Unit 4 Flashcards
1
Q
4 non-contraceptive benefits of combination oral contraceptives
A
- decrease the risk of ovarian, endometrial, and colon cancer
- decrease the risk of benign breast disease and ovarian cysts
- decrease the risk of endometriosis, fibroids, ovulation pain, PMS/PMDD, cramps, migraines, and anemia
- may improve acne and hirsutism (excessive hair growth)
2
Q
how to start a patient on oral contraceptives (2)
A
- start the pill pack on the first day of menses or start the Sunday after menses (if you want to avoid weekend menstruation)
- use backup form of birth control for the first 7 days
3
Q
what oral contraceptive to order if the patient has a hx of smoking(4)
A
progestin only
depo-provera
IUD
nexplanon
4
Q
what oral contraceptive to order if the patient is over 35
A
progestin only OCP
depo-provera
IUD
nexplanon
5
Q
what contraceptive to order if the patient has uncontrolled HTN
A
progestin only OCP
depo-provera
IUD
nexplanon
6
Q
what oral contraceptive to order if the patient has abnormal vaginal bleeding
A
progestin only OCP
depo-provera
IUD
nexplanon
7
Q
what oral contraceptive to order if the patient has DM with vascular complications
A
progestin only OCP
depo-provera
IUD
nexplanon
8
Q
what oral contraceptive to order if the patient has DVD
A
progestin only OCP
depo-provera
IUD
nexplanon
9
Q
what oral contraceptive to order if the patient has hx of PE
A
progestin only OCP
depo-provera
IUD
nexplanon
10
Q
what oral contraceptive to order if the patient has ischemic heart disease
A
progestin only OCP
depo-provera
IUD
nexplanon
11
Q
what oral contraceptive to order if the patient has HA with focal neuro symptoms
A
progestin only OCP
depo-provera
IUD
nexplanon
12
Q
what oral contraceptive to order if the patient has hx of breast CA
A
progestin only OCP
depo-provera
IUD
nexplanon
13
Q
what oral contraceptive to order if the patient has active hepatitis or cirrhosis
A
progestin only OCP
depo-provera
IUD
nexplanon
14
Q
2 contraindications of nexplanon
A
hepatic disease
thrombosis
15
Q
what oral contraceptive to order if the patient has endometriosis
A
monophasic continuous therapy
16
Q
what oral contraceptive to order if the patient is post-partum/lactating
A
progesterone-only minipill
17
Q
what oral contraceptive to order if the patient is noncompliant
A
depo provera
subdermal implant
18
Q
what oral contraceptive to order if the patient has breakthrough bleeding in first half of cycle
A
change to pill with high estrogen content in 1st half of cycle
19
Q
what oral contraceptive to order if the patient has breakthrough bleeding in second half of cycle
A
change to pill with high progestin content in 1st half of cycle
20
Q
what oral contraceptive to order if the patient is adolescent, perimenopausal, postpartum, non-lactating, and no medical risks
A
any OCP <50mcg EE
21
Q
3 serious side effects of oral contraceptive pills
A
increased risk of
VTE
MI/stroke (esp >35 and smoker)
liver disorder
22
Q
7 less serious side effects of oral contraceptive pills
A
breast tenderness
N/V
HA
bloating
acne
mood changes
spotting
23
Q
3 side effects associated with progestin-only contraceptive pills
A
weight gain
fluid retention
acne
24
Q
what type of contraceptive is depo provera and frequency
A
progestin-only
IM injection
q13 weeks
25
when to initiate depo provera
within first 5 days after menses
26
what to do if a patient presents after 13 weeks for their depo provera shot
pregnancy test before administering
27
6 SE of depo provera
wt gain
HA
dizziness
nervousness
amenorrhea
irregular bleeding
28
depo provera education
can cause reversible loss of bone mineral density-- educate the patient to increase calcium and vitamin D intake along with regular exercise
29
depo provera reversal
70% of women can conceive within the first year and 90% within the first 2 years. Discuss family planning before initiating and continuing therapy
30
who is depo provera a safer option for? (5)
CV disease
stroke
VTE
PVD
sickle cell disease
31
what type of contraceptive is an IUD
progestin-only OR
non hormonal
32
IUD maintanence
check strings after each period
33
who is an IUD a good choice for
dysmenorrhea
menorrhagia
anemia
34
8 SE of IUD
PID
ectopic pregnancy
uterine perforation
expulsion
ovarian cysts
irregular bleeding
amenorrhea
pelvic pain
35
4 contraindications of IUD
suspected pregnancy
uterine abnormalities
PID
unexplained vaginal bleeding
36
which contraceptive method has decreased efficacy in patients with high BMI
xulane transdermal patch
37
xulane transdermal patch risk
increased risk of VTE if pt over 198lbs or BMI >30
38
when to prescribe emergency contraception
within 5 days of unprotected sex (3 is best)
39
how does emergency contraception work
stops ovulation
40
what to do if no period within 21 days after use of emergency contraception
pregnancy test
41
emergency contraceptive drug options
Copper IUD
Levonorgestrel
Ulipristal acetate
Yuzpe regimen
42
considerations for levonorgestrel (2)
<94% effectiveness
less effective in women over 165 lbs
43
considerations for ulipristal acetate (2)
98% effective
less effective in women over 195 lbs
44
considerations for yuzpe regimen (2)
less effective
causes N/V
45
first line therapy for VVC
OTC topical 1-7 days (monistat) +
1x fluconazole PO
46
second line therapy for VVC
cultures for recurrent VVC
7-14 topical
PO fluconazole q72h x3 doses
47
third line therapy for VVC
referral
10-14 days topical
PO with maintenance therapy with fluconazole 1x per week for 6 months
48
first line therapy for trichomonas
metronidazole or tinidazole 2g single dose OR
metronidazole 500mg BID x7 days
49
education for trichomonas
must also treat sex partners
avoid sex until therapy is completed and symptom-free
50
second line therapy for trichomonas
referral
51
first line treatment for bacterial vaginosis
PO flagyl
topical clinda cream
flagyl gel intravaginally
52
education for bacterial vaginosis treatment (3)
1. flagyl can cause N/V if alcohol ingested during treatment or within 72 hours after stopping
2. avoid tight-fitting clothes, allow vaginal ventilation
3. avoid douching or other products that may alter pH
53
hormone therapy for patients with a uterus
progestin + systemic estrogen (oral or transdermal)
54
risk of taking estrogen alone for patients with a uterus
endometrial hyperplasia
increased risk of endometrial CA
55
hormone therapy for patients without a uterus
can use estrogen alone
56
contraindications of hormone therapy (6)
1. estrogen-dependent neoplasia
2. thrombophlebitis/thromboembolic disorder
3. pregnancy
4. undx vaginal bleeding
5. uncontrolled HTN
6. acute liver disease
57
monitoring for patients taking hormone therapy (5)
1. F/u 4-8 wks after therapy initiation, then q3-6 mo
2. review the decision to continue yearly
3. continue mammograms, PAPs, and DEXA scans
4. ht/wt, lipids, BP, breast exam, full pelvic exam
5. d/c 1-3 years after menopause, taper gradually to reduce rebound
58
risk of taking hormone therapy for over 3-5 years
breast CA
59
best treatment for vasomotor symptoms when hormone therapy is contraindicated (4)
SSRI/SNRI
gabapentin
clonidine
progestin only
60
treatment for genitourinary syndrome of menopause (hormone therapy) (3)
low dose vaginal estrogen OR
transdermal estrogen OR
ospemifene
61
treatment for genitourinary syndrome of menopause (non hormonal)
vaginal lubricant and moisturizers and continued sexual intercourse
62
6 antibiotics used for PID
cephalosporins
Clindamycin
doxycycline
gentamycin
Metronidazole
probenecid
63
2 cephalosporins used for PID
ceftriaxone
cefotetan
64
2 SE of cephalosporins
colitis
PCN allergy
65
2 SE of doxy
photosensitivity
hepatotoxicity
66
when to use clinda for PID
tubo-ovarian abscess
67
3 SE of gentamycin
renal/oto/neurotoxicity
68
3 SE of probenecid
GI upset
uric acid
kidney stones
69
when to avoid probenecid
avoid with ASA
70
contraindications of flagyl
pregnancy/lactation
with alcohol
71
SE of flagyl (1)
phototoxicity
72
how to treat severe PID
parenteral therapy with transition to PO within 24-48 hrs after symptom improvement
73
treatment of gonorrhea in patients allergic to cephalosporins
gentamycin IM + azithromycin PO
74
3 medications for suppressive therapy in patients with genital herpes
acyclovir
valacyclovir
famiciclovir
75
2 medications for suppressive therapy in pregnant patients with genital herpes
acyclovir
valacyclovir
76
acyclovir considerations
low bioavailability
more frequent dosing
more difficult compliance
77
doxycycline contraindication
2nd-3rd trimester
78
treatment for pregnant patients with chlamydia
azithromycin 1g PO x1 dose (amox. as alt)
79
considerations for pregnant patients with chlamydia
retest 3-4 weeks after treatment and again after 3 months to make sure it is not passed to the child
80
3 patient-applied treatments for genital warts
1. Imiquimod
2. Podofilox
3. Sinecatechins (green tea extract)
81
education for imiquimod
apply with finger at bedtime for up to 16 weeks
wash off in the morning
82
education for podofilox
apply solution with cotton swab or gel with finger BID x3days, 4 days off, repeat for 4 cycles
83
education for sinecatechins
apply up to 3x/day for up to 16wks
do NOT wash off
84
treatment for syphilis in pregnant patients with allergy to PCN
PCN G is only effective treatment during pregnancy
must desensitize (allows temporary tolerance) mom to PCN and treat with PCN G
85
first line treatment of ED (4)
phosphodiesterase-5 inhibitors:
Cialis
Vardenafil
Sildenafil
Avanafil
86
contraindiactions of phosphodiesterase-5 inhibitors (10)
nitrates
alpha-blockers
unstable angina
hypotension
uncontrolled HTN
recent stroke
arrhythmias
MI w/in 6 mo
severe HF
renal/hepatic failure
87
cialis usage
long duration of action and avoids the need to plan for sex
30 min onset
88
vardenafil usage
60 min onset
decreased absorption with fatty foods
89
sildenafil usage
take 30-60 min before sex
3-5 hr half-life
decreased absorption with fatty foods
90
avanafil onset and half-life
take 15 mins before sex
half-life 5-10 hours
91
MOA of antimuscarinics
inhibit binding of ACH at muscarinic receptors M3 on detrusor smooth muscle cells, causing relaxation and increasing bladder filling capacity
92
SE of antimuscarinics
anticholinergic SE (can't pee, see, spit, shit)
93
contraindications of antimuscarinics
narrow-angle glaucoma
urinary retention
CYP450 drugs
94
which formulation of antimuscarinics is preferred
ER
95
first line treatment of uncomplicated UTI
Bactrim
Nitrofurantoin (macrobid)** best
Fosfomycin
96
first line medications to avoid for uncomplicated UTI in patients with renal dysfunction
bactrim and nitrofuratoin
97
nitrofurantoin pregnancy considerations
do not use in 1st trimester or last 30 days
98
bactrim pregnancy considerations
do not use
99
first line treatment for uncomplicated UTI in pregnant patients
fosfomycin
100
second line treatment for uncomplicated UTI
bactrim
fluroroquinolones
101
flurorquinolones black box warning
achilles tendon rupture
102
fluroquinolones pregnancy considerations
weight risk vs benefit
103
third line treatment of complicated UTI for males or post-menopausal women
levaquin
104
third line treatment of complicated UTI for pregnant women
amox
keflex
nitrofurantoin/bactrim (not in 1st trimester or last 30 days)
105
why is treatment required for prostatitis
inflammation of the prostate can restrict the urinary outflow via the urethra
106
S/sx of prostatitis (8)
pain
difficulty emptying bladder
weak stream
nocturia
fever
malaise
pain on ejaculation
rectal pain
107
first line treatment of prostatitis
fluoroquinolones best choice
bactrim
108
second line treatment of prostatitis
doxy
azithromycin
clarithromycin
109
how long is abx therapy for prostatitis
4-6 weeks
may need up to 12 wks due to poor tissue penetration
110
treatment of BPH
1. alpha-adrenergic blockers
2. 5-alpha-reductase inhibitors
3. combo of 1+2
4. PDE-5 inhibitors (cialis)
5. Supplements
111
3 supplements for BPH
saw palmetto
ptgeum
zinc
112
MOA of alpha blockers
relax smooth muscle of the prostate and bladder neck to decrease bladder resistance to urinary outflow
113
SE of alpha blockers (7)
hypotension
ortho hypotension
fluid retention
HA
dizziness
weakness
drowsiness
114
who to avoid giving doxazosin to
CHF and renal failure pts
115
contraindication of tamsulosin
prostate CA
116
contraindication/consideration for silodosin (rapaflo)
hepatic/renal impairment
selective alpha antagonist so minimizes BP effects
117
MOA of 5-alpha reductase inhibitors
blocks 5-alpha reductase, weakening prostate growth by inhibiting the conversion of testosterone to DHT
118
5-alpha-reductase inhibitor suffix
-eride
119
alpha blocker suffix
-osin
120
SE of finasteride (2)
impotence
decrease libido
121
SE of dutasteride (3)
ortho hypotension
priapism
risk of prostate CA
122
monitoring for BPH treatment
monitor BP during first 2 weeks
keep open discussion about sexual health
AUA symptom score (3-4 point improvement is significant)
123
how to treat an AUA symptom score of 7
pharm treatment
124
how to treat an AUA symptoms score of <7
lifestyle mod
125
risk factors with long term use of agents that treat GERD
reduced efficacy and tolerance with H2RAs
126
treatment regimen for NSAID-induced PUD
1. find another pain management modality
2. use enteric-coated NSAIDs, take with meals, add misoprostol, switch to selective COX-2 inhibitor
3. pharmacological treatment
127
first line medications for NSAID-induced PUD
PPI
H2RA
sucralfate
128
3 antacid medication
calcium-carb
mag salts
aluminum salts
129
SE of antacids (6)
rebound hyperacidity
diarrhea (mag)
constipation (alum)
nausea
stomach pain
hypercalcemia
130
contraindications of antacids
none
131
instructions for antacids
take 1-4 hours after iron, sulfonylureas, tetracyclines, and quinolones
symptom relief only, doesn't heal ulcers
132
first line treatment hepatic encephalopathy
lactulose oral or rectal
133
second line treatment hepatic encephalopathy
rifaximin
134
third line treatment hepatic encephalopathy
miralax
135
treatment recommendation for mild UC
PO and rectal aminosalicylates
136
treatment recommendation for mod UC
add steroid
137
treatment recommendation for severe UC
hospitalization
138
treatment for mild Crohn's
oral/rectal amiosalicylate OR
rectal steroid
139
treatment for mod Crohn's
PO and rectal aminosalicylate AND short term steroids
140
treatment for severe Crohn's
IV steroids and/or IV cyclosporine
141
treatment for fulminant Crohn's (3)
IV steroids and/or IV cyclosporine
IV infliximab or SC adalimumab
supportive care (IVF, bowel rest, TPN)
142
goals of management of inflammatory bowel disease (7)
1. resume normal ADLs
2. restore general physical/mental well-being
3. maintain appropriate nutritional status
4. maintain remission
5. decrease frequency and severity of exac.
6. decrease med SE
7. increase life expectancy
143
2 aminosalicylates
azulfidine
mesalamine
144
MOA of aminosalicylates
decrease inflammation in the GI tract by inhibiting PG synthesis
145
MOA of steroids for CD/UC
immunosuppression and PG inhibition
146
3 immunosuppressive agents for CD/UC
imuran
puriethnol
rheumatrex
147
MOA of immunosuppressive agents for CD/UC
decrease prod. of various inflammatory mediators
148
2 abx used to treat CD/UC
flagyl
cipro
149
3 TNFa inhibitors for CD/UC
remicade
humira
cimzia
150
MOA of TNFa inhibitors
overexpression of immunologic cytokines including TNF seen in CD-> TNF inhibitors neutralize soluble forms of TNF and inhibit its binding to TNF
151
2 selective adhesion molecule inhibitors for CD/UC
tysabri
entyvio
152
MOA of selective adhesion molecule inhibitors for CD/UC
prevent migration of inflammatory lymphocytes into the gut mucosa
153
ingestion/admin causes of N/V (5)
chemo
opiates
abx
NSAIDs
HT
154
how to treat chemo induced N/V (4)
benzos
zofran
marinol/dronabinol
steroids
155
GI causes of N/V (2)
outlet obstruction
motility disorders
156
how to treat GI induced N/V
reglan
157
neuro causes of N/V (4)
cerebellar hemorrhage
tumor
hydrocephalus
elevated ICP
158
how to treat neuro causes of N/V (2)
surgery
steroids
159
metabolic causes of N/V (4)
Addisons
vol. depletion
DKA
hypercalcemia
160
how to treat metabolic causes of N/V
treat cause
161
how to treat PONV (2)
phenothiazines (compazine)
droperidol
162
how to treat anxiety related N/V
benzos
163
how to treat pregnancy related N/V (3)
antihistamines
anticholinergics
promethazine
164
how to treat motion sickness (2)
antihistamines
anticholinergics
165
first line treatment of N/V
phenothiazine
166
second line treatment of N/V
antihistamine
anticholinergic
167
third line treatment of N/V
re-eval cause
168
3 medications used for motion sickness
hydroxyzine
meclizine
dramamine
scopolamine
169
first line treatment of IBS-C
linacoltide or lubiprostone +osmotic laxative used to avoid diarrhea
170
second line treatment of IBS-C
osmotic laxative
171
third line treatment of IBS-C
stimulant laxative short term
172
first line treatment of IBS-D
loperamide
173
second line treatment of IBS-D (2)
Lomotil for short term
rifaximin for long term
174
constipation first line agent
bulk-forming laxative
175
constipation second line agent
mag hydroxide
saline laxative
176
constipation third line agent
stimulant laxative
177
enema contraindication
under 2 y/o
178
length of OTC constipation therapy
<7 days in a row
179
how to treat constipation in pregnancy
colace safe
avoid castor oil
180
constipation treatment considerations for the elderly
risk of electrolyte imbalance with laxative use
eliminate causative agent (antipsychotics, TCAs, Ca)
181
MOA of lomotil
decrease GI motility
182
MOA of loperamide
opioid receptor agonist acts on myenteric plexus of colon
183
5 types of medications used to treat diarrhea
antimotility agents
adsorbents
absorbents
semisynthetic antibiotic
atypical/antisecretory agents
184
2 antimotility agents
lomotil
loperamide
185
contraindications of antimotility agents
infectious diarrhea
caution in hepatic dys
186
SE of antimotility agents
constipation
drowsiness
blurry vision
187
lomotil interactions
HTN crisis with MAOIs
188
adsorbent medication
kaopectate
189
kaopectate MOA
binds to diarrhea and toxins to solidify stool
add a dose after each BM
190
absorbent medication
fibercon
191
MOA fibercon
absorbs water in the GI tract to make stool less watery
192
semisynthetic antibiotic medication
rifaximin
193
indications for rifaximin for diarrhea
noninvasive strains of e.coli
best for travelers diarrhea
194
contraindications for rifaximin
hypersensitivity
195
SE of rifaximin (6)
peripheral edema
nausea
fatigue
dizziness
HA
muscle spasm
196
how to treat diarrhea in peds
oral rehydration is priority
antidiarrheal agents not recommended
197
lomotil age limits
not for children under 4
198
indications for laxative use
lifestyle modifications fail
eliminated secondary cause
199
lifestyle modifications for constipation
diet
exercise
bowel training
200
subsalicylate medication
pepto bismol
kaopectate
201
contraindications of subsalicylates
hypersensitivity to ASA
kids with flu or chicken pox (Reye syndrome)
202
SE of subsalicylates (3)
black stool
dark tongue
tinnitus
203
subsalicylates interaction
warfarin
204
first line agents for IBS in pregnant women
colace and bulk forming agents (not absorbed systemically)
205
lactulose ok in pregnancy?
yes
206
sorbitol ok in pregnancy?
yes
207
stimulant laxatives ok in pregnancy?
only occasionally if necessary
208
castor oil ok in pregnancy?
no
risk of uterine contractions
209
mineral oil ok in pregnancy?
no
inhibits vitamin absorption
210
long term SE of PPIs
dementia
osteoporosis
211
first line treatment for GERD and length (2)
PPI 8-12 wks
diet and lifestyle mod.
212
treatment for hot flashes
paxil
213
rome 3 criteria
At least three months, with onset at least six months previously, of recurrent abdominal pain or discomfort associated with two or more of the following:
Improvement with defecation; and/or
Onset associated with a change in frequency of stool; and/or
Onset associated with a change in form (appearance) of stool.
