GET READY FOR SOME SEX THERAPY
What are the repro-related side effects of metoprolol?
ED
loss of sex drive
How many weeks pregnant does a woman have to be to have pregnancy hypertension?
20 weeks
If a pregnant woman has HTN, what should you also test?
urine protein
What defines preeclampsia?
A pregnant woman with HTN 140/90 and proteinuria
what kind of a urine test do you give to test for preeclampsia?
24 hour urine
What drug should you think to give as a preclampsia anti-HTN? or just pregnancy anti-HTN in general?
crack
but if your pt is concerned about having a crack baby, prescribe Labetolol
is methyl dopa ever going to be an answer?
like probably not
only ob/gyn prescribes this
what type of drug is labetolol?
nonselective beta blocker
(caution in lung d/o)
methyldopa has lots of side effects… why?
they cross the blood brain barrier
what do you need to make sure is in your pregnant patient’s multivitamins?
Fe abd FOLIC ACID
What does folic acid prevent as far as birth defects?
neural tube defects
e.g. spina bifida and ancephale
what is a tocolytic agent?
agents that we give to suppress premature labor or contractions
what is the #1 tocolytic agent?
magnesium sulfate
DVT, breast cancer, CVA, CAD
are these absolute or relative C/I of oral contraceptives?
absolute
is liver disease an absolute or relative c/i of oral contraceptives?
absolute
is tobacco use an absolute or relative c/i of oral contraceptives?
relative
what factor increases your risk of a) having your OCPs not work as well and b) having bad things happen during oral contraceptive use?
being a bad person
and obesity
is obesity a relative contraindication?
yes
why shouldn’t you eat your girlfriend’s peas?
because they are herpes
when you discontinue an IUD, up to how long can it take to regain the ability to get pregnant?
up to 6 months (says Steve)
12-18 months (says Tom)
when you discontinue the depo-provera shot, how long might it take for your menses to be normal/to get pregnant again?
12-18 months
they both agree on this one
which IUD stays in for 10 years?
copper IUD
what do IUDs do to prevent pregnancy?
thicken the endometrial wall and cervical mucosa so nothing can implant and it’s uninhabitable to sperm
aka you become a thick zygotic hell
your patient gets migraines with auras. if you put them on a COC, what are they at an increased risk for?
CVA (5-7x higher risk!!!)
What do you prescribe for a patient who wants oral contraceptives and does not get an aura with her migraines?
Tell her that she can hop on the COC train
What is the DOC in a patient who wants oral contraceptives but has a ton of C/I?
progestin-only
like Ovrette
what happens if you start a patient on COC and she gets migraines with auras?
discontinue durrrrr
which COC has less breakthrough bleeding?
a) monophasic
b) biphasic
c) triphasic
monophasic!
As you increase the generations of estrogen pills, do you increase or decrease the amount of estrogen in the pill?
decrease
Some estrogen pills have extended cycles like 168 days rather than 28… do these have increased or decreased risk of menses HAs?
decreased
what % of people who get pregnant have unintended pregnancies?
what % of these were on birth control when they got pregnant?
50%
50%
the issue is compliance
what side effects does estrogen increase?
HA, N/V
what side effects does progesterone increase?
breakthrough bleeding
which is more irritating to the GI tract: progesterone or estrogen?
estrogen
what’s it called when you spread the clap?
applause
what contraceptive method should you not use in a patient with acne?
progestin-only
what is the issue with oral contraceptives in an obese person?
it takes up to 2x as long to reach steady hormone levels
obesity changes the oral contraceptive’s:
a) absorption
b) distribution
c) metabolism
d) excretion
e) all of the above
errythang
what do you give for a woman with dysparunia?
estrogen cream like
[premarin]
[estrace]
what else can estrogen creams treat?
stress urinary incontinence
what is another insertive treatment for stress urinary incontinence?
a pessary
a young male is complaining of fatigue. does he qualify for testosterone treatment?
no tell him to suck it up
we’re all tired
to test testosterone levels, how many separate times do you have to test the levels?
3 different occasions
what HTN is Cialis C/I for?
170/110
does Cialis correct libido?
no!
unless it’s prescribed by a really hot doc
aside from testosterone, what other factors can contribute to low libido?
vascular problems
medications
alcohol use
life
Cialis vs Viagra:
a) which is once a day
b) which is PRN
a) Cialis
b) Viagra
what’s the deal with taking Cialis or Viagra prior to intercourse?
you can take them both 1h prior to intercourse
what’s the difference between niagara and viagra?
niagara falls
which drug is Plan B
Levonorgestrel
which other drug is an emergency contraceptive?
Ulipistral [Ella]
who should you get a pregnancy test on?
literally everyone 7-70
even if they say they’re monogamous
or abstinent
trust no one
cover your ass
does emergency contraception abort an existing egg?
no way jose this ain’t no OTC abortion
within how many hours do you have to take emergency contraceptives?
ASAP but take within 120 hours!
what’s a good treatment for menopause?
combo oral contraceptives
weight gain is a common side effect of which medication?
depo-provera
what are the 2 more common side effects of depo-provera?
hirsituism or whatever that word is
loss of bone density (while on the med)
does progesterone cause hirsutism?
yes
after bariatric surgery, what is the best option for contraceptives?
IUD
because we don’t know how high the risks are for the other options
after a bariatric surgery, how long should you wait to get pregnant?
1 year
if a person is obese, what kind of OCP would you choose to give them and why?
monophasic for less breakthrough bleeding
what do you prescribe for gonorrhea?
IM ceftriaxone + oral azithromycin
what is the mg of the IM ceftriaxone injection?
250mg
what should you tell men who are getting STDs?
to wrap that cap before getting in her trap to prevent getting the clap
what do you tell a woman who is getting STDs?
if he don’t wrap give him a slap
you can even get the clap
where you yap and where you crap
when do you follow-up with someone who has an STD to see if it has cleared?
3 months
can untreated STDs be transmitted to wittle itty bitty babies?
yes those poor innocent things
damaged by the sins of their parents
in the delivery room, why do they use ointment in baby’s eyes soon after a baby has been born?
to prevent conjunctivitis from chlamydia
how do you treat nausea and vomiting during pregnancy?
pyridoxine (Vitamin B6)
or
doxylamine (an antihistamine)
what do you give to a pregnant woman with a UTI?
nitrofurantoin [macrobid]
what do you prescribe to treat gonorrhea and chlamydia?
IM ceftriaxone and oral azithromycin
HEY DON’T FORGET what vitamin should pregnant women be on?
folic acid
trich or treat: your patient has trichomonas. how do you treat her?
give her some flagyl for her vagyl
[metronidazole]
what are the side effects of metronidazole [flagyl]
metallic taste
disulfram-like reaction with ETOH
what’s the generic name for viagra?
mycoxadroppin
^^^that is not true.^^^
what bacteria causes bacterial vaginosis?
Gardnerella
how do you diagnose bacterial vaginosis?
“clue cells” on wet prep
is metronidazole [flagyl] safe in pregnancy?
yas
how do you treat syphillis?
Penicillin G
what are the 4 stages of syphillis?
primary
secondary
latent
tertiary
how many people’s syphillis progresses to neurosyphillis?
1/3
what heart abnormality can neurosyphillis cause?
aorta enlargement
how does syphillis normally present?
ulcerative lesions on the genitalia that are painless
how do you treat genital herpes?
acyclovir
what lifestyle thing can cause a herpes outbreak?
stress
TRUE OR FALSE: herpes can only be transmitted during an outbreak
false
can a pregnant woman take acyclovir?
yes
what other sx might people with herpes present with?
fever, malaise, sickness
how do you dx herpes?
tzank smear
what is the name of the test for syphillis?
TPHA
what do you prescribe for syphillis if there is a penicillin allergy?
doxy
how do you test for most STDs in males?
dirty urine catch
(they used to stick a swab all the way down the urethra… which you can imagine was a reeeaaallll crowed pleaser… cringe)
when is the best time to take a urine catch?
in the morning
your girlfriend got pregnant (oops) while on an antibiotic like penicillin + while on her OCPs. What happened?
Well I hate to be the one to tell you but she definitely tricked you into a pregnancy because there is only 1 antibiotic that has been shown to interfere with OCPs.
so what is the antibiotic that has been shown to interfere with OCPs?
rifampin
which IUD is smaller and has less hormones: Mirena or Skyla?
Skyla
what’s the big deal with the progestin-only oral contraceptives?
you have to take it at the same time every single day in order for it to be effective
if a patient is on COCs and is having breakthrough bleeding, what hormone is causing that?
is this hormone too high or too low?
AND how many cycles should it take to clear this up?
progesterone
too low
3 cycles
which OCP is an extended-cycle pill?
Lybrel
Quartette
Ethinyl Estradiol alone
how long is an “extended cycle”?
128 days
what hormone(s) is/are in Ovrette?
progesterone only
what type of drug is viagra?
PDE-5 inhibitor
what drug can you NOT use with PDE-5 inhibitors?
NTG
how far apart can you take viagra and nitro?
you can take nitro 48 hours after taking viagra
what happens when taking NTG and viagra together?
hypotensive state
what’s the rule for taking cialis + nitro?
NEVER
what is tamulosin [flomax] for?
BPH
what is a s/e of tamulosin [flomax]?
hypotension
is tamulosin [flomax] a fast-acting drug?
yes
how long should you tell a patient it might take for tamulosin [flomax] to work?
2 weeks
how much tamulosin [flomax] should a person be on daily?
0.4mg
what OTC drug is used for BPH but doesn’t actually do a damn thing to help it?
saw palmetto
what drug that we haven’t mentioned is also given for BPH?
finasteride [proscar]
what’s the difference between tamulosin [flomax] and finasteride [proscar]?
tamulosin [flomax] is fast-acting and finasteride [proscar] is slow-acting
how long can it take for finasteride [proscar] to work?
up to 6 months
MAN OH MAN DON’T YOU JUST WANT TO HAVE SEX AFTER ALL THIS
yes? you weirdo
Now these were a lot of cards so I only have one last question for you…
What are you going to tell your female patients just before you give them a pevic exam?
https://www.youtube.com/watch?v=qqXi8WmQ_WM
if you think that this video is not worth watching then we are on two very different maturity levels