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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
Q

REDUCTION IN BLOOD LOSS

A

NSAID: 10-51%

CHC: 30-60%

PROGESTIN: 80%

TRANEXAMIC ACID: 50%

LEVONORGESTREL IUD: 97%

26
Q

Acute HMB treatment

A

High dose estrogen

If contraindicated for estrogen then Medroxyprogesterone

If contraindications for HT then use tranexamic acid

27
Q

Metrorrhagia

A

irregular bleeding between cycles

28
Q

Endometriosis (causes/symptoms)

A

pelvic inflammatory condition associated with growth of endometrial tissue found outside the uterus

asymptomatic to severe symptoms
dysmenorrhea, infertility, painful sex

29
Q

Patho of endometriosis

A

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
Q

Goals of therapy for endometriosis

A

minimize endometrial lesions

prevention of it progressing

minimize pelvic pain

prevention or correction of infertility

31
Q

Non pharm treatment for endo

A

exercise

acupuncture

massage

CBT

surgery

32
Q

FIRST LINE FOR ENDO

A

NSAID
CHC
PROGESTIN

33
Q

SECOND LINE FOR ENDO

A

GnRH AGONISTS
DANAZOL

34
Q

THIRD LINE

A

AROMATASE INHIBITORS

35
Q

DANAZOL

A

androgen that suppresses LH and FSH
BLACK BOX WARNING FOR THROMBOEMBOLISM

CONTRAINDICATED IN PREGNANCY AND BREASTFEEDING

36
Q

Uterine Fibroids

A

noncancerous growths in uterus

most common pelvic tumor

37
Q

Anatomy of fibroids

A

smooth muscle cells and fibroblasts of the myometrium

intramural
submucosal
subserosal

38
Q

Risk factors of uterine fibroids

A

black race
age
fam history
time since last birth
premenopause
HTN
Early menarche < 10yo

39
Q

Protective factors of uterine fibroids

A

smoking
pregnancies > 3
hormonal contraception

40
Q

Fibroid treatment considerations

A

severity of symptoms
patient age
reproductive plans

41
Q

PMS

A

You must have 1 symptoms for 3 menstrual cycles

42
Q

PMDD

A

must have 5 symptoms for 2 consecutive months

43
Q

Similarities PMS/PMDD

A

Onset: 5-7 days prior to menses
Symptoms end at the start of follicular phase
Require symptom free period for diagnosis

44
Q

Somatic symptoms

A

bloating
breast tenderness
headache
muscle pain
edema
weight gain
fatigue
dizziness
nausea
vomiting
constipation
appetite changes

45
Q

Affective symptoms

A

anxiety
depression
confusion
social withdrawal
difficulty focusing
forgetfulness
sadness
tension
tearfulness
restlessness
loneliness

46
Q

Patho of PMS/PMDD

A

Reduced levels of serotonin, GABA, allopregnanolone

Fluctuations in estrogen and progesterone

47
Q

Treatment NON PHARM

A

Limit sodium caffeine, alc
Exercise
Relax
Sleep
Ca, Mg, VITAMIN B D E

48
Q

1ST LINE FOR PMS/PMDD

A

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
Q

2ND LINE PMS/PMDD

A

DULOXETINE
VENLAFAXINE
COC
Clomipramine
Alprazolam

50
Q

3RD LINE PMS/PMDD

A

GnRH agonist
Surgery

PHRM 825 Exam 5 (7 decks)

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