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ENDO EXAM 2 TREATMEN
| NEED | MEDICATION(S) | NOTES |
|---|---|---|
| Preterm labor prevention: single gestation (not twins) and history that was preterm | Start progesterone at 16-24 weeks and through 34 weeks Hydroxyprogesterone caproate 250mg IM weekly | MOA: blocks calcium channels and reduces contraction-promotion proteins in uterus |
| To prevent/stop uterine contractions | Tocolytic therapy: nifedipine, indomethacin, magnesium sulfate, terbutaline | not long term therapy used to stop contractions while steroids kick in indo preferred when MgS is given before 32 weeks terbutaline has a boxed warning NO ORAL USE (will literally kill you) and can only use IV for 48-72 hours CI in weak fetus |
| To treat potential intrauterine infections in preterm deliveries | Give antibiotics if PROM (premature rupture of membranes) occurs before 34 weeks IV ampicillin and erythromycin IV 2 days PO 5 days 7 day treatment if allergic pick another strep agent (cefazolin or clinda) | do not use augmentin (amox/clav) |
| To help with fetal lung maturation | Give steroids to pts 24-34 weeks who are at risk of preterm birth in next 7 days give betamethasone of dexamethasone | can use multiple times if 7-14 days between before 34 weeks |
| For fetal neuroprotection | Magnesium sulfate decreases cerebral palsy chance and severity in babies expected before 32 weeks | ACOG recommend hospital specific guidelines |
| cervical ripening | Prostglandin agonists: dinoprostone (PGE2) or misoprostol (PGE1) (oral option) oxytocin (pitocin) | prostglandin MOA: soften cervix and increase contractions (can cause tachysystole >5 per minute) - dont use in pts with uterine scar monitor contractions and fetal HR |
| cervical ripening | oxytocin (pitocin) | Oxytocin MOA: increases Ca release to contract uterine muscles, can cause water intox low dose = hemorrage high dose = tachysystole monitor contrations an fetal HR |
| antibiotic prophylaxis (GBS) for labor and delivery | Penicillin G or ampicillin load dose then q4h until delivery Allergic to PCn: low risk - cefazolin, high risk clinda (if suseptible) or vanco | Minimum of 4 hours therapy is recommended |
| pain management during L&D | Nitrous oxide | almost instant acting, self admin through mask, control of labor, light effect and risk |
| pain management during L&D | systemic opioids: fentanyl, morphine, nalbuphine, butorphanol PCA, IM, bolus IV | increased risk of neonatal respiratory depression given close to delivery |
| pain management during L&D | neuraxial anesthesia: epidural, spinal, spinal epidural, dural punture epidural can add opioid for better results | hypotension, post puncture headache, fever , can prolong labor |
| pain management during L&D | peripheral anesthesia: paracervical block provides anesthesia to cervix and uterus prudendal block gives anesthesia to perineum, vulva and lower vagina) - used in second stage of labor (not common) | |
| Postpartum hemmorhage Prevention | Oxytocin (prevention and treatment) with or soon after delivery of anterior shoulder, controlled cord traction to deliver placenta, uterine massage after delivery of placenta | can give carboprost or methylgonovine(contractions and vasoconstriction) misoprostol if oxytocin not available or tranexamic acid (inhibits breakdown of fibrin) |
| Initiating COC (Comibined oral contraceptive) | High dose EE = 50mcg - for women on enzyne inducers low dose = 30-35mcg - most common ultra low 20mcg or below - used for teens and perimenopausal women | |
| CHC Patch Xulane | 35mcg EE + 150mcg norelgestromin daily | less effective if over 198lbs, apply to adbomen, buttock, upper torso, upper arm once weekly x 3 weeks followed by 1 patch-free week use back up in first 48 hours and if path falls off or is lose for more than 48 hours use back up for 7 days |
| CHC Patch Twirla | 30mcg EE + 120mcg levonorgestrel released daily | less effective if BMI 25 or over apply to adbomen, buttock, upper torso, upper arm once weekly x 3 weeks followed by 1 patch-free week use back up in first 48 hours and if path falls off or is lose for more than 48 hours use back up for 7 days |
| Vaginal Ring Nuvaring | 15mcg EE + 120mcg etonogestrel daily | store in refrigerator (4 months at room temp) inserted and left in place for 3 weeks, 1 week ring free if it comes out for more than 3 hours use back up for 7 days |
| vaginal Ring Annovera | 13mcg EE + 150mcg segesterone acetate daily | inserted and left in place for 3 weeks, 1 week ring free i years 13 cycles use back up for 7 days if it comes out for more than 2 hours |
| Progestin only contraception (POP) | Norethindrone 0.35mg Drospirenone 4 mg (slynd) Norgestrel 0.075 mg (Opill) | minipills MOA: thicken cervical mucous couseling: norethindrone and noregstrel use back up for 48 hours if you miss your 3 hour window drospirenone: use backup for 7 days if over 24 hours between pills immediate return to fertility |
| Opill = OTC POP | norgestrel 0.075mg daily no placebo | changes is mentral bleeding, period effects, dont use in breast cancer use back up for 48 horus if you miss your hours window, or if vomiy/diarhea within 4 hours of dose |
| Progestin injection | 150 o r104mg medroxyprogesterone acetate (provera) | MOA: progestin so high it inhibits ovulation BBW: osteoporosis if used over 2 years, weight gain, amenorrhea, increase glucose, LDL., thrombosis risk of meningiomas IM or SQ delayed fertility return (10m) |
| LARC Progestin implant | Nexplanon 60mcg etonogestrel daily tapered down to 25-30mcg/day in 3 years | MOA: inhibits ovulation and thickens cervical mucous in the arm Unpredictable bleeding effect, removed every 3 years, immediate return to fertile |
| LARC IUD | Copper IUD (Paragard) | good for 10 years MOA: copper ions inhibit sperm to prevent reaching fallopian tubes, endo eats sperm can be used or EC with 5 days of nut (best method) inflammation of endo, worsen period bleeding, avoid in wilsons diease (cant process copper) |
| LARC IUD | Copper IUD Miudella | less copper than paragard only works for 3 years more comfortable NOT EMERGENCY |
| Yuzpe method for emergency contraception | combined estrogen and progestin oral (2 dose 12 hours apart) | doses contain 0.1mg ethinyl estradiol and 0.5mg levonorgestrel or 1mg norgestrel blocks LH surge to inhibit or delay ovulation one time deal, if no period in 3 weeks take test, period may be irregular, better to take sooner than later |
| High dose progestin for EC | Levonorgestrel 1.5mg x1 | most effective within 72 hours of nut is OTC (plan B) blocks LH surge to inhibit or delay ovulation one time deal, if no period in 3 weeks take test, period may be irregular, better to take sooner than later |
| Selecive progesterone receptor modulator for EC | Ulipristal 30mg x1 | use within 5 days of intercourse DDIs decreases efficacy of concraceptives, if missed period take a pregnsncy test |
| Nonhormonal prescription optionf for menopause symptoms | SSRI and SNRIs for hot flashes only: paroxetine, citalopram, escitalopram, venlafaxine, desvenlafaxine gabapentin, oxybutinin, fezolinetant | |
| Hot flash drug | fezolinetant 45mg QD | effective, dangerous to liver, CI: cirrhosis, eGFR below 30, 1A2 inhibitors check ALT, AST, ALP, bilirubin at 1,2,3,6,9 months dc or do not start if bilirubin 2x ULN or transminase elevation 5x ULN |
Created by:
beezy41