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Endocrine > exam 2 menstruation pp > Flashcards

exam 2 menstruation pp Flashcards

1
Q

contraception prevents pregnancy by 1 of 3 ways

A

preventing ovulation
preventing implantation of fertilized ovum in the endometrium
inhibiting contact of sperm with mature ovum

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2
Q

most common coc contraindications

A

breastfeeding
shortly postpartum
women > 35 y/o who smoke >15 cigs/day
severe HTN
known thrombogenic history
migraine with aura
current or recent breast cancer

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3
Q

MEC category 3 and 4

A

Smoker who is > 35 years old
◦ Severe cirrhosis/liver tumors
◦ History of DVT or PE
◦ Major surgery with prolonged immobilization
◦ Migraine with aura
◦ Hypertension (even if controlled)
◦ Vascular disease
◦ Ischemic heart disease
◦ Multiple risk factors for ASCVD: older age, smoking,
diabetes, HTN, low HDL, high LDL, or high
triglycerides
◦ Stroke or history of stroke/CVA
◦ Breastfeeding
◦ Postpartum (0-42 days)
◦ Bariatric surgery patients who have malabsorption
(no COC’s)
◦ Current nephrotic syndrome
◦ Hemodialysis
◦ Lupus with antiphospholipid antibodies
◦ Multiples Sclerosis with prolonged immobility
◦ Breast cancer (w/i 5 yrs)
◦ Diabetic retinopathy, nephropathy, and/or
neuropathy
◦ Diabetes of > 20 years duration
◦ Current gallbladder disease
◦ Sickle Cell Disease
◦ Thrombophilia

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4
Q

additional goals of therapy

A

decreases PMDD symptoms
improved dysmenorrhea
menstrual cycle regularity
decreased acne and hirsutism
management of endometriosis and PCOS

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5
Q

PMDD symptoms

A

PMS symptoms: bloating, HA, breast tenderness
plus: extreme irritability, anxiety, depression, mood swings, insomnia, binge eating

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6
Q

MOA progestin

A

block LH surge that stimulates ovulation, and provides most of the contraceptive effects
prevents ovulation
thickens cervical mucus
slows sperm motility
endometrial atrophy

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7
Q

MOA estrogen

A

provides menstrual cycle control
prevents FSH release
stops recruitment and stimulation of follicles
provides stabilization to endometrial lining

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8
Q

follicular phase

A

day 1-14
first day of menses
continues through ovulation

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9
Q

days 1-4

A

FSH rises and allows recruitment of follicles for growth and development

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10
Q

days 5-7

A

a single follicle develops and begins to produce estradiol which stops menstruation from the previous cycle then signals the pituitary to release LH

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11
Q

ovulation

A

occurs 24-36 hours after estradiol peak and 10-16 hours after LH spike then the oocyte travels from ovary to fallopian tube

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12
Q

luteal phase

A

after rupture of follicle and release of the ovum, the remaining follicluar cells become the corpus luteum this synthesizes progesterone, estrogen, and androgens

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13
Q

when looking at coc what should you look at

A

ethinyl estrogen DOSE and progestin TYPE

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14
Q

1st gen progestins

A

norethindrone
norethindrone acetate
ethynodiol diacetate

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15
Q

2nd gen progestins

A

norgestrel
levonorgestrel

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16
Q

3rd gen progestins

A

desogrestrel
norgestimate

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17
Q

4th gen progestin

A

drospirenone

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18
Q

estrogen types

A

ethinyl estradiol (EE)
estradiol validate (EV)
mestranol

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19
Q

estrogen ADE

A

menstrual irregularity
break through bleeding
N/V (take with food and resolves in a few weeks)
fluid retention –> weight gain and breast tenderness
depression
photosensitivity
increase risk of VTE

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20
Q

progestins work on what receptors

A

progesterone
androgen
glucocorticoid

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21
Q

1st gen receptors

A

low progestin
low estrogenic
moderate androgenic
higher risk of unscheduled bleeding and spotting

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22
Q

2nd gen receptors

A

higher progestin
higher androgenic

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23
Q

levonorgestrel can increase what?
used for what?

A

may increase cholesterol
may increase androgenic side effects
used for heavy menstrual bleeding
used in planB and IUDs

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24
Q

norgestrel for?

A

may help with endometriosis

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25
3rd gen receptors
high progesterone minimizes estrogenic and androgenic effects reduced side effects (acne and weight gain) slight effect on increasing cholesterol increased risk of non fatal blood clots
26
4th gen receptors
anti androgenic and mineralcorticoid increased risk of blood clots Yaz for PMDD can help with weight and acne
27
OTC contraceptive
Opill norgestrel
28
transdermal patch interval
apply once weekly then patch free 1 week less effective >198lbs highest exposure to estrogen upper arm, stomach, back, buttocks and rotate sites backup for 1st 7 days
29
vaginal ring interval
inserted monthly, 3 weeks in then removed for 1 week lowest estrogen exposure
30
benefits of coc
acne reduced anemia reduced benign breast disease reduced cancer risk reduced (ovarian, endometrium) dysmenorrhea symptoms improved endometriosis symptoms improved
31
which coc mimics natural cycle
triphasic
32
progestin only pill (POP)
can be used if breastfeeding shorter half life must be taken at the same time every day not as effective >154lbs if 3 hours late, use back up for 48 hours
33
progestin only injection (depot)
every 3 months may take longer to conceive after discontinued can use if breastfeeding side effects: spotting, breakthrough bleeding, 5lbs gained in 5 years may take longer to get pregnant (18-24 months) FDA box warning: can decrease bone mineral density (need Vitamin D and calcium)
34
IUD
long acting reversible contraceptive (LARC) effective 3-8 years contraindicated: active pelvic infection, pregnant, distorted uterine anatomy fertile within 1 week of removal can cause menstrual irregularity for first 3-6 months ADE: late period, difference in bleeding, spotting abdominal paina nd pain with intercourse infection not feeling well, fever and chills string missing, longer or shorter
35
nexplanon
etonogestrel effective 3 years
36
hormonal contraception (oral transdermal, vaginal) switching to IUD
insert IUD at any time if during active weeks use pervious method for 7 days or until end of cycle
37
depot to IUD
insert IUD at any time if inserted >13 weeks after last injection use back up method for 7 days
38
implant to IUD
insert IUD same day as implant removed any time during cycle
39
who needs POP
breast cancer CVD CAD diabetes with major complications migraine with aura uncontrolled HTN breastfeeding liver disease pregnant surgery with prolong immobilization age >35 and smoking hyper coagulate states complicated valvular heart disease lupus
40
too much estrogen
nausea, breast tenderness, HA, weight gain: decrease estrogen and consider progestin only or IUD dysmenorrhea, menorrhagia, uterine fibroid growth: decrease estrogen, consider extended cycle or continuous, progestin only or IUD NSAIDs for dysmenorrhea
41
too much progestin
increased appetite/ weight gain, bloating, constipation: decrease progestin acne, oily skin, hirsutism: choose less androgenic progestin depression, fatigue, irritability: decrease progestin
42
too little estrogen
breakthrough bleeding days 1-9: increase estrogen if taking <30mcg, if on >30mcg try different progestin amenorrhea: rule out pregnancy, increase estrogen vasomotor symptoms, nerovousness, decreased libido: increase estrogen
43
too little progestin
dysmenorrhea, menorrhagia: increase progestin, consider extended cycle or continuous, progestin only or IUD breakthrough bleeding days 14-21: increase progestin hypermenorrhea: consider progestin only or IUD
44
transdermal specific ADE
higher rate for blood clots irritation at site
45
vaginal ring specific ADE
decreased libido device related events vaginal discomfort irregular bleeding
46
depot specific ADE
significant weight gain delayed return to fertility
47
implant specific ADE
site reactions: irritation, hematoma, redness at site difficult removal: rod breaks and hematoma irregular bleeding
48
coc interactions
3A4 inducers: Rifampin, St John’s Wort, phenytoin, barbiturates, oxcarbazepine, carbamazepine, topiramate decreases effects, these pts need IUD or implant estrogen induces metabolism of lamotrigine and valproate pts on mounjaro need backup for 4 weeks after initiation or dose increase
49
what would you give for menorrhagia acne endometriosis
extended or continuous cycle or IUD 3rd or 4th gen COC depo
50
drug that increases oc effects
atorvastatin
51
drugs that altered metabolism or clearance with oc
acetaminophen aspirin lamotrigine tricyclic antidepressant benzo BB caffeine corticosteroids cyclosporine theophylline
52
antibiotics and oc
prevent recirculation of free estrogen
53
antibiotics that do not decrease effectiveness of oc
ampicillin doxycyline fluconazole metronidazole miconazole fluoroquinolones tetracyclines
54
starting oc
can start anytime during cycle but use back up 7 days no backup needed if: first dose on first day of cycle first dose 2-5 days of cycle fist dose the first Sunday after start of cycle POP start anytime use backup for 48 hours unless within 5 days of start of period
55
hormonal contraceptions for: bariatric surgery breast cancer
patch, ring, depo copper IUD- within 5 years fam hx- can use chc or pop
56
coc missed doses
missed 1 dose- take 2 pills the day after missed dose missed 2 doses- take 2 pills for 2 days after missed dose and consider backup for 7 days missed 3 or more doses- discard current pack and start new pack consider backup for 7 days
57
pop missed dose
3 hours late or missed dose- take missed dose asap the keep regular schedule consider backup for 2 days more than 2 doses late or missed- take most recent missed pill asap and keep regular schedule, use backup for 7 days
58
miss patch dose
>48 hours: use backup for 7 days
59
copper IUD MOA
creates a sterile inflammatory reaction that impairs implantation, is toxic to sperm and ova, impairs sperm motility, capacitation and survival and increases sperm phagocytosis
60
copper IUD
10 years increase blood loss increased risk of infection usually STD
61
internal condoms
can be inserted up to 8 hours prior intercourse
62
diaphragms
contain latex may be inserted up to 2 hours before intercourse must be left in place for at least 6 hours after reusable for 2 years
63
sponges
contains spermicide: nonoxynol-9 may be inserted 6 hours prior must remain in place for 6 hours after increase risk of UTI, TSS< yeast infection
64
spermicide
apply in vagina within 10-15 minutes prior can cause irritation and vaginal dryness and increase risk of HIV transmission
65
cervical caps
can be inserted 2 hours before must be left in for 6 hours after reuseable up to 2 years
66
most effective contraceptives
implant IUD sterilization depot pill patch ring diaphragm condom withdrawal sponge fertility awareness spermicide
67
EC types
◦ Copper IUD: prevents implantation/creates hostile environment ◦ Levonorgestrel: prevents implantation of fertilized egg; will not terminate a pregnancy after implantation has occurred ◦ Ulipristal: mixed progesterone agonist/antagonist; can terminate an established pregnancy
68
EC ADE
N/V, abdominal discomfort, irregular menses
69
EC with vaginal ring
consider EC if unprotected sex within 5 days and: >48 hours since ring should've been inserted <48 hours since ring should've been inserted and delayed insertion earlier in cycle or in last week of previous cycle
70
EC with patch
consider EC if unprotected sex within 5 days and: >48 hours since patch should've been applied <48 hours since patch should've been applied and patch became detached earlier in cycle
71
EC with COC
consider EC if unprotected sex within 5 days and: >48 hours late taking pill in first week <48 hours late taking pill and active pills were missed earlier in cycle or during last week of previous cycle
72
restarting CHC after EC
IUD- resume next day but use backup for 7 days ulipristal- must wait till next menses and use backup method
73
medical abortion can be used up to
63-70 days gestation
74
medical abortion drugs
mifepristone 600mcg followed by misoprostol (cytotec) 400mcg 24-48 hours later misoprostol used vaginally can be used alone if before 9 weeks methotrexate; for ectopic pregnancies
75
medical abortion MOA
Mifepristone: Taken first Blocks the hormone progesterone Progesterone is needed for the fetus to grow inside the uterus Mifepristone begins process of slowly emptying the uterine contents and lining Misoprostol: Causes uterine cramping and cervical softening Expels the uterine contents from the body
76
PPI and estrogen containing products
community- at each fill inpatient- before first administration and every 30 days if not its misbranded
77
what must eb on the PPI
name of drug effectiveness in preventing pregnancy contraindications statement of risk vs benefit statement comparing oral to other methods boxed warning- increased risk associated with smoking and oc use conditions not contraindicated but deserve special consideration warning about most serious side effects statement about other adverse effects precautions to observe: risk to unborn child when used before or early in pregnancy excretion to milk and risk to nursing infants lab tests affected by oc drug, food, and other interactions to avoid

Endocrine (16 decks)

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