Pharmacology Flashcards

Question

Sulfonamides

Answer 1

2 groups - sulfonylureas (eg gliclazide) and thiazide diuretics Competitive inhibitor of dihydropteorate synthetase (enzyme in folate synthesis) Side effects - porphyria, Stevens-Johnson syndrome, toxic epiderminal necrolysis, blood - agranulocytosis, haem anaemia, thrombocytopenia

Answer 2

FDA category B Bactericidal Excreted by kidneys Poor tissue penetration so not for treating pyelo or renal abscess SEs of pulmonary fibrosis, neonatal haemolysis if antenatal

Answer 3

Clindamycin - binds to 50s ribosome, anaerobe cover, SE of pseudomembranous colitis, excreted in breast milk, catB Chloramphenicol - binds to 50s ribosome, broad spectrum, SE aplastic anaemia, excreted in breast milk, catC Macrolides eg azithro/clarithro/erythro - binds to 50s ribosome and accumulate within leukocyte, SE colitis, excreted in breast milk, catB Tacrolimus - SEs cardiac/hepato/nephro toxicity, breast feeding should be avoided, catC Tetracycline eg doxy - binds to 30s ribosome, broad spectrum, breastfeeding ok, catD Trimethoprim (sulfonamides) - inhibits folate, compatible with breastfeeding, catD

Answer 4

Rifampicin - inhibits DNA dependent RNA polymerase, gram +ve cover, heptatotoxic, compatible breastfeeding, catC Vancomycin/teicoplanin - inhibits cell wall synthesis, gram +ve cover, nephro/ototoxic, poor gut absorption, catB B-lactam penicillin - gram +ve cover, neurotoxicity, compatible with breastfeeding, catB Metronidazole - inhibits nucleic acid synthesis, covers anaerobes, catB Quinolone (cipro, levofloxacin) - inhibits bacterial DNA gyrase, broad spectrum, breastfeeding avoided, catC Aminoglycerides eg gentamicin - gram -ve cover, nephro/ototoxic, compatible with breastfeeding, catC

Answer 5

If <35/40 - pivmecillinam 400mg stat then 200mg TDS for 5-7 days - or if pen allergic, nitro 100mg BD 7 days If near term >35/40 - cefalexin 500mg TDS 7 days (if severe pen all then discuss) Never trimethoprim in 1st T (teratogenic)

Answer 6

Fungal cell wall is made of ergosterol But human cell wall made of cholesterol So antifungals work on ergosterol SEs - nephrotoxicty, hepatitis, anaphylaxis

Answer 7

Antiviral drugs do not destroy target pathogens but inhibit pathogen development Guanine analogue Prodrug - converted into active form in viral cell by thymidine kinase Inhibits viral DNA polymerase Primarily for herpes infections Poor water solubility, poor oral bioavailability Elimination half life 3hrs Renally excreted

Answer 8

Polyene group - eg nystatin - inhibits synthesis of ergosterol - catB Imidazole group - eg ketoconazole, clotrimazole, fluconazole - inhibits synthesis of ergosterol - catC Allylamines - eg terbinafine - inhibits enzyme required for ergosterol synthesis - catB Caspofungin - inhibits cell wall glucan synthesis

Answer 9

For treatment and prophylaxis of influenza virus A and B Both FDA catC Zanamivir (relenza) - inhaled, with minimal oral bioavailability, can cause bronchospasm in asthma Oseltamivir (tamiflu) - prodrug, 75% oral bioavailability, metabolized in liver then renally excreted - SEs Stevens-Johnson syndrome, neuropsychiatric disorders

Answer 10

FDA cat X For treatment of respiratory syncytial virus infection, hep C Prodrug, 45% oral bioavailability, long half life as RBCs concentrate drug and can't excrete it Purine analogue SEs - haem anaemia, teratogenic

Answer 11

For treatment of retroviral infections eg HIV Aims to achieve viral load <50 RNA copies/ml plasma Nucleoside reverse transcriptase inhibitor - so prevents synthesis of double-stranded viral DNA - tenofovir - catB - zidovudine, lamivudine - catC Non-nucleoside reverse transcriptase inhibitor - nevirapine, etravirine - catB - efavirenz - catD Protease inhibitor - inhibits protease activity - saquinavir, ritonavir - cat B Integrase inhbitors - realtegravir - catC Entry inhibitors - maraviroc - catB

Answer 12

HAART (highly active antiretroviral therapy) includes combination of at least 3 drugs belonging to at least 2 classes of antiretrovirals SEs - lactic acidosis, hyperglycaemia, hepatitis, pancreatitis, peripheral neuropathy Used in tx for HIV when: - CD4 T-lymphocyte count is 200-350cells/mm3 in asymptomatic patients - viral load > 10,000 HIV RNA copies/ml plasma - severely symptomatic

Answer 13

HAART if not on antiretroviral therapy prior to pregnancy - commence 20-28weeks, then discontinue after delivery - zidovudine PO to neonate up to 6w of life, START (short term) Alternatively, zidovudine monotherapy - only antiretroviral drug specifically for use in pregnancy but NOT in 1stT Women who conceive on HAART should continue through pregnancy

Answer 14

Chemo-prophylaxis - not 100% effective - causal or suppressive - mefloquine or malarone safe in pregnancy - doxycycline (teeth discolouration and bone growth disruption) and primaquine (fetal haemolysis) contraindicated

Answer 15

FDA catC antimalarial, = Lariam Recommended chemo-prophylaxis in pregnant women, can be used in 1stT Also drug of choice in chloroquine-resistant falciparum malaria Works to suppress RBC stage of malarial parasite Metabolized in liver Half life 2-4 weeks Excreted by bile and faeces Side effects - depression, insomnia, hallucinations, seizures

Answer 16

FDA catA Nanopeptide of 9 amino acids Synthesized in supraoptic and paraventricular nucleus Stored and released by the posterior pituitary gland Non-neuronal sources of oxytocin - retina, thymus, adrenal medulla, pancreas, Leydig cells, corpus luteum, placenta 6 min half life Excreted in bile and urine Acts on G-protein receptors which require magnesium and cholesetrol Destroyed in GI tract Regulates circadian rhythm, uterine contraction, letdown reflex Maternal oxytocin triggers transient inhibitory switch in GABA signalling from excitatory to inhibitory in fetal brain during delivery Can give - intranasal, IM or IV

Answer 17

CNS - SAH, seizures CVS - tachycardia, HTN, increased CO, arrhythmia GU - pelvic haematoma, uterine rupture Biochemical - oliguria, natriuresis, hyponatraemia, water intoxication

Answer 18

20carbon lipid molecules (with 5 carbon ring) derived from fatty acids Produced by all nucleated cells except lymphocytes Act as local messengers, = paracrine hormones Functions - many, including contraction and relaxation of smooth muscle Obstetric - IOL, TOP, management of PPH Prostaglandin E1 - eg misoprostol - for PPH and TOP Prostaglandin E2 - eg dinoprostone - for IOL by ripening the cervix Prostaglandin F2α - eg carboprost synthetic or dinoprost natural - for IOL, TOP, treatment of PPH

Answer 19

FDA catX Synthetic prostaglandin E1 analogue 40 min half-life Prevention of NSAID-induced gastric ulcers - inhibits secretion of gastric acid by parietal cell via G-protein coupled receptor mediated inhibition of adenylate cyclase (decreased intracellular cAMP) - increases secretion of gastric mucus - increases gastric mucosal blood flow And for labour induction SEs - uterine rupture, hyperstimulation, amniotic fluid embolism, diarrhoea, vomiting, headache

Answer 20

FDA catC Prostaglandin E2 analogue for ripening of cervix Transient pyrexia associated - within 15-45mins, return to usual temp 2-6hours after discontinuiation

Answer 21

FDA catX Chemically similar to LSD Works on 5HT1, dopamine and α-adrenergic receptors Functions - vasoconstrictor, constricts intracranial extracerebral vessels, uterine contraction, relieves migraine SEs - ergotism (St Anthony's fire, prolonged vasospasm -> gangrene, hallucinations, abortion), diarrhoea and vomiting Contraindications - IOL, 1st/2nd stages of labour, vascular disease, severe cardiac disease, severe HTN

Answer 22

4 types: Oxytocin receptor antagonist (eg atosiban) β2 agonists (salbutamol, terbutaline, ritodrine) Calcium channel blockers (nifedipine) NSAIDs (indometacin)

Answer 23

Tocolytic - oxytocin receptor antagonist IV administration Contraindications - PET, IUD, IU infection, APH, PROM after 30w SEs - vomiting, tachycardia, hypotension, headache, hot flushes, hyperglycaemia, fever

Answer 24

Tocolytic, FDA catB Ritodrine - 2h half life, PO Terbutaline - 6h half life, PO/INH/SC Salbutamol - 2h half life, PO/INH/IV SEs - fluid retention, increased myocardial workload, increased HR, gluconeogenesis of liver and muscle, glycogenolysis, hyperglycaemia, hypokalaemia, muscle cramps, headache

Answer 25

Ca channel blocker tocolytic No anti-arrhythmic activity 2h half life Excretion via urine and bile Unlicensed in pregnancy (catC) SEs - hypotension, vasodilatation, tachycardia, dependent oedema, dyspnoea CIs - cardiogenic shock, aortic stenosis, recent MI

Answer 26

FDA cat C Antihypertensive agent, as vasodilator of arterioles > venules Antioxidant Metabolized by acetylation Fast acting SEs - SLE, fluid retention, diarrhoea, headaches

Answer 27

FDA cat D Antihypertensive agent as α2 agonist, competitive inhibitor of DOPA decarboxylase (so less L-DOPA into dopamine) Prodrug - active metabolite is α-methylnorephinephrine metabolized in liver SEs - CVS - rebound HTN, angina, postural hypotension - GIT - dry mouth, hepatitis, pancreatitis - neuro - Parkinsonism, Bell's palsy - bone marrow suppression - leukopenia, thrombocytopenia, haem anaemia - increased prolactin - gynaecomastia, amenorrhoea - psychological - depression, anxiety

Answer 28

FDA cat C Mixed α1β blocker 8h half life Only used in 3rdT Associated with FGR and neonatal hypoglycaemia Maxdose 2.4g/day

Answer 29

Antihypertensive in pregnancy Non-dihydropyridine - verapamil (C), diltiazem (D) Dihydropyridine (vascular selective) - nimodipine (C) - nifedipine (C, preferential on cerebral arteries, used in vasospasm post SAH)

Answer 30

ACEis (eg ramipril) - cause CVS congenital malformations, impaired fetal renal function (oligohydramnios), skull defects Thiazide diuretics - neonatal thrombocytopenia if 3rdT Statins (FDA cat X) - CNS and limb defects

Answer 31

Epilepsy ↑ risk of teratogenicity regardless of medication - background risk 2% - if maternal epilepsy 4% - if on medication 6-8% Associated with NTDs, cleft palate, cardiac defects, urogenital defects, neonatal coagulopathies Should be on 5mg folic acid Vitamin K at birth

Answer 32

FDA cat D - safest antiepileptic in pregnancy Fetal levels 50-80% of maternal serum levels Also used in bipolar disorder and trigeminal neuralgia

Answer 33

FDA cat D Drug of choice for primary generalized epilepsy Worst teratogenic profile amongst antiepileptic drugs Fetal consequences - FGR, hyperbilirubinaemia, hepatotoxicity, transient hyperglycaemia, NTDs, cardiac anomalies, craniofacial defects, urogenital defects, limb defects

Answer 34

FDA cat D Lowers serum folate Fetal consequences - fetal anticonvulsant syndrome, cleft palate, microcephaly, cardiac abnormalities, mental retardation Not assoc with NTDs Maternal side effects - nystagmus, paraesthesia, megaloblastic anaemia, TEN

Answer 35

Lamotrigine (catC) - also used in bipolar disorder - crosses placenta and is excreted in breast milk - if on COCP as well then reduced AED effect Topiramate (catC) Levetiracetam (catB) Gabapentin (catB)

Answer 36

CatB Used in arrhythmias, asthma, eclampsia SEs - CNS depression, resp depression Antidote 10ml 10% calcium gluconate

Answer 37

CatD Positive allosteric modulator of GABA Used in status epilepticus, + insomnia, anxiety, restless leg, alcohol withdrawal If taken in 3rdT - neonatal benzodiazepine withdrawal syndrome (hypotonia, reluctance to suckle, cyanosis, impaired metabolic response to cold), floppy infant syndrome Antidote is flumazenil

Answer 38

FDA cat X Synthetic derivative of coumarin Interferes with vitamin K dependent clotting factors (2, 7, 9, 10) Initial effects thrombogenic due to decrease in protein S and protein C, then anticoagulant High protein binding Antidote is FFP, vitamin K, prothrombin complex concentrate 2% teratogenic risk Maternal SEs - skin necrosis, fat embolus, purpura fulminans Warfarin embryopathy - 5% of fetuses if warfarin at 6-12weeks - dose dependent - skeletal abnormalities, heart defects, short proximal limbs and phalanges

Answer 39

FDA cat C One unit heparin = 0.002mg pure heparin Naturally occurring anticoagulant in mast cells and basophils Activates antithrombin III, causing inactivation of thrombin and factor Xa SEs - heparin induced thrombocytopenia, osteoporosis, alopecia, hyperkalaemia Antidote - protamine sulfate Does NOT cross the placenta, NOT secreted in milk

Answer 40

FDA cat B Smaller risk of osteoporosis compared to unfractionated heparin Monitor effects via anti-factor Xa activity, no need to monitor APTT coagulation parameter Enoxaparin - 0.6mg/day prophylactic, 1mg/kg therapeutic Dalteparin - 75units/kg prophylactic, 100units/kg therapeutic Tinzaparin - 75units/kg prophylactic, 175units/kg therapeutic

Answer 41

t-PA, anticoagulant Catalyses conversion of plasminogen to plasmin (plasmin is fibrinolytic enzyme) Encoded by PLAT gene on chromosome 8 Streptokinase is form of tPA Recombinant t-PAs include alteplase, reteplase Antidote is aminocaproic acid (antifibrinolytic)

Answer 42

Danaparoid - inhibitor of activated factor X Lepirudin - direct thrombin inhibitor Fondaparinux - inhibitor of activated factor X

Answer 43

H2 receptor blockers (catB) - block action of histamine on parietal cells in stomach - eg cimetidine (avoid, anti-androgen), ranitidine (safer) PPIs - irreversibly block H/K-ATPase of gastric parietal cell - reduces gastric acid secretion by 99% - omeprazole (C), lansoprazole/pantoprazole (B) - risk anencephaly, and B12 deficiency in long-term use Antacids - to neutralize stomach acidity - eg magnesium hydroxide, calcium carbonate (rennie), aluminium hydroxide (gaviscon, safest in pregnancy)

Answer 44

Cyclizine (B) - H1 receptor antagonist, and central anticholinergic action - SEs - dry mouth, drowsiness, antimuscarinic and extrapyramidal effects Metoclopramide (B) - dopamine D2 receptor antagonists, 5-HT3 receptor antagonist, 5-HT4 agonist, gastroprokinetic agent - SEs - extrapyramidal effects, hyperprolactinaemia, agranulocytosis, SVT, neuroleptic malignant syndrome, tardive dyskinesia, oculogyric crisis - NOT licensed in <20yo Promethazine is histamine H1 antagonist Ondansetron (B) - 5-HT3 receptor antagonist - SEs constipation Prochlorperazine (C) - potent typical antipsychotic - SEs tardive dyskinesia, seizures, neuroleptic malignant syndrome

Answer 45

Bulking agents - bran, methylcellulose, fybogel Stool softeners - docusate Osmotic agents - lactulose (catB), sorbitol, glycerine, sodium phosphate Stimulants - senna (catC), bisacodyl, microlax enema, castor oil

Answer 46

FDA cat B Antidiarrhoeal μ-opioid agonist, but only acts on receptors in large intestine Does not cross BBB hence no opioid effects on CNS

Answer 47

Mostly catD Non-selective inhibitor of COX-1 and COX-2 Also antipyretic Acetic acid derivatives - indometacin, diclofenac, ketorolac Enolic acid derivatives - piroxicam, meloxicam Fenamic acid derivatives - mefenamic acid, flufenamic acid Propioninc acid derivatives - ibuprofen, naproxen Selective COX-2 inhibitors - celecoxib, rofecoxib

Answer 48

FDA cat C NSAID Inhibits synthesis of prostaglandin by inhibiting COX1 and COX2 enzymes Used to treat PDA postnatally Side effects if given antenatally - premature closure of ductus arteriosus, NEC, neonatal pulmonary HTM, neonatal renal damage

Answer 49

FDA catD aka acetylsalicylic acid Antipyretic, anti-inflammatory, antiplatelet (irreversibly inhibits synthesis of thromboxane A2) SEs - gastritis, Reye's syndrome (under age 12), metabolic acidosis in overdose, neonatal haemorrhage if within 5d of delivery (so stopped at 36w gestation), miscarriage under 12w (but low dose is used in treatment of recurrent miscarriage?)

Answer 50

FDA C Antenatal corticosteroid treatment in preterm deliveries is associated with reduction in rates of RDS, IV haemorrhage, neonatal death SEs - hyperglycaemia, leukocytosis, Cushing's, peptic ulcers, osteoporosis, psychiatric disturbance Betamethasone 12 mg IM x 2 doses or dexamethasone 6 mg IM x 4 doses are the steroids of choice to enhance lung maturation Hydrocortisone used to prevent adrenal crisis in patients who are taking prednisolone >7.5mg/day for >2 weeks, if undergoing surgical procedures, starvation, labour

Answer 51

FDA cat B Mesalazine, sulfasalazine For treatment of ulcerative colitis, crohn's SEs - agranulocytosis, hypospermia

Answer 52

Alkylating agents, cat D - cisplatin, carboplatin, cyclophosphamide, chlorambucil Antimetabolites (interfere with DNA production during S phase of cell cycle) - azathioprine (purine analogue), 5-fluorouracil (pyramidine analogue), methotrexate (antifolate) Alkaloids (block cell division by preventing microtubule function) - vincristine, vinblastine Topoisomerase inhibitors - topotecan Antineoplastic - doxorubicin

Answer 53

Cat D Purine analogue, interferes with purine synthesis Prodrug, active metabolite is 6-mercaptopurine and 6-thioionosinic acid, metabolized by xanthine oxidase SEs - bone marrow suppression, carcinogenic

Answer 54

Cat C Interferes with purine synthesis by inhibition of inosine monophosphate dehydrogenase Prodrug - active metabolite is mycophenolic acid Less toxic than azathioprine

Answer 55

FDA cat X Bone marrow suppression - anaemia, leukopenia, thrombocytopenia GIT - hepatitis, pancreatitis, pharyngitis, gingivitis, stomatitis Cardioresp - pericarditis, pericardial effusion, pulmonary fibrosis Thrombosis - DVT, retinal vein thrombosis, central thrombosis

Answer 56

Prodrug, active form is methimazole Prevents thyroid peroxidase enzyme from coupling and iodinating tyrosine residues on thyroglobulin Reduces production of T3 and T4 SEs - agranulocytosis (bone marrow suppression) Fetal risk - cat D

Answer 57

Inhibits thyroperoxidase enzyme Inhibits peripheral conversion of T4 to T3 by inhibiting tetraiodothyronine 5 deiodinase enzyme SEs - agranulocytosis Fetal risk - cat D (preferred over carbimazole as lower placental transfer and excretion in breast milk)

Answer 58

Biguanide agent Suppresses hepatic gluconeogenesis (AMP-activated kinase) Increases insulin sensitivity Enhances peripheral glucose uptake Increases fatty acid oxidation Not metabolized and excreted unchanged in the urine Reduces overall mortality by 30% when compared to insulin Reduces LDL cholesterol and triglycerides SEs - hypoglycaemia, lactic acidosis, GI upset Fetal risk - catB

Answer 59

Sulfonylurea class drug Stimulates insulin release by inhibiting ATP-sensitive K channels in pancreatic β cells Metabolized by liver SEs - hypoglycaemia, cholestasis Cat B

Answer 60

Thiazolidinedione agent Decreases insulin resistance and leptin levels by binding to peroxisome proliferator-activated receptors in fat cell nucleus SEs - MI risk, stroke, bone fractures, macular oedema, hepatotoxic Cat C

Answer 61

Meglitinide agent Stimulates insulin release by inhibiting ATP-sensitive K channels in pancreatic β cells SEs - hypoglycaemia, weight gain Cat C

Answer 62

Reduces rate of digestion of complex carbohydrates by inhibiting α-glucosidase enzyme in small intestines Inhibits pancreatic amylase Metabolized in GIT SEs - flatulence, diarrhoea Cat B

Answer 63

Dipeptidyl peptidase-4 inhibitor SE - pancreatitis Cat B

Answer 64

Incretin Glucagon-like peptide agonist Increases pancreatic insulin secretion Suppresses pancreatic release of glucagon SEs - pancreatitis, ?increase thyroid ca risk Cat C

Answer 65

FDA cat X Competitive progesteronic receptor antagonist Half life around 20hours Causes cervical softening and dilatation, decidual degeneration, release of endogenous prostaglandins, increased sensitivity of myometrium to prostaglandins Anti-glucocorticoid and anti-androgen Used for emergency contraception (delays ovulation and prevents implantation), and MTOP (up to 9weeks, 600mg) Contraindicated in severe asthma, chronic adrenal failure, ectopic pregnancy, acute porphyria, hepatic impairment, renal impairment

Answer 66

FDA cat X Anti-androgen - suppresses action of testosterone and DHT on tissues, suppresses LH Used in BPH, prostate ca, priapism, hirsuitism Weak progestogenic activity (for hot flushes) Suppresses synthesis of cortisol, aldosterone, oestrogen SEs - hepatotoxicity, low cortisol, low aldosterone (so hypoNa hyperK), gynaecomastia, galactorrhoea, osteoporosis, thrombosis (if with oestrogen)

Answer 67

aka Livial Selective tissue oestrogenic activity regulator Used as HRT, osteoporotic prevention Oestrogenic, progestogenic, androgenic properties Functions - relives climacteric symptoms, prevents osteoporosis, no endometrial stimulation, non-oestrogenic effects on breast tissue

Answer 68

SERMs - raloxifene, tamoxifen, clomifene Have both oestrogen and anti-oestrogen activity Excreted via faeces Used for prevention of osteoporosis, decreasing risk of breast ca SEs - thrombosis, endometrial ca, hot flushes

Answer 69

Derived from synthetic ethisterone (modified testosterone) Weak androgenic activity Gonadotrophic antagonist Acts on pituitary gland and inhibits LH and FSH causing inhibition of ovarian steroidogenesis, resulting in decreased secretion of oestradiol Does not affect pituitary hormones Used to treat endometriosis, uterine fibroids, menorrhagia Does not cause osteoporosis Can masculinize a female fetus SEs - fluid retention, weight gain, masculinisation

Answer 70

GnRH agonist Acts on pituitary gland and inhibits LH and FSH causing inhibition of ovarian steroidogenesis, resulting in decreased secretion of oestradiol Used to treat prostate and breast ca, endometriosis, uterine fibroids Maximum duration of treatment is 6 months SEs - menopausal symptoms, osteoporosis

Answer 71

Mechanism - inhibits ovulation (suppresses LH and FSH) and increases viscosity of cervical mucus} Contraindications - pregnancy, post partum (<6w breastfeeding, <3w non-breastfeeding), smoking >15/day above the age of 35, BMI >35, arterial disease, HTN (160/95), valvular heart disease with pulm HTN or subacute bacterial endocarditis, VTE, migraine with aura, breast ca, cirrhosis, Raynaud's, SLE Can be used in cervical, endometrial, ovarian ca First generation high dose oestrogen 50μg Second generation 30-35μg eg microgynon - both with levonorgestrel or norethisterone Third generation with new forms progesterone (desogestrel) - increase risk VTE - reduce risk acne, headache, weight gain, breast symptoms, breakthrough bleeding

Answer 72

If <3 pills (or 2 if taking low oestrogen content pill) - take missed pill, no need for extra precaution If >3pills missed (2 if taking low oestrogen content COCP) - take missed pill, extra precaution for 7 days - if in 3rd week then omit pill-free interval - if in 1st week use emergency contraception

Answer 73

Background risk 5 / 100,000 On 2nd generation COCP 15 / 100,000 On 3rd generation COCP 25 / 100,000 In pregnancy 60 in 100,000 Decreased risk ovarian cancer (50% if use >10yr) and endometrial cancer (50%, benefits lasting 20yr after discontinuing Increased risk breast ca (risk back to normal after 10yrs stopped) and cervical cancer

Answer 74

Inhibits ovulation - low-dose progesterones inconsistently inhibits ovulation in 50% of cycles - intermediate dose (cerazette) inhibit in 97-99% of cycles - high dose (Depo-provera) completely inhibit ovulation and follicular development And increases viscosity of cervical mucus Side effects - irregular bleeding, weight gain, breast discomfort, acne, depression Amenorrhoea in 20% POP, regular bleeding 40%, erratic bleeding 40% Can be used within 3w PP without any extra precautions Contraindications - pregnancy, undiagnosed PV bleeding, liver tumour, acute porphyria, breast ca in last 5yrs

Answer 75

Short time frame (3hr) for all except cerazette (12h) After missed pill take missed/late pill, use extra precautions for 48hours

Answer 76

Depo-Provera = medroxyprogesterone acetate IM Norethisterone enantate IM infection Implanon = etonogestrel-releasing implant effective up to 3y Reliable inhibition of ovulation

Answer 77

IM, lasts 12-14weeks Give 5days PP in non-breastfeeding women (higher risk of menorrhagia sooner) SEs - weight gain in 70%, osteoporosis (avoid for more than 2yr), delayed return to fertility by 6-18mo Often get irregular bleeding, but amenorrhoea in 60% by 12months Decreases serum oestrogen level due to complete inhibition effect on ovulation Assoc with reduction in bone density within first 2y use Reduces risk of endometrial ca by 80%

Answer 78

Etonogestrel 68mg Lasts 3yr Serum levels of progesterone reach ovultaion-inhibiting levels by 24hr from insertion 90% start to ovulate within 3w removal Bleeding patterns - amenorrhoea in 20%, prolonged bleeding in 20%, infrequent bleeding in 5%

Answer 79

Can be immediate after 1st or 2ndT TOP From 4w PP At any time in menstrual cycle Extra precuation not needed for copper coil at all, or for mirena if inserted on day1 of cycle Risk of expulsion 5%, common in first year Risk of uterine perforation 0.1% Risk of pelvic infection greatest in first 20days

Answer 80

Copper is toxic to ovum and sperm, inhibits fertilisation and implantation Irregular or heavy bleeding common in first 3-6months Licensed for 7-10years

Answer 81

Compartment gradually releases levonorgestrel Mediated via progestogenic effect on endometrium, so endometrial atrophy, increase in phagocytic cells, increase cervical mucus viscosity, 75% continue to ovulate Licensed for 5 years for HMB, 8 years for contraception Irregular bleeding common in first 6 months, then 65% amenorrhoea at 12months

Answer 82

Levonorgestrel 1500μg - within 72hr UPSI - 95% effective in first 24hr - inhibits ovulation for 5-7days if taken prior to ovulation - double dose if taking enzyme inducers - SEs - nausea, bleeding EllaOne = ulipristal acetate 30mg - selective progesterone receptor modulator - up to 120hours after UPSI - inhibits ovulation, suppresses growth of follicles, delays endometrial maturation Copper IUD - within 5days UPSI or 5days ovulation

Pharmacology Flashcards

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