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Treatments 6 Flashcards

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1
Q

Central precocious puberty

A

Continuous GnRH

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2
Q

Pseudoprecocious puberty

A

Remove tumor, cortisol replacement for CAH

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3
Q

Pros of HRT for menopause

A

Control symptoms
Reduced risk of osteoporosis
Reduced risk of colorectal cancer
May decrease coronary calcification if taken age 50-59 (unknown correlation w/ cardiac disease)

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4
Q

Cons of HRT for menopause

A

Increases risk of invasive breast cancer, endometrial cancer (NO estrogen w/o progesterone if woman still has uterus)
Increases risk of stroke, heart disease, hypercoagulability, biliary disease

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5
Q

Non-HRT options for hot flashes

A

Desvenlafaxine, venlafaxine
Clonidine
Gabapentin
Time

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6
Q

Menopause treatment

A

Vaginal lubricants (dyspareunia)
Calcium, vitamin D, bisphosphonates, weight bearing exercise (osteoporosis risk)
SERMs (tamoxifen, raloxifene) (osteoporosis risk)

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7
Q

Emergency contraception

A 
High dose OCPs (lots of AE)
Levonorgestrel (Plan B, just progesterone)
Copper IUD (insertion w/i 4-5 days of intercourse)
Mifepristone (RU 486) (low dose, high dose for abortion)
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8
Q

Pros of OCPs

A

Reliable
Reduce risk of endometrial and ovarian cancer
Decreased incidence of ectopic pregnancy
Menses lighter, more regular, less painful

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9
Q

C/I for OCPs

A

Pregnancy
History of DVT/PE/hypercoagulability disorder
History of estrogen-dependent tumor
History of stroke or CAD
Poorly controlled HTN
Smokers >35 yo
Hepatic disease or neoplasm
Abnormal vaginal bleeding of unknown etiology
Migraine w/ aura, neuro sx or vascular involvement

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10
Q

Amenorrhea, behavioral

A

Behavior modification (eating, exercise)

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11
Q

Amenorrhea, anatomic

A

Surgical correction

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12
Q

Amenorrhea, HPO dysfunction

A

Leuprolide (GnRH agonist), pulsatile

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13
Q

Amenorrhea, prolactinoma

A

Dopamine agonists (bromocriptine, cabergoline)

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14
Q

Dysmenorrhea

A

NSAIDs, OCPs

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15
Q

PMS, PMDD

A

NSAIDs, OCPs

Vitamin B6, SSRI +/- alprazolam, exercise, progestins

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16
Q

Endometriosis

A

OCPs, progestins, GnRH, NSAIDs, (danazol)
Laparoscopy
Definitive = hysterectomy + b/l salpingo-oopherectomy

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17
Q

Abnormal uterine bleeding

A

Treat cause
NSAIDs, OCPs
Endometrial ablation / hysterectomy

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18
Q

When to get endometrial biopsy w/ abnormal uterine bleeding

A

Patient >45
Patient w/ multiple risk factors for endometrial cancer
Patient w/ persistent AUB >6 months

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19
Q

PCOS

A 
Exercise, weight loss
OCPs (or at least progesterone by itself)
Spironolactone
Metformin
Consider statin, acne meds as needed
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20
Q

PCOS if patient wants to get pregnant

A

Clomiphene (antiestrogen, acts at hippocampus)

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21
Q

Pelvic prolapse

A

Mild - pelvic floor exercises
Moderate - pessary
Severe - surgery

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22
Q

Uterine fibroids (leiomyomas)

A

Asymptomatic - observation
GnRH agonists (temporary), OCP/IUD (for bleeding)
Myomectomy, hysterectomy, UAE

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23
Q

Endometrial cancer

A

TAH w/ bilateral salpingo-oopherectomy and LN sampling
Progestins to maintain fertility then surgery after finished
Add chemo/radiation for mets

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24
Q

Cervical cancer

A

Microscopic (<5 mm): TAH or conization
Visibly invasive: radical hysterectomy + lymphadenectomy
Major invasion/mets: radiation + chemo

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25
SCC of the vagina
Radiation
26
Lichen sclerosis
Punch biopsy to r/o SCC | Steroids (clobetasol)
27
Benign ovarian tumors
Observation for functional cysts Cysectomy or oopherectomy if malignant potential TAH-BSO for postmenopausal
28
Ovarian cancer
Epithelial - TAH-BSO w/ pelvic wall sampling, abdominal omentum resection, LN resection w/ adjuvant chemo Germ cell - oopherectomy +/- debulking w/ chemo
29
Fibrocystic changes
Observation | Caffeine and dietary fat reduction, OCPs
30
Breast abscess
I&D, antibiotics (dicloxacillin, cephalexin, amoxicillin-clavulanate, TMP-SMX for MRSA, metronidazole for anaerobes), continue breastfeeding
31
Phyllodes tumor
Excision (some malignant potential)
32
Fibroadenoma
May observe if asymptomatic | Surgical excision or US-guided cryotherapy
33
Intraductal papilloma
Surgical excision (rare malignant potential)
34
Physiologic anemia of pregnancy
Iron supplementation if Hct <10.5 (second trimester)
35
Increased nutritional demands of pregnancy
Folic acid, calcium, iron Protein, fluids Vitamin D, B12 for strict vegetarians
36
Vaccines indicated during pregnancy
Tetanus q10 years (esp P of TdaP) in 2nd/3rd trimester Influenza (shot) annually Only if indicated: pneumococcal, meningococcal, Hep A/B
37
Vaccines C/I during pregnancy
Live MMR, varicella Oral polio, intranasal influenaza
38
Postpartum or post-abortion vaccines
Rubella before discharge if non-immune TDaP if none in last 10 years Varicella before discharge if non-immune (2nd dose 4-8 weeks later)
39
Gestational or pregestational diabetes
Diet and exercise | Insulin = DOC
40
Preeclampsia
Delivery is only definitive cure Monitor patient closely (out or inpatient) Blood pressure control MgSO4 until 24 hrs post delivery
41
Eclampsia
Delivery is only definitive cure Stabilize w/ O2 and blood pressure control MgSO4 until 48 hrs post delivery Try diazepam to control acute seizure
42
BP medications in pregnancy
``` HTN moms love nifedipine Hydralazine Methyldopa Labetalol (BB) Nifedipine ```
43
Epilepsy in pregnancy
Keep on anticonvulsants w/ folate supplementation | Diazepam to break active seizures (Mg is useless)
44
Asthma in pregnancy
Same as non-pregnant Mild intermittent: short-acting B agonists (albuterol) PRN Mild persistent: add low dose inhaled steroid Moderate persistent: medium dose steroid or low dose steroid + long-acting B agonist (salmeterol) Severe persistent: high dose inhaled steroid + long-acting B agonist
45
Hyperemesis gravidarum
Hydration, avoid large meals Vitamin B6 + ginger OTC doxylamine Prescription ondansetron or promethazine
46
DVT in pregnancy
Heparin / LMWH until 6 weeks postpartum (stop during L&D) | Can switch to warfarin PP (safe during breastfeeding)
47
UTI in pregnancy
Amoxicillin, nitrofurantoin, cephalexin x7 days | NO fluoros
48
Toxoplasmosis in pregnancy
Pyrimethamine, sulfadiazine, folinic acid | avoid cat litter boxes, raw meat, unpasteurized milk, gardening
49
Rubella in pregnancy
No treatment while pregnant
50
Rubeola in pregnancy
Immune serum globulin during pregnancy
51
Syphilis in pregnancy
Maternal or neonatal penicillin
52
CMV in pregnancy
No treatment while pregnant | Ganciclovir may decrease effects in newborns
53
HSV in pregnancy
Acyclovir starting wk 34-36 Deliver by c-section if active lesions Acyclovir may be beneficial in newborns
54
Hep B in pregnancy
``` Maternal vaccination (can be during pregnancy) Vaccination and Ig for neonate ```
55
HIV in pregnancy
HAART during pregnancy (avoid certain drugs) AZT during labor Usually c-section No breastfeeding
56
Gonorrhea/chlamydia in pregnancy
Erythromycin for mom or baby (can be eye drops for neonate)
57
VZV in pregnancy
Varicela Ig to nonimmune mother and neonate born during active infection
58
GBS in pregnancy
IV B-lactams (penicillin/ampicillin) or clindamycin if: +GBS screening at week 36 +GBS bacteruria during pregnancy Previous infant with GBS infection If no screening, intrapartum fever, preterm labor or prolonged rupture of membranes
59
Parvovirus B19 in pregnancy
Monitor fetal hemoglobin | Possible transfusion by PUBS
60
Ectopic pregnancy
MTX (<5,000 B-hCG, etc) or surgical excision
61
Threatened abortion
Bed rest, limited activity
62
Missed abortion
Expectant management (most pass w/i 2 weeks) Misoprostol (PGE1) D&C
63
Inevitable abortion
Expectant management Misoprostol (PGE1) D&C
64
Incomplete abortion
Misoprostol (PGE1) | D&C
65
Complete abortion
None
66
Intrauterine fetal demise
<24 weeks can undergo D&E | Induce labor and delivery (oxytocin, PGE1, 2)
67
IUGR
Monitor Nutrition/O2/bed rest for mom Delivery if fetal growth slows further or maternal or fetal distress
68
Oligohydramnios
Expectant management if no fetal distress Delivery if fetal distress Hydration +/- bed rest
69
Polyhydramnios
Percutaneous drainage if mom very uncomfortable or threat of pre-term labor 32 weeks: amnioreduction alone
70
PROM / PPROM
34 weeks: abx + delivery
71
Preterm labor, tocolysis
MgSO4, terbutaline, indomethacin or nifedipine (48 hrs)
72
Preterm labor, overall
Tocolysis + glucocorticoids <34 weeks | Ampicillin if delivery imminent
73
Placenta previa
Bed rest, RhoGam, tocolysis + steroids | C-section usually (can try vaginal in low-lying)
74
Placenta abruptio
Bed rest inpatient | Usu have quick delivery, if not perform c-section for hemodynamic instability
75
Molar pregnancy
D&C | Follow B-hCG to zero and then 1 year after
76
Choriocarcinoma
Hysterectomy Chemo (MTX, etc) if metastatic Follow B-hCG to zero and then 1 year after
77
Early decels during labor
None (head compression)
78
Variable decels during labor
Change mother position
79
Late decels during labor
Possibly need prompt delivery
80
Labor dystocia - assessment
3Ps Power - contraction strength (>200 MVU/10 min), duration and frequency (every 2-3 min) Passenger - baby size, lie (anterior occiput/looking down > posterior occiput/looking up) Pelvis - shape and diameter
81
Non-reassuring fetal heart tones during labor
Maternal O2, movement to LLD Turn off oxytocin/cervidil (maybe terbutaline to stop) Manage maternal hypotension Vaginal exam for cord prolapse
82
Breech presentation
Offer ECV at 37 weeks | C-section if unchanged
83
Indications for c-section
Maternal: eclampsia, prior uterine surgery (inc c-section), cardiac disease, birth canal obstruction, maternal death, cervical cancer, active genital herpes Fetal: acute fetal distress, malpresentation, cord prolapse, macrosomia Both: failure to progress in labor, placenta previa or abruptio, cephalopelvic disproportion
84
Postpartum bleeding
Uterine massage + oxytocin/pitocin
85
Mastitis
Continue nursing Rest, ibuprofen, antibiotics (dicloxacillin cephalexin, TMP-SMX for MRSA, metronidazole for anaerobes) I&D for abscess
86
Oral contraceptives for lactating women
Progesterone only
87
Postpartum bleeding w/ HTN
Hemabate (if no asthma)
88
Postpartum bleeding w/ asthma
Methergine (methylergonovine) (if no HTN)
89
Postpartum bleeding, non medical options
Uterine or iliac artery ligation, arterial embolization, hysterectomy D&C for retained placenta Tamponade
90
Postpartum endometritis
Gentamicin + clindamycin +/- ampicillin
91
Infantile thrush
Nystatin oral suspension
92
SIDS prevention
``` Sleep on back Sleep on firm surface Avoid soft objects in bed Avoid overheating Use pacifier while sleeping No smoking ```
93
Work-up on newborn w/ single umbilical artery
Renal sonogram for abnormalities
94
Car seat guidelines
<13 in back seat

Medications (10 decks)

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