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OTC > Exam 3 - Menstruation, Vaginal, and Vulvovaginal Disorders > Flashcards

Exam 3 - Menstruation, Vaginal, and Vulvovaginal Disorders Flashcards

1
Q

3 menstruation disorders

A

Primary dysmenorrhea
Premenstrual syndrome (PMS)
Toxic shock syndrome

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2
Q

What are the best OTC medications for prevention of strong uterine contractions (cramping)

A

Ibuprofen
Naproxen

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3
Q

3 vaginal and vulvovaginal infections

A

Bacterial vaginosis (BV)
Trichomoniasis
Vulvovaginal candidiasis (VVC)

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3
Q

Non-drug measures for menstrual pain

A

Heating pad
Stop smoking
Eat more fish/fish oil supplement
Regular exercise

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4
Q

What is the key to reducing pain when NSAIDs are taken?

A

Start taking NSAID when menstrual period begins

Take medication and regular intervals

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5
Q

Menstrual cycle

A

Time between onset of menstrual flow and the start of the next flow (menses to menses)

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6
Q

Menstruation

A

Monthly cycling of the female reproductive system

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6
Q

Why is aspirin NOT a recommended OTC medication for menstruation

A

It causes more bleeding

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6
Q

4 causes of painful periods

A

Prostaglandins
Endometriosis
Fibereosis
Adenomyosis

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7
Q

At what age does a girl’s first period (menarche) begin?

A

11-14.5 years

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8
Q

What is the mean blood loss during menses?

A

30 mL

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8
Q

What is the average cycle length

A

28 days

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9
Q

How long does menses usually last?

A

3-7 days

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9
Q

When is the most blood lost?

A

Days 1 and 2

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10
Q

Anemia can result from periods lasting longer than ____ or if blood loss is > ____

A

7 days
80 mL

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11
Q

Proliferative (follicular) phase

A

First flow to ovulation

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12
Q

Luteal (secretory) phase

A

From ovulation to next flow

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13
Q

What are the 2 principle reproductive events that occur during each menstrual cycle

A

Maturation & release of an ovum from ovaries

Preparation of endometrial lining of the uterus for the implantation of a fertilized ovum

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14
Q

In primary dysmenorrhea, increased levels of prostaglandins and leukotrienes cause _____

A

Strong contractions like labor

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14
Q

WITHOUT dysmenorrhea, contractions are ____ and pressure is up to ______

A

Rhythmic
120 mmHg

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15
Q

In primary dysmenorrhea, contractions are ____ and pressure is up to _____

A

NOT rhythmic
180 mmHg

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15
Q

In primary dysmenorrhea, more ____ and _____ cause _____

A

Ischemia
Tissue hypoxia
More pain

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16
Q

Primary dysmenorrhea

A

Cramp-like lower abdominal pain at menstruation

Pain related to onset of menstruation

Cyclic in nature

Described as continuous dull ache w/ spasmodic cramping in lower mid-abdominal region

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17
Q

What causes prostaglandins and leukotrienes to be released

A

Low progesterone levels at the end of the luteal phase

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18
Q

______ levels are twice as high in women w/ dysmenorrhea

A

Prostaglandin

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19
Q

What do leukotrienes cause

A

Vasoconstriction and uterine contractions, which cause pain

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20
Q

(T/F): dysmenorrhea may be worse after childbirth

A

False

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20
Q

Risk factors for dysmenorrhea

A
  • Heavy menstrual flow/early menarche
  • Tobacco use
  • Low fish/vegetable/milk/dairy consumption
  • History of sexual assault
  • Stress/anxiety/depression
  • BMI < 20 mg/kg2

(Having To Leave Has Some Benefits)

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21
Q

Primary dysmenorrhea responds to ____ or _____

A

NSAIDs
Combined oral contraceptives

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22
Q

At what age does primary dysmenorrhea occur?

A

6-12 months after menarche

Usually ages 13-17

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23
Q

At what age does secondary dysmenorrhea occur?

A

At least 2 years after menarche

Mid-late 20s or older

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24
Q

What is the cause of secondary dysmenorrhea

A

Associated with:
- endometriosis
- fibroids
- IUD
- pelvic pathology

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24
Q

Who is an exclusion for self treatment of menstrual disorders?

A

Pts experiencing severe dysmenorrhea

Symptoms not consistent w/ primary dysmenorrhea

Pts using warfarin, heparin, lithium, or have an allergy to NSAIDs

People w/ bleeding disorders

People w/ history of infertility, irregular menstrual cycles, endometriosis

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25
Q

What are the 1st line pharmacological options for treatment of primary dysmenorrhea

A

NSAIDs
Hormonal contraceptives

(NOT aspirin though)

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25
Q

What are the treatment goals of primary dysmenorrhea

A

Provide relief or significant improvement in symptoms

Minimize the disruption of usual daily activities

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26
Q

Dietary supplementations for menstruation disorders

A

Fish oil
Vitamin D

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26
Q

What NSAID may increase flow, so it is not generally recommended

A

Aspirin

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27
Q

If APAP is used for primary dysmenorrhea, how should it be dosed?

A

650-100 mg q6h

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27
Q

This drug is effective for mild symptoms of primary dysmenorrhea but NOT as effective as NSAIDs

A

Acetaminophen

28
Q

Optimal pain relief is achieved when NSAIDs are taken…

A

On a scheduled basis instead of PRN

29
Q

Continue NSAID use for the first ___ hours

A

24-72 hours

30
Q

Avoid ____ in adolescents under 20 years old

31
Q

Oral contraceptives can ____ PMS

32
Q

Risk factors of PMS

A

Stress
Traumatic events

32
Q

PMS can occur anytime after

33
Q

When does PMS occur

A

During luteal phase when prostaglandins are made

34
Q

Does PMS occur regularly w/ every cycle

35
Q

PMS symptoms

A

Physical
Emotional/mood
Behavioral

36
Q

PMS symptoms improve by _____

A

The end of menses

37
Q

PMDD interferes with

A

Social and occupational functioning

38
Q

Diagnosis of PMS is made on the basis that symptoms are ____

39
Q

PMDD requires

A

Physician referral (no OTC treatment)

39
Q

Severe form of PMS

A

Premenstrual dysphoric disorder (PMDD)

40
Q

Most common negative symptoms of PMS

A
  • Fatigue
  • Crying spells
  • Breast tenderness
  • Appetite changes
  • Headache
  • Irritability/anger
  • Muscle pain
  • Anxiety/stress
  • Depression
  • Difficulty concentrating
  • Insomnia
  • Labile mood alternating sadness/anger
  • Abdominal bloating

(Feeling Crappy? Bitch At HIM All Damn Day In LA)

41
Q

Most common positive symptoms of PMS

A

Increased energy
Increased libido
Increased sense of control

42
Q

Goals for PMS treatment

A

Achieve relief or significant decreases of symptoms

Limit discomfort, distress, and the disruption of personal relationships/activities

43
Q

(T/F): therapy is considered effective if symptoms are reduced by 50% or more

44
Q

Treatment of PMS w/ nonprescription meds

A
  • Magnesium pyrrolidone (300-360 mg)
  • Vitamin D (600 IU)
  • Calcium (1200 mg)
  • Pyridoxine (100 mg)

(My Very Crampy Pussy)

44
Q

1st line PMS treatment

A

Calcium
Vitamin D

45
Q

Is PMS self treatable

A

Yes, with stress reduction

46
Q

Max daily dose of B6

A

100 mg

More risks neuropathy

47
Q

Tampon use carries ___ into the vagina

47
Q

4 conditions that promote toxin production

A

Elevated protein levels
Elevated CO2 levels
Elevated oxygen levels
Neutral pH

48
Q

Do diuretics help w/ PMS symptoms

A

No because most people do not experience weight gain

49
Q

TSS is caused by toxin producing strains of

49
Q

TSS is most common in women ages ____

50
Q

If TSS is suspected, it is best to

A

Seek treatment immediately

51
Q

What is the best treatment for TSS?

A

Prevention

51
Q

Use ___ not tampons for TSS

52
Q

___ can be treated w/ topical heat

A

Primary dysmenorrhea

53
Q

Bacterial vaginosis

A

Thin, off white foamy discharge
“Fishy” odor
Less irritation of vagina

54
Q

Trichomoniasis

A

Yellow-green frothy discharge
Itching
Vaginal irritation
No symptoms in ~ 50% of women

55
Q

Vulvovaginal candidiasis

A

Thick, white “cottage cheese” discharge with no odor

Itching and redness

Risk factors include antibiotics and type 2 diabetes

56
Q

BV and trichomoniasis are linked w/ health problems such as:

A

Pelvic inflammatory disease
Preterm birth
Facilitating transmission of HIV

56
Q

Treatment goals for VVC

A

Symptom relief
Infection eradication
Normal vaginal flora reestablished

56
Q

What symptoms is most likely to differentiate yeast infection from BV and trichomoniasis

A

Absence of offensive odor

57
Q

VVC exclusions to self-treatment

A
  • Pregnancy
  • Girls younger than 12
  • Concurrent symptoms (fever or pain in pelvic area, abdomen, back, shoulder)
  • Recurrent VVC
  • First vulvovaginal episode
58
Q

Do yeast infections alter pH

58
Q

pH greater than ___ may indicate a bacterial or trichomonal vaginal infection

59
Q

Key limitations to using vaginal pH tests

A

No testing until > 72 hrs since last vaginal preparation (contraceptives, spermicide, antifungal)

Test 48 hrs after sexual intercourse or douching

Test at least 5 days after period

60
Q

Self treatment of VVC is most appropriate for people w/ what 4 criteria?

A
  • Vaginal symptoms are infrequent
  • 1 previous episode of VVC diagnosed by provider
  • No foul odor
  • Vaginal pH < 4.5
61
Q

OTC treatment for VVC

A

Vaginal antifungals

62
Q

Topical imidazoles can be applied to infected area ___________ for treatment of VVC

A

Twice daily for 2-4 weeks

63
Q

Nonpharmacological therapy for VVC

A

Decrease consumption of refined carbs

Adding consumption of yogurt w/ live cultures

Discontinuing drug known to cause increased risk of VVC (antibiotics)

Sitz bath

64
Q

Initial therapy recommended for uncomplicated VVC

A

Imidazoles

64
Q

What drug needs monitored if taken concurrently w/ imidazoles

65
Q

Are systemic or topical imidazoles more effective

A

Both are equally effective

66
Q

VVC symptoms should improve within ___ days of initiation of therapy

67
Q

Resolution of VVC symptoms within

68
Q

Patients should contact their PCP about VVC if

A

Symptoms persist beyond 7 days or no improvement within 3 days

Persistent or new symptoms consistent w/ VVC

69
Q

Atrophic vaginitis

A

Inflammation of the vagina related to atrophy of vaginal mucosa secondary to decreased estrogen levels

70
Q

Common symptom associated w/ atrophic vaginitis

A

Dyspareunia (inadequate vaginal lubrication that can cause painful intercourse)

72
Q

Exclusions for therapy for atrophic vaginitis

A

Symptoms not localized to vagina/bleeding present

Dryness not relieved by personal lubricants

73
Q

Adverse effects of frequent douching

A
  • STI
  • Reduced fertility
  • Disruption of normal vaginal flora & pH
  • BV
  • Low birth weight
  • Ectopic pregnancy
  • Cervical cancer
  • PID

(Some Real Douche Bag Loser Escaped County Prison)

OTC (31 decks)

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