Exam 2- lecture 4

Question 1

DA agonist treatment for amenorrhea

Answer 1

bromocriptine BID-TID
cabergoline 2x/wk
- suppress prolactin release from pituitary-> >FSH/LH
- take 3-6 months
- take with food
- CYP3A4

Question 2

treatment for PCOS

Answer 2

• insulin resistance: metformin or TDZ +/- OC

Question 3

metformin MOA

Answer 3

inhibits glucose production & increases insulin sensitivity; redcues insulin resistance

Question 4

thiazolidinediones MOA

Answer 4

increase insulin sensitivity; reduce resistance

Question 5

menorrhagia treatment options

Answer 5

NSAIDS, OCs, mirena, progesterone,, tranexamic acid, surgery- endometiral ablation->hysterectomy

Question 6

menorrhagia first line treatment

Answer 6

mirena & NSAIDs

Question 7

progesterone for menorrhagia treatment

Answer 7

• during luteal phase or for 21 days starting on day 5 after onset of mendes

Question 8

tranexamic acid for menorrhadga treatment

Answer 8

tid

• antifibrinolytic
• blocks lysine binding sites on plasminogen & prevents fibrin degradation

Question 9

OC for menorrhagia treatment

Answer 9

> 35mcg estradiol

Question 10

follow up with menorrhagia

Answer 10

after 1 cycle

- measure hemoglobin/hematocrit- dont want anemia

Question 11

most common cause of anovulatory bleeding

Answer 11

PCOS

Question 12

perimenopausal symptoms

Answer 12

hot flashes, night sweats, vaginal dryness

- anovulatory bleeding

Question 13

PCOS symptoms

Answer 13

acne, hirsutism, obesity

- anovulatory bleeding

Question 14

if acute, severe bleeding episodes

Answer 14

estrogen is beneficial

Question 15

anovulatory OC treatment

Answer 15

estradiol dose <35mcg

Question 16

what increases sex hormone- binding globulin (SHBG)

Answer 16

OCs, metformine & TZDs

- binds & reduces androgens

Question 17

clomiphene citrate (Clomid)

Answer 17

50mg/day for 5 days between menstrual cycle days 3 & 5
- increase if no ovulation
anovulatory bleeding

Question 18

anovulatory follow up

Answer 18

with in 1 week

• bleeding should decline within 10 days
• ovulation should return w/in 3-6 months (metformin)

Question 19

dysmenorrhea nonpharmacologic treatment

Answer 19

topical heat therapy, exercise, low-fat vegetarian diet

Question 20

dysmenorrhea first line treatment

Answer 20

NSAIDs- improve w/in 1 hour

Question 21

dysmenorrhea follow-up

Answer 21

1-2 cycles

improved QOL within 1-3 cycles

Question 22

therapeutic lifestyle changes for PMS.PMDD

Answer 22

reduce caffeine, sugar, & Na, increase exercise, Vitamin B6(50-100mg/day), calcium carbonate (1200mg/day)

Question 23

first line PMS/PMDD treatment

Answer 23

SSRIs (fluoxetine, citalopram, paroxetine) & SSNRI(venlafaxine)
- other options- monophasic OCs 20mcg EE & 3 mg drospirenone, TCAs, GnRH agonists

Question 24

endometriosis treatment options

Answer 24

combined OCs, GnRH agonists, andogen analogs, surgery

Question 25

pharmacological treatment for endometiosis=

Answer 25

inducing a pseudopregnancy or pseudomenopausal state

Question 26

first line endometriosis treatment

Answer 26

combined hormonal contraceptives or progestins

- at least 3 month trial

Question 27

alternative treatments for endometriosis

Answer 27

• GnRH- functional oophorectomy via inhibitoing FSH/LH secretion->hypoestrogenic state
• danazol- testosterone analogue- supress LH/FSH->anovulation, amenorrhea, endometrial atrophy (do not use in hyperlipidemia or liver disease)-prego X

Question 28

last line alternative treatments for endometriosis

Answer 28

aromtase inhibitors (anastrazole, letrozole)- direct inhibition of estrogen production