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946: Women's Health
n/a
169
Pharmacology
Professional
02/21/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
Oxybutinin
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
Tolterodine
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
Trospium chloride
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
Darifenacin
Definition
Enablex for UUI
M3 specific

7.5 or 15 mg qd (ER)
Term
Solifenacin
Definition
Vesicare Mainly M3 for UUI
5/10 mg QD
with renal OR heaptic impairment dont exceed 5 mg if use at all
Term
Drugs that worsen UI
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
Alpha agonists
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
Diagnosis of UI
Definition
Hx--bladder diary

Physical exam

Mental assessment-check QOL

Functional/Environmental assessment
Term
nonpharm tx for UI
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
smoking and bones
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
1300 mg
Term
Ca req for women over 50
Definition
with HRT: 1200 mg
w/o HRT: 1500 mg

ALL over 65: 1500 mg
Term
Ca supp of choice
Definition
calcium carbonate
Term
Drug interactions with Ca
Definition
PPI
H2RA
tetracycline
FQ
iron
Term
Ca ADRs
Definition
Dyspepsia

Constipation

Kidney stones
Term
Types of Calcium Supp
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
calcitrol
Definition
does NOT require renal activation
Term
Vitamin D Dosing
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
Bisphosphonate MOA
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
Ibandronate
Definition
Boniva

150 mg/month
3 mg IV q3mo
Term
zolendronate
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
risedronate
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
ADRs of bisphosphonate
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
Raloxifene
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
Salmon calcitonin
Definition
Miacalcin NS 1 (200 IU) spray daily

Fortical SQ inj 100 IU QOD
Term
Calcitonin MOA
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
Teriparatide
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
PTH CI
Definition
Hx of osteosarcoma

Paget's disease

Hx of bone radiation therapy
Term
PTH ADRs
Definition
Hypotension, tachycardia post-inj

N/V

HA

Hypercalcemia--Tx worked too well
Term
Prolia
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
RANKL
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
denosumab ADR
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
30 years
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
infertility
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
Clomiphene
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
Clomiphene dosing
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
Gonadotropin Therapy
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
Gonadotropin dosing
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
T
Term
what percent of umbilical blood flow enters the fetus
Definition
40-60% through the umbilical vein
Term
most important stage of pregnancy
Definition
organogenesis
Term
when do most women know they are pregnant
Definition
4-6 weeks
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
~75% (US) and 53% (KY)
Term
Women take more meds/month when breastfeeding or pregnant?
Definition
Breastfeeding
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
10-20% of new mothers
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
N/V in Pregnancy
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
Heartburn and Pregnancy
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
Diarrhea and Pregnancy
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
UTI and pregnancy
Definition
ALWAYS TREAT

Use:
Amoxicillin
Augmentin
Cephalosporins
Nitrofurantoin-more for chronic UTIs
Term
Most common cause of premature labor
Definition
infection
Term
Common Cold and Pregnancy
Definition
Preferred: Doxylamine and Diphenhydramine

ONLY use if necessary/avoid first trimester:
Dextromethorphan
Psuedoephedrine
Term
Pain and Pregnancy
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
2 parts of birth
Definition
1. dilation
2. expulsion
Term
Terbutaline
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
Magnesium Sulfate
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
T
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
85
Term
Implant and IUD are the most effective methods of contraception. T or F
Definition
T
Term
Calendar method
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
spermicide
Term
Spermacide must be reapplied every ____ hours
Definition
1-2 hours
Term
Which contraception method has a similar 5 year efficacy rate to that of sterilization
Definition
IUDs
Term
Mirena
Definition
levonorgestrel (LNG-IUS)

good for 5 years
Term
Mirena MOA
Definition
inhibits fertilization
thickens cervical mucous
inhibits sperm function
thins and suppresses the endometrium
Term
Copper IUD
Definition
Paragard

good for 10 years
Term
Copper IUD MOA
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
IUD Counseling points
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
drospirenone
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
Triphasic
Term
Serious ADRs of COC
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
55 years old
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
F
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
non-compliance
Term
Benefits to nuvaring
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
Ortho Evra Patch
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
Progestin only products
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
Nexplanon
Definition
progestin implant
used for 3 years

can x-ray

suppresses ovulation within 1 day of insertion
Term
DMPA
Definition
depot-medroxyprogesterone acetate
Term
Depo-provera
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
Name some EC
Definition
1. OC formulations
2. Plan B
3. Ella
4. Mifepristone (off label)
5. Copper IUD
Term
Indications for EC
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
Yuzpe regimen
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
Dose of POP EC
Definition
1.5 mg once (or split in 2 doses) LNG
Term
Progestin-Only EC
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
Plan B vs Next Choice
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
Counseling for EC
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
Ella
Definition
uliristal 30 mg x 1 dose

Rx only

120 hour

Progesterone receptor modulator

similar safety to LNG
expensive
Term
Copper IUD as EC
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
Mifepristone
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
Estrogen 5 x 5
Definition
2.5 mg ethinyl estradiol BID x 5 days
higher risk of ectopic pregnancy
Term
GnRH analog for EC
Definition
suppress LH
narrow window of efficacy
$$$$
Term
Danazol for EC
Definition
NOT in US

blocks steroidogenesis

mixed effectiveness
Term
Aromatase inhibitors
Definition
1. Arimidex (anastrozole)
2. Femara (letrozole)
Term
Aromatase MOA
Definition
inhibit androgen to estrogen conversion

reduce negative feedback to increase GnRH output
Term
DOC for hyperprolactinemic anovulation
Definition
bromocriptine
Term
What drug can improve cervical mucus quality?
Definition
guaifenesin
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