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12. Reproductive.pptx Study review for naplex
- 1. M E N ’ S A N D W O M E N ’ S H E A LT H P R E S E N T E D B Y L E E R O Y A E S P O S O
- 2. T O P I C S C O V E R E D • Contraception & Infertility • Drug Use in Pregnancy and Lactation • Osteoporosis, Menopause, & Testosterone Use • Sexual Dysfunction • Benign Prostatic Hyperplasia • Urinary Tract Infection
- 3. B A C K G R O U N D • Menstrual Cycle • Follicular, Ovulatory, Luteal • Preconception • Folic Acid • Smoking • Vaccinations
- 4. C O N T R A C E P T I O N
- 5. C O N T R A C E P T I O N • Prompt return to fertility once discontinued • Only reversible contraceptive that has delay in return to fertility is injectable medroxyprogesterone • Male options are limited • Barrier • Sterilization
- 6. N O N - P H A R M • 100% way to prevent pregnancy and STDs • Temperature/Cervical Mucus Methods • Barrier Methods • Diaphragm • Condoms • Spermicide • Nonooxynol-9
- 7. H O R M O N A L C O N T R A C E P T I V E S • How do they work? • POP • COC • CHC
- 8. C O M B I N E D O R A L C O N T R A C E P T I V E S • Most contain EE and a progestin • Drospirenone • Monophasic vs others • Other Indications • Can contain inactive pills
- 9. O T H E R C O C I N D I C AT I O N S • Dysmenorrhea • PMS • Acne • Anemia • Regulation of menses • PCOS • Endometriosis
- 10. P R O G E S T I N O N LY • No inactive pills • Suppress ovulation • Thicken cervical mucus • Pregnancy and breastfeeding • Need good adherence • OK in migraine with aura
- 11. N O N - O R A L H O R M O N A L C O N T R A C E P T I V E S • Patch • Ring • Injectable • IUD This Photo by Unknown Author is licensed under CC BY-NC-ND
- 12. A D V E R S E E F F E C T S - C O C • Nausea, breast tenderness, bloating, weight gain, elevated blood pressure • Thrombosis • Heart attack • Stroke • DVT/PE • Increase risk of severe adverse events • Prolonged bed rest • Overweight • High Estrogen Exposure
- 13. A D V E R S E E V E N T S - P O P • Breast tenderness, headache, fatigue, mood changes • Break through bleeding • Drospirenone • Higher risk of clot • Increased potassium • DNU in kidney, liver or adrenal disease • Monitor K • Injectable medroxyprogesterone acetate • Loss of BMD
- 14. L O N G A C T I N G R E V E R S I B L E • Intra Uterine Devices • 3-5 years • Progestin • Copper-T IUD • Can be used as EC • The implant • 3 years • Progestin
- 15. E M E R G E N C Y C O N T R A C E P T I V E S • Non-Hormonal • Copper IUD • Effective if inserted within 5 days • Oral • Levonorgestrel • 89% effective if taken within 72 hours • Delay ovulation/thicken cervical mucus • Ulipristal acetate • Delay ovulation • Cousin to RU-486 bit different MOA
- 16. I N F E R T I L I T Y • Defined as not being able to get pregnant after one year or longer of unprotected sex • First line – clomiphene • SERM • Gonadotropins • Includes hCG or GnRHA • Trigger ovulation • Given IM or SC • Multiple eggs
- 17. P R E G N A N C Y A N D L A C TAT I O N
- 18. W H AT D O W H E N P R E G N A N T ? • Lifestyle management • Behavioral interventions • Tobacco cessation • Vitamin and mineral supplementation • Folate • Vitamin D • Calcium
- 19. W H AT D O ? PA R T D E U X • Immunizations • Influenza • TDAP • Avoid teratogens • See page 691 • Brigg’s Pregnancy and Lactation • Preeclampsia • Usually presents after the first trimester • Low dose ASA
- 20. L A C TAT I O N • Recommended for first 6 months of life if mutually desired • May need additional Vit D and iron supplementation • If HIV+ breastfeeding is not recommended • Drugs that get excreted in breast milk • Non-ionized, low molecular weight, lipophilic low Vd • Pain • APAP and IBU = ok • No codeine or tramadol
- 21. O S T E O P O R O S I S , M E N O PA U S E , & T E S T O S T E R O N E
- 22. O S T E O P O R O S I S
- 23. O S T E O P O R O S I S • Porous Bones • Common in postmenopausal women • Vertebral fractures can be most common • Can occur without fall • Common over 74 years of age • Wrist fracture common in younger people • Earlier indicator of poor health
- 24. R I S K FA C T O R S - PA G E 6 9 6 • Can be age related • Ethnicity • Low body weight • Anorexia • Menopause • Hyperthyroidism • RA and autoimmune diseases • Gastro diseases • Smoking • Excessive alcohol intake • Low calcium • Low vitamin D • Physical inactivity • PPIs • Anticonvulsants • steroids
- 25. D I A G N O S I S • Bone Mineral Density – BMD • Gold standard – DEXA Scan • Measures BMD of hip and spine • T-Score • Calculated from DEXA scan • Who should get one? • Women 65 and older • Men 70 and older • FRAX • 10 year risk This Photo by Unknown Author is licensed under CC BY-SA-NC
- 26. H O W D O T O S T O P B O N E L O S S ? • Fall Prevention • Lifestyle • Exercise • Calcium and Vitamin D This Photo by Unknown Author is licensed under CC BY-NC-ND
- 27. C A L C I U M A N D V I TA M I N D • Adequate intake required • Dietary preferred • Vitamin D required for Calcium absorption • Rickets and Osteomalacia • Exogenous absorption is saturable • Sunlight This Photo by Unknown Author is licensed under CC BY-SA-NC
- 28. D R U G T R E AT M E N T • Prevention • Bisphosphonates • Estrogen-based therapies • Raloxifene • Treatment • Bisphosphonates • Denosumab • Parathyroid hormone This Photo by Unknown Author is licensed under CC BY-SA
- 29. W H E N T O T R E AT ? • Osteoporosis • Presence of a fragility fracture OR • Postmenopausal women or men age 50 or older • T-score ≤ -2.5 • Osteopenia if high risk • Low bone density • T-Score -1 to -2.5 AND • FRAX score indicates ≥ 10% risk or osteoporosis related fracture or ≥ 3% hip fracture
- 30. C O U N S E L I N G P O I N T S – A L L Must supplement with calcium and vitamin D Do not Calcium Carbonate with PPIs If PPI necessary change to Calcium Citrate
- 31. C O U N S E L I N G P O I N T S B I S P H O S P H O N A T E S • Take in morning • Must stay upright for at least 30 minutes • Separate from multivitamins and mineral supplements • Can cause dyspepsia • Missed dose instructions • Vary depending on daily, weekly, or monthly This Photo by Unknown Author is licensed under CC BY-SA
- 32. C O U N S E L I N G P O I N T S R A L O X I F E N E • Can cause blood clots • Discontinue at least 72 hours prior to and during prolonged immobilization This Photo by Unknown Author is licensed under CC BY
- 33. C O U N S E L I N G P O I N T S P A R A T H Y R O I D H O R M O N E S • Teriparatide and Abaloparatide • Dizziness • Orthostasis This Photo by Unknown Author is licensed under CC BY-SA
- 34. C O U N S E L I N G P O I N T S C A L C I T O N I N Refrigerate unused bottles Refrigerate Use at room temp and discard after 30 doses Use Prime first use Prime Alternate nostrils Alternate
- 35. M E N O PA U S E • Last menstrual period was 1 year ago • Usually occurs between 40– 50 years of age • Can be earlier or later • Vasomotor Symptoms (VMS) • Hot flashes • Night sweats • Mood changes • Vaginal dryness • Painful intercourse This Photo by Unknown Author is licensed under CC BY-NC-ND
- 36. H O R M O N A L T R E A T M E N T S • Most effective for VMS • Estrogen • Transdermal • Local • Preferred for vaginal symptoms • Hormonal or lube • Low-dose oral This Photo by Unknown Author is licensed under CC BY-NC-ND
- 37. N AT U R A L P R O D U C T S • Black Cohosh • Evening primrose oil • Red clover • Soy • Flaxseed • Dong quai • St. John’s Wort • Chastberry
- 38. N O N - H O R M O N A L T R E AT M E N T S • Paroxetine – FDA approved for VMS symptoms • Lower dose than depression • CY2D6 • SNRI, clonidine, gabapentinoids • Not FDA approved • Ospemifene • Oral estrogen agonist/antagonist • Not for mild symptoms
- 39. H Y P O G O N A D I S M I N M A L E S • Age related or secondary to medical cause • Medications that lower testosterone • Opioids • Chemotherapy • Cimetidine • Spironolactone This Photo by Unknown Author is licensed under CC BY-SA
- 40. T E S T O S T E R O N E • Variety of uses • Increased risk of clotting • Increased hematocrit • Can enlarge prostate • Potential for abuse • Formulations • Injectable, topical, transdermal, buccal This Photo by Unknown Author is licensed under CC BY-SA
- 41. S E X U A L D Y S F U N C T I O N
- 42. S E X U A L D Y S F U N C T I O N I N W O M E N • Inability to reach orgasm • Painful intercourse • Hypoactive sexual desire disorder • Two FDA approved drugs • Flibanserin • Bremelanotide • Premenopausal only
- 43. S E X U A L D Y S F U N C T I O N I N W O M E N - D R U G S • Filbanserin • Agonist – 5-HT1A • Antagonist – 5-HT2A • Contraindicated with alcohol or strong CYP3A4 • REMS • Bremelanotide • Melanocortin agonist • Contraindicated – uncontrolled HTN, known cardiovascular disease
- 44. E R E C T I L E D Y S F U N C T I O N • Difficulty getting or sustaining an erection that is firm enough for sex • Common cause – reduced blood flow to the penis • Common with comorbidities • Psychological issues • Neurological illness • Medications This Photo by Unknown Author is licensed under CC BY-ND
- 45. M E D I C AT I O N S T H AT C A N C A U S E E D Alcohol Antihypertensives Antipsychotics BPH
- 46. N O N - D R U G T R E AT M E N T • Lifestyle changes • Weight loss • Quitting tobacco • Reduce alcohol • Natural Products • Yohimbe • L-arginine • Panax • Treatment of underlying disease
- 47. D R U G T R E AT M E N T • First line • PDE-5 • Sildenafil, vardenafil, tadalafil, avanafil • Titrated to effect • Can be used for other conditions • Oral, injection, suppository
- 48. B E N I G N P R O S T A T I C H Y P E R P L A S I A
- 49. B E N I G N P R O S TAT I C H Y P E R P L A S I A ( B P H ) • Overgrowth of prostate • Can look like LUTS • Bladder outlet obstruction • Symptoms impact QOL but rarely causes serious symptoms • Similar symptoms to prostate cancer
- 50. T R E AT M E N T • Treatment guided by symptom relief • Mild – watchful waiting • Moderate/Severe • Medications • Surgery • Transurethral resection of the prostate • TURP This Photo by Unknown Author is licensed under CC BY-SA
- 51. D R U G T R E AT M E N T • Alpha blockers • Used alone or in combo with 5 alpha-reductase inhibitors • 5 alpha-reductase inhibitors • Decrease size of prostate • PDE-5 inhibitors • With or without finasteride
- 52. A L P H A B L O C K E R • First Line • Relaxation of smooth muscle in prostate • Reduces outlet obstruction and improves urinary flow • Alpha-1 primarily in prostate • Floppy iris syndrome • Alpha-1 in the iris • Pupils do not dilate well • Delay alpha blocker until cataract surgery complete
- 53. 5 A L P H A - R E D U C TA S E I N H I B I T O R S • Blocks conversion of testosterone to dihydrotestosterone • Improve symptoms • Decrease risk of acute urinary retention • Decrease need for surgery • Contraindicated women of child-bearing age • May require 6 months of treatment for maximal efficacy
- 54. P D E - 5 • Tadalafil only one with FDA approval for BPH • How it works – not well known • Should not used in combination with alpha-blocker • Do not use with nitrates • Impaired color vision • Vision loss
- 55. U R I N A R Y I N C O N T I E N C E
- 56. O V E R A C T I V E B L A D D E R • ~30% - 40% • Affects more women than men • Overactive bladder is not a disease • Describes a group of urinary symptoms • Urgency • Incontinence • Frequency • Dry Vs. Wet
- 57. O V E R A C T I V E B L A D D E R
- 58. F I R S T L I N E T H E R A P Y • “First line treatment” • Change voiding habits • Bladder training, delayed voiding, fluid restriction • Bladder outlet • Pelvic floor muscle training, exercise • No one technique is considered superior to the other
- 59. M E D I C AT I O N T H E R A P Y • Antimuscarinic • Target: M3 receptor • Inhibits bladder contraction • Inhibits relaxation of sphincter muscles • Beta-3 agonists • Target: Beta-3 receptor • Inhibits bladder contraction • OnaboulinumtoxinA • 3rd Line • Stops release of ACh
- 61. T H A N K Y O U L E E R O Y A . E S P O S O W A S H I N G T O N S T A T E U N I V E R S I T Y C L A S S O F 2 0 2 1