Pharm Reproduction Exam 1 Flashcards
(137 cards)
1
Q
Vaginal antibacterial
A
Clindamycin
Metronidazole
2
Q
Vaginal Antifungals
A
Butoconazole
Miconazole
Terconazole
3
Q
Injectable Contraceptives
A
Medroxyprogesterone (Depo-Provera)
4
Q
Vaginal contraceptives
A
Etonogestrel/ethinyl estradiol (Nuva Ring)
5
Q
Monophasic oral contraceptives
A
Most common type of Birth control
They are single phase
Means they provide a steady dose of hormones throughout the entire pack
Usually start on low dose of estrogen
Switch to higher dose if they have bleeding or spotting
6
Q
B-phasic oral contraceptives
A
Contain 2 types of pills at different strengths
Usually the amount of progestin changes and
the amount of estrogen stays the same the entire pack
until you get to the placebo pills
7
Q
Tri-phasic oral contraceptives
A
Pills of 3 different doses
The level of progestin increases as you go through the pack (similar to the body)
Most common pattern is 7 days of one strength 7 days another strength 7 days another strength 7 days of inactive pills
8
Q
Quad-phasic oral contraceptives
A
levonorgestrel/ethinyl estradiol
Estradiol valerate/dienogest
9
Q
Oral progestin only contraceptives
A
norethindrone
drospirenone
10
Q
Selective estrogen receptor modulators
SERM
A
Clomiphene (Clomid)
raloxifene (evista)
Tamoxifen (soltamox)
11
Q
GYN bleeding (non hormones)
A
TXA (tranexamic acid (Lysteda)
12
Q
Labor induction
A
Misoprostol (cytotec)
Oxytocin (pitocin)
13
Q
Labor suppressives (tocolytics)
A
Mag sulfate
Terbutaline
14
Q
Pregnancy termination meds (abortion)
A
Misoprostol (cytotec)
Mifepristone (Mifeprex)
Oxytocin (pitocin)
15
Q
SSRI - GYN
For premenstrual dysphoric disorder
A
Paroxetine (Paxil)
Fluoxetine (Prozac)
Sertraline (Zoloft)
16
Q
In GU Section from PAM 640!
Review ED, Infectious processes such as epididymitis, orchitis, STIs.
Review Hypogonadism and Testosterone!
A
In GU Section from PAM 640!
Review ED, Infectious processes such as epididymitis, orchitis, STIs.
Review Hypogonadism and Testosterone!
17
Q
Pubertal gynecomastia typically develops at what age?
A
Ages 10 - 12
With a peak (65%) between ages 13-14
Regression follows in approximately 80% of cases in 6 months - 2 years
18
Q
Treatment for adolescent boys with severe breast enlargement
A
Brief trial (3 months) Tamoxifen (10mg BID) for tenderness
19
Q
Are Aromatase inhibitors effective in the treatment of severe breast enlargement in adolescent boys?
A
No
Aromatase inhibitors are not effective
20
Q
For men in whom no cause can be identified and the gynecomastia is tender and persists more than three months
What is the treatment?
A
Brief trial (3 to 6 months) of a selective estrogen receptor modulator (SERM) for relief of tenderness.
Tamoxifen (10mg BID) for tenderness
Inadequate experience withraloxifene. (not used)
21
Q
For men with already developed gynecomastia
and are on antiandrogen therapy
What is treatment?
A
Tamoxifen
If it is a recent onset
and if likely to be in proliferative phase
22
Q
Gynecomastia Causes
A
Spironolactone Antiandrogens Cimetidine Ketoconazole 5 - alpha reductase inhibitors
23
Q
Selective estrogen receptor modulators
SERM
A
Clomiphene (Clomid)
raloxifene (evista)
Tamoxifen (soltamox)
24
Q
What does a SERM do to breast tissue?
Selective estrogen receptor modulators
A
Tamoxifen
Exerts an anti estrogenic effect in breast tissue
It is important in treatment of estrogen/progesterone receptor positive breast cancer
25
What does a SERM do to bone?
Selective estrogen receptor modulators
Tamoxifen and raloxifene
Have selective agonist activity of estrogen receptors in bone tissue.
They decrease the risk of osteoporosis
26
What does a Tamoxifen (SERM) do to the uterus?
Selective estrogen receptor modulators
Tamoxifen
A partial estrogenic effect occurs in the uterus
Increases risk of endometrial carcinoma and uterine sarcoma
27
What does a Raloxifene (SERM) do to the uterus?
Selective estrogen receptor modulators
Raloxifene
Has a antagonistic effect of estrogen receptors on the uterus
Decreases risk endometrial carcinoma and uterine sarcoma
28
SERM Overview of different tissues
| Selective estrogen receptor modulators
Tamoxifen & Raloxifene
Tamoxifen
Treats breast cancer
Increases risk of endometrial carcinoma and uterine sarcoma
Raloxifene
Decreases risk endometrial carcinoma and uterine sarcoma
Both Tamoxifen and Raloxifene
Decrease risk of osteoporosis
29
Tamoxifen
Soltamox (anti-estrogen)
Treatment of metastatic breast cancer in men & women
Contra
Coumarin anticoagulants, history of DVT/PE, planned pregnancy, nursing mothers
CAT D
Adverse
Hot flashes, Vaginal discharge, altered menses, rash, HA, nausea
30
Raloxifene
Evista
(SERM) Selective estrogen receptor modulators
Contra
History of DVT/PE/Thrombotic events, nursing mothers, planned pregnancy
CAT X
Interactions
May antagonize warfarin, avoid cholestyramine
31
Goal of therapy in men with sexual dysfunction
Improve libido
address 2 vital sexual functions
acquire and maintain adequate erection
Treat premature ejaculation
32
Why are PDE-5 inhibitors recommended
Efficacy
ease of use
favorable side effects
33
Which PDE-5 inhibitor is best?
Sildenafil, tadalafil, avanafil
All are equally effective
Tadalafil
Contraindicated in men taking nitrates
34
Who are PDE 5-inhibitors contraindicated in?
Contraindicated in men taking nitrates
35
What are alpha adrenergic antagonists used for?
BPH
-osin
```
Terazosin
Tamsulosin
Alfuzosin
Silodosin
Doxazosin
```
36
What do alpha adrenergic antagonists cause when combined with PDE-5 inhibitors?
Symptomatic Hypotension
If used
Tamsulosin and silodosin are better and less likely to cause hypotension
37
Treatment for Premature Ejaculation
SSRI's are first line
Clomipramine is second line
38
5 P's of sexual history
```
Partners
Practices
Protection from STD's
Past history of STD's
Pregnancy Prevention
```
39
STIs from CDC-
Read on your own and be prepared for questions on Exam
```
Chlamydia Treatment for Adolescents and Adults.
Chlamydia Treatment for Pregnancy
Chlamydia Treatment for Neonates
Gonorrhea for Adolescents and Adults
Bacterial Vaginosis
Trichomoniasis
PID
Epididymitis
Primary and Secondary Syphilis
Chancroid
Herpes Simplex
```
STIs from CDC-
Read on your own and be prepared for questions on Exam
```
Chlamydia Treatment for Adolescents and Adults.
Chlamydia Treatment for Pregnancy
Chlamydia Treatment for Neonates
Gonorrhea for Adolescents and Adults
Bacterial Vaginosis
Trichomoniasis
PID
Epididymitis
Primary and Secondary Syphilis
Chancroid
Herpes Simplex
```
40
Most frequent STD's among women who have been sexually assaulted
Trichomoniasis
Bacterial vaginitis
Gonorrhea
Chlamydia
41
Treatment for sexual assaults in men
Empiric ABX for
Chlamydia
Ceftriaxone 500mg IM
Plus Doxy 100mg BID x 7 days
If over 150kg = 1 gram of Ceftriaxone
42
Treatment for sexual assaults in women
Empiric ABX for
Chlamydia
Gonorrhea
Trichomoniasis
Ceftriaxone 500mg IM
Plus Doxy 100mg BID x 7 days
Plus Metronidazole 500mg BID x 7 days
If over 150kg = 1 gram of Ceftriaxone
43
Infertility in men
resulting from secondary (hypogonadotropic) Hypogonadism
Treatment
Gonadotropin replacement therapy
44
Infertility in men
resulting from secondary (hypogonadotropic) Hypogonadism due to prolactin adenoma
Treatment
Dopamine agonist therapy
Cabergoline
(restores spermatogenesis and fertility)
45
Infertility in men resulting from
secondary (hypogonadotropic) Hypogonadism
Idiopathic dysspermatogenesis
Idiopathic male infertility
What not to use
Clomiphene citrate
Aromatase inhibitors
Gonadotropin therapy
46
Off label use Still being used despite up-to-date recommendations
(secondary Hypogonadism)
Clomiphene
anastrozole
hCG injection (Human chorionic gonadotropin)
47
Clomiphene Side effects
Changes in
Libido, Mood, Energy level
Increased aggression
Male pattern baldness
Enlarged prostate
Breast tenderness
Mild Acne
48
Clomiphene MOA
Pituitary gland secretes hormones into the blood
Clomiphene increases these hormones
This stimulates the production of testosterone and sperm in the testes
Boosted levels of these hormones will reduce symptoms of hypoandrogenism (low testosterone),
Increase sperm count, improve non obstructive azoospermia
(a blockage that prevent sperm from entering the semen)
49
Anastrozole MOA
Arimidex
Aromatase inhibitor
Originally for breast cancer
Now used off label for infertility in men
It blocks the enzyme aromatase
which prevents testosterone from changing into testosterone
50
Anastrozole Side effects
Arimidex
Aromatase inhibitor
Blood clots
cataracts
SJS
51
Herbs used in male fertility
| Coenzyme 10
Infertility
52
Herbs used in male fertility
| Yohimbe bark
ED
| Libido
53
Herbs used in male fertility
| Saw Palmetto
Low sperm count
Stress
Libido
54
Herbs used in male fertility
| Maca root
Hormonal balance
Energy
Normal sexual function
55
Herbs used in male fertility
| American Ginseng
Stamina
| Immune system
56
Herbs used in male fertility
| Tribulus
Sperm count
| Testosterone production
57
Which of the below medications is known to cause gynecomastia?
Tamoxifen
Acetaminophen
ASA
spironolactone
spironolactone
58
Which of the below medications is known to treat gynecomastia?
Tamoxifen
Acetaminophen
ASA
spironolactone
Tamoxifen
59
Which of the following is the most updated antibacterial for the treatment of Gonorrhea?
Ceftriaxone
Doxycycline
Amoxicillin
Benzathine PCN G
Ceftriaxone
60
Which of the following is the most updated antibacterial for the treatment of Chlamydia?
Ceftriaxone
Doxycycline
Amoxicillin
Benzathine PCN G
Doxycycline
61
Which of the following is first-line medication for premature ejaculation in men?
Paroxetine
Clomiphene
Sildenafil
Finasteride
Paroxetine
62
Which of the below vitamins/herbs has shown some efficacy for Male infertility?
Yohimbe bark
Co-enzyme 10
Saw Palmetto
American Ginseng
Co-enzyme 10
63
Chlamydia treatment
| Adults/adolescents
Doxycycline 100 mg PO BID for 7 days
64
Chlamydia treatment
| Pregnancy
Azithromycin 1 g orally in a single dose
65
Chlamydia treatment
| Neonates
Erythromycin base or ethyl succinate
50 mg/kg body weight/day orally
divided into 4 doses daily for 14 days
66
Gonorrhea Treatment
| Adults/adolescents
Ceftriaxone 500 mg* IM in a single dose for persons weighing <150 kg
If chlamydial infection has not been excluded, treat for chlamydia with doxycycline 100 mg PO BID for 7 days.
67
Epididymitis Treatment
For acute epididymitis most likely caused by chlamydia or gonorrhea: Ceftriaxone 500 mg IM once, plus Doxycycline 100 mg PO BID for 10 days
For acute epididymitis most likely caused by chlamydia, gonorrhea, or enteric organisms (men who practice insertive anal sex): Ceftriaxone 500 mg once, plus Levofloxacin 500 mg PO QD for 10 days.
For acute epididymitis most likely caused by enteric organisms only: Levofloxacin 500 mg PO QD for 10 days
68
Primary and secondary syphilis Treatment
Benzathine penicillin G 2.4 million units IM once
69
Bacterial vaginosis treatment
Metronidazole 500 mg orally 2 times/day for 7 days
or
Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once daily for 5 days
or
Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days
70
Trichomoniasis Treatment
Women
Metronidazole 500 mg orally 2 times/day for 7 days
Men
Metronidazole 2 g orally in a single dose
71
PID Treatment
Ceftriaxone 1 g by every 24 hours
plus Doxycycline 100 mg PO or IV every 12 hours plus Metronidazole 500 mg PO or IV every 12 hours
or
Cefotetan 2 g IV every 12 hours
plus Doxycycline 100 mg orally or IV every 12 hours
or
Cefoxitin 2 g IV every 6 hours
plus Doxycycline 100 mg orally or IV every 12 hours
72
Chancroid Treatment
Azithromycin 1 g orally in a single dose
or
Ceftriaxone 250 mg IM in a single dose
or
Ciprofloxacin 500 mg orally 2 times/day for 3 days
or
Erythromycin base 500 mg orally 3 times/day for 7 days
73
Herpes Simplex Treatment
???? (-vir's)
74
Most primary breast abscesses are caused by?
Staphylococcus aureus.
Methicillin-resistant S. aureus infections are increasingly common.
75
Patients with recurrent breast abscess have an increased incidence of?
mixed flora and anaerobic infection.
76
Management of primary breast abscess
Consists of drainage and antibiotic therapy.
77
Which of the following is not part of the 5 P’s in taking a good history?
```
Practice
Pregnancy
Passing
Past History
Partners
```
Passing
78
Which of the below medications is not considered a SERM?
clomiphene (Clomid)
raloxifene (Evista)
tamoxifen (Soltamox)
anastrozole (Arimidex)
anastrozole (Arimidex)
79
Which of the following is considered a aromatase inhibitor?
clomiphene (Clomid)
raloxifene (Evista)
tamoxifen (Soltamox)
anastrozole (Arimidex)
anastrozole (Arimidex)
80
Should breastfeeding continue during treatment for lactation-associated breast infections?
Yes
We suggest that breastfeeding continue during treatment for lactation-associated breast infections.
If there is difficulty with breastfeeding, hand expression or breast pumping can be effective for maintaining the milk supply until nursing can resume.
81
In the setting of non-severe infection in the absence of risk factors for methicillin-resistant S. aureus (MRSA),
Treatment
outpatient therapy may be initiated with dicloxacillin (500 mg orally four times daily)
or
cephalexin (500 mg orally four times daily),
pending culture results.
In the setting of beta-lactam hypersensitivity, clindamycin (300 to 450 mg orally three times daily) may be used.
82
In the setting of non-severe infection with risk for MRSA,
Treatment
outpatient therapy with trimethoprim-sulfamethoxazole (1 to 2 tabs orally twice daily)
or
clindamycin (300 to 450 mg orally three times daily) may be initiated.
83
In the setting of severe infection (eg, hemodynamic instability, progressive erythema)
Treatment
empiric inpatient therapy with vancomycin should be initiated
The optimal length of antibiotic therapy is not certain; 10 to 14 days following drainage is likely appropriate.
84
How to rule out anything bad from fibrocystic breast changes?
Fine needle aspiration
85
First-line therapy for breast pain It is typically safe but may not be effective.
Some practitioners also endorse therapies such as caffeine abstinence or evening primrose oil (EPO).
Although such therapies have not been proven effective by vigorous placebo controlled trials, they are generally harmless and may provide relief for some patients.
is conservative and typically includes reassurance that this is not a malignancy, physical support, over-the-counter analgesics, and manipulation of hormone-based medications for those who take them.
Acetaminophen or NSAID — Acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID), or both, can be used to relieve breast pain.
86
How long do you use first line therapies in breast pain
We prefer to treat with first-line therapy for six months before moving onto one of the second-line therapies,
which may be more effective but also have more side effects.
87
Alternative therapies in breast pain
Although such therapies have not been proven effective by vigorous placebo controlled trials, they are generally harmless and may provide relief for some patients.
88
Second-line therapy after NSAIDS for breast pain
Tamoxifen
89
Physiologic nipple discharge, or galactorrhea, is often caused by
hyperprolactinemia,
which may be secondary to medications, pituitary tumors, endocrine abnormalities, or other medical conditions.
90
Causes of hyperprolactinemia
```
may be secondary to
medications,
pituitary tumors,
endocrine abnormalities,
or other medical conditions.
```
91
Medications associated with galactorrhea
metoclopramide,
phenothiazines,
selective serotonin reuptake inhibitors [SSRIs]
92
Classes of medications that cause
| galactorrhea
```
Antipsychotics 1st and 2nd gen
Antidepressants (cyclic, SSRI, other)
Antiemetic and GI
Antihypertensive
Opioid analgesics
```
93
Most episodes of lactational mastitis are caused by?
Staphylococcus aureus.
Methicillin-resistant S. aureus (MRSA) has become an important pathogen in cases of lactational mastitis.
94
Medication that is used to prevent breast cancer in women and treat breast cancer in women and men.
Tamoxifen (Nolvadex)
95
SERM that has estrogenic actions on bone and anti-estrogenic actions on the uterus and breast.
Raloxifene (trade name Evista)
is an oral selective estrogen receptor modulator (SERM)
96
Ethinyl estradiol
EE2 is an orally bioactive estrogen used in many formulations of combined oral contraceptive pills and is one of the most commonly used medications for this purpose
97
Aromatase inhibitors-used in postmenopausal females with breast cancer-Know
Androstenedione is converted to estrone estradiol by the enzyme aromatase
Aromatase inhibitors prevent this conversion
Antiestrogens prevent estrone estradiol from activating
98
Aromatase inhibitors- in men
Testosterone is converted to estrogen by the enzyme aromatase
Aromatase inhibitors block this
99
Tamoxifen and estrogen receptors
Tamoxifen blocks the estrogen receptor so estradiol cannot bind
100
3rd generation aromatase inhibitors
| Steroidal
Superselective
Exemestane (aromasin)
101
3rd generation aromatase inhibitors
| Non-Steroidal
Superselective
Anastrozole (Arimidex)
Letrozole (femara)
102
Letrozole
Femara (aromatase inhibitor)
In postmenopausal women: Adjuvant treatment of hormone receptor positive early breast cancer
2.5mg QD
Contra
Pregnancy
Warnings
Monitor bone mineral density, serum cholesterol. Severe renal or hepatic impairment. Embryo-fetal toxicity;
Adverse
Pain (bone, musculoskeletal, and others), hot flashes, arthralgia, flushing, asthenia, edema,
103
What are the two most common causes of acute cervicitis.
Neisseria gonorrhoeae and Chlamydia trachomatis are the two most common causes of acute cervicitis.
Mycoplasma genitalium contributes to cervicitis, but this organism is likely responsible for a substantial minority of cases.
104
What is recurrent cervicitis and how is it treated?
Women who present with recurrent symptoms are reevaluated for possible re-exposure or treatment failure.
Treat persistent cervicitis for presumed M. genitalium with single-dose azithromycin (1 g orally),
105
HPV Vaccines
```
9-valent vaccine (Gardasil 9)
quadrivalent vaccine (6, 11, 16, and 18)
```
9-valent vaccine (Gardasil 9)
targets the same HPV types as the quadrivalent vaccine (6, 11, 16, and 18)
106
Gardasil 9
Contra
Yeast allergy
Adverse
Inj site reactions (eg, swelling, erythema, pain), headache; post-administration syncope (may be associated with tonic-clonic movements and other seizure-like activity).
107
Management of Polycystic ovary syndrome
The management of polycystic ovary syndrome (PCOS) requires treatment of individual components of the syndrome, including
menstrual dysfunction and the risk of endometrial hyperplasia,
hyperandrogenism (hirsutism and acne),
metabolic risk factors (obesity, glucose intolerance, and dyslipidemia),
and in some women, anovulatory infertility.
The choice of therapy depends upon whether the patient is pursuing pregnancy or not.
108
Management of Polycystic ovary syndrome
in women not pursuing pregnancy
and menstrual dysfunction
Menstrual dysfunction –
For women with PCOS, oligomenorrhea, and chronic anovulation we suggest COC therapy.
We typically start with a COC containing 20 mcg of ethinyl estradiol combined with a progestin such as norethindrone or norethindrone acetate, progestins that have lower androgenicity, but similar VTE risk compared with levonorgestrel-containing COCs.
109
Management of Polycystic ovary syndrome
in women not pursuing pregnancy
and hyperandrogenic symptoms
Women with hyperandrogenic symptoms –
For most women with hirsutism or other androgenic manifestations such as acne or female pattern hair loss, we also suggest starting with a COC (in addition to lifestyle measures).
We typically start with a COC containing 20 mcg of ethinyl estradiol combined with a progestin such as norethindrone or norethindrone acetate, progestins that have lower androgenicity, but similar VTE risk compared with levonorgestrel-containing COCs.
110
COC therapy for Polycystic ovary syndrome
| in women not pursuing pregnancy
We typically start with a COC containing 20 mcg of ethinyl estradiol combined with a progestin such as norethindrone or norethindrone acetate, progestins that have lower androgenicity, but similar VTE risk compared with levonorgestrel-containing COCs.
111
Management of Polycystic ovary syndrome
in women not pursuing pregnancy
and metabolic disorders
Metabolic disorders –
Weight loss, which can restore ovulatory cycles, improve metabolic risk, and possibly improve live birth rates, is the intervention for most women.
112
Management of Polycystic ovary syndrome
| in women planning to become pregnancy
Anovulatory infertility and ovulation induction –
For women with PCOS and anovulatory infertility, attempts at weight loss should be tried first in those who are obese.
If this does not restore ovulatory cycles, ovulation induction is required.
Letrozole, an aromatase inhibitor, is now the first-line ovulation induction agent over clomiphene citrate for women with PCOS.
113
Uterine disorders
Endometriosis
Leiomyoma
Prolapse
114
Endometriosis with mild to moderate pain
nonsteroidal anti-inflammatory drugs (NSAIDs)
and continuous hormonal contraceptives
rather than either agent alone.
These therapies are low-risk, have few side effects, are low-cost, and are generally well-tolerated compared with other medical therapies.
Women who wish to conceive can use the NSAID alone.
115
Endometriosis with severe pain
Severe symptoms, symptoms that do not respond to the other therapies, or recurrent symptoms,
Trial of gonadotropin-releasing hormone (GnRH) analog with add-back hormonal therapy rather than surgical resection.
GnRH analog treatment has demonstrated efficacy without the risks or negative impact on ovarian reserve of surgery.
116
Medical Treatment for endometriosis
Hormonal contraceptives
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
Progestin therapy
Danazol
Aromatase inhibitors
117
GnRH agonist
leuprolide
118
leuprolide depot 3.75mg
Lupron GNRH Agonist
3.75mg
Contra
Undiagnosed abnormal vaginal bleeding.
Pregnancy.
Nursing mothers.
When co-administered with norethindrone acetate, its contraindications also apply to this combination regimen.
119
Danazol
Androgen derivative
Indications:
Endometriosis, Fibrocystic breast disease
Orally active
Inhibit ovulation for 4-9 months
120
Danazol MOA
Weak synthetic androgen that suppresses the pituitary ovarian axis by inhibiting the output of pituitary gonadotropins
121
Elagolix
Orissa (GNRH antagonist)
Indications
Moderate to severe pain associated with endometriosis.
Contraindications:
Pregnancy. Osteoporosis. Severe hepatic impairment.
122
Leiomyoma treatment
Treatment of fibroids is aimed at resolving or reducing the symptoms associated with the lesions.
Common symptoms include prolonged or heavy menstrual bleeding (HMB), bulk symptoms, pain, and impaired fertility. Symptoms can be present in isolation or combination
123
Leiomyoma symptoms
```
Common symptoms include
prolonged or heavy menstrual bleeding (HMB),
bulk symptoms,
pain,
impaired fertility.
```
Symptoms can be present in isolation or combination
124
Treatment or patients with all other types of fibroids
(ie, not exclusively submucosal)
who do not desire pregnancy
(Leiomyoma)
Initial treatment with a combined estrogen-progestin contraceptive
(oral pills, transdermal patch, or vaginal ring).
Alternatives treatments
levonorgestrel-releasing intrauterine devices,
tranexamic acid
progestin-only pills
125
Alternatives treatments for patients with all other types of fibroids
(ie, not exclusively submucosal)
who do not desire pregnancy
(Leiomyoma)
Alternatives treatments
levonorgestrel-releasing intrauterine devices,
tranexamic acid
progestin-only pills
126
For patients whose symptoms persist despite trial of one or more first-tier therapies for
(Fibroids/Leiomyoma)
Second-tier medical treatments for fibroid-associated HMB include
gonadotropin-releasing hormone (GnRH) agonists and antagonists
127
Last line for (Fibroids/Leiomyoma)
Surgery
128
Most common types of vaginitis
The most common infections,
bacterial vaginosis (BV),
Candida vulvovaginitis,
trichomoniasis,
account for over 90 percent of infections.
129
Bacterial vaginosis (BV) treatments
Metronidazole 500 mg orally 2 times/day for 7 days
or
Metronidazole gel 0.75% one full applicator (5 g) intravaginally, once daily for 5 days
or
Clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days
130
Candida treatment
OTC
Clotrimazole
Nystatin
Miconazole
```
Prescription
Terconazole
Tioconazole
Butoconazole
Fluconazole
Ibrexafungerp
```
131
Treatment of complicated vaginitis
Severe or recurrent
| Oral Fluconazole 150mg Q72h
132
Treatment of complicated vaginitis
| and pregenant
Topical
Clotrimazole
Miconazole
for 7 days
133
Trichomoniasis
It is the most common non-viral sexually transmitted disease (STD) worldwide.
Women are affected more often than men
134
The most common non-viral sexually transmitted disease (STD) worldwide.
Trichomoniasis
Women are affected more often than men
135
Treatment of Trichomoniasis for both symptomatic and asymptomatic females and males.
(Non-pregnant)
For nonpregnant females and their sex partners, we suggest a seven-day course of metronidazole, 500 mg twice daily.
The single-dose regimen is a reasonable alternative for those who are unable to complete a seven-day treatment regimen or who prefer single-day treatment.
Oral administration is significantly more effective than topical administration.
Treatment reduces the prevalence of T. vaginalis carriage in the population, relieves symptoms, and reduces the risk of sequelae (including acquisition/transmission of HIV).
136
Treatment of Trichomoniasis for both symptomatic and asymptomatic pregnant females
We prefer the seven-day regimen and reserve the single-dose regimen for patients who are unable to complete a seven-day treatment course.
7-day course of metronidazole, 500 mg twice daily.
We recommend treating symptomatic pregnant females with confirmed T. vaginalis infections.
In addition, we suggest treating asymptomatic pregnant individuals with confirmed infection.
137
Tinidazole vs metronidazole
| Trichomoniasis treatment
Tinidazole generally causes fewer gastrointestinal side effects, but the cost is higher compared with metronidazole
