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Toronto Notes 2019 Common Medications
Gynecology GY51
Common Medications
Table 32. Common Medications
Drug Name (Brand Name)
acyclovir (Zovirax®) bromocriptine (Parlodel®)
clomiphene citrate (Clomid®)
clotrimazole (Canesten®)
danazol (Cyclomen® – CAN) (Danocrine® – US)
doxycycline fluconazole (Diflucan®) leuprolide (Lupron®)
menotropin (Pergonal®)
metronidazole (Flagyl®)
oxybutinin (Ditropan®)
Action
Antiviral; inhibits DNA synthesis and viral replication
Dopaminomimetic Agonist at D2R Antagonist at D1R
Acts directly on anterior pituitary cells to inhibit synthesis and release of prolactin
Increases output of pituitary gonadotropins which induces ovulation
Antifungal; disrupt fungal cell
membrane x7dor200mg/dx3dor500mgx1dose
Synthetic steroid that inhibits pituitary gonadotropin output and ovarian steroid synthesis
Has mild androgenic properties
Tetracycline derivative; inhibit protein synthesis
Antifungal; disrupt fungal cell membrane
Synthetic GnRH analog Induces reversible hypoestrogenic state
Human gonadotropin with FSH and LH effects; induce ovulation and stimulate ovarian follicle development
Bactericidal; forms toxic metabolites which damage bacterial DNA
Anticholinergic – relaxes bladder smooth muscle, inhibits involuntary detrusor contraction
Cream (1 or 2%): 1 applicator intravaginally qhsx3-7d
Topical: apply bid x 7 d
200-800 mg in 2-3 divided doses Used for 3-6 mo
Biannual hepatic U/S required if >6 mo use
100 mg PO bid x ≥7 d
150 mg PO x 1 dose
3.75 mg IM q1mo or 11.25 mg IM q3mo Usually ≤6 mo, check bone density if
>6 mo
Retreatment with Lupron® alone not recommended because of effects on bone density
75-150 U of FSH and LH IM OD x 7-12 d, then 10,000 U HCG one day after last dose
2 g PO x 1 dose or 500 mg PO bid x 7 d
5 or 10 mg/d PO
May increase doses by 5 mg weekly to a max of 30 mg/d
Dosing Schedule
First Episode: 400 mg PO tid x 7-10 d Recurrence: 400 mg PO tid x 5 d
Initial: 1.25-2.5 mg PO qhs with food Then: increase by 2.5 mg every 2-7 d as needed until optimal therapeutic response Usual Range: 1.5-15 mg OD
For IVF:
Initial: 1.25 mg/d PO between days 4-6 of follicular phase
Then: 2.5 mg/d until 3 d after onset menstruation
50 mg OD x 5 d
Try 100 mg or 160 mg OD
if ineffective 3 courses = adequate trial
Indications
Genital herpes
Galactorrhea + amenorrhea
2° to hyperprolactinemia Prolactin-dependent menstrual disorders and infertility Prolactin-secreting adenomas (microadenomas, prior to surgery of macroadenomas)
IVF
Patients with persistent ovulatory dysfunction (e.g. amenorrhea, PCOS) who desire pregnancy
Vulvovaginal candidiasis
Endometriosis
1° menorrhagia/DUB
Chlamydia, gonococcal infection, syphilis
Vulvovaginal candidiasis unresponsive to clotrimazole
Endometriosis Leiomyomata
DUB
Precocious puberty
Infertility
Bacterial vaginosis, trichomonas vaginitis
Overactive bladder (urge incontinence)
Side Effects (S/E), Contraindications (C/I), Drug Interactions (D/I)
S/E: headache, GI upset D/I: zidovudine, probenecid
S/E: N/V, headache, postural
hypotension, somnolence
C/I: uncontrolled HTN, pregnancy-induced HTN, CAD, breastfeeding
D/I: domperidone, macrolides, octreotide
S/E: Common – hot flashes, abdominal
discomfort, exaggerated cyclic ovarian enlargement, accentuation of Mittelschmerz
Rare – ovarian hyperstimulation syndrome,
multiple pregnancy, visual blurring, birth defects
C/I: pregnancy, liver disease, hormone-dependent tumours, ovarian cyst, undiagnosed vaginal bleeding
S/E: vulvar/vaginal burning
S/E: weight gain, acne, mild hirsutism, hepatic dysfunction
C/I: pregnancy, undiagnosed vaginal bleeding, breastfeeding, severely impaired renal/hepatic/cardiac function, porphyria, genital neoplasia, thromboembolic disease
D/I: warfarin, carbamazepine,cyclosporine, tacrolimus, anti-hypertensives
S/E: GI upset, hepatotoxicity
C/I: pregnancy, severe hepatic dysfunction D/I: warfarin, digoxin
S/E: headache, rash, N/V, abdominal pain, diarrhea D/I: terfenadine, cisapride, astemizole, hydrochlorothiazide, phenytoin, warfarin, rifampin
S/E: hot flashes, sweats, headache, vaginitis, reduction in bone density, acne, GI upset
C/I: pregnancy, undiagnosed vaginal bleeding, breastfeeding
S/E: bloating, irritation at injection site, abdominal/pelvic pain, headache, N/V, multiple pregnancy
C/I: primary ovarian failure, intracranial lesion (e.g. pituitary tumour), uncontrolled thyroid/adrenal dysfunction, ovarian cyst (not PCOS), pregnancy, undiagnosed uterine bleeding
S/E: headache, dizziness, N/V, diarrhea, disulfiram-like reaction (flushing, tachycardia, N/V)
C/I: pregnancy (1st trimester)
D/I: cisapride, warfarin, cimetidine, lithium, alcohol, amiodarone, milk thistle, carbamazepine
S/E: dry mouth/eyes, constipation, palpitations, urinary retention, dizziness, headache
C/I: glaucoma, GI ileus, severe colitis, obstructive uropathy, use with caution if impaired hepatic/renal function
Tablet: 100 mg/d intravaginally