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IDT Spring Term > Exam III - Lorinda > Flashcards

Exam III - Lorinda Flashcards

1
Q

What are the contraindications for HRT?

A 
Severe liver dysfunction
Acute vascular disease
Hyper-coagulability
Severely elevated TGL
Abnormal vaginal bleeding
Any history of current breast cancer
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2
Q

General conclusions from the WHI study:

A

Pretty safe for perimenopausal women to use HRT
Increased risks for older ages
Stroke and breast cancer risk are still increased
Overall reduced death in younger ages with those taking HRT

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3
Q

What HRT contains peanut oil?

A

Micronized progesterone

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4
Q

What HRT has an FDA warning about keeping away from children?

A

Evamist - 17B Estradiol spray

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5
Q

What vaginal ring gives you systemic coverage? Non-systemic coverage?

A

Estring is 17B estradiol = non-systemic

Femring is estradiol acetate = systemic

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6
Q

What estrogen product do you have to rub for three minutes into the thigh?

A

Estrasorb topical gel

One pouch per thigh

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7
Q

What SERM can be used for painful sexual intercourse but has a SE of hot flashes?

A

Ospemifene

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8
Q

What SERM + estrogen complex can be used to treat hot flashes or osteoporosis.

A

Bazedoxifene/Estrogen

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9
Q

What non-hormonal options are there for perimenopause?

A 
Megastrol
Venlafaxine
SSRI's (Fluoxetine, Paroxetine, Citalopram)
Clonidine
Gabapentin
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10
Q

Risk factors for PCOS

A 
Obesity
DM
Sporatic periods
premature adrenarche/delayed menarche
Family history
Anti-epileptic drugs (valproate esp)
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11
Q

PCOS symptoms

A 
Hyperandrogenism
Menstrual irregularities
Obesity
Insulin resistance
Acanthosis nigricans
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12
Q

What is the risk associated with developing diabetes if you have PCOS?

A

2-5x more likely

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13
Q

PCOS criteria:
NIH
Rotterdam
Adrogen Excess Society

A

NIH - Hyperandrogenism, oligo or a-ovulation
Rotterdam - 2/3 requirements
Adrogen Excess Society - hyperandrogegism and one more

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14
Q

Longterm risks of PCOS

A 
Hypertension
Dyslipidemia
Infertility
Sleep apnea
Endometrial hyperplasia and caner
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15
Q

PCOS treatment

A

First line: non-pharm (spearmint tea, shaving/waxing, vaniqa cream)

Second line: Treat to goal

  • Infertility: clomiphene, metformin, gonadotropins, ovarian drilling, aromatase inhibitors
  • Androgen symptoms (no pregnancy): combined oral contraceptives and metformin, spironolactone (monitor potassium)
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16
Q

When should you take clomiphene if you are trying to get pregnant?

A

Take for 5 days starting on the 5th day of the cycle

Do not use for more than 6 cycles (increases ovarian cancer risk)

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17
Q

What could you use if you are trying to get pregnant but don’t want cancer side effects?

A

Aromatase inhibitor like Letrozole
Take on days 3-7 of cycle
Similar efficacy to clomiphene

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18
Q

What is dexamethasone used for in conjunction with clomiphene?

A

Use on days 3-12 to increase ovulation rate to 75% from 15%, and pregnancy to 40% from 5%.

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19
Q

How is endometriosis diagnosed?

A

Only with surgery, where a camera is used laparoscopically.

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20
Q

What are some of the signs of endometriosis?

A

Infertility (if endometrial tissues grows in the ovaries)
Gi complications like constipation
Menorrhagia and anemia

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21
Q

What are treatments for endometriosis?

A

Treat pain with COC (continues use), GnRH agonist, Levonogestrel IUD.
Treat infertility with GnRH analogs and antagonists, surgery, IVF.

22
Q

How do you differentiate PMS from PMDD?

A

They both include a set of symptoms that appear cyclically before menses and disappear. When work or lifestyle is affected, then it progresses to PMDD.

23
Q

How do you diagnose PMDD?

A

They need at least 5 symptoms from the PMS symptom list, including one that has to do with mood, anger, anxiety, or tension. These symptoms have to be affecting the work or lifestyle of the woman.

24
Q

What do the guidelines say for treating PMS/PMDD?

A
  1. Lifestyle changes (1200mg calcium, vit B6, stress reduction and management, exercise)
  2. SSRI’s (fluoxetine, sertraline) - luteal phase
  3. OC’s (may increase symptoms)
  4. GnRH agonists - Leuprolide

Spironolactone 25mg TID x10 days prior to menses for bloating

25
Q

What folic acid dose is recommended?

A

400mcg/day

26
Q

What percent of women experience unintended pregnancy in their lifetime?

A

48%

27
Q

What are the contraceptive choices available?

A 
Permanent
LARCs
COC
Other hormonal methods
Barrier
Other
28
Q

What is the only thing that is used for STD prevention?

A

Condoms

29
Q

What would you talk about when assisting in choosing a contraceptive method for someone?

A 
Most effective options first
If they want to have children
Medical history/age
Patient's preference of options
Lifestyle/risk of STDs
Ability to pay
Partner support
30
Q

What contraceptive method is first line now?

A

LARCs

31
Q

What did the Contraceptive Choice Project in St. Louis find?

A

That LARCs were preferred and the most effective for preventing pregnancy if the access to care was provided for. There was a reduction in abortions and teenage births. Save $17 for every $ spent. And these are spendy devices.

32
Q

What is in the implant?

A

Etonogestrel
Effective for 3 years
SE irregular periods, but sometimes no periods
Use backup for 48 hours afterward
CI with breast cancer, cirrhosis, undiagnosed vaginal bleeding

33
Q

What are the levonorgestrel choices for IUDs?

A

Skyla
Mirena
Liletta
PID risk

34
Q

What is the mechanism for a copper IUD?

A 
ParaGard
Spermacide
EC
SE Increased bleeding and cramping.
Benefits = non-hormonal
No concerns of breast cancer
CI - cervical or uterine cancer, recent endoetriosis
35
Q

Go to the doctor if you experience these with an IUD:

PAINS

A 
Period late/abnormal bleeding
Abdominal pain/pain with intercourse
Infection exposure/abnormal discharge
Not feeling well, fever, chills
String missing, shorter or longer
36
Q

What are the benefits of COC therapy?

A 
Decreased:
ovarian cancer
endometrial cancer
colon cancer
ectopic pregnancy
anemia
benign breast  disease

Increased:
Possibly bone density

37
Q

What type of COC can we use continuously?

A

monophasic

38
Q

Who is the progestin only pill indicated for?

A

Breastfeeding women

39
Q

What is the normal starting dose of ethinyl estradiol?

A

20mcg. Can go down to 10mcg if dose is too high, can go up to 30mcg-50 if breakthrough bleeding is occurring.

40
Q

What doses of estradiol valerate are used?

A

1, 2, 3mg

41
Q

What is the equivalent ethinyl estradiol to 50mcg mestranol?

A

35mcg ethinyl estradiol

42
Q

What are estrogen SE’s?

A 
Breast tenderness
Nausea
Breakthrough bleeding
Headache?
Thrombo events
43
Q

What are progesterone-related SE’s?

A

Tiredness
Mood swings
BTB (#1)
Lighter flow

No risk of clots
If SE’s occur, switch type of progesterone

44
Q

What lab value needs to be monitored in someone taking drospirinone?

A

Potassium

45
Q

What are the effects of COC on androgenicity?

  • LH levels
  • Ovarian testosterone production
  • SHBG levels
  • Free testosterone levels
A
  • LH levels: Decrease
  • Ovarian testosterone production: Decrease
  • SHBG levels: Increase
  • Free testosterone levels: Decrease

Decreases acne

46
Q

What are the categories in the CDC US-MEC, and what do they mean?

A
  1. No restrictions for contraceptive use
  2. Condition where benefits outweigh risks
  3. Condition where risks usually outweigh benefits
  4. Unacceptable health risk if contraceptives are taken
47
Q

What age is the cutoff for birth control use if you also smoke?

A

35

48
Q

What route of administration of HC’s gives the highest area under the curve?

A

The patch

49
Q

When can you start hormonal contraceptives postpartum? Why?

A

After 42 days. High blood clot risk.

50
Q

Why is there a push to get the pregnancy category X changed on birth control?

A

because women may think that their children will have birth defects if they got pregnant on the pill, and try to abort them.

51
Q

What hormonal contraceptives have a higher risk of VTE?

A

Ortho Evra

2nd and 3rd gen progestins other than levonorgestrel.

52
Q

What are the serious adverse reactions to COC?

ACHES

A 
Abdominal pain
Chest pain
Headaches
Eye problems
Severe leg pain

IDT Spring Term (7 decks)

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