Drugs- Basic High Yield Stuff for Boards > Reproductive > Flashcards

Reproductive Flashcards

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1
Q

When are fetuses most susceptible to the effects of a teratogen?

A

3rd-8th week of pregnancy (embryonic period of organogenesis)

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2
Q

Teratogen Medication List (12)

A
  1. ACEi (and ARBs)
  2. Alkylating agents
  3. Aminoglycosides
  4. Antiepileptic drugs (commonly valproate, carbamazepine, phenytoin, phenobarbital)
  5. Diethylstillbestrol (DES)
  6. Folate antagonists (trimethoprim/ methotrexate, anti epileptic drugs)
  7. Isotretinoin
  8. Lithium
  9. Methimazole
  10. Tetracyclines
  11. Thalidomide
  12. Warfarin
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3
Q

Substance abuse teratogen (3)

A
  1. Alcohol
  2. Cocaine
  3. Smoking (nicotine, CO)
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4
Q

Miscellaneous teratogens (5)

A
  1. Iodine (lack or excess)
  2. Maternal diabetes
  3. Methylmercury
  4. Vitamin A excess
  5. Xrays
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5
Q 
Teratogen effect:
ACE inhibitors (and ARBs)
A

Renal damage

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6
Q 
Teratogen effect:
Alkylating agents (2)
A
  1. absence of digits

2. multiple anomalies

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7
Q

Teratogen effect:

Aminoglycosides(1)

A

Ototoxicity

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8
Q

Teratogen effect:
Antiepileptic drugs(4)
Names (4)
recommended supplementation?

A

Valproate, Carbamazepine,
Phenytoin, Phenobarbital

  1. Neural tube defects (high dose folate supplementation)
  2. Cardiac defects
  3. cleft palate
  4. skeletal abnormalities (phalanx/nail hypoplasia, facial dysmorphism)
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9
Q

Teratogen effect:

Diethylstillbestrol (DES) (2)

A
  1. Vaginal clear cell adenocarcinoma

2. Congenital Mullerian anomalies

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10
Q

Teratogen effect:
Folate antagonists (1)
Name 3 examples

A

Neural tube defects

  1. Trimethoprim
  2. Methotrexate
  3. Anti-epileptic drugs
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11
Q

Teratogen effect:
Isotretrinoin (1)
Recommendation

A

“isoTERATinoin”
Multiple severe birth defects

CONTRACEPTION MANDATORY

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12
Q

Teratogen effect:

Lithium(1)

A

Ebstein anomaly

apical displacement of tricuspid valve–>enlarged atrium

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13
Q

Teratogen effect:

Methimazole

A

aplasia cutis congenita

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14
Q

Teratogen effect:

Tetracycline(2)

A
  1. discolored teeth

2. inhib bone growth

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15
Q

Teratogen effect:

Thalidomide

A

“LIMB defects with ‘tha-limb-domide’”

- Limb defects (phocomelia, micromelia=flipper limbs)

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16
Q

Teratogen effect:

Warfarin(4)

A
  1. bone deformities
  2. Fetal hemorrhage
  3. abortion
  4. ophthalmologic abnormalities

” Do not wage WARFARe on the baby, keep it HEPpy with HEPARIN(doesn’t cross placenta)

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17
Q

Teratogen effect:

Alcohol

A 
Fetal Alcohol syndrome
#1 common cause of birth defects and intellectual disability
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18
Q

Teratogen effect:
Cocaine (4)
how?

A
  1. low birth weight
  2. preterm birth
  3. IUGR
  4. Placental abruption

cocaine–>vasoconstriction

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19
Q

Teratogen effect:
Smoking (5)
how?

A
  1. low birth weight (leading cause in developed countries)
  2. preterm labor
  3. placental problems
  4. IUGR
  5. SIDS

Nicotine–>Vasoconstriction
CO–> impaired O2 delivery

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20
Q

Teratogen effect:

Iodine (lack or excess) (2)

A
  1. congenital goiter

2. hypothyroidism (cretinism)

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21
Q 
Teratogen effect:
Maternal diabetes (4)
A
  1. Caudal regression syndrome(anal atresia - sirenomelia)
  2. Congenital Heart defects
  3. Neural tube defects
  4. macrosomia
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22
Q

Teratogen effect:
Methylmercury
Source (4)

A
  1. Neurotox
  • swordfish
  • shark
  • tilefish
  • king mackerel
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23
Q

Teratogen effect:

Vitamin A excess

A

EXTREMELY HIGH RISK

  1. spontaneous abortions
  2. birth defects (cleft palate, cardiac)
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24
Q

Teratogen effect:
X-rays

minimized by?

A
  1. microcephaly
  2. intellectual disability

-minimized by lead shielding

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25
Treatment for gestational hypertension(4) Define gestational hypertension (pregnancy-induced hypertension)
BP > 140/90 after 20wks. No pre-existing hypertension. No proteinuria or end-organ damage "Hypertensive Moms Love Nifedipine" 1. Hydralazine 2. a-Methyldopa 3. Labetalol 4. Nifedipine * deliver at 37-39wks
26
Treatment for Preeclampsia (3) Definition
New-onset HTN with either protienuria or End-organ dysfunction after 20wks (less than 20wks suggests molar pregnancy). 1. antihypertensives 2. MgSO4 3. Delivery= definitive treatment
27
Treatment of Eclampsia (3) Definition
Pre-eclampsia + maternal seizures Maternal death due to stroke/Intracranial hemorrhage, or ARDS 1. IV magnesium sulfate 2. antihypertensive (a-methyldopa, hydralazine) + bedrest 3. immediate delivery
28
treatment for HELLP (1) Definition
Hemolysis, Elevated Liver-enzymes, Low Platelets. A manifestation of severe preeclampsia. Blood smear shows schistocytes. Can lead to hepatic subcapsular hematomas--> rupture--> severe hypotension 1. Immediate delivery
29
Treatment for PCOS (5)
1. weight reduction (helps with insulin resistance-can use metformin as well) 2. OCPs 3. clomiphene citrate 4. ketoconazole 5. spironolactone
30
Treatment for Adenomyosis Definition
Extension of endometrial tissue into uterine myometrium 1. GnRH agonist 2. hysterectomy
31
Treatment for Endometritis Definition
Inflam of endometrium associated with retained products of conception following delivery, miscarriage, abortion, or with foreign body (IUD) Treatment: Gentamicin + Clindamycin +/- Ampicillin
32
Treatment for Endometriosis Definition
Non-neoplastic endometrial glands/ stroma outside endometrial cavity 1. NSAIDs 2. OCPs 3. progestins 4. GnRH agonist 5. danazol 6. laproscopic removal
33
drugs causing gynecomastia
"STACKED" 1. Spironolactone 2. THC (marijuana) 3. Alcohol (chronic) 4. Cimetidine 5. Ketoconazole 6. Estrogens 7. Digoxin
34
drug induced hot flashes (2)
1. Tamoxifen | 2. clomiphene
35
treatment of Varicocele (2)
1. varicocelectomy | 2. embolization
36
treatment of BPH (3)
1. a1-antagonists (terazosin, tamsulosin)-->relax of sm. muscle 2. 5a-reductase inhib (finasteride) 3. tadalafil
37
Leuprolide: MOA Clinical Use (5)
"LEUprolide can be used in LIEU of GnRH" - GnRH analog->agonist if pulsatile fashion - GnRH analog->antagonist if continuous fashion (downreg. GnRH-R in pituitary->decrease FSH/LH) 1. Uterine fibroids 2. endometriosis 3. precocious puberty 4. prostate cancer 5. infertility
38
Leuprolide: | Adverse (3)
1. startup flair 2. hypogonadism 3. N/V
39
Estrogens: | Name 3
1. Ethinyl estradiol 2. DES 3. Mestranol
40
Estrogens: MOA Clinical Use (6)
- Bind estrogen-R 1. Hypogonadism 2. Ovarian failure 3. Menstrual abnormalities 4. HRT in postmen women 5. androgen-dep. prostate cancer (men) 6. OCPs
41
Estrogens: Adverse (4) Contra (2)
1. increase risk of endometrial (maybe breast) cancer 2. bleeding in postmenopausal women 3. Clear cell adenocarcinoma in Vagina (DES) 4. thrombi Contra: 1. ER+ breast cancer 2. DVT history
42
Selective estrogen-R modulators: | Name 3
1. Clomiphene 2. Tamoxifen 3. Raloxifene
43
Clomiphene: MOA(2) Use (1)
1. Antagonist at E-R in hypothalamus-->prevents normal feedback inhibition. 2. Increase release of LH/FSH form pituitary--> stimulates ovulation Use: infertility due to anovulation (like PCOS)
44
Clomiphene: | Adverse (4)
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
45
Tamoxifen: MOA (2) Use (1)
1. Antagonist at Breast 2. Agonist at Bone/Uterus (pro-bone) Use: treat/prevent recurrence of ER/PR+ breast cancer
46
Tamoxifen: | Adverse (2)
1. increase risk of thromboembolic events | 2. increase risk of endometrial cancer
47
Raloxifene: MOA Use (2)
1. Antagoist at Breast/Uterus 2. Agonist at Bone (pro-bone) Use: osteoporosis
48
Raloxifene: | Adverse(1)
1. increase risk of thromboembolic events | * no increase risk of endometrial cancer like with tamoxifen
49
Aromatase Inhibitors: | Name 3
1. Anastrozole 2. Letrozole 3. Exemestane
50
Aromatase Inhibitors: Anastrozole, letrozole, exemestane MOA Clinical Use (1)
- inhib peripheral conversion of androgens-->estrogen | 1. ER+ breast cancer in postmenopausal women
51
Hormone Replacement Therapy: | Use(3)
Relief/Prevent Menopausal symptoms: 1. Hot flashes 2. Vaginal atrophy/dyspareunia 3. Osteoporosis (increase estrogen/decrease osteoclasts)
52
Hormone Replacement Therapy: | Adverse(2)
1. Unopposed estrogen--> increase endometrial cancer risk (must admin with progesterone) 2. Cardiovascular risk (heart attack/stroke)
53
Main treatment for Prostate Cancer (2)
1. Flutamide | 2. Leuprolide
54
Progestins: | Name 5
1. Levonorgestrel 2. Medroxyprogesterone 3. Etonogestrel 4. Norethindrone 5. Megestrol *often combined with estrogen
55
Progestins: MOA Clinical Use(3)
Bind P-R--> decrease growth and increased vascularization of endometrium & thicken cervical mucus 1. Contraception (pill, IUD, implant, depot) 2. endometrial cancer 3. abn. uterine bleeding
56
Explain the Progestin Challenge
presence of withdrawal bleeding excludes anatomic defects (Asher syndrome) and chronic anovulation without estrogen
57
Anti-progestins: | Name 2
1. Mifepristone (=RU-486) | 2. Ulipristal
58
Antiprogestins: MOA Clinical use (
-Competitive inhb of progestins at P-R 1. Termination of pregnancy (mifepristone w/ misoprosto-PGE1 analog) 2. emergency contraception (ulipristal) 3. peptic ulcer disease (mifepristone)
59
Combined contraception: Components Forms(3) MOA(3)
- Progestins & EE - pill, patch, vaginal ring 1. estrogen&progestins inhib LH/FSH-->prevent estrogen surge/LH surge-->No ovulation 2. Progestins thicken cervical mucous (limit sperm access to uterus) 3. Progestins inhib endometrial prolif (limits implantability)
60
Combined contraception: | Contra
1. smokers >35yo (increase Cardiovascular events) 2. patients at increased risk of CV events(VTE history, CAD, stroke) 3. migraine (esp. with aura) 4. breast cancer
61
Copper Intrauterine device: MOA Clinical Use(2)
- Produces local Inflam Rxn toxic to sperm/ova (prevents fertilization/implantation) * No hormones 1. Long acting reversible contraception 2. Most effective emergency contraception
62
Copper Intrauterine device: Adverse (3) Contra (1)
Adverse: 1. Heavier/longer menses 2. dysmenorrhea 3. PID risk with insertion Contra: PID/ pelvic infection
63
Terbutaline, Ritodine: MOA Use
Terbutaline (B1/B2) Ritodrine (B2) -B2 agonists that relax the uterus Use: decrease contraction frequency in women during labor/decrease premature contractions (a.k.a=tocolytic)
64
Danazol: MOA Clinical Use (2)
-synthetic androgen that acts as partial agonist at androgen-R1 1. Endometriosis 2. hereditary angioedema * Danazol has largely been replaced by Leuprolide/Goserelin for endometriosis
65
Danazol: | Adverse (7)
1. Weight gain 2. edema 3. acne/hirsutism 4. masulinization (of fetus w/ pregnancy) 5. decrease HDL levels 6. hepatotox 7. pseudotumor cerebri (increase ICP, papilledeam, HA)
66
Drugs causing pseudotumor cerebri
1. Danazol | 2. excess Vit A
67
Testosterone, Methyltestosterone: MOA difference between the 2 drugs? Clinical Use(3)
- Androgen-R agonist - Methyltestosterone has better oral bioavailability 1. Hypogonadism 2. promote dev. of 2ary sex characteristics 3. stimulate anabolism to promote recovery after burn/injury
68
Testosterone, Methyltestosterone: | Adverse(4)
1. masculinizationof Females 2. decrease intratesticular testosterone in males via (-) feedback on LH--> gonadal atrophy 3. premature closure of epiphyseal plates 4. increase LDL, decrease HDL (not good)
69
Antiandrogens: | Name 4
1. Finasteride 2. Flutamide 3. Ketoconazole 4. Spironolactone
70
Finasteride: MOA Clinical Use (2) Adverse
-5a-reductase inhibitor (decrease testosterone-->DHT conversion) 1. BPH (drug of choice w/o HTN) 2. male pattern baldness Adverse: impotence, gynecomastia, abn. sex function
71
Flutamide: MOA Clinical use(1) Used with what?
-Nonsteroidal Competitive inhib at androgen-R --> decrease Testosterone 1. Prostate carcinoma w/ Leuprolide (decrease LH/FSH)
72
Ketoconazole: | MOA
inhib steroid synthesis | inhib 17,20-desmolase which prevents chol-->pregnenolone
73
Spironolactone: | MOA
inhib steroid binding, 17a-hyrdoxylase, and 17,20-desmolase
74
Ketoconazole & Spironolactone: Clinical Use(1) Adverse (2)
- PCOS to reduce androgenic symptoms 1. gynecomastia 2. amenorrhea
75
Tamsulosin: MOA Clincial Use
- selective a1(A,D)-antagonist--> inhib sm. muscle contraction on prostate (limited effect on vascular a1(B)-R) 1. BPH (in contrast to non-specific a1-antagonist which all end in "-zosin" 1. prazosin 2. terazosin 3. doxazosin and can cause adverse orthostatic hypotension)
76
Phosphodiesterase Type5 inhibitors: | Name 3
"PDE type5 inhibitors FILl the penis" 1. Sildenafil 2. Tadalafil 3. Vardenafil
77
Phosphodiesterase Type5 inhibitors: | MOA
1. Inhib PDE-5--> increase cGMP-->prolong sm. muscle relaxation in response to NO 2. this increases b.flow in corpus cavernous of penis 3. decrease pulm. vascular resistance
78
Phosphodiesterase Type5 inhibitors: Clinical Use (3) Adverse
1. Erectile dysfunction 2. Pulm HTN 3. BPH (Tadalafil) Adverse: "Hot and sweaty, but then HA, Heartburn, Hypotension" 1. HA, Flushing 2. Dyspepsia 3. cyanopia = Blue-tinted vision ("viagra is a blue little pill")
79
Phosphodiesterase Type5 inhibitors: | DD interaction
Risk of life-threatening Hypotension in patients taking NITRATES * IF suspecting MI in patient, ask about erectile dysfunction drugs b/c NItrates+Sidenafil-->life-threatening hypotension
80
Minoxidil: MOA Clinical Use
-Direct arteriolar vasodilator (K+ channel blocker) 1. Androgenic alopecia ("Rogaine") 2. Severe refractory Hypertension
81
Only anti fungal with anti-androgenic effects?
Ketoconazole w/ adverse of gynecomastia
82
Drug of choice for BPH w/o HTN? | w/ HTN?
``` w/o= Finasteride w/ = Tamsulosin ```
83
Drug which impairs Blue-Green vision? | Drug which impairs Red-Green vision?
``` Blue-Green= PDE-5 inhib Red-Green= Ethambutol ```
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