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Therapeutics > lecture 5 exam 5 > Flashcards

lecture 5 exam 5 Flashcards

1
Q

What is dysmenorrhea

A

pain associated with menstruation

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2
Q

primary vs secondary dysmenorrhea

A

primary- normal ovulatory cycles and pelvic anatomy
secondary- underlying or anatomic cause

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3
Q

pathophysiology of dysmenorrhea

A

Buildup of fatty acid in cell membrane, released during menses
Prostaglandins and leukotrienes are released
causes inflammatory symptoms

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4
Q

risk factors for dysmenorrhea

A

less than 20 yo (primary)
menarche before 12 yo

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5
Q

Dysmenorrhea first line of treatment

A

NSAIDS
OC

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6
Q

dysmenorrhea second line of treatment

A

Depo shot
levonorgestrel IUD

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7
Q

non pharmacologic treatment of dysmenorrhea

A

Heating pad
exercise
O-3 fatty acid
smoking cessation

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8
Q

NSAID counseling point, side effects and rug names

A

take with food, not for long term
GI bleeding
Naproxen, Ibuprofen,

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9
Q

mechanism of action of NSAIDs

A

inhibits COX 1 and COX 2 leading to decrease in prostaglandin production

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10
Q

when to take NSAIDs for dysmenorrhea

A

2 days before
short term

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11
Q

pros and cons of NSAIDs

A

pros- good option for those wanting to conceive, short term

cons- side effects can be intolerable, not a great option for those with CV

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12
Q

Side effect of NSAIDs

A

GI bleeding, ulcers
onset of CV events
exacerbate HTN

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13
Q

Pros and cons of hormone therapy for dysmenorrhea

A

pros- appropriate for those seeking contraception
can be used with NSAIDs
cons- Not appropriate for patients desirimg pregnancy
Rx needed
delayed relief

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14
Q

Side effects of hormone therapy for dysmenorrhea

A

increased BP
weight gain
fluid retention
risk of blood clots/ stroke

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15
Q

Name the two hormone therapies in order of choice for dysmenorrhea

A

1st- levonogestrel IUD
2nd- depot

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16
Q

What is amenorrhea

A

absence of blood flow

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17
Q

Primary vs secondary amenorrhea

A

primary- no menses by 15
secondary- no menses X 3 months in previously menstruating women

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18
Q

What lab tests can be seen for amenorrhea

A

pregnancy test, FSH/LH, TSH, prolactin, estrogen

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19
Q

pathophysiology of amenorrhea

A

uterus and ovary anatomic abnormality
pituitary gland (GNRH, LH, FSH)
hypothalamus- stress bulimia

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20
Q

What are the drugs that cause drug induced amenorrhea

A

First gen psychotics- prochlorperazine
chlorpromazine
haloperido

2nd gen anti psychotics- risperidine

antihypertensives- verapamil

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21
Q

if cause of amenorrhea is medication, what can we do?

A

consider alternative agent that does not inhibit dopamine receptor or increase prolactin levels
or initiate dopamine agonist

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22
Q

what kind of drugs should be considered during drug induced amenorrhea

A

drug that does not inhibit dopamine receptor or increase prolactin levels

or get drug that initiates dopamine agonist

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23
Q

If cause of amenorrhea is hypoestrogenic, provide

A

supplemental estrogen
must include progestin component

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24
Q

What are some conjugated equine estrogens that can be provided for hypoestrogenic amenorrhea

A

premarin
enjuvia
cenestin

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25
Q

If amenorrhea is caused by medications that increase prolactin levels, what should we provide

A

Dopamine agonists
(bromocriptine, cabergoline)

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26
Q

What is the difference between bromocriptine and cabergoline

A

bromocriptine is multiple daily dosing
cabergoline is weekly or twice weekly

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27
Q

contraindications to bromocriptine and cabergoline

A

breast feeding and uncontrolled HTN

28
Q

define oligomenorrhhea

A

menstrual cycle interval> 35 days but less than 90 days

29
Q

define polymenorrhea

A

Menstrual cycle intervals less than 21 days

30
Q

common causes of polymenorrhea

A

stress
std
endometriosis
menopause

31
Q

why does polymenorrhea cause challenges conceiving

A

does not allow for time for ovulation

32
Q

What is HMB (heavy menstrual bleeding)

A

Bleeding >80 ml or lasting 7 days
or excessive blood loss that interferes with a womans physical social emotional QOL

33
Q

prevalence of HMB

A

18-30%

34
Q

pathophysiology of HMB

A

Must rule out pregnancy, ectopic pregnancy, miscarriage

  1. hematologic- bleeding, clotting disorders
  2. hepatic- cirrhosis
  3. endocrine- hypothyroidism
  4. uterine- structure abnormality or uterine fibroids
35
Q

Two types of HMB

A

acute and chronic

36
Q

two treatments for chronic HMB

A

hormonal therapies
non hormonal

37
Q

What are some hormonal therapies for HMB

A

CHC
progestins
levonorgestrel
danazol
GnRH

38
Q

what are some non-hormonal therapies for HMB

A

NSAIDs
tranexamic acid
Iron

39
Q

How is tranexamic acid a treatment for HMB

A

prevents degradation of blood clots (lessens bleeding)
Intended for short term use

40
Q

contraindications of Tranexamic acid

A

Active or history of deep vein thrombosis and pulmonary embolism
history of seizure

41
Q

What is metrorrhagia

A

bleeding in between cycles

42
Q

Causes of metrorrhagia

A

hormone imbalance
IUD
medication
infection
fibroids
endimetrosis

43
Q

Treatment for metrorrhagia

A

hormonal contraceptive

44
Q

Which Menstrual conditions are related to length? What are the days?

A

Oligomenorrhea (cycle>35 days but less than 90)
amenorrhea (cycle>90 days)
polymenorrhea (cycle<21 days)
metrorrhagia (bleeding in between cycles)

45
Q

What is endometriosis

A

Pelvic inflammatory condition associated with growth of endometrial tissue outside of uterus

46
Q

what are some symptoms of endometriosis

A

Dysmenorrhea, infertility, dyspareunia, chronic pelvic pain

47
Q

prevalence of endometriosis

A

1 in 10 women

48
Q

What is the most commonly supported cause of endometriosis

A

retrograde menstrual flow

49
Q

First line of treatment of endometriosis

A

NSAIDs
CHC
progestins

50
Q

2nd line of treatment for endometriosis

A

GnRH agonist/antagonist
Danazol

51
Q

3rd line of treatment for endometriosis

A

Aromatase inhibitors

52
Q

What is danazol? How does it work? why is it not used as much?

A

2nd line of treatment for endometriosis
suppresses FSH and LH
intolerable side effects (weight gain, acne, hirsutism, lipid abnormalities)

53
Q

black box warning for danazol and contraindication

A

Thromboembolism
contraindicated in pregnant and nursing women

54
Q

What are uterine fibroids and when are they most likely to develop

A

Common non cancerous growths in uterus (most common pelvic tumor)

More liklely to develop before 50 yo

55
Q

What are the causes of fibroids

A

1.Increased estrogen and progesterone
increased mitotic rate
increased likelihood of mutations

  1. genetic predisposition
    3.response to injury
56
Q

How does response to injury cause uterine fibroids

A

Increased prostaglandins and vasopressins with onset of menses

57
Q

Non pharmacologic treatment of uterine fibroids

A

Myomectomy-removal of fibroids
-resolution of symptoms while preserving uterus, fertility preserved ( big chance fibroids will come back)
hysterectomy

58
Q

Do NSAIDs help with
reduction in fibroid size
dysmenorrhea
HMB

A

no reduction in fibroid size
helps with both HMB and dysmenorrhea

59
Q

Do CHC help with
reduction in fibroid size
dysmenorrhea
HMB

A

no reduction in fibroid size
helps with both HMB and dysmenorrhea

60
Q

Does levonorgestrel IUD help with
reduction in fibroid size
dysmenorrhea
HMB

A

Helps all 3

61
Q

does tranexamic acid help with
reduction in fibroid size
dysmenorrhea
HMB

A

Only HMB

62
Q

Does GnRH help with
reduction in fibroid size
dysmenorrhea
HMB

A

Helps with HMB and reduces fibroid size by 35-65%

63
Q

Do SPRMs help with
reduction in fibroid size
dysmenorrhea
HMB

A

Help with HMB
reduces fibroid size by 25-50%

64
Q

Which two drugs help with reduction in fibroid size

A

SPRMs and GnRH

65
Q

What are some SPRM drugs

A

Mifepritone
Ulipristal (NOT FDA APPROVED FOR BOTH)

66
Q

Difference between GnRH and SPRMs for fibroid treatment

A

SORMs do not cause hypoestrogenic effects

Therapeutics (46 decks)

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