Contraceptives and Hormonal Birth Control
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Questions and Answers

Which of the following medications is used to treat Overactive Bladder?

  • Empagflozin
  • Oxybutinin (correct)
  • Tadalafil
  • Pseudoephedrine

    • Which medication for Stress Incontinence is not FDA approved?

  • Pseudoephedrine
  • Duloxetine (correct)
  • Oxybutinin
  • Phenylephrine

    • Which of the following medications is used to treat Heart Failure?

  • Mirabegron
  • Darifenacin
  • Empagflozin (correct)
  • Tospium

    • Which of the following medications has a side effect of assoc.?

    <p>Digoxin</p> Signup and view all the answers

    Which of the following medications is used to treat BPH?

    <p>Sildenafil</p> Signup and view all the answers

    Which of the following medications is a B3 agonist?

    <p>Mirabegron</p> Signup and view all the answers

    What is the primary indication for Vinorelbine?

    <p>Non-Small Cell Lung Cancer</p> Signup and view all the answers

    What is a common side effect of Topoisomerase Inhibitors?

    <p>Alopecia</p> Signup and view all the answers

    What is the name of the chemotherapy regimen that includes Vincristine?

    <p>ABVD</p> Signup and view all the answers

    What is the name of the drug that is often used in combination with fluorouracil?

    <p>Irinotecan</p> Signup and view all the answers

    What is the primary indication for Teniposide?

    <p>Acute Lymphoblastic Leukemia</p> Signup and view all the answers

    What is the name of the drug that requires pre-medication with acetaminophen?

    <p>Vinorelbine</p> Signup and view all the answers

    What is the dose-limiting toxicity of Irinotecan?

    <p>Myelosuppression</p> Signup and view all the answers

    What is the name of the drug that is often used in combination with cisplatin?

    <p>Topotecan</p> Signup and view all the answers

    What is the primary mechanism of action of estrogen in combined oral contraceptives?

    <p>Inhibiting FSH and ovulation through pituitary feedback</p> Signup and view all the answers

    What is the likely cause of acne in patients taking combined oral contraceptives?

    <p>Progestin's androgenic effect</p> Signup and view all the answers

    What is the recommended approach for managing breakthrough bleeding in patients taking combined oral contraceptives?

    <p>Adhere to the current prescription for 3 months and then switch based on when bleeding occurs</p> Signup and view all the answers

    What is the primary concern when prescribing combined oral contraceptives to patients who smoke?

    <p>The increased risk of serious adverse events</p> Signup and view all the answers

    What is the reason for avoiding the use of combined oral contraceptives in patients taking anticoagulants?

    <p>The increase in clotting factors</p> Signup and view all the answers

    What is the likely cause of nausea in patients taking combined oral contraceptives?

    <p>Estrogen's effect on the central nervous system</p> Signup and view all the answers

    What is the primary mechanism of action of DNA cross-linking drugs?

    <p>Formation of cross-links between adjacent nucleotides to prevent transcription and replication</p> Signup and view all the answers

    Which of the following drugs is associated with hemorrhagic cystitis?

    <p>Ifosfamide</p> Signup and view all the answers

    What is the primary indication for the use of dacarbazine?

    <p>Hodgkin's lymphoma</p> Signup and view all the answers

    Which of the following drugs is associated with cardiotoxicity?

    <p>Doxorubicin</p> Signup and view all the answers

    What is the primary mechanism of action of DNA intercalating drugs?

    <p>Insertion into the DNA helix to prevent transcription and replication</p> Signup and view all the answers

    Which of the following drugs is associated with pulmonary toxicity?

    <p>Bleomycin</p> Signup and view all the answers

    What is the primary mechanism of action of mitotic inhibitors?

    <p>Inhibition of microtubule function</p> Signup and view all the answers

    Which of the following drugs is associated with infusion reactions?

    <p>Taxol</p> Signup and view all the answers

    What is the primary indication for the use of temozolomide?

    <p>Brain tumors</p> Signup and view all the answers

    Which of the following drugs is associated with extravasation necrosis?

    <p>Doxorubicin</p> Signup and view all the answers

    What is the primary toxicity associated with Etoposide?

    <p>Requires large volume of fluids</p> Signup and view all the answers

    What is the common toxicity associated with Tyrosine Kinase Inhibitors?

    <p>Rash and diarrhea</p> Signup and view all the answers

    What is the indication for ImatINIB?

    <p>CML and GI stroma</p> Signup and view all the answers

    What is the adverse effect of ErlotINIB?

    <p>Skin rash, diarrhea, and mucositis</p> Signup and view all the answers

    What is the treatment for infusion reactions?

    <p>Acetaminophen, diphenhydramine, and methylprednisolone</p> Signup and view all the answers

    What is the indication for Rituximab?

    <p>Non-Hodgkin's Lymphoma, SLE, RA, and ITP</p> Signup and view all the answers

    What is the treatment for Irinotecan-induced diarrhea?

    <p>Loperamide</p> Signup and view all the answers

    What is the highest risk of infusion reaction associated with?

    <p>mab: X[i]</p> Signup and view all the answers

    What is the indication for Gemtuzumab?

    <p>CD33 (+) AML</p> Signup and view all the answers

    What is the dose of Glucarpidase used to treat toxic levels of?

    <p>[c]</p> Signup and view all the answers

    Study Notes

    Contraception

    • Combined Oral Contraceptives (COCs) contain estrogen and progestin, preventing pregnancy (93% effective), acne, and premenstrual dysphoric disorder.
    • Off-label uses of COCs include treatment of hirsutism, headaches, premenstrual syndrome, iron deficiency anemia, and cramps.
    • Beyaz is a COC specifically used to treat premenstrual dysphoric disorder.

    Estrogen

    • Estrogen types include ethinyl estradiol, estradiol valerate, and mestranol.
    • Estrogen's effects on the body include:
      • Pituitary feedback: inhibiting FSH and ovulation
      • Increasing aldosterone and sodium and water retention
      • Increasing sex hormone binding globulin, which can lead to acne and hirsutism
    • Adverse effects of estrogen include:
      • Nausea
      • Cyclic weight gain
      • Bloating/edema
      • Cyclic headaches
      • Hypertension
      • Breast tenderness/fullness

    Progestin

    • Progestin types include norethindrone, ethynodiol diacetate, noregestrel, desogestrel, and drospirenone.
    • Progestin's effects on the body include:
      • Pituitary feedback: inhibiting ovulation
      • Endometrial atrophy and thickening of cervical mucus to prevent sperm travel
    • Adverse effects of progestin include:
      • Hair loss
      • Hirsutism
      • Acne
      • Oily skin
      • Libido changes

    WHO Contraindications for COCs

    • Breakthrough bleeding: adhere to the prescription for 3 months and switch based on when bleeding occurs.
    • Nausea: likely related to estrogen; suggest taking it before bed or with food.
    • Acne: likely related to progestin/androgens; select a higher estrogen or lower progestin.
    • Serious adverse effects: ask the patient about ACHES.
    • Drug-drug interactions: anticoagulants, antibiotics, and smoking.

    Urge Incontinence / Overactive Bladder

    • Anti-muscarinic/cholinergic medications: oxybutynin, tospium, and darifenacin.
    • B3 agonist: mirabegron.
    • Botox: onabotulinumtoxin A.

    Stress Incontinence

    • Alpha-adrenergic agonists: pseudoephedrine and phenylephrine.
    • Topical estrogen: cream, insert, or ring.
    • SNRI: duloxetine (not FDA approved).

    Heart Failure

    • Diuretics: empagliflozin and dapagliflozin.
    • ACEI/ARBs: ACEI has cough, hyperkalemia, uricemia, and angioedema.
    • Digoxin: associated with sickle cell, sudden onset myelosuppression, and increased liver function tests.

    DNA Cross-Linking Drugs

    • Ciclophosphamide: has a broad spectrum, used in rheumatoid arthritis, and SLE.
    • Ifosfamide: used in sarcoma, has a high risk of hemorrhagic cystitis.
    • Platinum drugs: cisplatin, carboplatin, and oxaliplatin, used in various types of cancer.

    Other DNA Alkylating Agents

    • Dacarbazine: used in IV Hodgkin's lymphoma and melanoma.
    • Busulfan: used in CML, has a high risk of dose-limiting myelosuppression.
    • Mitomycin: used in salvage therapy with vincristine, end-stage breast cancer, and bladder cancer.

    DNA Intercalating Drugs

    • Anthracyclines: doxorubicin, daunorubicin, and idarubicin, used in various types of cancer.
    • Dactinomycin: used in Ewing's sarcoma and childhood cancer.

    Mitotic Inhibitors

    • Taxanes: paclitaxel, docetaxel, and ixabepilone, used in various types of cancer.

    • Vinca alkaloids: vinblastine, vincristine, and vinorelbine, used in various types of cancer.

    • Topoisomerase inhibitors: teniposide, irinotecan, and topotecan, used in various types of cancer.### Chemotherapy

    • Etoposide: PO palliative chemotherapy, requires large volume of fluids, often used with cisplatin for lung cancer, and in BMT/refractory disease, phosphate salt form requires less fluid.

    • Diarrhea: common side effect of etoposide, can be managed with loperamide.

    Targeted Anticancer Drugs

    • Tyrosine Kinase Inhibitors (TKIs): most successful, impede pathways promoting malignant cell transformation and proliferation, common side effects: rash, diarrhea, and mucositis.
    • Common Toxicities with TKI Target:
      • EGFR: rash, diarrhea, mucositis
      • HER2: rash, diarrhea, left ventricular dysfunction
      • VEGF: hypertension, proteinuria, prolonged wound healing, VTE risk
      • BCR-ABL: cytopenia, hypothyroidism

    Tyrosine Kinase Inhibitors

    • Imatinib (1st line): inhibits TK expressed by Philadelphia chromosome, used in CML, GI stroma, side effects: rash, diarrhea
    • Dasatinib:
    • Nilotinib:
    • Erlotinib: epidermal growth inhibitor, used in 2nd line NSCLC, side effects: skin rash, diarrhea, mucositis
    • Bortezomib: used in multiple myeloma, side effects:

    Monoclonal Antibodies

    • Often used as adjuvant to chemotherapy regimens, side effects: Stevens-Johnson syndrome, anaphylaxis, infusion reactions
    • Infusion reactions: can be managed with acetaminophen, diphenhydramine, and methylprednisolone 30 minutes before infusion
    • Highest risk of infusion reactions: -mab, -xiab, -zumab, lowest risk: -mab, -umab

    Monoclonal Antibodies (continued)

    • Rituximab: used in non-Hodgkin's lymphoma, SLE, RA, ITP, can cause tumor lysis syndrome
    • Alemtuzumab: used in CLL after alkylating, side effects:
    • Gemtuzumab: used in CD33 (+) AML, side effects:
    • Glucarpidase: used to treat toxic [c] levels due to renal dysfunction

    Diarrhea Management

    • Loperamide: used to manage irinotecan-induced diarrhea, and fluorouracil-induced diarrhea, may require steroids, and atropine.

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    Description

    This quiz covers different types of contraceptives, including combined oral contraceptives and progestin-only options, their mechanisms, and effects on the body.

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