Study Guide Exam III Flashcards
(255 cards)
1
Q
what are the first line drugs for PD treatment?
A
dopaminergics & dopamine agonists
2
Q
what are the dopaminergics & dopamine agonists used to tx PD?
A
Bromocriptine (Parlodel) Pergolide (Permax) Pramipexole (Mirapex) Ropinirole (Requip) *as symptoms worsen, introduce levodopa* cholinergic blockers control tremor (relax smooth muscle)
3
Q
how do anticonvulsants work?
A
stimulate influx of chloride ions (usually associated with GABA)
delay influx of sodium
delay influx of calcium
4
Q
what are the most common ADRs of hydantoins?
A
nystagmus dizziness pruritis paresthesia HA somnolence ataxia confusion
5
Q
what are the ADRs of iminostilbenes?
A
bone marrow depression liver damage impairs thyroid function drowsiness dizziness blurred vision N/V dry mouth diplopia HA
6
Q
what are the ADRs of succinimides?
A
GI most common somnolence fatigue ataxia agranulocytosis aplastic anemia granuloytopenia
7
Q
what are the ADRs of GABA?
A
somnolence
CNS effects
8
Q
what are the ADRs of lamotrigine?
A
GI: mostly N/V constipation chest pain peripheral edema somnolence fatigue dizziness anxiety insomnia HA amblyopia nystagmus
9
Q
what are the goals of migraine therapy?
A
minimize impact on quality of life
avoid medication overuse
10
Q
which medications are used in prophylactic treatment of migraines?
A
beta blockers
tricyclic antidepressants
antieleptic drugs
11
Q
when is preventative migraine therapy initiated?
A
consider for pts with more than 2 migraines per months
goal: 50% reduction
Use HA diary
takes time to work (4 wks)
12
Q
which beta blockers are FDA approved in preventative migraine therapy?
A
propranolol
timolol
13
Q
which beta blockers should be used in pts who have asthma or respiratory concerns?
A
metoprolol
atenolol
14
Q
what are the ADRs of beta blockers?
A
fatigue
lethargy
depression
15
Q
which TCAs are used for migraine prevention?
A
Elavil
nortriptyline can be used
16
Q
what are the ADRs of TCAs?
A
drowsiness
weight gain
constipation
17
Q
which antieliptics are used for migraine prophylaxis?
A
depakote
neuronton
topamax
18
Q
what are the miscellaneous drugs used for migraine prophylaxis?
A
NSAIDs (Naproxen for menstrual migraines)
CCBs (verapamil for pts with HTN who cannot tolerate beta blockers)
19
Q
what are the medications used to treat Alzheimer’s disease?
A
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)
Memantine (Namenda)- *not a cholinesterase inhibitor
20
Q
what are the ADRs of drugs used to tx Alzheimer’s disease?
A
Constrict pupils Increased saliva Bronchoconstriction Increased GI mucous Bladder fundus contraction
21
Q
what is used to tx tension HAs?
A
beta blockers TCAs *non-pharma therapy -stress management -biofeedback -exercise -acupuncture -heat/cold -massage therapy -relaxation therapy
22
Q
when is treatment for tension HAs considered?
A
if more than 1 or 2 per week
23
Q
what do tension HAs NOT respond to?
A
triptans
ergots
24
Q
what are the combination drugs used to tx tension HAs?
A
Fiorinal/Fioricet
Midrin
25
what are the SSRI medications?
```
Fluoxetine (Prozac)
paroxetine (Paxil)
sertraline (Zoloft)
fluvoxamine (Luvox)
citalopram (Celexa)
escitralopram (Lexapro)
```
26
what is the MOA of SSRIs?
have selective inhibitory effects on presynaptic serotonin reuptake and wqak effects on norepinephrine and dopamine neuronal uptake; more serotonin is available to bind with the postsynaptic receptors
27
explain the pharmacokinetics of SSRIs
slow absorption
half-life 21-26 hours
extensive first pass metabolism
*fluoxetine half-life of 1-3 days & first metabolite 4-16 days (why it can be given weekly)
28
what is the indication for prescribing SSRIs?
depressive d/o
anxiety
panic d/o
*fluvoxamine (Luvox) is approved for OCD
29
what are the ADRs of SSRIs?
CNS
GI
sexual dysfunction (up to 35%)
caution: pts with severe hepatic or renal impairment
30
what should you educate patients who are taking SSRIs on?
adherence (can take 3-4 wks)
suicide risk
avoid alcohol, OTC meds that stimulate, insomnia or dizziness, suicide ideology
31
SSRIs are pregnancy category what?
B/C
avoid in 1st and last trimester
*Sertraline been used w/o adverse consequences
32
what are the initial SE of SSRIs?
```
nausea
light-headedness
sedation
muscle restlessness
sleep disturbances
```
33
what should you monitor in elderly patients taking SSRIs?
electrolytes
| *half dose recommended
34
higher doses of Celexa put the patient at risk for what?
QTc prolongation
35
Lexapro is the active metabolite of what?
citalopram (Celexa)
36
what are the indications for Prozac?
depression
OCD
bulimia
panic d/o
37
what are the indications for Luvox?
OCD
social anxiety d/o
depression (off-label)
38
what are the indications for Paxil?
```
Depression
OCD
panic disorder
social phobia
PTSD
anxiety
PMDD (CR)
```
39
what are the indications for Zoloft?
```
Depression
OCD
GAD
PMDD
PTSD
Social Anxiety disorder
```
40
when does serotonin syndrome happen?
in the presence of serotogenic activity
41
serotonin syndrome can be fatal. what are the symptoms?
```
nausea
diarrhea
chills
sweating
hyperthermia
HTN
myoclonic jerking
tremor
agitation
ataxia
disorientation
confusion
delirium
```
42
what can be done to prevent serotonin syndrome?
Adhere to maximum recommended doses
Avoid adjunctive combinations of serotonergic agents
Adequate time for titration when changing agents (5 half lives per dose decrease)
43
what is withdrawal syndrome?
when shorter half life drugs can show withdrawal symptoms with just one missed dose
44
which medications have the potential for withdrawal syndrome?
paroxetine
sertraline
citalopram
escitalopram
45
what are the symptoms of withdrawal syndrome?
nausea
dizziness
paresthesias (electric shock sensations, visual tracers w/eye movements)
46
SSRIs require gradual slow tapering except...
fluoxetine (long half-life, active metabolites)
47
the black box warning on all antidepressants for increased risk of suicidal though and behavior affects which population?
children
adolescents
young adults to age 24
- during first two months of tx
48
what is the MOA of benzos?
all benzos work on chloride ion channels of GABA-A receptors; enhance GABA neurotransmission which lengthens hyperpolarization and slow down responses
49
benzos are:
anxiolytic
anticonvulsion
muscle relaxants
sedating
50
what is the non-benzo GABA agonist?
Buspar
51
what are the short-acting benzos?
Clorazepate (Tranxene)
Halazepam (Paxipam)
Prazepam (Centrex)
52
what are the intermediate-acting benzos?
Alprazolan (Xanax)
Lorazepam (Ativan)
Oxazepam (Serax)
Chlordiazepoxide (Librium)
53
what are the long-acting benzos?
Diazepam (Valium)
| Clonazepam (Klonopin)
54
when are benzos used as anxiolytics?
```
muscle relaxant
pre-anesthesia sedation
prevention and tx of panic attacks
acute agitation and dystonia
emergency tx of uncontrollable seizures
restless leg syndrome
```
55
which benzos are thought to be higher risk for dependence?
alprazolam
lorazepam
d/t high potency, and rapid, short-term action
56
when are benzos contraindicated?
```
pregnancy
lactation
children < 6
hepatic & renal disease
*caution in elderly
```
57
when do the symptoms of benzo withdrawal usually occur?
1-2 days after last dose of short-acting
| 5-10 days after long-acting
58
what are the main ADRs of benzos?
excessive sedation
potential for cardiac & respiratory depression in combo with other CNS depressants
paradoxial anxiety, agitation & acute rage may occur
59
why should Buspar be taken with food?
reduces first pass affect, allowing for more active drug going directly into circulation
60
why is Buspar contraindicated with panic attacks?
one metabolite has noradrenergic effects
61
how long does it take for Buspar to take effect?
up to two weeks for onset
| and up to six weeks for max effect
62
what is the half life of Buspar and why is that important?
1-10 hours
| requires multiple dosing during the day
63
what are the positive symptoms in psych disorders?
```
agitation/aggression
disorganized speech
hallucinations
delusions
paranoia
```
64
what are the negative symptoms in psych disorders?
```
anhedonia (no pleasure)
flattening of affect
poverty of speech content
poor self care
social withdrawal
decreased motivation
```
65
what are the phenothiazines used to tx + symptoms in psych d/o?
Chlorpromazine (Thorazine) fluphenazine (Prolixin) Perphenazine (Trilafon) Thioridazine (Mellaril) Trifluoperazine (Stelazine)
66
what are the non-phenothiazines used to tx + symptoms in psych d/o?
Haloperidol (Haldol)
molindone (Moban) Thiothixene (Navane)
Loxapine (Loxitane)
67
what are the ADRs of the typical antipsychotics?
```
*too much dopamine stimulation*
Shuffling
pill-rolling
cog-wheeling
tremors
drooling
akathisia (restlessness) dystonia (involuntary movements)
tardive dyskinesia (involuntary buccolongual movements)
--------------------------------------
sedation
weight gain
photosensitivity
reduction of seizure threshold
sexual dysfunction
```
68
what is given to counteract EPS?
antiparkinson
antihistamines
anticholinergics
69
what is neuroleptic malignant syndrome (NMS)?
```
life threatening
fever up to 107
elevated pulse
diaphoresis
rigidity
stupor/coma
acute renal failure
```
70
what are the high-potency typical antipsychotics?
haloperidol
| fluphenazine
71
what are the low-potency typical antipsychotics?
chlorpromazine
| thioridazine
72
what are the contraindications for typical antipsychotics?
narrow-angle glaucoma
bone marrow depression
severe liver or cardiovascular disease
73
what are the atypical antipsychotics?
```
Aripiprazole (Abilify)
Asenapine (Saphris)
Clozapine (Clozaril)
-Risk of fatal agranulocytosis – monitor CBCs
Iloperidone (Fanapt)
Olanzapine (Zyprexa, Zyprexa Zydis, IM, Relprevv)
Olanzapine-fluoxetine: Symbyax
Paliperidone (Invega, Invega Sustenna)
Quetiapine (Seroquel, Seroquel XR)
Risperidone (Risperdal, Risperdal Consta)
Ziprasidone (Geodon)
-Mild to moderate QTc prolongation
```
74
what kind of symptoms do atypical antipsychotics tx?
+ and -
75
what are the ADRs of atypical antipsychotics?
```
weight gain- can lead to metabolic syndrome
seizures
hyperprolactinemia
dizziness
orthostatic hypotension
tachycardia
sleep disturbance
constipation
*caution: hepatic or renal dz
```
76
what makes clozapine unique?
risk of fatal agranulocytosis
reserved for tx of severe schizo refractory to complete trials of at least two different types of antipsychotics
available only through patient management system in which clinician and patient are both registered
77
clozapine should be monitored for how long after tx is discontinued?
4 wks
78
what are the indications for using atypical antipsychotics?
```
schizophrenia
schizoaffective d/o
depression or mania with psychotic features
severe agitation
delusions with dementia
```
79
when changing from one atypical antipsychotic to another what should be done?
slowly titrating off the first and on to the second
| washout period if possible
80
what are the pseudoparkinsonism extrapyramidal symptoms?
Tremor
muscle rigidity
stooped posture
81
what are the acute dystonia EPS?
Muscle spasms of face, tongue, neck or back
82
what are the akathisia EPS?
Inability to rest and relax; pacing
83
what are the tardive dyskinesia EPS?
Lip smacking
wormlike movements of the tongue
uncontrolled chewing and grimacing
84
schizophrenia & atypical APs increase the risk of what?
diabetes
85
what should be assessed before starting any atypical AP?
```
waist circumference
BMI
blood pressure
fasting plasma glucose
lipid profile
```
86
what is lithium used to treat?
considered tx of choice for classic bipolar mood d/o
| adjunct for tx of unipolar depression
87
what is the half-life of lithium?
15-36 hours
| steady state: 5-7 days
88
what is the therapeutic index for lithium?
0.6-1.5 mEz/L
89
what are the signs of lithium toxicity?
```
hand tremors
N/V
diarrhea
confusion
stupor
polydipsia/polyuria
muscle weakness
ataxia
```
90
lithium takes how long to reach max efficacy?
10-14 days (not for acute mania)
91
lithium is indicated for what?
maintenance of mood stability
| prevention of mania or hypomania
92
pts should be educated on what in regards to intake of lithium?
maintain adequate salt intake
| take with food to minimize GI distress
93
lithium is contraindicated in which pt population?
children < 12
94
what are the ADRs of lithium?
Fine tremors
nausea
dry mouth
headache
drowsiness
Hypothyroidism and kidney failure may occur with long term administration
Sustained released – can minimize adverse effects associated with dosage peaks
95
lithium interacts with which medications?
Diuretics – increase sodium excretion and increase lithium levels
NSAIDs – reduce renal elimination and increase lithium levels
96
what are the most common pathogens that require anti-infectives?
staph aureus
| strep pyogenes
97
what are the basic principles of topical anti-infectives?
```
culture if unsure
treat empirically
follow progress & culture
watch for resistance
change med if appropriate
```
98
what are some of the common antibacterials used to treat skin d/o?
bacitracin
mupirocin
retapamulin
neomycin
polymyxin B
double antibiotic (polymyxin B, bacitracin)
triple antibiotic (polymyxin B, neomycin, bacitracin)
99
what are the indications for using bacitracin?
minor cuts
wound
impetigo (1-2 lesions only)
100
what are the indications for using mupirocin?
impetigo
| nasal colonization with MRSA
101
what are the indications for using retapamulin?
impetigo
102
what are the indications for using neomycin?
minor cuts
wounds
impetigo (1-2 lesions only)
103
what are the indications for using polymyxin B?
minor cuts
wounds
impetigo (1-2 lesions only)
104
what are the indications for using double antibiotic?
minor cuts
wounds
impetigo
105
what are the indications for using triple antibiotic?
minor cuts
wounds
impetigo (1-2 lesions only)
106
what are some of the common antifungals used to treat skin d/o?
```
butenafine
ciclopirox olaminr
clotrimazole
econazole
gentian violet
ketoconazole
miconazole
naftifine
nystatin oral suspension
nystatin cream or ointment
oxiconazole
sertaconazole
terbinafine
tolnaftate
```
107
what are the indications for using butenafine?
```
tinea corporis (ringworm)
tinea cruris (jock itch)
```
108
what are the indications for using ciclopirox olamine?
```
tinea corporis (ringworm)
tinea cruris (jock itch)
```
109
what are the indications for using clotrimazole?
oral candidiasis
fungal skin infections, including candidiasis
tinea pedis (athlete's foot)
110
what are the indications for using econazole?
```
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
```
111
what are the indications for using gentian violet?
oral candidiasis
112
what are the indications for using ketoconazole?
```
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
```
113
what are the indications for using miconazole?
```
fungal skin infections, including candidiasis
tinea pedis (athlete's foot)
```
114
what are the indications for using naftifine?
```
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
```
115
what are the indications for using nystatin oral suspension?
oral candidiasis
116
what are the indications for using nystatin cream or ointment?
cutaneous candida infections
117
what are the indications for using oxiconazole?
```
tinea corporis (ringworm)
tinea capitis (ringworm of the scalp)
tinea pedis (athlete's foot)
```
118
what are the indications for using sertaconazole?
interdigital tinea pedis in immunocompetent patients
119
what are the indications for using sulconazole?
```
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
```
120
what are the indications for using terbinafine?
```
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
```
121
what are the indications for using tolnaftate?
tinea pedis (athlete's foot)
122
what are some of the common antivirals used to treat skin d/o?
acyclovir
docosanol
penciclovir
123
what are the indications for using acyclovir?
initial herpes genitalis
| mucocutaneous HSV infections in immunocompromised patients
124
what are the indications for using docosanol?
recurrent oral-facial herpes simplex episodes
125
what are the indications for using penciclovir?
recurrent herpes labialis (cold sores) on lips and face
126
what are the low potency topical corticosteroids?
hydrocortisone 1% or 2.5%
| triamcinolone acetonide 0.025%
127
what are the intermediate potency topical corticosteroids?
```
hydrocortisone valerate 0.2%
triamcinolone acetonide 0.1%
betamethasone valerate 0.12%
desoximetasone 0.05%
mometaxone furoate 0.1%
```
128
what are the high potency topical corticosteroids?
betamethasone dipropionate augmented 0.05% (cream or lotion)
triamcinolone acetonide 0.5%
halcinonide 0.1%
129
what are the super-high potency topical corticosteroids?
bethamethasone dipropionate augmented 0.05% (ointment or gel)
clobetasol propionate 0.05%
flurandrenolide 4-mcg/cm2 tape
130
topical corticosteroids are pregnancy category what?
C
| avoid use and/or limit amounts and duration
131
who should not use high and super high potency topical corticosteroids?
children
132
what is used to treat contact dermatitis?
topical corticosteroids
oral corticosteroids ( up to 2-3 wks of therapy)
wet dressings or baths: Al acetate solution (Burow's, Domeboro) applied 30 mins 4x/day; colloidal oatmeal solids (Aveeno) or oils (Alpha Keri Bath Oil, Lubriderm Bath Oil)
133
what is used to treat seborrheic dermatitis?
```
topical anti-seborrheic shampoo (selenium sulfide, ketoconazole, pyrithione zinc)
topical corticosteroids (low potency, only if no response from shampoo)
```
134
which medications are used to tx psoriasis?
topical intermediate to high potency corticosteroids
| coal tar- creams, shampoos, ointments, lotions, gels, and oils 1-2x/daily (can cause photosensitivity)
135
what should be used in the tx of scabies?
permethrin
lindane
topical corticosteroids for itching & inflammation (prolong healing phase)
136
what are the topical retinoids used to tx acne?
tretinoin (Retin-A)
adapalene (Differin)
adapalene & benzoyl peroxide (Epiduo)
137
what kind of acne do retinoids tx?
inflammatory & noninflammatory
* can cause redness and peeling
* can cause acne to initially worsen
138
what are the topical antibiotics used to tx acne?
```
benzoyl peroxide
benzoyl peroxide/clindamycin
erythromycin
benzoyl peroxide/erythromycin
clindamycin
tetracycline
metronidazole
```
139
what are the oral antibiotics used to tx acne?
tetracycline
erythromycin- *take with food
minocyclin
140
what is the only oral retinoid?
isotretinoin
141
what does a pt need to be educated on when taking an oral retinoid?
pregnancy category X
reseved for severe recalcitrant cystic acne
requires iPledge
liver enzyme and lipid levels need to be monitored
142
what is acne rosacea?
chronic inflammatory d/o of the blood vessels and pilosebaceous glands of the face
143
what is used to tx acne rosacea?
```
topical metronidazole (Metro-gel, Noritate)
tx for life
```
144
how long does it take to determine of tx of acne rosacea is effective?
6-8 weeks
145
what are the most common bacterial skin infection pathogens?
s. aureus
| strep pyogenes
146
what is used to tx worsening impetigo or > 5 lesions?
```
oral medications:
cephalexin
amoxicillin/clavulanate
dicloxavillin
clindamycin
```
147
if MRSA is suspected with an impetigo infection, which medication should be used?
clindamycin
TMP/SMZ
doxycycline
148
which pathogen causes a furuncle?
s. aureus
149
which medications are used to tx furuncles?
cephalexin
amoxicillin/clavulanate
dicloxacillin
150
which medications are used to tx perianal strep infections?
penicillin
| erythromycin
151
which pathogen causes cellulitis?
strep pneumoniae
s. aureus
haemophilus influenzae (children only)
152
which medications are used to tx oral candidiasis?
topical nystatin
| oral fluconazole
153
which pathogen causes tinea capitis?
```
microsporum (present with broken hairs and fine gray scale)
trichophyton tonsurans (black dot tinea; presents with tiny black dots- remains of broken hair shafts)
```
154
which medications are used to treat tinea capitis?
oral griseofulvin
| biweekly shampoo with selenium sulfide or ketoconazole
155
which pathogens cause tinea corporis & tinea cruris?
microsporum canis
t. tonsurans
epidermophyton floccosum
156
which pathogen causes tinea pedis?
dermatophytes
e. floccosum
t. rubrum
t. mentagrophytes
c. albicans
157
which pathogens cause tinea vesicolor?
pityrosporum orbiculare
158
which medications are used to tx tinea vesicolor?
```
selenium sulfide shampoo
topical antifungal (miconazole, clotrimazole, econazole)
```
159
which medications are used to treat onychomycosis?
```
griseofulvin
ketoconazole
itraconazole
terbinafine
ciclopirox nail lacquer
efinaconazole (Jublia)- for up to 48 wks
```
160
which medications are used to treat superficial fungal infections?
```
azoles
allylamines: naftifine (Naftin)
benzylamine: butenafine (Lotrimin Ultra)
ciclopirox olamine
tolnaftate (Tinactin)
nystatin
```
161
what are the systemic antifungals used to tx fungal infections of the skin?
```
griseofulvin
ketoconazole
itraconazole
fluconazole
terbinafine (Lamisil)
```
162
what precautions are there with systemic antifungals?
used cautiously in pts with liver disease
| griseofulvin has possible cross-sensitivity with penicillin
163
what are the ADRs of topical antifungals?
```
skin irritation
itching
burning
rash
gentian violet can cause staining of skin/clothing
```
164
what are the drug interactions associated with topical antifungals?
theoretical interaction with azoles and amphotericin B
| clotrimazole intravaginal should not be administered concurrently with nonoxynol-9 and octoxynol
165
which medications are used to tx candidiasis infections?
Cutaneous Candida: OTC azoles, nystatin, prescription azoles
Gentian violet can be used for thrush refractory to azoles
Fluconazole may be used systemically for thrush or vaginal candidiasis
166
which medications are used to tx tinea capitis infections?
```
Griseofulvin
Terbinafine
Use sporicidal shampoo
-Selenium sulfide
-Ketoconazole
```
167
which medications are used to tx tinea corporis infections?
topical azoles
naftifine
ciclopirox olamine
168
which medications are used to tx tinea cruris infections?
topical azoles
169
which medications are used to tx tinea pedis infections?
topical azoles
170
which medications are used to tx tinea vesicolor infections?
selenium sulfide shampoo
| topical antifungal
171
what should be monitored when taking griseofulvin?
renal
liver
CBC
172
what should be monitored when taking ketoconazole?
liver function
173
what should be monitored when taking itraconazole?
liver function
| electrolytes
174
what should be monitored when taking terbinafine?
liver enzymes
| CBC
175
which medications should be used to tx head lice?
pyrethrins
permethrin
benzoyl alcohol (Ulesfia)
2nd line- lindane & Ovide
176
which medications should be used to tx body lice?
topical lindane & permethrin
177
which medications should be used to tx pubic lice?
topical lindane, pyrethrin, & permethrin
178
lindane should not be used in which population?
pregnancy
| children
179
which medication is safer to use in pregnancy for lice?
permetherin
180
what are the anticholinergics?
```
Darifenacin (Enablex)
Fesoterodine (Toviaz)
Oxybutynin (Ditropan, Ditropan XL)
Solifenacin (VESIcare)
Tolterodine (Detrol, Detrol LA)
Trospium (Sanctura)
```
181
what are the anticholinergic ADRs?
```
Dry mouth
Dilate pupils
Increased contractility
Increased HR
Bronchodilation
Blurred vision
Constipation
Drowsiness/sedation
Hallucinations/delirium
Confusion
Decreased sweating
Decreased saliva
Bladder fundus relaxes, sphincter contracts (urinary incontinence)
```
182
what are the alpha1 antagonists?
```
Tamsulosin (Flomax)
-Use caution in hepatic impairment
Alfuzosin (Uroxatral)
-Dose not use with mild to moderate hepatic impairment
-Use caution with CrCl < 30 do not use
```
183
what are the alpha1 antagonist ADRs?
```
Orthostatic Hypotension – may result in syncope – tends to occur within 30-90 minutes of drug administration (decreased w/evening administration)
fluid retention
nasal congestion
blurred vision
dry mouth
constipation
impotence
urinary frequency
```
184
what is testosterone replacement therapy used for?
muscle mass/strength
| sexual desire, function, & performance
185
TRT is contraindicated in which patients?
male breast or prostate cx
pregnancy & lactation
transdermal NOT used in women
186
what are the ADRs of TRT?
hepatitis
hepatic neoplasm
cholestatic hepatitis
jaundice
hepatocellular carcinoma
Men: gynecomastia, reduced sperm levels, decreased libido, depression
Women: menstrual irregularities, virilization
187
what are the PDE5 inhibitors?
```
Sildenafil citrate (Viagra)
Tadalafil (Cialis)
Can be given 2.5-5mg once daily instead of prn
Vardenafil (Levitra)
Avanafil (Stendra)
```
188
what are the PDE5 inhibitor contraindications?
food decreases absorption
cannot use concurrently with nitrates
alpha blockers have additive hypotension
189
what are the ADRs of PDE5 inhibitors?
```
HA
flushing
dyspepsia
blue hue vision change
tadalafil- low back pain & < visual disturbances
```
190
what is priapism?
erection > 4 hours
191
diflucan doesn't reach steady state for how many days?
5-10
192
what is diflucan used for?
vaginal candidiasis
| oropharyngeal candidiasis
193
UTIs can be treated empirically with which medication?
bactrim 1st line when no complicating factors
194
UTIs should be treated with what kind of medications?
gram -
195
which pathogen is the primary culprit for UTIs?
E. coli
196
what is the alternative first-line treatment for UTIs?
ciprofloxacin
| can also use levofloxacin
197
which medication should not be used to treat UTIs?
moxifloxacin (poor concentration in urine)
198
which medication should be used in children when treating a UTI?
ciprofloxacin
199
what is second line therapy in treatment of UTIs?
amoxicillin
| or cephalosporins
200
which medications should be used to treat UTI in pregnancy?
2nd line drugs
| nitrofurantion
201
when is nitrofurnation contraindicated?
Contraindicated in CrCl<60- no harm to the patient but not effective; UTI won’t go away
202
what are the antibiotics used to tx UTIs?
```
Trimethoprim/sulfamethoxazole (TMP/SMX, Bactrim)
Nitrofurantoin (Furadantin, Macrodantin)
Fluoroquinolones
-Ciprofloxacin (Cipro)
-Levofloxacin (Levaquin)
Cephalosporins
-Cephalexin (Keflex)
-Cefpodoxime (Vantin)
-Cefixime (Suprax)
Penicillins
-Amoxicillin (Amoxil)
-Amoxicillin/clavulante
```
203
when is estrogen only contraindicated?
```
women with an intact uterus
Pregnancy (category X)
Breast cancer
Estrogen-dependent cancers
Active DVT or PE
Hx in past year of stroke or MI
Liver dysfunction
Smokers
```
204
what are the ADRs of estrogen?
can interfere w/lab tests (endocrine, LFTs, thyroid, & PT)
impaired glucose tolerance
increased triglycerides
thromboembolic phenomena (leg pain, visual disturbances, severe HA- smoker s& diabetics are at increased risk)
205
what are the common drug interactions with estrogen?
anticoagulants
anti-TB drugs
corticosteroids
anti-seizure
206
what are the delivery methods of contraception?
```
oral
topical
vaginal ring
subdermal implants
IM
IUDs
```
207
when choosing a contraceptive, what should be done first?
start with absolute contraindications- estrogen contraindications
208
what are the common oral contraception formulations?
```
progestin only
ultra low dose (20m mcg EE)
monophasic COC
multiphasic COC
non-daily administration
```
209
what are the two formulations of estrogen that are available in contraceptive preparations?
```
ethinyl estradiol (EE)
mestranol (rarely seen)
```
210
when there is an increased dose of estrogen, what kind of symptoms does the patient have?
more pregnancy symptoms
211
when there is a low dose of estrogen, what kind of symptoms does the patient have?
less cycle control
212
what are the first generation progesterones?
Norethindrone norethindrone acetate ethynodiol diacetate
213
what are the SE of first generation progesterones?
highest chance of spotting & breakthrough bleeding
| least risk of androgen SE
214
what are the second generation progesterones?
norgestrl
| levonorgestrel
215
what are the SE of second generation progesterones?
lowest risk of breakthrough bleeding
| increased risk of androgen SE (acne, hirsutism, dyslipidemia)
216
what are the third generation progesterones?
desogestrel
| norgestimate
217
what are the SE of third generation progesterones?
balance between 1st & 2nd gen
| reduce SE on carbohydrate and lipid metabolism; acne; hirsutism
218
which generation of progesterones are first line for contraception?
third
219
what are the goals of OC treatment?
tolerance
-current OCs has less estrogen (less pregnancy like symptoms)
-newer gen progestins have fewer weight changes, reduced mood swings
effectiveness
-N/V decrease effectiveness (decreased absorption), backup method x7 days
220
what are the dosing regimens for OCs?
traditional- 21 days active drug, 7 inactive
extended cycle: 84 days of active, 7 days off
monophasic: same dose of estrogen & progestin for full cycle
biphasic: vary dose of progestin (rare)
triphasic: vary estrogen, progestin or both (more popular)
221
what are the extended cycle dosing medications?
seasonique
loSeasonique
lybrel
222
what is the difference of new monophasics?
24 active and 4 non-active pills per cycle
| -goal lighter & shorter withdrawal bleeds & to decrease breakthrough spotting
223
when are progestin-only pills used?
when estrogen is contraindicated
224
what are the common ADRs of progestin-only pills?
changing bleeding patterns
| breast tenderness
225
what should pts taking progestin-only be educated on?
dose MUST be taken at the same time daily
| if a pill is taken even a few hours late, backup method is recommended for 48 hours
226
how do progestin-only pills work?
thickening of cervical mucus and prevention of sperm penetration
227
what are the injectable progestins?
depo-provera
228
what are the advantages of the injectable progestin?
once every 12 week dosing
| effective
229
what are the disadvantages of the injectable progestin?
spotting and then amenorrhea
weight gain
depression
decreased bone-density with long-term use
230
how do intrauterine progestins work?
releases 20 mcg of levonorgestrel daily
231
how long can IUDs be left in place?
5 yrs
232
what is an advantage of IUDs?
only small levels of systemic circulating hormone
minimal SE
can cause changes in menstrual bleeding, amenorrhea
233
what are the progestin implants?
implanon/nexplanon; contains 68 mg of etonogestrel
234
how long do progestin implants provide contraception?
up to 3 yrs
235
when is hormone replacement therapy used?
any time there is a loss of the body's ability to produce estrogen and progestin (removal of ovaries, menopause)
236
what are the goals of HRT treatment?
provide relief from symptoms associated with menopause
used to tx moderate to severe menopausal symptoms
used to tx/prevent other chronic illness not encouraged
lowest dose & shortest duration recommended
237
what are the symptoms of decreased hormones?
vasomotor symptoms
vaginal atrophy
osteoporosis
238
what are the "rules" for rational HRT drug selection?
use lowest dose that relieves symptoms for shortest time (up to 5 yrs)
individualize the drug choice and dose on woman's risk profile
monitor women annually for changes in risk profile, development of AE, & cont. need for therapy
239
when is HRT not recommended?
to prevent CHD
| women with h/o breast cx or 1st degree family memeber
240
when is HRT indicated?
can decrease r/o colon cancer
reduces r/o osteoporosis
will improve symptoms of vasomotor symptoms & vaginal atrophy
241
what is estrogen therapy used for?
relief of perimenopausal/postmenopausal symptoms
vulvovaginal atrophy/dryness
reduction in colon and rectal cancers
242
when treating vulvovaginal atrophy & dryness what is the preferred route?
topical d/t lower overall estrogen dose
| oral estrogen improves symptoms
243
what are some of the alternative "medications" used to treat perimenopausal/postmenopausal symptoms?
```
phytoestrogens
-red clover
-soy
-black cohosh
botanicals/herbals
-black cohos
-chaste tree fruit
```
244
there is an increased risk of what type of cancer with estrogen therapy?
endometrial with unopposed estrogen
245
the risk of what increases with estrogen therapy?
CHD
stroke
thromboembolic events
246
estrogen therapy is correlated with reduction of what?
colon and rectal cancers
247
what is progestin alone used for?
contraception
| menorrhagia
248
progestin is combined with estrogen to treat peri & postmenopausal women for what reason?
prevent endometrial hyperplasia (increases risk for endometrial cx)
249
combo of estrogen & progestin are used when what is intact?
uterus
250
what are the combo medications available?
prempro
| premphase
251
what is the outcome of continuous regimens?
eliminate monthly withdrawal bleeding
| have higher rate of breakthrough bleeding esp. first 6 mths
252
what is the outcome of cyclical/sequential therapy?
given when problem with breakthrough bleeding
estrogen taken daily
medroxyprogesterone taken part of the cycle
253
when is testosterone therapy used?
when hot flashes don't improve with HRT/ERT
254
testosterone is combined with what?
estrogen
255
testosterone alone an lead to what?
masculinization
