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PHRM 825 Exam 5 > AUB, Endometriosis, PMS, PMDD > Flashcards

AUB, Endometriosis, PMS, PMDD Flashcards

1
Q

Dysmenorrhea

A

Pain associated with menstruation

Primary: normal ovulatory cycles
Secondary: underlying anatomic or physiologic cause

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2
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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3
Q

Symptoms dysmenorrhea

A

dizziness
cramps
muscle cramps
nausea
vomiting
diarrhea
headache

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4
Q

First line therapy for dysmenorrhea

A

NSAIDs
Oral Contraceptives +/-
Non-pharmacologic

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5
Q

Second line therapy for dysmenorrhea

A

DMPA
Levonorgestrel-releasing IUD

TRY LEVONORGESTREL BEFORE DMPA

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6
Q

Nonpharmacologic treatment for dysmenorrhea

A

heating pad
exercise
omega-3 fatty acids, vitamin B, ginger
smoking cessation
acupuncture

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7
Q

EXAMPLE NSAIDS FOR DYSMENORRHEA

A

CELECOXIB
DICLOFENAC
IBUPROFEN
NAPROXEN

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8
Q

PROS/CONS of NSAID therapy for dysmenorrhea

A

PROS: Good for those wanting to conceive
short-term use
pain relief within hours

CONS: side effects can be intolerable
not a great option for those with CV history

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9
Q

PROS/CONS of Hormone therapy for dysmenorrhea

A

PROS: good for those seeking contraception
can be used in combination with NSAIDs

CONS: not good for those wanting to become pregnant
RX
DELAYED RELIEF

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10
Q

AMENORRHEA

A

Absence of cycle

Primary: no menses by age 15
Secondary: no menses for 3 months in previous menstruating women

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11
Q

Pathophysiology of amenorrhea

A

Uterus and Ovaries: anatomic abnormalities

Pituitary gland: disruption to GnRH, LH, FSH, and prolactin hormones

Hypothalamus: anorexia nervosa, bulimia, intense exercise, stress

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12
Q

DRUG-INDUCED AMENORRHEA

A

First generation antipsychotics: prochlorperazine, chlorpromazine, and haloperidol

Second-generation antipsychotics: risperidone

Antihypertensives: verapamil

GI promotility agents: metoclopramide

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13
Q

Goals of therapy for amenorrhea

A

Ovulation restoration

Bone density preservation

Bone loss prevention

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14
Q

Amenorrhea first line therapy

A

Rule out pregnancy
Determine underlying cause

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15
Q

If cause is hypoestrogenic for amenorrhea then

A

conjugated estrogen

Patch

must include a progestin component

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16
Q

Oligomenorrhea

A

menstrual cycle interval > 35 days but less than 90

overlaps with amenorrhea

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17
Q

Polymenorrhea

A

menstrual cycle interval < 21 days which results in trouble conceiving because no time to ovulate

causes can be from stress, STDs, Endometriosis, Menopause

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18
Q

Heavy Menstrual Bleeding (HMB)

A

bleeding > 80 ml or lasting > 7 days

interferes with women’s physical, social, emotional, or QOL

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19
Q

HMB patho

A

MUST RULE OUT: pregnancy, ectopic pregnancy, miscarriage

Hematologic: bleeding/clotting disorders
Hepatic: cirrhosis
Endocrine: hypothyroidism
Uterine: structural abnormalities, uterine fibroids

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20
Q

Symptoms of HMB

A

Heavy flow with menstruation

With or without pain

Fatigue and lightheadedness

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21
Q

Goals of therapy

A

Reduce menstrual blood flow

Correct iron-deficiency anemia or underlying disorders

Improve QOL

22
Q

Hormonal treatment of HMB

A

CHC
Progestin
Levonorgestrel IUD
Danazol
GnRH agonists

23
Q

Non hormonal treatment of HMB

A

NSAID
Tranexamic acid
Iron

24
Q

Tranexamic acid

A

MOA: antifibrinolytic- prevents degradation of blood clots

Dosing: 1300 mg TID for 5 days

Short term use

Nonhormonal for those wanting to conceive

Can cause HA and nasal symptoms

25
REDUCTION IN BLOOD LOSS
NSAID: 10-51% CHC: 30-60% PROGESTIN: 80% TRANEXAMIC ACID: 50% LEVONORGESTREL IUD: 97%
26
Acute HMB treatment
High dose estrogen If contraindicated for estrogen then Medroxyprogesterone If contraindications for HT then use tranexamic acid
27
Metrorrhagia
irregular bleeding between cycles
28
Endometriosis (causes/symptoms)
pelvic inflammatory condition associated with growth of endometrial tissue found outside the uterus asymptomatic to severe symptoms dysmenorrhea, infertility, painful sex
29
Patho of endometriosis
not fully understood but to sum it up the blood flows backwards into the fallopian tubes into the pelvis cause different things to attach to one another (spiderweb)
30
Goals of therapy for endometriosis
minimize endometrial lesions prevention of it progressing minimize pelvic pain prevention or correction of infertility
31
Non pharm treatment for endo
exercise acupuncture massage CBT surgery
32
FIRST LINE FOR ENDO
NSAID CHC PROGESTIN
33
SECOND LINE FOR ENDO
GnRH AGONISTS DANAZOL
34
THIRD LINE
AROMATASE INHIBITORS
35
DANAZOL
androgen that suppresses LH and FSH BLACK BOX WARNING FOR THROMBOEMBOLISM CONTRAINDICATED IN PREGNANCY AND BREASTFEEDING
36
Uterine Fibroids
noncancerous growths in uterus most common pelvic tumor
37
Anatomy of fibroids
smooth muscle cells and fibroblasts of the myometrium intramural submucosal subserosal
38
Risk factors of uterine fibroids
black race age fam history time since last birth premenopause HTN Early menarche < 10yo
39
Protective factors of uterine fibroids
smoking pregnancies > 3 hormonal contraception
40
Fibroid treatment considerations
severity of symptoms patient age reproductive plans
41
PMS
You must have 1 symptoms for 3 menstrual cycles
42
PMDD
must have 5 symptoms for 2 consecutive months
43
Similarities PMS/PMDD
Onset: 5-7 days prior to menses Symptoms end at the start of follicular phase Require symptom free period for diagnosis
44
Somatic symptoms
bloating breast tenderness headache muscle pain edema weight gain fatigue dizziness nausea vomiting constipation appetite changes
45
Affective symptoms
anxiety depression confusion social withdrawal difficulty focusing forgetfulness sadness tension tearfulness restlessness loneliness
46
Patho of PMS/PMDD
Reduced levels of serotonin, GABA, allopregnanolone Fluctuations in estrogen and progesterone
47
Treatment NON PHARM
Limit sodium caffeine, alc Exercise Relax Sleep Ca, Mg, VITAMIN B D E
48
1ST LINE FOR PMS/PMDD
SSRI (FLUOXETINE, SERTRALINE, PAROXETINE) Start on day 14 of cycle BLACK BOX SUICIDE SIDE EFFECTS: nausea, drowsiness, weight gain, insomnia, sexual dysfunction NSAID SPIRONOLACTONE
49
2ND LINE PMS/PMDD
DULOXETINE VENLAFAXINE COC Clomipramine Alprazolam
50
3RD LINE PMS/PMDD
GnRH agonist Surgery

PHRM 825 Exam 5 (7 decks)

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