Male and Female Health: osteoporosis, menopause, hypogonadism in males

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Pregnancy & lactation:

folate deficiency causes what?
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Pregnancy & lactation: management what natural product is rated possibly effective for treating morning sickness?gingerPregnancy & lactation: management GERD/heart burn?lifestyle first calcium carbonate (Tums) if lifestyle failedPregnancy & lactation: management flatulence?simethicone (GasX)Pregnancy & lactation: management constipation?lifestyle first if failed, psyllium or calcium polycarbophilPregnancy & lactation: management cough, cold, allergies?first line: cromolyn second line: first gen antihistamine, chlorpheniraminePregnancy & lactation: management when would non sedating 2nd gen antihistamines be recommended?second and third trimestersPregnancy & lactation: management if nasal steroids are required, which ones are preferred?budesonide (Rhinocort) and beclomethasone (Beconase AQ)Pregnancy & lactation: management asthma?budesonide but all are safe rescue: albuterolPregnancy & lactation: management hypertension?nifedipine, labetalol, or methyldopaPregnancy & lactation: management diabetes?insulin is preferred metformin and glyburide are commonly usedPregnancy & lactation: what comorbidity put pregnant patients at risk for preeclampsia?DM type 1 and 2Pregnancy & lactation: management avoid what in vaginal infections?fluconazolePregnancy & lactation: management vaginal infections?topical antifungals x7daysPregnancy & lactation: management UTI? (2)cephalexin 500 mg PO q6h x7 days ampicillin 500 mg PO q6h x7 daysPregnancy & lactation: management nitrofurantoin and SMX/TMP for UTI?last line during 1st trimester do not use in the last 2 weeks of pregnancyPregnancy & lactation: management VTE treatment? prophy?Tx: LMWH Prophy: SCDs +/- LMWHPregnancy & lactation: AAP recommends infants breastfeed for how long?exclusively for the first 6 monthsPregnancy & lactation: babies should receive how much vitamin D? when would they stop with supplementing?400 IU (10 mcg) stop when consuming at least one liter of vit D fortified formula/dayPregnancy & lactation: how much iron do infants require? during which months?1 mg/kg/day during months 4-6 since they have enough iron stores for first four monthsPregnancy & lactation: what pain meds should not be used by breastfeeding mothers?codeine and tramadolOsteoporosis: most common locations of fractures?vertebrae proximal femur (hip) wristOsteoporosis: medications that increase risk in osteop?anticonvulsants aromatase inhibitors depo-medroxy GnRH lithium PPIs steroids (>5 mg pred for >3 months) thyroid hormones in excess loops, SSRIs, heparin, TZDsOsteoporosis: how is bone health evaluated? what is the gold standard measurement and diagnostic tool?bone mineral density (BMD) DEXA or DXAOsteoporosis: what does DEXA measure and calculate?measures BMD of spine and hip calc T score or Z scoreOsteoporosis: what is a T score?compares patients BMD to the avg peak BMD of a healthy, young, white adult of the same sexOsteoporosis: what is the major difference between a T score and Z scoreZ score compares BMD to avg of an age, sex, and ethnicity matched population!!!!Osteoporosis: how are T scores reported?negative valuesOsteoporosis: interpreting T scores: normal? osteopenia? osteop?normal: >-1 osteopenia: -1 to -2.4 osteoporosis: <-2.5Osteoporosis: who should have BMD measured?women >65 men >70 younger patients at high riskOsteoporosis: what is the FRAX tool similar to?ASCVD FRAX estimates risk of osteop fracture in the next 10 yearsOsteoporosis: the FRAX tool is intended for what patients?postmen women men >50 yoOsteoporosis: vitamin D deficiency causes what in children? what about adults?children: rickets adults: ostemalaciaOsteoporosis: what is the recommended vitamin D intake per day?800-2000 IU (25-50 mcg)Osteoporosis: calcium PK?saturable at doses >600 mgOsteoporosis: calcium carbonate vs citrate?carbonate: more elemental calcium (40%) per unit, needs acidic environment (take WF) citrate: 21%, better absorption with increased gastric pHOsteoporosis: vitamin D deficiency can be treated with high doses of which vit D? how long is treatment?D2 (ergo) or D3 (chole) 8-12 weeksOsteoporosis: recommended daily intake of calcium?1000-1200 mg elemental calcium (similar to vit D)Osteoporosis: vitamin D deficiency treatment dosing?5000-7000 IU daily or 50000 IU weeklyOsteoporosis: which drugs are approved for prevention?bisphosphonates (except IV iban) estrogen based therapies Raloxifene DuaveeOsteoporosis: treatment which drugs are indicated for treatment? (4)bispho denosumab PTH analogs: teriparatide calcitoninOsteoporosis: treatment criteria for initiating tx?T score <-2.5 in spine, femoral neck, total hip or 1/3 radius OR presence of a fragility fracture, regardless of BMDOsteoporosis: treatment Bispho ADEs? (3 typical and 2 rare)esophagitis, hypocalcemia, GI effects atypical femur fractures, ONJOsteoporosis: treatment bisphosphonate IV formulations are given how frequent?quarterly/yearlyOsteoporosis: treatment bisphos treatment duration?3-5 years in patients with a low risk of fractureOsteoporosis: treatment Denosumab brand name?proliaOsteoporosis: treatment denosumab SC admin frequency?every 6 monthsOsteoporosis: treatment side effect of denosumab?hypocalcemiaOsteoporosis: treatment Teriparatide brand name?ForteoOsteoporosis: treatment Abaloparatide brand name?TymlosOsteoporosis: treatment when are PTH analogs recommended?very high risk patients only (h/o vertebral fractures)Osteoporosis: treatment major side effect of PTH analogs?HYPERcalcemiaOsteoporosis: treatment PTH analog admin frequency?SC dailyOsteoporosis: treatment what drugs are alternative to bisphos in high risk patients?Evista and Duavee (bazedoxifene/estrogens)Osteoporosis: treatment Raloxifene can be used if low risk of ______ or high risk of ____low risk of VTE high risk of breast cancerOsteoporosis: treatment what is Duavee?bazedoxifene/estrogensOsteoporosis: treatment Duavee can be used prophylactically in women with what?intact uterus!!!!Osteoporosis: treatment bisphos MOA?inhibits osteoclast and bone resorptionOsteoporosis: treatment which bisphos only reduces vertebral fractures?ibandronate (Boniva)Osteoporosis: treatment Fosamax treatment dosing?10 mg PO daily or 70 mg PO weeklyOsteoporosis: treatment which bisphos come as injectables? (2)ibandronate (Boniva) Zoledronic acid (Reclast)Osteoporosis: treatment what is a CI for all bisphos?hypocalcemia!!!!!Osteoporosis: treatment Boniva IV admin freq? Reclast?3 months yearlyOsteoporosis: treatment Calcitonin brand name?MiacalcinOsteoporosis: treatment PTH analog treatment duration?less than 2 yearsOsteoporosis: treatment Prolia MOA?Mab that binds RANKLOsteoporosis: treatment which bisphos is taken with >4oz water immediately after breakfast?Atelviawhat is the most effective treatment for vasomotor symptoms?systemic hormone therapy with estrogenHormone therapy: estrogen in a women with a uterus?must have progesterone!!!Hormone therapy: micronized progestins brand name?PrometriumHormone therapy: criteria for use of hormone therapy?healthy, symptomatic women who are within 10 years of menopause, <60 yo, and no CIHormone therapy: which patches are applied twice weekly?Vivelle-Dot, Alora, MinivelleHormone therapy: which patches are applied once weekly?Climara and MenostarHormone therapy: what are some natural products used for vasomotor symptoms? (4)black cohosh evening primrose oil red clover soy flaxseed, dong quai, st john, chasteberryHormone therapy: apply Divigel where?upper thighHormone therapy: apply Elestrin where?upper arm and shoulderHormone therapy: apply Estrogel where?entire arm from wrist to shoulderHormone therapy: where is Evamist spray applied?inside of forearm qAMHormone therapy: where are patched applied?below waistline; lower abdomenHormone therapy: paroxetine brand name for vasomotor symptoms?BrisdelleHormone therapy: Brisdelle should not be used with which drugs? (2)warfarin or tamoxifenHormone therapy: Brisdelle inhibits what CYP?2D6!!!Hypogonadism in males: meds that lower testosterone? (4)methadone chemo cimetidine spironolactonehypogonadism in males: testosterone will increase what lab value?hematocrithypogonadism in males: common side effects of testosterone? (3)baldness, acne, gynecomastiahypogonadism in males: what are some new topical testosterone formulations that reduce accidental exposure risk? (2)Fortesta Natestohypogonadism in males: what DEA class schedule are testosterone products?C-IIIhypogonadism in males: Apply Androgel where?upper arms, shoulders, and/or abdomenhypogonadism in males: apply Androderm where?back, abdomen, thighs, upper arms each night!!!