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Pharm 359 > Dysmenorrhea, PMS, Endometriosis > Flashcards

Dysmenorrhea, PMS, Endometriosis Flashcards

1
Q

What is dysmenorrhea?

A

painful periods
either before, and/or during

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2
Q

What is primary dysmenorrhea?

A

Painful with NORMAL pelvic anatomy
NORMAL cycles

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3
Q

When does dysmenorrhea present?

A

6-12 months after first menarche

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4
Q

What is secondary dysmenorrhea?

A

painful period with underlying pelvic anatomies
weirder cycles, irregular bleeding

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5
Q

Probable cause of dysmenorrhea?

A

prostagladins probably because increased amount during
prostaglandins also cause stronger uterine contractions and more frequent

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6
Q

Risk factors for dysmenorrhea?

A

<12 first period, family history, heavy menses, smoking, <20 BMI

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7
Q

Sx of dysmenorrhea?

A

cramping, pain, Headache, NDV, fatigue

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8
Q

How long does dysmenorrhea last?

A

typically 2-3 days after peak

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9
Q

When would you consider painful periods to be secondary dysmenorrhea?

A

pain after years of normal
heavy bleeding
painful sex
rectal pain
no response to drug therapy

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10
Q

GOT of dysmenorrhea?

A

relieve sx
minimize lost time
identify 2 dysmenorrhea

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11
Q

Treatment of dysmenorrhea?

A

3 month trial of NSAIDs or COC

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12
Q

Non pharm for dysmenorrhea?

A

exercise, TENS, acupuncture, topical heat

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13
Q

OTC agents for dysmenorrhea and do they work?

A

Acetaminophen- yes for mild
pamabrom- diuretic not awesome
pyrilamine- 1st gen antihistamine NOT effective good for mood tho

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14
Q

Are all NSAIDs equal for dysmenorrhea?

A

DUH

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15
Q

Dosing of NSAIDs for dysmenorrhea?

A

at onset of pain OR bleeding
continue for 3 days

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16
Q

When does PG peak in dysmenorrhes?

A

48 hours

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17
Q

Common NSAIDs and dosing for dysmenorrhea?

A

Ibuprofen - OTC OR 800mg q8h
Naproxen- OTC
Mefenamic acid- 500mg stat then 500mg BID

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18
Q

For MA of dysmenorrhea, how much can we prescribe?

A

for 5 days, up to 6 cycles

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19
Q

How do COCs help with dysmenorrhea?

A

prevent enometrial proliferation/ovulation= stops PG synthesis

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20
Q

What dosing of COCs may be better for dysmenorrhea?

A

continuous may be better

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21
Q

When to see pain control of dysmenorrhea with COCs?

A

3-6 months
may be combined with NSAIDs

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22
Q

Are progestin-only products also good for dysmenorrhea?

A

not as well studied but proven effective

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23
Q

If dysmenorrhea is treatment-resistant, what is next?

A

laparoscopic findings

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24
Q

What is premenstrual syndrome?

A

cyclic recurrence during luteal phase (after ovulation and before menses)

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25
What is PMDD?
more severe and disruptive, more mood sx
26
What is premenstrual exacerbation?
worsening of other disorders during premenstrual stage
27
sx of PMS?
mood sx ance appetite change bloat breast pain fatigue hot flash NV weight gain
28
Examples of PMS patterns?
sx at ovulation and worsen sx in 2nd weeek of luteal (right before menses) sx brief at ovulation then recurrence in late luteal sx at ovulation, worsen and only stop once menses is over
29
PMS cause theories?
oversensitivity to progestin serotonin low parathyroid high (calcium low)
30
Risk factors for PMS?
BMI>30, violence, trauma, substances, genetic
31
Does PMS happen in follicular phase?
NO
32
Criteria for PMS diagnosis?
>5 sx that CHANGE in severity throughout cycle for at least 2 cycles
33
Diagnosis of PMDD?
>5 sx and >1 severe mood sx for >2 cycles
34
Other conditions to rule out for PMS?
anemia, DM, thyroid, endometriosis, PCOS, s/e of COCs
35
Differences between PMS and dysmenorrhea?
PMS= luteal phase, behavioural sx, varied treatment dysmenorrhea= right before menses, PG, physical only, NSAIDs and OC
36
Non pharm for PMS?
massage, CBT, stress reduction, sleep hygiene, exercise, AVOID caffiene, Increase complex carbs, lower salt
37
Top two treatments for PMS?
calcium carbonate and SSRIs
38
How does calcium help wiht PMS?
improves bad mood, fluid retention, cravings, pain
39
Dose of calcium for pms? for how long?
1200 mg elemental (can only absorb 500 at a time) for 3 months trial
40
How do SSRIs help with PMS?
good for cognitive sx better for PMDD
41
Do you need depression for SSRIs to help with PMS?
NO
42
True or false: you need high doses of SSRIs to help with PMS?
no, either or
43
When to see effect of SSRI in PMS?
in first cycle
44
Which are better SSRI or SNRI for PMS?
more evidence for SSRI
45
Whihc dosing of SSRI is best?
all work - continuous - only luteal phase - at onset
46
Why do SSRIs work so fast in PMS?
because it could be working at a different receptor, and because PMS is cyclical
47
What is an adequate trial of SSRI for PMS?
2 cycles
48
If partial response to SSRI for PMS what next?
increase dose
49
If no response to SSRI for PMS what next?
switch agent
50
Who is at risk of sx relapse if d/c SSRI for PMS?
if sx are very severe
51
Do NSAIDs work for PMS?
yes but only for pain and headache
52
Does pyridoxine (B6) work for PMS?
maybe for excitatory sx (irritable) due to maybe that B6 is cofactor in making serotonin and dopamine 50-100mg daily
53
S/e of B6 and at what dose?
>200mg = peripheral neuropathy
54
Do OC help with PMS?
maybe but evidence is mixed
55
Is POP good for PMS?
NOOOOO
56
WHen would we give OC for patients with PMS?
if need contraception as well
57
Do diuretics (caffeine/pamabrom) or pyrlamine good for PMS?
prob not
58
Are other AD good for PMS?
less evidence than SSRI
59
Are benzos good for PMS?
dependence issues
60
Are spirinolactone for PMS?
only for fluid retention
61
Are GnRH analogues/danazol good for PMS?
only for severe or PMDD
62
Is chasteberry good for PMS?
prob not
63
Is magnesium good for PMS?
maybe for fluid retention
64
Is evening primrose oil good for PMS?
NO
65
Is St. John's Wort good for PMS?
NO- doesn't work and interferes with OC
66
Is vitamin E/ Ginko good for PMS?
probably not
67
What is endometriosis?
endometrial tissue outside uterus
68
What is the retrograde menstruation theory of endometriosis?
endometrium is shed and flows back up tubes and implants on organs
69
WHat is the immunologic theory of endometriosis?
endometrial tissue able to evade immune system= presence of abnormal cytokines and t and B cells
70
What is coelomic metaplasia theory of endometriosis?
lesions develop and undergo metaplasia
71
What is vascular/lymphatic theory for endometriosis?
cells are spread to distant locations due to lymph or vascular pathways
72
So endometrial tissues implants, what happens?
dependent on estrogen and they can grow and bleeed
73
Why does endometrial tissue able to get high estrogen levels?
aromatase present and no progesterone receptors to antagonize estrogen
74
WHat does high estrogen promote?
inflammation through increased COX
75
WHat can happen from pain from endometriosis?
inflammation neuropathic pain central sensitization bleeding
76
True or false: There is a way to predict if endometriosis remains stable, regress or progress?
FALSE
77
What are risk factors for endometriosis?
first period <10 heavy menses short cycles genetic
78
Sx of endometriosis?
often asymptomatic pain infertility painful sex fatigue constipation
79
How do you diagnose endometriosis?
laproscopy
80
What is the cure for endometriosis?
NONE
81
1st line for endometriosis?
contraceptives
82
WHen may we want progestin only for endometriosis?
same effective but less s/e
83
What do we give for pain in endometriosis?
NSAID
84
Why do OC help in endometriosis?
hypoestrogen state due to drug having less potent estrogen and progestin preventing rise in estrogen
85
S/e of OC?
breast tender, spotting, mood, headache, N, weight gain
86
How long is an OC trial for endometriosis?
3 months
87
How would GnRH agonists help with endometriosis?
bind to GnRH receptors and increase LH/FSH= down reg og pituitary pathway= hypoestrogen
88
True or false: Lupron therapy will cause hyopestrogen state with in the first month.
False- surge first then drop
89
What is general duration for GnRH?
6 months
90
S/e of GnRH
bone loss hot flashes, sweat, vag dryness, insomnia, libido, headache, mood swing
91
What MUST we ensure before starting GnRH?
not pregnant
92
How can we counter the s/e of GnRH?
add low dose estrogen/progestin
93
True or false: add back treatment will stop pregnancy?
FALSE
94
Why does add back therapy not ruin therapy?
estrogen threshold effect
95
WHy does norethindrone acetate (POP) work for endometriosis?
a progestin that has both progesterone and estrogen effects
96
What is elagolix for?
SEVERE endometriosis
97
How does elagolix work?
oral GnRH antagonist= RAPID, reversible Hypoestrogen state
98
WHat dose of elagolix have partial and full estrogen suppression?
150mg daily= partial 200 BID=full
99
Does elagolix act as birth control as well?
NOOOOOO= use something without estrogen
100
s/e of elagolix?
hot flashes, headache, insomnia, nausea, no perioid, mood swings, bad BMD, increases lipids
101
WHat is an issue with elagolix?
CYP interactions
102
What should we ensure patients are also taking if on GnRH therapy?
BC calcium, vitamin D
103
What are the aromatase inhibitors?
anastrozole, letrozole, exemastane
104
What is role of aromatase inhibitors?
stops conversion of androgens to estrogen not great evidence
105
Pro of aromatase inhibitors?
less s/e than GnRH
106
How does danazol work?
synthetic androgen to decrease estrogen
107
WHy isnt danazol used?
androgenic s/e such as voice change, weight gain, hair growth, acne, lipids
108
WHen do we elect for surgery in endometriosis?
infertile and want pregnancy, or non responders
109
Issues with laproscopic treatment of endometriosis?
recurrence rate high- may limit with hormonal suppression
110
Will a hysterectomy stop endometriosis?
10% have recurrence
111
True or false: Pregnancy often stops endometriosis for a bit?
TRUE
112
When is it okay to get pregnant if on medications for endometriosis?
1 month after d/c
113
WHy does endometriosis cause infertility?
scarring, autoimmune, hostile environment due to inflammation, irregular cycles

Pharm 359 (16 decks)

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