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IDT Spring > Female Health Topics > Flashcards

Female Health Topics Flashcards

1
Q

MoA of Mifepristone? always combined w/?
it is not as effective past?
it can be used up to?

A

antiprogestin causing endometrial changes and increased sensitivity to prostaglandins (causes uterine contractions during childbirth)
Misoprostol (an exogenous prostaglandin) which contributes to uterine contractions
the 7th week
70 days (10 wks)

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2
Q

as of 2023, how have prescribing protocols for mifepristone been updated?

A

qualified pharmacies or healthcare providers can order and dispense. dispensing does not need to be in-person

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3
Q

what is the directions for use of abortive medication?

A

Day 1: Mifepristone 200mg
Day 2-3: Misoprostol 800mcg buccally
7-14 days later: follow-up

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4
Q

SEs of abortive med?

A

-heavy bleeding may indicate an incomplete abortion or infection
-bleeding/spotting up to 30 days
-uterine cramping (misoprostol)
-prostaglandin effects: nausea, dizziness, diarrhea

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5
Q

what is the leading cause of anovulatory infertility?

A

poly-cystic ovarian syndrome

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6
Q

what is the most common endocrinopathy in pre-menopausal females?

A

poly-cystic ovarian syndrome

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7
Q

what are risk factors for poly-cystic ovarian syndrome?

A

-oligomenorrhea (irregular menstural bleeding)
-obesity
-DM
-early puberty or delayed menstruation
-family history
-anti-epileptic drugs - valproate

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8
Q

classic symptoms of poly-cystic ovarian syndrome?

A

-menstrual irregularities and hyperandrogenism
-obesity
-insulin resistance
-acanthosis nigricans (darkening of skin)

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9
Q

what are key changes in hormones caused by PCOS?

A

inc androgen
incr LH
dec FSH
dec progesterone
dec SHBG

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10
Q

according to the androgen excess society, to diagnose PCOS the pt needs to have the symptoms of HA and?

A

hyper-androgenism

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11
Q

according to the NIH, to diagnose PCOS the pt needs to have what sx?

A

hyper-androgenism and oligo- or anovulation

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12
Q

T/F polycystic ovaries is required to diagnose factor for PCOS

A

False

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13
Q

why do we give pts with PCOS a OGTT?

A

they have a 2-5x increased risk of developing diabetes and are prone to insulin resistance

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14
Q

T/F reducing insulin levels can resolve oligo-anovulation

A

true

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15
Q

what are long-term health risks of PCOS?

A

HPT
dyslipidemia
infertility
sleep apnea
endometrial hyperplasia and cancer

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16
Q

what is first line non-pharm treatment for PCOS?

A

lifestyle modifications

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17
Q

what is an example of an anti-androgenic non-pharm treatment for PCOS?
a. peppermint oil
b. spearmint tea
c. onion extract
d. ginger extract

A

b

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18
Q

how do we treat pts with PCOS who don’t want to get pregnant in regards to menstrual-related disorders and insulin-sensitizing?

A

CHCs: suppress LH, treat menstrual disorders, suppress ovarian androgen secretion, and increase SHBG
Metformin: reduce risk of diabetes, reduce LH and androgen levels, and resume ovulation

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19
Q

when do we use spironolactone for PCOS?
SEs?
what lab value should be monitored?

A

for anti-androgenic effects to treat hirsutism
SEs: polymenorrhea, mastodynia (breast pain), mood swings, HAs, fatigue, GI distress
potassium

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20
Q

how do we treat pts with PCOS who want to get pregnant?

A

First line: letrozole (off-label) 2.5mg for 5 days taken days 3-7 of the cycle. can go up to 7.5mg
second line: clomiphene 50mg for 5 days starting on 5th day of cycle. can increase up to 150mg (may add dexamethasone)
and metformin

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21
Q

what is the approved use for letrozole?

A

breast cancer

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22
Q

what is the MoA of clomiphene citrate?

A

causes estrogen R depletion to interrupt estrogen negative feedback which increases FSH secretion leading to ovulation

23
Q

what is the MoA of letrozole (aromatase inhibitor)?

A

suppresses ovarian E2 secretion and reduces estrogen negative feedback to increase FSH secretion leading to ovulation

24
Q

what is metformin’s role in how it affects the menstrual cycle?

A

restores the menstrual cycle to increase the chance of ovulation, reduce pregnancy loss, and prevent gestational diabetes

25
Q

for people wanting to get pregnant, when would we end up using CHCs?

A

as third line therapy for 2-3 months, then starting them on clomiphene on the 5th day of withdrawal bleed

26
Q

which third line treatment for women wantign to become pregnant with PCOS can cause ovarian hyperstimulation?

A

hCG injection or pulsatile GnRH

27
Q

which drug increases the risk of ovarian cancer?

A

clomiphene

28
Q

what are the common symptoms of dysmenorrhea?

A

spasms of pain in pelvic area that may radiate to back or legs. may cause fatigue, nausea, vomiting, or diarrhea

29
Q

what is the primary cause of dysmenorrhea?

A

menstrual bleeding causes by the endometrium secreting prostaglandins that induce contractions

30
Q

what age-group of females are at greater risk of increased symptom severity of dysmenorrhea?

A

younger females

31
Q

what can improve dysmenorrhea symptoms over time?

A

childbirth and increasing age

32
Q

what is a cause of secondary dysmenorrhea?
when would we consider a pt is suffering from secondary dysmenorrhea?

A

endometriosis (uterine cells growing outside uterus)
-sx occur before or late in menses
-sudden with no history of dysmenorrhea
-during sex
-if pt is infertile

33
Q

non-pharm tx for primary dysmenorrhea?

A

-smoking cessations
-exercise
-heat therapy
-dietary changes
-TENS (nerve stimulation)
-acupuncture

34
Q

pharm tx for primary dysmenorrhea?

A

NSAIDs: ibuprofen >400mg q6-8h
hormonal contraceptives: 90% efficacy

35
Q

T/F patient’s can use both COCs and NSAIDs together for dysmenorrhea

A

true

36
Q

what are meds marketed for dysmenorrhea and when would you recommend them?

A

Midol, Pamprin, and Premasyn
use if they have NSAID

37
Q

what are complications of endometriosis?
how is it diagnosed?

A

infertility
GI complications (constipation)
menorrhagia and anemia
surgical procedure

38
Q

how do we treat pain associated with endometriosis?
what about treating infertility?

A

-levonogestrel IUD
-CHC
-GnRH agonist with HRT such as leuprolide

-GnRH analogs and antags
-srugery
-IVF

39
Q

what does treating endometriosis pain with a GnRH agonist mimic, and what other sx can be expected?

A

causes cessation of all hormones… mimics menopause… can cause got flashes

40
Q

define PMS (premenstrual syndrome)

A

sx that occur just prior to menses, followed by a period w/o any sx

41
Q

define PMDD (premenstrual dysphoric disorder)

A

sx related to menses that effect work and lifestyle. it begins during first week of luteal phase and again after onset of menses

42
Q

how do we diagnose PMDD:
must have at least 5 symptoms in the week prior to start of menses, which include?
and at least one of the following symptoms must be present:

A

-decreased interest
-difficulty concentrating
-lack of energy
-change in appetite
-hypersomnia/insomnia

  1. mood swings
  2. anger/irritability
  3. depressed
  4. anxiety, tension, on edge feeling
    -feeling out of control
    -physical sx (breast tenderness, swelling, bloated…)
43
Q

T/F PMS/PMDD sx are usually the most severe in younger females

A

false, worsens with increasing age

44
Q

T/F PMS/PMDD sx worsen after pregnancies

A

true

45
Q

according to ACOG, what are the guidelines for PMS/PMDD? (first line, second line, etc)

A

first line: lifestyle changes
second line: SSRIs, continuous CHCs, alprazolam
last line: GnRH agonists

46
Q

which SSRIs have the most data for improving PMS/PMDD sx?
what are counseling points?

A

sertraline and fluoxetine
onset of efficacy is immediate. helps decrease mood sx, food cravings, irritability, and weight gain

47
Q

which other antidepressants have shown efficacy for PMS/PMDD?
which show low efficacy?

A

venlafaxine and clomipramine
bupropion and amitriptyline

48
Q

what is an important counseling point for pt with PMs/PMDD starting continuous CHC?

A

may increase sx, so stop if sx worsen

49
Q

T/F GnRH agonists used for PMS/PMDD are effective for behavioral and physical sx, but not for psychiatric sx

A

true

50
Q

what can we do to manage pts with PMS/PMDD experiencing bloating/edema?

A

salt restriction, or spironolactone 25mg up to TID for 10 days prior to menses

51
Q

what can we do to manage pts with PMS/PMDD experiencing hyperprolactinemia (causing breast pain)?

A

bromocriptine 0.5-2.5mg daily titrated for 2-7 days

52
Q

what can we do to manage pts with PMS/PMDD experiencing insomnia?

A

low dose trazodone or diphenhydramine

53
Q

what can we do to manage pts with PMS/PMDD experiencing anxiety?

A

alprazolam or busprone

IDT Spring (22 decks)

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