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314 Cards in this Set
- Front
- Back
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Fever
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<36 degrees C or >39 degrees C
|
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Normal UO
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0.5mL/kg/hr
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Drugs associated with drug fever
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amphoterecin B, antibiotics, phenytoin
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Most common pathogens in CAP requiring hospitalizations
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1.strep pneumoniae
2.h.influenzae 3.mycoplasma pneumoniae 4.chlamydia pneumoniae |
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Most common pathogens in outpatient CAP
|
1.strep pneumoniae
2.mycoplasma pneumoniae 3.chlamydia pneumoniae 4.viruses |
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MIC of penicillin resistant pneumococcus
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>2ug/mL
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Pneumococcal resistance to penicillin is a marker of resitance to what antibiotics
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macrolides, TCN, cephalosporin, TMP/SMX
|
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Mechanism of resistance
|
alteration in penicillin binding proteins
|
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H. influenzae beta lactamase production
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30-40%
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Moraxella catarrhalis beta lactamise production
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90%
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What can be used for beta lactamase producing h.influenzae and moraxella catarrhalis
|
2nd gen ceph, bactrim, FQ
|
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What bacteria produce ESBL (extended spectrum beta lactamase)
|
ecoli, klebsiella
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What can be used for ESBL producing bacteria
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carbapenems, not cephalosporins
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PCN susceptible (MIC <0.1mcg/mL) treatment
|
PCN or doxycycline, macrolide, cephalosproin, extended spectrum FQ
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Intermeidate PCN resistance (MIC=0.12-1.0mcg/mL)
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PCN or ceftriaxone 1g IV q24h or extended spectrum FQ
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High level PCN resistance (MIC >2.0mcg/mL)
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vancomycin 25mg/kg/day or extended spectrum FQ
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6 risk factors for penicillin-resistant strep pneumoniae
|
1.age <2 or >65
2.b lactam treatment w/in 3 months 3. alcoholism 4. medical comorbidities 5. immunosuppressive illness or treatment 6. exposure to a child in a day care center |
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3rd generation cephalosporin indicated for penicillin resistant S.pneumoniae, b lactamase prodcuing H.influenzae, and MSSA
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cefditoren (Spectracef)
|
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cefditoren should be used in caution in who
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patients with milk protein hypersensitivity
|
|
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Protein synthesis inhibitor indicated for gram positive organisms including resistant staphylococcus and streptococcus
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linezolid (Zyvox)
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Zyvox side effects
|
thrombocytopenia, leukopenia, diarrhea, abdominal pain
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New generation of antibiotic with 2 ribosomal binding sites indicated for mild-moderate CAP
|
telithromycin (Ketek)
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|
Ketek coverage
|
enhanced coverage for strep pneumoniae with less resistance than macrolides
-S.pneumoniae -H.influenzae -M. catarrhalis -Strep pyogenes -C. pneumoniae -Legionella pneumophilia -M.pneumoniae |
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Ketek drug interactions
|
Strong inhibitor of CYP450 3A4
-digoxin -theophylline -sotalol -rifampin |
|
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Ketek warnings and contraindications
|
warnings: acute hepatic failure
contraindications: myasthenia gravis |
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Ketek toxicities
|
-QTc prolongation
-exacerbation of myasthenia gravis -hepatotoxicity -visual disturbances -loss of consciousness |
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Extended spectrum FQs used for pneumoniae
|
moxifloxacin (Avelox), gemifloxacin (Factive)
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Gemifloxacin spectrum of activity
|
Staph sp, Strep sp, atypicals
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Gemifloxacin adverse effect
|
phototoxicity
|
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Smoker
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H.influenzae, M.catarrhalis
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COPD
|
H.influenzae
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Poor oral hygiene
|
oral anaerobes
|
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HIV
|
pneumocystis carinii (PCP), TB
|
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Alcoholism
|
klebsiella
|
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Bird exposure
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chlamydia psittaci
|
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Empiric outpatient therapy
|
doxycycline (DOC), macrolide, FQ, augmentin (suspected aspiration)
|
|
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Empiric inpatient therapy-Non ICU
|
ceftriaxone 1g IV qd or cefotaxime
PLUS macrolide (erythromycin) 500mg IV QID Beta-lactamase inhibitor PlUS macrolide Extended spectrum FQ (levaquin) |
|
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Empiric inpatient therapy-ICU
|
ceftriaxone 2g IV q24h or cefotaxime 1g IV q8h or b-lactam/lactamase inhibitor (Zosyn) 3.375g IV q6h
PLUS macrolide or Levaquin 500mg IV qd Beta lactam allergy: FQ + clindamycin |
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|
Duration of therapy
|
7-10days
chlamydia pneumoniae: 14d legionella: 21d |
|
|
dosing of ceftriaxone in:
a)meningitis b)osteomyelitis |
a)2g q12h
b)1g q12h |
|
|
Uncomplicated cystitis
a)ecoli resistance <20% b)ecoli resistance >20% |
a)TMP/SMX x 3d
b)FQ x 3d |
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Complicated cystitis
|
FQ x 7-14d
|
|
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Acute pyelonephritis
|
FQ x 7-14d
|
|
|
Is a nucleoTIDE reverse transcriptase inhibitor
|
tenofovir (Viread)
|
|
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Zidovudine
|
Retrovir
|
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didanosine (ddI)
|
Videx
|
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stavudine (d4T)
|
Zerit
|
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lamivudine (3TC)
|
Epivir
|
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abacavir
|
Ziagen
|
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lamivudine/zidovudine
|
Combiver
|
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abacavir/lamivudine/zidovudine
|
Trizivir
|
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abacavir/lamivudine
|
Epzicom
|
|
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emtricitabine/tenofovir
|
Truvada
|
|
|
nRTI that must be taken with food
|
tenofovir (Viread)
|
|
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Non-nucleoside analogues (nnRTI)
|
nevirapine (Viramune)
efavirenz (Sustiva) delaviridine (Rescriptor) |
|
|
Causes autoinduction of its own metabolism
|
nevirapine (Viramune)
|
|
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Should be given without food
|
indinavir (Crixivan)
|
|
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Should be given with fatty meals
|
saquinavir (Fortovase)
|
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nelfinavir
|
Viracept
|
|
|
lopinavir/ritonavir
|
Kaletra
|
|
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atazanavir
|
Reyataz
|
|
|
Not recommended if CrCl <50
|
Epzicom
|
|
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Contraindicated if CrCl <30
|
Truvada
|
|
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Indicated for adult patients with drug-resistant HIV
|
tipranavir (Aptivus)
|
|
|
Contains sulfonamide moiety
|
tipranavir (Aptivus)
|
|
|
Contraindicated HIV drug combinations
|
-AZT(zidovudine)/d4T(stavudine)=antag
-Indinavir/Saquinavir=antag + difficult dosing ddI(didanosine/d4T(stavudine)=inc risk neuropathy, CI in pregnancy |
|
|
Agents associated w/ peripheral neuropathy and pancreatitis
|
d4T(stavudine)
ddI(didanosine) ddC(zalcitabine) |
|
|
Agent associated with fatal hepatotoxicity
|
nevirapine (Viramune)
|
|
|
Agent associated with nephrolithiasis
|
indinavir (Crixivan)
|
|
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Agent associated with severe hypersensitivity reaction
|
abacavir (Ziagen)
|
|
|
indinavir patient counseling
|
-take on empty stomach
-drink at least 1.5L fluid/d -don't administer w/in 2 hours of ddI |
|
|
nelfinavir patient counseling
|
-take w/ meals
-treat diarrhea w/ loperamide |
|
|
ritonavir patient counseling
|
-keep in fridge
-take w/ food, but no w/in 2h of ddI |
|
|
saquinavir patient counseling
|
-take w/ large, high fat meals
|
|
|
didanosine patient counseling
|
-take on empty stomach
|
|
|
zalcitabine patient counseling
|
-potential mouth inflammation
|
|
|
amprenavir patient counseling
|
-avoid vit E supp
|
|
|
tipranavir patient counseling
|
-contains sulfonamide moiety
|
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PI subrates for what isoenzyme
|
CYP3A4 isoenzyme
|
|
|
Most potent inhibitor of CYP3A4
|
ritonavir
|
|
|
PIs not recommended unless boosted
|
tipranavir
saquinavir |
|
|
Less effected by ritonavir because it is mostly metabolized by CYP2C19
|
nelfinavir
|
|
|
pneumocysitis carinii pneumonia treatment
|
bactrim 15-20mg/kg/d IV/PO x21d in 3-4divided doses
Alt: pentamidine (dose limiting toxicity =pancreatitis) |
|
|
CMV
|
ganciclovir (Cytovene) 5mg/kg IV q12h x14d,then 5mg/kg/d (neutropenia)
or valganciclovir or cidofovir + probenacid before each dose, and at 2,8hours post dose (nephrotoxicity) |
|
|
Varicella zoster
|
acyclovir 30mg/kg IV/d or 800mg PO 5x/d x 7d
|
|
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Cryptococcal meningitis
|
amp B 0.7mg/kg/d IV x10-14d
plus flucytosine 100mg/kg/d PO then fluconazole 400mg/d PO x8-10wks |
|
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toxoplasma encephalitis
|
pyrimethamine
plus folinic acid plus sulfadiazine |
|
|
Avoid perinatal transmission
|
zidovudine (70% reduction)
start week 14-34, IV during laor and delivery, baby takes ZDV liq PO q6h x 6wks |
|
|
HIV meds to avoid in pregnancy due to birth defects
|
efavirenz
stavudine (Zerit) amprenavir (oral liq) hydroxyurea |
|
|
Isoniazid MOA
|
inhibition of mycolic acid synthesis
|
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INH elimination
|
hepatic
|
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INH effect on CYP
|
inhibits CYP450 metabolism
|
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Rifampin MOA
|
inhibits DNA-dependent RNA polymerase inhibiting DNA transcription
|
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Rifampin elimination
|
hepatic w/ enterohepatic recycling
|
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Rifampin effect on CYP
|
induces CYP450
|
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Rifampin adverse effects
|
hypersensitivity
thrombocytopenia hemolytic anemia discoloration of secretions hepatotoxicity |
|
|
Inactive in neutral medium, best in acidic environement
|
pyrazinamide (PZA)
|
|
|
PZA metabolism
|
hepatic
|
|
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PZA adverse effects
|
photosensitivity/rash
hepatotoxicity hyperuricemia |
|
|
Used for treatment in areas w/ INH resistance >4%
|
ethambutol (ETH)
|
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ethambutol bacterocidal or static
|
static
|
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ethambutol distribution
|
minimal to low CSF penetration
|
|
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ethambutol elimination
|
renal
|
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|
ethambutol adverse effects
|
hyperuricemia
optic neuritis |
|
|
ketoconazole brand
|
Nizoral
|
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|
itraconazole brand
|
Sporonox
|
|
|
voriconazole brand
|
Vfend
|
|
|
azole MOA
|
inhibition of ergosterol synthesis
|
|
|
azole spectrum of activity
|
coccidiodes
blastocystis candida albicans cryptococcus tinea trichophyton |
|
|
azoles active against Aspergillus spp and fluconazole-resistant Candida albicans
|
voriconazole
itraconazole |
|
|
azoles with high bioavailability
|
fluconazole >90%
voriconazole 96% |
|
|
Increases in gastric pH decreases oral bioavailability (i.e. give with acidic beverage like coke)
|
itraconazole
ketoconazole |
|
|
azole with high CSF penetration
|
fluconazole 75%
|
|
|
azole with renal excretion
|
fluconazole
IV itraconazole requires dosage adjustment in renal impairment all other azoles hepatic excretion |
|
|
azole common class adverse effects
|
GI disturbances
increase LFTs |
|
|
itraconazole adverse effects
|
dose related hypokalemia
hypertension edema |
|
|
voriconazole adverse effects
|
dose related visual disturbances
|
|
|
azoles effect on CYP
|
inhibits CYP450
|
|
|
combination azoles and amphoterecin B
|
not recommended although fluconazole did not result in antagnonism or synergy
|
|
|
itraconazole effect on CYP
|
potent inhiitor of CYP3A4
|
|
|
posaconazole (triazole) brand
|
Noxafil
|
|
|
posaconazole activiity
|
aspergillus
candida |
|
|
posaconazole adverse effects
|
hypokalemia
fever headache GI (administer with meal) |
|
|
caspofungin brand
|
Cancidas
|
|
|
caspofungin MOA
|
inhibits beta glucan synthetase in fungal cell membranes
|
|
|
caspofungin indication
|
invasive aspergillosis
|
|
|
mycafungin brand
|
Mycamine
|
|
|
mycafungin MOA
|
interferes w/ fungal cell wall synthesis
|
|
|
mycafungin actiivty
|
fungicidal against most (all?) candida
static vs aspergillus sp |
|
|
mycafungin adverse effects
|
histamine mediated reaction (RASH) most common
leukopenia hepatic/renal dysfunction |
|
|
amphoterecin class
|
polyene antifungal
|
|
|
amphoterecin MOA
|
binds to fungal cytoplasmic memb sterols (ergosterol) which alters structure and increases permeability leading to leaking of intracellular contents and cell death
(also binds to human sterols accounting for toxicity) |
|
|
amp B acitivy
|
excellent:
histoplasma candida albicans cryptococcus coccidiodes variable: aspergillus (needs WBC) |
|
|
amp B oral absorption
|
poor (9%)
|
|
|
amp B elimination
|
3% urine, 0.8-14% bile
renal/hepatic failure don't alter levels terminal half life 15-40d |
|
|
amp B distribution
|
everywhere (lung, spleen, liver, kidneys)
Not fat (dose on IW) 95% protein bound (not dialyzed) |
|
|
amp B adverse effects
|
nephrotoxicity (premedicate)
infusion effects (fever) thrombophlebitis ACD hypokalemia, hypomagnesemia |
|
|
amp B nephrotoxicity
reversible or not? |
reversible
occurs >80% of patients w/in first 2wks of therapy |
|
|
2 mechanisms of amp B nephrotoxicity
|
1.binds to cholesterol cells in kidney
2. prostaglandin mediated renal vasoconstriction |
|
|
tigecycline brand
|
Tygacil
|
|
|
tigecycline class
|
glycylcycline antibiotic
|
|
|
tigecycline MOA
|
binds to 30S ribosome, inhibits protein translation
|
|
|
tigecycline cidal or static
|
static
|
|
|
tigecycline benefits
|
unaffected by two mech of TCN resistance: ribosomal alteration and efflux
|
|
|
tigecycline spectrum of activity
|
e. faecalis (vanco susceptible)
MSSA and MRSA citrobacter enterobacter streptocooci |
|
|
tigecycline adverse effects
|
pancreatitis
photosensitivity |
|
|
bacteriodes fragilis
|
metronidazole
|
|
|
chlamydia pneumoniae
|
doxycycline
|
|
|
enterobacter
|
imipenem
meropenem piperacillin + tobra |
|
|
enterococcus faecalis
|
penicillin G
|
|
|
enterococcus faecium
|
quinupristin + dalfopristin (Synercid)
|
|
|
gardnerella vaginalis (bacterial vaginosis)
|
metronidazole
|
|
|
haemophilus influenzae
a)meningitis, epiglotitis, and other life threat infections b)non-life threatening infection |
a)cefotaxime/ceftriaxone`
b)augmentin or bactrim |
|
|
klebsiella pneumoniae
|
ceftriaxone
cipro |
|
|
moraxella catarrhalis
|
augmentin
cefuroxime bactrim |
|
|
neisseria gonorrhoeae
|
ceftriaxone
cefixime cefpodoxime |
|
|
neisseria meningitidis
|
pen G
|
|
|
proteus mirabilis
|
ampicillin
bactrem |
|
|
pseudomonas aeruginosa
|
piperacillin
ceftazidime tobramycin |
|
|
staph epidermidis
|
vancomycin
|
|
|
stenotrophomonas maltophilia
|
bactrim
|
|
|
strep pyogenes
|
pen G
|
|
|
vibrio cholerae
|
doxycyclin
|
|
|
strep pneumoniae (pen-sens) CAP
|
pen G or V
amoxicillin |
|
|
strep pneumoniae (pen res) CAP
|
levaquin
vancomycin |
|
|
H.influenzae CAP
|
2nd/3rd gen cehp
bactrim |
|
|
moraxella catarrhalis CAP
|
2nd/3rd gen ceph
bactrim augmentin |
|
|
legionella CAP
|
FQ
|
|
|
mycoplasma pneumoniae CAP
|
doxycycline
|
|
|
chlamydia pneumoniae CAP
|
doxycycline
|
|
|
enterobacteriaceae (Ecoli, klebsiella, proteus, enterobacter)
|
2nd/3rd gen ceph
FQ |
|
|
anaerboes CAP
|
clinamycin
bl/blactamse inhibitor |
|
|
pseudomonas aeruginosa CAP
|
antispeudomonal bl (piperacillin, ceftazidime, cefepime, aztreonam, imipenam, meropenam) plus aminoglycoside
|
|
|
cephalosporins that can be used to treat infection with bacteriodes
|
ceftizoxime
cefixime cefotetan |
|
|
Rapid acting insulins
|
lispro (Humalog)
aspart (Novolog) glulisine (Apidra) inhalation |
|
|
Short acting insulins
|
regular
|
|
|
Intermediate acting insulins
|
NPH
Lente |
|
|
Long acting insulins
|
Ultralente
|
|
|
Very long acting insulins
|
glargine (Lantus)
detemir (Levemir) |
|
|
Total daily dose non-resistant patient
|
0.5-0.7units/kg/day
|
|
|
units of insulin for units above target BG
|
1-2 units for every 30-50 over
|
|
|
units of insulin and carbohydrates
|
1 units for every 15-30g carbohydrate
|
|
|
exubera units to SQ regular insulin
|
1mg=3units SQ regular
3mg=8units SQ regular |
|
|
insulin in use needs to be refrigerated T or F
|
F
|
|
|
discard vials after how long
|
1month
|
|
|
withdraw regular before NPH or lente insulins T or F
|
T
|
|
|
Sulfonylureas
|
glimepiride (Amaryl)
glipizide (glucotrol) glyburide (Micronase) |
|
|
Glucovance
|
glyburide + metformin
|
|
|
TZDs
|
rosiglitazone (Avandia)
pioglitazone (Actos) |
|
|
TZD adverse effects
|
fluid retention - avoid in patients with NYHA class III or IV CHF
weight gain peripheral and macular edema hepatitis |
|
|
Biguanide
|
metformin (Glucophage)
|
|
|
secretagogues-meglitanides
|
repaglinide (Prandin)
nateglinide (Starlix) |
|
|
meglitanides adverse effects
|
hypoglycemia
weight gain |
|
|
alpha-glucosidase inhibitors
|
acarbose (Precose)
miglitol (Glyset) |
|
|
exenatide brand
|
Byetta
|
|
|
exenatide MOA
|
incretin mimetic
binds and avtivates human GLP-1 (glucagon like peptide) receptor, increases glucose dependent synthesis of insulin and secretion from beta cells |
|
|
exenatide dose
|
5mcg SQ BID 60mins before morning and evening meals
|
|
|
sitagliptan brand
|
Januvia
|
|
|
sitagliptan MOA
|
dipeptidyl peptidase (DPP)-4 inhibitor (incretin enhancer)
causes GLP-1 and GIP levels to rise, increasing insulin secretion from beta cells |
|
|
isoproterenol brand
|
Isuprel
|
|
|
terbutaline brand
|
Brethine
|
|
|
albuterol
|
Proventil, Ventolin
|
|
|
pirbuterol brand
|
Maxair
|
|
|
levoalbuterol brand
|
Xopenex
|
|
|
salmeterol brand
|
Serevent
|
|
|
inhaled anticholinergics
|
ipratropium (Atrovent)
tiotropium (Spiriva) |
|
|
Combivent
|
albuterol + ipratropium
|
|
|
ipratropium vs tiotropium frequency
|
ipratropium QID
tiotropium 18mcg DPI once daily |
|
|
Mass cell stabilizing agents
|
Cromolyn
nedocromil (Tilade) |
|
|
Cromolyn and nedocromil use
|
prophylaxis against bronchospasm due to allergies
exercise-induced asthma |
|
|
Theophylline MOA
|
methylxanhine that inhibits phosphodiesterase
|
|
|
Antileukotrienes
|
zileuton (Zyflo)
zafirlukast (Accolate) montelukast (Singulair) |
|
|
Zyflo MOA
|
inhibits 5-lipoxygenase
|
|
|
Antileukotriene indicated for children >12months
|
Singulair
|
|
|
antileukotriene that must be taken on an empty stomach
|
Accolate
|
|
|
antileukotriene side effects
|
Liver damage
|
|
|
antileukotrienes that inhibit CYP 450
|
Zyflo
Accolate |
|
|
budenoside
|
Pulmicort Turbuhaler
DPI Corticosteroid Hepatic clearance >12yo |
|
|
formoterol
|
Foradil Aerolizer
long-acting beta2 agonist >5yo |
|
|
Advair Diskus
|
fluticasone + salmeterol
DPI |
|
|
omalizumab
|
Xolair
anti-IgE agent SQ q2-4wks asthma related to allergies |
|
|
Medications that contribute to GERD
|
CCB
Opiods Oral contraceptives Nitrates Theophylline (methylxanthines) Anticholinergics |
|
|
food that lower LES tone
|
peppermint
onions tomato-based products |
|
|
aluminum/magnesium brand
|
Maalox
Mylanta |
|
|
Antacids drug interactions
|
FQs, TCNs
ketoconazole, itraconazole iron |
|
|
Aluminum hydroxide side effects
|
constipation
hypophophatemia |
|
|
nizatidine brand
|
Axid
|
|
|
cimetidine drug interactions
|
drugs metabolized by CYP450
|
|
|
H2 blockers patient education
|
don't take otc h2blockers >2wks
|
|
|
PPI MOA
|
inhibits H+/K+ ATPase enzyme
|
|
|
PPI that can be given IV
|
pantoprazole
|
|
|
PPI patient education
|
administer 30-60mins before meals in morning
Aciphex not indicated for <18yo |
|
|
Prokinetic agents
|
metoclopramide (Reglan)
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metoclopramide MOA
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increases Ach activity in myenteric plexus to increase GI motility
strengthen of force of contraction and LES tone |
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metoclopramide patient education
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may cause sedation
involuntary movements administer 30mins before meals |
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sucralfate (Carafate) side effects
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constipation
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sucralfate patient education
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take on empty stomach at least 1hr before meals and at bedtime
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PUD treatment strategies
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2 week course of triple therapy
2 ABX and acid suppressor |
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Helidac QID regimen
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bismuth 262mg (2tabs)
metronidazole 250mg (1tab) tetracycline 500mg (1tab) |
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Alt tx options
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MOC x 2wks
metronidazole 500mg bid clarithromycin 500mg bid omeprazole/lansoprazole AOC x 2wks amoxicillin 1gm bid clarithromycin omeprazole/lansoprazole |
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bismuth adverse effects
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dark stool
black tongue avoid in renal insufficiency |
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metronidazole advere effects
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N/V/D
disulfiram rxn (EtOH containing products like mouthwash, cough/cold medicine) |
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Tetracycline adverse effects
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skin hypersensitivity
dose adjust in renal insufficiency |
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clarithromycin adverse effects
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taste disturbances
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H2 antagonists adverse effects
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dizziness
headache N/V |
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PPI adverse effects
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angina
headache brady/tachycardia |
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tomoxifen brand
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Nolvadex
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tomoxifen FDA approvals
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tx estrogen rec pos bc
px bc |
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tomoxifen agonist effects
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bone
lipid profile endometrial tissue |
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tomoxifen adverse effects
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blood clots
stroke endometrial cancer cataracts hot flashes nausea |
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SERM
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tomoxofen
toremifene (Fareston) |
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anastrazole brand
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Arimidex
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anastrazole FDA approval
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adjuant tx of hormone-rec pos early bc in postmen women
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anastrazole MOA
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suppresses estrogen synthesis
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anastrazole adverse effects
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stroke (less than tomoxifen)
thrombosis endometrial cancer |
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letrozole brand
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Femara
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letrozole MOA
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aromatase inhibitor
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exemestane brand
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Aromasin
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exemestane MOA
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aromatase inactivator
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goserelin brand
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Zoladex
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goserelin MOA
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stops production of estrogen in premen women
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goserelin adverse effects
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osteoporosis
hot flashes vaginal bleeding |
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raloxifene brand
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Evista
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raloxifene MOA
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SERM
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raloxifene agonist effects
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bone
serum lipid profiles |
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raloxifene antagonistic effects
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endometrial tissue
breast tissue |
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raloxifene FDA approval
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tx and px of postmen osteoporosis
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does raloxifene increase risk of endometrial cancer
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no
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raloxifene adverse effects
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venous thromboembolism
hot flashes |
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bisphosphonates
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alendronate (Fosamax)
risedronate (Actonel) ibandronate (Boniva) |
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postmen symptoms-hot flashes treatment
-estrogen replacement |
conjugated equine estrogen (Premarin)
ethinyl estradiol (Estinyl) micronized estradiol (Estrace) |
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-progestin replacement
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medroxyprogesterone
norethindrone progesterone (Prometrium) |
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-estrogen and progestin combo
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Prempro
Combipatch Femhrt (northindrone + ethyinyl estradiol) |
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use of premarin and medroxy combination in WHI outcomes
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increase in
invasive bc coronary heart disease stroke PE beneficial decrease in colorectal cancer hip fracture |
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estrogen only risks
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endometrial cancer
breast cancer ovarian cancer |
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HRT summary
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don't start in pts w/ CAD
short term use in pts w/out CAD for menopausal sxs |
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estrogens MOA in oral contraception
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prevents formation of follicle
prevents release of FSH from anterior pituitary ovulation inhibited by low FSH levels |
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High androgenic activity
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norgestrel
levonorgestrel |
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progestins MOA in oral contraception
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in combo: inhibit LH surge required for ovulation
alone: endometrial atrophy which inhibits egg implantation and thickening mucus |
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Yasmin
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ethinyl estradiol 30mcg/drospirenone 3mg
monophasic progestin structually similar to aldactone (for women who experience water retention) hyperkalemia |
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Ortho Evra Patch
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ethinyl estradiol 20mcg/norgestimate 150mcg)
apply to buttock, upper outer arm, or upper torso on 1st d of mens cycle new patch each week x3 then 1 wk off |
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IUDs
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copper-containing
progestasert (Progesterone)-12mo levonorgestrel (Mirena)-5yr |
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IUD adverse effects
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PID
irregular bleeding |
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Vaginal contraceptive ring
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ethinyl estradiol 15mcg/etonogestrel 120mcg (Nuvaring)
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nuvaring instructions
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insert by 5th day of cycle, leave in place x3wks, remove x1wk
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Intramuscular injcetions
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medroxyprogesterone (Depo-Provera) 150mg IM q3months
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depo provera pt instructions
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1st injection must be given w/in 5 days of menstruation
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depo provera adverse effects
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decrease bone mineral density
weight gain irregular bleeding |
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Subcutaenous injections
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medroxyprogesterone (Depo-SubQ Provera) 104mg sq q3months
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deposubq provera MOA
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prevents ovulation
thins endometrium |
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estrogen deficiency effects
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early cycle spotting
hot flashes amenorrhea vaginal dryness |
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estrogen excess effects
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HTN
breast tenderness migraine N/V weight gain |
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progestin deficiency effects
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late cycle spotting
dysmenorrhea |
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progestin excess effects
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acne
weight gain hirsutism HTN fatigue |
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estrogen containing BCP contraindications
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smoker >35
liver disease breastfeeding hx MI, stroke, DVT, PE, CVA, CAD Atrial fibrillation surgery <4wks |
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decreases enterohepatic recirculation of BCP
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pen
ampicillin tmp/smx minocycline tetracycline griseofulvin |
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Missed BCPs
miss 1 |
take as soon as remembered -no BUM
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miss 2 in wk 1 or 2
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take 2 x2d + BUM x7d
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miss 2 in wk 3
a)day 1 starter b)sunday starter |
a)begin new pack that day + BUM x7d
b)one daily until sunday, start a new pack on sunday + BUM x7d |
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miss 3 in 3 weeks
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same as miss 2 in wk 3
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S/Sx of BCP problems
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ACHES
abdominal pain chest pain headache eye pain severe leg pain |
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Most common cause of vaginitis
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candida
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vaginal yeast infections treatment
|
clotrimazole crm x7-14d
miconazole crm x7d nystatin vaginal tab x7d terconazole cm x 3 or 7d fluconazole 150mg PO x1d |
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cervical cancer vaccine approved by FDA
|
Gardasil
9-26yo HPV 6,11,16,18 |
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treatment of HPV genital warts
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imiquimod 5% crm
podofilox 0.5%sol or gel cryotherpay surgery |
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treatment for cervical and internal vaginal warts
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thiotepa
FU |
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trichomoniasis treatment
|
metronidazole 2g PO once
tinidazole 2gm PO x1 treat sexual partners |
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chlamydia treatment
|
zithromax 1g PO once
or doxycycline 100mg PO bid x7d treat sex partners in pregnancy: azithromcyin 1gm PO once or erythromycin base or amoxicillin |
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when is suppressive therapy indicated for genital herpes
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6 or more recurrences per year
therapy for one year |
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gonorrhea treatment
|
treat simultaneously for chlamydia
ceftriaxone 125mg IM once or cefixime 400mg po once or cipro 500mg po once or levofloxacin 250mg po once plus azihtromycin or doxycycline |
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hepatitis B treatment
|
interferon alpha and lamivudine
prevention w/ vaccination |
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primary, secondary or early latent syphilis
|
benzathine pen G 2.4MU IM once
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late latent, latent syphilis of unknown duration or tertiary syphilis w/o neurosyphillis
|
benzathine pen G 2.4MU IM qwk x 3doses
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neurosyphilis
|
aq crystalline pen G 18-24MU/d given as 3-4MU IV q4h or cont infusion x10-14d
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