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Therapeutics 2 Kappa Epsilon > Chen's Women's Health Lectures > Flashcards

Chen's Women's Health Lectures Flashcards

1
Q

Contraindications of Estrogen

A
  • undiagnosed abnormal vaginal bleeding
  • DVT or PE
  • Active history of STOKRE or MI
  • Breast cancer
  • Hypercoaguable disorder
  • pregnancy
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2
Q

Therapeutic Uses of Estrogen

A
  • Breast cancer palliation (aka ok to use estrogen in breast cancer if tumor is not estrogen based)
  • Uremic Bleeding
  • Prevent postmenopasual osteoporosis
  • Menopause (vasomotor sx)
  • Vulvar and vaginal atrophy
  • female hypogonadism
  • Ovarian failure
  • abnormal uterine bleeding
  • contraception
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3
Q

Therapeutic Uses of Progestin

A
  • long term prevention of pregnancy
  • treatment of heavy menstrual bleeding
  • emergency contraception
  • amenorrhea
  • endometriosis
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4
Q

Menopause:

no period for _____ months and will have elevated _____ levels

A

12; FSH

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5
Q

Premature menopause occurs before age _____

A

40

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6
Q

Things that can cause premature menopause

A
  • hysterectomy
  • radiation therapy
  • chemotherapy
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7
Q

Worst symptoms of menopause occur during the first ____ years

A

1 -2

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8
Q

How does smoking affect Menopause

A

smoking decreases estrogen levels —- can cause early menopause

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9
Q

What are menopausal symptoms

A
  • Vasomotor Sx
  • Irregular Menses
  • Episodic Amennorrhea
  • Sleep disturbances
  • Mood changes
  • Genitourinary Syndrome of menopause
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10
Q

Long Term Consequences of Menopause

A
  • CV disease
  • Bone loss
  • Osteoarthritis
  • Body composition
  • Skin changes
  • Balance
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11
Q

3 Main Kinds of MHT (Menopausal Hormonal Therapy)

A
  • Estrogen only
  • Estrogen and progestin
  • SERM (estrogen and selective-estrogen receptor modulator)
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12
Q

3 ways to treat Menopausal Symptoms

A

Non-pharmacologic
Hormonal Replacement
Non-Hormonal

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13
Q

3 ways to treat Menopausal Symptoms

A

Non-pharmacologic
Hormonal Replacement
Non-Hormonal

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14
Q

what are the indications for menopausal hormone therapy

A
  • vasomotor symptoms
  • Vulvovaginal atrophy
  • Osteoporosis prevention
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15
Q

what are absolute contraindications for menopausal hormone therapy

A
  • unexplained vaginal bleeding
  • pregnancy
  • estrogen-dependent malignancies (endometrial or breast cancer)
  • Stroke
  • Active thromboembolic disorders
  • Active liver disease
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16
Q

What type of women CAN use estrogen monotherapy

A

women without a uterus

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17
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Premarin

A

ORAL

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18
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Estrace

A

oral

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19
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Estrogel

A

topical gel

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20
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Divigel

A

topical gel

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21
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Elestrin

A

topical gel

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22
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Estring

A

ring

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23
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Femring

A

ring…

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24
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Vagifem

A

Vaginal Tablet

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25
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Menostar

A

transdermal

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26
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Alora

A

Transdermal

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27
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Climara

A

transdermal

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28
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Minivelle

A

transdermal

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29
Q

What type of product is it?
(oral, topical gel, ring, vaginal tablet, transdermal, or topical spray)
Vivelle-Dot

A

transdermal

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30
Q

If a woman is experiencing vulvovaginal atrophy - what product is appropiate

A

topical vaginal products

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31
Q

Non-pharmacologic things to do for menopause

A
  • stop smoking
  • avoid hot drinks, tea, soup
  • avoid alcohol
  • dress in layers to keep cool
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32
Q

Explain the Womens Health initiative study

A
  • compared estrogen vs estrogen and progesterone vs placebo - made it look like the hormone caused more issues long term —-but more data analysis showed that if therapy initiated within 10 years of menopause start
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33
Q

Recommended Treatment Duration for Estrogen/Progestin therapy (for menoapause)

A

3 - 5 years

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34
Q

Recommended Treatment Duration for Estrogen therapy (for menoapause)

A

up to 7 years

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35
Q

What drug class(es) can be used for Hot flashes in menopause

A

SSRIs/SNRIs

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36
Q

What are alternative options for Vasomotor Symptoms

A
  • Phytoestrogens (plant estrogen)
  • Black Cohosh (not recommended)
  • Dong Quai (not recommended)
  • Gabapentin/Pregabalin
  • Clonidine
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37
Q

Treatment Algorithm of Menopause: Combines _________ and _________

A
  • 10 year CVD risk scores

- years since menopause onset

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38
Q

Women in menopause have low or high levels of FSH? and WHY

A

HIGH! because no estrogen being produced leads to the hypothalamus trying to make more — leads to more FSH being produced

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39
Q

what critical factors were used to evaluate the Womens Health Initiative that lead to them discovering that there can be reduced risk for CHD

A
  • age of initiation

- time since menopause

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40
Q

Current Recommendations for Menopausal Hormone Therapy:
Treatment should start and be limited to women that are under age _______ OR within the last _____ years of the last period

A

60; 10

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41
Q

What are the 4 types of methods of administration of combined estrogen and progesterone for menopause treatment?

A
  • continuous cyclic
  • continuous long cycle
  • continuous combined
  • intermittent combined
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42
Q

How does Continuous Cyclic Therapy of Estrogen/Progesterone work? (Used in Menopause treatment)

A

Estrogen DAILY
Progesterone given for ~ 12 - 14 days per a 28 day cycle
- just like a period… draw side is that its like a period - have the withdrawal bleeding

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43
Q

What is the associated risk continuous cyclic therapy that was pointed out?

A

2 fold increase risk in endometrial cancer after 6 - 10 years

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44
Q

How does Continuous LONG CYCLE Therapy of Estrogen/Progesterone work? (Used in Menopause treatment)

A

Estrogen DAILY
Progesterone give w/ estrogen ~ 12 - 14 days EVERY OTHER MONTH!
(Causes periods for only 6 months per year)

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45
Q

How does Continuous Combined Therapy of Estrogen/Progesterone work? (Used in Menopause treatment)

A

Estrogen and Progesterone DAILY

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46
Q

Estrogen and Progesterone Therapy in Menopause:

- which type of administration results in ENDOMETRIAL ATROPHY and ABSCENCE of VAGINAL BLEEDING

A

Estrogen/Progesterone TOGETHER EVERYDAY aka continuous combined

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47
Q

Estrogen and Progesterone Therapy in Menopause:

- which type of administration has a decreased risk for endometrial cancer

A

Estrogen/Progesterone TOGETHER EVERYDAY aka continuous combined

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48
Q

What are the 3 oral options for Estrogen and Progesterone drug therapy for menopause

A
  • Prempro
  • Angeliq
  • Activella
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49
Q

What are the 2 transdermal options for Estrogen and Progesterone drug therapy for menopause

A
  • Climarapro

- Combipatch

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50
Q

What is the idea behind using intermittent combined therapy for menopause

A

estrogen for 3 days then estrogen and progesterone for 3 days
(Do this so that the progesterone receptors are NOT DOWNREGULATED)

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51
Q

what drug is used for intermittent combined therapy for menopause

A

prefest

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52
Q

what drug is a estrogen and SERM combo?

A

Duavee

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53
Q

What is the SERM component name in the drug Duavee?

A

bazedoxifene

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54
Q

SERM agents are NON-HORMONAL and have agonist activity at the _____

A

bone

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55
Q

SERM agents are NON-HORMONAL and have antagonist activity at the _____ and _____

A

breast; uterus

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56
Q

SERM agents decrease or increase the risk for endometrial cancer

A

DECREASE!

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57
Q

First line treatment for Genitourinary Syndrome in Menopause

A
  • NON HORMONAL (Lubricants/ vaginal Mositurizers)
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58
Q

Second line treatment for Genitourinary Syndrome in Menopause

A

Estrogen based prodcuts (topical or low dose oral contraceptives)

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59
Q

What topical estrogen products can be used for Genitourinary Syndrome in Menopause

A

Ring, Cream, Tablet

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60
Q

Estrogen products that are given vaginally - do they need a progesterone “counterpart” for offering endometrial protection

A

Nope! - low dose and not a lot of systemic exposure means that progestin is not needed

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61
Q

what is Ospemifene (osphena)? and it is used to treat what?

A

it is a SERM product used for treating moderate to sever Dyspareunia

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62
Q

3 main questions you should ask yourself when creating a treatment plan for managing menopausal symptoms?

A
  • Location of symptoms (vasomotor or genitourinary)
  • Any contraindications?
  • Does the pt have an intact uterus
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63
Q

Types of Primary Osteoporosis

A

Type 1,2, and 3

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64
Q

what is type 1 primary osteoporosis

A

postmenopausal

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65
Q

what is type 2 primary osteoporosis

A

age-related

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66
Q

what is type 3 primary osteoporosis

A

idopathic, juvenille, adult

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67
Q

What are some medical conditions that cause secondary osteoporosis

A

alcoholism, cushing’s syndrome, eating disorders, GI disorders, Hyperparathyroidis, skeletal cancer

68
Q

What are the medications that can cause osteoporosis

A
  • Glucocorticoids
  • anticonvulsants
  • medroxyprogesterone
  • proton-pump inhibitors
  • aromatase inhibitors
  • gonadotropin releasing hormone agonists
  • immunosupressants
  • warfarin
  • lithium
  • heparin
  • thyroid supplements
  • vitamin A supplements
  • Thiazolidinedione
  • SSRIs
  • cytotoxic drugs
  • Canagliflozin
69
Q

How to be diagnosed with Osteoporosis

A
  • Atraumatic fracture of spine, femur, or distal radius

- WHO bone mineral density interperation by Dual-Energy X-Ray

70
Q

how many stages of labor

A

3

71
Q

what is stage 1 of labor

A

going towards full cervical dilation

72
Q

what is stage 2 of labor

A

time from full dilation to deliver

73
Q

what is stage 3 of labor

A

time from delivery of infant to delivery of placenta

74
Q

Oxytocin is used in labor what in what stages?

A

2 and 3!

75
Q

3 categories of Labor Dystocia

A
  • power (contractions not good, mom having hard time pushing)
  • passenger (size of position of fetus)
  • passage (bone or tissue in the way of the baby)
76
Q

what kind of labor dystocia is it ok to use oxytocin

A

power issue (get them contractions going)

77
Q

options for Labor dystocia

A
  • C-section

- IV oxytocin

78
Q

how to be diagnoes with labor dystocia

A

below or minimal normal rate of change or descent in labor

79
Q

what are the contraindications for inducing labor

A
  • placenta previa (placenta covering cervix)
  • sideway positioned fetus
  • previous c -section
  • prior uterine incision
  • umbilical cord prolapse (cord hanging out of cervix)
  • prior uterine rupture
80
Q

Oxytocin is given IV with ____ or ____

A

NS or LR

81
Q

Oxytocin can cause (hypo or hyper) tension and uterine (hypo or hyper) stimulation

A

HYPOtension; HYPER stimulation

82
Q

max dose of oxytocin -

A

40 milliunits/min

83
Q

Adverse effects of oxytocin

A
  • too many contractions (> 5 contractions in 10 minutes) this is called TACHYSYSTOLE
  • hyponatremia (why best to give with NS)
  • Hypotension
  • Hyperbillirubinemia (in infants)
84
Q

Oxytocin is the first line agent for uterine atony to prevent _______

A

excessive blood loss (aka postpartum hemorrhage)

85
Q

If the fetus dies inside the mother and oxytocin is needed for medical termination… is the dose higher or lower than oxytocin used in labor

A

the dose is higher

86
Q

Hallmark symptoms of Diabetes Insipidus

A
  • polyuria (pee a lot)
  • polydipsia (super thirsty)
  • Dehyradtion
87
Q

Diabetes Insipidus is characterized by excretion of abnormally large volumes of ______ urine

A

dilute;

88
Q 
Diabetes Insipidus is characterized by 
more than
 \_\_\_\_ L/m^2 of urine per 24 hours
OR 
> \_\_\_\_ mL/kg per 24 hours (adults)
A

2; 40

89
Q

what are the different types of Diabetes Insipidus

A
  • Central
  • Nephrogenic
  • Primary Polydipsia
90
Q

What is the explanation behind central diabetes insipidus

A

deficiency of vasopressin secretion; (hypothalamus neurons or destroyed or degenerated)

91
Q

What is the explanation behind nephrogenic diabetes insipidus

A

renal resistance to vasopressin action

body still makes vasopressin but kidney doesn’t know what to do with it

92
Q

What are different causes of nephrogenic diabetes insipidus

A
  • LITHIUM
  • Hypercalcemia
  • hypokalemia
  • pregnancy
93
Q

What is the explanation behind primary polydipsia

A

excessive fluid intake will suppress vasopression secretion (no hormone or receptor defect is present)

94
Q

Different ways to diagnose Diabetes insipidus

A
  • 24 hour urine volume
  • Lab tests (electrolytes, kidney, plasma or urine osmolality)
  • water deprivation test
  • aquaporin2 abnormalities
95
Q

Osmolality Changes in Diabetes Insipidus:

PLASMA Osmolality: would be _______ mOSM

A

> 300 ( v concentrated plasma bc water is being lost)

96
Q

Osmolality Changes in Diabetes Insipidus:

URINE Osmolality: would be _______ mOSM

A

< 200 (v small because urine is so dilute..)

97
Q

Osmolality Changes in Diabetes Insipidus:

Urine specific gravity will (decrease or increase)

A

decrease - because means v dilute

98
Q

what is normal plasma osmolality levels

A

280 - 295 mOSM

99
Q

Non-Pharm treatments for Diabetes Insipidus

A
  • Remove underlying cause

- LOW SOLUTE DIET (low protein and sodium)

100
Q

Non-Pharm treatments for Diabetes Insipidus:

limit sodium to < ____ g/day

A

2.3

101
Q

Non-Pharm treatments for Diabetes Insipidus

limit protein to < ___ g/kg/day

A

1

102
Q

What drugs can be used for Central Diabetes Insipidus

A
  • Chlorpropamide
  • Carbamazepine
  • (Hydro)Chlorothiazide
  • Indomethacin
  • Desmopressin
103
Q

what are the ADEs of Desmopressin

A

Dose Related - Nausea; HA, Flushing

  • Hypertension/hypotension, tachycardia, palpitations
  • Hyponatremia/Seizure
104
Q

Pharmacologic Treatment for Nephrogenic Diabetes Insipidus

A
  • correct undelrying cause (like drug related)
  • salt restriction - and thiazide diuretic
  • indomethacin
  • Amiloride ( a potassium sparing diuretic and hydrochlorothiazide)
105
Q

Infertility: inability to become pregnant after _____ months

A

12

106
Q

what are some factors that can lead to female infertility

A
  • cervical factors
  • uterine factors
  • tubal/peritoneal factors
  • ovulatory factors
107
Q

what are some non-pharmacologic ways to help with infertility

A
  • weight adjustment (if BMI to low probably are not ovulating, or too high of BMI causes issues (insulin resistance)
  • avoid smoking, alcohol, caffeine, illicit drugs
  • Reduce stress
  • “expectant management”
108
Q 
Expectant Management ideas:
Want to confirm evidence of ovulation when infertile - good to increase chances of pregnancy
- \_\_\_\_\_\_\_\_\_ kits
- timed \_\_\_\_\_\_
- change in \_\_\_\_\_\_\_\_
A

urine ovulation predictor; intercourse; cervical mucus

109
Q

Timed Intercourse “facts”

  • sperm lives for _____ days after ejaculation
  • egg lifespan is _____ hours after ovulation
A

1 -2 (up to 5)

12 - 24

110
Q

Expectant Management:
Change in cervical mucus
Normal mucus acts as _______ but during ovulation the is ________ so that sperm can pass through

A

a protective barrier; clear/slippery/stretchy

111
Q

Pharmacologic Treatment Options for infertility:

  • Controlled _________
  • _________ w/ or w/o IUI
  • Assisted Reproductive Techniques
A
  • ovarian hyperstimulation

- Gonadotropins

112
Q

Types of assisted Reproductive techniques

A
  • IUI
  • IVF
  • ICSI
113
Q

Drugs that are used for controlled ovarian hyperstimulaiton

A
  • Clomid

- Aromatase inhibitors

114
Q

what aromatase inhibitor drugs are used for controlled ovarian hypertstimulaton

A

letrozole

anastrozole

115
Q

Drug therapy for infertility:

what is used to develop multiple follicles by increasing FSH

A

Gonadotropins (FSH and LH or either alone)

116
Q

Drug therapy for infertility:

what is used to trigger ovulation

A

hCG

117
Q

hCG is typically used in infertility after use of ___________

A

gonadotropins, aromatase inhibitors, or clomiphene

118
Q

the TIMING of what drug in infertility treatment is very important

A

hCG

119
Q

Complications of infertility treatment

A
  • OHSS (ovarian hyperstimulation syndrome)
  • Risk of female cancers
  • Multiple births
120
Q

Symptoms of PCOS

A
  • hyperandrogenism (acne, hirsutism, alopecia)
  • Menstrual disturbances (no period or irregular period)
  • (possibly) Obesity
121
Q

What are the 3 possible mechanisms for PCOS

A
  • inappropriate gonadotropin secretion
  • insulin resistance w/ hyperinsulinemia
  • excessive androgen production
122
Q

PCOS Mechanism:
If there is an increase in GnRH :
a ________ never develops because it causes a pulse frequency of _____ too soon

A

dominant follicle; LH

123
Q

PCOS Mechanism:

Too much GnRH - which phase never occurs? Follicular or Luteal

A

Luteal

124
Q

PCOS - at higher risk of _________ cancer because ________

A

endometrial; no shedding of lining

125
Q

Hyper________ is a major contributor to hyper_________ in PCOS

A

insulinemia; androgenism;

126
Q

PCOS:
If insulin resistance is in fat or muscle - the body compensates this by making more insulin (because the body thinks it needs it)
- the ovary reacts to extra insulin how?

A

ovary has increased insulin senstivity in the ovarian andrgoenic pathway and will make more androgens! (aka hyperandrogenism)

127
Q

How does insulin resistance affect the liver ?

A

in the LIVER:
Insulin will inhibit SHBG (sex hormone binding globulin) SHBG normally binds testosterone therefore more insulin = LESS TESTOSTERONE bound to SHBG = MORE FREE TESTOSTERONE

128
Q

PCOS Diagnosis Criteria

A

Need 2 out of the 3

  • Chronic Anovulation
  • Polycystic ovaries
  • Hyperandrogenism
129
Q

PCOS Cause:

Hypersecretion of ______ and ______ will increase androgen production

A

LH; insulin

130
Q

PCOS Complications:

A
  • INFERTILITY (bc no ovulation)
  • CV disease/ T2DM/HTN/Dyslipidemia
  • endometrial hyperplasia and cancer
  • depression/anxiety
  • obstructive sleep apnea
  • pregnancy complications
131
Q

Treatment goals for PCOS

A
  • maintain normal endometrium
  • block actions of androgens on target tissues
  • reduce insulin resistance and hyperinsulinemia
  • reduce weight
  • prevent long-term complications
  • ovulation induction
132
Q

What are the 3 things that need to be thought about for PCOS treatment decisions

A
  • patient priorities
  • efficacy vs risks of treatment
  • desire to become pregnant
133
Q

Non-Pharmacological treatments for PCOS

A
  • Weight loss (can decrease free testosterone and reduces miscarriage)
  • Exercise can prevent the development of metabolic syndrome
134
Q

Pharmacologic Treatment for PCOS:

what is 1st line treatment for menstrual irregularity

A

COC (combined oral contraceptive)

135
Q

Pharmacologic Treatment for PCOS: what is 1st line for hirsutism

A

COC (combined oral contraceptive)

136
Q

Pharmacologic Treatment for PCOS: what is first line for acne

A

COC (combined oral contraceptive)

137
Q

Pharmacologic Treatment for PCOS:

why is estrogen in COC helpful

A

estrogen levels will suppress LH –> decrease ovarian andgroen production

138
Q

Pharmacologic Treatment for PCOS:

What are the two options for Anti-Androgen Therapy

A
  • Spironolactone

- 5a-reductase inhibitors (finasteride, dutasteride)

139
Q

Pharmacologic Treatment for PCOS

Spironolactone blocks _______ effects at the follicle

A

androgenic

140
Q

Pharmacologic Treatment for PCOS:

Monitor for _____ when pt takes sprionolactone

A

K+

141
Q

Pharmacologic Treatment for PCOS:

what are the adverse effects of spironolactone

A
  • vaginal bleeding
  • breast tenderness
  • HA
  • dizziness
142
Q

Pharmacologic Treatment for PCOS

Spironolactone and Pregnancy - safe or not safe?

A

NOT SAFE! category c for pregnancy - MUST USE RELIABLE FOR OF CONTRACEPTION

143
Q

Pharmacologic Treatment for PCOS:

what should be used if COC and spironolactone are not helping with hirsutism?

A

finasteride

dutasteride

144
Q

Side effects of 5areductase inhibitors

A

orthostasis; HA

145
Q

Pharmacologic Treatment for PCOS

Taking a 5a reductase inhibitor - safe with pregnancy or nah?

A

No! - must use reliable form of contraception

146
Q

Pharmacologic Treatment for PCOS

Insulin Sensitizer - what is the drug option?

A

metformin

147
Q

When is metformin seen as 1st line treatment?

A

if PCOS pt has glucose abnormalities too and failed lifestyle modifications

148
Q

metformin: may take up to _______ to see an effect for fixing menstrual irregularity

A

6months

149
Q

when is metformin seen as second line treatment

A

for menstrual irregularity

150
Q

For Treating Insulin Resistance in PCOS:

what is first and second line treatment

A

1st- lifestyle modification

2nd- metformin

151
Q

For Treating Mesntrual Irregularity in PCOS:

what is first and second line treatment

A

1st- COC

2nd - Metformin

152
Q

For Treating Hyperandrogenism in PCOS:

what is 1st, 2nd, 3rd, and last line treatment

A

1 - COC
2 - Antiandrogens (spironolactone, dutasteride, finasteride)
3 - topical Vaniqa (for facial hair only)
4 - cosmetic procedures (bleach, plucking, waxing, shaving, laser)

153
Q

Clomid for PCOS - how does it work/what is it used for

A

it is used for Anovulation/infertility in PCOS; it works by telling the body it is low on estrogen (when it is not) therefore more GnRH –> more LH, FSH occurs - this will cause ovulation

154
Q

Do NOT use Clomid for more than _______ (how long…)

A

6 months

155
Q

Start Clomid for Anovulation infertility when? (in relation to cycle)

A

Fay 2 - 5 after menses

156
Q

Max dose for Clomid

A

100 mg/day

157
Q

Monitor Parameters for Clomid

A
  • OHSS (ovarian hyperstimluation syndrome)

Risks: Kidney failure, thrombosis; stroke

158
Q

Signs and Symptoms for OHSS (ovarian hyperstimulation syndrome)

A
  • enlarged ovaries
  • ascites
  • abdominal pain
  • hydrothorax
  • decreased urine output
  • HYPERCOAGULABILITY (clot risk)
159
Q

What aromatase inhibitor is a possibility for treating PCOS/Anovulation Infertility

A
  • letrozole
160
Q

how does letrozole work to help with anovulation infertility

A

it will inhibit estrogen from being made –> hypothalamus is like “woah lets make LH and FSH” will cause ovulation

161
Q

currently is clomid or letrozole “better”

- which one has less side effects/potenitally better outcomes

A

Letrozole

162
Q

how long can someone use letrozole for anovulation infertility

A

up to 5 cycles

163
Q

1st/2nd/3rd line treatment for (PCOS induced) Anovulation?

A

1 - Clomiphene; Letrozole
2 - Clomiphene + metformin OR low dose gonadotropin therapy OR laparoscopic ovarian drilling
3 - IVF

164
Q

WHO DEXA Diagnostic Criteria for Osteoporosis:

t score for a NORMAL diagnosis

A

> 0 -> -1 SD

165
Q

WHO DEXA Diagnostic Criteria for Osteoporosis:

t score for osteopenia

A

-1.1 -> - 2.4 SD

166
Q

WHO DEXA Diagnostic Criteria for Osteoporosis:

t score for Osteoporosis

A

< - 2.5 SD

167
Q

WHO DEXA Diagnostic Criteria for Osteoporosis:

t score and criteria for SEVERE osteoporosis

A

< - 2.5 SD AND more than 1 fragility fracture

Therapeutics 2 Kappa Epsilon (22 decks)

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