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65 Cards in this Set
- Front
- Back
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What the risks and benefits to estrogen
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Benefits
- relieves genitourinary atrophy, vasomotor sx's, osteoporosis, sexual functional Risks - Endometrial cancer with unopposed estrogen - breast cancer with unopposed estrogen - increased risk of thromboembolism - bloating, HA, breast tenderness, uterine bleeding |
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What are the benefits and risks progestogen
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- decreased risk of uterine bleeding, protection against carcinoma
ADE: bloating, weight gain, irritability, depression |
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When do you use unopposed estrogen
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- in women with hysterectomy
- transdermal patches - vaginal cream use for short periods of time |
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Estrogen with cyclic progestins
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similiar to female cycle with withdrawal bleed each cycle
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Estrogen with continuous progestogen
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Irregular menstrual cycle for first 8-12 months
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What is first line treatment for vasomotor symptoms
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SSRI
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How do you define osteoporosis and ostepenia
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Osteopenia BMD between -1 and -2.5
Osteoporosis BMD less than -2.5 |
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Risk factors for osteoporetic fractures
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White, female, early menopause, estrogen deficiency, glucocorticoids, heparin, levothyroxine, low weight, family hx, cigarettes, alcoholism
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What are the treatments for osteoporosis
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1. Bisphosphonates
- GI effects, HA, muscolosketal rash, osteonecrosis of jaw - do not use in clcr less than 35 2. Calcium - 1000-1250 IU/day 3. Vitamin D - 800-1000 IU/day 4. SERM - Raloxifene/Evista - hot flashes, leg cramps - do not use in pregnancy or hx of VTE 5. Calcitonin (Miacalcin) - not first line, also used for bone pain 6. Teriparatide (Forteo) - recombinant human parathyroid hormone - reserved for high risk of fracture - nausea, hypotension 8. Denosumab (Prolia) - inhibits osteoclast mediated bone resorption - administered SQ every 6 months - not contraindicated in patients with renal dysfunction - REMS drug |
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What are common cat D or X drugs which are teratogen
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Alcohol, anticonvulsants, cocaine, live vaccines, tetracyclines, ACEI, androgens, statins, warfarin, chemo
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What drugs are contraindicated in breast feeding
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Amphetamines, cocaine, lithium, bromocriptine, ergotamine, nicotine
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What is the treatment of pregnancy induced hypertension
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- methyldopa is 1st line
- hydralazine, labetalol |
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What drugs prevent preterm labor
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- Terbutaline, mag sulfate, indomethacin, nifedipine
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What drugs induce labor
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Oxytocin, dinoprostone, misoprostol
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What adverse effects are attributed to estrogen
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N/V, bloating, edema, irritability, weight gain. HTN
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What adverse effects are attributed to progestin
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HA, weight gain, increased appetite, depression, hirsutism, acne, oily skin
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What contraindications exist for combined oral contraception
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Breastfeeding less than 6 weeks postpartum
Smoker Blood pressure>160 Hx of DVT/PE Stroke |
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How can you intervene if pt having breakthrough bleeding
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If occurs early in cycle, choose OC with higher estrogen
If late in cycle, select OC with higher progestin In general, increase both |
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Serious adverse effects of OC (ACHES)
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A - abdominal pain
C - chest pain H - headache E - eye problems S - severe leg pain |
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Paragard (Copper)
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IUD - acts primarily as a spermicide.
Works for up to 10 years Causes blood loss, spotting/cramping, expulsion |
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Progestin (Mirena)
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IUD, stays up to 5 years
Causes progestin ADE's, irregular menses |
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What are the ADE's you find with IUDs
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PAINS
Period late Abdominal pain Inection exposure Not feeling well String missing |
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What are the ADE's of Implanon
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Similar to progestin related ADE's
Bleeding irregularities |
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What are the options for emergency contraception
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1) Yuzpe method (high dose estrogen plus progestin)
- Ovral, Levora, Nordette, Portia, Seasonale, Trivora, Alesse 2) Progestin only method - Ovrette, Plan B 3) Ella (ulipristal) - newly approved - progesterone receptor modulator - indicated for EC within 120 hours of unprotected intercourse 5) Copper IUD 6) RU-486 - Disrupts existing pregnancy |
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Clomiphene citrate (Clomid, Serophene)
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Used to stimulate ovulation, sperm production in men
Administered on days 2-5 of cycle First line agent SERM that blocks estrogen receptors ADE: hot flashes, abdominal distention, breast tenderness |
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Human Menopausal Gonadotropins (HMG)
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Pergonal, repronex, humegon
ADE: flu like sx's, muscle ache, malaise |
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Follicle stimulating hormone (Fertinex, Gonal-F)
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Mood swings, depression, breast tenderness
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Luteinizing hormone (Luveris)
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Helps stimulate release of egg
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Human Chorionic Gonadotropin (Ovidrel)
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Stimulate release of egg
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GnRH agonists
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Leuprolide (Lupron), nafarelin (synarel), goserelin (zoladex), buserelin
Helps optimize effectiveness of HMG or FSH Administered by nasal spray or injection Also used to treat endometriosis |
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GnRH antagonist
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Ganirelix (Antagon) and cetrorelix (Cetrotide)
Faster onset than agonists |
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Timeline of medications used for invitro fertilization
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First stage - ovulation stimulation
- drugs used: Clomid, FSH - to stop LH surge, GnRH agonists/antagonists given Second stage - egg retrieval - given HCG to cause ovulation |
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How do you treat an initial HSV infection
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Acyclovir
Famciclovir Valacyclovir 7-10 day treatment |
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How do you treat HSV encephalities
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Acyclovir 5-10mg/kg every 8 hours for 2-7 days followed by oral treatment for 10 days total therapy
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How do you treat syphilis
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Treponema pallidum
Primary syphilis - chancres Benzathine PCN 2.5 MU in a single dose PCN allergy: doxycycline 100mg po bid or tetracycline 500mg qid for 2 weeks Secondary syphilis: Benzathine PCN 2.5MU in a single dose Doxycycline, tetracycline Latent Benzathine PCN Q3 weeks Doxycycline or tetracycline for 4 weeks Same treatment for tertriary syphilis |
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How do you treat neurosyphilis
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PCN G 3-5 MU IV Q4hrs for 10-14 days
PCN allergy: CTX 2gm/day IM/IV for 10 days |
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How do you treat chlamydia
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Azithromycin 1gm in a single dose, doxycycline 100mg bid for 7 days
Alt: erythromycin 500mg po QID for 7 days, levofloxacin 500mg/day for 7 days |
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How do you treat gonococcal infxn
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Ceftriaxone 250mg IM x1
Or if CTX not an option, cefixime 400mg po x 1 or cefoxitin 2gm IM with probenecid 1gm orally Treat for chlamydia at same time Gonococcal infxn of pharynx: ceftriaxon plus treatment of chlamydia For PCN allergy, use azithromycin |
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How do you treat urethritis
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Metrondazole
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GnRH agonists
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Leuprolide (Lupron), nafarelin (synarel), goserelin (zoladex), buserelin
Helps optimize effectiveness of HMG or FSH Administered by nasal spray or injection Also used to treat endometriosis |
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GnRH antagonist
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Ganirelix (Antagon) and cetrorelix (Cetrotide)
Faster onset than agonists |
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Timeline of medications used for invitro fertilization
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First stage - ovulation stimulation
- drugs used: Clomid, FSH - to stop LH surge, GnRH agonists/antagonists given Second stage - egg retrieval - given HCG to cause ovulation |
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How do you treat an initial HSV infection
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Acyclovir
Famciclovir Valacyclovir 7-10 day treatment |
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How do you treat HSV encephalities
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Acyclovir 5-10mg/kg every 8 hours for 2-7 days followed by oral treatment for 10 days total therapy
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How do you treat syphilis
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Treponema pallidum
Primary syphilis - chancres Benzathine PCN 2.5 MU in a single dose PCN allergy: doxycycline 100mg po bid or tetracycline 500mg qid for 2 weeks Secondary syphilis: Benzathine PCN 2.5MU in a single dose Doxycycline, tetracycline Latent Benzathine PCN Q3 weeks Doxycycline or tetracycline for 4 weeks Same treatment for tertriary syphilis |
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How do you treat neurosyphilis
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PCN G 3-5 MU IV Q4hrs for 10-14 days
PCN allergy: CTX 2gm/day IM/IV for 10 days |
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How do you treat chlamydia
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Azithromycin 1gm in a single dose, doxycycline 100mg bid for 7 days
Alt: erythromycin 500mg po QID for 7 days, levofloxacin 500mg/day for 7 days |
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How do you treat gonococcal infxn
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Ceftriaxone 250mg IM x1
Or if CTX not an option, cefixime 400mg po x 1 or cefoxitin 2gm IM with probenecid 1gm orally Treat for chlamydia at same time Gonococcal infxn of pharynx: ceftriaxon plus treatment of chlamydia For PCN allergy, use azithromycin |
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How do you treat urethritis
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Metrondazole
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How do you treat pelvic inflammatory disease
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Parenteral:
1. Cefotetan 2gm IV Q12hours OR Cefoxitin 2gm IV Q6hrs plus docycycline 100mg IV Q12 hrs 2. Clindamycin 900mg IV Q8hrs plus gentamicin IV 3. Unasyn 3gm IV Q6hrs plus doxycycline 100mg Q12hrs Oral treatment: Ceftriaxon 250mg IM x1 or cefoxitin 2gm IM plus probenecid 1gm po plus doxycycline for 14 days with or without metronidazole |
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How do you treat bacterial vaginosis
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Can lead to PID and endometriosis
Nonpregnant women: Metronidazole for 7 days or clindamycin 2% vaginal cream for 7 days, or metrogel for 7 days Clindamycin ovules vaginlly for 3 days or clindamycin PO for 7 days Pregnant woen: metronidazole po for 7 days or clinda 300mg po bid for 7 days Do not use clinda gel during pregnancy |
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How do you treat trichomoniasis
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Metronidazole 2gm po x1 or tinidazole 2gm x 1
Alt: metronidazole 500mg po bid for 7 days |
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How do you treat vulvovaginal candidiasis
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Butoconazole cream, clotrimzole, miconazole, nystatin vaginal tab, nystatin vaginaal tab, ticonazole, fluconazole oral tab
For recurrent vulvovaginal candidiasis: 7-14 days of fluconazole |
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How do you treat prostatis
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Acute prostatits:
14-28 days Gonorreha: CTX FQ: cipro or ofloxacin Septra Chronic prostatits: 28 day treatment FQ, minocycline, eptra |
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How do you treat epididymitis
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CTX 250mg IM plus doxycycline for 10 days
For enteric organisms: Ofloxacin, levofloxacin |
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How do you treat erectile dysfunction
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1. Testosterone replacement
- depot injection every 2-3 weeks - transdermal patch daily, androderm or testoderm - contraindicated in prostate cancer - may cause blood pressure, acne, liver toxicity 2. Phosphodiesterase inhibitor - ADE: HA, hot flashes, heartburn, hypotension - contraindicated with nitrate use, HTN, MI/stroke 3. Alprostadil - caverject intracavernosal injection |
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How do you treat premature ejaculation
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SSRI, EMLA cream
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How do you treat pelvic inflammatory disease
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Parenteral:
1. Cefotetan 2gm IV Q12hours OR Cefoxitin 2gm IV Q6hrs plus docycycline 100mg IV Q12 hrs 2. Clindamycin 900mg IV Q8hrs plus gentamicin IV 3. Unasyn 3gm IV Q6hrs plus doxycycline 100mg Q12hrs Oral treatment: Ceftriaxon 250mg IM x1 or cefoxitin 2gm IM plus probenecid 1gm po plus doxycycline for 14 days with or without metronidazole |
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How do you treat bacterial vaginosis
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Can lead to PID and endometriosis
Nonpregnant women: Metronidazole for 7 days or clindamycin 2% vaginal cream for 7 days, or metrogel for 7 days Clindamycin ovules vaginlly for 3 days or clindamycin PO for 7 days Pregnant woen: metronidazole po for 7 days or clinda 300mg po bid for 7 days Do not use clinda gel during pregnancy |
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How do you treat trichomoniasis
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Metronidazole 2gm po x1 or tinidazole 2gm x 1
Alt: metronidazole 500mg po bid for 7 days |
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How do you treat vulvovaginal candidiasis
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Butoconazole cream, clotrimzole, miconazole, nystatin vaginal tab, nystatin vaginaal tab, ticonazole, fluconazole oral tab
For recurrent vulvovaginal candidiasis: 7-14 days of fluconazole |
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How do you treat prostatis
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Acute prostatits:
14-28 days Gonorreha: CTX FQ: cipro or ofloxacin Septra Chronic prostatits: 28 day treatment FQ, minocycline, eptra |
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How do you treat epididymitis
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CTX 250mg IM plus doxycycline for 10 days
For enteric organisms: Ofloxacin, levofloxacin |
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How do you treat erectile dysfunction
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1. Testosterone replacement
- depot injection every 2-3 weeks - transdermal patch daily, androderm or testoderm - contraindicated in prostate cancer - may cause blood pressure, acne, liver toxicity 2. Phosphodiesterase inhibitor - ADE: HA, hot flashes, heartburn, hypotension - contraindicated with nitrate use, HTN, MI/stroke 3. Alprostadil - caverject intracavernosal injection |
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How do you treat premature ejaculation
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SSRI, EMLA cream
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