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Therapeutics > Lecture 6 Exam 5 > Flashcards

Lecture 6 Exam 5 Flashcards

1
Q

What is PCOS

A

leading cause of anovulatory infertility

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2
Q

What percebnt of women have PCIS

A

6-10%

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3
Q

What can be caused by PCOS

A

miscarriage and endometrial cancer

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4
Q

What are the 3 hallmarks for PCOS

A

Hyperandrogenism
menstrual disturbances
overweight or obese

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5
Q

What are symptoms of hyperandrogenism

A

Hirsutism
Acne
Alopecia

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6
Q

Symptoms of menstrual disturbances

A

Amenorrhea
Oligomenorrhea
Anovulation

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7
Q

What are the 3 proposed mechanisms that are thought to cause PCOS

A
  1. Inappropriate gonadotropin secretion
  2. Insulin resistance with hyperinsulinemia
  3. Excessive androgen production
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8
Q

Mechanism of inappropriate GnRH secretion in causing PCOS

A

Increase in GNRH
Causes a surge in LH too soon
No rise in FSH
No dominant follicle
No ovulation
unopposed estrogen
luteal phase never enetered
elevated androgen levels

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9
Q

Compare regular menstrual cycle and PCOS menstrual cycle

A

Normal- Normal GnRH level
LH and FSH levels spike during cycle
One dominant follicle forms

PCOS cycle

An increase in GNRH causes high LH level
FSH levels stay normal/low
no dominant follicle forms

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10
Q

Why does PCOS cause insulin resistance

A

PCOS causes body to think that it does not have enough insulin. This causes the body to be in a state of compensatory hyperinsulinemia where it makes more insulin.

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11
Q

Hyperinsulinemia is a major contributor of ________ in PCOS

A

hyperandrogenism

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12
Q

Where is SHBG produced? What binds to SHBG?

A

LIver
Testosterone binds to SHBG

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13
Q

What happens to SHBG synthesis in the liver in patients with insulin resistance

A

In patients with insulin resistance, Liver stops SHBG synthesis, this causes us to have free testosterone in blood stream, increasing free testosterone.

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14
Q

What are the 3 criteria that diagnose PCOS (two have to be met to diagnose PCOS)

A

hyperandrogenism
PCOS
chronic anovulation

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15
Q

What are some complications that could be caused by PCOS

A

Infertility
CVS thromboembolism
Type 2 diabetes
HTN
Depression and anxiety

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16
Q

What is a non-pharmacologic and 1st line of treatment for PCOS

A

exercise and weightloss

leads to improved pregnancy rates, reduced miscarriages, reduced testosterone and hyperinsulinemia

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17
Q

What is the 1st line of pharmacologic treatment for PCOS hyperandrogenism and menstrual irregularity

A

Combined oral contraceptives

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18
Q

What is the concentration of estrogen that should be given to a PCOS patient

A

If patient is over 39 yo or obese, give lowest effective dose (20 mcg of EE)

If not then give 30

19
Q

What kind of progestins do we use for PCOS patients

A

low androgenic effect progestin

20
Q

What are some low androgenic effect porgestins that can be used for PCOS patients

A

Norgestimate (lower VTE risk), norethindrone

21
Q

What are some progestins to avoid when giving to PCOS patients

A

Avoid- Desogestrel, Cyproterone, drosperinone

22
Q

Name two anti-androgen therapies

A

Spironolactone
5-a-reductase inhibitors

23
Q

How does spironolactone help as an anti androgen therapy
side effects?

A

Blocks androgen effect at hair follicle
hyperkalcemia, teratgenic (fetal abnormality)

24
Q

How does 5-a-reductase help as an antiandrogen therapy?
Most common drug?
Side effects?

A

Prevents testosterone to DHT conversion
FInasteride
teratogenic

25
Q

FIrst line of treatment for patients with PCOS and type 2 diabetes after failed lifestyle modifications

A

Metformin

26
Q

Can we take metformin if pregnant?

A

no

27
Q

Can metformin help with menstrual irregularity and endometrium protection

A

Metformin can help with menstrual irregularity, but endometrial protection is not established until regular menses and ovulation

28
Q

What does metformin do in the ovary

A

reduces insulin rate and androgen production

29
Q

Dose of metformin?
how long to see results

A

500 mg—>1000 mg
takes up to 6 months to see results (GI side effects decrease after 2-3 weeks)

30
Q

Treatment of insulin resistance in PCOS order (1st and 3nd line)

A

1st- life style modification
2nd- metformin

31
Q

Treatment of menstrual irregularity 1st line of treatment

A

COC

32
Q

treatment of menstrual irregularity 2nd line of treatment

A

Cyclic progestin (medroxyprogesterone, micronized progeserone)
levonorgestrel IUD
Metformin

33
Q

What percent of women regain ovulation on metformin

A

30-40%

34
Q

What are the treatments of hyperandrogenism in order of preference

A

1) COC
2) Antiandrogen (spironolactone, finasteride)
3) topical vaniqua (eflorinthine (for facial hair only)))
4) cosmetic procedures

35
Q

Treatment for PCOS if pregnancy is desired?

A

Aromatase inhibitors like Letrozole (femara)

36
Q

name an aromatase inhibitor drug

A

Femara (letrozole)

37
Q

Mechanism of femara as an aromatase inhibitor

A

Non steroidal competitive inhibitor of aromatase enzyme, inhibition stops the conversion of androgen to estrogen)

38
Q

effect of aromatase inhibitors or estrogen levels

A

Significant reduction

39
Q

How do aromatase inhibitors induce ovulation

A

lower estrogen levels increase LH and FSH secretion, this induces ovulation

40
Q

side effects of aromatas einhibitors

A

low estrogen side effects like hot flashes

41
Q

How do aromatase inhibitors work in relation to BC pills

A

They work opposite to each other

BC pills trick pituitary gland into thinking that it is giving estrogen and progesterone, so there is no surge in LH

Aromatase inhibitors tell brain there is low estrogen, increasing LH and FSH

42
Q

Letrozole (femara) dosing
what if ovulation does not occur?
Max number of cycles

A

2.5-7.5 mg X 5 days
If ovulation does not occur increase by 2.5 mg increments
upto 5 cycles total

43
Q

Treatment of anovulation in PCOS order of therapy

A

Letrozole
Low dose gonadotropin or Ovarian drilling
last is invitro fertilization

44
Q

spironolactone dose

A

50-100 mg BID

Therapeutics (46 decks)

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