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Therapeutics > 50: Endometriosis and PMS > Flashcards

50: Endometriosis and PMS Flashcards

1
Q

Endometriosis

A

-Pelvic inflammatory condition associated w growth of endo tissue found outside uterus

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2
Q

Endometriosis presentation

A

-asymptomatic
-dysmenorrhea
-infertility
-dyspareunia
-pelvic pain
-heavy bleeding
-fatigue
-painful bowels
-ab bloating
-flank pain

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3
Q

Risk factors for endometriosis

A

-under 20yo
-weight loss attempts
-depression/anxiety
-heavy menses
-menarche before 12
-nulliparity
-smoking
-fam history

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4
Q

Endometriosis pathophysiology

A

-most likely retrograde menstrual flow
?

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5
Q

Goals of therapy for endometriosis

A

-minimize endometrial lesions
-prevent progression
-minimize pain
-treat infertility

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6
Q

Nonpharmacologic treatments for endometriosis

A

-exercise
-acupuncture
-massage
-CBT
-surgery

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7
Q

First line treatment of endometriosis

A

-NSAIDs
-CHCs
-Progestins

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8
Q

Second line treatment of endometriosis

A

-GnRH agonists/antagonists
-Danazol

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9
Q

third line treatment of endometriosis

A

-aromatase inhibitors

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10
Q

Danazol

A

-androgen that supresses FSH and LH
-previously widely used now reserved for later treatment consideration
-bad side effects
-do NOT take if preg/breastfeeding

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11
Q

Danazol dosing

A

-PO BID

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12
Q

Danazol side effects

A

-weight gain
-acne
-hirstuism
-lipid abnormalities
-liver probs
-change in blood sugar

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13
Q

Danazol black box warning

A

-thromboembolism

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14
Q

Danazol contraindication

A

-preg
-breastfeeding

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15
Q

Endometriosis monitoring and follow up

A

-assess symptom improvement

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16
Q

Uterine Fibroids (leiomyomas)

A

-common non cancerous growths in uterus
-developing in up to 70-80% by age 50

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17
Q

Fibroid anatomy

A

-smooth muscle cells and fibroblasts of myometrium
-classified based on location
-vary in size and number

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18
Q

Fibroid classification

A

-intramural
-submucosal
-subserosal

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19
Q

Fibroid pathophysiology

A

-not well understood
-inc estrogen and progesterone = inc mitotic rate and prob mutations
-genetic factors
-response to injury (inc prostaglandins and vasopressin with onset of menses)

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20
Q

Risk factors for fibroids

A

-black race
-age
-family history
-time since last birth
-premenopausal
-HTN
-early menarche before 10 yo

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21
Q

protective factors against fibroids

A

-smoking
-more than 3 pregnancies
-hormonal contraception use

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22
Q

Symptoms of uterine fibroids

A

-asymp
-heavy bleeding (anemia and fatigue)
-dysmenorrhea
-noncyclic pain
-ab protrudance
-painful sex
-bladder/bowel dysfunction
-repro probs

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23
Q

Fibroid treatment considerations

A

-severity of symptoms
-patient age
-reproductive plans

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24
Q

Goals of therapy for fibroids

A

-reduce size or remove
-reduce symptoms
-respect fertility wishes
-improve QOL

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25
Q

Non-pharmacologic treatment of fibroids

A

-expectant therapy
-myomectomy (remove fibroids but keep fertility)
-hysterectomy

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26
Q

Treatment overview for fibroids

A

-NSAIDs
-hormonal contraceptives
-tranexamic acid
-GnRH agonists
-SPRM

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27
Q

GnRH agonist use for fibroids

A

-only for 3-6 months near menopause
-decrease size
-sec blood loss, surgery and recovery time

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28
Q

GnRH agonist disadvantages

A

-long-term use more $$, menopausal symptoms and bone loss
-inc recurrence risk w myomectomy

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29
Q

GnRH agonist fertility impact

A

-dependent on subsequent procedure

30
Q

SPRM use in fibroids

A

-short-term pre-op or near menopause
-decrease size
-dec blood loss and recovery time
-NOT associated with HYPO estrogenic effects

31
Q

SPRM disadvantages

A

-HA and breast hurt
-PRM-associated endometrial changes
-inc fibroid recurrence risk with myomectomy

32
Q

SPRM fertility impact

A

-dependent on subsequent procedure

33
Q

SPRM regimens

A

-mifepristone 10-50mg
-ulipristal 5-10mg

-not FDA approved for fibroids

34
Q

Complications of fibroids in pregnancy

A

-miscarriage
-premature labor and delivery
-abnormal fetal postition
-placental abruption

35
Q

Treatment of fibroids in pregnancy

A

-avoid myomectomy unless it cannot be safely delayed
-pain management w acetaminophen, NSAID, or opioid

36
Q

Premenstrual syndrome (PMS)

A

-at least one symptom x 3 cycles

37
Q

Premenstrual Dysphoric Disorder (PMDD)

A

-DSM-5
-at least 5 symptoms with at least on in 2 dif critera x 2 consecutive months

38
Q

PMS and PMDD similarities

A

-onset 5-7 days before period
-end at onset of menses
-require symptom-free period for diagnosis
-some level of impairment to QOL
-no definitive test
-more than 200 symptoms

39
Q

PMDD diagnostic symptoms (need at least one)

A

-affective lability
-irritability
-depression
-anxiety

40
Q

PMDD diagnostic symptoms (need at least one)

A

-dec interest in activities
-hard to concentrate
-lethargy
-change in appetite
-hyper or insomnia
-overwhelming feelings
-physical symptoms

41
Q

Pathophysiology of PMS and PMDD

A

-reduce levels of serotonin, GABA, and allopregnanolone
-fluctuations in estrogen and progesterone

42
Q

Goals of therapy for PMS/PMDD

A

-improve/resolve symptoms
-improve productivity and relationships
-improve QOL

43
Q

Nonpharmacologic treatment of PMS and PMDD

A

-limit sodium, caffeine, alcohol
-aerobic exercise
-relaxation techniques
-sleep schedule
-calcium (1200mg/day)
-magnesium (200-400mg/day)
-vitamin B, D, E

44
Q

First line treatment of PMS/PMDD

A

-SSRIs
-NSAIDs
-spironolactone

45
Q

Second line treatment of PMS/PMDD

A

-venlafaxine
-Duloxetine
-Clomipramine
-Alprazolam
-COCs

46
Q

last line treatment of PMS/PMDD

A

-GnRH agonists
-surgery

47
Q

Complementary therapy treatment of PMS/PMDD

A

-Ginkgo
-St. John’s Wort

48
Q

SSRIs FDA approved for PMDD

A

-Fluoxetine 20mg daily
-Sertraline 50-150mg daily
-Paroxetine CR 12.5-25mg daily

49
Q

SSRI intermittent dosing

A

-start day 14
-stop 1-2 days after onset of menses

50
Q

SSRIs not FDA approved but can treat PMDD

A

-citalopram 20-30mg daily
-escitalopram 10-20mg daily

51
Q

Continuous/daily dosing of SSRIs for PMDD

A

-mood symptoms outside of luteal phase
-irreg cycle
-intolerable side effects upon discontinuation
-difficulties with on/off schedule

52
Q

SSRI black box warning

A

-inc risk of suicidal thinking and behavior in children, adolescents, and young adults with depression

53
Q

SSRI side effects

A

-nausea
-drowsiness
-sex sydfunction
-sweating
-insomnia
-diarrhea
-HA
-weight gain

54
Q

improvement of symptoms after SSRI treatment

A

-within 2-3 cycles

55
Q

Spironolactone

A

-non FDA approved indication for PMDD
-antimineralocorticoid and antiandrogenic effects interfere w testosterone synthesis

56
Q

Spironolactone dose

A

-100mg daily days 15-28

57
Q

Spironolactone advantages

A

-dec weight gain
-somatic symptoms (breast and bloating)
-negative mood

58
Q

Spironolactone side effects

A

-hyperkalemia
-somnolence
-irreg menses
-diarrhea
-nausea
-headache

59
Q

SNRIs for PMS/PMDD

A

-Venlafaxine 75-112 mg during luteal phase or 50-200 mg daily
-Duloxetine 60mg daily
-try before other second line options

60
Q

SNRI side effects

A

-headache
-inc BP

61
Q

COCs for PMS

A

-EE 20mcg/drospirenone 3mg qd for 24days
-use if they want contraception
-use before clomipramine and alprazolam

62
Q

Clomipramine

A

-2nd line
-25-75mg daily
-consider before alprazolam

63
Q

Clomipramine side effects

A

-blurred vision
-dry mouth
-constipation
-fatigue
-Headache

64
Q

Alprazolam

A

-2nd line for PMS
-0.23-1mg TID-QID during luteal phase
-try other 2nd lines first

65
Q

Alprazolam side effects

A

-sedation
-drowsiness
-risk of dependence

66
Q

SSRI relieve which symptoms

A

-mood
-physical
-social functioning
-work performance and QOL

67
Q

Spironolactone relieves which symptoms

A

–breast tenderness
-bloating
-mood

68
Q

COCs relieve which symptoms

A

-physical but it can also cause these
-social functioning and productivity

69
Q

Alprazolam relieves which symptoms

A

-depression
-tension
-anxiety
-irritability
-hostility
-social withdrawal

70
Q

Monitoring and follow up of PMS treatment

A

-evaluate symptoms

Therapeutics (78 decks)

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