Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine and Women's Health > Infertility, Miscarriage, and Abortion > Flashcards

Infertility, Miscarriage, and Abortion Flashcards

1
Q

what is infertility?

A

inability to conceive a child after one year of frequent contraceptive free intercourse

if woman is>35, then 6 months of the same

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

two types of infertility

A

Primary: never conceived a child
Secondary: prior conception w. subsequent inability to conceive again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

causes of infertility

male factor

A

endocrine, anatomic, sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

causes of infertility

female factors

A

PCOS
cervical issues
Tubule/uterine/peritoneal issues (PID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

non pharmacologic management of Infertility

A
  1. diet
    a. men and women: protein, fruits, vegetables
    b. men: zinc
  2. exercise
    a. weight loss/ gain. best weight is a normal BMI or within 15% of IBW
  3. smoking cessation
  4. d/c meds that are associated with infertility
  5. assistive reproductive procedures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

medications that impair fertility

cause hyperprolactinemia

A 
phenothiazines
haloperidol
opiates
h2 antagonists
SSRI's
verapamil
estrogen
metoclopramide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mediations that impair fertility

impaired spermatogenesis

A 
alcohol, caffeine, marijuana, nicoteine
allopurinol
anabolic steroids
codeine
spirinolactone
sulfasazaline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Predicting ovulation

A
  1. Basal Body temperature

2. Ovulation predictor kits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

basal body temperature testing

what is it?
how does it work?
counseling?

A

use a specific basal body temperature thermometer
progesterone causes an increase in basal body temp
04-0.6 degree rise in body temp->ovulation has occurred

counseling: place at bedside at night.
start at least 5 min and prior to rising for activity
chart temp, illness, intercourse, medications, et.
test daily, start day 1 of cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ovulation predictor tests

how does it work?
counseling

A

detects lh IN URINE FOR THE SURGE PRIOR TO OVULATOIN

counseling: start 3-4 days before expected ovulation
check at same time every day until you see a color change on the test
have intercourse 24-48 hours after color change detected
all kits vary in testing method and accuracy so you must counsel patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clomiphene Citrate

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Dosing:

Adverse Effects: Serious:

Absolute Contraindications:

Pregnancy: –

Warning/ Precautions:

Drug-Drug Interactions (DDIs):

Monitoring Parameters:

%chance of pregnancy:

Pearls:

A

Clomiphene Citrate

Class: Selective estrogen receptor modulator

Indication: treatment of ovulatory dysfunction in women desiring pregnancy

Mechanism of Action: Blocks estrogen receptors, makes body think it is in a hypoestrogenic state. in turn increases GNRH production.

Effects of mechanism of Action:
increases FSH, LH, therefore stimulating ovulation

Dosing: 50-150 mg oral daily for five days starting on days 3,4,5 of the cycle. max dose 150mg daily for 5 days. not recommended for more than 6 cycles

Adverse Effects: ovary enlargenement, hot flashes, headache, abdominal distention, abdominal distress, bloating. N&V, breast discomfort, abnormal uterine bleeding, visual disturbances

Absolute Contraindications: thyroid and adrenal dysfunction

Pregnancy: –

Warning/ Precautions:

Drug-Drug Interactions (DDIs):

Monitoring Parameters:

pretreatment screening of triglycerides

% chance of pregnancy: 30% chance. 7.98% dance of multiple gestations

Pearls:

  1. OHSS rare
  2. 50-150 mg oral daily for five days starting on days 3,4,5 of the cycle. max dose 150mg daily for 5 days. not recommended for more than 6 cycles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Letrozole
Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Dosing:

Adverse Effects: Serious:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs):

Monitoring Parameters: –

%chance of pregnancy:

Pearls:

A

Class: aromatase inhibitor

Indication: stimulation in anovulatory females with PCOS

Mechanism of Action: converts androgens into estrogens. Hypoestrogen state causes increase in GNRH. also causes thin cervical mucus

Effects of mechanism of Action: increase in GNRH causes increase in FSH, LH thus leading to ovulation

Dosing: 2.5-7.5 mg oral daily for 5 days starting on days 3,4, and 5 of the cycle

up to 5 treatment cycles, with dose increase with subsequent cycles if poor ovulatory response. MDD 7.5 mg for 5 days

Adverse Effects: Serious: flushing, edema, headache, dizziness, fatigue. night sweats, hypercholesterolemia, weight gain, nausea,

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs):

Monitoring Parameters: –

%chance of pregnancy:
23% (but higher in women with PCOS and unexplained fertility)
multiple gestations: 13%

Pearls:
1st line in women with PCOS or unexplained infertility.
2.5-7.5 mg oral daily for 5 days starting on days 3,4, and 5 of the cycle

up to 5 treatment cycles, with dose increase with subsequent cycles if poor ovulatory response. MDD 7.5 mg for 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pearls of clomiphene

A

Pearls:

  1. OHSS rare
  2. 50-150 mg oral daily for five days starting on days 3,4,5 of the cycle. max dose 150mg daily for 5 days. not recommended for more than 6 cycles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pearls of Letrozole

A

Pearls:
1st line in women with PCOS or unexplained infertility.
2.5-7.5 mg oral daily for 5 days starting on days 3,4, and 5 of the cycle

up to 5 treatment cycles, with dose increase with subsequent cycles if poor ovulatory response. MDD 7.5 mg for 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Follitropin alpha (Gonal-f, Gonal-fRFF),Follitropin beta

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Dosing:

Adverse Effects: Serious:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

%chance of pregnancy:

Pearls:

A

Class: Gonadotropin (FSH)

Indication: to stimulate the development of multiple follicles with assisted reproductive technology.

induction of ovulation and pregnancy in alignment-anovulatory infertile patients in whom the cause of infertility is functional and not caused by primary ovarian failure

Mechanism of Action: stimulated ovarian folicular growth in women who do not have primary ovarian failure.

Effects of mechanism of Action: growth and maturation of follicles

Dosing: dose should be individualized based on response to therapy. doses can vary from 37.5-450 IU SQ or IM per day

Adverse Effects: headache, ovarian cysts, abdominal pain, nausea, enlargement of the abdomen, injection site reaction, URTI

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs):–

Monitoring Parameters: –

%chance of pregnancy:
35%
multiple gestations: 32%

Pearls:
1. risk of OHSS and multiple births is higher b/c injectables stimulate the ovary more

2.SQ and im INJECTION(IM in canada)

  1. follitropin alpha is a pen
  2. Gonal f vials require reconstitution.
  3. store in refrigerator,
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

pearls of follitropin/ Gonal-f

A

Pearls:
1. risk of OHSS and multiple births (32%) is higher b/c injectables stimulate the ovary more

2.SQ and im INJECTION(IM in canada)

  1. follitropin alpha is a pen
  2. Gonal f vials require reconstitution.
  3. store in refrigerator,
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

LEUPROLIDE (lupron-Depot)
Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Dosing:

Adverse Effects: Serious:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

%chance of pregnancy:–

Pearls:–

A

Class:Gonadotropin releasing hormone agonist

Indication: IVF

Mechanism of Action: initially causes stimulation of pituitary gonadotropins LH and fsh. Continues use causes levels go gonadotropins to fall, ultimately decreasing LSH and FH productions.

Effects of mechanism of Action: reduces interference from pituitary gland with development of eggs when FSH is administered. creates high response to gonadotropins when simultaneously used with leuprolide

Dosing: 0.5- 1 mg SQ injection qd

Adverse Effects: Serious: pain at injection site, vasodilation, emotional lability, mood changes, headache, pain, acne, seborrhea etc.

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

%chance of pregnancy:–

Pearls:–

18
Q

CEtrorelix, Ganireliz
Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Dosing:

Adverse Effects: Serious:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

%chance of pregnancy:

Pearls:

A

Class:Gonadotropin releasing hormone antagonists

Indication: controlled ovarian stimulation

Mechanism of Action: competes with naturally occurring GNRH for binding on receptors in the pituitary. delays LH surge, preventing ovulation until the follicles are of adequate size

Effects of mechanism of Action: inhibition of premature LH surges in pts. undergoing controlled ovarian stimulation

Dosing: 0.25 mg SQ

Adverse Effects: Serious: headache, OHSS, abdominal pain, nausea, pelvic pain, vaginal hemorrhage, injection site reaction

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

%chance of pregnancy:–

Pearls: higher risk of OHSS and multiple births

19
Q

HCG (human and recombinant)
Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Dosing:

Adverse Effects: Serious:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

%chance of pregnancy:–

Pearls:

A

Class:

Indication: induction of ovulation and pregnancy in the anovulatory, infertile woman

Mechanism of Action: HCG acts as a substitute for LH to stimulate ovulation.

Effects of mechanism of Action: stimulate ovulation

Dosing: 5k-10k units of IM one day after last dose of menotropin

Adverse Effects: Serious: risk of OHSS

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

%chance of pregnancy:–

Pearls:trigger injection

20
Q

Menotropin
Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Dosing:

Adverse Effects: Serious:

Absolute Contraindications:

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

%chance of pregnancy:–

Pearls:

A

Class: human menopausal gonadotropin

Indication: for multiple follicular development and pregnancy in ovulatory women as part of an assisted reproductive technology cycle

Mechanism of Action: purified combo of LH and FSH. provides ovarian follicular growth and maturation in females who do not have primary ovarian failure

Effects of mechanism of Action: follicular maturation and growth

Dosing: varying protocols

Adverse Effects: Serious: multiple gestations (35%)
headache, OHSS, abdominal pain, vomiting, diarrhea, breast tenderness, ectopic pregnancy etc.

Absolute Contraindications: women with primary ovarian failure (HIGH FSH)

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters: –

%chance of pregnancy:–

Pearls:
CI: in women with primary ovarian failure

21
Q

Somatopin
Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:–

Dosing:

Adverse Effects: Serious:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters:

%chance of pregnancy:–

Pearls:–

A

Class: Human growth hormone

Indication: IVF

Mechanism of Action: activator of proliferation and differentiation of the ovarian follicles, and administration generally increases ovarian weight and follicular size

Effects of mechanism of Action:–

Dosing: 2.5 mg SQ every other day starting day 6 of menstual cycle until HCG is given

Adverse Effects: Serious:

Absolute Contraindications:–

Pregnancy: –

Warning/ Precautions: –

Drug-Drug Interactions (DDIs): –

Monitoring Parameters:
fluid status
glucose level
hgba1c, LIPID PROFILE, bp, THYROID FUNCTION, bmi

%chance of pregnancy:–

Pearls:–

22
Q

EStrogen

A

not a contraceptive form

frequency of adverse events specific to product

perform a transvaginal ultrasound blood test

23
Q

progesterone

A

BBW for invasive breast cancer, dementia, and cv DISEASE

24
Q

example of fertilization protocol

A
  1. GNRH agonists (total 1-3 weeks) starting days 21-28
  2. gnrh AGONISTS+ GONADOTopin
    (starting days 2-13)
  3. HCG: day 14
  4. Progesterone (day 15 and beyond
25
Q

fertility treatment complications

multiple births

A

multiple births,

Gonadotropins have highest rate of multiple births.

  1. clomiphene and letrozole,
  2. gonadotropins
  3. VF
26
Q

Ovarian Hyperstimulation Syndrome

patho

SS:

A

life threatening

vary enlargement causes increased capillary permeability. protein rich fluids escapes into intravascular space.

SS: bloating, sob, LETHARGY, N/V/D

27
Q

stages of ohss

A

mild: GI symptoms, mild dyspnea
moderate: mild feature+ ascites
severe: mild and moderate feature + ascites, hydrothorax, severe dyspnea, oliguria/anuria, intractable NV
critical: low BP, pleural effusion, rapid weight gain 9>24 hours), syncope, severe abdominal pain, VT, anuria/ acute renal failure, pericardial effusion, rapid respiratory distress syndrome

28
Q

psychiatric disorders with infertility

A

women have psychiatric disorders related to emotional reactions to infertility. most often anxiety and depression.

29
Q

insurance complications

A

one IVF session costs more than 12k

30
Q

Disorder:PCOS

What is it:

Diagnosis:

Patho:

risk factors:

Signs and Symptoms:

Treatment:
non pharm

pharm:

A

What is it:

Diagnosis:

  1. chronic annovulation
  2. clinical or biochemical signs of androgen excess
  3. polycystic ovaries in absence of other metabolic disturbances

Patho:
inappropriate gnrh stimulation, excessive lh fsh, follicles do not mature and ovulation does not occur, excessive androgen production, metabolic dysfunctions (insulin resistance and hyperinsulinemia)

risk factors: family history, DM, insulin resistance, irregular menses or annovulation, or CV disease

Signs and Symptoms: androgen excess: irregular menses, amenorrhea, oligomenorrhea, hirsutism, acne,,
Metabolic: obesity, insulin resistance dyslipidemia, metabolic syndrome
polycystic ovaries: 12 or more follicles measuring 2-9 cm in diameter or increased ovarian volume

Clinical Presentation:

Treatment:
non pharm
1. exercise
2.diet
3. hirsutism: bleaching, plucking, shaving, electrolysis, eflorinthine (vaniqa cream)

pharm:
pharm:
metabolic agents may be treatedtraditionally

  1. CHC; targets menstrual irregularity
    first line if fertility not desired
    nonandrogenic progestin preffered (norgestimate, desogestrel, drospirinone
  2. anti androgens: to target hirsutism and acne. synergistic effect with CHC. spironolactone
  3. insulin sensitizers: metformin-increased insulin sensitivity and decrease androgen excess. targets androgen excess symptoms as well as infertility. additional to clomiphene to reg menstrual cycles and ovulation to improve infertility
  4. oral ovulation induction: clomiphene, letrozole: targets infertility in those who desire improvements in firtility
  5. injectable ovulation induction: used in those who have failed oral therapies for infertility
31
Q

pharm treatment of PCOS

A

pharm:
metabolic agents may be treatedtraditionally

  1. CHC; targets menstrual irregularity
    first line if fertility not desired
    nonandrogenic progestin preffered (norgestimate, desogestrel, drospirinone
  2. anti androgens: to target hirsutism and acne. synergistic effect with CHC. spironolactone
  3. insulin sensitizers: metformin-increased insulin sensitivity and decrease androgen excess. targets androgen excess symptoms as well as infertility. additional to clomiphene to reg menstrual cycles and ovulation to improve infertility
  4. oral ovulation induction: clomiphene, letrozole: targets infertility in those who desire improvements in firtility
  5. injectable ovulation induction: used in those who have failed oral therapies for infertility
32
Q

timeline for infertility in pcos

A
  1. recommend lifestyle modification (if obese)
  2. if not pregnant after that (or wasn’t obese to begin with), add clomiphene or letrizole
  3. if not pregnant, add metformin,
  4. if not pregnant after that, refer to infertility expert
33
Q

Disorder:endometriosis

What is it:

Diagnosis:

Patho:

risk factors:

Signs and Symptoms:

Treatment:
non pharm

pharm:

A

Disorder: endometriosis

What is it: endometrial like tissue outside of the uterus

Diagnosis: based on hx and pelvic exam findings

Patho: peritoneal disease results from retrodage menstruation or lymphatic spread of steroid hormone sensitive endometrial cells and tissues

risk factors:
obstruction of menstrual flow
exposure to diethylstilbestrol in utero
prolonged exposure to endogenous estrogen due to monarch, late menopauseobesity
short menstrual cycles
low birth weight
exposure to endocrine disrupting chemicals

Signs and Symptoms:

pelvic pain
4 D'S:
dysmenorrhea
dyspareunia (painful sex)
dysuria
dyschezia (painful bowel movements

Treatment:
non pharm
surgical

pharm:
nsaids for dysmenorrhea
CHC (most common)FOR DYSMENNORHEA AND Pelvic pain
progestins for dysmenorrhea and pelvic pain (norethindrone, DPMA, levonorgestrel IUD
gnrh AGOnists for up to 6 mo. due to risk of boneless
gnrh antagonist

34
Q

pharm treatment of endometriosis associated pain

A

pharm:
1. nsaids for dysmenorrhea.

can add

2.CHC (most common)FOR DYSMENNORHEA AND Pelvic pain

OR

progestins for dysmenorrhea and pelvic pain (norethindrone, DPMA, levonorgestrel IUD

  1. gnrh AGOnists for up to 6 mo. due to risk of boneless

OR

gnrh antagonist

(cannot use this and CHC at ssame time. must have pt use non hormonal contraceptives)

  1. Danazol, aromatase inhibitors
35
Q

treatment of endometriosis associated infertility

A
  1. surgical
  2. artificial insemination
  3. assisted reproductive surgery
36
Q

DisorderMiscarriage

What is it:

Diagnosis:

Patho:–

risk factors:

Signs and Symptoms:

Treatment:
non pharm

pharm:

A

Disorder:PCOS

What is it: early pregnancy loss within the first <13 weeks of gestation

Diagnosis: ultrasound

Patho:–

risk factors: women who have experienced previous early pregnancy loss.
advanced maternal age

Signs and Symptoms:
vaginal bleeding
uterine cramping

Treatment:
non pharm

pharm:
1, expectant management:
2. med management:
misopristol 800 mg vaginally. may repeat if needed within 7 days
ae: moderate to heavy bleeding and cramping
call md if soaking 2 maxi pads / hour for 2 hours
3.surgical evacuation

37
Q

Misoprostol (miscarriage)

moa

route

counseling

A

mimics prostalgandins: bonds to smooth muscle myometrium and causes uterine contractions.

route: vaginally

38
Q

Medications for medical abortion

A

Mifepristone

misoprostol

methotrexate

39
Q

mifepristone

moa

route

ae

contraception

A

blocks progesterone, causing, decimal necrosis, rhythmic uterine contraction, cervical ripening

route: buccal or vaginally
ae: bleeding, pain,N/V/D, dizziness, headache, chills, weakness, (can use nsaids for pain)

contraception: all methods can be provided immediately after uncomplication medication abortion
DMPA and etonogestrel injection can be given say of mifepristone

CHC can be started on day of misoprostol

40
Q

abortion counseling sheet

A
  1. instructions
    mifepristone: taken at home
  2. misoprostol would be taken 24-48 hours after mifepristone was taken. place 2 pills inside each check for 30 min, then swish with water and swallow anything remainin
    expect: bleeding cramping within a couple hours after misoprostol, may have some bleeding b4 with the mifeprisone

may experience N/V/D fever and chills

OTCs: no extra NSAIDS, orc’s FOR DIARRHEA

went to call provider: bleeding that soaks 2 full size pads per hour for 2 cones hours
confirm pt has provider phone number.

Endocrine and Women's Health (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions