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IPT: Endocrine > Block 2 > Flashcards

Block 2 Flashcards

1
Q

AE of SNRIs?

A

SSRI AE

+

Noradrenergic AE such as dry mouth, tachycardia, constipation. Venlafaxine worsens HTN and arrhythmias

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2
Q

How does estrogen affect bone mass?

A

Stimulates osteoblast activity Decrease number of osteoclasts Prevents Ca2+ resorption from cortical bone

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3
Q

Estrogen prevents the pituitary from producing _____

A

LH + FSH (ovulation won’t occur)

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4
Q

Monitoring serum testosterone + IM testosterone undecanodate?

A

Right before 4th dose

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5
Q

What are the therapeutic uses of androgens?

A
  1. Androgen replacement therapy 2. Breast cancer 3. Endometriosis 4. Female hypopituitarism 5. Anabolic therapy 6. Anemia
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6
Q

Androgen AE?

A
  1. Inhibit gonodotropin release - suppress testicular function, decrease testicular size, testosterone release and lower sperm count 2. Acne 3. CV issues 4. Neuropsychiatric effects
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7
Q

What are some indications for increased % of gestational diabetes?

A
  • Macrosomia (>8 lbs)
  • Neonatal hypoglycemia
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8
Q

What is the treatment algorithm for heavy menstrual bleeding?

A

First find out if contraception is desired If no, give them NSAIDs If not effective consider TXA or progesterone If neither work, consider hormonal contraceptives, levonorgestrel-releasing system, or surgery If they wanted contraception, consider levonorgestrel-releasing system If not effective, consider oral contraceptives If that doesnt work, surgery

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9
Q

To be considered prediabetic, what results do you need?

A

2 out of 3 positive results (HgbA1c, Fasting, or OGTT)

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10
Q

Basic breakdown of uterine cycle

A

Menses ► Proliferative ► Secretory

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11
Q

What are some pearls of norethindrone and norethindone acetate?

A

Raises HDL and lowers LDL

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12
Q

What are the functions of amylin?

A
  • Secreted w/ insulin
    • Suppresses postprandial glucagon secretion
  • Reduce food intake + maintain body wt
    • slows gastric emptying + increases satiety
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13
Q

Norethindrone or Norethindrone acetate are considered to be ____ gen

A

1st

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14
Q

Type 1 vs 2 diabetes

Which one progressively loses beta cell function?

A

Type 2

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15
Q

If you miss the last week of active pills on combined oral contraceptives, what should you do?

A

Omit the hormone-free stuff and finish the active drug tablets Use backup for 7 days. Counsel on emergency contraception

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16
Q

Type 1 vs 2 diabetes

Which one has an increased % of micro and macrovascular disease?

A

Type 2

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17
Q

What are the therapeutic uses of progestins?

A
  1. Hormone replacement 2. Contraceptive (planned or emergency) 3. Tx endometriosis and menstrual disorders
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18
Q

What is the pathophysiology behind menopause?

A
  • Estradiol goes down
  • FSH + LH goes up
  • Loss of ovarian follicular activity, so corpus luteum has to handle it all
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19
Q

What are some pearls of drospirenone?

A

Fewer androgenic ADRs Higher risk of blood clots Hyperkalemia Approved for premenstrual dysphoric disorder

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20
Q

When is a pregnancy test supposed to be used by?

A

Measured 1 wk after missed period

Measures hCG hormone

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21
Q

What are some non-pharmacologic options for amenorrhea?

A

Too much exercise? Decrease it Calcium and Vit. D if hypoestrogenic

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22
Q

20mcg of EE is found in Yaz or Gianvi, what progestin is found?

A

Drospirenone

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23
Q

AE of progestin excess?

A
  1. Noncyclic weight gain* 2. Headache between pill pack* 3. Fatigue *Cyclic weight gain in estrogen *Headache during active pill in estrogen
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24
Q

Monitoring of Alprostadil?

A
  1. First dose should be given under supervision 2. Take on an empty bladder 3. Max of 2 doses/day
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25
Q

What are the high risk categories to be prescribed oral contraceptives?

A
  1. <42 days postpartum + VTE risk factors 2. Breastfeeding ≤ 30days postpartum 3. Moderate risk for VTE 4. On ritanavir, rifampin, rifabutin, or anticonvulsants 5. Multiple CV risk factors
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26
Q

How long do you leave Nuvaring for?

A

Leave in place for 3 wks, then remove for 1 wk

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27
Q

What are some cautions with Bazedoxifene?

A

Exposure to obesity (BMI >27) may have increassed risk of endometrial hyperplasia

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28
Q

Type 1 vs 2 diabetes

Which one has increased % of hyperosmolar hyperglycemia syndrome?

A

Type 2

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29
Q

What are the therapeutic uses of Ospemifene?

A

*Agonist in vaginal epithelium and endometrium *Antagonist in breast *Treats dyspareunia (painful sex)

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30
Q

To treat amenorrhea, what is the whole algorithm?

A

1st = check to see if they are pregnant. If not, find underlying cause If anorexia or excessive exercise, consider psychotherapy. If that doesnt work consider estrogen If hyperprolactinemia, consider bromocriptine or cabergoline If unknown, use progestin to induce bleeding followed by estrogen/progestin therapy

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31
Q

Granulosa cells found in the ovary produce what?

A

Feed into progestins Converts to Inhibin, which negatively impacts the hypothalamus only Estrogens, which either go to target tissue or travels to CNS for behavioral effects

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32
Q

Contraindications of Alprostadil?

A
  1. Pregnant partner 2. Sickle cell disease 3. Anticoagulants (warfarin, rivaroxaban, etc)
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33
Q

Gestational diabetes is diagnosed when?

A

2nd or 3rd trimester of pregnancy

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34
Q

Monitoring serum testosterone + buccal system?

A

Before dose

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35
Q

Beta cells found in the pancreas produce…

A

Both insulin and amylin

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36
Q

Which AE of contraceptives should you d/c immediately?

A

ACHES Abdominal pain Chest pain Headache Eye problems Severe leg pain

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37
Q

What are some absolute contrainidcations for hormonal therapy?

A
  • Undiagnosed genital bleed
  • Breast cancer
  • Estrogen / Progesterone dependent neoplasia
  • VTE
  • Heart issues
  • Liver issues
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38
Q

Type 1 vs 2 diabetes

Which one has a % of diabetic ketoacidosis?

A

Type 1

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39
Q

If patient is on anticonvulsants and oral contraceptives, what could they do?

A

Besides d/c, you can switch to another form of contraception Depot medroxyprogesterone or IUDs

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40
Q

Where is the primary location for insulin resistance?

A

Skeletal muscle

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41
Q

What creams can decrease latex strength of condoms?

A

Cleocin, Premarin, and Monistat

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42
Q

What are the intra-vaginal estrogen formulations?

A

Mix of creams, ring, and tablet

Cream

  • Premarin - conjugated estrogen
  • Estrace - 17 ß-estradiol

Ring

  • Estring - 17 ß-estradiol

Vaginal tablet

  • Vagifem - Estradiol hemihydrate
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43
Q

Abrupt decline in ______ induces menstruation

A

Progestins

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44
Q

What class increase thick cervical mucus secretion?

A

Progestins

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45
Q

What is the first line Tx for erectile dysfunction?

A

PDE inhibitors

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46
Q

MOA of Alprostadil?

A

Stimulates adenylyl cyclase, which increases cAMP production, which decreases Ca 2+, causing arterial blood vessel relaxation

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47
Q

Type use of oral contraceptives are ___% effective

A

92

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48
Q

ACHES side effects refer to what kind of contraceptives?

A

Oral

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49
Q

What are some advantages of Annovera over Nuvaring?

A
  1. no refrigeration 2. used for 13 cycles 3. Cannot be removed for more than 2 hrs during 21 day cycle
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50
Q

How does Goserelin work?

A

Analog of GnRH - injection Initially increases serum lvls of LH and FSH which will lead to suppression of those sex hormones Tx endometriosis AE = hot flash, sexual dysfunction, diarrhea

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51
Q

What is a normal testosterone level?

A

300 to 1,100

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52
Q

Type 1 vs 2 diabetes

Which one is associated w/ weight loss?

A

Type 1

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53
Q

Pearls of Amethyst?

A

28 days w/o placebos - all active pills

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54
Q

What are some pearls of desogestrel?

A

Slight increase % of thrombosis Fewer androgenic ADRs

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55
Q

What is the characteristic of ovary (follicles) during the control of the menstrual cycle?

A

Develops female sex characteristics Thickens endometrium for pregnancy Antagonizes PTH Increase blood clotting

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56
Q

AE of testosterone?

A
  1. Gynecomastia (mostly in obese or pt w/ liver cirrhosis) 2. Hepatotoxicity (oral) 3. Polycythemia (stop ins and replace w/ transdermal)
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57
Q

20mcg of EE is found in “drug” 24 or 1/20, what progestin is found?

A

Norethindrone acetate

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58
Q

What happens if you displace the Nuvaring?

A

<3hrs = no backup, rinse and re-insert ≥3hrs? = insert new ring and use backup for 7 days During 3rd week? = skip hormone free and insert new ring

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59
Q

Estradiol vs Progestin only pills Which must be taken continuously (no placebo tablets are found)?

A

Progestin

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60
Q

What are some counseling points with Andoderm?

A
  1. Rotate application site q7days 2. Avoid swimming/showering/washing for 3 hrs after patch application
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61
Q

What is the Tx algorithm for HRT on someone who has NOT tried 3 months of lifestyle modifications + has moderate to severe hot flashes and/or night sweats?

A
  • First find out if they have any genitourinary symptoms
  • If no, avoid hormone therapy
  • If yes, find out if they have breast/endometrial cancer or any other hormonal-sensitive cancer
    • Yes = Vaginal lubricant/moisturizer
    • No = Vaginal lubricant/mositurizer +/- low dose vaginal estrogen or ospemifene
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62
Q

What self-monitoring tool detects baseline chloride ion levels peaks?

A

OV-Watch Fertility Predictor

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63
Q

If you miss one tablet of progestin-only pill, what should you do?

A

If it is more than 3 hrs late, backup should be used for 48hrs

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64
Q

Type 1 vs 2 diabetes

Which one has relative insulin deficiency?

A

Type 2

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65
Q

Type 1 vs 2 diabetes

Which one has Autoimmune beta cell destruction?

A

Type 1

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66
Q

AE of Alprostadil?

A

Penile pain + urethral burning

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67
Q

Which self-monitoring tool identifies up to 6 fertile days for women?

A

Clearblue Ferility Monitor

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68
Q

20mcg Drospirenone, what’s the brand?

A

Yaz or Gianvi

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69
Q

What are the progestogen only Rx for HRT?

A
  • 1st Gen
    • Norethindrone, norgestrel (2nd as well)
  • 2nd Gen
    • Levonorgestrel, MPA
  • 4th Gen
    • Drospirenone
  • Micronized progesterone

Provera - MPA

Aygestin - Norethindrone

Prometrium - Micronized progesterone

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70
Q

When is it recommended and not recommended to screen for T1DM?

A
  • Appropriate = research trials, first-degree family members with T1DM
  • Not recommended = asymptomatic general population
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71
Q

What AE do hormonal contraceptives cause?

A

Breast tenderness, fluid retention, spotting

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72
Q

How would you assess ASCVD risk since menopause onset?

A
  • > 10 yrs ► AVOID HORMONAL THERAPY
  • < 10 yrs ► calculate risk
    • <5% = gucci
    • 5 - 10% = consider transdermal
    • >10% = AVOID HORMONAL THERAPY
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73
Q

What is the characteristic of ovary (corpus luteum) during the control of the menstrual cycle?

A

Prepares endometrium for pregnancy Inhibits contraction of uterus Inhibits development of new follicles

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74
Q

Androgens (promotes/inhibits) FSH and LH release

A

inhibit + develop male sex organs and increase bone/muscle growth

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75
Q

Testing for prediabetes and/or T2DM should be considered in children (aged 10+ or after puberty) when…

A
  • BMI ≥85th percentile (overweight) or ≥95th percentile (obese)
  • 2+ additional risk factors (1+ in adults only)
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76
Q

Why is there a sudden increase of LH on day 14?

A

Estrogen is produced by dominant follicle, also causes FSH to go down slightly

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77
Q

Contraindications and Flibanserin?

A
  1. Alcohol 2. Using CYP3A4 inhibitors *Start Flibanserin 2 wks after CYP3A4 inhibitor **Start CYP3A4 inhibitor 2 days after last dose of Flibanserin 3. Hepatic impairment D/C after 8 wks of no improvement
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78
Q

What are the 1st Gen select progestin oral contraceptives?

A

Norethindrone and norethindone acetate Norgestrel (also considered Gen 2)

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79
Q

What is primary amenorrhea?

A

Absence of menses by 15 yrs old with otherwise normal secondary sexual development

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80
Q

Day 0 of menstrual cycle, which one has a higher level FSH or LH?

A

FSH

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81
Q

How is Clomiphene dosed?

A
  1. 50mg daily x5days, if no ovulation, continue
  2. 100mg daily x5days, if no ovulation , repeat
  3. 100mg daily x5days, continue for 6 cycles
  4. Consider alternative Tx
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82
Q

What are the therapeutic uses of estrogens?

A
  1. Hormone replacement (hot flash, vaginal dryness, urogenital atrophy, or osteoporosis) 2. Contraceptive (by suppressing LH surge and prevent ovulation
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83
Q

How does vomiting/diarrhea affect oral contraceptives?

A

V/D <48hrs = no redoes V/D >48hrs = use back for 7 days after V/D subsides V/D is on the last week = skip placebos and begin new pack + use backup for 7 days

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84
Q

Which ADR of contraceptives have a higher % of thrombotic risk?

A

Transdermal (has higher estrogen exposure)

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85
Q

What is HgbA1c? When does it lose accuracy?

A

Marker for glycemia over 3 months

Loses accuracy in anemia, pregnancy, or hemodialysis

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86
Q

How does estrogen affect lipids?

A

Increase HDL Decrease LDL Decrease cholesterol Increase TG

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87
Q

What is the function of the uterus, fimbriae and ovary?

A

Uterus - where eggs implant and develop during pregnancy Fimbriae - tissue that swells during ovulation to facilitate egg release into Fallopian tube Ovary - egg producing organ

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88
Q

What are the clinical uses of Clomiphene? Place in therapy?

A
  1. Induce ovulation
  2. Secondary hypogonadism

Useful for PCOS/Anovulation + test for ovarian reserve

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89
Q

When is fasting + random blood glucose testing preferred?

A

To those w/ increased RBC turnover

EX: sickle cell, second + third trimester pregnancy, hemodialysis, blood loss, erythropoietin therapy

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90
Q

20mcg Levonorgestrel, what’s the brand?

A

Lutera or Aviane

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91
Q

AE of Gabapentin?

A
  1. Somnolence
  2. Dizziness
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92
Q

What are the general non-hormonal Rx for HRT?

A
  1. Vaginal lubricants/moisturizers
  2. SSRIs + SNRIs
  3. Gabapentin, Pregabalin, clonidine
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93
Q

What are the functions of incretin?

A
  • Includes GLP-1 + Gastric inhibitory polypeptide (GIP)
    • Only GLP-1 inhibits glucagon secretion
  • Stimulates postprandial insulin secretion
  • Released in response to oral glucose
  • Degraded by DPP-4
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94
Q

What hormones do the anterior pituitary stimulate for the menstrual cycle?

A

Estrogen - to stimulate growth of immature ovarian follicles in ovary Progesterone - trigger ovulation + development of corpus luteum

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95
Q

What are some counseling points with Androgel?

A
  1. Apply in the morning 2. Site of application should not be washed for 4 to 6 hours to prevent reduced absorption or transfer of drug
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96
Q

AE of Pregabalin?

A
  1. Sedation
  2. Dependence
  3. Dizziness
  4. Headache
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97
Q

What happens if you forget to use the Nuvaring?

A

As long as the total time is ≤4 wks, you Gucci, no backup needed

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98
Q

Type 1 vs 2 diabetes

Which one contains absolute insulin deficiency?

A

Type 1

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99
Q

FSH from the anterior pituitary promotes the production of what in the ovary?

A

Only Granulosa cells

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100
Q

MOA of aromatase inhibitors?

A

Inhibits conversion of androgens to estrogens

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101
Q

What are the therapeutic uses of Raloxifene? AE?

A

Agonist in bone cells Treat/prevent osteoporosis Antagonist in breast and uterus Reduction in risk of invasive breast cancer AE = hot flash

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102
Q

What are the common symptoms of diabetes?

A
  1. Polyuria
  2. Polydipsia
  3. Polyphagia
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103
Q

What are some issues surrounding progestin only contraceptives?

A
  1. Taken continuously w/o placebo 2. Taken at the same time every day (3hr delay = backup method x48 hrs) 3. May not block ovulation
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104
Q

AE of estrogen?

A
  1. Carcinogenicity (endometrium and breast) 2. CV disease
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105
Q

What is the incretin effect?

A
  • Greater insuilin effect due to oral glucose intake vs IV intake
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106
Q

AE of Clonidine?

A
  1. Dizziness
  2. Drowsiness
  3. Hypotension
  4. Dry Mouth
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107
Q

Testing for prediabetes and/or T2DM in asymptomatic ppl should be considered of any age who…

A
  • BMI ≥25 or ≥23 in Asian Americans
  • 1+ additional risk factor for diabetes (2+ in children)
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108
Q

Pathophysiology behind Polycystic ovarian syndrome (PCOS) includes what?

A
  • Increase androgen ► increase testosterone
  • Increase insulin due to resistance (glucose up as well which results in wt gain
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109
Q

Rifampin and oral contraceptives have an interaction, how long should you use the backup for after d/c?

A

7-28 days

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110
Q

Progesterone vs Estrogen Which one thickens the cervical mucus which hinders sperm travel?

A

Progesterone

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111
Q

What are the main categories that cause infertility for women?

A
  1. Hypothalamic-pituitary failurek
  2. HPO axis (85%)
  3. Ovarian failure

Primary cause - ovulatory DYSFUNCTION

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112
Q

Whats the definition of dysmenorrhea?

A

Pelvic pain prior to or concurrent with menses

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113
Q

Which select progestins are the most to least androgenic?

A

Most = Levonorgestrel 2nd most = Norgestrel Middle = Norethindrone w or w/o acetate, norgestimate, and desogestrel Least = Drospirenone and segesterone acetate

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114
Q
A
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115
Q

What are the AE associated with androgenic progestins?

A
  1. Acne/oily skin 2. Noncyclic Wt gain 3. Hirsutism 4. Fatigue 5. Depression
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116
Q

Besides using aromatase inhibitors or clomiphene, what alternatives are there to help with ovulation?

A

Metformin + Pioglitazone (thiazolidinediones)

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117
Q

Planned contraceptives contain (estrogen/progestin)

A

Progestins w/ or w/o estrogen

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118
Q

If you miss one tablet or are late on combined oral contraceptives, what should you do? Two tablets missed/late?

A

One tablet = take one as soon as you remember. Take rest of the pack as prescribed. Typically no backup needed Two tablets = take one as soon as you remember. Throw away remaining missed tablets. Take rest of pack as prescribed (Two may need to be taken at the same day, one for missed dose and another for scheduled dose). Use back up for 7 days. Counsel on emergency contraception

119
Q

50mcg Norethindrone, what’s the brand?

A

Necon 1/50

120
Q

What are the general Rx (hormonal) Tx for menopause?

A
  1. Estrogen
  2. Estrogen w/ Progesterone
121
Q

What are the second and third line Tx for erectile dysfunction?

A

Intracavernosal and intraurethral alprostadil

122
Q

Basic breakdown of ovarian cycle

A

Follicular ► Lutueal

123
Q

What are the select estrogen based contraceptives?

A

Ethinyl estradiol + mestranol

124
Q

With the hypothalamus-pituitary-ovarin axis, how is amenorrhea started?

A

Stress causes hypothalamus to not secrete GnRH Dopaminergic Rx or thyroid disease cause altered secretion of LH and FSH Ovarian failure or Uterus obstruction

125
Q

Norgestrel is considered to be ____ gen

A

1st or 2nd

126
Q

What are the oral estrogens for HRT?

A
  • Premarin - dosed daily
  • Menest - dosed daily for 3 wks, then 1 wk off
127
Q

Which oral contraceptive has 10mcg of EE content?

A

Lo Loestrin Fe - Norethindrone acetate

128
Q

What is fasting?

A

No caloric intake for at least 8 hrs

129
Q

What are the transdermal estrogen formulations?

A
  • Alora, Climara, Estraderm, Minivelle/Vivelle - 17 ß estradiol
    • Most twice weekly
130
Q

Women should get a lower dose of oral contraceptives if…

A
  1. Underweight 2. >35 yrs old 3. Perimenopausal
131
Q

What should you do if you missed a patch exchange?

A

Delayed by <48 hrs w/ old patch still on? = no backup and apply new patch ASAP Delayed ≥48hrs? = new patch ASAP and backup for 7 days On third week? = omit hormone-free week and apply new patch ASAP

132
Q

What are some pearls of segesterone acetate?

A

Approved in one-year ring product

133
Q

AE of Leuprolide?

A

Vaginal dryness, hot flash, bone density loss

134
Q

Pros and Cons of topical estrogen?

A

Pros

  • Limited systemic absorption and AE

Cons

  • Variability in Rx absorption
135
Q

What are some pearls of diaphragms?

A

88% effective *Reusable **Requires sizing and RX ***Can insert ≤6hrs prior to intercourse and must leave in for 6-24hrs after (48hrs for cervical caps) ****Does NOT protect against STIs

136
Q

What are the contraindications to SSRI/SNRIs?

A
  1. Neuroleptic Malignant Syndrome
  2. Serotonin Syndrome
  3. Concurrent MAOI use
  4. Hypersensitivity
137
Q

For non-pharmacologic Tx of menopause, how long of a period should you see if symptoms improve?

A

For any severity, trialed for 3 months

138
Q

What is the continuous (non-cyclic) estrogen-progestogen for HRT?

A
  • Both estrogen + progestogen are administered for 28 days
  • Leads to endometrial atrophy and NO vaginal bleed
139
Q

What are the therapeutic uses of Clomiphene? AE?

A

Primarily antagonist in pituitary and hypothalamus Binds to estrogen receptor Increases release of gonadotropins (FSH + LH) to induce ovulation - induces ovulation AE = Ovarian enlargement + hot flash

140
Q

AE of progestin deficiency?

A
  1. Weight loss 2. Heavy menstrual bleed 3. Late cycle breakthrough bleed* *Early/mid = estrogen deficiency
141
Q

Which Rx can cause infertility?

A
  • NSAIDs
  • Spironolactone
  • Thyroid Rx
  • Narcotics
  • Sulfasalazine
  • Chemos
  • Antipsychotics + Antiepileptics
  • Steroids
  • Recreational stuff
142
Q

What are the selective estrogen receptor modulators (SERM) drugs?

A

Ends w/ “fene” or “phene” Raloxifene Bazedoxifene Ospemifene Clomiphene

143
Q

What are the macrovascular complications associated w/ diabetes?

A
  1. Coronary heart disease
  2. Stroke
  3. Peripheral arterial disease (feet)
144
Q

AE of estrogen deficiency?

A
  1. Early - mid breakthrough bleed* 2. Decreased libido 3. Vasomotor symptoms 4. Dry vaginal mucosa 5. Headaches *Late cycle = progestin deficiency
145
Q

What are the non pharmacological options for premenstrual dysphoric disorder (PMDD)?

A

Attempt lifestyle intervention for 2 months while keeping a symptom journal Decrease sodium, caffeine, and sugar* Increase exercise* *insufficient evidence

146
Q

What is the Black Box Warning on Ospemifene (Osphena)?

A

Increased risk for endometrial hyperplasia + endometrial cancer, stroke, and VTE

147
Q

Day 14 of menstrual cycle, which one has a higher level? FSH or LH?

A

LH

148
Q

When initiating oral contraceptives, when should the start date be?

A
  1. First day of bleeding 2. First Sunday after menstrual cycle begins 3. 5th day after menstrual cycle begins
149
Q

Plasma glucose is maintained at what level?

A

70 to 100mg/dL

150
Q

What are some pearls of spermicide?

A

85% effective *apply 10 min before intercourse **effective for 1hr ***Does NOT protect against STIs

151
Q

Drospirenone is considered to be ____ gen

A

4th

152
Q

General oral contraceptive AE?

A
  1. No protection from STIs 2. Small increase in BP 3. Thromboembolism* *Estrogen increase factor VII and X, and fibrinogen 4. Breakthrough bleeding 5. Weight gain
153
Q

Progesterone prevents the pituitary from producing ____

A

LH (ovulation won’t occur)

154
Q

How does Clomiphene work on females and males?

A
  • Females = follicular growth + rupture
  • Males = increase testosterone and sperm count
155
Q

Theca cells found in the ovary produce what?

A

Androgens which feed into granulose cells Progestins which loops back to the hypothalamus and anterior pituitary as well as goes to target tissue

156
Q

What are the 2nd Gen select progestin oral contraceptives?

A

Norgestrel (also considered Gen 1) Levonorgestrel

157
Q

What is the intermittent estrogen-progestogen for HRT?

A
  • 3 days of estrogen ► 3 days of progesogen ► repeat
  • Lower risk of bleed
158
Q

What is secondary amenorrhea?

A

Absence of menses for 3 cycles in previously menstruating women

159
Q

What are the concerns with using oral contraceptives and being postpartum?

A
  1. Those women are hyper coagulable 2. OC may interfere w/ lactation 3. Avoid estrogen for 21 days after birth 4. Consider only progestin only OC
160
Q

Monitoring serum testosterone + IM testosterone cypionate or enathate?

A

Midpoint of dosing interval

161
Q

What are the SERM Rx for HRT?

A
  1. Duavee - Conjugated estrogen + Bazedoxifene
  2. Osphena - Ospemifene
162
Q

What are the unacceptable risk categories to be prescribed oral contraceptives?

A
  1. <21 days postpartum 2. Breast cancer (current) 3. Decompensated cirrhosis 4. High risk for VTE 5. Heart issues 6. Migraines w/ aura
163
Q

What should you do if detachment occurs with transdermal contraceptives?

A

<24hrs? = no backup, new patch ASAP or reapply old patch >24hrs? = new patch ASAP + backup for 7 days If on 3rd week? = omit hormone-free week and apply new patch ASAP

164
Q

What are the doses of ethinyl estradiol?

A

10 to 50mcg ≤20 = ultra low ≤35 = low ≥50 = high

165
Q

What are some pearls of norgestimate?

A

Slight increase % of thrombosis Fewer androgenic ADRs Approved for acne

166
Q

What abortifacients are used to induce abortion?

A

First, Mifepristone (blocks progesterone) - effective for 10wks after first day of last period Second, Misoprostol (induce uterine contraction) - expect cramps and heavy period Premedicate with ibuprofen 30min prior to misoprostol Use anti-nausea and/or heating pads NO ASPIRIN!

167
Q

What are the hormonal Tx options for someone w/ an intact uterus?

A
  • Estrogen
  • Estrogen w/ Progesterone
168
Q

Segesterone acetate is considered to be ____ gen

A

4th

169
Q

Which oral contraceptive has 50mcg of EE content?

A

Necon 1/50 (Norethindrone)

170
Q

10mcg of EE is found in Lo Loestrin FE, what progestin is found?

A

Norethindrone acetate

171
Q

What are the vaginal estrogen formulations?

A
  • Femring
    • changed every 3 months
    • delivers estrogen systemically
172
Q

What class does Danazol (Danocrine) belong to?

A

Weak androgen agonist

173
Q

What is the 1st line pharmacologic therapy for premenstrual dysphoric disorder (PMDD)?

A

SSRSs; will see effect within 2 cycles Concern w/ paroxetine due to congenital effects ADRs = sedation, sexual dysfunction

174
Q

What are the diabetic HbA1c, fasting plasma glucose, and oral glucose tolerance test values?

A
  • HBA1c = ≥6.5
  • Fasting = ≥126
  • OGTT = ≥200
175
Q

Conception is most effective from what days?

A

Days 12-14

176
Q

What does the dominant follicle eventually become? What is its function?

A

Corpus luteum Produces progesterone (to prepare endometrium for pregnancy, thicken cervical mucus and elevate body temp) Produces Estrogen

177
Q

When is the oral glucose tolerance test preferred?

A
  • Gestational diabetics
  • Post transplantation
  • Cycstic fibrosis-related diabetes
178
Q

20mcg Norethindrone acetate, what’s the brand?

A

Look for 24 or 1/20

179
Q

What is the continuous long-cycle estrogen-progestogen for HRT?

A
  • Estrogen is admin daily
  • Progestogen is co-admin 12-14 days of the 28 day cycle every other month
  • Results in 6 periods / year
  • Decreases incidence of withdrawal, but there may be heavier bleeds
180
Q

What is the definition of heavy menstrual bleeding?

A

Blood loss >80mls/cycle Bleeding >7days/cycle

181
Q

What are the main categories that cause infertility for men?

A
  1. Hypogonadism
  2. Erectile and ejaculatory dysfunction
  3. Anatomical abnormalities
182
Q

Which selection progestins have the most estrogenic property?

A

Norethindrone w or w/o acetate

183
Q

What are some pearls of norgestrel?

A

Androgeneic ADRs are common

184
Q

10mcg Norethindrone acetate, what’s the brand?

A

Lo Loestrin Fe

185
Q

What are the SSRIs and SNRIs used for HRT?

A

SSRIs

  • Brisdelle or Paxil (Paroxetine)
  • Fluoxetine

SNRIs

  • Effexor (Venlafaxine)
  • Pristiq (Desvenlafaxine)
186
Q

How would you administer Flibanserin?

A

Bedtime for reduce hypotension and CNS depression

187
Q

If one PDE-5 inhibitor does not work, what do you do?

A

You can try using another PDE-5 inhibitor rather than moving to a second-line agent

188
Q

What are some pearls of levonorgestrel?

A

Most widely prescribed Negative impact on lipids Used for emergency contraception

189
Q

What are some non-pharmacologic options for dysmenorrhea?

A
  1. Heat 2. Exercise 3. Low fat vegetarian diet 4. Powdered ginger (reduce pain) 1-3 decrease intensity
190
Q

What are some pearls of sponges?

A

91% effective to those that never gave birth 80% effective to those who did *contains 1g of nonoxynol-9 **Moisten w/ water, insert ≤6hrs prior to intercourse, and must leave in 6-24hrs after (48hrs for diaphragms) ***effective for multiple acts of intercourse within 24hrs ****Does NOT protect against STIs

191
Q

Monitoring serum testosterone + Transdermal gel?

A

Anytime after first 1-2 wks of continuous use

192
Q

PDE-5 inhibitors + Vardenafil, what happens?

A

QT interval prolongation; monitor therapy

193
Q

What are the benefits and risks of long-term hormonal replacement therapy?

A

Benefits

  • Alleviates symptoms
  • Decreased fractures
  • Decreased colorectal cancers

Risks

  • Heart issues
  • Breast cancer
194
Q

Texas requires parental consent for prescription contraception unless…

A
  1. Married 2. 16/17 yrs old, lives apart from parents, AND manages own finance 3. Emancipated from parental guardian 4. On medicaid
195
Q

When should you consider changing contraceptives if you have breakthrough bleeding?

A

Btw, it is expected If it lasts longer than 6 months

196
Q

What Rx are the GnRH agonists/antagonists?

A
  1. Leuprolide 2. Elagolix 3. Goserelin
197
Q

What is the most potent estrogen type?

A

Estradiol

198
Q

What is the ovarian cycle?

A

Follicular phase: Follicular growth period in ovary (10days to 3wks) Ovulation: 1+ ripened follicle is released by ovary Luteal phase: Ruptured follicle ->Corpus luteum secretes hormones to prepare for pregnancy **if no pregnancy occurs, corpus luteum stops working after 2 wks

199
Q

Estrogen and Progesterone are dominant in which phase of the ovarian cycle?

A

Estrogen for follicular Progesterone for luteal, estrogen is present however

200
Q

Norgestimate is considered to be ____ gen

A

3rd

201
Q

AHA recommendations of PDE-5 inhibitors and peeps w/ CVD?

A

Useful only to those with STABLE CVD

202
Q

What are the subcategories that result from HPO axis failure that results in infertility?

A
  1. Polycystic ovarian syndrome (PCOS)
  2. Hyperprolactenemia
203
Q

Pros and Cons of transdermal estrogen?

A

Pros

  • Less risk of breast tenderness, heart issues compared to PO

Cons

  • Compliance + skin irritation
204
Q

What are the normal HbA1c, fasting plasma glucose, and oral glucose tolerance test values?

A
  • HBA1c = about 5.7
  • Fasting = ≤99
  • OGTT = ≤139
205
Q

When would you use non-hormonal therapy for HRT?

A
  • Mild symptoms
  • Contraindications from moderate-severe
  • Patient preference
206
Q

What are aromatase inhibitors used for? AE?

A
  1. Tx breast cancer in menopausal women 2. Treat endometriosis 3. Treat gynecomastia in men AE = hot flash, joint pain, bone fracture, wt gain, headache
207
Q

Levonorgestrel is considered to be ____ gen

A

2nd

208
Q

What physical factor can contribute to a higher % of pregnancies even with oral contraceptives? Mechanism?

A

Obesity Mechanism: Increase basal metabolic rate, increases liver enzymes, lowers serum concentration of contraceptives Issue with low dose oral contraceptives

209
Q

AE of injectable progestins?

A
  1. Short term bone loss 2. Return of fertility may be delayed 3. Can receive immediately postpartum if not breastfeeding
210
Q

What is the concern with using vaginal lubricants and moisturizers for HRT?

A

Oil-based stuff may weaken latex condoms

211
Q

What is the continuous cyclic estrogen-progestogen for HRT?

A
  • Estrogen is admin. daily continously
  • Progesogen is co-admin for 12-14 days of the 28 day cycle
  • Scheduled withdrawal bleed in most women 1-2 days after progestogen stops
212
Q

What are the general lab values for secondary hypogonadism in men?

A
  • Low T
  • Low or normal LH + FSH
213
Q

Alpha cells found in the pancreas produce….

A

Glucagon

214
Q

What are the intracellular receptors for estrogen?

A

ERalpha ERbeta Both are not always expressed in same tissue ERalpha is predominant for growth regulation

215
Q

What are the microvascular complications associated with diabetes?

A
  1. Retinopathy
  2. Neuropathy
  3. Nephropathy
216
Q

What is the oral glucose tolerance test?

A

Having no food/drink for 8 to 12 hrs, then having exogenous glucose intake, and then plasma blood glucose levels are checked

217
Q

When does your basal body temperature begin to drop during the menstrual cycle? Increase?

A

Day 14 - lowest After Day 14 it goes up much higher

218
Q

What Rx is indicated for hypoactive sexual desire disorde in premenopausal women? MOA?

A

Flibanserin 5HT1A and 2A antagonist

219
Q

When managing with ADR of oral contraceptives, how long should you wait before changing?

A

≥3months

220
Q

What antagonizes the parathyroid hormone in the control of menstrual cycle?

A

Ovary (follicle)

221
Q

What are the prediabetic HbA1c, fasting plasma glucose, and oral glucose tolerance test values?

A
  • HbA1c = 5.7 to 6.4
  • Fasting = 100 to 125
  • OGTT = 140 to 199
222
Q

What are the therapeutic uses of Bazedoxifene?

A

Antagonist in uterus

If added w/ conjugated estrogens (Duavee), reduces risk of endometrial hyperplasia

223
Q

What are the oral estrogen formulations?

A
  • Premarin - Conjugated estrogen
    • Dosed daily
  • Femtrace - Estradiol acetate
    • Dosed daily
  • Estrace - Micronized estradiol
    • Dosed daily, but 3 wks on and 1 wk off
  • Menest - esterified estrogens
    • Dosed daily, but 3 wks on and 1 wk off
224
Q

Pros and Cons of vaginal estrogen formulations?

A

Pros

  • Less systemic exposure, so less AE
  • Decrease vaginal pH ► less risk of UTI

Cons

  • Treats urogenital atrophy only
  • AE = VVC, vaginal bleed, breast pain, nausea
225
Q

What are some pearls of female condoms?

A

79% effective Patient complains of noise

226
Q

Monitoring serum testosterone + Transdermal patch?

A

3-12 hrs after patch application

227
Q

What is the effective % of the withdrawal method?

A

70%

228
Q

What are the instructions of use for transdermal contraceptives?

A
  1. Apply to abdomen, butt, upper torso, or upper arm 2. Apply at beginning of menstrual cycle 3. Replace weekly and be patch-free on week 4
229
Q

50mcg of mestranol is found in Necon 1/50, what progestin is found?

A

Norethindrone

230
Q

Which contraceptive uses mestranol instead of EE?

A

Necon 1/50 (Norethindrone progestin)

231
Q

What are some Rx associated w/ hyperglycemia?

A
  1. Glucocorticoids
  2. Nicotinic acid or Niacin
  3. Thyroid rx
  4. Beta adrenergic agoinsts
  5. Thiazide diuretics
  6. Phenytoin
  7. Protease inhibitors
  8. Atypical antipsychotics
232
Q

What is the treatment algorithm for dysmenorrhea?

A

First try non-pharmacological stuff like heat pad If not effective, try monthly NSAIDs If not effective, try hormonal contraceptives for 2-3 cycles If not effective, try depo shot or levonorgestrel-releasing system

233
Q

Monitoring serum testosterone + testosterone SubQ implant?

A

1-4 months after implantation

234
Q

What are some lifestyle modifications for Tx of menopause?

A
  • Lowering room temp.
  • Decrease spicy foods, caffeine, hot items, alcohol
  • Smoking cessation
  • “Paced” respiration
235
Q

What is the effective % of condoms?

A

82% due to spillage or perforation Use water-soluble lubricants only

236
Q

What class of drugs can cause or exacerbate erectile dysfunction?

A

Antihypertensives + Antidepressants

237
Q

What does insulin maintain in adipose tissue?

A

Insulin stimulates uptake and storage of FA (inhibits lipase)

238
Q

Alcohol + PDE-5 inhibitors, which ones are affected?

A

Only avanafil (3) and tadalafil (5)

239
Q

What are the combination estrogen + progestogen Rx for HCT?

A

Oral

  • Prempro - Conjugated estrogen + MPA

Transdermal

  • CombiPatch - Estradiol + Norethindrone
240
Q

Which oral contraceptive has 20mcg of EE content?

A

Brand names? Look for 24 Fe or 1/20 - Norethindrone acetate

Yaz + Gianvi - Drospirenone

Lutera + Aviane - Levonorgestrel

241
Q

What is infertility?

A
  • Failure to conceive after 12 months of regular, unprotected sexual intercourse (<35 yrs old)
  • 6 months for ≥35yr olds
242
Q

What happens around day 26 of the menstrual cycle in regards to the corpus luteum?

A

Apoptosis, egg passes through Fallopian tube and decreases estrogen and progesterone Removes negative feedback on hypothalamus and with the decrease of progesterone, menstruation occurs

243
Q

What are the subcategories that result from hypothalamic-pituitary failure that results in infertility?

A
  1. Amenorrhea
  2. Low gonodatropin levels
244
Q

How many doses of PDE-5 inhibitors should you take before you declare it as a non-viable option?

A

At least 5 to 8

245
Q

How many doses of PDE-inhibitors can you have in one day?

A

Just one

246
Q

During the menstrual cycle, when does progesterone increase?

A

A little after day 14

247
Q

How does Leuprolide work?

A

Analog of GnRH - injection Initially increases serum lvls of LH and FSH which will lead to suppression of those sex hormones Tx endometriosis AE = hot flash only

248
Q

Backup method for oral contraceptives must be used for ___ days

A

≥7 days

249
Q

What is the pathophysiology behind dysmenorrhea?

A

Primary - prostaglandins and leukotrienes are released into menstrual fluid which cause inflammation and vasoconstriction

250
Q

What are some special characteristics of mestranol?

A

Must be activated by liver

251
Q

Desogestrel is considered to be ____ gen

A

3rd

252
Q

If a patient has met the criteria for T1DM, what needs to be done next?

A
  1. C-peptide or insulin level needs to be drawn
  2. If insulin deficient, ß-cell auto AB will be tested for BG rather than HgbA1c
253
Q

What kind of condom is NOT impermeable to viruses?

A

Lamb intestine

254
Q

When d/c oral contraceptions to return to fertility, how long is ovulation delayed?

A

Typically 1-2 wks If it continues for >6 months, see physician

255
Q

Pearls of Yaz, Gianvi, Loestrin 24, Beyaz?

A

Only has 24 tablets, causes lighter, shorter menses

256
Q

When should injectable progestins be administered?

A

Within 5 days of bleeding every 3 months **97% effective

257
Q

What are the (minor) risk factor categories to be prescribed oral contraceptives?

A
  1. Age ≥40 yrs old 2. Sickle cell 3. Untreated cervical cancer 4. DM 5. Major surgery 6. Migraines
258
Q

20mcg of EE is found in Lutera or Avaiane, what progestin is found?

A

Levonorgestrel

259
Q

What is included in the male fertility assessment?

A
  • Abstinence from ejaculation (48-72 hours)
  • Minimum of 2 samples (wait 3 months before 2nd sample)
260
Q

What are the 4th Gen select progestin oral contraceptives?

A

Drospirenone Segesterone acetate

261
Q

What are the hormonal Tx options for someone w/ a hysterectomy?

A

Only estrogen

NO PROGESTERONE

262
Q

PDE-5 inhibitors + alpha 1 antagonists, what happens?

A

Consider therapy modification; hypotensive episode

263
Q

Progesterone vs Estrogen Which one supports uterine lining to prevent breakthrough bleeding?

A

Estrogen

264
Q

What is the uterine cycle?

A

Menses: Corresponds to beginning of follicular phase **Menstrual bleeding from uterus Proliferative phase: Corresponds w/ later part of follicular phase **Endometrium adds a new layer of cells in anticipation for pregnancy Secretory phase: Corresponds w/ luteal phase **Corpus luteum converts endometrium into secretory structure **Layers are lost during menstruation if pregnancy doesn’t occur

265
Q

What are some pearls of cervical caps?

A

86% effective to those that never gave birth 71% effective to those who did *Requires sizing and RX **Fill with spermicide prior to insertion ***Can insert ≤6 hrs prior to intercourse and must leave in 6-48hrs afters (24hrs for diaphargms and sponges) ****Does NOT protect against STIs

266
Q

How does Elagolix work?

A

GnRH receptor antagonist Tx pain associated w/ endometriosis AE =hot flash, bone loss, menstrual pattern change

267
Q

What is the policy on ADA screening for gestational DM?

A
  • Test at first prenatal visit in those w/ risk factors
  • Test at wks 24-28 of gestation in pregnant women not previously known to have diabetes
  • Test women w/ gestational DM for prediabetes/diabetes at wks 4-12 postpartum using 75g oral glucose tolerance test
  • Women w/ history of gestational DM should have lifelong screening at least every 3 yrs
268
Q

What is Ovarian Hyper-stimulation Syndrome?

A

Caused by excess response to FSH or Clomiphene which produce large amounts of estrogen and progesterone

269
Q

What is the Tx algorithm for HRT on someone who has tried 3 months of lifestyle modifications + has moderate to severe hot flashes and/or night sweats?

A
  • First find if they have any contraindications for hormonal therapy
  • If no, do they have a prior hysterectomy?
    • Yes = estrogen
    • No = estrogen + progesterone or estrogen + bazedoxifene
  • If yes, do they have any contraindications to SSRI/SNRIs?
    • Yes = consider gabapentin, pregabalin, clonidine
    • No = SSRI/SNRI
270
Q

Estradiol vs Progestin only pills Which is more effective

A

Estradiol

271
Q

What are some counseling points on placebo pills in contraceptives?

A

Encourage pt to take them to enhance adherence

272
Q

MOA of PDE-5 inhibitors?

A

Inhibits PDE-5, therefore blocks breakdown of cGMP and resulting in vasodilation

273
Q

Which select progestins have the most to least progestational properties?

A

Highest = Levonorgestrel, Desogestrel 2nd highest = Norgestrel 3rd highest = Northindrone w or w/o acetate Lowest = Drospirenone and segesterone acetate

274
Q

Pros and Cons of oral estrogen

A

PRO

  • Patient acceptance

CON

  • Nausea, headache, breast tenderness, bleed
  • Serious AE = increased risk of heart issues, breast cancer, gallbladder disease
275
Q

LH from the anterior pituitary promotes the production of what in the ovary?

A

Theca cells and Granulosa cells

276
Q

Progestins (promotes/inhibits) FSH and LH release

A

inhibits

277
Q

What are the pharmacologic options for premenstrual dysphoric disorder (PMDD)?

A

Vitamins/Minerals (Vit. B6 + calcium carbonate) SSRIs SNRIs Hormonal contraceptives Leuprolide

278
Q

What is the pathophysiology behind premenstrual dysphoric disorder (PMDD)?

A

Differs from major depressive disorder MIGHT be due to low levels of progesterone metabolite allopregnanolone in luteal phase and/or cortical gamma-aminobutyric acid levels MIGHT be due to low serotonin levels

279
Q

Where is SGLT-2 found in the body? Purpose?

A

Proximal tubules

Reabsorbs 90% of urinary glucose

280
Q

How long is Nuvaring good for outside the fridge?

A

4 months

281
Q

What are the 3rd Gen select progestin oral contraceptives?

A

Norgestimate Desogestrel

282
Q

AE of estrogen excess?

A
  1. Cyclic weight gain* 2. Uterine cramps 3. Headache during active pill* 4. Bloating 5. Edema 6. Nausea *Noncyclic wt gain in progestin and androgen excess *Headache between pill pack in progestin
283
Q

What are the oral estradiols for HRT?

A
  • Femtrace
  • Estrace
284
Q

Pearls of Beyaz?

A

Similar to Yaz/Gianvi, but has levomfolate (active form of folate)

285
Q

What is the alternative to the 1st line pharmacologic therapy for premenstrual dysphoric disorder (PMDD)?

A

SNRIs Venlafaxine ADRs = Increased BP, insomnia, diaphoresis (sweat), xerostomia (dry mouth)

286
Q

What are the signs/symptoms of menopause?

A
  1. Hot flashes/night sweats
  2. Genitourinary symptoms
  3. Impaired bone metabolism
  4. Psychological symptoms
287
Q

What Rx is a weak androgen agonist?

A

Danazol (Danocrine)

288
Q

What Rx are the aromatase inhibitors?

A

Anastrozole Letrozole

289
Q

Testing for prediabetes and/or T2DM should begin at what age?

A

45 yrs old

290
Q

What are the general lab values for primary hypogonadism in men?

A
  • Low T
  • High LH + FSH
291
Q

Monitoring serum testosterone + Oral?

A

2-3 hrs after dose

292
Q

What are the topical estrogen formulations?

A
  • Estrasorb - 17 ß estradiol
    • 2 pouches once daily (legs)
  • Elestrin - 17 ß estradiol
    • 1-2 does once daily (upper arm)
293
Q

AE of SSRIs?

A
  1. Insomnia
  2. Sexual AE
  3. Serotonin syndrome
  4. Risk of upper GI bleed
  5. Low sodium
294
Q

What are some Rx for hypoactive sexual desire disorder in women?

A
  1. Sildenafil 2. Bupropion 3. Hormonal Therapy 4. Ospemifene

IPT: Endocrine (4 decks)

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