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PHRM 825 > irons > Flashcards

irons Flashcards

1
Q

menstruation

A

days 1-5

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2
Q

follicular phase

A

days 1-13

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3
Q

ovulation

A

day 14

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4
Q

luteal phase

A

days 15-28

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5
Q

follicular phase

A

increase in estrogen
maturation of ovarian follicles
proliferation of endometrium

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6
Q

luteal phase

A

increase in progesterone
thickening of uterine lining
drop is hormones unless egg is fertilized

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7
Q

PMS somatic sx

A

abdominal pain/bloating
breast swelling/tenderness
headache or migraine
N/V/C/D
acne
changes in appetite

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8
Q

affective PMS sx

A

anger
confusion
anxiety and /or depression
irritability
sadness
food cravings

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9
Q

diagnosis for pms

A

> 1 symptoms present during 5 days before menses in the last 3 months

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10
Q

PMS pathophysiology

A

hormonal fluctuations- release norepinephrine from the hypothalamus
lifesytle- dietray conumptions of sugars

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11
Q

PMDD

A

mood disorder accompanied by meotional cognitive and phsyical symptoms

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12
Q

PMDD sx

A

liability, anger, irritability, markedly depressed mood, anxiety*, decrease interest acitivies, fatigue, difficulty concentrating, changes in appetite or sleep, breast tenderness or swelling, bloating, headaches

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13
Q

PMDD Dx

A

symptoms associated with last week of luteal phase
>5 sx related to PMDD present
sx interfere significantly with daily living
sx have occured over 2 menstrual cycles in the past year

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14
Q

pmdd risk factors

A

preexisting mental health conditions, cigarette smoking, obesity, genetics

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15
Q

PMDD pathophys sex streoids

A

fluctuations in progesterone and allopregnanolone

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16
Q

neurotransmitters pmdd pathophys

A

decrease in serotonin
decrease in g-aminobutyric acid (GABA)

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17
Q

pms/pmdd treament goals

A

improve or resolve sx
improve productivity and or personal relationships
improve qol

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18
Q

non-pharm therpay in pms and pmdd

A

limit sodium, caffeine, and alc
aerobic exercise
relaxation techniques
structured sleep schedule
calcium and mg

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19
Q

treament overview for pms/pmdd FIRST LINE

A

SSRIs, COC, NSAIDS

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20
Q

SECOND TX FOR PMS AND PMDD

A

SNRIs and GnRH agonst

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21
Q

LAST LINE TX FOR PMDD AND PMS

A

Clominparine and xanax

22
Q

SSRIS PMDD tx

A

FDA approved: fluoxetine, proxetine, sertraline
off label use: citalopram, escitlopram
prefered in pt who do not wish to seek contraceptive methods

23
Q

SSRI continuous dosing

A

once daily
decreased libido

24
Q

SSRI intermittent dosing

A

start on day 14 of cycle
stop 1-2 days after onset of menses
ideal for minimizing drug exposure

25
SSRI tx boxed warning
increased risk in suicidal thinking and behavior in childern, teen, and young adults with major depressive disorder and other psychiatric disorders
26
ssri side effects
varies depending on SSRI selected nausea, drowsiness, sexual dysfunction, sweating symptoms imrpove within 2-3 mentrual cycles
27
VENLAFAXINE
SNRI, off label use in PMDD dosed with ER formulation at 37.5-150 mg once daily
28
COC in PMDD
monophasic regimens for mood
29
COC in PMS
triphasic and monophasic regimens of physical symptoms but not mood
30
Drospirenone
COC tx in PMDD 3mg/EE 20 mcg FDA approved for PMDD
31
levonorgestrel
COC tx in PMDD 90 mcg/EE 20 mcg off label use for PMDD
32
Drospirenone in PMDD (YAZ)
Antimineralcorticoid and antiandrogenic properties decrease emotional lability higher risk for VTE and hyperkalema than other progestins Approved for additional indications including tx of acne
33
Leuprolide acetate
GnRH agonist continuous administration results in eventual suppression of hormones and improvement in sx after 1-2 months dosing: 3.75 mg IM monthly side effects: hit flashes, night sweats, HA, and nausea
34
Clomipramine
LAST LINE AGENT tricyclic antidepressant 25-75 mg once daily blurred vission, dry mouth, constipation, fatigue
35
Alprazolam
LAST LINE AGENT benzodiazepine hsitorically used in the past however is NO LONGER RECOMMENDED due to side effects and potential misuse
36
tx summary
tx should be tailored to patients' needs and preferences agents can be used as monitherapy or in combo (ssri and coc) Monitor for resolution or improvement of sx and tolerability of treatment
37
Tx summary: ssri/snri
mood/emotional and physical symptoms, psychosocial functioning work performace, quality of life
38
tx summary: cocs
phsycial symptoms, social functioning and productivity
39
Tx summary: GnRH agonists
emotional symptoms, some phsycial sx (bloating and breast tenderness)
40
Female sexual disorders
affects 43% of american women prevalence increases with age sx may present in many ways
41
Etiologies
mental health, metabolic disorders, menopause, postpartum, aggravating medications, stress
42
Premenopausal sexual disorders tx
FILBANSERIN and BREMELANOTIDE
43
Postmenopausal hormonal tx
Testosterone, estrogen, ospemifene
44
Postmenopausal nonhormonal tx
prasterone
45
Flibanserin
hypoactive sexual desire disorder in premenopausal women Mixed 5-Ht1A agonist/ 5-HT2A antagonist 100 mg once daily at bedtime Monitoring: efficacy, adverse effects like hypotension and syncope DO NOT DRINK WITH ALCOHOL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
46
Bremelanotide
Hypoactive sexual desire disorder i premenopausal women MOA: melanocortin receptor agonist 1.75 mg sc prn, take ~45 minutes before sexual acitivity (max of 8 doses/ month) Monitoring: BP and HR
47
estrogen
hormonal agent low-dose, vaginal formulations are preferred for genitourinary sx related to menopause
48
testosterone
hormonal agent short-term, transdermal use can be considered for postmenopausal women with interest or arousal disorders
49
Ospemifene
SERM genitourinary sx of menopause (painful sex and or vaginal dryness)
50
Prasterone
non-hormonal agent synthetic stroid and vaginally applied useful for genitourinary sx, specifically painful sex
51
Compounded hormones
NOT FDA APPROVED
52

PHRM 825 (11 decks)

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