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Pharmacotheraputics > OB/GYN > Flashcards

OB/GYN Flashcards

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1
Q

Classes of Drugs

A

estrogens

SERMs

progestogens

progesterone agonist/antagonist

androgens

anti-androgens

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2
Q

DEA drug schedule class I

A

high abuve potential with no accepted medical use *heroin, LSD

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3
Q

DEA drug schedule class II

A

high potential for abuse, some medical indications with high restrictions (morphine, cocaine, oxycodone)

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4
Q

DEA drug schedule class III

A

less abuse potential than I and II, all have accepted medical uses (codeine, steroids, marinol)

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5
Q

DEA drug schedule class IV

A

low potential for abuse, accepted medical uses (benzodiazepines, phenobarbitol)

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6
Q

DEA drug schedule class V

A

lowest abuse potential (low dose codeine, opium, pregabalin

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7
Q

FDA use in pregnancy ratings category A

B

C

D

X

A

controlled studies show no risk

no evidence of risk in humans but no controlled studies

risk cannot be ruled out OR animal studies show risk to fetus

positive evidence of risk but benefits may outweigh risks

contraindicated in pregnancy

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8
Q

where do most drugs fall on the FDA use in pregnancy list

A

category B and C

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9
Q

how is the FDA safe in pregnancy list changing as of 2015

A
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10
Q

trends in worldwide contraception, what is used most

A

sterilization 20%

IUD 15%

oral 8%

condom 5%

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11
Q

what types of contraception are used most in developing nations

A

injectable contraceptives and IUDs

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12
Q

what types of contraception are considered (SC) steroid contraception

A

oral

patches

nuvaring

intramuscular

progestin IUD

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13
Q

general strategies used to make contraceptives work

A

block sperm

block ovulation

block sperm access to the cervix

block sperm transit through the uterus

block fallopian tubes

block embryo implantation

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14
Q

types of male contraceptives

A

permanent (vasectomy)

reversible (barrier contraception, gonadotropin suppression)

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15
Q

how does gonadotropin based male contraception work

what is the failure rate

A

testosterone enanthate/undeconoate injections to suppress FSH and cause azosperima or oligospermia

2-3%

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16
Q

how long does injected male contraception take to work

what are the draw backs

A

8-12 weeks to reach 90% azoospermia

requires frequent follow up for injections and semen analysis

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17
Q

how does contraception block ovulation

what drugs use this method

A

suppression of FSH

steroid contraceptives, GnRH analogs (lupron)

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18
Q

steroid components of contraceptives:

estrogens

progestins

A

estrogens: ethinyl estradiol (most common), estradiol valerate, mestranol
progestins: >8 forms, 21 carbon deriviatives, 19-notestosterone dervitives, estranes, gonanes

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19
Q

common steroid contracptive doses:

estrogen

progestin

A

estrogen: 10-50mcg
progestin: 0.15-1mg

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20
Q

adverse side effects of estrogen contraception

A

increased clotting (increased risk of DVT, MI, CVA)

activaion of RAA cycle (5% risk of HTN, poss fluid retention)

increase in cholestasis

increased risk of endometrial hyperplasia if not given with progestins

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21
Q

mortality related to estrogen use

A

MI

venous thrombosis

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22
Q

Why are estrogen contraceptives contraindicated for smokers over 35

A

there is a significant increased risk of MI compared to non-smokers

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23
Q

at what point in using estrogen contraceptives is the risk of venous thrombosis minimal

A

2 years

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24
Q

T/F Pregnancy is safer than usings OC

A

false, OC is much safer than pregnancy

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25
issues related to progestin contraception
lipid changes some are androgenic can cause dysphoria
26
lipid changes associated with progestin
Triglycerides and LDL go up, HDL goes down
27
2 21 carbon progestin choices how many 19-nortestosterone progestins are there
provera, progesterone four generations with over dozens of choices
28
issues with fourth generation progestin contraception
29
why are GnRH analogs not used to for contraception
because it would cause an extreme loss of estrogen and put women at risk for heart disease and osteoporosis if they aren't added back
30
why is ethinyl estradiol the most commonly used estrogenn for OC
because it is well absorbed orally
31
if a patient presents a medication for oral contraception called mestranol 1/50, what does the 1/50 mean
1 is the dose of progestin, 50 is to dose of estradiol
32
what are the advantages of combined estrogen/progestin OC what is the function of progestin estrogen
highly effective progestin blocks ovulation and makes cervical unimplantable estrogen controls uterine bleeding with a 3 weeks on, 1 wk off
33
T/F period are necessary to maintain health
false, estrogen flucuaton is
34
methods of oral contraception adminstration
cyclic with a fixed dose or triphasic dose continuous
35
why is HTN related to estrogen contraception not as common anymore
because pills used to be much high dose and the risk of HTN is dose dependany
36
T/F it is possible to take OC continuously without time off for menstruation
true
37
three types of non-cyclic OCs
seasonale (7 placebos that give 3 periods) seasonique (only one period at the end) Lybrel (no periods, continuous
38
advantages of non-cyclic OCs
less dysmenorrhea and issues with endometriosis fewer hormone flucuations lead to less premenstrual dysphoria and menstrual migranes
39
issues with non-cyclic OC use
more total hormone doses mean more exposure and cost breakthrough bleeding
40
how to deal with breakthrough bleeding related to non-cyclic OC use
if its mild reassure that patient that all is well persistent, withdraw treatment for 1 wk then resume
41
issues with fourth generation progestin use
blocks to effect of aldosterone that prevents fluid retention but increases the risk of hyperkalemia drospirenone seems to increase thrombosis risk
42
describe what makes triphasic OCs unique
estrogen and progestins vary during the cycle mimics a normal cycle
43
what issues are found with triphasic OCs
some individuals will have menstrual migrains and PMS
44
what percent of pregnancy are the result of contraceptive failures how many women miss 1 pill/mo 3/mo when is it most dangerous to miss a pill
50% 50% 30% at the beginning of a pill pack
45
possible issues with contraceptive patches
some patch adhesive reactions less effective in women over 200lvs
46
are contraceptive patches safe
yes, early studies show a higher risk of DVT and PE due to higher estradiol levels but recent studies don't bear that out
47
what issues are associated with vaginal ring contraceptive use
the ring can fall out if the ring isn't inserted on day 1 after the break it can cause failure
48
if contraception starts on cycle day 1 or 2, when will they take effect what if you start whenever you want
contraception starts immediately restart with a new pack after the first period and use condoms until the second pack
49
side effects related to estrogen oral contraceptives progestin
breast tenderness, nausea, fluid retention dysphoria, breast tenderness, oily skin, fat gain
50
how likley is breakthrough bleeding to occur with OC use what should you do if this occurs
5-30% in the first two cycles warn them ahead of time, reassure them change to a different pill with more estradiol or add a short course of extra extrogen
51
what challenges are there in prescribing OCs to women under 30
there are compliance issues due to side effects the side effects don't outweigh the risk of getting pregnant
52
what a challenges are found with women over 35 and contraceptive use
they never want to quit, but if they are smoking or have HTN, DM, etc they need to stop
53
absolute contraindications for OC
smokers after age 35 undiagnosed breast tumors undiagnosed vaginal bleeding acute liver disease history of DVT or hypercoagulation
54
two factors that will reduce OC efficacy
large body size and drug interactions
55
drug interactions associated with decreasd OC efficacy
st johns wort some anti convulsants anti fungal agents
56
advantages of OC
reduced quantity and duration of menstrual bleeding reduced dysmenorrhea predictable periods or no periods reduced risk of uterine and ovarian cancer
57
what happens that makes missing OC pills risky
follicular development is still happening, if the pill isn't resumed fast enough the follicle may survive and they may ovulate
58
T/F OC does not effect future fertility
true
59
where can OC patches NOT be placed
over bony prominences or on your breasts
60
guidelines to decide which OC to use
match estrogen to body size use 2nd, 3rd, 4th generation progestin be familiar with 4-5 brands with different progestins go with what the patient tells you
61
general guidelines to match estrogen to body size
15-20 mcg for small to average size women 30-35 mcg for larger women
62
what is the advantage to starting OC on the first sunday after a period disadvantage
you will have your period on a monday or tuesday vs the weekend you have to use condoms for the first month
63
T/F progestins are more effective than other OCs issues related
false, they are slightly less effective irregular bleeding, metabolic changes
64
choices for long acting reversible contraception (LARC)
injectable progestins implantable progestins IUDs injectable GnRH analogs
65
side effects related to injectable progestin contraception
bleeding, weight gain, dysphoria
66
concerns related to injectable progestins
CV/lipid concerns probably bone loss (Low E2) female sexual dysfunction from low androgens and dysphoria
67
types of implantable progestins side effects
implanon, nexplanon risks and side effects similar to progestins
68
how does plan B prevent or dely ovulation
disrupting follicle growth or blunting the LH surge
69
what is the method of action for IUDs
inflammatory response that blocks the passage of sperm
70
progestine blockers for emergency contraception uses mirepristone ulipristal
will terminate a pregnancy before 7 wks; contraception; used to treat cushings
71
goals of menopausal hormone support
reduce/prevent hot flashes improve sleep to improve cognition and reduce depression prevent bone loss maintain healt of the GI system
72
health risks associated with menopause HRT
cardiovascular risk breast cancer risk increase probably no help in cognition
73
five possible treatments of hot flashes
estrogen (high efficacy) SSRI (moderate to good) gabapentin (moderate) progestin (moderate) clonidine (some help)
74
two types of vaginal estrogen creams what are they used for
estradiol and conjugated estrogens treatment of vaginal atrophy (dysparenunia, urinary incontinence/urgency)
75
risks of unopposed estrogen how to fix this
endometrial hyperplasia and carcinoma if there is a uterus you must add progestin
76
common methods of estrogen replacement
estradiol (tablets, patch, spray) conjugated estrogens + progesins (combipatch, prempro, fem HRT)
77
strategy for dosing estrogen for HRT pills
start with a moderate dose that can be titrated up or down based on relief of symptoms
78
why would you use vaginal vs oral estrogen
vaginal creams for vagina atrophy, orals for hot flashes
79
is there an advantage to used in progestin on a daily vs cyclic schedule
no, in fact you take a lower total dose with continuous scheduling
80
three SERMs and their uses
tamoxifen (nolvadex) breast cancer prevention and treatment raloxifene (evista) osteoporosis bazedoxifene (duavee) SERM + estrogen for HRT
81
what is the benefit of giving a SERMs with estrogen for HRT
blocks estrogen receptors in the breast and uterus so there is no need for progestin
82
should HRT be used for every
no, focus on those with significant hot flashes for 3-5 years
83

Pharmacotheraputics (10 decks)

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