Gonorrhea

chlamydia

syphillis

These are all types of _______ infections

Trichomoniasis is a ____ infection.

Scabies and pediculosis are _____ infections.

Trichomoniasis is a protozoan infection.

Scabies and pediculosis are parasitic infections.

These symptoms are associated with that ype of infection?

How do you treat?

Gonorrhea

Ceftriaxone 125 mg IM (ROCEPHIN)

•       3^RD gen. cephlasporin

•       Bactericidal: interferes with formxn of of bacteria’s cell wall, rupturing the wall → deat of bacteria

•       MW: 661.60,  chem. Formula: C₁₈H₁₆N₈Na₂0₇S₃•3.5H₂0

Cefixime 400 mg PO: Oral cefixime not available (1000mg suspenxn available)

Pt presents with the following symptoms: what is it? how do you treat?

o   Begin 2-5 days after exposure

o   Urgency, frequency, dysuria

o   Vaginal discharge (cervicitis)

o   Pelvic pain

o   Dyspareunia

o   May be asymptomatic

Gonorrhea

Ceftriaxone 125 mg IM (ROCEPHIN)

•       3^RD gen. cephlasporin

•       Bactericidal: interferes with formxn o f of bacteria’s cell wall, rupturing the wall → deat of bacteria

•       MW: 661.60,  chem. Formula: C₁₈H₁₆N₈Na₂0₇S₃•3.5H₂0

Cefixime 400 mg PO: Oral cefixime not available (1000mg suspenxn available)

Azithromycin 2 g single dose effective for uncomplicated cases

o   Low blood levels

o   GI side effects

Potential emergence of resistance - multiple transferable resistance (mtr) efflux system

What are alternative treatments to gonorrhea?

(ie. other than ceftriaxone)

Cefpodoxime 400 mg (less efficacious than ceftriaxone)

Cefuroxime axetil 1 g (marginal)

Spectinomycin not available

What is the most common STI?

How do you diagnose?

Chlamydia

o   Culture techniques definitive but difficult to obtain:   Involves tissue culture with McCoy cells

o   DNA-based tests (PCR, ligase chain reaction testing)

Pt presents with the following:

what could it be? what's the treatment?

o   Frequently Asx

o   Urgency, frequency, dysuria

o   Vaginal d/c (cervicitis)

o   Pelvic pain

Dyspareunia

Chlamydia

o   Azithromycin 1 gm single dose

o   Doxycycline 100 mg bid x 7d

Equivalent efficacy and tolerance of azithromycin and doxycycline

o   Erythromycin base 500 mg qid for 7 days

o   Erythromycin ethylsuccinate 800 mg qid for 7 days

o   Ofloxacin 300 mg bid for 7 days

Levofloxacin 500 mg daily for 7 days

§  Women with CT or GC

–      Retest 3 months after treatment

–      Retest all women- next present for care within 12 mo

–      Whether patient believes partner treated or not

§  Less evidence on men (suggest retest in 3 mo)

transmitted primarily through casual contact prior to finishing elementary school

•   50-80% of US population positive
•   Causes 5-10% of genital HSV lesions; mostly oro-facial lesions (“cold sores”); resides in trigeminal ganglion

what type of HSV does this describe?

Pt presents with the following:

burning and pain, new vesicle formation,

–      Fever

–      Malaise

–      Headache

–      Myalgias

–      Adenopathy

what is it?

primary genital herpes

Acyclovir 400 mg tid or 200 mg 5x/day:  for  HSV 1&2, EBV, VZV

                  or

Famciclovir 250 mg tid: HSV 1&2, VZV

                  or

Valacyclovir 1000 mg bid: comcurrent mononucleosis and EBV

Duration o f tx = 7-10 days

Acyclovir 400 mg three times daily x 5 days

                                or

Acyclovir 800 mg twice daily x 5 days

                                or

Famciclovir 125 mg twice daily x 5 days

                                or

Famciclovir 1000 mg twice daily for 1 day

                                or

Valacyclovir 500 mg twice daily x 3 days

                                or

Valacyclovir 1 gm orally daily x 5 days

Acyclovir 40mg bid

                or           

Famciclovir 250mg bid

                or

Valacyclovir 500-1000mg daily

o   Early:  macule/papule ® erodes

o   Late:  clean based, painless, indurated ulcer with smooth firm borders

True or False

Primary and secondary syphilis resolves with or without treatment.

•  Painless ulcer at site of inoculation

•  Well-demarcated raised borders

• Systemic illness

• Fever, sore throat, headache, adenopathy

• Mucocutaneous lesions on soles and palms

NOTE: these are highly contagious

Cutaneous lesions may include condylomalata and alopecia

What stage is this:

•    Historical or serological evidence of syphilis but no clinical manifestations

These manifestions are consistent with what stage of syphillis?

o   Musculoskeletal (gummas)

o   Cardiovascular: main effect is on ascending aorta and root

o   Neurological

tertiary syphillis

What is the treatment for primary, secondary or early latent syphillis?

What do you give if PNC allergy?

Recommended regimen

Benzathine Penicillin G, 2.4 million units IM

Penicillin Allergy*

Doxycycline 100 mg twice daily x 14 days

or

Ceftriaxone 1 gm IM/IV daily x 8-10 days (limited studies)

or

Azithromycin 2 gm single oral dose (preliminary data)

What is recommended tx for latent syphillis?

What do you give if PNC allergy?

Recommended regimen

Benzathine penicillin G 2.4 million units IM at one week intervals x 3 doses

Penicillin allergy*

Doxycycline 100 mg orally twice daily

or

Tetracycline 500 mg orally four times daily

 Duration of therapy 28 days; data to support alternatives to pcn are limited

o   No definitive criteria for cure or failure are established

o   Follow clinical symptoms and serological titers

o   Consider treatment failure if signs/symptoms persist or sustained 4x increase in nontreponemal test

What is the youngest age you can give HPV vaccine?

What are indicated ages?

youngest: 9

indicated ages 13-26

o   Schedule:  Gardisil is administered in 3 doses. Dose 2 should be administered 1-2 months after dose 1. Dose 3 is given 6 months after dose 1.

§  Podophyllotoxin 0.5%

 Imiquimod 5%

§  Cryotherapy repeated every 1-2 weeks (requires substantial training)

§   Podophyllin resin - allow to air dry to prevent irritation

§   TCA/BCA 80-90% - applied sparingly

 Surgical removal - requires substantial training, equipment and longer office visit

Tests show pt has the protozoan T. vaginalis.

What the hell is that?

TRICHAMONIASIS

These symptoms are consistent with what STI?

diffuse, malodorous, yellow-green discharge with vulvar irritation, friable cervix, “strawberry cervix”

WHAT'S THE TREATMENT?

TRICHOMONIASIS

TX:

Metronidazole 2 g PO x 1

TRADE: FLAGEL

ALSO Used in Pregnancy

if you see term

"frothy discharge"

what do u think?

o   Between the fingers, on the sides of the feet, on the wrists and genitals, and in the bends of the knees and elbows.

What is the treatment for scabies?

what tx is not for use immed after shwoering by people with extensive dermaitits or pergnant or lactating women?

•       TREATMENT:

o   Permethrin Cream (Eliminite) (5%) applied to all areas of the body (neck down); washed off after 8-14 hours, OR

o   *Lindane Cream (1%)- applied in thin layer to all areas of body (neck down); washed off after 8 hours

*  Lindane: Not for use immediately after showering/bath, by persons with extensive dermatitis, or pregnant or lactating women

•       Tx:

o   Premethrin Cream (5%) applied infected areas; washed off after 10 minutes

o   *Lindane Shampoo (1%)- applied for 4 minutes to infected areas; washed off

                                  * Not for use by pregnant or lactating women

The following are associated with:

o   Cervix (cervicitis)

o   Uterus (endometritis)

o   Fallopian tubes (salpingitis)

o   Ovaries (oophoritis, tubo-ovarian abscess)

o   Peritoneal cavity (peritonitis)

What are the classical organisms assoc with PID? (4)

who are the new organisms (2)?

o   C. trachomatis

o   N. gonorrheae

o   T. vaginalis

Herpes simplex virus

New:

o   M. genitalium

o   BV

What is this?

o   Endocervical mucopus

o   Easily induced bleeding

o   WBC eliminated as criterion

what is treatment?

Tx of cervicitis:

o   If age < 25 years or multiple partners, empiric therapy

o   Give azithromycin 1g as single dose or doxycycline 100 mg bid for 7 days

o   Management of persistent cervicitis unclear

role of further antibiotic treatment unknown

What is the minimal criteria for PID?

–      Uterine/adnexal tenderness

Cervical motion tenderness

Oral Regimen B

Ceftriaxone 250 mg IM in a single dose

or

Cefoxitin 2 g IM in a single dose and Probenecid 1 g administered concurrently

PLUS

Doxycycline 100 mg twice daily for 14 days

WITH or WITHOUT

Metronidazole 500 mg twice daily for 14 days

Parenteral Regimen A

Cefotetan 2 g IV q 12 hours

          or

Cefoxitin 2 g IV q 6 hours

PLUS

Doxycycline 100 mg orally/IV q 12 hrs

Parenteral Regimen B

Clindamycin 900 mg IV q 8 hours

PLUS

Gentamicin loading dose IV/IM (2 mg/kg) followed by maintenance dose (1.5 mg/kg) q 8 hours. Single daily dosing may be substituted.

OUTPT OR INPT: Hospitalize at discretion of health care provider and especially for

•       Uncertain diagnosis

•       Lack of response to outpatient treatment

•       Unable to tolerate oral meds

•       Severe illness, nausea, vomiting or high fever

Tubo-ovarian abscess

o   Tubo-ovarian abscess

§  Diagnosed by ultrasound, CT or MRI

§  May respond to antibiotics

§  May need drainage or even TAH-BSO if it fails to resolve or ruptures

o   Chronic salpingitis with chronic pelvic pain

o   Ectopic pregnancy

o   Infertility

(1) the presence of homogenous discharge

(2) pH>4.5

(3) positive KOH whiff test

(4) presence of clue cells on microscopic assessment of a saline smear. KOH Whiff Test: a mix of 10%-20% KOH and vaginal fluid aids in detecting a foul, fishy odor. This strong unpleasant odor is indicative of BV or

Metronidazole oral 500 mg orally twice a day for 7 days; or metronidazole gel 0.75% one 5 g applicator intravaginally once a day for 5 days

Clindamycin cream 2% one 5 g applicator intravaginally for 7 days.

What's alternative tx for BV?

What do you give if pt pregnant?

Metronidazole 2 g orally in a single dose; or clindamycin 300 mg orally twice a day for 7 days; or Clindamycin ovules 100 g intravaginally once at bed-time for 3 days.

Prego:

Pregnancy -Metronidazole oral 250 mg orally three times a day for 7 days; or clindamycin oral 300 orally twice a day for 7 days

Pt presents with: White curdlike discharge adherant to the vaginal mucosa & Hyphae and pseudohyphae on wet prep

What's the tx?

Butoconazole 2% cream 5 g intravaginally for 3 days*

Butoconazole 2% cream 5 g (Butaconazole1-sustained release), single intravaginal application

Clotrimazole 1% cream 5 g intravaginally for 7–14 days*
Clotrimazole 100 mg vaginal tablet for 7 days

Clotrimazole 100 mg vaginal tablet, two tablets for 3 days

Miconazole2% cream 5 g intravaginally for 7 days*

Miconazole 100mg vaginal suppository, 1 suppository for 7days*

Miconazole 200mg vaginal suppository, 1 suppository for 3days*

Miconazole 1,200mg vaginal suppository, 1 suppository for 1day*

Nystatin 100,000-unit vaginal tablet, one tablet for 14 days

Tioconazole 6.5% ointment 5 g intravaginally in a single application*

Terconazole 0.4% cream 5 g intravaginally for 7 days
Terconazole 0.8% cream 5 g intravaginally for 3 days
Terconazole 80mg vaginal suppository, 1suppository X 3 days

o   Cardiovascular diseasez:  Develops in ½ of postmenopausal women

o   Osteoporosis

•          Treatment of menopausal symptoms

•          Used alone only in women without a uterus

•          Must be used in combination with estrogen treatment (unless uterus absent)

What type of therapy is this?

•          Decreases risk of estrogen induced irregular bleeding and endometrial problems

•          Increases risk of breast cancer and negates positive lipid effect of estrogen

What hormone replacement therapy is this:

•          For decreased libido and severe vasomotor disturbances

•          Hirsutism, voice changes, and decreased HDL levels

These adverse effects are associated with what hormone therapy?

bloating, abdominal cramping, edema, irritability, weight gain, headache, breakthrough bleeding and acne

These adverse effects are assoc with what hormone replacement therapy?

Eye problems, headache, depression, gallbladder disease, nausea, abdominal cramps, increased blood pressure, bloodclots, breakthrough bleeding, edema, breast cancer and tenderness

•          Breast cancer, endometrial cancer, liver disease, thromboembolic disease, pregnancy

What are contraindicatiosn for progesterone replacemetn therapy?

Who does this:

•          Decreases risk of estrogen induced irregular bleeding and endometrial problems

•          Increases risk of breast cancer and negates positive lipid effect of estrogen

What are non hormonal therapies?

When are they indicated?

SSRI/ SNRI

Examples:  Paroxetine, fluoxetine and venlafaxine

Indications: Vasomotor disturbances

•          Nausea, insomnia and headaches

Dry mouth, constipation and decreased appetite

What type does this describe?

·         greater surface area, less dense, at end of long bones, site of bone marrow

Type I - Postmenopausal Osteoporosis, vertebrae and distal femur

Type II - Senile Osteoporosis, hip, vertebrae, and pelvic region

Type III - Secondary Osteoporosis, 2* to dz state, any age & sex

estrogen analogs

bisphosphonates

selective estrogen receptor modulators

calcitonin

WHo has this MOA:

Decrease activity of osteoclasts

These meds are types of ______

Aldndronate, ibandronate and risedronate

These meds work by:

Deposited in sites of mineralization and resorption lacunae

These adverse effects are associated with which type of resportion inhibiting drugs?

GI disturbance, inflammation of esophagus, diarrhea, abdominal pain, osteonecrosis of the jaw

What drug has this effect"

–        Mimics effect of estrogen on bones without effecting breast tissue or uterus

1.       Selective Estrogen Receptor Modulators

1.       Selective Estrogen Receptor Modulators

Pts taking raloxifene should watch out for: (adverse effects)

This med is

Treatment ONLY, some analgesic effects from compression

This drug has the following MOA:

Inhibits osteoclast activity

Don't take this med if you have an

Allergy to salmon or fish products

These meds are examples of:

:  teriparatide, recombinant parathyroid hormones

What drug class does this:

Mimics PTH and stimulates osteoblast activity

Bone anabolic agents

These adverse effects are assoc with what drug class?

increased calcium levels, dizziness, nausea, leg cramps, joint pain and gout, INCREASES DIGOXIN LEVELS

Pt comes in and they are at high risk of fracture or who have failed other therapies.

What treatment are you thinking?

What type of med has this effect:

Mimics osteoprotegerin and reduces osteoclast activity

–        Cataracts, rash, joint pain, eczema, constipation

This med is NOT approved in the US, but we will learn it anyway:

this is its MOA: Stimulates osteoblasts and inhibits osteoclasts

Strontium Ranelate:

how is it administered?

What are adverse effects?

What can it do for you?

how is it administered? PO

What are adverse effects? Thromboembolisms, eczema, diarrhea

What can it do for you? prevention and tx

hormone

barrier methods ie. condoms, sponges

IUD

permamanent sterilization methods

natural methods

What factors dictate what methods you use for contraception?

(8)

Efficacy

Patient desire/acceptance

Patient compliance

Patient social situation (Married, monogamous relationship v. Multiple partners)

Medical history and contraindications

Age, Parity

Desire for future fertility

Cost

–        Inhibition of ovulation

•          95% in combination contraceptives

•          50% in progestin only contraceptives

–        Thickening of cervical mucous

–        Induces thin, atrophic endometrial lining

–        Slows tubal motility

•          Ovarian cancer risk decreased (30-50% reduction)

•          Endometrial cancer risk decreased (30-50% reduction)

•          Fibrocystic breast disease decreased

•          Acute PID risk decreased

•          Menses effects

•          Increased menstrual cycle regularity

•          Decreased blood loss

•          Decreased incidence of dysmenorrhea

•          Decreased ectopic pregnancy incidence

what type of oral contraceptive is

(Cyclessa: ethinyl estradiol & norgestrel)?

What type of birth control is

(Mircette: ethinyl estradiol & norgestrel)?

What type of birth control is

(Ovral: ethinyl estradiol & norgestrel)?

What type of birth control is

Micronor: norethisterone?

•Allows spontaneous intercourse

•Cycle control

•Improved dysmenorrhea and PMS

•Decreased recurrence of ovarian cysts

•Eliminates mittelschmerz

•Easily reversible

•Treats acne

•Increased bone mineral density

•Decreased risk ovarian cancer

•Decreased risk endometrial cancer

•Occasional spotting

•Decreased libido

•Need to remember daily medication

•Need to see physician for Rx

•Side Effects

–Estrogen related

•Nausea, Breast tenderness, +/- Weight gain

–Progestin related

•Depression, Mood changes

•No protection against STIs

•Cost depending on brand of OCP

•Venous Thromboembolism

–Risk greater than general population, less than pregnancy

•Hypertension

–Approx 1% of pill users develop HTN

•MI/CVA (rare)

•Gallbladder disease

•Hepatocellular adenoma (Only with >50mcg pills)

•Increased risk breast cancer (Studies have not shown consistent link)

•Pregnancy  

•Smoking after the age of 35

•History of DVT or PE

•Cerebrovascular disease

•Coronary artery disease

•Hypertriglyceridemia

•Known or suspected breast cancer

•Known or suspected estrogen dependant tumor

•Unexplained vaginal bleeding.

•Active liver disease

•Uncontrolled HTN

•Migraine HAs with neurologic symptoms

–Ortho-Novum 1/35

–Ovcon

–Ortho Novum 7/7/7

–Tri-Norinyl

–Tri-Levlen

–Triphasil

Dysfunctional Uterine Bleeding 

–Demulen 1/35

–Loestrin 1.5/30 or 1/20

–Brevicon 0.5/35

–Modicon 0.5/35 

Loestrin 1.5/30 or 1/20

                        Desogen

                        Ortho-Cept

                        Demulen 1/35

high progestational activity needed

If pt complain of acne, what type of OCPs would be good to use?

what type of hormone activity?

Demulen 1/35

            Modicon

            Ortho-Cyclen

            Ortho Tri-Cyclen

low androgenic activity

Pt complains of breast tenderness, what type of OCP should you change to?

What type of hormone activity are you looking for?

Loestrin 1.5/30

                        Nordette

                        Levlen

                        Levora 0.15/30

activity:

–Low Estrogenic Activity

–Higher Androgenic Activity

What are indications for season oral contraceptives?

(3)

•Menstrual migraine

•Heavy menstrual bleeding

•Woman wanting to reduce menses to 4 times per year

•Apply one patch q weekly x3 weeks (upper arm, buttock, lower abdomen, upper torso)

•May be less effective in women > 198 pounds

–Must be placed in vagina monthly for three weeks and removed for menses to occur.

Progesterone only pills are used in women who _______

what is primary mechanism of action?

Who are progesterone only pills good for?

who can't take estrogen

•Primary mechanism of action is thickening of cervical mucous and atrophy of endometrium

–Effects last < 24 hours

–Must be taken at same time everyday

•Good for:

–Postpartum women

–Perimenopausal women

•Pregnancy

•Undiagnosed vaginal bleeding

•Acute liver disease

•Known or suspected breast cancer

increase thickness cervical mucus

atrophy of endometrial lining

at time of insertion

3 weeks to 3 months

copper IUd needs to be placed within 8 days of unprotected intercourse

99% effective

How does diaphragm or cervical cap work?

what is advantage?

What is disadvantage?

Are they expensive?

blocks sperm from entering cervix

advantage: can be placed 6 hrs prior to coitus, decreases STIs except HIV

Disadvantages: requires fitting in office, pts don't like placing things in vagina, can be messy/cause odor, increased risk UTI

Cost: LOW

Withdrawal

Lactational Amenorrhea method

Fertility Awareness methods

These are all what methods?

•Mechanism

–Breastfeeding causes increase in Prolactin levels which inhibit ovulation.

•Must exclusively breast feed, day and night q3h

•Must have amenorrhea

•Must be less than 6 months post partum

•Must have no blood borne infections i.e. HIV

•Advantages

–Breastfeeding benefits

–Improves postpartum weight loss

post-partum tubal ligation

laparscopic tubal ligation

1. Last menstrual period within last 5 days

            Start oral contraceptive now

            Use backup contraception for 1 week

2. Last menstrual period >5 days

            Obtain pregnancy test and if negative proceed

            No unprotected intercourse since LMP

–Start oral contraceptive

–Follow protocol as for LMP within 5 days

            Last unprotected intercourse was >5 days ago

–Counsel that urine pregnancy test not conclusive

–Can start oral contraceptive without fetal harm

            Unprotected intercourse within last 5 days

–Offer Emergency Contraception

–Follow protocol for last intercourse >5 days ago 

Give an example of diphenhydramine.

What is its MOA?

Side effects?

Diphenhydramine: Benadryl

MOA: blocks histamine at H1 receptors

side effects: sedation, antinausea, antiparkinsonism, anticholinergic: stops your running nose and also stops your running urine-can induce urinary retention, blurry vision

Be careful about Allegra D 12 and 24 in kids

why?

What is medication needed for allergic rhinitis?

When do you follow up?

Nasal spray : non-selective antihistamine like Astelin

Montelukast: Leukotriene receptor anatagonist

Decongestant

Follow up in 3 days

The skin over the area is indurated, erythematous and tense, and tender. No fluctuance or wound drainage is noted.

What is this?

How do you treat?

Cellulitis

Cephalospoprin or Combo Abx for MRSA

Cephalexin (Keflex) 25-100mg/kg/day in 4 divided doses.

Group A, B, C, G strep

Staph

MSRA

Bactrim (also Bactrim DS)

Sulfamethoxazole (sulfanomide)+ trimethoprim (folic acid inhibitor)

return in 24 hrs to assess

if it got worse: require IV abx in hosptial seting

if stayed some continute with follows up ensure improvement

HEENT: (+) severe conjunctivitis R eye, (+) moderate conjunctivitis L eye, (-) palpable nodes

Diagnosed with Chlamydia conjunctivitis and pneumonia. How do you treat?

What is the fluid calculation for newborns?

__cc/kg/day

How do you treat AOM?

What are top 3 causes?

treat with broad spectrum PCN: AMOX

s pneumo, h.influenza, m. cat

How do you treat barking cough with low grade fever?

What is it?

Croup

Tx: O2, racemic epi, dexamethasone

High fever and HA

Upon your exam you find a lethargic child that has a positive Kernig’s and Brudzinski’s sign.  In addition you notice a petechial rash present mostly on the lower extremities.

What could it be? How do you treat?

meningitis

Tx: ceftriaxone

epigastric pain that is made better when eating or taking Tums.

What is it?

How do you treat?

h.Pylori with peptic ulcer

Triple tx: amox, clarithro, omeprazole

Gonadal hormones dervied from  cholesterol that help develop and maintian female characteristics.

What is this describing?

If the androgen you start with is testosterone, what type of estrogen will be produced?

If your androgen you start with is androstendione, what type of estrogen will be produced? (COMMON IN OBESITY!)

Fill in for estrogen formation:

_____→pregnenonline→androgens→estrogens

What's most potent estrogen?

WHat is found in high concentrations in post menopausal women?

Estradiol 10 x more potent then estrone

Estrone found in post menopausal women

ovaries: developing follicles

adrenal glands:  *main site of estrogen synthesis in males

placenta during pregnancy

Estrogen Pharmacokinetics:

What is half-life?

How is it absorbed?

Where is it hydroxylated?

Short half life (under 13 hours)

high 1st pass effect

hydroxylated in liver by P450 system (estradiol→estrone→estriol)

Name some effects of estrogen on organ systems.

(9)

Think BBRRRTHCC

Breast growth

Bone growth: osteoblast inhibited

Regulates menstrual cycle

Reduce muscle mass

Renin stimulated causes water retention

Tubular muscular contractions

HDL increased; LDL decreased

Cervical mucous increases

Clotting factors in liver stimulated

Bad effects of estrogen.

7

N/V/HA

Thromboembolic problems

MI

HTN

Edema

breast tenderness

name the hormone

Steroidal hormone involved in the support of pregnancy and maintenance of the menstrual cycle

placenta during pregnancy

Adrenal cortex

Ovaries: corpus luteum

name the word:

Causes bone resorption

Forms bone

osteoclasts: causes bone resorption

osteoblast: forms bone

Progesterone does NOT need androgens as intermediary

Both form from cholesterol

Progestin Pharmacokinetics:

What is absorption? ie. half-life

Distribution: how much is protein bound: what is it bound to?

Metabolism: How is it conjugated/excreted?

What is absorption? short half-life

Distribution: how much is protein bound: what is it bound to? 90% protein bound in serum

Metabolism: How is it conjugated/excreted?

Conjugated with glucoronic acid

excreted as glucoronide derivatives

Endometrium and cervix thickening

Basal body temp increases

Water retention

Tubular muscular contractions decreases

Increase LDL and decrease HDL

if no fertilization, helps stimulate menstruation

If fertilization occurs, maintain pregnancy

depressant/hypnotic actions in the CNS

MI

HTN

headache

Edema

Decreased Libido

INcreased appetite

Why do women feel tired before their period?

Name the hormone.

Name the phase:

Marked by the start of menstruation

When the ovarian follicle is developing the majority of estrogens are produced.

Name the phase:

When the mature follicle ruptures releasing an egg

Name the phase:

When the corpus luteum is formed and the majority of progestins are produced.

These pills are under what category of hormonal contraceptives:

the pill

nuvaring

contraceptive path

injectable: cyclofem

What type of hormonal contraceptives are these:

minipill

injectable: depo provera

norplant

IUD

Morning after pill

abortion pil

What types of these hormonal contraceptives?

What is the MOA of combined hormonal contraceptives?

What is the secondary MOA?

supplying body with exogenous estrogen and progestins so you shut off production of FSH and LH (negative feedback)

MOA: decrease release of LH and FSH

Secondary MOA: alters tubal peristalsis

monophasic: constant dose of estrogen and progestin for 21 days

Biphasic: constant estrogen while progestin is initially low but increases in second half of cycle

Triphasic: increase progestin in second half of cycle and increase estrogen dose midcyle 

cardiovascular and thromboembolic

metabolic

serum lipids

ectopic pregnancy

nausea

breast tenderness

cardiovasular and thromboembolic disease

women over 35 who smoke

estrogen sensitive breast cancer- bc estrogen causes cells to grow

migraine headaches

known or suspected prego

undiagnosed vaginal bleeding

What does acronym ACHES stand for?

as it related to combined hormonal contraceptives

A: abdominal pain ie gallbladder disease due to muscular contractions

C: chest pain ie. PE or MI

H: headaches ie. tension, stroke

E: eye problems ie. stroke, HTN

S: severe leg pain ie. DVT

This is a type of combined hormonal contraceptive:

it is less affected by antibiotics

only requires action weekly

HOWEVER,

increased DVTs compared to the pill

Name the combined hormonal contraceptive:

periods do not begin while using device

lower estrogen exposure than pill or patch

This combined hormonal contraceptive reduces ovarian and endometrial risks.

It has the benefit of lighter less painful periods.

How often do you need to change the patch?

where can you put it on?

every week

where to put: arm, butt, back

Vaginal ring:

it fell out: use warm or hot water?

how long can it be out to still be affective?

DO NOT USE HOT WATER

if out more than 3 hrs, need back up

Every 3 mts

If pt is more than 33 days late to get her next shot then it's in effective.

What is the MOA of progesterone only contraceptives?

What is the secondary MOA?

MOA: prevents ovulation 60-80% of time

Progestins decreases the frequency of GnRH release

Secondary MOA:

alters tubal peristalsis

alters cervical secretions

alters endometrial receptivity

What are adverse effects of progesterone only contraceptives?

irregular breakthrough bleeding

acne, HA, weight gain

vaginal dryness

high cholesterol

decreased bone density

ectopic pregnancy

migraine headaches-due to increase water retention

malignant liver disease

known or sus[ected breast cacner

hx of depression is contraindicated

known or suspected pregnancy

Hx of depression

depresses CNS: affects levels of serotonin

No

due to continuous progestin 

This progesterone only contraceptive causes lighter less painful periods

Reduced ovarian and endometrial cancer risks

No risk of DVTs, cardiac problems or stroke.

However: stricter time frane for administration

wt gain and acne more commonly experienced.

How do you give progesterone only contraceptive: Injectables

How is this different from combined pill injections?

progesterone only: Subcutaneous

Combined pill: IM injection

What hormone is emergency contraception?

when is it most effective?

What is MOA?

progesterone only

75-80% effective if taken within 72 hrs

MOA: thought that interferes with ovulation or with transport of fertilized egg to uterus

adverse effects: n/v

headache

fatigue

heavier period and severe cramps with period

Contraindications: cases of confirmed prego

What is another name for the abortion pill?

What is MOA?

Adverse effects

Abortion pill: antiprogestin: MIFEPRISTONE

MOA: interferes with progesterone and causes decline in HCG

Adverse effects: significant uterine bleeding/possible incomplete abortion

What can cause decrease in hormonal contraceptive effectiveness?

(4)

ABX

anti-seizure meds

tuberculosis meds

St. John's wart

abx decreases bacteria in gut so not much free estrogen in blood stream

usually bacteria in gut breaks bone between sex hormones and binding globulin causing free form to be released and go back to blood stream.