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BCPS study guide

drugs in preggers and lactation; contraception; STDs

QuestionAnswer
what molecular weight does a drug have to exceed to avoid placental transfer 400-600 daltons crosses the placenta
drugs that increase milk production - does not preclude that these drugs are safe for use during breast feeding amoxapine, antipsychotics, cimetidine, methyldopa, metoclopramide, reserpine
drugs that decrease milk supply androgens, bromocriptine, ergot alkaloids, estrogen, levodopa, MAOIs nicotine, pyridoxine, sympathomimetics
drugs contraindicated in breastfeeding amphetamines, antineoplastics, bromocriptine, cocaine, drugs of abuse, ergotamine, lithium, nicotine
treatment recommendations for gestational diabetes regular insulin is currently first line but glyburide is becoming more common. NPH and short acting insulins are being used as well. metformin not first line.
definition of preeclampsia gestational hypertension plus proteinuria (300 mg + Q24H)
definition of eclampsia tonic clonic seizures
treatment of preeclampsia if at term, induce. if not, bed rest and monitor BP. in severe preeclampsia give IV mag to prevent seizures. methyldopa is first line therapy but alternatives can use some beta blockers, labetalol and calcium channel blockers. avoid ACEi and ARBs.
tocolytic drugs - drugs that inhibit uterine contractions beta agonists such as terbutaline, magnesium sulfate, NSAIDS, calcium channel blockers such as nifedipine and verapamil though doses are prohibitively large.
drugs used to induce labor oxytocin, ergot alkaloids (only used to terminate pregnancy, NOT for term induction), prostaglandins (dinoprostone or misoprostol)
a surge in what hormone occurs just prior to ovulation LH
what hormone stimulates the release of FSH and LH during the follicular phase and what do those hormones cause GnRH stimulates FSH which stimulates estradiol secretion and development of follicles. LH causes increase in androgen values.
during the luteal phase what is the predominant hormone progesterone
exogenous estrogen has what effect on the pituitary? what are the effects on aldosterone and androgens estrogen feeds back to the pituitary which inhibits FSH and ovulation. estrogen also increases aldosterone which results in increased sodium and water retention. free androgens decrease via increases in sex hormone binding globulin
effects of progestins on the pituitary, endometrium and cervix inhibits ovulation via the pituitary, thins the uterine lining/endometrial atrophy, and cervical mucus thickening which inhibits sperm.
other than breast feeding, what is the reason for the postpartum period in which hormonal contraceptives are contraindicated DVT risk. wait 21 days if no RFs for DVT and 48 days if RFs for DVT.
breakthrough bleeding can occur early or late in the cycle and is one of the reasons women stop taking OCs. what hormone is responsible for early vs late early breakthrough bleeding is due to not enough estrogen and late is due to not enough progesterone
nausea is typically due to which of the two hormones in OCs estrogen
ACHES is an acronym to help identify serious ADEs associated with OCs. what does it stand for A=abdominal pain potentially related to liver issues. C=chest pain, or other s/sx of PE. H=Headaches could signal a stroke. E=Eye problems such as blurred vision, lights, etc could signal optic neuritis or stroke. S-Severe leg pain due to DVT
max wt for use of transdermal contraceptive patch 90 kg
time frame for taking emergency contraception 120 hours, pkg insert says 72 but studies show more
MOA of clomiphene citrate for infertility stimulates ovulation and sperm production. SERM that blocks estrogen receptors which increases release of GnRH which increases release of FSH and LH
clinical signs of ovarian hyperstimulation syndrome rapid weight gain, ascites, pleural and pericardial effusions, oliguria or anuria, hemoconcentration, leukocytosis, hypovolemia, hyponatremia, hyperkalemia, ARDS, hypercoagulability, multiple organ failure
treatment of ovarian hyperstimulation syndrome fluids, physical activity if OP, thrombosis ppx in hospital
diagnostic tests for syphilis nontreponemal tests detect serum concentrations of antibody to cardiolipin. treponemal tests detect antibodies to T pallidum. typically use nontreponemal for screening and confirm with treponemal.
symptom of primary syphilis chancre. lasts 2-6 weeks and resolves on its own.
treatment of syphilis if primary or secondary first line is a singe dose of pen G 2.4 MU IM. if pt has an allergy to PCNs then give doxycycline 100 mg PO BID or tetracycline 500 mg PO QID x2 weeks.
hallmark of secondary syphilis/early latent lesions on palms and soles of feet. when lesions resolve latent phase begins
treatment of late latent syphilis or tertiary syphilis. pen G 2.4 MU weekly for 3 weeks. if allergic use doxycycline 100 mg BID or tetracycline 500 mg QID for 4 weeks.
treatment of neurosyphilis crystalline pen G 3-4 MU IV Q4 hrs for 10-14 days. alternatively can use procaine PCN 2.4 MU daily IM with probenecid 500 mg QID x10-14 days. if PCN allergic either use CTX 2g daily for 10-14 days or desensitize to penicillin and give.
treatment for chlamydia Azithromycin 1g once. or doxy 100 mg BID x7 days. can also use levoflox 500 mg x7 days or erythromycin,
treatment for gonorrhea CTX 250 mg IM AND treatment of chlamydia. Azithromycin or doxy
treatment of pelvic inflammatory disease cefotetan/cefoxitin+doxy clinda + gent/ Unasyn + doxy CTX IM + probenecid + doxy +/- flagyl
treatment of bacterial vaginosis flagyl or clinda. various dosage forms. if preggers do not use intravaginal clinda
Created by: mjuhlin