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PHRM 825 > Abnormal Bleeding > Flashcards

Abnormal Bleeding Flashcards

1
Q

Normal Bleeding
* Cycle length: ___ days
* Menstruation lasting ___ days
* ___ mL of blood per day
* median age of menarche ___ years

A
  • 22-35 days
  • 3-7 days
  • 35
  • 12.4 years
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2
Q

Dysmenorrhea definition

A

painful menstruation

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3
Q

Patho of Dysmenorrhea

  • build up of ___ acids in cell membranes, then released
  • ___ and ___ released in the uterus
  • ___ reponse causes symptoms
A
  • fatty acids
  • Prostaglandins and leukotrienes
  • inflammatory
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4
Q

Risk Factors of Dysmenorrhea

  • less than ___ years old
  • weight loss ___
  • depression/anxiety
  • ___ menses
  • menarche before ___ yo
  • no previous ___ (nulliparity)
  • smoking
A
  • 20 yo
  • attempts
  • heavy
  • 12 yo
  • pregnancy
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5
Q

First Line treatments for Dysmenorrhea

A
  • NSAIDS
  • OC
  • non-pharmacologic
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6
Q

Second Line treatments for Dysmenorrhea

A
  • DMPA
  • Levonorgestrel IUD

try IUD before shots

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7
Q

Primary Amenorrhea:
no menses by age ___

A

15

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8
Q

Secondary Amenorrhea: no menses for ___ months in someone who was previously menstruating

A

3 months

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9
Q

Patho of Amenorrhea

  • Uterus and ovaries (___ abnormalities)
  • Pituitary gland (disruption ___)
  • hypothalamus (anorexia, exercise, stress)
A
  • anatomical
  • hormones (GnRH, LH, FSH, and prolactin)
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10
Q

Drug Induced Amenorrhea

  • First-Gen antipsychotics (3)
  • Second-Gen antipsychotics (1)
  • Antihypertensives (1)
  • GI promotility agents (1)
A
  • prochlorperazine, chlorpromazine, haloperidol
  • risperidone
  • verapamil
  • metoclopramide
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11
Q

Treatment for Amenorrhea

If low estrogen is the cause, add estrogen (must also have progestin)
* Conjugated equine estrogen (3)
* Estradiol (patch) (2)

A
  • Premarin, Cenestin, Enjuvia
  • Climara, Vivelle-Dot
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12
Q

Treatment for Amenorrhea

if caused by medications that increase ___ levels, provide dopamine agonist (2)

Contraindications: ___ feeding and uncontrolled ___

A
  • prolactin
  • Bromocriptine and Cabergoline
  • breastfeeding, hypertension
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13
Q

Oligomenorrhea Definition:
Menstrual cycle interval > ___ days (but less than ___ days)

A

35 days, 90 days

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14
Q

T or F: Oligomenorrhea has simialr causes and treatment approaches as amenorrhea

A

True

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15
Q

Polymenorrhea Definition:
menstrual cycle greater than ___ days.

A

21 days

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16
Q

Causes of polymenorrhea (4)

A
  • stress
  • STDs
  • Endometriosis
  • menopause
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17
Q

HMB Definition:
bleeding over ___ mL OR lasting over ___ days

A
  • 80 mL
  • 7 days
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18
Q

Patho of HMB

Hematologic: bleeding/ ____ disolders
Hepatic: ___
Endocrne: ___ thyroidism
Uterine: ___ abnormalities and uterine ___

A
  • clotting
  • Cirrhosis
  • hypothyroidsm
  • structural, fibroids
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19
Q

Chronic HMB Treatment

Hormonal (5)

A
  • CHC
  • progestins
  • Levonorgestrel IUD
  • Danazol
  • GnRH agonists
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20
Q

Chronic HMB Treatment

Non-hormonal (3)

A
  • NSAIDs
  • Tranexamic Acid
  • Iron
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21
Q

Contraindiations to tranexamic acid:
* active or history of ___ or pulmonary ___
* history of ___

A
  • DVT, embolism
  • seizure
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22
Q

Acute HMB Treatment

  1. high dose ___
  2. ___ 20 mg PO TID x7 days
  3. ___ acid
A
  • estrogen
  • medroxyprogesterone
  • tranexamic
23
Q

Metrorrhagia Definition:
Irregular menstrual bleeding ___ cycles

A

between

24
Q

Causes of Metrorrhagia

A
  • hormone imbalance
  • Fibroids, polyps,endometriosis
  • Medications
  • IUDs
  • infections
25
Q

Endometriosis Definition:
Pelvic inflammatory condition associated with growth of endometrial tissue found ___ the uterus

A

outside

26
Q

T or F: Endometriosis had the same risk factors as dysmenorrhea

A

True

27
Q

Most supported theory behind endometriosis: ___ menstrual flow

A

retrograde

28
Q

First line endometriosis treatment (3)

A
  • NSAIDs
  • CHCs
  • Progestins
29
Q

Second line endometriosis treatment (2)

A
  • GnRH agonsits/antagonists
  • Danazol
30
Q

Third line endometriosis treatment (1)

A
  • aromatase inhibitors
31
Q

Danazol is an ___ that supresses ___ and ___.
* Blackbox warning for ___
* containdicated in ___ and ___feeding

A

androgen, LH, FSH
* thromboembolism
* pregnancy and breastfeeding

32
Q

T or F: the patho of fibroids is not well understood

A

True

33
Q

Risk factors for fibroids:
* ___ race
* time since last ___
* premenopausal
* hyperstension
* menarche less than ___ yo

A
  • black
  • birth
  • 10
34
Q

protective factors against fibroids
* smoking
* more than ___ pregnancies
* hormonal ___ use

A
  • 3
  • contraception
35
Q

Treatment of fibroids

  • NSAIDs
  • hormonal contraception
  • ___ acid
  • ___ agonists
  • selective ___ receptor modulators (SPRM)
A
  • tranexamic
  • GnRH
  • progesterone
36
Q

GnRH Agonists for Uterine Fibroids

  • ___ term preoperative
  • ___ size
  • __ blood loss
  • Decrease ___ and ___ time
  • long term treatment associated with ___ symptoms and ___ loss
  • Increased recurrence risk with ___
A
  • short
  • decrease
  • decrease
  • operative and recovery
  • menopausal, bone
  • myomectomy
37
Q

SPRM for Uterine Fibroids

  • ___ term preoperative
  • ___ size
  • decrease blood ___
  • Decrease ___ and ___ time
  • not associated with ___ estrogenic effect
  • increased recurrence risk with ___
  • HA and ___ tenderness

not FDA-approved
* mifepristone ___ mg daily
* ulipristal ___ mg daily

A
  • short
  • decrease
  • loss
  • operative and recovery
  • hypo-estrogenic
  • myomectomy
  • breast
  • 10-50 mg
  • 5-10 mg
38
Q

T or F: Fibroids can increase the risk of complications during pregnancy

A

True; can rseult in miscarriage, premature, abnormal fetal position, and placental abruption

39
Q

PMS

Must have at least 1 symptom (affective or somatic) for at least ___ menstrual cycles

A

3

40
Q

PMDD

included in the DSM-5
* must have at least ___ symptoms with at least 1 in 2 different criteria for ___ consecutive months

A
  • 5 symptoms
  • 2 months
41
Q

PMS and PMDD similarities

  • Onset: 5-7 days prior to menses (during the ___ phase)
  • Symptoms ending at the start of the ___ phase (onset of menses)
  • Requires ___ free period for diagnosis
A
  • luteal
  • follicular
  • symptom
42
Q

Patho of PMS/PMDD

Largely unknown, many theories:
* reduced levels of ___, ___, and ___
* fluctuations in ___ and ___

A
  • serotonin
  • GABA
  • allopregnanolone
  • estrogen
  • progesterone
43
Q

PMS/PMDD First Line Treatment

A
  • SSRIs
  • NSAIDs
  • Spironolactone
44
Q

PMS/PMDD Second Line Treatment

A
  • Venlafaxine
  • Duloxetine
  • Clomipramine
  • Alprazolam
  • COCs
45
Q

PMS/PMDD Last Line Treatment

A
  • GnRH agonists
  • Surgery
46
Q

Patients on SSRIs typically see improvement in symptoms within ___ menstrual cycles

A

2-3

47
Q

FDA approved SSRIs for PMS/PMDD
* Fluoxetine ___ mg daily
* Sertraline ___ mg daily
* Paroxetine CR ___ mg daily

A
  • 20 mg
  • 50-150 mg
  • 12.5-25 mg
48
Q

Spironolactone for PMS/PMDD

  • Non-FDA approved indication
  • antimineralcorticoid and antiandrogenic effects interfere with ___ synthesis
  • Dose: ___ mg daily on days ___
  • decreases fluid ___, somatic symptoms, ___ tenderness, and low mood
  • SE: ___kalemia and irregualr menses
A
  • testosterone synthesis
    *100 mg, 15-28
  • retention, breast
  • hyperkalemia
49
Q

Second Line options for PMS/PMDD in order

A
  1. SNRIs
  2. COCs
  3. Clomipramine
  4. Alprazolam
50
Q

T or F: for second line treatment of PMS/PMDD you should consider Alprazolam beforeClomipramine

A

False; Xanax is last option

51
Q

How SSRIs Help PMS/PMDD

  • emotional and physical symptoms
  • ___ funtioning
  • work performancy
  • quality of life
A

psychosocial

52
Q

How Spironolactone Helps PMS/PMDD

  • ___ tenderness
  • bloating
  • ___ mood
A
  • breast
  • low
53
Q

How COCs Help PMS/PMDD

  • physcial symptoms: bloating, HA, abdominal pain, breast tenderness
  • ___ functioning and productivity

***COC can also cause physical symptoms

A

social

54
Q

How Alprazolam helps PMS/PMDD

  • depression
  • tension
  • anxiety
  • irritability
  • hostility
  • and ___ withdrawal
A

social

PHRM 825 (49 decks)

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