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Physiology
Graduate
04/12/2012

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Term
02: Herbals for Women
Definition
Black Cohosh
CranBerry
Dong Quai
Fenugreek
Term
What is Black Cohosh for?
Definition
PMS, Dysmenorrhea, Menopause
Term
MOA of Black Cohosh
Definition
Has Phytoestrogen and sm amount salicylic Acid.
Term
What does Phytoestrogen Do?
Definition
Its Estrogen-Like so it has sterol molecules and SERM (Selective Estrogen Recptors) that help Supress LH.
Term
Adverse of Black Cohosh
Definition
Usual GI. Plus
Headache,
Rash
and Weight Gain
(due to supressing LH).
Term
Black Cohosh Drug Ixns
Definition
Oral Contraceptives and
Estrogen Replacement Therapy.
Term
Dosing of Black Cohosh?
Definition
20mg BID for 4 Weeks.
Term
Counseling Patients on Black Cohosh
Definition
Do not use for more than 6 months.
Beware of allergies to Salicylic Acid
Might Cause Hepatotoxicity
Term
What was the Study for Black Cohosh and what did they find?
Definition
HALT Study.
Not effective.
HRT (hormone replacement therapy is though).
Term
Cranberry is used for?
Definition
Prevent UTI
Term
MOA of Cranberry?
Definition
Inhibit E.Coli using HIPURRIC Acid.
Term
Adverse Effect of Cranberry
Definition
No significant. Just usual GI, stomach issue
Term
Drug Interactions of Cranberry
Definition
Warfarin and small amounts of Salycilic acid in Juice.
Term
Dosing of Cranberry
Definition
300-400mg BID or 8-16oz Daily.
*There is more befit with juice than Capsules.
Term
Counseling points for Cranberry
Definition
-The Dried Tablet may Cause Kidney Stones
-beweary of Salicylate Allergy
Term
Any Studies and what found on Cranberry
Definition
Journal of Anticmicrobial Chemotherapy saw semi positive results.
Term
Dong Quai is also known as
Definition
Eumenol
Term
Don Quai Uses?
Definition
Monopause
PMS
Dysmenorrhea
Term
MOA of Dong Quai
Definition
Phytoestrogen and Serotoinin Effect
Term
Adverse Effects of Dong Quai
Definition
Photosensitivity
Bleeding and Bruising (due to Coumarin ingredients).
Term
Drug IXn's with Dong Quai
Definition
Warfarin.
Term
So so far, Cranberry and Dong Quai have ixn's with Warfarin.
Definition
In addition, Both Black Cohosh and Cranberry have salicylic acid.
Term
Counseling points on Dong Quai
Definition
Benificial when in use with other herbals.
Its safe for 24 weeks max.
Beweary of unusual bruising
Term
Evidence for Dong Quai?
Definition
nope.
Term
What are the Uses for FenguCreek
Definition
Lactation
Decreases Glucose (will cause loss of appetitie).
Usually flavored (maple)
Term
MOA of Fenugreek
Definition
Galactagogue and reduce glucose levels after means.
Term
What is Galactagogue
Definition
Don't know. maybe a mamary gland simliar to SWEAT.
Term
Averse Effects of Fengucreek?
Definition
A LOT:
Maybe Syrup urine/sweat
Incraesed sweating
Exacerbate Asthma
Allergic Reactions
Term
Drug IXN with FenguCreek
Definition
Antidibetic
and Antiplatelet (warfarin and aspirin)
Term
Counseling points on Fengugreek
Definition
Breast milk has maple smell
Blood glucose is lowered
Term
Evidence for Fengugreek?
Definition
Yes. Incrased milk production.
Term
Three Herbals for Men
Definition
Panax Ginseng
Sal Palmetto
Yohimbe
Term
Use for Panax Ginseng
Definition
Male Fertility
Impotence
Premature Ejaculation
Adaptogen = cope with stress
Term
What are the Active Constituents?
Definition
Ginsenosides
and Panaxosides
Term
So more indepth of MOA
Definition
Hypertension/hypotension effects as well as stimulatino/depression.
Will enhance NO.
Relax Penile Muscle (corpus cavernosum)
Term
Adverse for Panax Ginseng
Definition
Insomnia
Hypertension/hypotension
Palpitations
Edema
Term
Drug Ixns' of Panax Ginseng
Definition
Ethanol
Anticoagulant
AntiDiabetic
Caffeine
Term
Dosing of Panax Ginseng
Definition
Use 1 hour before intercourse.
Term
Counseling Tips of Panax Ginseng
Definition
Red (steam cured = heat = more ginsenosides) vs White.
Term
Do not Use Panax Ginseng for more than...
Definition
3 Months
Term
Clinical Evidence for Panax Ginseng
Definition
Positive Results!60% on improved libido, duration of action, and patient satisfaction.
Term
Saw Palmetto Use
Definition
Improve Lower Urinary Tract Symptoms (LUTS)
Term
MOA of Saw Palmetto
Definition
Inhibit 5-Alpha-Reductase
Antiestrogenic
Antiinflamatory
Term
Adverse of Saw Palmetto
Definition
Headache
Abdominal Pain
and of course, GI.
Term
Drug Ixn of Saw Palmetto
Definition
Dutasteride (AvoDart)
Finesteride (Proscar)
Tamsulosin
Alpha Adrenergic Blockers
Term
Counseling tips on Saw Palmetto
Definition
DO NOT use unless Diagnosis confirmed
Use up to 1 year only
Should have 85% standardized fatty acids.
Term
Saw Palmetto's other name
Definition
Permixon
Term
There are no additive benefit when used in conjunction with other Rx therepaies
Definition
Term
Evidence for Saw Palmetto
Definition
Positive and well tolerated.
Term
evidence for Saw Palmetto for Enlarged Prostrates
Definition
no improvement
Term
Use for Yohimbe
Definition
Erectile dysfunction
Sexual Vitality
Term
MOA of Yohimbe
Definition
A2 Antagonist
CNS Stimulant
Increase nerve impulses..to genital
Term
Adverse of Yohimbe
Definition
Excitation
Tremor
Anxiety
Insomnia
Dizzy
Term
Drug Ixn of Yohimbe
Definition
Antihypertensives (other A2 antagonists)
MAO
Caffeine
Term
Counseling tips on Yohimbe
Definition
Synergistic with L-Argigine
Unsafe for OTC use because of hypotension/hypertension
Term
another name for Yohimbe
Definition
Yocon
Term
Evidence for Yohimbe
Definition
Safe and more effective than placebo for erectile dysfunction
Use up to 8 weeks.
Term
Section on Vaginal Anatomy and Physiology
Definition
Term
What occurs From Puberty to Menopause
Definition
increase ovarian Estrogen production,
Term
Increaesd Estrogen leads to?
Definition
Increased stratified squamos epithlial cells on vaginal lining
Term
Increased vaginal lining leads to
Definition
increased glycogen production
Term
Increased glycogen production leads to
Definition
increased vaginal flora such as Lactobacillus Acidophilus (bacteria)
Term
Lactobacillus + Glycogen =
Definition
Lactic Acid and (H2O2) which decreases vagianl pH (4-4.5).
Term
Importance of H202 and Lactic acid
Definition
Protects vagina from other bacterial phatogen.
Term
Typically where do infections usually occur?
Definition
vulva and vagina, not
cervix or other reproductive organs
Term
What is Leukorrhea? Its characteristics?
Definition
It is a vaginal discharge.
Usually odorless, clear egg white and sticky viscous.
Term
What normally increases Leukorrhea?
Definition
ovulation,
pregnancy,
menses/post-menses
sexual arousal
emotional flares.
Term
What are the common vaginal infections?
Definition
Bacterial Vaginosis,
vulvogavinal Candidiasis,
Trichomonaiasis
Term
The three Vaginal Symptoms, BC, VVC, Trichomonaiasis, account for how much of the abnormal Leukorrhea Vaginal Infections?
Definition
65%
Term
Main way of differentiation is based on
Definition
Smell/odor,
Color,
pH
Term
BC's Symptoms and Etiology
Definition
Increased Vaginal pH due to decrease in lactobacilli.
Green/Grey Color that's thin/foamy.
Fishy odor
*intensity of irritation,itchy, and dysuria is less prounced than Trichomiasis.
Term
What are risk factors for BV?
Definition
African American,
IUD (better to use Oral Contraceptives)
12% virginal adolescents
New sex partner doing oral.
Douching
Prior pregnacy
Term
What are exclusions to treatment of BV?
Definition
Pregnant
HIV
PID, UTI, Cervictis, Endometriosis
Term
Is BV an STI?
Definition
No. But we support wearing a condom.
and using oral contraceptives (as opposed to IUD).
Term
PharmaCo treatment for BV
Definition
(RX)Clindamycin, Metronidazole.
Requires compounding - Providine/Iodine. (again. not for pregnant or breastfeeding)
Term
Etiology and Symptoms of VC (Vulvovaginal Candidiasis)
Definition
No change in pH.
Cottage cheese thick white.
No odor.
Very intense erythema,itchy, and vulvar edema.
A fungal yeast infection.
Term
Complications and risk factors for VC
Definition
Systemic Antibiotic use (Diflucan)
Immunosupressants (Diabetes, Aids, HIv, Corticosteroid use).
We can see an increase transmission of other infections.
Term
is VC considered an STI?
Definition
Nope
Term
Prevention?
Definition
We think maybe yogurt, but not really
Term
Treatment for VC
Definition
Ask. Are there any exclusions to self care? no Odor? is the Consistency cheesy curd like? Are there lots of itcy, red, and edema? Is normal pH? Irritant?
Then we can give 4 things.
Butoconazole. Clotrimazole.
Micronazole. Iconazole.
*note the AZOLE.
Term
The Main VVC and on infectious vulvovaginal self care exclusions...(6)
Definition
Pregnant.
Less than 12 yeras old
Fever
Meds: Coticosteroids, ABX, Antineoplastics.
Recurrent: More than 3 infections in past year. or Within past 2 months.
HIV or DM
Term
Ticonazole is the the only dosage form that's
Definition
ointment.
The other Azoles are usually cream, though Miconzole can be a suppository.
Term
Generally which dosage form is best?
Definition
Creams and ointments, especially for siginficiant vulvar symptoms.
Term
What are non curative products for? Examples.
Definition
Hydrocortisone
Bonzocaine
Providine Iodine (no breast feed)
HomeopathicL Pusatilla, C Albicans, C Parapsilosis).
Term
What are two complimentary treatment not to use?
Definition
Douche's
Yogurt kinda sucks too
Term
Beneficial Anti-irritant for Vaginal
Definition
Sodium Bicarbonate Bath
Term
Beneficial Antibacterial/Antifungal:
Definition
Tea Tree Oil Suppoistory
Term
Beneficial Resistant
Definition
Gentian Violet and Boric Acid
Term
Any risk factors to the complimentary treatments mentioned?
Definition
Tea Tree oil can be allergic reaction.
Boric Acid can be Toxic.Teratogenic
Term
Pros and Cons to OTC pH tests
Definition
Confirms if need treatment and decreases inappropriate self care
Cons: Added cost and Added step.
Term
Trichomoniasis Symptoms and Etiology
Definition
Flagellated Anerobic Protozoan....
Increases vaginal pH
Yellow green discolored
Copious and frothy texture
Very bad odor (just not fishy)
Intensity is more than BV.
Term
Risk Factors and complications of Trichomoniasis
Definition
Mutiple sex partners
STI's
Pregnant, Tubal Infertility,
Hiv
Term
Is Tri an STI?
Definition
Yes
Term
Treatment for TRI
Definition
Metronidazole.
Timidazole.
Term
Name two Estrogen Deficiency Disease
Definition
Atrophic Vaginitis and
Dyspareunia.
Term
Symptoms of Atrophic Vaginitis
Definition
Inflamation.
Dysparenia (painful sex)
Leukorrhea: thin, bloody spotting, yellow, malodorous.
Less Vaginal Lube = irritation, dry, burn, itchy.
Term
Exclusions
Definition
Severe DRYNESS = bleeding
not localized
Personal Lubes don't help
Term
What are the main causes of Dysparunia (aka painful sex)
Definition
Menopause
Anti-Estrogen Meds
Transient Estrogen deficiency = breast feeding or recent childbirth
Term
Treament for Atrophic Vaginitis
Definition
*Water, not oil based..
Glycerin
Propylene Glycol
any methylceullulose
Vit E.
Acacia honey.
Glycol's
Term
Non Drug Treatment?
Definition
Increased Arousal time, More frequent Intercourse.
Term
name three types of OTC douching products
Definition
Water/Vinegar
Antiseptics
Provodine Iodine
Term
Outcome and exclusion to use for Water/Vinegar
Definition
No effect on Lactobacili.
Don't use if pregnant
Term
Outcome and exclusion for Antiseptics
Definition
Inhibits ALL vaginal flora
Don't use if pregnant
Term
Outcome and exclusions for Provodine/Iodine
Definition
Reduce TOTAL vaginal flora = allow pathogenic species to proliferate.
Systemicaly Absorbed
Don't use if pregnant or breast feeding
Term
Name of Brands for Douching
Definition
Massengill
Summer's Eve,
Vagi-Guard.
Term
How to use Summer's Eve?
Definition
Sit over toilet or Stand in Shower
Insert 3 inches Gently into vagina.
Don't close the lips of vagina.
Term
How to adminster the Bag douche?
Definition
*Can be an enema as well...
Lie down, knees bent. bag 1 foot above.
Fill and hold for 30-60 seconds.
Term
Patient Counseling on Douching.
Definition
Not for birth control
not for vaginal infections
don't do after 6-8 hours after sex.
Dont' use if preg or breast feed
no more than 2x weekly
don't if Dryness/irritation present
Don't w/n 3days of using vaginal antifungal
Don't if 48hrs before gynecologic exam
Term
Not STIs
Definition
Bacterial Vaginosis
VVC
Term
Which STI's are curable?
Definition
Stop Using T Computer Graphics
Spyillus
Urethritis
Trichomoniasis
Chylmydia
Gonorrhea
Term
Non Curable Vaccine Preventable
Definition
Genital Warts and Hep B
Term
Non Curable but Preventable
Definition
AIS
Herpes
Hep C
Term
T/F
The only sti self-care products are condoms
Definition
T
Term
Which group is a great risk for STI
Definition
Postmenopausal women
Term
Are women more likely to get STI than men?
Definition
yes
Term
1/4 Teenage girls are infected with STI
Definition
T
Term
Other STI Facts
Definition
65 Million have STI
with 15mil infected anually
Term
Prevention Strategies
Definition
no sex.
monogamous
self exam
Term
STI Prevention Products
Definition
CONDOMs!!!
Rx Imunize for Hep B and HPV
Term
What was teh results of a Tenofovir Vaginal Gel Clinical Trial?
Definition
Good. Decreased HIV transmission and Herpes.
Term
What are good Contraceptives
Definition
Latex and Polyurethane
Natural is good only for Bacterial and not Viral.
Sponges might for bacteria, and not for Viral
Term
What are bad Contraceptive ingredients
Definition
Spermicides (can actually increase risk)
Fertility Awareness only helps prevent pregnancy, not STI.
IUD (intrauterine device) increases risk of PID (Pelvic Inflamatoy D)
Horomonal Oral Contraceptives increase risk for Chlaydia
Term
50% of women with unintended pergnanicies were using a method of contraceptions and of those 50 there were 20% taht had been using it incorrectly
Definition
Term
Oil or water based Condom lubriacant should be use?
Definition
Water
Term
What are percent of pregnancy using male and female condoms perfectly? not?
Definition
2 to 5 (m to f)
15-21 (m to f)
Term
What causes condom breakage?
Definition
manufacturer defects
bad placement
oil based lubes
reuse
Increased duration of Coitus
Jewelery or nails
Term
If a condom breaks...
Definition
Use cream or gel spermicides.
not suppositories or films (they have slow dissolution time delay).
Do not Douche.
Term
What is GERD?
Definition
1)Abnormal reflux of gastric into the esophagus...or
2) Heartburn for 2 more days per week
Term
Manifestations of GERD
Definition
1) Regurgitation without nausea
2) Water Brash incident
3) hypersalivation
4) Pyrosis
Term
GERD is due to
Definition
Compromised LES (lower esophageal sphincter).
Term
Caustic effects of stomach contents are due to 4 things...
Definition
HCL
Pepsin
Bile Acids
Pancreatic Enzymes - Lipases and Proteases.
Term
What is Barrett's Esophagus
Definition
When squamous epithelial is replaced to specialized columnar epithelial.
Term
Repeated exposure of esophagus to those casutic agents can leads to....
Definition
Inflamation
Erosion of the squamos epithlial.
Term
Does GERD cause mortality?
Definition
No, but it can affect the quality of life.
Term
What modulates LES tone?
Definition
Autonomic Nervous System.
Term
Specifically how does ANS accomplish the LES Tone?
Definition
Using Non-adrenergic-noncholinger neurons.
Term
What are the Specific Non Adrenergic Non Cholinergic neurons?
Definition
NANC - releases NO
and VIPergic -release VIP (a vasoactive intestinal peptide).
Term
TONE of LES varies by what factors?
Definition
Food
Life-style
Meds
Hormones.
Term
What decreases LES pressure?
Definition
Certain foods like fat, peppermint and choclate.
-Caffeine and coke
-Nicotine
-Ethanol
-Nitrates, Ca Channel Blockers
-Estrogen/progesterone
Term
LES Pressure is increased by
Definition
-Protein
-Prokinetic agents(i.e. metoclopramide
-Adrenergic alpha agonists
Term
Treatment of GERD for Stage 1
Definition
Life Style changes:
-no smoke, no caffeine, no stress
-high protein meals and no meals in the evening
Term
Treatement of GERD in stage 2
Definition
Prokinetic agents(MCP and Tegaserod)
Antacids
Term
Treatment of GERD stage 3
Definition
-H2 antagonists
-proton pump inhibitor
Term
Gastritis is?
Definition
Inflammation of the lining of the stomach.
Can be Acute or Chronic.
Term
Gastritis usually involves...
Definition
H-PYLORI
-sometimes with infectious granulomatous, CMV infection, Automimune or Reactive gastropathy.
Term
What is Type A Chronic Gastritis
Definition
Fundal or Autoimmune Gastritis:
-a autoimmune destruction of acid secreting mucosa.
Term
What is one major danger about TYPE A Gastritis?
Definition
Anti-parietal cells that cause a lack of intrinsc factors and reduces the absorption of vitamin b-12.
Term
What is Type B Gastritis?
Definition
Antral Gastritis which is the most common Chronic Gastritis.
H-pylori is inflamed with mononuclear leucocytes.
Term
So what is H-Pylori
Definition
Gram negative flagellated corscrew shaped bacteria
Term
What is the distinctive enzymatic marker for H-Pylori?
Definition
Urease
Term
What Does Urease do?
Definition
Converts Urea to CO2 and NH3.
Term
What is Ulcerogenic action of H-Pylori?
Definition
Neutralized gastric juice of the duodenum incraeses Gastrin production and more acid production by Parietal Cells.
Term
How does H-Pylori MOA?
Definition
Causes inflammatory response and damages epithelial cells
Term
How test presence of H-Pylori?
Definition
C-Urea Breath Test
Term
What are Peptic Ulcers usually caused from?
Definition
Proteolytic action of Pepsin on mucosal where can see ischemia, inflamation or infection.
Term
There are three forms of peptic ulcers
Definition
H-pylori
Nsaid
SRMD
Term
Traits of H-pylori Peptic Ulcers
Definition
Chronic,
at duodenum >stomach
Dependent on pH
Epigastric pain
Superficial ulcer depth
mild GI Bleeding
Term
NSAID Peptic Ulcer
Definition
Chronic
Stomach>Duodenum
not dep on pH
Asymptomttic
Deep Ulcer Depth
Severe GI bleeding
Term
SRMD Peptic Ulcer Traits
Definition
Acute
Stomach> Duodenum
Asymptomiac
not dep on pH
severe gi bleeding
Term
What is the focus of treatment of ulcers?
Definition
Supress gastric acid production from Parietal Cells.
Term
What percentage of ulcers heal spontaneously?
Definition
50%
Term
How is acid production regulated in Parietal cells?
Definition
Release of HCL is caused by H,K-ATPase (a Proton Pump) enzyme.
Term
how is H+ released?
Definition
When the H2CO3 (carbonic acid) is dissoicated to H and bicarbonate (HCo3)
Bicarbonate is exhcnaged with Cl so that Cl comes from Intersitial fluid to the lumen of the gastric gland where it acts as a cotransporter for H back out to the interstitial fluid
Term
Difference between gastric ulcers, duodenum ulcers, and peptic ulcers.
Definition
Gastric has normal levels of HCl but backed up HCL.
Duodnum has increased levels of HCL.
Peptic is caused by Pepsin causing damages
Term
Compare the difference between Gastric and other H/ATPases.
Definition
Gastric:
-only in parietal cells
-2 subunits
-4X10^6 gradient
-Requires K+ions
Other ATPases
-found in every cell
-8-9 Subunits
-100X Gradient
-K not required.
Term
Secretion of HCL by Parietal cells is induced by 3 factors.
Definition
-Histamine
-Gastrin receptors
-Muscarinic (M1/M3) via AcH
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