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Pharm 2 > Womens Health 1 > Flashcards

Womens Health 1 Flashcards

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1
Q

What should be considered when prescribing meds to a woman of childbearing age?

A

Teratogenicity
Inadequate prenatal care could be harmful
Breastfeeding could pass medicines
Cultural beliefs may influence how a women considers and accepts health counseling from a clinician

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2
Q

Why do women absorb many oral drugs differently than men?

A
  • have longer gastric emptying times
  • estrogen
  • lower BMI than men
  • higher proportion of fat
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3
Q

Why do women have lower levels of lipophilic drugs circulating the plasma?

A

Higher proportion of body fat compared to men, therefore, the drugs absorb more easily

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4
Q

Why are women better liver metabolizers than men?

A

Have more CYP450 3A4 substrate compared to men

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5
Q

Tx options form PMS and PMDD

A

Conventional medications, exercise, dietary changes (caffeine reduction, supplements, mind-body approaches, and counseling)

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6
Q

What is a med that can be used to tx PMS/ PMDD associated anxiety?

A

alprazolam (Xanax)

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7
Q

What is a med that can be used to tx PMS/ PMDD associated endometriosis?

A

danazol (Cyclomen)

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8
Q

What is a med that can be used to tx PMS/ PMDD associated dysmenorrhea?

A

Ibuprofen

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9
Q

What is a med that can be used to tx PMS/ PMDD associated behavioral sxs?

A

SSRIs - citalopram, fluoxetine, paroxetine, sertraline

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10
Q

Herbal options for PMS/ PMDD

A

primrose oil
chaste tree berry
calcium salts
magnesium salts
Vit E and Vit B

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11
Q

Meds that may cause abnormal vaginal bleeding?

A

Progesterone only OCPs
Phenytoin
Tamoxifen
Antipsychotics
Oral steroids

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12
Q

Which herbal supplements can cause abnormal vaginal bleeding?

A

Garlic
ginkgo biloba
soy
St. John’s wort

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13
Q

What are the primary goals of management of dysfunctional uterine bleeding?

A

Stabilize the bleeding
Prevent endometrial hyperplasia or cancer

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14
Q

What are the steps for stopping severe dysfunctional uterine bleeding?

A
  • correct volume status
  • stop uterine bleeding
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15
Q

What is used to stop uterine bleeding when it is severe?

A

Rapid onset of IV conjugate equine estrogen therapy is effective

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16
Q

What can be used to stop uterine bleeding that is not severe?

A

Oral estrogen can also be administered, 2.5 mg every 6 hours until bleeding stops

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17
Q

High dose estrogen SE

A

Nausea, vomiting, headache, fluid retention, edema, thrombosis, MI, stroke

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18
Q

What is the general rule of thumb w/ OCPs and which women should avoid taking them?

A

Caution should be taken with women who have a history of liver disease, >35 years, and/or smoke

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19
Q

In which women is high dose oral estrogen contraindicated?

A

history of a thromboembolic event or an estrogen-dependent tumor

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20
Q

What is an alternative for estrogen (for women w/ hx of thromboembolic event/ estrogen dependent tumor)?

A

combination oral contraceptives (COC), oral progestins, surgical intervention (if not responsive to therapy)

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21
Q

How can heavy menstrual bleeding be tx?

A

levonorgestrel- releasing intrauterine device (IUD) (Mirena)
OR estrogen containing contraceptives (w/ long term use)

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22
Q

How can endometrial hyperplasia w/o atypia be tx?

A

can be treated with the off-label use of cyclic or continuous progestins

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23
Q

Selection of OCP should be guided by?

A

Selection requires care in selecting the formulation with the lowest dose of estrogen that can be tolerated

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24
Q

How are low-dose monophasic oral contraceptives used?

A

continuous or extended daily dosing pattern lasting 2-3 months

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25
How often will a woman have her menses on a low-dose monophasic oral contraceptive?
allows a woman to have her menses 4x/year
26
Multiphasic pills are best used to tx?
menstrual migranes
27
Multiphasic pills may only be used for regular monthly cycles, what occurs when doses are missed?
Breakthrough bleeding?
28
Progesterone-only pills are effective when?
always used in continuous-dose fashion with no withdrawal breaks, these pills are effective only when taken in regular 24-hour intervals
29
Women w/ a family hx of ovarian CA should be placed on what type of OCP and why?
use of combined oral contraceptives offers reduced risk of ovarian cancer
30
How do Combined Oral Contraceptives work?
Suppress the pituitary-ovarian axis and generally prevent ovulation
31
How are Combined Oral Contraceptives doses scheduled?
regular cyclic pattern (21 days on, 7 days off) - less blood loss than a non-medicated cycle
32
Which pts should not be prescribed OCPs?
history of CVA, complicated migraines, heart or liver disease, clotting disorders, estrogen-sensitive cancers, undiagnosed vaginal bleeding, or possible pregnancy
33
OCPs can cause an increased risk of thrombosis, as such, which pts should avoid their use d/t this risk?
personal or family history of DVT or factor V Leiden, protein C or S deficiency
34
OCP SE concerning for stroke
unilateral numbness, tingling, weakness, slurring of speech, or vision loss could suggest stroke
35
OCPs DO NOT reduce the risk of this type of CA?
They do not reduce the risk of cervical cancer
36
If a pt forgets to take a OCP pill, what should they be advised to do?
patients should be taught appropriate catch-up strategies, and should be warned to use backup methods of contraception for the remainder of their cycle
37
How should OCPs first be prescribed and f/u?
Prescribe a 3-month supply and schedule a return visit at 3 months to evaluate the patient
38
Which estrogens are commonly used in OCPs?
Mestranol Ethinyl estradiol Estropipate
39
Which progastrins are commonly used in OCPs?
Norethindrone Ethynodiol diacetate Norethynodrel Levonorgestrel Norgestimate Desogestrel Drospirenone Medroxyprogesterone Entonogestrel
40
What does the estrogen in combination oral contraceptives do?
estrogen stabilizes the endometrial lining and controls bleeding
41
What does progestin in combination oral contraceptives do?
progestin that halts follicle growth
42
OCP Estrogen MOA
Stabilizes the endometrial lining Inhibition of ovulation
43
OCP Progestin MOA
Halts follicle growth “Hostile cervical mucus”
44
COC uses
For cycle regulation, contraception, and acne relief
45
Estrogen SE
Breast tenderness Cerebrovascular accidents Myocardial infarction Thrombosis Hepatic adenoma
46
Estrogen deficiency sxs
*Mimic menopause sxs* Hot flashes Early and midcycle spotting Decreased libido Dry vaginal mucosa Irritability, nervousness, depression
47
Progestin SE
Hypertension Oily scalp, acne Weight gain
48
Progestin deficiency sxs
Late breakthrough bleeding and spotting Heavy menstrual flow Delayed onset of menses Dysmenorrhea Weight loss
49
General OCP SE
Hypercoagulability, DVT and PE, and CVA risks Liver abnormalities
50
Contraindications for OCPs
Cigarette smoking/HTN (patient over 35 years) Liver disease Heart disease Thromboembolic disease Breast cancer Breast feeding Undiagnosed vaginal bleeding Pregnancy Complicated migraine Major surgery with prolonged immobilization
51
Which progestin OCP has the highest risk of clots?
Drospirenone (Yasmin)
52
Combo OCP black box warning
Women over age of 35 yrs who smoke should not use
53
Which meds decrease OCP efficacy?
Anticonvulsants, PCN, Rifampin, Griseofulvin, St Johns Wort, and Topiramate by inducing the OCP metabolism in the liver
54
Transdermal contraception contain which hormones?
Estrogen and progesterone
55
Transdermal Contraception MOA
Suppress ovulation and cause thickening of cervical mucus.
56
How long do transdermal patches stay on?
3 wks to allow for bleeding
57
Benefit of transdermal patch over OCP in terms of interactions?
Avoids 1st pass - be less affected by use of antibiotics, antacids, and other drugs
58
Transdermal patch is the best option for?
pts who are unable to reliably take a daily OCP on schedule (teenagers, shift workers, college students, and other women with hectic schedules)
59
Transdermal patch SE
Increased risk of DVT Contact dermatitis, adhesive intolerance, or skin hyperpigmentation
60
Transdermal patch contraindications
Same as OCP
61
How often should the patch be replaced?
Needs to be replaced once weekly
62
In which pts is the patch unreliable?
May not achieve reliable hormone levels to suppress ovulation in patients weighing >200 lbs
63
How are injectable contraceptives formulated?
progestin-only product that is effective for 2-3 months or a combined formulation that contains both a progestin and an estrogen and is effective for 1 month
64
Injectable contraception MOA
thicken cervical mucus
65
Injectable contraception SE
little to no increased risk of cardiovascular events with the use of progestin-only injectables Acne Liver tox Decreased libido
66
Injectable contraceptive's efficacy can be lessened by?
Drugs that induce liver enzymes may lessen the efficacy of the injectable hormones.
67
Contraindications for injectable contraceptives
Not for IV usage; use IM only + same as w/ other hormonal contraceptives
67
Contraindications for injectable contraceptives
Not for IV usage; use IM only + same as w/ other hormonal contraceptives
67
Contraindications for injectable contraceptives
Not for IV usage; use IM only + same as w/ other hormonal contraceptives
68
Disadvantages of injectable contraceptives
pain of injection, weight gain, and irregular menses
69
Depo-provera injections are every?
3 months
70
Implants contain which hormones
Single hormone progesterone-based subdermal agents
71
Implant advantages
Lack of first-pass metabolism through the liver The ability to avoid daily dose requirement Inhibits ovulation effectively for 3 years
71
Implant advantages
Lack of first-pass metabolism through the liver The ability to avoid daily dose requirement Inhibits ovulation effectively for 3 years
72
Implant SE
irregular bleeding, weight gain, and acne
73
In which women is the implant a great choice for?
women with heart or liver disease, breastfeeding mothers, women with clotting disorders, and smokers >35 years
74
Intravaginal rings should not be used in?
the ring does contain estrogen, it should not be used in patients with a contraindication to estrogen
75
Which hormones do intravaginal rings contain?
Made of a soft ethylene polymer, which elutes 15 mcg of ethinyl estradiol daily and 120 mcg of etonogestrel (desogestrel) daily
76
Intravaginal rings have fewer drug interactions because?
minimizes systemic side effects because circulating hormone levels remain lower than even low-dose oral contraceptive levels
77
How should the intravaginal ring be used?
The preferred method is 3 weeks on (in) and 1 week off (out) to allow for withdrawal bleed
78
Diaphragms and cervical caps must be obtained via rx because?
must be fitted by a clinician for each individual user
79
Spermicides can increase transmission of STDs because?
Contains nonoxynol-9, which is an irritant to mucous membranes
80
Contraceptive sponges
Non-prescription, unfitted vaginal insert containing a specified quantity of spermicide

Pharm 2 (8 decks)

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