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too much estrogen
HTN, melasma, nausea
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too little estrogen
early/mid-cycle breakthrough bleeding, increased spotting, hypomenorrhea
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too much progestin
fatigue, changes in mood
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too little progestin
late breakthrough bleeding
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most potent progestin
desogestrel, levonorgestrel, norgestrel
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least potent progestin
norgestimate
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most androgenic progestin
norgestrel
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least androgenic progestin
desogestrel, norgestimate
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anti-androgenic progestin
drospirenone
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only four-phasic pill
Natazia (estradiol valerate + dienogest)
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365 day a year pill
Lybrel (ethinyl estradiol + levonorgestrel)
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oxytocin (Pitocin) interaction
simpathomimetics (increased risk of severe HTN)
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oxytocin BBW/caution
not for elective labor induction. hypotension c rapid infusion.
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reproductive prostaglandins (PGE1, PGE2, PGF2a)
misoprostol (Cytotec), dinoprostone (Hemabate), carboprost
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reproductive prostaglandins indications (PGE1/PGE2; PGF2a)
labor induction and cervical ripening; postpartum hemorrhage (not first line)
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reproductive prostaglandins BBW/contraindications
not for pregnant pts (abortion), women of child-bearing potential. contraindicated c severe asthma, glaucoma, MI.
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antitussives: centrally acting
dextromethorphan, codeine (Cheratussin AC), hydrocodone
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antitussives: peripherally acting
camphor, menthol, benzonatate (Tessalon)
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dextromethorphan interaction
dextromethorphan + MAOI (seritonin storm)
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benzonatate BBW
severe hypersensitivity rxns (bronchospasm, laryngospasm, CV collapse) possibly related to local anesthesia from sucking/chewing capsule instead of swallowing it
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decongestants: direct alpha-1 agonists (work best topically)
phenylephrine, oxymetazolone (opthalmic Visine), naphazoline (opthalmic Naphcon/Visine A)
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decongestants: indirect alpha-1 agonists (work best orally)
pseudoephedrine, ephedrine
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decongestant interactions
decongestant + MAOI (hypertensive crisis)
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rebound congestion
Rhinitis Medicamentosa
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H1 antagonists: first gen
chlorpheniramine, brompheniramine, cyproheptadine, clemastine
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H1 antagonists: second gen
loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra)
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fexofenadine dosing
Allegra: 60mg PO BID or 180mg PO qd
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Cherratussin AC dosing
codeine/guaifenesin 10/100/5mL, 10-20mg codeine (1-2 tsp) PO q4-6h PRN
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dual antihistamine/mast cell stabilizer
epinastine (Elestat)
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Mast Cell Stabilizers
cromolyn. opthalmic nedocromil and lodoxamide.
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Opthalmic Prostaglandins
latanoprost (Xalatan), travoprost (Travatan), bimatoprost (Lumigan)
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Opthalmic Prostaglandins MOA
increase intraocular outflow via uveoscleral route (not Schlemm's canal)
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latanoprost dosing
Xalatan, 1ggt in eye(s) qpm
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Aptamers
pegaptanib (Macugen)
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pegaptanib MOA
Macugen: binds to vascular endothelial growth factor, inhibiting the proliferation of blood vessels and reducing blood vessel permeability/leakage
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pegaptanib dosing
injected directly into the eye!
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Topical Corticosteroids super-high
super-high: clobetasol (Temovate) 0.05%
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Topical Corticosteroids high
high: fluocinonide (Lidex) 0.05%
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Topical Corticosteroids medium
medium: triamcinolone acetonide (Kenalog) 0.1%
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Topical Corticosteroids low
low: fluocinolone acetonide 0.01%, desonide 0.05%, hydrocortisone 1%
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Benzoyl peroxide MOA
both antibacterial and comedolytic properties. penetrates the stratum corneum or follicular openings where it is converted to benzoic acid.
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Benzamycin
benzoyl peroxide + erythromycin
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BenzaClin
benzoyl peroxide + clindamycin
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Epiduo
benzoyl peroxide + adapalene
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Benzoyl peroxide c oral antibiotics (TCAs)
combo helps prevent antibiotic resistance. No go in pregnancy.
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Azelaic acid brand
gel form = Finacea, cream - Azelex
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Topical Antifungals: both candida/dermatophytes
imidazoles (fungastatic) ("azoles")
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Topical Antifungals: dermatophytes only
allylamines and benzylamines (fungicidal) ("afines")
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Topical Antifungals: candida only
polyenes (fungistatic) (nystatin)
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Topical Vitamin D analogs
calcipotriene, calcitriol
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Topical Vitamin D MOA
inhibit keratinocyte proliferation
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Taclonex
calcipotriene/betamethason (Vitamin D analog/anti-immune)
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Keratolytics
salicylic acid, lactic acid, urea
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imiquimod MOA
modifies immune response to skin (increases inflammation in dermis -> eradication of abnormal cells)
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imiquimod indications
actinic keratoses, basal cell carcinoma, genital/perianal warts
-
imiquimod dosing
16 wks max (6 wks for BCC)
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