adults 65 and older
190
what food should be avoided when taking PDE 5 inhibitors
Grapefruit juice
| alcohol
191
effects of tadalafil lasts for
36 hours and has fastest onset of action
192
Which PDE 5 inhibitor has adverse effects of headache, dyspepsia, back pain, myalgia, limb pain, flushing and nasal congestion. Very rarely the drug can alter color vision
Tadalafil
193
which PDE 5 inhibitor has the fastest onset
Avanafil
194
what PDE 5 inhibitor is the only one approved for daily dosing
Tadalafil
195
overgrowth of epithelial cells causes ________of the urethra in men
mechanical obstruction
196
overgrowth of smooth muscle causes ______ of the urethra in men
dynamic obstruction
197
```
urinary hesitancy
urinary urgency
increased frequency of urination
dysuria
nocturia
straining to void
postvoid dribbling
decreased force and caliber of the urinary stream
sensation of incomplete bladder emptying
```
symptoms of
BPH
198
what drug class is best used for mechanical obstruction of the prostate - very large prostate
5 alpha reductase inhibitors (Finasteride, dutasteride)
| on it for life
199
what drug class is best used for dynamic obstruction of the prostate - relatively small prostate
Alpha blockers
200
Finasteride, dutasteride
5 alpha reductase inhibitors
| -reduces prostate size and takes several months for a noticeable effect (6-12 months)
201
Finasteride
protects against low grade prostate cancer
can decrease libido
gynecomastia
teratogenic
202
pt education for Finasteride and dutasteride
Women should not handle this drug
men who are taking this drug cannot donate blood
for dutasteride
do not break open capsules to sprinkle on food
must be swallowed due to irritation of the oropharyngeal mucosa
203
monitoring while taking Finasteride
```
PSA levels (marker for prostate cancer)
should be determined before treatment and 6 months later. These numbers should decline 30-50%
if they do not fall, pt should be evaluated for prostate cancer
```
204
half life of dutasteride
very long - 5 weeks
205
```
alfuzosin (Uroxatral)
terazosin (Hytrin)
doxazosin (cardura)
Silodosin (Rapaflo)
Tamsulosin (Flomax)
```
Alpha Adrenergic Antagonists
206
which 3 alpha adrenergic antagonists also cause hypotension
alfuzosin, terazosin, doxazosin
207
what 2 alpha adrenergic antagonists have no effect on BP
silodosin
| tamsulosin
208
men who are anticipating cataract surgery should
Postpone use of an alpha adrenergic antagonist until after surgery due to risk of floppy iris syndrome
209
strong inhibitors of CYP3A4 can dramatically ____ the levels of alfuzosin and silodosin
increase
210
what medication is approved for men who have BPH and ED
Tadalafil
