Term
|
Definition
Ditropan (M3 Specific Antagonist)
UUI Tx
2.5-5 mg BID-QID
BAD: High incidence of ADR (weight gain, orthostatic hypotension)-->TAPER (start at 2.5 mg BID) or use ER PO/TD/gel
CHEAP |
|
|
Term
|
Definition
Detrol (M2 and M3 Antagonist)
UUI Tx
2 or 4 mg or LA
Hepatic Metabolism: higher levels in ppl with liver dysfunction/no CYP2D6
Increase detrol levels with PPI/antacids--BUT NO APPARENT PROBLEMS |
|
|
Term
|
Definition
Sanctura (M2 and M3 Antagonist)
UUI Tx
20 mg BID on empty stomach/before meal (ER available)
Renal function imp (decrease dose in renal dysfunc and patients over 75 y/o) |
|
|
Term
|
Definition
Enablex for UUI
M3 specific
7.5 or 15 mg qd (ER) |
|
|
Term
|
Definition
Vesicare Mainly M3 for UUI
5/10 mg QD
with renal OR heaptic impairment dont exceed 5 mg if use at all |
|
|
Term
|
Definition
Diuretics (increase volume)
Alpha antagonists (decrease tone)
Calcium Channel Blockers (urinary retention)
Sedatives and hypnotics (functional incontinence)
Alcohol (increase volume)
ACEIs (cough--stress UI) |
|
|
Term
| Contraindications for alpha agonists |
|
Definition
HTN
CAD
tachyarrhythmias
MI
Hyperthyroidism
glaucoma |
|
|
Term
|
Definition
pse
phenylpropanolamine
ephedrine
norfenefrine
midodrine |
|
|
Term
| Causes of Urinary Incontinence |
|
Definition
Pregnancy/Childbirth: stres UI
Aging
Obesity: extra weight
Smoking: loss of sphincter muscle control
UTI: increase urge
EtOH: increased volume
Neurologic Causes: stroke, MS, neurologic injury, parkinsons, pelvic surgery |
|
|
Term
|
Definition
Hx--bladder diary
Physical exam
Mental assessment-check QOL
Functional/Environmental assessment |
|
|
Term
|
Definition
weight loss
dietary changes: decrease caffeine, etoh, tea
electrical stimulation to lower pelvic muscles
biofeedback/bladder training
Kegels
Collagen and fat implants: catheterization, dryness aids, surgery |
|
|
Term
| Give Drug therapy for osteoporosis if: |
|
Definition
T score at or below -2.5
T score between -1 and -2.5 at the femoral neck or spine, age of 50+, 10-yr hip fracture probability over 3%, OR 10-yr major osteoporosis-related fracture probability over 20% |
|
|
Term
| Diet to help osteoporosis |
|
Definition
limit caffeine, etoh, sodium, carbonated drinks
increase ca, vit d, vit k (cofactor for protein activation)
protein
soy (estrogen-like effects) |
|
|
Term
|
Definition
smoking is and INDEPENDENT risk factor for osteoporosis
dose and duration dependent
Mechanism: [1] decrease sex hormone levels [2] decrease Ca absorption and [3] direct effect on onsteoblasts |
|
|
Term
| Daily Ca requirement for teen girls |
|
Definition
|
|
Term
|
Definition
with HRT: 1200 mg
w/o HRT: 1500 mg
ALL over 65: 1500 mg |
|
|
Term
|
Definition
|
|
Term
| Drug interactions with Ca |
|
Definition
PPI
H2RA
tetracycline
FQ
iron |
|
|
Term
|
Definition
Dyspepsia
Constipation
Kidney stones |
|
|
Term
|
Definition
Carbonate (40% elemental) DOC--CHEAP; acid dependent (take with meals)
Citrate (24%) acid-independent = less gi upset
Gluconate (9%)--requires more tablets
Take divided doses up to 600 mg |
|
|
Term
|
Definition
| does NOT require renal activation |
|
|
Term
|
Definition
Adults: 600 IU *some think should be 1000-2000
over 70: 800 IU
UL: 4000 mg
If vit D deficient-take up to 50,000 IU/week for replacement or until normal range |
|
|
Term
|
Definition
inhibit osteoclast activity to reduce bone loss and resorption
gets incorporated into bone and therefore has long half-life
decreases fracture risk and increases BMD |
|
|
Term
|
Definition
Boniva
150 mg/month
3 mg IV q3mo |
|
|
Term
|
Definition
Zometa/Reclast
5 mg iv qyear (over 15 min)
1200 mg ca and 800-1000 IU vit D QD x 2 weeks after dose of Z
$$$$ |
|
|
Term
|
Definition
actonel (+/-) ca
35mg Qweek
150 mg/month |
|
|
Term
| Bisphosphonate counseling |
|
Definition
empty stomach
at least 6 oz water
sit up and dont eat/drink for 30 min (60 min with boniva)
do not take at same time as other meds
maintain good oral hygeine |
|
|
Term
|
Definition
GI
fever, chills, injection site rxns
musculoskeletal probs
osteonecrosis of the jaw (primarily with cancer patients receiving IV therapy) |
|
|
Term
| bisphosphonate duration of action |
|
Definition
review yearly
if at low-risk may be able to d/c after 5-7 years, but high-risk women should continue therapy
if therapy d/c'd--perform a DXA scan Q2years, if bone density falls...
1. over 8% in 1 year
2. over 10% in 2 years
3. over 5% below pre-treatment levels
...consider restarting
Can rotate agents too! |
|
|
Term
| Estrogen and osteoporosis |
|
Definition
approved for prophylaxis if at significant risk and cant take non-estrogen thearpy
lowest dose possible
NOT FIRST LINE |
|
|
Term
|
Definition
Evista 60 mg QD
MOA: agonist at bone
antagonist in breast and uterine tissue-decrease CA risk
Low adherence rate
Black Box: PE/DVT |
|
|
Term
|
Definition
Miacalcin NS 1 (200 IU) spray daily
Fortical SQ inj 100 IU QOD |
|
|
Term
|
Definition
acts like endogenous calcitonin
higher affinity for calcitonin receptor
decrease serum Ca and bone resorption
second line tx for osteoporosis in women >5 yr post-menopause |
|
|
Term
|
Definition
PTH1-34, Forteo
Severe osteoporosis
20 mcg sq daily into thigh/abdomen
for up to 2 years
MOA:
PTH analog--maintain Ca and PO4 homeostasis (promotes reabsorption in constant doses
stimulates bone formation by increasing serum Ca and decreasing serum PO4
Inhibits apoptosis of osteoblasts |
|
|
Term
|
Definition
Hx of osteosarcoma
Paget's disease
Hx of bone radiation therapy |
|
|
Term
|
Definition
Hypotension, tachycardia post-inj
N/V
HA
Hypercalcemia--Tx worked too well |
|
|
Term
|
Definition
denosumab
MAb agst RANKL
For severe osteoporosis
60 mg sq Q6h + Ca 1000 mg and 400 IU vit D
**NOW approved under Xgeva for patients with hormone related cancer |
|
|
Term
|
Definition
RANK ligand is produced by osteoblasts and binds to receptors on osteoclasts (helps give balance)
If block RANKL then shifts bone balance to bone building |
|
|
Term
|
Definition
pain (back, musculoskeletal, extremity)
hypercholesterolemia
cystitis
pancreatitis |
|
|
Term
| denosumab CI and Precautions |
|
Definition
uncorrected pre-existing hypocalcemia
Precautions
serious infections
derm rxns
osteonecrosis of the jaw |
|
|
Term
| Peak bone mineral density occurs at what age? |
|
Definition
|
|
Term
| z-score vs t-score for osteoporosis |
|
Definition
z-score: compares to the same population (ex: other older ladies who also have osteoporosis--not a good comparison)
t-score: compares to standard of a woman who is 30/35 y/o--better standard |
|
|
Term
|
Definition
| 12 months of trying wihtout getting pregnant |
|
|
Term
| Factors that can impair fertility |
|
Definition
etoh
smoking
caffeine
recreational drugs (+ affect fetus)
recreational drugs
solvents, pesticides, chemicals (will ask about job)
thermal exposure (ex: hot tub decreased sperm production)
under/over weight (<17.5; >27.5) |
|
|
Term
| Meds that impair fertility: WOMEN |
|
Definition
NSAIDS
ASA
Vaginal Lubricants (slow sperm mvmt) |
|
|
Term
| Meds that impair fertility: MEN |
|
Definition
inhibit spermatogenesis
anabolic steroids
caffeine
Calcium Channel Blockers (amlodipine, nifedipine)
Allopurinol
Colchicine
Cyclosprine
Spirnolactone
SMX/TMP |
|
|
Term
| Drugs that cause hyperprolactinemia |
|
Definition
Chlorpromazine
Haloperidol
metoclopramide
TCAs
Cimetidine |
|
|
Term
| Ovulatory Disorders are the only cause of infertility T or F |
|
Definition
| F-(~30-40%) but they are the only things we can really change |
|
|
Term
|
Definition
SERM (Clomid, serophene)
MOA: inhib negative feedback response on the hypothalamus by binding to estrogen receptors-->increases FSH and LH-->promote follicle growth/development |
|
|
Term
|
Definition
50 mg/d x 5 days (beginning day 5 of cycle)
**May increase dose to 100 mg/d if 1st cycle fails (max=150 mg/day; 6 cycles)
**For PCOS start at 25 mg/day
Expect ovulation 5-10 day after last dose |
|
|
Term
|
Definition
More effective than clomiphene--but use as second line because more ADRs (multiple gestations, ovarian hyperstimulation syndrome, fever, inj site rxns, breast pain, abdominal symptoms, $$$$)
daily IM or SC injection
MOA: promotes follicular growth |
|
|
Term
| Types of Gonadotropin Therapy |
|
Definition
Menotropin (hMG)-equal amounts of FSH and LH
Urofollitropin (highly purified FSH)-sc administration; minimal LH activity
Follitropin-alpha and -beta (Recomb FSH)-less allergenic
GOOD for PCOS (has high LH:FSH ratio) and ART |
|
|
Term
|
Definition
initial dose 75-150 IU/d based on FSH
start day 3/4 of cycle
target is serum estradiol of 500-2000 pg/ml and 1-2 follicles 17-20 mm in diameter
usually not more than 12 days |
|
|
Term
| congenital malformation vs anomalies |
|
Definition
Malformation: structural abnormalities
Anomalies: malformations that cause a functional change |
|
|
Term
| Almost 1/2 of all women received Rx drugs during pregnancy - T or F? |
|
Definition
|
|
Term
| what percent of umbilical blood flow enters the fetus |
|
Definition
| 40-60% through the umbilical vein |
|
|
Term
| most important stage of pregnancy |
|
Definition
|
|
Term
| when do most women know they are pregnant |
|
Definition
|
|
Term
| New changes in the Drug Rating system |
|
Definition
Development of new 'pregnancy' and 'lactation' subsections
main components of each section:
1. Fetal Risk Summary
2. Clinical Considerations
3. Data Section |
|
|
Term
| US and KY average for breastfeeding |
|
Definition
|
|
Term
| Women take more meds/month when breastfeeding or pregnant? |
|
Definition
|
|
Term
| Determinants of Medication Transfer into Breast Milk |
|
Definition
Passive diffusion
Maternal Plasma drug levels and plasma protein binding (in mother's plasma)
Lipid solubility (colostrum has less fat than milk)
pH of breast milk (slightly less than blood pH)
drug's molecular size and weight
maternal half-life of medication |
|
|
Term
| Folic Acid Recommendations |
|
Definition
400 mcg
PREG/Want to get PREG should take: 1-4 mg daily for at least 1 month before concenption |
|
|
Term
| Before getting pregnant you should: |
|
Definition
1-4 mg folic acid for atleast 1 month
screen for STDs and immunizations against rubella and varicella
Stop tobacco, EtOH, drug abuse |
|
|
Term
| Physiological changes during pregnancy |
|
Definition
increased blood volume, cardiac output, renal blood flow/GFR
decreased GI motility
weight gain
hypercoaguable state |
|
|
Term
| how many women have post-partum depression |
|
Definition
|
|
Term
| Treating chronic depression in pregnancy |
|
Definition
SSRI and TCAs-category D
SSRIs can be used in breastfeeding but NOT 1. paroxetine or 2. fluoxetine (because long half-life) |
|
|
Term
|
Definition
**Ondansetron (5HT receptor antagonist)--more used NOW
Pyridoxine (vitamin)-category A
Doxylamine (antihist)-category A
--but neither that effective
Meclizine (Cat B)--sedating
Promethazine (Cat C)--sedating |
|
|
Term
|
Definition
more frequent smaller meals
avoid triggers
antacids-(Ca or Mg)-moderation
H2RA: famotidine (not cimetidine--too many interactions) |
|
|
Term
| Constipation and Pregnancy |
|
Definition
Increase fiber and fluid
exercise
DOC: bulk laxatives
Other alternatives:
docusate sodium
polyethylene glycol prep 3500
lactulose
Senna--LAST LINE |
|
|
Term
| Avoid during pregnancy for constipation |
|
Definition
Mineral oil: decreased absorption of fat soluble vitamins
Castor Oil: premature uterine contractions
Saline osmotics: promote sodium and fluid retention |
|
|
Term
|
Definition
Stool bulking agents = DOC
Loperamide 2 mg prn
NOT: bismuth subsalicylate or diphenoxylate and atropine |
|
|
Term
| Hemorrhoids and pregnancy |
|
Definition
avoid constipation
sitz bath
preparation H and tucks
NOT Local anesthetics |
|
|
Term
|
Definition
ALWAYS TREAT
Use:
Amoxicillin
Augmentin
Cephalosporins
Nitrofurantoin-more for chronic UTIs |
|
|
Term
| Most common cause of premature labor |
|
Definition
|
|
Term
| Common Cold and Pregnancy |
|
Definition
Preferred: Doxylamine and Diphenhydramine
ONLY use if necessary/avoid first trimester:
Dextromethorphan
Psuedoephedrine |
|
|
Term
|
Definition
DOC: APAP
NSAIDS: Category B in 1st and 2nd; Category D in 3rd (ductus arteriosis)
Morphine: Category B during 1st and 2nd for SHORT periods of time; Category D if high dose or prolonged use
Time breastfeeding--pump and dump |
|
|
Term
|
Definition
|
|
Term
|
Definition
Beta-adrenergic receptor agonists (tocolysis)
SQ, PO, IV infusion
2 day delay in delivery
ADRs: tachycardia, dyspena, agitation, hypokalemia, hyperglycemia
Must be at really high risk because of ADRs |
|
|
Term
|
Definition
IV infusion tocolytic
ADR: feels drunk (mom and baby)
serum mg concentration can exceed 9 mg (normal 1.5-1.8 mg/dL) |
|
|
Term
| Progesterone and 17-alpha hydroxyprogesterone |
|
Definition
Caproate-weekly IM inj or vaginal supp
weeks 24-34 of gestation
IM associated with HA and sleepiness
Use for women with short cervixes or Hx of premature birth (NOT for twins-only singletons) |
|
|
Term
| Prostaglandin-Synthase Inhibitors |
|
Definition
before 32 weeks
dont use after 32 weeks because of risk of ductal closure
PR or PO |
|
|
Term
| Number one method of contraception |
|
Definition
| Sterilization (both men and women combined) |
|
|
Term
| half of pregnancies in the US are unintended? T or F |
|
Definition
|
|
Term
| Contraceptive vs Intraceptive |
|
Definition
C: prevents egg meeting sperm
I: prevents fertilized egg implanting into uterine lining |
|
|
Term
| Method of contraception with worst failure rate |
|
Definition
| Spermicide (perfect use 18/100; typical use 29/100) |
|
|
Term
| if no contraception how many women out of 100 would get pregnant in one year |
|
Definition
|
|
Term
| Implant and IUD are the most effective methods of contraception. T or F |
|
Definition
|
|
Term
|
Definition
| limit sex to post-ovulatory phase (Ex: ovulate day 14, have sex after day 16) |
|
|
Term
| basal body temperature contraceptive method |
|
Definition
| look for a rise of 0.5 degrees 2 days post-ovulation |
|
|
Term
| Women who are not candidates for fertility awareness methods (ex: calendar method) |
|
Definition
Adolescents
Premenopausal/perimenopausal women
postpartum/breastfeeding women |
|
|
Term
| prescription barrier contraceptives |
|
Definition
diaphragm
cervical cap
lea's shield |
|
|
Term
| T or F: barrier methods of contraception are more effective in women who have had a baby alreaday |
|
Definition
| F: barrier methods are LESS effective in parous women |
|
|
Term
| which barrier method can increase risk of UTIs |
|
Definition
|
|
Term
| Spermacide must be reapplied every ____ hours |
|
Definition
|
|
Term
| Which contraception method has a similar 5 year efficacy rate to that of sterilization |
|
Definition
|
|
Term
|
Definition
levonorgestrel (LNG-IUS)
good for 5 years |
|
|
Term
|
Definition
inhibits fertilization
thickens cervical mucous
inhibits sperm function
thins and suppresses the endometrium |
|
|
Term
|
Definition
Paragard
good for 10 years |
|
|
Term
|
Definition
inhibits fertilization
releases copper ions that reduce sperm motility
may disrupt normal division of oocytes and the formation of fertilizable ova |
|
|
Term
| Non-contraceptive benefits of IUDs |
|
Definition
1. decrease risk of endometrial cancer
2. LNG-IUS can be used as a first line for menorrhagia (97% decrease in menstrual bleeding, can be used in presence of fibroids)
3. Copper IUD: can be used for emergency contraception |
|
|
Term
|
Definition
no protection against HIV or STIs
ADR:
upon insertion-variable pain, cramping, vasovagal rxn
first few days-light bleeding/cramping
First few months-intermenstrual bleeding/cramping
with copper IUD-heavier/prolonged menses (no progestin)
Can check string to see if still there
can insert any time it is confirmed they are not pregnant |
|
|
Term
| What are four things that can increase the risk of breakthrough bleeding? |
|
Definition
1. starting a new formulation
2. inconsistent dosing
3. smoking-possibly b/c of fluctuations in estrogen levels
4. chlamydial cervicitis and endometritis--more likely after several months of COC use |
|
|
Term
| Drug interactions with COC |
|
Definition
1. Drugs that decrease enterohepatic circulation-Ampicillin, TCN, sulfa
2. Drugs that induce COC metabolism:
RIFAMPIN, carbamazepine, phenytoin, phenobarbital, primidone, ethosuximide
*causes spotting or breakthrough bleeding |
|
|
Term
| Pharmacologic action of Progestin (in COC) |
|
Definition
1. Ovarian and pituitary inhibition
2. thickening of cervical mucous
3. endometrial atrophy/transformation
4. cycle control (bleeding at appropriate time) |
|
|
Term
| Pharmacologic Actions of Estrogen in COC |
|
Definition
1. ovarian and pituitary inhibition
2. thinning of/increase in cervical mucus
3. endometrial proliferation
4. cycle control (bleeding at appropriate time) |
|
|
Term
| Most common estrogen found in COC |
|
Definition
ethinyl estradiol
Mestranol is found only in high dose COC |
|
|
Term
| What is a low dose vs a high dose COC |
|
Definition
High: >50 mcg estrogen
Low: 20-35 mcg estrogen |
|
|
Term
| First generation progestin |
|
Definition
norethindrone
ethynodiol diacetate
norethynodrel
not particularly estrogenic or androgenic |
|
|
Term
| Second generation progestins |
|
Definition
levonorgestrel****
norgestrel
ANDROGENIC |
|
|
Term
| Third generation progestins |
|
Definition
desogestrel
norgestimate
estrogenic |
|
|
Term
| What is the spirnolactone derived progestin |
|
Definition
|
|
Term
| what should you monitor with drospirenone products |
|
Definition
potassium levels (in first mo)
**Hyperkalemia**
Esp with ACE inhibitors and NSAIDs |
|
|
Term
| Products with drospirenone |
|
Definition
Yasmin
Yaz
Beyaz
Safyral
Angeliq--For vasomotor symptoms |
|
|
Term
| Who is at the greatest risk for VTE? |
|
Definition
| Pregnant women (then women on COC with drosperinone) |
|
|
Term
| Which phasic formulation is associated with less spotting, breakthrough bleeding, and amenorrhea? |
|
Definition
|
|
Term
|
Definition
A:abdominal pain-gallbladder disease, VTE
C: chest pain (MI)
H: headaches-stroke, HTN, migraine
E: eye problems-stroke, HTN, vascular problems
S: severe leg pain-VTE in legs |
|
|
Term
| Increased risk for VTE for: |
|
Definition
Smokers (espeically in over 35 years)
HTN
patients on estrogen products >35 mcg |
|
|
Term
| What is the risk of breast cancer associated with OC use? |
|
Definition
| women who already have breast cancer cells will see stimulated growth of the cancerous cells, but there is no creation of cancer cells |
|
|
Term
| When is breakthrough bleeding most likely to occur with COC? |
|
Definition
first 3 months of COC use
especially with low dose COC |
|
|
Term
| If breakthrough bleeding occurs before the 10th pill it is due to _________. you should do __________. |
|
Definition
due to estrogen deficiency
change to progestin that is more estrogenic or increase the estrogen component |
|
|
Term
| If breakthrough bleeding occurs after the 10th pill it is due to ___________. you should do _________. |
|
Definition
due to progestin deficiency
change progestin component |
|
|
Term
| Patient with amenorrhea (not tapered of bleeding, but more suddenly) and is on a COC it is most likely because _______. |
|
Definition
insufficient estrogen to stimulate growth of endometrium
**Always rule out pregnancy |
|
|
Term
| Which type of phasic are extended cycle products? |
|
Definition
| monophasic (multi-phasics run into insurance problems) |
|
|
Term
| If no risk factors, what is the oldest recommended age to prescribe a COC? |
|
Definition
|
|
Term
| Consider OC with at least ______ mcg estradiol in women over 154 lbs. |
|
Definition
30 mcg estradiol
because there is a proven decreased efficacy in low dose COC in overweight women |
|
|
Term
| Which method of starting COCs is associated with less breakthrough bleeding? |
|
Definition
Starting on the first day of menses
*Difficult for patients with irregular cycles |
|
|
Term
| Which method of starting COCs is associated with the MOST breakthrough bleeding? |
|
Definition
Today start--starting when you get it prescribed
**must use backup method of 2 weeks to be safe |
|
|
Term
| T or F: COC protects against STIs? |
|
Definition
|
|
Term
| If miss one pill of birth control, they should _________. |
|
Definition
| take the missed pill asap-even double up |
|
|
Term
| if miss 2 pills in a row then _________. |
|
Definition
| take 2 pills on the day remembered then take 2 pills on the next day. and Use back up method for 7 days |
|
|
Term
| if miss 3+ pills then _________ |
|
Definition
| use back up method (for at least a week, but more conservative would be for the whole next cycle) and call physician |
|
|
Term
| OC can help to reduce what types of cancer |
|
Definition
Ovarian
Endometrial
Colorectal |
|
|
Term
| number one reason for failure of COCs |
|
Definition
|
|
Term
|
Definition
-higher compliance rates
-low estrogen dose
-constant hormone levels
-no gi interactions with antibiotics
-no first pass metabolism of progestin
similar efficacy and ADRs to OCs |
|
|
Term
| When should she start nuvaring |
|
Definition
| within 5 days of onset of menses (when pregnancy can be excluded) |
|
|
Term
| what should you do if the vaginal ring slips out? |
|
Definition
if less than 3 hours-rinse and reinsert
if over 3 hours-rinse, reinsert, and use back-up contraception for 1 week
if not replaced by the eighth day (when time for next ring)--consider emergency contraception, insert new ring after ruling out pregnancy, use back-up contraception for 1 week |
|
|
Term
|
Definition
Contraceptive patch
apply to butt, upper outer arm, lower abdomen, upper torso (excluding breast)
Do NOT cut or flush down toilet |
|
|
Term
| Disadvantages of Ortho Evra Patch |
|
Definition
less effective if >198 lb
ADR similar to OC except:
1. increased breast pain first 2 months
2. increased dysmenorrhea
increased total estrogen exposure (but lower peak) |
|
|
Term
| T or F: patch users have less risk of VTE than with COC |
|
Definition
| F: more risk of VTE with patch |
|
|
Term
| When to consider NON hormonal contraception |
|
Definition
1. over 35 y/o
2. smoking
3. obesity
4. less than 4 weeks post-partum
5. 4 weeks prior to surgery and 2 weeks after surgery
6. bed rest
7. personal or family history of MI or stroke |
|
|
Term
|
Definition
1. PO: norgestrel (Ovrette) and Norethindrone
2. EC: levonorgestrel
3. Depoprovera: injectable
4. Implanon/Nexplanon-implant
5. Mirena-IUS |
|
|
Term
| Women who are candidates of POP but NOT COC |
|
Definition
1. VTE
2. Vascular Disease
3. HTN
4. Smoking (>35)
5. Lactating women-Estrogen decreases milk production |
|
|
Term
| Advantages and Disadvantages of POP |
|
Definition
A:
decrease bleeding
can start immediately post-partum
avoid estrogen-related ADRs
D:
Irregular bleeding
SAME TIME EVERY DAY-no missed days
patient may still ovulate (so not as effective) |
|
|
Term
|
Definition
progestin implant
used for 3 years
can x-ray
suppresses ovulation within 1 day of insertion |
|
|
Term
|
Definition
| depot-medroxyprogesterone acetate |
|
|
Term
|
Definition
IM medroxyprogesterone acetate
also comes as subQ
duration = 3 months--but SLOW return of fertility |
|
|
Term
| Disadvantanges of Depo-Provera |
|
Definition
bleeding irregularities/amenorrhea
weight gain
depression
decreased bone density**
ADRs can last 6-8 months post-injection
changes in lipid proflie--caution with hyperlipidemia
must go to dr for administration |
|
|
Term
| What is a problem can occur with all progestin products |
|
Definition
irregular and prolonged bleeding (especially at initiation)
espeically with depo-provera
-to fix
1. consider OC for 1 cycle
2. Ibu for 5 days
3. other forms of exogenous estrogen for 5 days |
|
|
Term
| Noncontraceptive benefits of depo-provera |
|
Definition
1. amenorrhea for many
2. decreased menstrual cramps, pain, mood changes, HA, breast tenderness, and nausea
3. decreased risk of ovarian cancer
4. decreased risk of PID
5. decreased pain associated with ovulation and endometriosis |
|
|
Term
| When to inject depo-provera |
|
Definition
on day 1-5 of menstrual cycle
within first 5 days post-partum if not breastfeeding (after 6th week if breastfeeding)
within first 7 days of an abortion
Reinject weeks 11-13
If late injection: back up contraception should be used and absence of pregnancy must be confirmed |
|
|
Term
|
Definition
1. OC formulations
2. Plan B
3. Ella
4. Mifepristone (off label)
5. Copper IUD |
|
|
Term
|
Definition
1. intercourse within past 72 (120) hours without contraception (indep of time of menstruation)
2. contraceptive mishap
3. sexual assault
4. exposure to teratogens |
|
|
Term
|
Definition
using OC formulations for EC
EE levels: 100-120 mcg/dose x 2 doses
LNG: 0.5-0.6 mg/dose x 2 doses
Main problem--it is a lot of estrogen at once = nausea--so take anti-emetic prohylactically
menses within 3 weeks |
|
|
Term
|
Definition
| 1.5 mg once (or split in 2 doses) LNG |
|
|
Term
|
Definition
Levonorgestrel
MOA: primarily prevents ovulation and fertilization; does not disrupt events that occur after implantation
ONLY CI: known pregnancy (but not harmful to baby) |
|
|
Term
|
Definition
Plan B: 1 dose
Next Choice: 2 doses (but can take both at once)
BOTH: must be over 17 y/o
BOTH: LNG |
|
|
Term
|
Definition
1. how to take
2. expected ADR: N/V/cramping--use antiemetic (if patient vomits in 1 hour--need another dose)
3. expect menses within 21 days
4. dont use EC as regular means of contraception (not as efficacious as other methods or as cheap) |
|
|
Term
|
Definition
uliristal 30 mg x 1 dose
Rx only
120 hour
Progesterone receptor modulator
similar safety to LNG
expensive |
|
|
Term
|
Definition
MOA: impairs fertilization, alters sperm motility, impairs implantation
Only ideal if want IUD for a while after (not just temporarily)
Contraindications: Pregnancy, sexual assault with high risk of STD (increased risk of infection) |
|
|
Term
|
Definition
RU 486
Mifiprex
synthetic steroid
only available Rx at dr office
prevents progesterone from binding to receptor
greater delay of menses (for EC) than LNG and very heavy
abortifacient
MOA:
1. disrupts follicular maturation and endocrine function of the granulosa cells
2. disrupts the midcycle surge in LH
3. interrupts hormonal suppport of the endometrium--makes it asynchronous |
|
|
Term
|
Definition
2.5 mg ethinyl estradiol BID x 5 days
higher risk of ectopic pregnancy |
|
|
Term
|
Definition
suppress LH
narrow window of efficacy
$$$$ |
|
|
Term
|
Definition
NOT in US
blocks steroidogenesis
mixed effectiveness |
|
|
Term
|
Definition
1. Arimidex (anastrozole)
2. Femara (letrozole) |
|
|
Term
|
Definition
inhibit androgen to estrogen conversion
reduce negative feedback to increase GnRH output |
|
|
Term
| DOC for hyperprolactinemic anovulation |
|
Definition
|
|
Term
| What drug can improve cervical mucus quality? |
|
Definition
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