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38 Cards in this Set
- Front
- Back
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Methotrexate MOA
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Antifolate antimetabolite, single dose, cytotoxic during S-phase, inhibits DNA synthesis
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Mifepristone MOA
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Abortifactent: Anti-progesterone, softens/dilates cervix, decidual necrosis, prostaglandin release/contraction. Day 1.
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Misoprostol MOA
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Abortifactent: Prostaglandin binds to myometrial cells to cause contractions, cervical softening/dilation. Effects: diarrhea, longer induction times.
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Misoprostol route reduces infection risk and shortens time of termination
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Buccal
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Rhogam MOA
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Anti-D gamma globulin mops up fetal RBC in maternal circulation/ prevents B cell activation and memory cell formation.
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Tx for Invasive moles
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Methotrexate followed by hCG monitoring
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Prevent HSV outbreak during pregnancy
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Prophylactic Acyclovir
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Oral contraceptive used for PCOS treatment
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Ethinyl-estradiol; Drospirenone (Yasmin) a progresterone with spironolactone-like properties
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OC to avoid in PCOS treatment
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Levonorgestrel (a progestin) can be androgenic
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Rx to treat insulin resistance
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Metformin- decreases hepatic gluconeogenesis, intestinal absorption of glucose, peripheral glucose uptake, fasting insulin levels, LH, free testosterone
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Antiandrogens for PCOS treatment and major side effect
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Spironolactone, flutamide, finasteride. All are teratogenic.
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Treatment of acanthosis nigricans
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Correct hyperinsulinemia. Lac Hydrin lotion (ammonium lactate 12%) and Retin A cream (Retin A 0.05%)
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NSAID treatment for Endometriosis
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Ibuprofen / Mefenamic acid (prostaglandin receptor antagonist and COX inhibitor) - Decrease intra-uterine pressure and lowers PGF2α; GI upset common
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Contraindications to NSAID Tx for Endometriosis
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Renal insufficiency, PUD, gastritis, bleeding disorder, aspirin hypersensitivity
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OCP treatment for Endometriosis
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COC's- ethinyl estradiol and progestin (norgestimate, norethindrone, desogestrel); reduce menstrual flow, inhibit ovulation / prostaglandin production in luteal phase.
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GnRH Analog treatment of Endometriosis
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Leuprolide, Nafarelin, Goserelin- GnRH analogs are continuous, not pulsatile, causing initial LH/FSH burst and pituitary desensitization and loss of LH/FSH production. Causes profound hypoestrogenic state.
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Progestin treatment of Endometriosis
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Norethindrone acetate, Medroxyprogesterone acetate (MPA) - Negative feedback on hypothalamus, antagonizes estrogen at endometrium
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Androgen treatment of Endometriosis
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Danazol - suppresses FSH through HPO axis and endometriosis locally, weak androgen, may cause virilization.
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Aromatase Inhibitor (AI) treatment of Endometriosis
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Letrozole- Decrease body supply of estrogen and local production in implant
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Definitive surgery for Endometriosis treatment
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Hysterectomy with bilateral salpingo-oophorectomy (surgical menopause)
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Treatment of adenomyosis
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NSAID / progesterone for symptoms, but hysterectomy is only definitive treatment.
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Treatment for Lichen Sclerosus
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Topical corticosteroids (Clobetasol)- ultrapotent topical steroid; ointment preferred
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Side effects of Clobetasol treatment
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Pituitary-adrenal axis suppression, atrophy, hypopigmentation, allergic contact dermatitis
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Treatment of Lichen Simplex Chronicus
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Topical medium-strength steroids and prophylactic fluconazole (for history or current Candida)
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Treatment of Hidradenitis Suppurativa
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Stage I - Antiandrogenics, antibiotics, zinc gluconate, intralesional steroids. Stage II- early local unroofing. Stage III- Wide excision.
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Treatment of BV
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Oral / vaginal therapy with metronidazole or clindamycin, or single dose therapy with tinidazole for everyone except pregnant patients.
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OTC Treatment for Uncomplicated VVC
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Azole intravaginal prep w/ topical creams (Butoconazole, Clotrimazole, Miconazole, Tioconazole)
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Rx Treatment for Uncomplicated VVC
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Vaginal agents (Butoconazole, Nystatin, Terconazole) or Oral Fluconazole
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Treatment for Complicated VVC
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Topical therapy or oral fluconazole with weekly maintenance fluconazole.
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Treatment for non-albicans VVC
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Non-fluconazole azole drug, boric acid capsule vaginally
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Treatment of Condyloma
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Medical imiquimod- topical immunoresponse modifier. Surgical ablative or cryotherapy approach. Chemical cautery: tri-chloro or bichloro acetic acid. Podophyllin resin (Condylox) home Tx.
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Treatment for Chlamydia
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Azythromycin (oral, once) or Doxycycline (7 days)
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Treatment for Lymphogranuloma venereum
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21 day course of doxycycline
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Treatment for Gonorrheal cervicitis / urethritis
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Ceftriaxone or cefixime
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Treatment of PID
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Ceftiraxone + Doxycycline +/- Metronidazole
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Treatment for Tuboovarian Abscess
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(A) Cefotetan or Cefoxitin + Doxycycline (B) Clindamycin + Gentamicin
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Management of PTL
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Hospitalization, tocolytic drugs, antenatal glucocorticoids, antibiotic prophylaxis
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How does magnesium sulfate work as a tocolytic?
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Uncouples excitation-contraction in myometrial cells and decreases calcium uptake while activating intracellular adenylyl cyclase
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