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Therapeutics > 47: Abnormal Uterine Bleeding > Flashcards

47: Abnormal Uterine Bleeding Flashcards

1
Q

Drug chart study guide

A

fill it out

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2
Q

Normal bleeding

A

-22-35 day cycle
-35mL blood/day
-menstruation 3-7 days

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3
Q

Types of abnormal bleeding

A

-dysmenorrhea
-amenorrhea
-oligomenorrhea
-polymenorrhea
-heavy menstrual bleeding (HMB)
-metrorrhagia

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4
Q

Dysmenorrhea

A

-painful menstruation
-17-90%

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5
Q

primary dysmenorrhea

A

-normal ovulatory cycles and pelvic anatomy

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6
Q

secondary dysmenorrhea

A

-underlying anatomic or physiologic cause

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7
Q

Pathophysiology of dysmenorrhea

A

-buildup of fatty acids in cell membranes, then released
-prostaglandins and leukotrienes released in uterus
-inflammatory response causes symptoms

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8
Q

Risk factors of dysmenorrhea

A

-<20 y/o
-weight loss attempts
-depression/anxiety
-heavy menses
-menarche before 12 y/o
-nulliparity
-smoking
-family history

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9
Q

Symptoms of dysmenorrhea

A

-crampy pelvic pain
-nausea/vomiting
-diarrhea
-headache
-muscle cramps
-dizziness

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10
Q

Goals of therapy for dysmenorrhea

A

-provide symptomatic relief
-reduce lost productivity
-improve QOL

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11
Q

First line treatment for dysmenorrhea

A

-NSAID
-oral contraceptives
-non-pharmacologic

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12
Q

second-line treatment for dysmenorrhea

A

-DMPA
-LNG IUD

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13
Q

Nonpharmacologic treatment of dysmenorrhea

A

-heating pad
-exercise
-omega 3, vit B, ginger
-smoking cessation
-acupuncture

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14
Q

NSAID therapy mech

A

-inhibits COX 1 and 2
-dec prostaglandin production

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15
Q

NSAID dosing

A

-taken around the clock 1-2 days before cycle start
-short-term use

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16
Q

Pros of NSAID therapy

A

-good for those wanting to conceive
-short-term
-pain relief within hours
-cheap, otc

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17
Q

cons of NSAID therapy

A

-intolerable side effects
-not great for CV risk

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18
Q

NSAID side effects and precautions

A

-GI bleeding/ulcers
-renal injury
-onset of CV, inc HTN

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19
Q

NSAID counseling

A

-take w food or milk to minimize GI upset
-monitor for abnormal bleeding
-scheduled dosing vs PRN

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20
Q

Oral contraceptive therapy mech

A

-inhibit endometrial tissue proliferation
-dec endometrial production of prostaglandins and leukotrienes

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21
Q

oral contraceptive therapy dosing

A

-CHCs
-efficacy noted w cyclic vs continuous regimens (one isn’t better than the other)

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22
Q

Pros of hormone therapy

A

-appropriate for those seeking contraception
-can be used w NSAIDs

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23
Q

cons of hormone therapy

A

-not appropriate for pt wanting pregnancy
-Rx needed
-delayed relief (1-2 months)

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24
Q

side effects and precautions of hormone therapy

A

-inc BP
-weight gain
-fluid retention
-risk of clots and stroke

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25
Q

pt counseling and education

A

-monitor for nausea, HA, boob hurt, mood swings

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26
Q

LNG IUD or DMPA therapy

A

-related to amenorrhea side effect
-beneficial in those who want contraception
-delayed relief
-try IUD before DMPA

27
Q

Dysmenorrhea monitoring and follow up

A

-asses symptom improvement
-if symptoms have not lessened or resolved in 3-6 months, REFER

28
Q

Amenorrhea

A

-absence of menstrual cycle

29
Q

primary amenorrhea

A

-no menses by 15
-less than 0.1%

30
Q

secondary amenorrhea

A

-no menses x 3 months in previously menstruating women
-3-4%

31
Q

Amenorrhea symptoms

A

-often asymptomatic
-can be accompanied by weight loss/gain
-often a symptom itself rather than condition

32
Q

Some causes of amenorrhea

A

-PCOS, low BMI, ED, excessive exercise
-medications

33
Q

Tests to preform if amenorrhea

A

-preg test
-FSH/LH levels
-TSH
-prolactin
-estrogen

34
Q

Amenorrhea pathophysiology

A

-abnormalities in uterus or ovaries
-disruption to pituitary hormones
-stress and ED effect hypothalmus

35
Q

Drug induced amenorrhea

A

-some antipsychotics (Prochlorperazine, chlorpromazine, haloperidol, risperidone)
-some antidepressants
-MAOIs
-anti-HTN (verapamil)
-GI promotility agents (metoclopramide)

36
Q

Goals of therapy for amenorrhea

A

-ovulation restoration
-bone density preservation
-bone loss prevention

37
Q

First-line treatment of amenorrhea

A

-rule out pregnancy
-determine underlying cause

38
Q

Treatment for ED related ammenorrhea

A

-gain weight
-cut back on exercising
-go to therapy

39
Q

treatment for medication induced amenorrhea

A

-may consider alternative agents that do NOT inhibit dopamine receptor or inc prolactin levels
-OR initiate dopamine agonist

40
Q

Treatment of hypoestrogenic amenorrhea

A

-provide supplemental estrogen
-must include progestin component

41
Q

dopamine agonists

A

-bromocriptine (muliple x day)
-cabergoline (weekly or twice weekly)

42
Q

contraindications of dopamine agonists

A

-breastfeeding
-uncontrolled HTN

43
Q

side effects of dopamine agonists

A

-N/D
-HA
-orthostatic hypotension
-fatigue

44
Q

Monitoring and follow up of dopamine agonists

A

-side effects
-take BP, HR, liver/kidney function, preg status, prolactin level
-should take 6-8weeks to resolve
-if not, try the other agent

45
Q

Oligomenorrhea

A

-cycle >35 days but less than 90
-overlaps with amenorrhea

46
Q

oligomenorrhea causes and treatment approaches

A

-similar to amenorrhea

47
Q

Polymenorrhea

A

-menstrual cycle less than 21 days
-may cause challenges in conceiving

48
Q

Common causes of polymenorrhea

A

-stess
-STDs
-endometriosis
-menopause

49
Q

Heavy menstrual bleeding

A

-more than 80mL of blood OR lasting more than 7 days
-18-30% of gyno visits

50
Q

heavy menstrual bleeding pathophysiology

A

-bleeding/clot disorders
-cirrhosis
-HYPOthyroidism
-uterine abnormalities
-uterine fibroids (most ofteN)

51
Q

Symptoms of heavy menstrual bleeding

A

-heavy flow
-with or without pain
-possibly fatigue and lightheadedness

52
Q

Goals of therapy for heavy menstrual bleeding

A

-reduce flow
-correct iron-deficiency anemia or underlying disorders
-improve QOL

53
Q

heavy menstrual bleeding treatment options

A

-acute vs chronic
-hormonal vs nonhormonal

54
Q

Hormonal treatment of heavy menstrual bleeding

A

-CHC
-progestin
-LNG IUD
-Danazol
-GnRH agonists

55
Q

nonhormonal treatment of heavy menstrual bleeding

A

-NSAIDs
-tranexamic acid
-iron to treat anemia

56
Q

Tranexamic acid mech of action

A

-antifibrinolytic
-prevents degradation of blood clots

57
Q

Tranexamic acid dosing

A

-1,300mg PO TID for 5 days at onset of menses
-use only during menses

58
Q

tranexamic acid contraindications

A

-DVT or pulmonary embolism
-h/o seizure

59
Q

side effects of tranexamic acid

A

-not too bad
-maybe HA or nasal symptoms

60
Q

Drug class ranking by reduction in blood loss

A

-LNG IUD
-oral progestin
-CHCs
-tranexamic acid
-NSAIDs

61
Q

Metrorrhagia

A

-irregular bleeding between cycles

62
Q

Metrorrhagia causes

A

-hormone inbalance
-fibroids, polyps, endometriosis
-meds
-IUDs
-infections

63
Q

treatment of metrorrhagia

A

-target underlying cause
-hormonal contraceptive

Therapeutics (78 decks)

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